Berks County Medical Society Medical Record Summer 2020 - 13

positive inpatients with pneumonia with hypoxia with symptoms
for less than 10 days.
We have used tocilizumab, which is an interleukin-6
inhibitor, to treat cytokine storm with limited success. We
have been recently approved for a treatment study using
canakinumab, an interleukin-1 beta monoclonal antibody, to
treat cytokine storm. We hope to enroll patients shortly in this
study.
The only way we will determine if these medications work is
by participating in clinical trials.
MR: What impressed you most about the response of the entire
health care team to this crisis?
I have been most impressed by the dedication of the
health care team in the setting of uncertainty. As health care
professionals, we come to work each day to take care of others.
This is always our focus.
MR: Much has been discussed regarding the world and national
response to the pandemic. What do you think overall was done
correctly to confront COVID-19? What could have been done
better? Were there opportunities missed or were we invariably going
to fall behind due to the rapidity and novelty of this virus?
I think that nationally we have defunded a number of public
health initiatives that should be reimplemented. Locally we need
a stronger public health system. We are now starting a process
for contact tracing within our county. Ideally this contact tracing
should have been performed earlier in the outbreak.
I was impressed how quickly PCR testing was developed for
this virus. Typically this process takes months to years and was
released in months under Emergency Use Authorization (EUA).
However, the capacity remains limited and the need is expanding
as we are asked to test more of the population. Initially we
had testing available through the Department of Health (who
required prior approval), and then by reference laboratories (who
continued to accept specimens beyond their capacity which led
to a back log). Commercial hospital-based laboratory platform
tests are being released but not enough to supply the extensive
number of hospital laboratories across the country. We are
currently using both reference laboratories with limited in-house
testing. Testing capacity remains a big challenge.

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MR: For the past several years you and members of your staff gave
presentations on such topics as "Emerging viruses" and there were
always comments warning listeners not "if there is a next pandemic
but when" and indeed in the last several years we saw both the
SARS (Severe Acute Respiratory Syndrome) and the MERS (Middle
East Respiratory Syndrome) coronaviruses emerge. Should we (the
entire world) have been better prepared for this?
continued on next page >

SUMMER 2020

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Berks County Medical Society Medical Record Summer 2020

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