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8 Oct, 4 tweets, 1 min read
Often asked for my opinion of the latest #COVD19 therapeutic. Yesterday it was the antibody cocktail. Here's how I think about this stuff:
For any new treatment, I want to know if it's 1) safe and 2) effective. I also look at distribution mechanisms. Do we have a way to get this thing to the people who need it? In many cases, the answer is no.
I'm not bullish on antibody cocktails because there's a mismatch between supply & demand. Urgent care clinics don't want to administer cocktails because the infusion is time-consuming and reimbursements are low. Primary care clinics will feel a similar crunch. So what happens?
Perhaps there's a small group of high-risk patients who will receive it in the hospital. Does anyone who treats patients think otherwise?

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More from @DrMattMcCarthy

Matt McCarthy Profile picture
22 May
NEW: The long-awaited remdesivir data has arrived: nejm.org/doi/full/10.10…
"These preliminary findings support the use of remdesivir for patients who are hospitalized with Covid-19 and require supplemental oxygen therapy. However, given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not..."
"...likely to be sufficient. Future strategies should evaluate antiviral agents in combination with other therapeutic approaches or combinations of antiviral agents to continue to improve patient outcomes in Covid-19."
Read 4 tweets
Matt McCarthy Profile picture
14 May
NEW: Case definition for Kawasaki-like syndrome created based on 102 children in New York. First standardized criteria for a condition that is being called pediatric multi-system inflammatory syndrome:
Clinical definition: 1) Fever, 2) Hospitalization, and 3) One or more of: Shock/Cardiac illness/Severe organ damage (excluding lung disease) OR 4) Two more more: rash, conjunctivitis, GI symptoms, mucocutaneous inflammation.
Lab criteria: 2 or more: Neutrophilia, lymphopenia, thrombocytopenia, hypoalbuminemia,☝️CRP/ESR, fibrinogen, D-Dimer, ferritin, lactic acid, LDH, IL-6, OR elevated procalcitonin. And: Detection of: 1) #Coronavirus RNA at hospitalization (or within prior 4 weeks) or 2) antibody.
Read 4 tweets
Matt McCarthy Profile picture
13 May
NEW: Kawasaki-like syndrome now reported in 15 states. Based on publicly-available data, the United States case count is at least 164, including: New York (102), New Jersey (18), Massachusetts (8), Connecticut (6), Illinois (6), California (4), Delaware (3), Georgia (3)...
Louisiana (3), Washington D.C. (3), Kentucky (2), Ohio (2), Pennsylvania (1), Utah (1) Washington state (1), and Mississippi (1).
CDC is preparing to release an alert warning doctors to look for a potentially-lethal inflammatory syndrome in children that could be linked to coronavirus. CDC will also release a working case definition, which does not yet exist: 
cnn.com/2020/05/13/hea…
Read 4 tweets
Matt McCarthy Profile picture
11 May
I began studying pandemics in 2003, when I joined Peter Daszak’s research team👇. I traveled to Africa to help answer the question: Where does Ebola go between outbreaks? The virus would destroy a village, killing hundreds, then it would disappear for decades. Where did it go?
Daszak had a hunch; our group went to Cameroon to find Ebola. We traveled into the bush, tracking the flight pattern of bats. My job was to scurry up a hill or climb a tree to place a net in their flightpath. We caught hundreds🦇& sent their blood to the U.S. for analysis.
Our group & others discovered that bats were harboring deadly viruses, including Ebola. From our work, we knew that the next pandemic would likely emerge from a bat. I interviewed Daszak five years ago & he mentioned the dangers of Chinese meat markets: slate.com/technology/201…
Read 4 tweets
Matt McCarthy Profile picture
9 May
ANALYSIS: There are now ~100 children in the United States with an inflammatory syndrome that overlaps with Kawasaki & may be linked to #coronavirus. We know very little about these patients. When I think about a potential link between the virus & a syndrome, I ask 4 questions:
1. Is this link biologically plausible? Take a step back. Does it make sense that a respiratory virus could cause an inflammatory vasculitis? Yes. Coronavirus induces an aggressive immune response in a subset of adults (cytokine storm); this *could* be a pediatric variant.
2. Is there an alternative explanation for the phenomenon? Perhaps. There's a seasonality to Kawasaki Disease; it peaks January-March in some parts of Northern Hemisphere. Children's Hospital LA reported an uptick in Kawasaki over the past 2 years. What about the past 10 years?
Read 5 tweets
Matt McCarthy Profile picture
8 May
Testing Update: There are now more commercially available antibody tests for SARS-CoV-2 than any other infectious disease. Many of the 200 new tests on the market (or in development) are worthless. Here's what happened:
In the race to create more testing options, the FDA made an important decision: It allowed internal validation of new antibody diagnostics. Translation: FDA didn't review performance metrics; it simply relied on companies to say their new antibody test works. That's a problem:
SARS-CoV-2 is not the only coronavirus; there are several others circulating around the world. Most adults have antibodies to one of them. We don't yet know if new tests for SARS-CoV-2 antibodies will cross-react (interfere) with antibodies from other coronavirus infections.
Read 6 tweets

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