Saturday, 25 April 2020

The 6th WACEM-ACAIM Joint Special Global Web Conference on Advance therapeutics in COVID19: Opinions from Experts around the World.




The 6th in the series of WACEM-ACAIM Joint Group meeting was a very productive conversation that included protocol-sharing, current data sharing, development of algorithms and standards, and expanding our thinking to the future of not just COVID-19, but beyond.

We continue to express our gratitude to all presenters and panellists.

Resource Conscious Approach

We need to be wary when generating data or developing guidelines of the resource-rich and resource-limited environments and institutions of healthcare.

As an example, idealistic practice of medicine would involve the monitoring of P/F ratio (PaO2/FiO2) but a resource-limited institution or patient-centric approach may consider monitoring of S/F ratio (SpO2/FiO2) in prognostication of respiratory optimization.

Standardization and Quantification

Because of limited data and gradual evidence emergence in a new disease, there is a common-sense approach and individualistic approach to monitoring and management of COVID-19. However 5 months into wide knowledge of existence of the disease, and 2 months into declaration of a pandemic, the need of the hour is to develop standardized and quantifiable methods of management of the disease. 

We discussed the use of a modification of the CURB-65 criteria as a clinical prognosticator, with concurrent use of the ROX index when considering invasive ventilation. 

We discussed using awake proning as a rescue therapy or indeed a temporizing measure while making an informed and well-thought decision for invasive ventilation. 

We are working on creating a standardised algorithm.

Immunology and Pathogenesis

A key factor in generating therapeutic regimens and working vaccines is to first understand the immunology and pathogenesis of the disease.

There was a thought-provoking discussion which is beyond the scope of this blog, however to elaborate two take-home messages: 

1) Not every presentation is that of a cytokine storm, there is in fact a preceding step of cytokine release syndrome (CRS). 

2) The goal for management would be to develop an IL-6 immune-modulation treatment rather than suppressing IL-6 altogether, as IL-6 is an expected and needed part of the body's normal immune response.

Crisis Telemedicine

This has to be treated differently to non-crisis telemedicine, especially when considering its role in the future of healthcare management. 

Development of a good model should consider the principles of confidentiality, patient safety, reimbursement, and data storage.

Testing

Antibody testing involves IgG or IgM or a combination of both.
The at-home tests/finger-prick tests utilize lateral assays.

These are not diagnostic, rather their main use is in understanding disease burden. 

The presence of antibodies to a disease does not necessitate the development of immunity to ii. 

Vaccine trials rely on studying both the antibody generation response, as well as immunity-conferred. 

Reinfection

It is important to understand, especially in the era where it is easy to share anecdotal medicine, that there is no known data about re-infection, re-activation, or resurgence of this disease. Studies are ongoing. 

Transformational biosafety in healthcare

Wider experiences shared by this global group led to the observation that this pandemic highlighted compromising of parameters and the onus going forward rests on improving these parameters instead. 

There in ongoing work to elaborate on this. 

Coming up next...

Our next meeting will recap on the work currently in development by the WACEM-ACAIM team, more on telemedicine, immunology and COVIFLU - anticipating and preparing for concurrent infection. 


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