Issue of January 10, 2021
     
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Colchicine was first approved by the United States Food and Drug Authority in 1961 for the treatment of gout, a condition in which there is painful deposition of urate crystals in joints.

The drug is derived from colchicum autumnale, also known as autumn crocus. Colchicine has well-documented anti-inflammatory actions. It disrupts cellular processes and prevents the activation of inflammatory mediators called interleukin. It also prevents the adhesion and recruitment of inflammatory cells and other pathways to prevent inflammation.

Chronic inflammation is a risk factor for heart disease like heart attack. In a large study (LoDoCo2 trial), it was shown that patients who received low-dose colchicine along with the other established heart medications had lower risk for heart attack and the need for coronary artery revascularization. It is now recommended that colchicine at a daily dose of 0.5mg to 0.6mg be added to secondary preventive measures in patients with stable coronary artery disease. It is to be taken upon recommendation and under the supervision of a physician since the drug, like any other drug, has its side effects, drug interactions, and safety precautions in the presence of other diseases.

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Ivermectin is a drug also approved by the U.S. FDA as a broad spectrum anti-parasitic drug. It has been shown to have in vitro (in a test tube or glass dish in a laboratory medical study or experiment) anti-viral activity against several viruses like HIV-1, simian virus large tumor antigen, dengue virus, Venezuelan equine encephalitis virus, and influenza virus. An example of an in vivo study for the drug was done in Thailand in 2014-2017 against dengue virus where it was shown that it could reduce blood levels of viral NS1 protein. It did not however show decrease in viremia and no clinical benefit was noted. Studies are now being done to evaluate if ivermectin may be repurposed for use in SARS-CoV2 containment.

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The AstraZeneca-Oxford Covid-19 vaccine was developed by transferring coronavirus spike genes to an adenovirus taken from chimpanzees. This adenovirus has been modified so that it will not grow in human beings and is thus considered harmless. When injected as vaccine, it triggers the production of antibodies and T-cells against SARS-CoV2.

Initial trials showed that its efficacy was 70 percent but it is suggested that modifying or perfecting the dose can increase the efficacy to 90 percent. The vaccine is given in two doses and is now in use in the United Kingdom. It is cheaper and is easier to transport compared to the Pfizer-BioNTech vaccine because it does not require cold temperature.

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Herd immunity is important in controlling the spread of the SARS-CoV2 in a community. It occurs when a large number of the population becomes immune to infection – through actual exposure or infection and through vaccination – and the risk of spreading the virus is decreased. This herd immunity indirectly protects those who have not been exposed yet.

What percentage of a population should be immune to provide herd immunity? This depends on how contagious the infection is. It can range from 50 to 90 percent. For measles, which is very contagious, herd immunity should be 94 percent. For the Covid-19, the infectious agent is a novel/new virus and this is a new disease, further studies are needed. Authorities initially said it should be 60 to 70 percent but higher proportions may be more protective.

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In behalf of the Philippine College of Physicians-Northern Luzon Chapter, I would like to thank our generous donors who gave personal protective equipment, purified drinking water, and other donations, which were distributed to hospitals and healthcare workers.

Future donations will be given to dialysis nurses, technicians, and physicians. They cater to patients whose lives depend on regular dialysis treatments and/or emergency dialysis. During the lockdown, these health workers rendered services continuously and unselfishly, some of them got infected with the Covid-19 themselves.

The city does not yet have a dialysis center solely dedicated to the care of Covid-19 suspects or Covid-positive patients. These patients are accommodated in all centers which observe strict preventive measures, isolation, and virus-containment protocols based on Department of Health and Philippine Society of Nephrology guidelines.

In the process, dialysis centers and staff are in constant need of PPEs and assistance in any form. The community’s support will help not only the dialysis team but patients as well.

Donations may be coursed through the Baguio Midland Courier for the Covid Renal Response Team. Donors will be properly acknowledged, and donations will be properly accounted for.

Again, our thanks to our donors.

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