An Update on Covid-19 Testing, Treatments, and Vaccines

In this UCSF Medical Grand Rounds (July 30, 2020), we get updates on three key issues in the Covid-19 pandemic. Chaz Langelier reviews testing, including test shortages, false positives and negatives, and the meaning of persistent PCR positivity. Annie Luetkemeyer offers an update on treatments, including remdesivir, dexamethasone, convalescent plasma and antibodies, interferon, hydroxychloroquine, and the prospects for oral therapies. Finally, Joel Ernst reviews the latest information about vaccines, including trials of the Moderna and Oxford vaccines, our growing understanding of Covid-19 immunity, the ethics of challenge trials, and determination of priority groups once a vaccine is approved. The session is hosted by UCSF Department of Medicine chair Bob Wachter.

Program
Bob Wachter: Introduction
00:05:30 – Testing: Chaz Langelier, Assistant Professor of Medicine, Division of Infectious Diseases at UCSF Health
00:23:35 – Q&A
00:27:20 – Treatments: Annie Luetkemeyer, Professor of Medicine, Division of HIV, ID and Global Medicine at ZSFG
00:48:36 – Q&A
00:52:43 – Vaccines: Joel Ernst, Professor of Medicine and Chief of Division of Experimental Medicine at ZSFG
01:12:30 – Q&A
01:15:18 – Panel Discussion
01:28:43 – Bob Wachter: Closing

See previous Covid-19 Medical Grand Rounds:
• July 23: Covid-19: Reports of New Surges from Miami, Atlanta, Houston, and UCSF
• July 16: How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, and More
• July 9: The State of the Pandemic, Opening the Schools, and the Outbreak at San Quentin State Prison
• June 25: Special Presentation: An Interview with John Barry, Author of the Bestselling Book, The Great Influenza: The Story of the Deadliest Pandemic in History

[lonivogler]

Thank goodness you are exploring this! In TWIV I saw Dr Michael Mina talk about these types of cheap, repeatable tests. I believe this could be our best strategy moving forward!

[lte]

Thanks so much, UCSF School of Medicine! I really enjoyed you well prepared, well researched presentation, expert views and insights! Your weekly "grand rounds" is a must watch.

[dontworrybehappy]

Thanks again Bob and UCSF staff for these highly informative videos which are also very topical and useful for almost everyone who has time to watch them.

[stephenh]

First time I have found these videos series. Appreciate the details and timely updates even from recent day's information. Looks like I'll be binge watching older videos. Thanks for all you are doing to educate us.

[sbartdbarcelona]

Thank you UCSF and team. Excellent fact based/science based information.

[brucegordon]

Dr. Wachter - Thank you very much for these videos. I have learned a lot, I believe I understand better why wearing a mask is important for both me and others around me, and while I am trying to be as cautious as possible, I feel a bit less anxious, being armed with more knowledge. Again my sincere thanks.

[sorichvacations]

Wonderful online symposium as usual. Thank you

[zedgarden]

These are the best videos I have seen on YouTube with regards to Covid19 update. Thank you.

[guygrotke]

Huge problem with all of the treatment options: For almost every patient, Covid-19 has two phases. The viral replication phase, and then possibly the autoimmune phase. If you look at the viral load over time chart, you can see why antivirals have very limited benefit in phase 2. You can also see why steroids are contraindicated in Phase 1. In fact, antivirals would offer the most benefit before any symptoms appear! So the FDA's humanitarian use standard for remdesivir only allows it to be given when it does no good. But the scarcity and cost of remdesivir also contributes to the problem: In order to see benefits you would have to give it to everybody post-exposure, not knowing if they would get sick or not.

Testing every day with spit strips would offer early detection, before any symptoms appear. Getting a positive test would be the ideal time to use an antiviral treatment.

[anaa]

Great speakers. Professor Luetkemeyer has such an easy way to convey complex information❤️

[GnomeGardeners]

Watch MedCram live interview with Dr. Mina 8/5/2020. He discusses paper antigen tests that can be done cheaply and frequently at home.

[randmorf]

What about anti-coagulants and anti-platelet drugs? Much of the damage caused by medium and severe cases of COVIDS is due to micro-blood clots that form in various tissues and organ systems of the body. How has testing been going with various anti-coagulants and anti-platelet drugs at reducing the COVIDs damage caused by blood clotting? Which of these drugs have proved most useful?

[KhAn-qlwp]

HydroxyChloroquine study from WHO and Oxford have used 10 times the acceptable dose for Malaria
The Belgium study with 200mg dose was shown.to be 25 to 30% improved mortality rate.
And at such high dose of HC, obviously some people will.die from over dosage.
And the study that shown HC can cause hear attack has retracted their study due to possible manipulated data.

How do you reconcile some success with HC at other countries?

[francisdelacruz]

How about Hydrochloroqine as a preexposure or prophylaxis application? World needs cheap prophylaxis alternatives.

[buzzpedrotti]

Very instructive. Thanks. Again, , proud of UC.

[ronmiller]

So if your 70 yo Mom is diagnosed with COVID what are outpatient treatment? Remdesivir ? Tylenol? Hcq? Zpac ?

[jamesandrews]

Yes. Yes. cheap quick tests. This week in virology episode 640 covered this well. Call or write your rep.

[Childless-cat-lady]

So so scary to hear “nothing good to offer outpatients.”

[Shelmerdine]

May I suggest you do an update on professor Krogan’s work? And maybe give a status on Navajo Nation. With your report from May 7th in mind, of course.

[davidhor]

Where is the a study of non-toxic doses of HCQ with zinc that the combination is not effective?