Background
Severe acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available.

Results
We report, however, that chloroquine has strong antiviral effects on SARS-CoV infection of primate cells. These inhibitory effects are observed when the cells are treated with the drug either before or after exposure to the virus, suggesting both prophylactic and therapeutic advantage. In addition to the well-known functions of chloroquine such as elevations of endosomal pH, the drug appears to interfere with terminal glycosylation of the cellular receptor, angiotensin-converting enzyme 2. This may negatively influence the virus-receptor binding and abrogate the infection, with further ramifications by the elevation of vesicular pH, resulting in the inhibition of infection and spread of SARS CoV at clinically admissible concentrations.

Conclusion
Chloroquine is effective in preventing the spread of SARS CoV in cell culture. Favorable inhibition of virus spread was observed when the cells were either treated with chloroquine prior to or after SARS CoV infection. In addition, the indirect immunofluorescence assay described herein represents a simple and rapid method for screening SARS-CoV antiviral compounds.

I completed four days as the attending physicianon a COVID-19 floor at my local hospital, and here is some of what I learned:

First, this is like nothing we have seen before. This virus is its own animal — it’s totally different in so many ways. As a physician, so much of what I’ve learned to treat over the years does not apply. Throw conventional wisdom out the window.

Thought we treated sepsis with fluids? Think again.

Thought we treated chronic obstructive pulmonary disease exacerbations with steroids? Think again.

Thought we ventilated people with pneumonia on their backs? Think again.

Think we knew much about anything?
A medical worker transports a patient at Montefiore Medical Center, Wednesday, April 1, 2020, in New York. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (Photo: Mary Altaffer, AP)
I showed up ready to serve, like thousands of my colleagues and health care workers across the globe. This is totally different.

Second, most in the health care profession don’t whine. They just do it. I’ve never seen anything like it before. Doctors, nurses, aids, clerks, janitorial staff: They show up every day. They are apolitical. They believe in humanity, however imperfect.

Third, there is hope in all adversity. We have to listen for the truths buried within the struggle. It may be transformative. No one can do this for us.

Fourth, I have some guarded hope for treatment. This virus is nasty. I’m the first to admit that I did not “get it.” Now I do. All of the practitioners on the front lines see how bad it can be. I won’t quote outcomes, but we’re gathering data as we go. There will be more studies published over the next few months than can be digested in a lifetime. I don’t claim to be any authority. Most of us only have observational, nonscientific analysis, but I had some positive results. Yes, I think I did.

I ran a floor of COVID-19 positive patients with severe symptoms. Our team used the combo of hydroxychloroquine with azithromycin and it seemed to help! Of the patients that I treated for these four days who where acutely ill — all ages and health conditions — most (loosely defined and footnoted) seemed to improve and were able to be discharged home. I can say that I transferred no one to the ICU but I sent many people home.

Progress? I sure hope so. Would they have responded without? I don’t know.

Unfortunately, there are also very severe cases whose victims aren’t as fortunate. When people go bad, they go bad quickly. Please keep them in your prayers.

None of us know why this is happening or where it will lead, but there is no better time to accept that we are all in this together.

Let’s all listen and learn. God bless.

Dr. Christopher R. DeAngelis is an internal medicine physician based in Woodhaven, on staff at Beaumont-Trenton. He lives in Grosse Ile.