Impractical Strategies for COVID-19

Country by country, public health policies and research practices have varied greatly in coronavirus 2019 (COVID-19) response.

But not all are beneficial—particularly some implemented in suggested theory among the US population, or those even attempted.

In this month’s episode of Lungcast, interview guest David Ho, MD, of the Columbia University Vagelos College of Physicians and Surgeons, detailed some of the more impractical or ineffective practices proposed to combat the pandemic.

Selective masking

Plain and simple, most people should be able to tolerate wearing an effective and agency-recommended mask, Ho said.

“There may be some special cases where the mask might impair one’s respiratory function, but I think that’s extremely rare,” he said.

At a time when the idea of public masking in the US has been “evolving,” Ho noted the benefit of total population buy-in: it reinforces that a commonly asymptomatic virus could be prevalent in anyone, and minimizes spread. Anything more targeted than that, and stigma is introduced into what’s a more widely accepted public health preventive measure elsewhere in the world.

“We cannot come out and say, ‘You’re infected, you’re not infected, you wear a mask, you don’t need a mask’,” Ho said.

Convalescent plasma therapy

One of the initial leading strategies to therapy development has occurred in prominent institutions including New York-based Mount Sinai, Ho said. Though clinical results in some cases are still pending, he anticipates they will be short of the successes observed in China.

This is because plasma donors have been largely any COVID-19 patients who has recovered, without greater evaluation into the patient’s case.

“And we now know there’s extreme variability in antibody titers—particularly if one had only mild disease, then the antibody titers are unimpressive and probably not helpful,” Ho said.

What’s been observed is that recovered patients with more severe COVID-19 cases are reporting greater titers, but it’s not commonplace to collect samples from patients previously treated in intensive care units (ICUs).

“For every plasma unit you receive, you could probably help 1 or 2 cases,” Ho said. “It’s hard to scale.”

At the same time, this is why Ho’s laboratory has more aggressively pursued clinical research of monoclonal antibodies—a more easily optimized therapy.

Herd immunity

The strategy most notably adopted by Sweden does not bode well in theory for the US. Based on most mathematician or epidemiologist projections, herd protection would be feasible in a population that is already about 60-70% infected.

“And of course, historically speaking, in other infections, that build up is over decades—long periods of time,” Ho said. “If we want to reach 60-70%, it’s going to be a disaster in the meantime.”

Based on mortality rates compared to neighboring countries—and even in terms of economic successes, as suggested by herd immunity supporters—Sweden’s pursuit of the practice should serve as a cautionary tale, Ho said.

“The best way to build herd immunity is through an effective vaccine,” he said.