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Overview
According to the World Health Organization, as of Tuesday, April 28, 2020, the Coronavirus SARScoV-2, has infected more than three million people worldwide (one million in the United States) and killed more than 200,000 (56,000 in the United States).
Symptoms of COVID-19 Update
People with COVID-19 can have a wide range of symptoms ranging from almost no symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Early recognition of
symptoms can help reduce the spread of the disease. The full list of symptoms recognized by the CDC now includes:
- Fever
- Cough
- Shortness of breath or difficulty breathing
- Chills
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- Loss of taste or smell
Viral Testing update
Testing is a key part of the strategy to prevent the spread of the disease and reopen the country. Widespread testing would allow states to better track infections and safely isolate individuals who are sick, shifting from broad restrictions to more precise solutions. Danielle Allen, lead author of “Roadmap to Pandemic Resilience”, and a professor at Harvard University’s Edmond J. Safra Center on Ethics, stated “Test producers will need to deliver five million tests per day by early June to safely open parts of the economy by late July. To “fully re-mobilize the economy,” the country will need to see testing grow to 20 million a day, the report suggests. According to the CDC, the United States is currently testing about 100,000 people per day. Despite the increase in availability of testing in the last month, there is obviously quite a chasm between these numbers. “What people need to recognize is that a massively scaled-up testing, tracing and supported isolation system is the alternative to national quarantine,” Allen said.
There has been a flurry of activity and conflicting information this week about testing. Questions include which test(s) to use, the availability of test kits and reagents (the chemicals used to run the tests), where to have the tests administered, and how long it takes for test results to be returned. The answers have not been easy to obtain.
FDA approvals have been granted for viral self-testing and home testing kits, as well as rapid response tests and saliva versus nasal swab tests. Many of the companies offering these tests, like Quest Diagnostics and LabCorp, the two largest commercial laboratories in the United States, claim that the bottleneck lies in the inability to secure supplies and test kits.
Several retail pharmacies (i.e., RiteAid, CVS, Walgreens, and Walmart) have made promises of opening drive-through and parking lot testing. Specific information on where and when these tests will be available is still being developed. We suggest visiting the pharmacy websites for details in specific regions.
Adding to the volume of testing needed, the CDC is also expected to release new guidelines expanding criteria to people who may not have symptoms, but who work in high-risk settings. Research shows that people without symptoms or who have yet to develop them may still be able to spread the disease. More information to follow in next weeks’ brief.
Medication and Antibody Update
Medication
Status
Specific Information
Kevzara
In human trials.
Kevzara, an arthritis drug sold by Sanofi and Regeneron was being tested in hospitalized patients with severe COVID-19. The thinking was that the drug might be able to tamp down inflammation in the lungs that occurs in serious COVID-19 cases. On April 27, 2020, Regeneron and Sanofi said the trial would continue only for the sickest patients.
Actemra
In human trials.
Actemra is a Roche arthritis drug that, like Kevzara, is being studied for its potential to manage COVID-19 side effects in patients who develop pneumonia. Chinese health officials recommend its use in some COVID-19 patients.
Kaletra
In human trials.
Kaletra, an HIV drug sold by AbbVie, returned disappointing results in a COVID-19 trial in midMarch, but more trials are being conducted. The drug is a combination of two antivirals, called lopinavir and ritonavir, and first received FDA approval as an HIV treatment in 2000.
Baricitinib
Human trials set to start at the end of April.
Eli Lilly planned to test its arthritis drug Baricitinib in a National Institute of Allergy and Infectious Disease trial of seriously ill COVID-19 patients. The hypothesis that it could reduce inflammation in the lungs. The company also says there is a secondary hypothesis that the drug could have an antiviral effect. The company expects the trial to begin at the end of April in hundreds of patients, with data expected two months later.
Hydroxychloroquine and Chloroquine
In human trials.
On Friday, April 24, 2020, the FDA issued a safety announcement regarding the use of Hydroxychloroquine or Chloroquine, saying “the use of drugs should be limited to clinical trial settings or for treating certain hospitalized patients.” The move came in response to a growing number of “adverse incident” reports from hospitals and outpatient treatment, focused on a known side effect of Chloroquine and its known derivatives: changes in heart rhythm that can be (and apparently have been) fatal.
Source: https://www.barrons.com/articles/9-experimental-coronavirus-treatments-human-trialstherapeutics-vaccine-COVID-19-51585678737 and
https://COVID19treatmentguidelines.nih.gov/therapeutic-options-under-investigation/
Vaccine Update
Currently, there are at least 47 vaccine programs under way, according to the Milken Institute, which is tracking the development of treatments and vaccines for COVID-19. Many of these vaccines are already involved in human trials or have plans to do so very soon. There is hope that a safe and effective vaccine could be realized by this coming winter. If that occurs, the next hurdle will
be to mass produce and administer the vaccine to those who are candidates to receive it.
Source: https://www.barrons.com/articles/coronavirus-vaccine-update-when-will-a-COVID-19-vaccine-be-ready-51585587652 and https://milkeninstitute.org/COVID-19-tracker
Return to Work Policies
Creating a Return-To-Work policy will be highly individualized by employer. The Buck team is here to help create and review these policies to conform with the best practice guidelines. Some of the questions that employers may first want to answer include:
When should employers reopen the office?
It depends on the jurisdiction and nature of the job. Employers should be looking to their local health departments and government for guidance on when to return to the office.
What will a screening look like?
Most employers are contemplating a screening process that will help determine if the person entering the facility (whether employee or visitor) is free of disease. This is complicated, due to reports that 20-50% of carriers of the COVID-19 may be asymptomatic for 5-14 days or may not ever develop symptoms. Companies are struggling to decide if their screenings should include temperature checks and surveys and/ or viral testing before opening their doors.
What precautions do employers need to take after reopening?
At a minimum, employers will need to increase sanitation and social distancing. Employees will need to have antibacterial cleaning products, hand sanitizer, soap, and masks (and perhaps other personal protective equipment depending on their role. Employees will need additional time during their shifts to properly clean their work areas. Management teams should also speak with their facilities department or building maintenance about environmental hygiene.
Learn more
This health brief on the clinical topics and innovations surrounding the SARS-coV-2 virus and COVID-19 disease was prepared by Buck’s Health Intelligence practice. For more information, contact us at 866-355-6647 or talktous@buck.com.