Covid-19 Update
I original wrote about the corona virus in late-January, and have left the post up even though in retrospect, the conclusion was that it probably was not going to be a big deal. Wow, was I ever wrong. Based on the information available at the time, my interpretation was supportable. The goal should not be image control. Admit your mistakes, I do. Learn from it and move on. Experts in infectious disease (which I am not) had much greater fears about a pandemic, which appear to be all too real.
The are a couple topics which have cropped up worthy of comment. Why the change in recommendations about facial coverings. Initially the focus involved “keeping myself” safe. The only masks available to keep the virus out (M95) are still in short supply, therefore not recommended to general public to keep them safe. The situation has now changed, now about “keeping others” safe. If we start to assume that many if not most people have the virus even if asymptomatic. Facial coverings are now viewed as a method to reduce your spreading of virus particles. So the understanding is that wearing a bandana will not keep you from catching it, but may prevent you from spreading it, is not so much a reversal of recommendation as an evolution due to the staggering progress of the disease. Our estimates of how deadly the virus is has not changed as much as has our understanding of the transmission patterns.
Second topic: hydroxychloroquine also known by the trade name Plaquenil. I have never treated a malaria patient. I have some familiarity with this drug as used by patients with autoimmune disorders like lupus. Again my background is cardiology and the two cardiac concerns which can develop with hydroxychloroquine use are cardiomyopathy (heart muscle toxicity more an issue which chronic use and not with 5 day course) and arrhythmias (abnormal electrical heart rhythms). The major concern is that both the hydroxychloroquine and the antibiotic azithromycin (Z-pac), can affect the electrical properties of the heart and cause, QT prolongation. The first step of QT prolongation is only detected on electrical testing like a 12-lead EKG. By changing the electrical heart properties the time from activation (Q) to reseting/repolarization (T) prolongs. This change then puts the patient at risk for an unstable heart rhythm called torsades (Torsades de pointes). If not treated immediately can lead to sudden cardiac death. Unfortunately some individuals (like the President) are promoting the drug;s use in the COVID-19 pandemic before the science is complete. When the President stated on TV, “what have yo got to lose”, in response to Americans taking hydroxychloroquine, my answer is “your life”.
