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There is no proven effective antiviral drug for the treatment of #SARSCoV2

Several compounds are suggested for Rx of #COVID19. Based on the available in vitro and clinical data, which one is your preferred Rx, if available? #MayoIDQ references follow...
1/
 #Chloroquine
Anti-malaria

Several potential mechanisms: change in cell membrane pH, impairs viral fusion, interferes with glycosylation of viral proteins

#chloroquine and #redemsivir are active against SARS-COV2 in experimental models

doi.org/10.1038/s41422…
2/
 #Hydroxychloroquine
- Analogue of chloroquine
- Anti inflammatory effect

Hydroxychloroquine was more potent than chloroquine against #SARS-CoV2 in vitro.

doi.org/10.1093/cid/ci…
3/
 #lopinavir-ritonavir
Protease inhibitor against HIV
Inhibits viral replication (in combo with ribavirin)

MIRACLE trial for #MERSCoV

Clinical data during the #SARS outbreak

thorax.bmj.com/content/59/3/2…
4/
 #Darunavir
Lack of evidence based on this report

jnj.com/lack-of-eviden…
5/
 #Remdesevir

A nucleotide-analog inhibitor of RNA-dependent RNA polymerases

Activity against many RNA viruses including #coronavirus in vitro and animal models (against #MERS Cov)

doi.org/10.1073/pnas.1…
6/
 #Remdesevir

A nucleotide-analog inhibitor of RNA-dependent RNA polymerases

Clinical: anecdotal only
Compassionate use - contact company
Enrol in clinical trials

nature.com/articles/s4146…
7/
 #Tocilizumab
Anti-human IL6 receptor monoclonal antibody

Inhibits signal transduction by binding to IL6 receptor to reduce severity of lung inflammation

21-patient clinical data from China showed promise in #COVID19

thepharmaletter.com/article/tizian…
8/
 #Sarilumab
IL6 inhibitor

Clinical trials are being planned for selected #SARSCoV infection

genengnews.com/news/regeneron…
/9
There is no proven effective therapy against #COVID19. We encourage participation in clinical trials.

Stay safe everyone! We will upload more data as they become available.

For now, please limit your exposure!
#socialdistancing #handwashing #flattenthecurve
10/
 #Ribavirin
Active against many RNA viruses

It was used in combination with lopinavir and ritonavir for Rx of #SARS

thorax.bmj.com/content/59/3/2…

However, in vitro data suggest that, by itself, it may not be active vs #SARSCOV2

nature.com/articles/s4142…
11/
 #Nitazoxanide

Antiparasitic with antiviral activity including #coronavirus

It vitro, it inhibited the 2019-nCoV at a low-micromolar concentration (EC50 = 2.12 μM; CC50 > 35.53 μM; SI > 16.76).

However, no in vivo or clinical data is available.

doi.org/10.1038/s41422…
11/
 Monoclonal antibody that neutralizes #SARSCOV2 has been reported as another experimental therapy

biorxiv.org/content/10.110…
12/
 Convalescent plasma has been proposed for prevention / treatment of #SARSCOV2.

This is an important effort that will need serological tests to identify individuals who have recovered with high antibody titers @ElliTheelPhD is leading our effort

jci.org/articles/view/…
13/
 #Faviripavir
Active vs. many RNA viruses: inhibition of viral RNA polymerase

China: 80 participants with #COVID19
- “Earlier viral clearance / recovery”

Pharmaceutical Technology › newsWeb resultsFavipiravir by Fujifilm may treat Covid-19, say Chinese officials.
14/
 #Hydroxychloroquine #azithromycin for #COVID19

The results is reported: viral load decline is better with combination Rx
See link below (photo)

mediterranee-infection.com/hydroxychloroq…
15/
 #Kaletra #LopinavirRitonavir
- RCT, open label, n=199
- No difference in mortality and outcomes when compared to standard of care in patients with severe #COVID19

nejm.org/doi/full/10.10…
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Related hashtags

#SARSCOV2 #COVID19 #MayoIDQ #chloroquine #redemsivir #Hydroxychloroquine #SARS #lopinavir #MERSCoV #Darunavir #Remdesevir #coronavirus #MERS #Tocilizumab #Sarilumab #SARSCoV #socialdistancing #handwashing #flattenthecurve #Ribavirin #Nitazoxanide #Faviripavir #azithromycin #Kaletra #LopinavirRitonavir

More from @MayoClinicINFD see all

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Mayo Clinic Infectious Diseases
@MayoClinicINFD
35M DM with severe influenza B
CXR (photo). WBC 30. N80%

Required mechanical ventilation. VV ECMO.
Rx: peramivir —> oseltamivir

D+1 Blood / sputum culture: MRSA
TEE (-). Rx: vancomycin.
#MayoIDQ MCQ next Image
35M MRSA pneumonia / bacteremia during severe influenza.

D+5: vanco —> linezolid
D+6: T40C. Sweating. Loose stools.
PE: BP 150/100. PR 120. Agitated. Confused. Shivering. No focal deficits.
Blood / sputum culture: negative
WBC 12. AST 32. Cre 1.5

What is most likely cause?
1/
 Case diagnosis:
Severe #Influenza B infection complicated by #MRSA pneumonia and bacteremia

#Linezolid associated #serotonin syndrome (interaction with fentanyl)

Let us discuss....
Read 14 tweets
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Mayo Clinic Infectious Diseases
@MayoClinicINFD
52M. HIV, Rx non compliant
Current VL / CD4 not known

CC: 2mo cough, progressive dyspnea
2 wks: chills, HA, night sweats

Exposures: parakeets / pigeons

Chest imaging (photo)
BAL: Galactomannan +
Serum CrAg 1:320

Comment on diagnostic and treatment approach? #MayoIDQ MCQ next Image
52M HIV not on Rx, CD4?, presents with likely disseminated cryptococcosis. BAL culture: Cryptococcus neoformans.
CT head no mass.

LP performed. Which of the following CSF findings confers higher mortality? #MayoIDQ
The HIV-infected patient (prior thread) with disseminated cryptococcosis and meningitis was started on induction Rx with AmBisome + 5FC.

HIV VL 120K. CD4 36. He tells you he will now be compliant to ART. No resistance mutations detected.

When do you start antiretroviral Rx?
Read 16 tweets

Related threads

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Julia Cheek
@JuliaTCheek
1/ UPDATE 🙌 My proudest day ever at @everly_well is today. We’re launching the first solution in the U.S. to get tested and diagnosed for #COVID-19 from your home on Monday, March 23. bit.ly/2J00Jhw
2/ Our at-home collection kit with telehealth diagnosis for #COVID-19 will be available to consumers and through a handful of partners starting Monday.
prn.to/2U3nvvn
3/ Our initial supply is 30,000 #coronavirus tests will increase the nationally tested numbers substantially. We will ramp to 250K tests weekly. That could double if the FDA allows sputum & saliva, which our labs have already started validating.
Read 7 tweets
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Maralyssa Bann, MD
@mbann_md
1/Week 2 of #COVID disaster response here in Seattle. King County has reported 420 cases and 37 deaths. We are seeing more volumes in our hospitals, though I think we it may be the tip of the iceberg and anticipate more to come.

A couple of additional lessons this week:
2/1. Your PPE supplies are directly related to the time it takes to rule out COVID19. @JohnLynchID has denoted this the “MAK unit” (named after the inimitable @molsenmoose) and it represents the time from initiation of PPE for a patient to negative test and de-escalation.
3/ It is CRUCIAL. A large amount of your patient volume initially will be rule-outs and being efficient here will save your resources.

Low "MAK" time allows you to have low threshold to test inpatient and keep your care moving forward.
Read 11 tweets
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QuillnInk1776 - 2020 landslide!
@QuillnInk1776
Do you believe in coincidences?

Event 201 Corona Virus pandemic simulation 10/18/19 was hosted by the Johns Hopkins Center for Health Security in partnership with the World Economic Forum and the Bill and Melinda Gates Foundation.

centerforhealthsecurity.org/event201/about

(cont...)
The Johns Hopkins Center for Health Security, The World Economic Forum, and the Bill and Melinda Gates Foundation developed the recommendations. Notable among the recommendations:

- develop vaccines
- do *NOT* stop travel including to other countries

centerforhealthsecurity.org/event201/recom…
Note the vast difference in mortality rate between the 2019-2020 flu and the COVID-19 virus. Statistics for COVID-19 may be impacted by unstable/incomplete test data. (Cont...)

cdc.gov/flu/about/burd…

cdc.gov/coronavirus/20…
Read 10 tweets
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Kate Starbird
@katestarbird
My colleagues & I have been studying/researching crisis informatics for over a decade, looking at how people converge online to make sense of crisis events. This field is informed by much older research in the sociology of disaster. Many of our lessons are relevant to #covid-19.
Crisis events, as they unfold, are often characterized by high uncertainty — about what is happening and what we should do about it, individually and collectively. In these cases, the “facts” of the situation are dynamic, and there are still unknowns.
This uncertainty feeds anxiety — about the personal and collective impacts of the event, as well about what actions we should take. What should we do? Where should we go? When should we evacuate, or in this case quarantine?
Read 13 tweets
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Ali
@aliostad
I gathered some alarming information on the rise of #COVID in Iran in this thread. I can see that it has been read by many hence increases my responsibility on what I share now.
As I stated before:

- I am not a trained reporter or journalist
- I am not based in Iran
- Not affiliated with any poilitical group, for or against the government
- Most of my information comes from the internet with occasional conversations with people in Iran
Today I shall try to gather information which I will share in the thread below.
Read 40 tweets
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UCCat20
@UCC_Official
UCC had opportunity to comment on the #Data.Protection & Privacy Bill. The enactment of this law is long overdue. A comprehensive law on the collection & processing personal information gives effect to the right to Privacy envisaged under Article 27(2) of the Constitution
UCC welcome the protections offered by the Bill in terms of export of data, breach notification requirements, data subjects access rights, automated decision making, compensation and the right to be forgotten and provision for financial and penal sanctions for breach of the law.
Distinction between Data collectors & data controllers.
The Bill should however clarify & distinguish Data Collectors, from Data Processors & Data Controllers. Clause 2 is inconsistent with international good practice which provides for two broad categories of Data Controllers
Read 17 tweets

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