Innovations to help COVID-19 treatment efforts

[berkeman]

TL;DR Summary

Medical innovations to help fight the COVID-19 pandemic

I didn't see a thread so far in the Medical forum that addressed the specific innovations that are being worked on to help combat this pandemic, so I thought I'd start this thread.

There is a thread about trying to use a single ventilator to serve multiple critical Patients (Pts) in ICU, but that is very problematic for several reasons, so that will not be merged into this thread. Instead, it would be good to focus on positive potential innovations.

One such innovation may be using plasma from Pts who have recovered from the virus to help treat new Pts. I don't know much about that, so hopefully Bill or Jim or others can comment.

One innovation that I saw today was a new protocol to sterilize N95 masks for re-use (with minimal damage to the masks, which may permit dozens of re-uses). This isn't something that we can do at home, but it may be possible to do it in some hospitals...

https://www.cnn.com/2020/03/27/health/n95-respirator-rewear-coronavirus-duke-trnd/index.html

Duke researchers are decontaminating N95 masks so doctors can reuse them to treat Coronavirus patients

The protocol published by Duke researchers:

https://www.safety.duke.edu/sites/default/files/N-95_VHP-Decon-Re-Use.pdf

 

[BillTre]

Summary:: Medical innovations to help fight the COVID-19 pandemic

One such innovation may be using plasma from Pts who have recovered from the virus to help treat new Pts. I don't know much about that, so hopefully Bill or Jim or others can comment.

I don't know about specific cases of using plasma (or isolated antibodies) to treat corona virus, but the basic idea is that someone who has gained immunity against the virus does so by making antibodies against the virus. This anti-corona virus antibodies can be extracted from the blood by getting plasma from the recovered patient.
They could then be injected into a sick person and the antibodies would them direct the patients immune response to the virus.
Not sure how may treatments could be made from one person's plasma in a short time period.

I believe it is now possible to make human monoclonal antibodies from cells that can be obtained from people. This could, once accomplished make really large amounts of antibody, but only of one specific antibody. A serum (or plasma) is usually composed of a mix of many different antibodies which can bind different areas of a (or many) molecule, (possibly providing more labels for the immune system/ molecule), possibly more different molecules labeled, and the different antibodies could have different strengths of binding to molecules and therefore have different levels of effectiveness.

Vaporized H₂O₂ should work well to sterilize unless there is some gunky build-up of dried saliva or whatever. H₂O₂ and more-so bleach (a good sterilant) will tend to breakdown things like paper (but glass fiber paper will be immune to this effect).
Eventually gunky build-ups will limit the filter's usefulness due blocking up the filter's pores and increasing its resistance to flow through it.

You can use a pressure cooker as an autoclave substitute.
I have one at home for just this reason. Got it to sterilize things for setting up cultures of foods for fish.
Reaches the same pressures and temperatures, but you have to know for how long to cook things (especially if autoclaving solutions, which will probably not be the case).
There should be charts available on somewhere on the internet.
Autoclaving can be problmatic due to the heat melting varous materials, particularly many plastics. Polypropylene is an OK to autoclave plastic.

Bleaching can kill lots of things (including viruses), but can degrade a lot of materials. Works well with lots of plastics though.
Bleach can be "neutralized" (inactivated?) with sodium thiosulfate.

 

[BillTre]

Not really an innovation, but there are several recipes for making solutions for virus killing purposes:

You can also make your own hand sanitizer. The Nebraska Medical Center – famous for its biocontainment unit and treatment of Ebola patients – offers this recipe:

What you’ll need:

• 2/3 cup 91% isopropyl alcohol (rubbing alcohol)
• 1/3 cup aloe vera gel
• Mixing bowl
• Spoon or something for whisking
• Small container, such as a 3 oz. travel bottle
• Optional: essential oil to give your hand sanitizer a fragrance

Directions:
In a mixing bowl, stir isopropyl alcohol and aloe vera gel together until well blended.
Add 8-10 drops of scented essential oil (optional, but nice!). Stir to incorporate.
Pour the homemade hand sanitizer into an empty container and seal.
Write “hand sanitizer” on a piece of masking tape and affix to the bottle.
-----------------------------

I got a 16 oz. bottle of aloe vera gel from the grocery store and just ordered 99% isopropyl alcohol from McMaster-Carr (it will be delivered in four days!).

________________________________
“Unexpired household bleach will be effective against coronaviruses when properly diluted,” the US Centers for Disease Control and Prevention said.

https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcommunity%2Fhome%2Fcleaning-disinfection.html#disinfect calls for diluting 5 tablespoons (or ⅓ cup) of bleach per gallon of water, or 4 teaspoons of bleach per quart of water.
--------------------------------
This would be household bleach, which is only about 5 or 6%.
Other sources of bleach can be stronger and therefore more diluted.
Bleach can be destructive to certain materials, but good for hard surfaces like glass, rock counters, plastic surfaces.

 

[Ygggdrasil]

Here's a good article on the idea of using plasma from recovered patients to treat COVID-19:

When it comes to creating treatments for Covid-19, the disease caused by the novel coronavirus, the first line of defense may be a century-old technology: purified blood plasma.

Medical literature published during the Spanish flu pandemic of 1918 includes case reports describing how transfusions of blood products obtained from survivors may have contributed to a 50% reduction in death among severely ill patients. In 1934, a measles outbreak at a Pennsylvania boarding school was halted when serum harvested from the first infected student was used to treat 62 fellow students. Only three of the 62 students developed measles — all mild cases.

More recently, plasma-derived therapy was used to treat patients during outbreaks of Ebola and avian flu. And on Wednesday the Japanese drugmaker Takeda Pharmaceutical Co. said it was developing a new Coronavirus drug derived from the blood plasma of people who have recovered from Covid-19. Its approach is based on the idea that antibodies developed by recovered patients might strengthen the immune system of new patients.

https://www.statnews.com/2020/03/05...overed-patients-could-help-treat-coronavirus/ (note the article is from Mar 5, so Takeda began developing the therapy a couple of weeks ago)

The approach probably doesn't scale well, but at least it could help some fraction of patients.

Here's a pair of good articles reviewing potential therapeutics against COVID-19:
https://blogs.sciencemag.org/pipeline/archives/2020/03/06/covid-19-small-molecule-therapies-reviewed
https://blogs.sciencemag.org/pipeline/archives/2020/03/09/covid-19-biologic-therapies-reviewed

 

[TeethWhitener]

Convalescent sera therapy was tried with SARS:
https://link.springer.com/article/10.1007/s10096-004-1271-9
The upshot is that it works better as a prophylactic than a therapy, and better early on as a therapy than after serious symptoms have developed. Here’s a recent viewpoint:
https://www.jci.org/articles/view/138003

 

[Auto-Didact]

I don't know about specific cases of using plasma (or isolated antibodies) to treat corona virus, but the basic idea is that someone who has gained immunity against the virus does so by making antibodies against the virus. This anti-corona virus antibodies can be extracted from the blood by getting plasma from the recovered patient.
They could then be injected into a sick person and the antibodies would them direct the patients immune response to the virus.
Not sure how may treatments could be made from one person's plasma in a short time period.

I believe it is now possible to make human monoclonal antibodies from cells that can be obtained from people. This could, once accomplished make really large amounts of antibody, but only of one specific antibody. A serum (or plasma) is usually composed of a mix of many different antibodies which can bind different areas of a (or many) molecule, (possibly providing more labels for the immune system/ molecule), possibly more different molecules labeled, and the different antibodies could have different strengths of binding to molecules and therefore have different levels of effectiveness.

Vaporized H₂O₂ should work well to sterilize unless there is some gunky build-up of dried saliva or whatever. H₂O₂ and more-so bleach (a good sterilant) will tend to breakdown things like paper (but glass fiber paper will be immune to this effect).
Eventually gunky build-ups will limit the filter's usefulness due blocking up the filter's pores and increasing its resistance to flow through it.

You can use a pressure cooker as an autoclave substitute.
I have one at home for just this reason. Got it to sterilize things for setting up cultures of foods for fish.
Reaches the same pressures and temperatures, but you have to know for how long to cook things (especially if autoclaving solutions, which will probably not be the case).
There should be charts available on somewhere on the internet.
Autoclaving can be problmatic due to the heat melting varous materials, particularly many plastics. Polypropylene is an OK to autoclave plastic.

Bleaching can kill lots of things (including viruses), but can degrade a lot of materials. Works well with lots of plastics though.
Bleach can be "neutralized" (inactivated?) with sodium thiosulfate.

I was wondering just yesterday if our masks could survive the autoclave, will report back soon. Will also definitely try the pressure cooker out as well. Thanks!

 

[BillTre]

We used to autoclave fish nets between use at the university.
Different lots of fish net from the same producer would react different to autoclaving.
Some melted, some didn't.
Had to test different lots before buying.

 

[David_777]

Web searching on destroying virion on viral masks, did not find much more solid information than the 70C (158F) linked study that has been out for weeks and is suspect as that is a rather low temperature.

https://link.springer.com/article/10.1007/s00430-004-0219-0

Instead read some Korean site stating hot steam is effective that is not surprising as that is at 100C (212F) though one must be careful at higher temperatures as that may affect the filter elements and adhesives that hold a mask together. Note I have been reusing a 3M 8393 P100 mask each time I go into supermarkets that will be about once a week now to replenish perishable items like fresh fruits vegetables, and refrigerated drinks.

That gave me an idea to buy a cheap steam cleaning appliance that are increasingly popular for cleaning household items. Thus just ordered this from amazon for $37 total including shipping/tax that will arrive next Wednesday.

Bissell, 39N7V Shot Hard Surface Steam Cleaner

 

[berkeman]

Instead read some Korean site stating hot steam is effective

This is the technical section of the PF. Please post your credible link for this. "I read somewhere" is not a valid reference. Thank you.

 

[berkeman]

in non-medical home setting

That's different from a medical setting like the current pandemic. You probably were not using an autoclave in your cleaning procedure...

 

[Klystron]

That's different from a medical setting like the current pandemic. You probably were not using an autoclave in your cleaning procedure...

Correct, posted in wrong sub-forum/thread. Plus an EMT relative warns not to touch the outside of a virus contaminated mask without proper protection. I'll remove my post and save it for a DIY thread on safety equipment. Thanks.

 

[Astronuc]

OncoImmune gets approval to trial CD24Fc for Covid-19 in US
https://www.clinicaltrialsarena.com/news/oncoimmune-covid-19-therapy-trial/

CD24Fc is designed to modulate host inflammatory response to tissue injuries which is believed to be involved in autoimmune disease, cancer, graft-versus-host disease (GvHD) and metabolic syndromes.
. . .
OncoImmune co-founder and CEO Dr Yang Liu said: “CD24Fc is a first-in-class biologic that fortifies an innate immune checkpoint against excessive inflammation caused by tissue-injuries.
. . .
Participants will receive a single 480mg IV infusion of the drug candidate or placebo.

Biotechnology firm Novavax is set to start the human clinical trial of a Covid-19 vaccine candidate called NVX-CoV2373 in May.
https://www.clinicaltrialsarena.com/news/novavax-covid-19-vaccine-trial/

Novavax plans to use its Matrix-M adjuvant with the vaccine candidate to boost immune responses and induce high levels of neutralising antibodies.

 

[berkeman]

Summary:: Medical innovations to help fight the COVID-19 pandemic

One innovation that I saw today was a new protocol to sterilize N95 masks for re-use (with minimal damage to the masks, which may permit dozens of re-uses). This isn't something that we can do at home, but it may be possible to do it in some hospitals...

https://www.cnn.com/2020/03/27/health/n95-respirator-rewear-coronavirus-duke-trnd/index.html

And now a follow-up: The FDA has approved a process to be used in hospitals (with equipment many of them already have) to sterilize N95 masks for re-use a couple of times:

https://abc7news.com/health/fda-approves-process-to-sterilize-millions-of-n95-masks-per-day/6100455/

Coronavirus shortage: FDA approves process to decontaminate 4 million N95 masks per day

 

[chemisttree]

OncoImmune gets approval to trial CD24Fc for Covid-19 in US

And what is CD24Fc? Man! How do they come up with these abbreviations?

CD24 extracellular domain-IgG1 Fc domain recombinant fusion protein CD24FcA recombinant fusion protein composed of the extracellular domain of the mature human glycoprotein CD24 linked to a human immunoglobulin G1 (IgG1) Fc domain, with potential immune checkpoint inhibitory, anti-inflammatory and antineoplastic activities. Upon administration, the CD24 extracellular domain-IgG1 Fc domain recombinant fusion protein CD24Fc binds to injured cell components, also called DAMPs (Danger-Associated Molecular Patterns), thereby preventing the interaction of DAMPs with toll-like receptors (TLRs) and inhibiting both nuclear factor-kappa B (NFkB) activation and secretion of inflammatory cytokines.

 

[Mary Conrads Sanburn]

OncoImmune Receives FDA Approval for COVID-19 Clinical Trial

April 08, 2020 02:40 PM Eastern Daylight Time

ROCKVILLE, Md.--(BUSINESS WIRE)--OncoImmune, Inc. has received a study-may-proceed letter from the FDA for its Phase III clinical trial testing the safety and efficacy of CD24Fc for the treatment of hospitalized COVID-19 patients (SAC-COVID). A cohort of 230 subjects with severe clinical symptoms will be randomized and administered a single dose of CD24Fc (480 mg IV infusion) or placebo and followed for a 14-day period to assess safety and efficacy in clinical improvement. The SAC-COVID trial consists of two interim analyses, respectively, for safety and therapeutic activity, and for therapeutic efficacy. This is a double blind, randomized, multi-center clinical trial.

SARS-CoV-2 causes clinical symptoms by killing cells in the lung and by causing inflammation that further exacerbates clinical symptoms. “In addition to anti-viral therapy, a comprehensive strategy in treating COVID-19 patients should include a non-antiviral approach targeting the tissue injury-induced inflammation”, said Dr. Pan Zheng, Chief Medical Officer and co-founder of OncoImmune. CD24Fc will be tested in combination with the best available therapy. Patients receiving other experimental therapies are welcome to participate in the trial.

“CD24Fc is a first-in-class biologic that fortifies an innate immune checkpoint against excessive inflammation caused by tissue-injuries. We are very excited to launch a global effort to test the clinical efficacy of CD24Fc in speeding up recovery of hospitalized COVID-19 patients”, said Dr. Yang Liu, CEO and co-founder.

[ . . . ]

###

https://www.businesswire.com/news/h...Receives-FDA-Approval-COVID-19-Clinical-Trial