Unmasking COVID-19

In this episode, Joel M. Gelfand, MD, MSCE, is joined by Leonard H. Calabrese, DO, and Amesh Adalja, MD, FIDSA, as they discuss quarantine and isolation guidelines, emerging therapies to treat COVID-19, and the anticipated future of the COVID-19 pandemic. Welcome from Joel Gelfand, MD, MSCE :10 About Calabrese and Adalja :11 At day five, what's your recommendation for clinicians how to counsel people about testing to get out of isolation? Do you recommend people go ahead and get tested to end isolation or to just end isolation if not having much symptoms or improving? :51 How should we counsel our immunocompromised patients? Should they really isolate for 20 days? 5:21 Can people continue to test positive and antigen test beyond the infectious period? 10:13 In the clinical setting, you know, should physicians be wearing N95 masks, and if so, what's that databased on? 15:22 If a person has a positive antigen test but a negative PCR on the same day, how do you interpret that information for a patient? 22:12 Now we finally have emergence of effective therapies for people with COVID-19. How do you think about these different therapies? Do you have an algorithm that you'd recommend to clinicians in the field about which one to reach for first? 24:05 When someone has a COVID infection how soon thereafter can you give them a COVID immunization? 27:47 With Omicron working its way through the US and obviously through the world, where do you see the next three to six months going? 28:34 Thank you everyone 31:29 Amesh Adalja, MD, FIDSA,is senior scholar at Johns Hopkins and a practicing infectious disease and critical care physician in Pittsburgh. Leonard H. Calabrese, DO, is chief medical editor of Healio Rheumatology, professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic. Joel M. Gelfand, MD, MSCE, is chief medical editor of Healio Psoriatic Disease and professor of dermatology and epidemiology at the Perelman School of Medicine at the University of Pennsylvania. He is also vice chair of clinical research, medical director at the Dermatology Clinical Studies Unit, and director of the Psoriasis and Phototherapy Treatment Center at Penn Medicine. We’d love to hear from you! Send your comments/questions to Dr. Gelfand, Calabrese and Adalja at covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews, @GoHealio, @DrJoelGelfand, @LCalabreseDO and @AmeshAA. Disclosures: Adalja reports no relevant financial disclosures. Calabrese reports consulting for AstraZeneca, GSK and Regeneron. Gelfand reports serving as a consultant for Abcentra, Abbvie, BMS, Boehringer Ingelheim, GSK, Lilly (DMC), Janssen Biologics, Novartis Corp, UCB (DSMB), Neuroderm (DSMB), Trevi, and Mindera Dx., receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from Boehringer Ingelheim, and Pfizer Inc.; and received payment for continuing medical education work related to psoriasis that was supported indirectly pharmaceutical sponsors. Gelfand is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma. Gelfand is a deputy editor for the Journal of Investigative Dermatology receiving honoraria from the Society for Investigative Dermatology, is chief medical editor for Healio Psoriatic Disease (receiving honoraria) and is a member of the Board of Directors for the International Psoriasis Council, receiving no honoraria.

In this episode, Joel M. Gelfand, MD, MSCE, and Leonard H. Calabrese, DO, are joined by Paul E. Sax, MD, as they discuss advances in the outpatient management of COVID-19 and emerging information about the omicron variant. Welcome from Joel Gelfand, MD, MSCE :10 About Calabrese, Gelfand and Sax :25 A quick update since the last webinar :51 Sax’s thoughts on the effectiveness of monoclonal antibodies 1:46 What are the situations where we should be thinking about postexposure prophylaxis with these agents? 7:06 When you start using pre-exposure prophylaxis therapy, how would you counsel the patients receiving it? 12:56 How does Merck’s molnupiravir work? 17:22 Sax’s thoughts on Pfizer’s paxlovid 22:23 What’s your perspective on fluvoxamine? Does it work? 25:26 Paul, what have you learned so far about the omicron variant? 30:15 How much more contagious is this than Delta and what would you compare it to? 31:09 Questions from the audience 35:27 Tweet your questions @DrJoelGelfand, @LCalabreseDO and @PaulSaxMD. 38:35 Leonard H. Calabrese, DO, is chief medical editor of Healio Rheumatology, professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic. Joel M. Gelfand, MD, MSCE, is chief medical editor of Healio Psoriatic Disease and professor of dermatology and epidemiology at the Perelman School of Medicine at the University of Pennsylvania. He is also vice chair of clinical research, medical director at the Dermatology Clinical Studies Unit, and director of the Psoriasis and Phototherapy Treatment Center at Penn Medicine. Paul E. Sax, MD, is clinical director of the Infectious Disease Clinic and professor of medicine at Harvard Medical School. We’d love to hear from you! Send your comments/questions to Drs. Gelfand, Calabrese and Sax at covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews, @GoHealio, @DrJoelGelfand, @LCalabreseDO and @PaulSaxMD. Disclosures: Calabrese reports consulting for AstraZeneca, GSK and Regeneron. Gelfand and Sax report no relevant financial disclosures. 

This is the first in a series of town halls featuring Joel M. Gelfand, MD, MSCE, and Leonard H. Calabrese, DO, who will discuss the latest knowledge and research on COVID-19. In this episode, they’re joined by Carlos del Rio, MD, who discusses the use of booster shots in the general population and in patients with underlying autoimmunity. Welcome from Joel Gelfand, MD, MSCE :10 About Calabrese, del Rio and Gelfand :30 del Rio on the future of the pandemic 1:12 Recommendations for boosters in general population 3:25 What does “immunocompromised” mean in terms of boosters? 6:14 What is an additional dose vs. booster dose? Who’s eligible? 9:24 Summary 14:12 Immunosuppressed patients – degree of severity 16:14 Safety of boosters in general population 17:00 Safety of boosters in those with underlying autoimmunity 18:12 Questions from the audience 22:03 Tweet your questions @DrJoelGelfand, @LCalabreseDO and @CarlosdelRio7 29:24 We’d love to hear from you! Send your comments/questions to Drs. Gelfand, Calabrese and del Rio at covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews, @GoHealio, @DrJoelGelfand, @LCalabreseDO and @CarlosdelRio7.

Researchers and regulatory agencies are racing against the clock to develop a safe and effective vaccine against COVID-19. This episode outlines the path of vaccine development, the top contenders currently in phase 3 trials, as well as questions that remain unanswered. Intro :08 The path of vaccine development 2:55 Regulatory agencies working on a vaccine 4:09 The lifecycle of vaccines 7:43 Potential targets of the vaccines 10:58 Top contenders in phase 3 trials 14:13 Viral vector vaccines 21:03 Protein-based vaccines 23:31 Approval process 25:46 Vaccine safety monitoring 28:23 Unanswered questions 31:09 Let’s stay tuned for more information 33:12 A fairytale analogy to explain vaccine development difficulties 35:10 We’d love to hear from you! Send your comments/questions to Dr. Pai at covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.

Research and data on potential treatment modalities continue to emerge at a rapid pace. This episode explores the IDSA and NIH guidelines for the treatment and management of COVID-19, as well as available evidence on antivirals, glucocorticoids and antibodies. Intro :08 Recap on spectrum of disease 1:53 Treatment goals: 3 broad approaches 4:07 Disease pathogenesis 5:45 Remdesivir 7:58 Dexamethasone 17:18 Convalescent plasma 34:26 Words from JFK 40:20 We’d love to hear from you! Send your comments/questions to Dr. Pai at covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.

As the country prepares to reopen, rapid and effective testing remains “the need of the hour.” In this episode, Dr. Pai discusses diagnostic testing for COVID-19, including which populations to prioritize for testing, available modalities and new options. Overview of symptoms 1:05 A look at testing modalities 3:34 Saliva samples for COVID-19 11:19 Antibody testing 13:03 Antigen testing 21:48 Nothing can replace clinical judgment 24:20 We’d love to hear from you! Send your comments/questions to covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.

In this episode, Dr. Pai answers questions specific to HIV in the context of COVID-19, including parallels between the two pandemics, repercussions of COVID-19 on patients with HIV and guidance for handling potential changes to antiretroviral regimens. Questions: From Peter Chin-Hong, MD, at the University of California, San Francisco: "What are the parallels between the HIV and COVID-19 epidemic?" "What lessons can we learn from the early response to HIV that can inform how we approach COVID-19?" "Are HIV patients with COVID-19 doing worse? What information do we have?" "What repercussions of COVID-19 will HIV patients have (mental illness, etc.)?" From Jennifer Ross, PharmD, at the University of Iowa College of Pharmacy: "Many antiretroviral agents (e.g., l lopinavir/ritonavir, boosted darunavir), are being evaluated in clinical trials or are prescribed for off-label use for the treatment or prevention of COVID-19. What additional considerations should be made when proposing a change in a patient’s antiretroviral regimen in the midst of COVID-19?" We’d love to hear from you! Send your comments/questions to covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.

This episode features questions regarding the use of masks, the use of steroids, universal PPE, antibody testing, convalescent plasma, COVID-19 in pets and whether hydroxychloroquine has any effect on the cytokine storm. Questions: From Gail D. Deyle, DSc, of the Brooke Army Medical Center, in San Antonio, Texas: “The information available to the general public has ranged from masks do very little to help reduce the spread of the virus, to statements that if 80% of the population wore a mask, most transmission would be stopped. Consistent with current evidence, and distinct from fears of the general public competing with healthcare providers to purchase masks, what benefit do homemade and other masks provide? Is your family wearing masks?”  From Mike Putman, MD, of Feinberg School of Medicine at Northwestern University: “I'd love to hear the panel talk about steroids.” From Adam Cheifetz, MD, of Beth Israel Deaconess Medical Center: “How contagious are carriers prior to being symptomatic and for how long after diagnosis are you still contagious? “When will we see a serology test to determine if someone, ourselves included, have already had COVID-19?” From Masoud Sakhaei, MD, of Baptist Health in Jacksonville, FL: “Most likely, COVID-19 will be with us. Until we have a vaccine or cure, we do have to find a balance between livable society and avoidance of infection and fatality.  We need a better universal PPE to be cheap and abundant for everybody to be able to go back to work and be protected.” “We need universal screening to collect antibodies from recovered individuals in case somebody got sick. I’d like the panel’s opinion on this.” From Scott Harris, MD, a retired cardiologist previously in private practice in Texas: “Does the activity of hydroxychloroquine in reducing cytokine levels in vitro have a possible beneficial effect in blunting the cytokine storm?” From Marcia Miller-Hjelle, PhD, of the University of Illinois College of Medicine at Peoria: “Why have veterinarians not been brought into the mix of providing information and studies, such as are cats and dogs carriers of COVID-19? Hopefully, someone is testing this.” From Stephen Hanauer, MD, of Northwestern University: “We are planning a meeting in December, but faculty are concerned about recycling of the virus. Are there any predictions on what will happen when we return to socializing and winter returns?” We’d love to hear from you! Send your comments/questions to mailto:covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.

This episode focuses on diabetes and COVID-19. Questions are answered regarding the risk for COVID-19 among patients with diabetes, medication concerns in those who test positive for the virus, and the importance of self-monitoring of glucose levels among patients with type 1 and type 2 diabetes. Questions: From Shelley Johns, PsyD, HSPP, ABPP, from Indiana University Melvin and Bren Simon Comprehensive Cancer Center: "Do individuals with diabetes have any added risk of contracting coronavirus, and does this risk vary by their recent blood glucose control?" From Rachel Pessah-Pollack, MD, from NYU Langone Health: "Are there any medications that should be stopped if a patient has diabetes and COVID-19?" "Are glucose levels higher if a patient has diabetes and COVID-19?" "Is there any additional monitoring that should be done if patients have type 1 diabetes and COVID-19?" We’d love to hear from you! Send your comments/questions to mailto:covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.

As the enormity of the COVID-19 pandemic sinks in and as we feel its impact across the globe, join us as we discuss mitigation, solutions and new discoveries and approaches to help you better prepare to serve your patients across all specialties. In this episode, we focus on immunocompromised patients. Questions: From David Duong, MD, from the Harvard Primary Care Center: Should the safe default be to recommend testing for COVID-19 if they have any URI +/- diarrheal symptoms since the implications could be huge for them? Or is there additional screening that we should do before recommending to test? What do you do if tests are extremely limited/not available? From Derek Raghavan, MD, PhD, from the Levine Cancer Institute: How do you balance long-term outcomes from dose-intense regimens vs. the immediate threats of myelosuppression with COVID-19 hovering around? What is your view of broad-based antiviral therapies in association with cancer treatments as a protective adjunct, given the absence of hard data? Are you routinely prescribing chloroquine and similar compounds and why/why not? From John Sweetenham, MD, from the University of Texas Southwestern Medical Center: One question comes to mind immediately: We are applying a symptom screen for our patients on entry to the cancer center and are now likely to add a temperature screen to that process. I would love to know what threshold temperature we should consider a positive screen in immunocompromised patients. It’s a simple question but of huge practical importance and I can’t find a good answer anywhere. From Shelley Johns, PsyD, HSPP, ABPP, from Indiana University Melvin and Bren Simon Comprehensive Cancer Center: Does a history of cancer -- and treatment with chemotherapy, radiation therapy, endocrine therapy and/or any targeted therapies -- raise a person’s risk of contracting coronavirus or their health complications from it? From Deepak Bhatt, MD, from Brigham and Women's Hospital: How should we deal with a health care worker who gets a needlestick from a COVID-positive patient? From Carl Pepine, MD, from the University of Florida Health: The most immunocompromised patients that we see in cardiology are those who have had heart transplantation for heart failure. What are the recommendations for patients who have had a heart transplant after they leave the hospital? We’d love to hear from you! Send your comments/questions to mailto:covid19podcast@healio.com. Be sure to check Healio.com/coronavirus for daily updates on the pandemic and follow us on Twitter @InfectDisNews and @GoHealio. Disclosures: Pai reports serving on the advisory boards of Abbvie and Gilead Sciences.