STERNBERG: Vaccine? Terrific. But What About Treatment

LETTER from RICHARD STERNBERG

Vaccine? Terrific. But

What About Treatment

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Richard Sternberg, retired Bassett Hospital orthopedic surgeon, is providing his professional perspective weekly during the COVID-19
threat. A village trustee,
he resides in Cooperstown.

I was asked to give a talk at the Center for Continuing Adult Learning recently in Oneonta. It was supposed to be on vaccine development and distribution, but two days before I was to give it, I was asked by a participant to address treatment of active COVID-19.

Up to this point I have avoided discussing this because each physician chooses treatment for each patient based on many factors, including recommended protocols, approved medications, and most important, consideration of each patient as an individual.

Nonetheless there is some general advice from the NIH (National Institute of Health).

The NIH divides severity levels for COVID-19 into five parts with their recommendations.

►ONE: Not hospitalized, mild to moderate COVID-19.

There is insufficient evidence to recommend for or against any specific antiviral or antibody therapy.

SARS-CoV-2 neutralizing antibodies are available for outpatients who are at high risk of disease progression.

Antibodies bind to the virus, block its ability to get into a cell, and trigger a response from white blood cells to come and attack the virus.

Antibodies could be natural or manufactured. Dexamethasone is a steroid anti-inflammatory which is approved in more severe stages and should not be used here.

►TWO: Hospitalized but does not require supplemental oxygen.

Dexamethasone should not be used. There are insufficient data to recommend for or against the routine use of Remdesivir. (Remdesivir is a drug specifically to treat viral diseases). For patients at high risk for disease progression, the use of Remdesivir may be appropriate. (Yes, I too find this statement very confusing.)

►THREE: Hospitalized and requires supplemental oxygen, but does not require high-flow oxygenation, mechanical ventilation, or an ECMO (extracorporeal membrane oxygenator – sort of like a heart/lung machine used in open heart surgery).

Use one of the following three options: Remdesivir for patients who require minimal oxygenation, Dexamethasone and Remdesivir for patients who require increasing amounts of supplemental oxygenation, or Dexamethasone alone when combination therapy cannot be used or if remdesivir is not available.

►FOUR: Hospitalized and requires oxygen through a high-flow device or non-invasive ventilation. Use one of the following options; dexamethasone or dexamethasone and remdesivir.

►FIVE: Hospitalized and require mechanical ventilation or ECMO. Use dexamethasone.

There are other drugs that have been considered for use in COVID-19.

One is Invermectin. Others are monoclonal (all one type) antibodies as described above. Another drug fluvoxamine (Fluvox) is a drug used for obsessive-convulsive disorder and was hypothesized to block excessive inflammatory reactions.

Bottom line if sick is, find a physician who you trust. A good physician will listen to a patient’s concerns and questions and then when you are comfortable with them, your best shot is to follow their instructions.


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