Eve Glazier, Elizabeth Ko

DEAR DOCTOR,

I heard on the news about a coronavirus medicine made with blood from people who were sick and got better. But my husband says it’s actually a blood test to see if someone ever had the virus. Who’s right?

DEAR READER,

You and your husband are both correct. Two different uses for antibodies have recently been greenlit by the U.S. Food and Drug Administration.

You’re referring to an experimental treatment that was approved on March 24 for very limited use. Your husband is talking about a quick and simple blood test approved by the FDA on April 2. The test, which is already in use in other parts of the world, reveals whether or not someone has been infected with the novel coronavirus. The treatment and the test each rely on antibodies, which are blood proteins that the immune system produces during and after its fight against a foreign invader, such as a virus or bacterium.

Let’s start with the therapy you’re asking about. It’s based on the idea that, when introduced to antibodies used to fight a specific pathogen, a sick person’s immune system will produce those very antibodies. This type of treatment has been in use since the 1890s for diseases such as polio, SARS, Ebola and the H1N1 flu. The idea of using it to treat COVID-19 arises from a very small pilot study — just six men and four women — recently conducted in three hospitals in China.

Each of the patients, who were gravely ill with COVID-19, received a single dose of antibodies gathered from the blood of patients who had recovered from the illness. According to the published research, the treatment resulted in improved oxygen levels and a shorter duration of symptoms in all 10 patients. Most improved within one to three days after receiving the antibodies. The patients also cleared the virus from their bodies more quickly than those who did not receive the treatment. This sounds promising, but it’s important to note that the FDA approval limits treatment to patients who are so ill that they have no other options, and to clinical trials.

The antibody test that your husband is referring to is much closer to a wide release. It uses a pinprick of blood and delivers results in about 15 minutes. Unlike the diagnostic test for COVID-19, which identifies genetic material from the virus itself, this test looks for the antibodies that will be present only if the body has already encountered and fought off the virus. This is valuable information on two fronts. First, widespread use of the antibody test will give scientists a clearer picture of the spread and reach of coronavirus infection in the U.S. Just as important, the test hints at a potential path forward after the height of the epidemic has passed. People who have been exposed to the virus may have some degree of immunity, which would allow them to safely rejoin normal daily life. The challenge here is that, at this time, how much immunity is granted by prior infection, and how long that immunity may last, is not yet known.

Atrial Fibrillation Diagnosis requires Cardiologist’s care

DEAR DOCTOR,

Our mom is 66 years old and has always been healthy. She was diagnosed with atrial fibrillation during her last physical. She says she feels fine, so she hasn’t followed up with her doctor. What can happen if she doesn’t get treatment?

DEAR READER,

Atrial fibrillation is a common heart rhythm disorder, or arrhythmia, that affects anywhere from 2.5 million to 6 million people living in the United States. Also referred to as AFib or AF, the condition causes a rapid and irregular heartbeat. People living with AFib have an increased risk of stroke, heart failure and other heart-related complications. The good news is that there are several effective treatment avenues for the condition. Without treatment, however, the symptoms of AFib often get worse.

The condition gets its name from an electrical malfunction in the upper chambers of the heart, known as atria, which pump blood into the ventricles, the two lower chambers of the heart. It occurs due to a glitch in the sinus node, a cluster of specialized cells in the upper wall of the right atrium, which act as the heart’s natural pacemaker. Instead of producing a steady, rhythmic contraction, the atria quiver, or fibrillate. The result is a disorganized heartbeat, rapid and irregular, which interferes with optimal blood flow. It often causes blood to pool in the left atrium, which can lead to the formation of blood clots. If a blood clot breaks free, it can circulate and block blood flow to other parts of the body. A blood clot that travels to the brain can cause a stroke.

Many people with AFib — and it sounds as though your mother may be one of them — don’t experience any noticeable symptoms. Those who do will feel a jittery, racing heartbeat; the sensation of a skipped heartbeat followed by a “thump” within the chest; exhaustion; shortness of breath; dizziness; chest pain or pressure; or unusual fatigue during exertion. The condition runs the gamut from mild to severe. Occasional episodes, known as paroxysmal AFib, last from a few seconds to a few hours, and the heart recovers on its own. AFib that requires medication or an electric shock to return to normal rhythm is labeled as persistent. Permanent AFib is when normal heart rhythm cannot be restored.

Treatment depends on which specific type of AFib a person has, as well as on any additional medical issues that may be present. In all types of AFib, the dual goals are to restore normal heart rate and to prevent blood clots. Medications such as digoxin, beta blockers and calcium channel blockers may be used to restore heart rate. Blood thinners, including Warfarin and newer anticoagulants, are often prescribed to prevent stroke. If medications don’t work, procedures to inactivate the sinus node cells causing the arrhythmia may be used. In some cases, a pacemaker is the best option.

Even though your mother can’t feel the symptoms of her AFib, the condition is dangerous when it goes untreated. We strongly urge her to see a cardiologist and begin a potentially lifesaving therapy.

Dr. Eve Glazier, MBA, is an internist and assistant professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and primary care physician at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.

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