Latest News from COVID Front Lines
Critical care specialists and clinical researchers are joining us to discuss the latest fontline experience and major headlines in the COVID pandemic.
Panelists will discuss topics such as the announcement of FDA approval for convalescent plasma, production and deployment of a vaccine, the latest in drug trials, treatment protocols and survival rates.
Who:
- Dr. Gabriel Lockhart - Pulmonologist in the division of pulmonary, critical care and sleep medicine at National Jewish Health.
- Dr. Kenneth Lyn-Kew - Associate Professor & pulmonologist at National Jewish Health.
- Dr. William Janssen - Section Head, Critical Care Medicine, Professor of Medicine, Section of Critical Care Medicine, Division of Pulmonary, Critical Care & Sleep Medicine Department of Medicine at National Jewish Health.
When: August 27, 2020. 2PM-2:45PM EDT
Where: Newswise Live Zoom Room
Registration for media, as well as colleagues from participating Newswise member institutions
This live event will also be recorded and transcribed for use by media and communicators after it is concluded.
Thom: Welcome to today's Newswise live expert panel. We have with us today several critical care specialists and researchers joining us to discuss some of the latest in frontline, pandemic news, in particular how things are working in the hospitals, as well as some research into drug trials and the best standard of care for treatment of Covid patients. Today's panel was made possible in part by the support of the American Thoracic Society. They recently launched their 2020 annual meeting as a virtual conference and the sessions and meeting content are available on demand up until November. So I'll paste in a link to where you can find more information about the American thoracic society's virtual meeting and if you have any questions or follow up for today's panellists, and you'd like to connect with them by email or for further interview, contact Dasia Morris at the ATS, I am going to paste her email into the chat. For media who are on the call, we welcome your questions, we want to make sure that our panellists can talk about the topics that matter most to you. So, giving us your questions helps us to do that. Please note the chat and go ahead and chat any questions to me that you'd like to ask our panellists. We'll start with a question that I have prepared for each of the panellists. And then if we get any questions from you folks in the media, we'll go ahead to you after that, and we have other additional questions, of course, prepared so I want to go ahead and get started by introducing our panellists.
We have with us. First, I'll spotlight Dr. Gabriel Lockhart. He's a pulmonologist in the Division of pulmonary critical care and sleep medicine at National Jewish Health based in Denver. We also have Dr. Ken Lyn Kew. He's an associate professor and a pulmonologist that now National Jewish Health and we have Dr. William Janssen. Dr. Janssen is the section head of Critical Care Medicine and he's also a professor of medicine there at national Jewish health as well among several other credentials and job titles there that Dr. Janssen does. So Dr. Janssen, I want to start with you, because I'd like to a little bit of sort of that big picture, since you're involved in so many different clinics and parts of the hospital there. Do you think the current rates of cases per day and hospitalizations that we're seeing while they've come down from the sort of mid-summer peak - is that a sustainable level for our healthcare system to bear? Or do we need to start flattening the curve even further than this and take more drastic measures?
Dr. Janssen: Well, thanks for the question, Thom. Obviously, we would love to see fewer cases. There's no doubt about it. And if we can flatten the curve even further, that's certainly ideal. I think from a national sense the number of cases we're seeing now, is probably sustainable. However, it's important to note that when we see cases, they're generally in pockets. So, some states may have a very high rate of disease where other states don't. And so, as we look at the overall numbers in the US, it's probably sustainable. But we'll certainly continue to see outbreaks in different regions. And those outbreaks, those hotspots are going to be ones that could put the healthcare system to the breaking point. And so, we would definitely love to see the numbers continue to come down even further.
Thom: And what is some sort of target where either percentage of tests being positive or cases per 100,000 population? What's a really ideal level to get this to that the public can start to feel safer about things?
Dr. Janssen: Well, the simplest answer is as low as possible. We'd love to see the number of cases drop to zero. I don't know that that's achievable. But that's certainly what we'd love to see. The Coronavirus Task Force and the CDC have published guidelines that should provide instruction on opening up. And those are the ones that we should follow. So ideally, we'd love to see the percentage of cases per test be less than 10%. And ideally, if we could get that down to 5%, that would be really good.
Thom: For Dr. Lockhart, how are healthcare providers and public health officials planning for the eventual deployment of a vaccine? I understand that you've been involved in some of the planning stages for this and wonder what the public and the media ought to know about how that process will roll out once the vaccine reaches final approval?
Dr. Lockhart: I've had the opportunity to work in a Medical Advisory Group with the governor of Colorado and we're starting with a template that the advisory committee with Immunization Practices from the CDC has been working on as well, the ACIP, and they've been able to utilize what was put out in 2018 in relation to influenza vaccine that they utilize practices from when H1N1 took off and seeing a way to have a tiered system of how to disseminate the vaccine to the most at risk population groups at first and then having the general population at the last – with the five tiered system. And so that hasn't been finalized yet. But we're going to use that as a template to decide what's the best practice to do so with limited resources, and essentially the broad nature of it is the frontline workers in the inpatient over the outpatient providers, the people generating the vaccine - high ranking government officials, and as well as at risk population groups are going to be a target amongst the earlier tiers. These at risk population groups are going to involve groups like the African American population, the Latino population, indigenous peoples who have been affected at disproportionate rates to their population share, and that's going to be a big issue going forward is trying to improve our numbers of vaccine acceptance, because especially in those population groups, that they have legitimate gripe against health care in America with some, some issues have had in the past, and there's distrust amongst that population in terms of vaccine acceptance, and you can tell that the population that they're going to be amongst the first group being vaccinated. It can naturally brew a sense of distrust and calling themselves lab rats and so forth, when really that's not the case. And that can be our biggest issue going forward is working on vaccine acceptance for the good of those populations that have been historically not targeted in a positive manner – and this is the opposite of that.
Thom: To Dr. Lyn Kew, you're working on a trial of a clot buster drug - the presence of blood clots in severe Covid cases, I don't think has been really covered very widely and I understand that there's not a whole lot known about why it's happening or what it causes just that it is happening. Can you tell us more about the trial that you're conducting and how this process is understood with blood clots forming in Covid patients?
Dr. Lyn Kew: Yes, so we're participating in a trial of a clot busting drug called TPA and that trial is a multi-hospital trial. Dr. Janssen is also one of the investigators on the trial. And the trial is looking at whether busting these tiny clots that form in the lung can actually help our sickest patients who are on mechanical ventilation improve how much oxygen they require, and ultimately help them get off the ventilator. We have seen throughout the press, allusions to this clotting disorder that people believe is going on with Covid. And I think the New York times for example, covered the stroke you know, the risk of stroke in young people in New York a couple months ago, and other various news outlets have picked up on little pieces here and there. But when you look at the bigger picture, we've seen clots in the lungs, both on a macro or big clot burden and on the little micro clots that occur in the tiny vessels that we can’t see, as well as the stroke in it. So, it hints towards the increased clot burden of this disease affecting some people disproportionately than others. And so, the idea behind the trial is to see if we can actually get rid of these clots and improve their outcomes.
Thom: Dr. Lyn Kew mentioned, the experience of healthcare providers in New York. Dr. Lockhart, I understand that you are one of many health care providers that went to New York, along with many other colleagues of yours who went to various of the hotspots early on, what can you tell us about what that experience helped for us to learn about treating the disease and led to some of the improving outcomes that we've seen and what are the comparisons to those early peaks and hotspots back in the spring compared to what we're seeing now.
Dr. Lockhart: That was an invaluable experience and something that Dr. Lyn Kew as well went to New York, but the experience was being able to see first-hand the devastation to disease at this huge hotspot, being able to see what practices works from a logistics standpoint of how to expand the ICU resources and now, potentially some places were at the brink of running out of certain things like PPE and ventilators – with our experience personally, we didn't quite get to that point, we ran out but certainly there were times when they were very stressed out about the resources and being able to see how they were able to essentially - I don't want to see MacGyver, but they're able to really come up with new ways and better ways to figure out how to overcome these shortages and I was able to relay that information in real time back to our folks back in our home institution in Denver, and able to give us a head start over what we expected to be a higher peak for us, and to prepare for that earlier for the people of our home state. With that, us being able to benefit and help the people of New York while helping people back at home was a great experience. And so, what we saw early on was that people in New York are using steroids earlier than we've been - was nationally accepted. They were doing trials along the way with – and utilizing blood thinners earlier than what was accepted. And, there was a transition from early intubation to later intubation as patients – as we realized that we may be wait a little longer to pull the trigger intubating patients and they had a very high mortality rate once patients were put on the ventilator, and we didn't experience that same mortality rate in Colorado. But certainly, we utilized that experience that they had in New York to help guide our practices going forward and what seemed to be an acceptable threshold to put patients on the ventilator. And so, these were crucial practices, that helped to improve our numbers as we had a head start and took heed of what was happening in New York. And we had better outcomes as a result.
Thom: If media on the call, have any questions, please do chat them to me and we'll invite you to go ahead and ask the question yourself, or if you don't want to do that, I'll be happy to ask it for you. Dr. Janssen, what would you add to anything that Dr. Lockhart said about the experience of traveling to New York and other hotspots to assist in the early spikes back in the spring and bringing that experience and bringing that knowledge to the best current treatments that we're offering in other parts of the country right now.
Dr. Janssen: Yeah. Thanks, Thom. I think this gets back to an issue that you raised earlier. And that's the one of health care system and its breaking point. The whole reason that we sent doctors to New York is we knew that the system was stressed. And they had shortages of not only doctors, but respiratory therapists, nurses, and staff, you know, throughout the hospital. And so, I think what this highlights is that when a healthcare system is stressed, outcomes for patients can suffer. And so, the whole goal for us really going forward is going to be to reduce the rates of Covid in the community to prevent spread of infection. And then critically when someone does come into the hospital are now armed with some additional knowledge that we can use to treat those patients. Whereas early in the pandemic, everything was just brand new to us.
Thom: Dr. Lyn Kew, your colleague, Dr. Janssen alluded to hospitals reaching a certain capacity where they're under stress and can't deliver the proper standard of care. What are some of the biggest concerns that you see in terms of that hospital capacity, and what can you us about how just that standard of care and that presence and that monitoring that can happen in an ICU that's not overrun - how that can ultimately lead to the best survival rates?
Dr. Lyn Kew: Yes, so I think Dr. Janssen already alluded to it, which is that when you provide good care, you can do everything right and control your mortality rate. So here in Colorado, we know we were not as stressed as other locations, and when we look at our mortality for patients on our ventilator, they line up with national standards of care from well controlled trials that showed that the mortality should be within a certain range. When you look at the mortality rate in New York, even though they weren't, they didn't break, they were very stressed. And you see that, in that people were put into roles that were a little bit off from their usual role, etc, just because of the stress. And all those little things start to change those outcomes. We also saw that in Seattle with their initial experience, where they were very stressed and their mortality was a little higher than what it usually is. So, we know that these stressors are very important. We also know that the stressors a lot of times are not equipment stressors, as Dr. Janssen alluded to, it's how many nurses do you have, how many respiratory therapists do you have? Do you have a CRNA - you know who might be very brilliant - CRNA is a certified nurse anaesthetist, they might be, you know, be wonderful at their job in the operating room, but if you have them trying to fill in the role of a respiratory therapist, which we saw in New York, there's little things that a respiratory therapist does on a day to day basis that that person – the CRNA is not trained to do, or an anaesthesiologist filling in for that respiratory therapist job or a pulmonologist such as myself. So, the team approach to care is extremely vital in critical care. And I think all my colleagues on the call would agree to that. And when you have breakdowns in the team, it's no different than if we were to use a sports analogy having the third stringer who never practice suddenly thrown into the starting line-up, you're not going to have the same team dynamics and you're not going to perform the same way and that's what happens in these stressed environments. And so, we were able to see the difference that that makes with our experience in New York versus our experience in Colorado.
Thom: We have a question in the chat from a member of the media. I'm not sure of her full name or where she writes, but she asked if we could comment on the CDC recent guidance on testing - Dr. Janssen, the CDC announcement of changes to testing guidelines, is that going to affect the ability to track infections properly - are we at risk of them being undercounted are these guidelines appropriate?
Dr. Janssen: Yeah, so that's a good question. So just to kind of reiterate, so the prior guidance from the CDC was that anybody that had close contact with a person that was infected with SARS- Cov-2 - a virus that causes Covid. The prior recommendations were that those close contacts should get a test. And then, earlier this week, I think many of us were surprised when the CDC revised those recommendations, and what they now read is that if you've been in close contact with a person for more than 15 minutes within six feet, that one of the following should happen - you should get a test only if you have symptoms, or if your physician or local or state health officials recommend it.
So, what this change does is right goes away from recommending that everybody gets a test to kind of putting it on your local and state health officials. So, a lot of people are somewhat mystified by this - I'm one of them. I think what this is doing is really putting the onus on the states and local officials to come up with rules. And this might help better leverage some local and state resources. I think that might be the intent. The unintended consequences of the announcement could be that fewer people will get tested and we will have less contact tracing. And that really flies in the face of everything that we've been told, and what we understand about the disease. If someone's been in contact with somebody that's been sick, and they're at risk, they should be tested. And if positive, they should quarantine or self-isolate, that's the most effective way to spread disease. So, I think that the announcement from the CDC has certainly been a surprise. And I think it really puts the onus on the state and local health authorities with a statement
Thom: Correct me if I'm wrong, Dr. Janssen, but I believe I've been told by many experts in these panels that we've been doing for the last six months, that people are most infectious before they even display symptoms. So, if having symptoms is a cut-off for having a test or not, we're failing to detect cases as they potentially become the most infectious, right?
Dr. Janssen: Well said, I don't have much to add to that. You know, we know that a high proportion of people that get infected are asymptomatic. Typically, those who are younger, healthier people. And as colleges, universities, high schools, elementary schools are opening up, I think we're going to see even more and more of that asymptomatic spread. So, you're absolutely right. You can spread the disease without being symptomatic.
Thom: Dr. Lockhart, what are your thoughts about these changes to the guidelines and how they'll impact the frontline care?
Dr. Lockhart: Sure, it I think I worry with a lot of other colleagues that this may undermine the value of asymptomatic spread or pre symptomatic spread. Where you know there is going to be - there's a fair amount of diseases spread that way where people don't know that they're infected because of the high incubation time, it goes before the 14 days, which is, you know, much more unprecedented compared to other viruses like the flu and the original SARS virus. Now, if you have to look at it from a practical perspective as well, and part of the reason why this may have been put into place as testing is increasing, is that they have to worry about logistics of having enough of testing. Now, I'm very much a proponent of there needs to be much an overhaul of the testing in this country as compared to what other countries are doing, in that increasing the per capita availability of tests. Having the ability to have quick turnaround for testing and an increase in contact tracing. I think these are all methods to do that - to curtail the numbers of cases spread in the community and allow for people to have the knowledge base that they're infected, you need to be quarantining yourself. And it needs to be contacting people who you could have potentially infected. And so, with these changes in the in the CDC, this may be partially reflective of just us not having the capability of testing as maybe we should have. And so that's something that comes to mind for me when I see these changes in CDC recommendations.
Thom: Dr. Lyn Kew with regard to the changes in the testing protocol and the possibility of missing people during the most infectious pre symptomatic or asymptomatic cases, how much more important than is masking and social distancing and all these other proper protocols. I see you have your mask on I'm guessing that you're in the office and in proximity enough with other people that you're wearing your mask. That's great. Yeah, really bring it all home to us with how we can prevent spread, if we don't know that people actually have it because of the testing changes,
Dr. Lyn Kew: So, as I sit here in my mask, it's because I'm in the hospital. I'm not in a private office. So, we know that wearing a mask, washing your hands and maintaining distance are the three hallmarks of how we prevent the spread of this disease. This has been proven in our country, it's been proven in other countries, places that did not enforce masking, we saw what happened to them when they tried to reopen. I don't think that this is a political question. This is a medical question. And I have my mask on right now because I'm abiding by the rules, because the last thing we want to do is lose another healthcare provider to Covid because we've lost enough of them as it is. If we're going to take the opposite direction of what we need to do with testing and I will say that this is a step backwards, I will be blunt about it. The CDC was flat out wrong. The epidemiologists there should know this because standard epidemiology is to contact trace and find out who has it early. And this is a failure to do this with testing, if we're not going to do this it all puts it amongst all of us the burden to make sure we stomp out this disease the best we can. And again, to reinforce masking, handwashing and social distancing are the three tenants that are going to get us through this. It got us - the world through this in 1918. Before we had all the fancy technologies we have, and it's what's going to get us through this pandemic as well.
Thom: I want to turn to another announcement from public officials with the emergency use authorization of convalescent plasma and ask Dr. Lockhart, Dr. Janssen, Dr. Lyn Kew. thoughts about the status of use of convalescent plasma, how effective it's been seen in early trials and what more needs to be understood about it for it to be deployed effectively.
Dr. Lockhart: So right now, we don't have a good quality randomized control trial compared placebo to the convalescent plasma. Now, there's a recent study that is in the works of being peer reviewed that suggests that there's an improvement with data, with patients that were given convalescent plasma early in the first three days of diagnosis compared to those who were given convalescent plasma in the later stages. In it that seemed to show benefit, but we haven't had - that hasn't been peer reviewed yet. So that's first of all, and then we haven't had a published trial, where you compare it to placebo. Now, I think that the risks are fairly minimal with giving convalescent plasma. And there's a possibility of benefit. And so that seems to be worthwhile. I certainly practice giving qualifying patients for convalescent plasma for setting of trial. And certainly, I can understand the reasoning behind the decision to make that announcement to allow more access to convalescent plasma. And I think that overall, it seems to be fine, but I don't think that we have a silver bullet at all to treat this disease quite yet. And, and certainly, we hope that this will help benefit patients. But you know, time will tell, but we don't think that we have a silver bullet quite yet.
Thom: Dr. Janssen, anything you'd like to out about investigating convalescent plasma?
Dr. Janssen: Yeah, yes.
So, what, what my colleague Gabe says is correct. We don't have any studies that show a benefit of convalescent plasma. The data seem to think, seem to support the notion that convalescent plasma is safe. And we think there may be a benefit. But a randomized control trial has not been done. So, there's an assumption that the plasma is beneficial. And I think many people lean in that direction. And I want to make it clear that the gold standard trial has not been done. So, it's still an open question. The emergency use authorization is going to make it more difficult to perform those randomized control trials. Many patients that are sick with Covid are simply going to say, I want the plasma don't put me in a trial. So, I think it might set our ability back to do a randomized control trial. I think that's the downside of it. The upside is that it may improve access for patients to get convalescent plasma, which again is a therapy that we don't know is - we don't know whether it's truly beneficial or not. That's the downside. We don't think there's a harm.
Thom: Dr. Lyn Kew as this gets added to the arsenal and we investigate whether it will be effective, the convalescent plasma? How does that fit into the whole picture of the use of remdesivir and steroids with the clot buster that you're investigating? Other things like when to put someone on a ventilator? How's the whole picture shaping up in terms of the best approach currently? And what more can we figure out to do to improve outcomes on the basis of those things?
Dr. Lyn Kew: Yeah, this will loop back to what I was talking about earlier about standards of care and critical care. So, I think when you look at what we have, everything is early data. What we do know is that providing good standard of care, critical care, which is timely, not too early, not too late in initiation, mechanical ventilation for those that need it, providing protection from the harms that can come with all the technologies in the ICU, providing the right nursing ratios, the right respiratory therapist ratios, these are all the things that are going to take care of patients with Covid. While we sort out the data. I've told my colleague this, and I will tell the national press this - I believe every therapy we do in Covid, outside of standard of care should be done in the context of a registry or a clinical trial. We have data for remdesivir that shows improvement in hospital length of stay, right mechanistically those are hospital patients and mechanistically remdesivir should work earlier than that, and ideal world you'd want to see it given before then, but there's issues with the how the drug is formulated. It's currently only available as an IV formulation. Steroids, there's some promise there. Absolutely. We had a trial that came out on steroids for ARDS the principal disease caused by Covid that showed some promise that came out in the end of February, just before Covid ramped up, and that plus the current data on steroids and Covid are encouraging that this is a therapy that may be beneficial. However, when you look at standards of care, I think this is where the steroid trial and Covid takes a knock which is you know, we usually see about a somewhere between 30 32% mortality and patients with ARDS in hospitals that maintain good standards of mechanical ventilation, and that mortality was 42%, in this particular trial, so when you start to say the steroids benefit the patient, we don't know if the steroids are rescuing the patient from other changes in care in that trial, or if the steroids are truly beneficial, and if applied to our population, which we actually know how the mortality of that was lower than the mortality with steroids in the in the steroid trial. I don't know that my mortality would improve or would it get worse or would it stay the same? And so, jumping to just giving these drugs after one trial is risky, because we don't know what the true benefit is in all these patient populations, particularly given that our patient population that we've seen in the United States is different from the patient population that I was studied in that trial. So, when we look at how we bundle all this care in, whether it's, you know, weakly positive data for convalescent plasma that is not done in a randomized trial. It's the steroids. It's the remdesivir. Even if we have trials, and we can't do a fully randomized control trial going forward, we still collect registry data. Because if we know that this patient's getting it and this patient was refusing it, because they have a distrust, or whatever, at least it gives us some data to look back on and try and sort out - Do we need to revisit this or not? Are there more side effects that we didn't recognize upfront or not? And so, standards of care in critical care are important – I know the society to Critical Care Medicine, I know to not the whole society for this meeting. You know, they have a saying right care right now. And I think that that saying is very important in the care of our patient. And we want to make sure that we're getting the first part of that, which is the right care part down.
Dr. Janssen: My stand to that if I can. I think to summarize, we have some therapies that have promised. And those include convalescent plasma, steroids, and remdesivir, an antiviral medication. So, we've made progress. But one thing we should bear in mind is that only 20% of patients that get Covid and maybe even fewer - need hospitalization. So, 80% of patients don't. But within that 80% there's still a burden of illness. And there are a number of patients that can get sick and miss school, miss work and have long term health consequences. And so, while it's vitally important to focus on the patients that are hospitalized, and in the intensive care unit, because that's where we save lives, there was a huge segment that Don't need hospitalization. And so, we desperately need therapies that can prevent the spread of disease, or that can treat it in patients that are in a sick, and we lack that completely right now.
Thom: Dr. Lockhart as we discuss the best current treatments available, the ultimate goal that everyone's sort of holding out for and banking on is a vaccine eventually - you talked a little bit about how that vaccine would be deployed when we first got started. Recent polls have shown some pretty high levels of reluctance. You referred to certain communities that might have some suspicion and reluctance to adopt the vaccine. What's the most important thing to get people to get on board and get vaccinated once a vaccine is approved?
Dr. Lockhart: I think that we have to have a good understanding of - that this is a new era that we haven't been in before - the vaccine that is coming out for this particular virus, it's a different type of vaccine than we've had to put up before. But at the same time, Dr. Lyn Kew alluded to certain principles about how we're going to be able to get over this pandemic, I would include vaccine into what he listed earlier, as a crucial part of how we get over this pandemic. You know, there are legitimate concerns about releasing a vaccine, that it's a different type of vaccine we've had in the past, with expedited trials. I think that all we can ask for is transparency from the CDC and these trials that are going on to see what's going on. And then when it's deemed to be safe from FDA perspective, it's going to require good acceptance amongst our population for it to be beneficial. And again, this is going to be a huge way that we overcome this pandemic. And now there's a lot of population groups that are going to have a distrust for government. And, and some of them have legitimate concerns about why they would have distrust for health officials based on certain population groups, such as African American population with regards to Henrietta Lacks and that her cell lines that were taken without her consent and acknowledgement. And the Tuskegee Syphilis trial that went on for 40 years. So certainly, we understand and things that are happening even more currently, where bad outcomes are happening to African American population, I absolutely understand the concerns. However, this is a different era. This is something where that these population groups with African Americans, Latino population, and indigenous people are being infected at extraordinary rates compared to a Caucasian population, the African American population has never died at a rate less than twice that of the Caucasian population. And with the already big divide in health care outcomes from those populations towards the norm, I worry that if these populations don't accept the vaccine that is, to the best of our ability is released, when it's known to be safe, at least in the short side effect outcomes, then these potential gap in and healthcare outcomes are going to widen even further if they're not accepting of this vaccine. And so, I think as a community from a provider in medicine, I think we need to acknowledge that we haven't always done right by this populations, but we need to come together and heal together with and grow the trust with these populations, so they accept vaccine. And we can finally do right by targeting these populations in a positive manner.
Thom: Dr. Janssen, what would you say to help build confidence in those communities that Dr. Lockhart is talking about in, in the vaccine trial process - in the whole scientific process? For example, your hospital being part of a hydroxychloroquine trial, which was halted because of the findings that it wasn't bringing benefit? What can you tell us about that process? And what was indicating that to the conclusion of halting the hydroxychloroquine trial? And how can that reassure people about the security of this whole process for the ultimate outcome?
Dr. Janssen: I think there without question, there's tremendous pressure to find new therapies and in large measure, that's driven by the fact that 1000 Americans are dying every day. And even more, are getting sick. So tremendous pressure to find new therapies. But that has to be balanced with safety. And so, hydroxychloroquine is a great example there. It was initially touted as a promising therapy based on a very small study; I have to say that I really wanted hydroxychloroquine to be a therapy that worked. We are desperate for anything that could treat Covid. And so, it's too bad that it didn't work. But it needed studies to validate its effectiveness. And so, what we've seen from a number of large randomized controlled trials is that hydroxychloroquine doesn't benefit our patients with Covid. And that's unfortunate, but that's the fact. And so, the same type of rigor needs to happen with vaccine development and is happening with vaccine development. We need to push the boundaries and to push as fast as we can to get vaccines. But that's got to be tempered with safety. And so, we need to make sure that the studies of the vaccines are following all the same levels of scrutiny and rigor that we use for any other drug. And we have to ensure that that's being done. So, when a vaccine comes out, and it's ready for the population, we have to be very confident that it's safe. And to the best of my knowledge, that's what's being done, despite all the pressure to get the stuff out early.
Thom: Dr. Lyn Kew one other looming factor in this next coming month is Covid combining with flu season – what are your concerns about what we might see in critical care units when that starts to happen?
Dr. Lyn Kew: So, my biggest concern is that people don’t get vaccinated for the influenza season. We know that people have foregone care and are afraid to go into hospitals for other care with this pandemic – and my fear would be that people do not get vaccinated and then we have a flu pandemic or a flu season – flu epidemic would be probably the correct term because it wouldn’t be world wide – but a flu epidemic on top of a corona virus pandemic would probably overrun our healthcare system. That being said, we know that in Australia, which is usually the – like a canary in a coal mine for a flu season, it tells us what’s going to happen with ours, that with masking, social distancing, that they actually had a very mild flu season. We also know from our experience in March of this year, that once we started shutting everything down and social distancing, influenza season which was in full swing went away. So, I also have hope that through vaccination – and I will stop for a quick – everybody get your flu vaccine! – that between vaccination and the three items for controlling corona – we’ve actually talked about that, we’ll actually have a positive impact on our influenza season as well.
Thom: Thank you Dr. Lyn Kew – Dr. Lockhart, anything you’d like to add if you can real quick – we just have a few more minutes about flu season combining with the pandemic?
Dr. Lockhart: Sure, not much more that I can compared to Dr. Lyn Kew – I think that one of the interesting things that we’re talking about in our discussions for the dissemination of the vaccine is the actual production of influenza vaccine in conjunction with the looming Covid vaccine and resources related to that. And so I think that – I would hope that there’s going to be an increase in the amount of people on a year to year basis that are going to accept influenza vaccine, especially to be overrun by influenza on top of corona virus would be devastating for a lot of populations, but I'm hoping that that wont be the case, we’ll be able to have the right amount of population for that.
Thom: Dr. Janssen, anything you’d add about concerns that the public should be aware of for Covid plus flu?
Dr. Janssen: Yeah so, I echo Dr. Lyn Kew’s statements, we’re all hopeful that the flu season will be mild, but if its not we could be in for some real trouble. And so there are four things that are efficacious for the flu and they happen to be the four things that are going to help us get through Covid as well, and so if I had any message, that would be do the following – number 1] keep your distance, number 2] wash your hands, number 3] wear a mask, number 4] get a flu shot – those are civic responsibilities, as all Americans we should be doing those things.
Thom: Yeah thank you Dr. Janssen – it just seems like the potential of an influx of influenza patients on top of trying to provide the standard of care that Dr. Lyn Kew was talking about for those Covid patients, being able to tell the difference between the two – these are all things that add just too many variables into the system and are a recipe for disaster, so thank you for the clear and concise four things to do and get your flu shot.
With that we’ll go ahead and wrap up, we have another panel starting in a little bit at 3 pm Eastern to talk about some global business topics related to China and global trade, so we want to take a break until that. Meanwhile for anybody who is interested in following up with our doctors who were part of today’s panel on Covid – I'm going to chat the link to more information about the American Thoracic Societies virtual annual meeting and the contact for Dasia Morris at the ATS who can help you get in touch with any of our doctors from todays panel for further follow up questions. Media, we will send you a video and a transcript of todays panel, if you registered for today’s event, we’ll get that to you automatically. If you didn’t register and you just clicked the link to join and you want to get that video on demand, simply send us an email to [email protected] and we’ll make sure to get you on the list to get that video once its available and finished processing.
With that, I'm Thom Canalichio for Dr. Lockhart, Dr. Janssen and Dr. Lyn Kew – thank you all very, very much for your participation in todays panel and for your excellent answers, stay safe, stay healthy and good luck!
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