COMMENTARY

Mar 20, 2020 This Week in Cardiology Podcast

John M. Mandrola, MD

Disclosures

March 20, 2020

Please note that the text below is not a full transcript and has not been copyedited. For more insight and commentaryon these stories, subscribe to the This Week in Cardiology podcast.

In This Week’s Podcast

For the week ending March 20, 2020 John Mandrola, MD comments on the following cardiology news [and features] stories.

COVID-19 Resources

Yesterday brought news of 4000 new COVID19 cases in the United States. Overall numbers were even more stunning; 8 days ago we had 1700 cases, yesterday there were 12,000 cases. This is what exponential growth looks like.

Medscape has a useful COVID-19 resource center, including a fantastic piece on how French hospitals are getting ready.

Personal Protective Equipment (PPE) Crisis

If we don’t do something about the PPE shortage, we will have serious problems. Not only will health care workers get sick and die, but without proper PPE we will become super spreaders of the disease. What’s more, if health care workers are sick, who will care for the patients?

Drug Candidates for COVID-19

The chatter comes from a couple of tiny studies, a small nonrandomized study and an in-vitro study. One is a French case series of 26 patients in Marseilles who received the hydroxychloroquine, six of whom also received azithromycin to prevent bacterial super-infection, and 16 control patients. The endpoint was viral load. Hydroxychloroquine reduced viral load significantly more than controls, and the small group with azithromycin cleared virus even faster.

A previous study from China showed that in vitro hydroxychloroquine did better than chloroquine for inhibiton of coronavirus activity.

Given the severity of COVID-19, it will be easy to conduct a pragmatic RCT with viral load and clinical endpoints. Viremia is not the only way this disease kills—it can also be an immune response run amok.

The New England Journal of Medicine published a disappointing trial of lopinavir/ritonavir in patients with COVID-19. This trial of about 200 patients found that mortality at 28 days was similar in the lopinavir/ritonavir group and the standard-care group.

FDA director Hahn has announced that the National Institutes of Health began a randomized controlled trial for the treatment of COVID-19 patients with the investigational antiviral drug remdesivir. And on the FDA site they write that about 250 patients have been granted compassionate use.

The use of convalescent plasma and hyperimmune globulin is an interesting approach in which people who recover and are virus free can donate blood, and the plasma of antibody-rich blood can be given to ill patients.

COVID-19 in Cardiology

Some studies show the not so small prevalence of cardiac involvement. Left ventricular dysfunction, ventricular arrhythmias, and cardiogenic shock can be the proximate cause of death.

I have also seen reports of COVID-19 myocarditis. This means transferring patients to the cath lab and exposing lots of people. There is talk of using lytic agents in an effort to reduce exposure of the cath lab. We will have to be careful about giving lytic agents to patients with myocarditis.

Virtual ACC and HRS

The American College of Cardiology will attempt to have some sort of virtual meeting soon. The Heart Rhythm Society has not postponed yet, but this is an absolute certainty given that May is likely to be close to the peak.

I would encourage both societies to scrub attempts at virtual meetings. Not because it is not possible, but because literally no one cares at this point.

How can we garner any interest in anything but the biggest trials?

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