And now for something completely different on my plengegen.com blog. This blog was written in partnership with a number of scientists and clinicians in my local community and serves as rationale for comprehensive viral testing program in K-12 schools. The document (pdf link here) was circulated to members of our community and discussed as part of a town webinar last week (link here).
Executive summary:
There is much debate about the value of viral testing program for K-12 schools. As described here, we support a comprehensive viral testing plan that returns results in less than 24 hours as part of an overall risk reduction strategy. Testing should be prioritized as follows: (1) baseline “time zero” at the start of school of all students, teachers and staff; (2) symptomatic testing of all students, teachers and staff; (3) at least weekly surveillance testing of all teachers and staff; (4) at least weekly surveillance testing of older students; and (5) at least weekly surveillance testing of younger students. While symptomatic testing is available through local hospitals, clinics and testing centers, baseline time zero testing and surveillance testing of asymptomatic individuals is not. Thus, additional investment is required to support a comprehensive viral testing program in K-12 schools.…
[I am an employee of BMS. The views expressed here are my own.]
The blog is long, so I will start with an executive summary. (You can download a pdf copy of the blog here.) Pharmacologic intervention has the opportunity to impact disease progression in the SARS-CoV-2 / COVID-19 crisis. Repurposing of approved therapies is the fastest way to impact patients today, as these medicines have regulatory approval to enable investigator-initiated trials and have a manufacturing process to ensure drug supply. Here, I focus on a specific clinical inflection point in COVID-19 disease progression – hospitalized patients early in their disease course and with signs of a maladaptive immune response, with the intervention intended to prevent disease progression and admission to the ICU. Based on an understanding of disease biology today – which is still quite limited – this clinical inflection point is due to a “maladaptive immune response” seen early in the disease course in patients who later progress to critical illness. Rigorous clinical trials are required to test therapeutic hypotheses related to repurposed therapies, which need to be done in a clinical setting caring for extremely sick patients. Finally, I describe additional research that is required to understand the biology of SARS-CoV-2 / COVID-19, and how such research (e.g.,…
