Starting now! .@accpchest webinar on Patient Management with Drs Bin Cao and Qingyuan Zhan. I’ll be leading the Q&A so please follow along and ask questions via the webinar or on @Twitter! Register here for a link chestnet.org/Guidelines-and… 
First, Dr. Bin Cao will speak on "Looking for the Cure" to #COVID19
Dr. Cao: There are several potential targets for potential therapies.
Dr. Cao: There are two potential mechanisms that they are focusing on (1) Inhibition of SARS-CoV-2 fusison/entry and (2) Disruption of SARS-CoV-2 replication.
Dr. Cao: Will now discuss specific therapies. First, Lopinavir, a drug used for HIV. Lopinavir showed promise in the SARS outbreak of 2003-2004.
Dr. Coa: Because of this promise, trialled Lopinavir for #COVID19 SARS-CoV-2.
Dr. Cao: Although no benefit was observed with lopinavir–ritonavir treatment beyond standard care, encourages readers to look at whole paper, not just abstract nejm.org/doi/full/10.10…
Dr. Cao: Next will discuss Remdesivir, and antiviral with superior antiviral activity to lopinavir/ritonavir in vitro with MERS.
Dr. Cao: Remdesivir also may better improve acute lung injury
Dr. Cao: Ongoing placebo-controlled trial of Remdesivir trial in China #COVID19 SARS-CoV-2.
Dr. Cao: NIH and WHO also conducting Remdesivir trials, although treatment window longer
Dr. Cao: Chloroquine & Hydroxychloroquine have also gained interest, although scientists have no idea why these might be effective
Dr. Cao: Some of the studies so far that have gotten a lot of attention have been very poorly done and deeply flawed in study design and conduction.
Dr. Cao: CD147 might be a novel target. Monoclonal antibody to CD147 (Meplazumab) might be effective, although studies very small
Dr. Cao: Convalescent plasma has also gained attention. They have treated several patients with ARDS with convalescent plasma, although data should be interpretted with caution due to small numbers jamanetwork.com/journals/jama/…
Dr. Cao: Several issues with the use of convalescent plasma however.
Dr. Cao: Patients with high IL-6 seem to due worse and several trials of anti-IL-6 planned
Dr. Cao: In summary, several antivirals and other candidate drugs, but trials ongoing and limited data available
Next up, Dr. Quingyuan Zhan speaking on Prediction and Management of Critical #COVID19 patients
Dr. Zhan: #COVID19 patients exhibit different clinical phenotypes. How can we recognize impending worsening?
Dr. Zhan: Conducted observational study of risk factors
Dr. Zhan: High frequency of need for respiratory support for #COVID19
Dr. Zhan: But these therapies carry risk of dispersion and HCW infections.
Dr. Zhan: They recommend several measures to reduce air dispersion of #COVID19 virus
Dr. Zhan: HFNC may be effective treatment for mild-moderate respiratory failure in #COVID19, but failure associated with poor prognosis
Dr. Zhan: Recommend short trial of non-invasive ventilation and HFNC. If fails, move quickly to intubation
Dr. Zhan: Compared to H1N1 to COVID19 patients in #journalCHEST
Dr. Zhan: General recommendations for #COVID19 respiratory therapies
Dr. Zhan: Glucocorticoid therapy for #COVID19 controversial. In their hospital, the indications they use is below
Dr. Zhan: In Summary, a team approach is essential in the management of critical #COVID19 patients. And appropriate use of respiratory support can save lives
And couldn't live-tweet the Q&A but my summary and Dr. Cao's very blunt and passionate responses ?
Empiric treatment for DIC? No.
Vitamin C? No.
Any therapy that doesn't have evidence: No.
Thank you @accpchest team for hosting an extremely well-done and informative webinar!
Empiric treatment for DIC? No.
Vitamin C? No.
Any therapy that doesn't have evidence: No.
Thank you @accpchest team for hosting an extremely well-done and informative webinar!
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