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10 Mar, 4 tweets, 2 min read
UPDATE: The NIH-sponsored #COVID19 study, ACTIV-1, has now enrolled 470 patients at 31 medical centers in the United States. A data safety monitoring board will soon meet to evaluate preliminary results. This meeting could alter the way doctors treat #coronavirus. 1/
Hospitalized COVID patients who need oxygen are treated with two drugs: remdesivir (an antiviral) & dexamethasone (an anti-inflammatory). Patients in ACTIV-1 receive these drugs AND are randomized to one of 3 immunomodulators: abatacept, infliximab, or cenicriviroc (or placebo).
I lead this study at my hospital (we've enrolled 33). Clinicians occasionally stop me in the hall and ask if any one of the drugs seems to be working. The truth: I don't know. It's a double-blind study, so patients and doctors don't know if they're actually getting the real drug.
But the monitoring board does know. Soon, they'll make an assessment. If there's no clear winner, we'll continue enrolling in the U.S. & around the world until there are more than 2000 volunteers.
Cases are dropping, but there are still far too many hospitalized with #COVID19.

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More from @DrMattMcCarthy

Matt McCarthy Profile picture
1 Mar
New York confirmed its first case of coronavirus one year ago today. I went on @CNBC the next day to discuss what was coming: "Widespread disruption to daily life." 1/
I treated my first confirmed case on March 9, 2020. I prescribed hydroxychloroquine and azithromycin and did not use steroids. These decisions would later prove to be wrong.
I've spent most of the past year treating and studying #COVID. Surprises:
1) Patients may have oxygen levels that appear incompatible with life yet feel fine (silent hypoxia).
2) Some seem to have blood clots we can't find.
3) Others develop severe inflammation of blood vessels.
Read 6 tweets
Matt McCarthy Profile picture
10 Feb
NEW from CDC: "Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID-19." Here's what it means to "meet criteria": 1/
cdc.gov/vaccines/covid…
1. Fully vaccinated (≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine).
2. Are within 3 months following receipt of the last dose in the series.
3. Have remained asymptomatic since the exposure.
Guidance does not appear to be based on new experimental data: "...individual and societal benefits of avoiding unnecessary quarantine may outweigh the potential but unknown risk of transmission."
Read 4 tweets
Matt McCarthy Profile picture
8 Feb
COVID Mystery: Why are some patients asymptomatic while others need to be hospitalized? We've known for a year that #COVID19 patients who have trouble breathing often have too much inflammation in the lungs (alveolitis). Now we know what's happening on a microscopic level: 1/
Within the lungs, an inflammatory cell called a macrophage becomes infected with #coronavirus, prompting the cell to release signals that attract T cells. These activated T cells then stimulate macrophages, forming a feedback loop that drives inflammation. nature.com/articles/s4158…
This is a crucial insight with important implications for treatment. It suggests we might help the sickest #COVID patients by disrupting the inflammatory feedback loop with drugs that inhibit macrophages or activated T cells. There's an NIH-sponsored study trying to do just that.
Read 4 tweets
Matt McCarthy Profile picture
8 Feb
The FDA has updated its emergency authorization for convalescent plasma, narrowing its use to a smaller subset of #COVID patients. It was a necessary move, but I'm concerned the revision doesn't do enough to curb the emergence of viral variants. Here’s the problem: 1/
Plasma is still authorized for hospitalized #COVID19 patients who have impaired humoral immunity. These patients have trouble making antibodies and other proteins. At first glance, this makes sense: People who can’t make antibodies should be given some. But it’s not that simple.
Patients with immune impairment can serve as incubators that accelerate viral evolution, especially when they’re given plasma. Some won't clear the virus, allowing it to fester and mutate. If given at the wrong time, plasma could make things worse.
nature.com/articles/s4158…
Read 6 tweets
Matt McCarthy Profile picture
5 Feb
Speaking to students at @wakeforestmed today about the best ways to communicate the avalanche of new #COVID19 information to patients. The challenge: Enthusiasm for a new drug may be inversely related to the quality of data supporting its use. 1/
The two most controversial drugs at the moment are ivermectin and tocilizumab. Over the past few months, some doctors have been prescribing ivermectin (an anti-parasitic) to newly-diagnosed #COVID19 patients. The change in practice may be due to two things:
1) There aren’t many treatment options for non-hospitalized #COVID19 patients and 2) Ivermectin has been shown to inhibit the replication of #coronavirus in a lab. It may also work as an anti-inflammatory.
Read 7 tweets
Matt McCarthy Profile picture
4 Feb
NEW: Variants pose a threat because they may weaken vaccines. COVID patients with impaired immune systems can have trouble clearing the virus, inadvertently serving as incubators for new variants. Insights from individual patients reveal why these cases deserve more attention. 1/
A cancer patient known as “Pittsburgh long-term infection 1" was unable to clear #coronavirus and died 74 days after diagnosis. Viral replication lasted more than 2 months, giving the virus ample opportunity to mutate.
Three key points from the case:
academic.oup.com/cid/advance-ar…
1. Variants are largely characterized by viral substitutions (one amino acid for another) but deletions are also important. Coronavirus has a lower substitution rate than other RNA viruses due to a proofreading mechanism but this cannot correct deletions. 
science.sciencemag.org/content/early/…
Read 6 tweets

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