Inside Medicine. What Are You Seeing? [COVID-19 medical news]

I happened catch the interview with Dr. Arturo Casadevall, MD on Dr.Radio – hosted by NYU Langone Medical Center….His point…convalescent plasma is an effective, low cost and very low risk treatment for early covid. We gave up on it to early and for the wrong reasons.


The condensed version

    1. Covid is TWO diseases. A. the viral infection – which the vast majority of people clear and are fine. B. The runaway inflammatory response some people get to the viral infection. Those are the ones who wind up in the hospital.
    1. We are currently sending people home to ‘wait until it gets bad’ and telling them to come back when they re already in the runaway inflammatory process.
    1. Original data on convalescent plasma showed it to be ineffective

BUT… As for why some clinical trials found no benefit for plasma use, the researchers note in their paper that many of the clinical trials with negative results had used plasma—mainly considered an antiviral treatment—relatively late in the course of COVID-19, when patients may have been too ill to benefit, and when the disease is driven mainly by immune-related responses rather than the coronavirus itself.

    1. There is data to support the use of convalescent plasma early in the disease process.
    1. He spoke of an independent network of doctors and researchers who are pushing for the use of CP as an early and successful intervention
    1. CP is cheap and plentiful it’s walking all around us
    1. There is no identified downside to using CP

Any time a treatment has a narrow window or a very specialized route of administration, it is a problem. It might work well in a major research hospital like our Harborview… but Imagine a chaotic, overcrowded rural hospital… not happening.

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Why hospitals? Have rapid testing.go straight to infusion center based on positive test. Yes, an overly simplified description but there is VERY little risk with CP

How about this. Drive thru and get a 20 minute PCR test (CUE is coming to a wider market).

Get a positive result…drive to an infusion center. Get a dose of CP.

That’s what they did with DH a few years ago with the flu. The flu has variants, they are detected. Tamiflu works on all variants - administered early enough.

Our way out is to get to this point…to avoid hospitalization.

Unlike monoclonals or a small molecule, CP is hard to standardize and the supply is unpredictable. CP can be a stop gap measure while other therapies are being considered, but it can’t be a global panacea due to its nature.

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Is it that cheap?

Also, only about 37% of people in the US are eligible to donate blood by US blood donation rules. Antibody levels in convalescent plasma may also vary from donor to donor, and over time for the same donor.


I’m not positive but have taken Tamiflu 3 different times—1st 2 times it was pretty quick and effective. The 3rd time not as effective. Could have been different strains of flu or I don’t know why.

I am glad to have my 3 doses of Pfizer and am glad there are Rx I can take if I get a breakthrough case. I don’t have much extra lung function to spare.


It seems remdesivir has mostly been given too late in the course of the illness, when people are hospitalized already. That is also an antiviral. Have there been any studies on effectiveness when given earlier in the course of a COVID infection? I saw an animal study in which it was effective as prophylaxis.

Remdesivir is given by injection. A pill is easier of course. But injection is easier than the monoclonal antibody infusion. Curious how the three compare for effectiveness if given early enough.

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I’m still not convinced those who test positive without symptoms or only minor symptoms will be interested in getting anything that involves needles. For those who are, as with MAb, it’s good to offer choices, but I wouldn’t count on all of them, or even a majority of them, being willing. These are the same folks (generally) who didn’t want vaxxes.

Pills are easier to swallow.

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There are problems with advocating early treatment in a disease where most won’t actually need it.

First, most patients that would do just fine without are exposed to potential drug side effects. It’s really like advocating that anyone with a small, isolated breast malignancy be given the full court press for metastatic disease. Treatments have side effects that need to be weighed against potential benefits. For most, treatment would not be beneficial.

Second, the cost would be astronomical. Had everyone who has tested positive for COVID in the US been given a full course of Remdesivir, the total tag for that alone would have been 132 billion dollars.

We need a way to differentiate early on who is most likely to fare well and who isn’t. So far, beyond the fairly generic things like age, habitus, and comorbidities, we haven’t yet found those markers.


This is a very interesting statement and a statement that is true. However, this is exactly what people who have already had Covid are saying about the vaccine. They already have natural immunity so why expose themselves to potential vaccine side effects. While serious side effects may be rare, they do exist and I know a few people who have suffered from some of these rare serious side effects.

I really wish we would stop ignoring natural immunity and focus on those who have not had Covid getting the vaccine. Ignoring natural immunity is only contributing to the hesitant and mistrust.


Immunity only lasts so long, be it through vaccination or wild type infection. Now that we can measure memory cells, well after antibodies have waned, we should really have an immunity passport rather than a vaccine passport.

That said, those who refuse vaccination, will be living Ground Hog Day over and over. Repetitive wild type infection has way more potential side effects than repetitive vaccination. A local, very healthy guy, under 50, got to experience that in a brutally harsh way. He died from his second SARS-Cov-2 infection.

The bottom line is that morbidity and mortality are possible with either vaccination or wild type infection. They are just radically more probable with the latter.


I work as a nurse practitioner in Texas with 50% vaxxed rate. We do very minimal telemed in our clinic. 99% of our visits are in person. I do not work in the attached hospital but do round on our in patients daily, so I am in the hospital daily. Hospital was very full of Covid. But now the percent of hospitalized Covid cases are dropping quickly. They do not use Plaquenil in their Covid regimen. EDIT I thought I was replying to a post asking about what others were seeing in their hospital. But the post I replied to is gone.


I meant for those who need a treatment early on.

Thanks for the report even if the original post you were replying to is gone.

Very glad to hear that cases are going down. Maybe we are over the hump in this surge

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I don’t see how downplaying natural immunity (nobody is ignoring it) contributes to hesitance and mistrust. On the other hand, won’t hailing the power of natural immunity and overplaying the risk of the vaccines encourage people to take their chances with the virus?

I also wanted to add that there is a really high percentage of people who continue to feel effects of the virus months later. We don’t really know the long term effects of Covid and the damage it might do to the body.


Vaccination after previous infection does give stronger immunity against future infection than either alone, so there is benefit to getting vaccinated after previous infection. Also, those with “long COVID” often improve after vaccination. So there is benefit to vaccination after previous infection, although the incremental benefit is smaller than vaccination of someone who never had it (unless perhaps in someone with severe “long COVID” who improves after vaccination).

It does look like previous infection gives enough immunity that it can make sense to accept it as equivalent to vaccination. However, that requires verification of such previous infection. Not all previous infections have verified medical records. Someone may have done only an at-home test, or assumed without testing that “COVID-like symptoms” were COVID-19 even though they may have been flu or something else, or assumed without testing that they got an asymptomatic infection due to household close contact with someone with COVID-19. Such people may have to get antibody tests in order to be accepted as equivalent to vaccination. However, antibody tests cost more than vaccines, so, in the absence of medical contraindication to all of the vaccines, it makes more sense for someone who believes that they had a previous unverified infection just to get vaccinated. That way, they either gain vaccine-based immunity if they never really had COVID-19, or they gain super-immunity if they actually did have it.

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It’s rare that the patients who go south present that way at the outset, unless they’ve been toughing it out at home for a while.

Based on age and health conditions. Monoclonal antibodies were given in CA to those over 65 once a positive test was received.

A new study (preprint) from the University of California, Davis, Genome Center and UC San Francisco shows no significant difference in viral load between vaccinated and unvaccinated people who tested positive for the delta variant of SARS-CoV-2. It also found no significant difference between infected people with or without symptoms.

Some highlights:

  • When they analyzed the data, the researchers found wide variations in viral load within both vaccinated and unvaccinated groups, but not between them. There was no significant difference in viral load between vaccinated and unvaccinated, or between asymptomatic and symptomatic groups.

  • Although vaccinated people with a breakthrough infection are much less likely to become severely ill than unvaccinated, the new study shows that they can be carrying similar amounts of virus and could potentially spread the virus to other people. This study did not directly address how easily vaccinated people can get infected with SARS-CoV-2, or how readily someone with a breakthrough infection can transmit the virus.

“Our study does not provide information on infectiousness,” Michelmore said. “Transmission will be influenced by several factors, not just vaccination status and viral load.”

Actual study:

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They are using Ct to determine viral loads?!