As a follow up to last week’s email,  a large, international,  randomized controlled study was released last Friday, printed in the Lancet,  a prominent British Medical Journal,  which compared the effects of Chloroquine or Hydroxychloroquine with or without antibiotic, to placebo in patients admitted with a Covid 19 infections.  Fifteen thousand patients were treated with either chloroquine, chloroquine plus an antibiotic, hydroxychloroquine, or hydroxychloroquine with an antibiotic.  These treatment groups were compared to a control group who were not treated with any of these medications.    Results were as follows:

So, patients with Covid-19 are about twice as likely to die if treated with any combination of the drugs above, compared with a placebo. This is now a settled issue, confirmed by other smaller trials.  If you have the infection, you are better off sucking on a Lifesaver then pounding the Chloroquine. 

Herd Immunity

Preliminary studies have been released recently on the percentage of patients in various parts of the country and the world who have antibodies to the Corona virus.  The studies are conducted on a random sample of the population in a city.  The results are likely not completely accurate but give a picture of the relative immunity (or possible immunity) in any one location.  New York City has the highest percentage of the population with antibodies (20%).  Other cities of interest include Boston at 9.9%, Wuhan at 10%, London 17.5%, Madrid 11.3%, and Barcelona at 7.1%.  Stockholm, Sweden, (which is purposefully trying to enhance immunity in the young population by letting them frolic) came in at only 7.3%.  Experts believe that at least 60% of the population must have active antibodies to squash the virus.  We are not there yet. 

Vaccines

News about vaccines for the Corona Virus have caused the stock market to soar, in the face of the worst economic disaster of our lifetimes.  So, God Bless Vaccines. The details about vaccine development are obscure, for us in the medical field included, because they deal with very specific constructs in the field of immunology where most of our minds just don’t wander.   But here is a brief summary of what is going on:

• Vaccine development   is a three-phase process. During Phase I, small groups of people receive the trial vaccine. In Phase II, the clinical study is expanded, and vaccine is given to people who have characteristics (such as age and physical health) similar to those for whom the new vaccine is intended. In Phase III, the vaccine is given to thousands of people and tested for efficacy and safety.
• The development process usually takes years, both  because it takes time to see if the vaccine is effective and at each phase there could be disastrous side effects from being inoculated; we don’t want  the treatment to be  worse than the disease. (An illustration of what could happen with a bad Corona Virus vaccine is the rare disease that some children are developing (Multi-system inflammatory disease) that is the result of the immune system becoming hyperactive, and causing devastating effects on multiple organ systems)
• To produce a vaccine for the current virus at “warp speed” as the President muses,  phases of vaccine development are being folded into one another,  so that after an initial small test group,  much larger groups in the thousands will be tested earlier to determine efficacy and safety.
• The warp speed concept also involves gearing up factories to manufacture massive quantities of a vaccine before the efficacy and safety are known.  Companies are making bets on which one of a large group of vaccines may be the most effective and safe and planning manufacturing as if they already knew the results of these trials. 
• Bets are being place on the company “Moderna” who had good results in a Phase 1 study published last week on an RNA vaccine.  Other companies in the running include Inovio Pharmaceuticals which is producing a DNA vaccine, Sinovac which is producing an inactivated viral vaccine, and CanSino Biologics, producing a “nonreplicating vector” vaccine.  It is possible that multiple vaccines will be effective and all of them will be produced, which would result in a higher number of total vaccines available at an earlier date. One type of vaccine may be safer for some populations like pregnant women or the elderly.  
• If these efforts are successful by the end of 2020 or early 2021, it will be one of the most remarkable feats in medical science in our lifetime.  Let’s hope. 

Measles Mumps and Rubella Vaccine

As I indicated last week, a patient emailed me a report about the MMR vaccine and the correlation of immune status to MMR and protection from Covid-19.  The MMR vaccine was first given in 1971 as a single dose to children between the age of 1 and 2.  It was later changed to a 2-dose vaccine in 1979.  Adults older than 49 may not have received the vaccine at all, unless they are working in the medical field -immunity must be demonstrated to MMR on a blood test before getting a job in a medical facility. 

The report shows some compelling relationships between MMR status and Covid Infection and Death including

• The major change in death rate from contracting the virus occurs at about age 49 (read 1971).  Very few people under 40 die from the disease.  Children routinely vaccinated in almost all countries of the world are essentially free from the disease.
• Countries that have a high immunization rate to MMR  (some countries have initiated programs to vaccinate the adult population) have a very low death rate from Covid including  South Korea,  population 51 million,  Covid deaths 269; Hong Kong, population 73 million,  deaths 4;  Taiwan, population 23 million, deaths 7; Madagascar, population 25 million, deaths 2. 
• Countries with lower vaccination rates to MMR have higher death rates from Covid 19 including Belgium, population 11.5 million, Covid deaths 9,388; Italy, population 62 million, deaths, 33,000.
• There appears to be some structurally similarities between the Measles, Mumps and Rubella viruses (all are RNA viruses like Covid) and Covid 19

I must caution that the data above show associations and not causality.  This is akin to asking all patients admitted to the hospital for a heart attack if they drank lemonade in the last month.  If they all did, you could make the association that all heart attack patients drank lemonade, but you would be hard pressed to say that the lemonade caused the heart attack.

So, I think this is compelling information that should be studied.  The best way to do this would be to check a patient’s MMR immune status when they are admitted to a hospital for the disease, then follow their course.  Other studies might study the effect of an adult booster of the MMR vaccine on the risks of contracting or succumbing to Covid. 

Also, other factors surely influenced the death rate in these countries including the degree to which the countries practiced containment strategies, testing, influences of immigration, etc.   But it is food for thought and hopefully more information will emerge on this topic.  

Maryland’s numbers are looking a little better, the weather is getting warmer, and on Friday evening we may be able to eat at an outdoor restaurant.   So, there is cause for celebration.   We will resume a regular schedule next week and see how that works out.   Stay safe.