With input from Dr Monica Vasudev

1116: Minutes of Virtual Meeting of CMAAO NMAs on “Drug & Vaccine failures in COVID-19”

17^th October, 2020, Saturday, 9.30am-10.30am

Participants, Member NMAs: Dr KK Aggarwal, President CMAAO; Dr Marthanda Pillai, Member World Medical Council; Dr Alvin Yee-Shing Chan, Hong Kong Treasurer, CMAAO; Dr SM Qaisar Sajjad, Secretary General, Pakistan Medical Association; Dr JA Jayalal, President-elect, Indian Medical Association

Invitees: Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia and Dr S Sharma, Editor IJCP Group

Key points from the discussion

• Three drug trials have been halted in the last one week due to unexplained effects.

o  Johnson & Johnson has paused phase III trial of its single dose vaccine JNJ-78436735 (human adenovirus Ad26 combined with spike protein).

o  Astra Zeneca and Oxford have resumed trials of their ChAdOx 1 vaccine in the UK, India, South Africa, Brazil; however, the US FDA has not given the go-ahead for the trial to restart in the US.

o  Eli Lilly has halted the trial of its coronavirus antibody drug LY-CoV555 (ACTIV-3). The comparison drug is remdesivir.

• The WHO Solidarity trial has found that remdesivir, hydroxychloroquine, interferon and ritonavir + lopinavir had little or no effect on mortality in hospitalized patients with COVID-19.
• Three out of the five approved vaccines are killed vaccines. India is working on a killed vaccine.
• Two of vector vaccine trials (J&J, Oxford) have been halted.
• About 30% of vaccines do not produce antibodies; hence, will a single dose (J&J vaccine) be effective? We do not know.
• This is an inflammatory virus and it is inflammation which kills. Early detection of inflammation/hypoxia can reduce mortality.
• The inflammatory process is not dependent on the virus; once started, it will continue.
• Antiviral drugs will only reduce communication of the virus to others and will not reduce inflammation. The viral load only indicates infectiousness and not severity of the infection.
• In the current scenario, any three unusual symptoms such as headache, low grade fever, skin rash, sore throat, dry cough, muscle pain, calf pain without loss of smell and taste is COVID, unless proved otherwise.
• New loss of smell and taste should be presumed to be COVID, unless proved otherwise.
• One must have a high index of suspicion for atypical symptoms.
• In flu, fever is higher than 100.4 and nasal symptoms are predominant. In COVID, fever is less than 100.4 and throat symptoms are predominant. If fever is higher than 100.4 in COVID, this is suggestive of pneumonia.
• CRP is the test for resource-limited countries. Doubling of CRP within 24 hours is indicative of cytokine release. Get CRP done on Day 3 and Day 5. If rapid doubling of CRP can be detected within this time, and appropriate anti-inflammatory (steroids) and oral anticoagulants are started, then mortality can be reduced.
• Masking (consistent and correct use of proper mask) is important.
• The outer layer of the mask should be water resistant and have a splash resistance of more than 120mmHg. The breathability should be less than 49 Pascals/sq cm. If splash resistance is high, breathability will reduce.
• The middle layer is important. It should be made of melt blown propylene (not spun) and should have filtration efficiency of 80%. There should be no visible holes in this layer.
• The inner layer should be water absorbent (should not have splash resistance).
• The mask has to fit closely to the face; there should be no gap. Face shield is not a replacement for mask.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA