Covid-19: Current State, Falling Mortality Rates, and “AeroNabs”

We kick off the fall series of UCSF Covid Medical Grand Rounds with a wide-ranging program on epidemiology and therapeutics. George Rutherford will discuss the current state of the pandemic, including the falling infection rates in the South and West, and the growing rates in the Midwest, schools, and universities. Monica Gandhi will discuss why Covid mortality rates seem to be falling, including the possibility (as discussed in her recent New England Journal of Medicine paper that mask wearing leads to less severe infections). Finally, Aashish Manglik will describe the discovery made by him and his UCSF colleagues that inhalable molecules (“AeroNabs”) can block the receptors that allow the coronavirus to gain entry to the human upper respiratory tract. The session is moderated by UCSF Department of Medicine chair Bob Wachter.

Program
Bob Wachter: Introduction
00:04:22 Current State of the Pandemic: George Rutherford, Professor, Dept. of Epidemiology & Biostatistics; Director of the Prevention and Public Health Group
00:30:11 Q&A for Dr. Rutherford
00:32:21 Covid’s Mortality Rate: Monica Gandhi, Professor of Medicine; Associate Chief of Division of HIV, Infectious Diseases, and Global Medicine at ZSFG; Director of the UCSF-Gladstone Center for AIDS Research; and Medical Director of the HIV Clinic, Ward 86, ZSFG
00:52:04 – Q&A for Drs. Rutherford and Gandhi
01:01:36 – AeroNabs: Aashish Manglik, Assistant Professor, Dept. of Pharmaceutical Chemistry
01:15:07 – Q&A for Dr. Manglik
1:26:00 – Bob Wachter: Closing

See previous Covid-19 Medical Grand Rounds:
• August 13: New Approaches to Covid-19: Rapid Testing, Herd Immunity, and the Role of Narrative
• August 6: A Conversation with Ashish Jha
• July 30: An Update on Covid-19 Testing, Treatments, and Vaccines
• July 23: Covid-19: Reports of New Surges from Miami, Atlanta, Houston, and UCSF

[dianegrace.]

Appreciate all your discussions!! I am not in the medical field - just a grandma - and would appreciate anyone here to comment. If indeed it is still the facts that 80% who get COVID19 will either be the asymptomatic or mild case; 20% showing more symptoms of which 5% severe cases. And, if the vulnerable group is still the 60 plus elder age plus of course those younger who may have preconditions than my question is this: vaccines are for the elderly, medical staff and those with preconditions who may be younger: but for the majority in the 80% bracket, they do not need to get the vaccine for if they even get COVID19 they may never know it ... COVID19 is unlike many other viruses as it is relatively selective in age group compared to annual flu which impacts all ages. Why are we applying one shoe fit all when this is not the case.

[ashvarma]

Dr. Aashish Manglik’s idea about Aeronabs is very novel, very bright and very practical. Wish all the best on the Project.

[stevencats]

Although all reasons mentioned for falling death rate are valid, surely the main reason is that early in the pandemic, as the pandemic swept through Europe, the number of cases represented such a minute percentage of the actual infections and therefore case fatality rate was way over estimated. Only people presenting at hospitals with serious disease were being tested. Data from UK suggests that actual infections were in excess of 200, 000 per day although reported cases were only approx 8, 000. With subsequent screen testing, a much higher percentage of infections are now being detected.

[sfzombie]

I’m been waiting for this update about AeroNabs .

[patriciahoke]

I share Dr Gandhi's enthusiasm for masking, but to push back a bit. I have heard that even asymptomatic cases of Covid-19 can have lungs seen on CT and x-ray showing damaged lungs and/or the so-called Covid pneumonia.

[lisalisa]

Thank you for these fascinating presentations.

[andymullarx]

I'd like to know if most or all countries are using the same testing methods outside of the distinction of testing everyone as opposed to just symptomatic people. Is the familiar nasal probe that we see here n America being used universally to test ?

[kamleshthaker]

Great work. Thanks for upload and sharing knowledge
Dr T

[stephend]

I'm a little surprised that Dr. Rutherford took uncritically the research alleging 260, 000 cases attributable to the Sturgis Rally. This was not peer-reviewed. South Dakota itself recorded a spike of about 600 cases following this event, but this may partly reflect increased testing. It is difficult to see how the figures in the study can be justified.

[chalfontstgiles]

Could the lower fatality rate be due to the decrease in vitamin D deficiency in the northern hemisphere populations that normally accompanies the summer months and the beneficial effect of greater sun exposure?

[xnpfbce]

I believe that the most vulnerable have been infected earlier.

[ireneb]

There are nightly gatherings of everyone off of work all over California where I live. Parties with music, Casinos, not to mention all the homeless and social rights movements.

[suescannon]

Could the aeronabs be used to spray in a patient room when the pt has a high viral load and or is receiving aerosolizing treatments? Plus could people who can't get vaccines (Cancer and other immune suppressed patients) to protect them? And lastly what happens if you're allergic?

[videorezensent]

Reduction of "raw" case fatality rate in the summer could be due to better detection of cases, especially asymptomatic and mild cases (both in young and older people). Masking may be a factor, but I would not consider this to be proven until other changes between spring and summer have been ruled out or quantified with regard to their effect on the actual infection fatality rate.

[solar]

Is AeroNabs in clinical trials anywhere?

[hank-uhzq]

Yes, age, masking etc. But was sun light a factor?

[kevingormley]

Vitamin D is NOT really a vitamin and a functional immune system is important. If one believes insulin can lower blood sugar, why can’t one believe that the hormone Vitamin D can help a functioning immune system. Both are hormones and have profound effects on the body.

[hank-uhzq]

What does she mean “we didn’t know about masking?!” We’ve used masking in Medicine for over one hundred years by now. Now, were you to wait for the perfect EBM paper on masking, you would still be not wearing a mask...

[franzculetto]

What about the risk of SARS-CoV-2 aerosol transmission enhancement by cigarette/cigar/pipe smoke micro/nanoparticles, or by such from other combustion processes (including ritual incense usage too) contributing in a kind of vectorial way? If such pathway, one maybe could explain the higher indoor infection probability as well as such pretty high one (not easily understood super spreading situation) outside in the open.

[Syncopator]

The Aeronabs research sounds fascinating-- but the first question that comes to mind is, there's more than one spike protein on a Sars-Cov12 molecule, is there not? If so, to what extent is the viral replication/spread impaired if not *all* of the spike proteins on a given virus molecule are bound to an Aeronab?