Several people asked me to write something again this week, so I will update items not easily available in the lay press and expand upon this Motzei Shabbos May 9th, iy”H at 9:30 PM by Zoom Conference.
BH, cases at local hospitals continue to decline, with Nassau County still seeing a 14 day decline in total COVID admissions. Hatzalah is reporting a return to pre-COVID-19 call levels across the region, and we are preparing to care for non-COVID patients in all settings (in-patient, ambulatory practices, procedural areas, endoscopy units) although pure elective surgeries are still not being performed.
The OU and the Agudah are coming out with detailed guidelines for the gradual re-opening of shuls in the near future, date undetermined. If published before Shabbos, I will discuss key aspects of these proposals Motzei Shabbos.
While most people in our community have been taking social distancing extremely seriously, and are the major reason we are in the good position we are in today, I have been getting many emails and calls about a minority that have been disregarding these essential practices and have taken liberties, especially among those with recent illness who have recovered. No one within 14 days of illness onset should leave their house; they must stay in self-quarantine for at least that period of time. A physician should usually be consulted before ending such quarantine.
Finally, the Governor also outlined new safety precautions that each business must put in place upon re-opening to help lower the risk of spreading the virus.
Businesses will be required to:
Adjust workplace hours and shift design as necessary to reduce density in the workplace;
Enact social distancing protocols;
Restrict non-essential travel for employees;
Require all employees and customers to wear masks if in frequent contact with others;
Implement strict cleaning and sanitation standards;
Enact a continuous health screening process for individuals to enter the workplace;
Continue tracing, tracking and reporting of cases; and
Develop liability processes.
What is this new pediatric illness?
Unfortunately, hospitals worldwide have identified 100 cases of “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19,” with sixty-four suspected cases in children in New York State hospitals, including New York City. Fortunately, the number of children affected is tiny (relatively speaking), and most have responded well to treatment and have been discharged.
This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Fever, rash and abdominal symptoms may be prominent; cardiovascular problems may be seen; and a very few have developed shock and required ICU care. This inflammatory syndrome occur days to weeks after acute COVID-19 illness. Only one death worldwide was reported, and physicians have emphasized parents should not panic. However, this is a stark reminder we still have a lot to learn about COVID-19 and new findings are being discovered daily.
Anything new regarding antibodies?
Actually, lots of new information here. Highly specific antibody testing is now easily available through both LabCorp and Quest, and can be obtained at most physician offices. While it still remains unknown whether these antibodies actually neutralize the virus (i.e. if their presence protects from reinfection), a new paper suggests that not only are COVID-19 specific antibodies detected in almost all convalescing patients, but in most, these antibodies are neutralizing – meaning they should be protective! Unfortunately, it is still unknown how long this protection lasts or if mutations in the virus will make reinfection possible.
We now also know that IgG antibodies occur in 50% of patients by day 7, and 100% by day 14. More importantly, a new paper demonstrated that live virus was not detected after day 7 of symptoms. Of note, virus was detected a few days before symptoms began, and declined over the next 10 days or so.
These studies suggest that people do develop protective immunity after COVID-19. However, this was only shown for a very small number of patients; larger studies are needed. While more work is needed, these results continue to provide assurance that natural infection will confer protective immunity, and that future vaccination may be effective.
Any new tests?
We are seeing breakthroughs in point-of-care and at-home tests for diagnosing acutely if someone has COVID-19. Using CRISPR technology (usually used for editing DNA), scientists at MIT designed a rapid test that detects COVID-19 RNA. “The STOPCovid Test” takes less than an hour to perform – and can be done at the “point of care” (in a doctor’s office) or even at home! It works like a pregnancy test, and does not require any complex instrumentation. The STOPCovid kit has been validated on patient samples but is not yet FDA authorized or available in stores.
This isn’t the only CRISPR-based COVID-19 test kit being studied. The University of California San Francisco and Mammoth Biosciences also developed a kit. In a just released paper in the journal Nature Biotechnology, results were obtained in 30-45 minutes with their self-contained kit that also doesn’t require sophisticated, expensive equipment needed in currently approved COVID-19 tests.
If these are accurate, and inexpensive (some suggest price will be only $6.00), this breakthrough technology will be another simple, inexpensive, great way to detect disease early on.
Anything new about treatment?
Remdesivir is being received TODAY at hospitals with high levels of COVID-19 patients, and protocols for its use are in place at our hospital as well as other centers. Plasma therapy continues to be available because of the many people who have donated – thank you! Please continue to do so even if it does take time to get called to donate.
Finally, and maybe most interesting, synthetic antibody that could block a key COVID-19 protein from interacting with our bodies and thus prevent illness is being developed at Mount Sinai and other institutions across the world, including Israel. As convalescent plasma therapy has shown promise in treating COVID-19, the goal is to develop a similar, but targeted, artificial antibody, which will have the ability to disengage and block COVID-19 from entering cells. The goal: have a targeted antibody for the first human trials within the next 12 months, or sooner, if everything goes as planned.
Rabbi Aaron E. Glatt, MD
