Minnesota doctors and researchers are on the cutting edge leading the fight in the war against COVID-19. Doctors and researchers at the University of Minnesota and Mayo Clinic are searching for medications that help ease the effects of the virus, including a process of plasma transfer, while also working to develop a vaccine.
No ‘new normal’ until August
The MSR interviewed Dr. David Hamlar (DH), assistant professor of the Department of Otolaryngology at the University of Minnesota
MSR: Incredibly, despite the number of cases and deaths, there are some in our community calling the coronavirus a conspiracy or hoax. What do you say to them?
DH: This is no hoax!
MSR: Why has the CDC and others recommended people stay six feet apart?
DH: People who are within six feet of one another may spread the virus through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of those who are nearby or potentially be inhaled into the lungs. The droplets are airborne through aerosolization [producing a fine mist of minute particles].
MSR: How does one actually contract the virus?
DH: The COVID-19 virus can live in any living cell. It is transmitted primarily via the aero-digestive system, meaning airways and oral mucosa.
MSR: Has anything been found to be effective in fighting off the effects of the virus?
DH: Peridex or chlorhexidine has been found to decrease the viral load but not eliminate the virus itself.
MSR: There has been talk about anti-virals being effective in helping those who have contracted the virus to fight it off. Tell us more about that.
DH: Antivirals are the same medications initially utilized in HIV-positive patients who contracted AIDS. These seemed to lessen the symptoms if not reduce the viral load and increase the CD4-T cell count.
MSR: What makes the virus fatal?
DH: COVID-19 deaths are attributed to pulmonary or lung disease progression such as pneumonia. Cardiac events such as heart attacks have not been found to be part of the disease progression and death.
MSR: Why are pre-existing diseases a serious problem for people if they contract the virus?
DH: Pre-existing conditions such as asthma, chronic obstructive pulmonary disease, COPD, diabetes, congestive heart failure, CHF, and autoimmune diseases limit the body’s ability to fight diseases.
MSR: There has been a lot of discussion in the medical community about a vaccine. How soon do you anticipate one being ready for use?
DH: With controlled protocol-based studies, the estimate for a safe vaccine is 9-12 months away.
MSR: There have been problems in the U.S. getting people tested for COVID-19, some reporting long waits for test results. It has been reported that Abbott Labs has come up with a test that can provide results in a matter of minutes. How are they able to do this?
DH: Abbott Labs can detect the COVID-19 virus through a technique called molecular point-of-care testing for COVID-19, which offers healthcare workers rapid results in more settings where people show up for care.
Molecular testing technologies help detect the presence of a virus by identifying a small section of the virus’ genome, then amplifying that portion until there’s enough for detection. This process can cut testing wait time from hours, if not days, to as little as five minutes for positive results and 13 minutes for negative results. They have been using this technique for influenza detection since 2014.
MSR: There has been some discussion around Vitamin C that it can help stave off the disease. What is your professional opinion about its effectiveness?
DH: Vitamin C is a potent antioxidant, helping to reduce the damage caused by free radicals and thereby helping prevent the development of conditions like heart disease and cancer. Severe vitamin C deficiency is a serious condition, known for centuries as the sometimes-fatal disease scurvy. It helps in wound healing. It is a part of a healthy diet. It is not a specific inhibitor of contracting COVID-19.
MSR: When do you expect the virus to peak? When do you think the country can get back to normal?
DH: I personally feel that this is a virus that will be with us for prolonged periods until a vaccine is found. If the virus mutates or recurs in different forms, then even vaccines will be limiting disease agents like with influenza.
Once we get control or flatten the curve, we can start to realize a “new normal.” I predict August.
MSR: Any advice to our readers on how to stay safe during this pandemic?
DH: Stay healthy. Eat right, get rest, don’t smoke, limit alcohol use, and do all of the things your mother told you to do but you neglected!
Push for plasma treatment underway
At Mayo Clinic in Rochester, Dr. Michael Joyner (MJ) is part of a group of experts who are pursuing a unique but time-tested treatment to help patients with COVID-19 fight off the virus. Convalescent plasma treatment has been used historically to treat infectious diseases before the discovery of vaccines.
MSR: What is involved in convalescent plasma treatment?
MJ: It involves taking antibody-rich plasma from the blood of patients who have survived COVID-19, then infusing it into those who are ill to help their bodies fight off the disease. The approach is known as “convalescent plasma treatment.”
MSR: Why is it called convalescent plasma treatment?
MJ: It’s called convalescent because the word refers to when people are getting better.
MSR: You spent most of your career as a physiologist. How did you get involved in this?
MJ: That’s true, and I am also an anesthesiologist. What happened is my friend Dr. Arturo Casadevalle at John Hopkins wrote an editorial in the Wall Street Journal discussing the historical use of convalescent plasma.
I reached out to Arturo, and since we have a large network of collaborators, we reached out to them. This was me repurposing my career for a few months in my lab to help attack this problem, to see if we could find some way to push back.
I have thrown in with Arturo and want to help him move this forward. He is our visionary and spiritual leader.
MSR: Tell us who else is involved in this project.
MJ: We have people from about 40 universities and medical centers all over the country from about 20 states working on this, and we are getting cooperation from the Food and Drug Administration. We are trying to get this online right away. It’s already started in New York and Houston, and we hope the pace is going to pick up throughout April.
MSR: The FDA has approved the process but with limitations. Can you explain the limits?
DJ: You have to get special permission. It’s one off at a time. We are currently working to get an expanded access protocol going so we can begin to collect more [plasma] all over the country and treat more people.
It’s going to be a while until the supply is high. Infrastructure is being put in place to collect it at scale, distribute it, and get it to the people who can benefit from it. And then keep detailed records and make sure we do all the compliance and reporting, get people’s permission, and study it while we are actually using it. We want to do it in a rigorous and ethical way.
MSR: When does this treatment date back from?
MJ: Before 1900 it was tried.
MSR: It appears some people have died from heart failure as a result of contracting the virus. How do you explain this?
MJ: One of things that can happen when you have an overwhelming infection is you have a condition called myocarditis, meaning the heart becomes inflamed and the efficiency of the pumping action becomes worse. It’s unclear if COVID-19 does anything unusual.
It appears that when you are septic and when you have critical illness, when you have multi-organ failure, typically your heart function goes down as well. It’s unclear if there is any kind of nasty stuff being excreted by this virus.
It’s possible it targets the heart, but we don’t know that yet. My guess is it is more of the general phenomena. Time will tell. We have to do the research.
MSR: How does COVID-19 attack the body?
MJ: It’s not clear exactly how COVID attacks the body. I think we are 80 percent there. We have the general game plan, but the details are still being worked out.
MSR: How are you going to get started in Minnesota?
MJ: There are plans to collect it [plasma] and distribute it nationally. Most of the people we will begin to collect [plasma] from will be in the Rochester and southeastern Minnesota region.
MSR: What is plasma?
MJ: When you look at your blood it is red, but red cells are about 40 percent. The rest is protein-containing fluid that, if you separate it, put it in a centrifuge and spin it around, you will get this kind of yellowish material. That’s plasma. It is the part of the blood that is not the red and white cells, the non-cellular part of the blood.
MSR: What are this treatment’s chances of success?
MJ: It’s too soon to tell. It depends on how sick the patient is. Our best shot is people who are sick but not terribly sick or in the ICU yet. And it may help people in the ICU.
What we are trying to do is bend some curves. We want to stop people deteriorating as they go from sick to the ICU, and as they get in the ICU and do worse, we want them to stabilize and get better.