Revelations in Malaysia’s pioneering Covid-19 study

‘Malaysia has something new to be proud of... Just two weeks ago, a band of Malaysian medical professionals wrote and published Southeast Asia’s first national study on Covid-19 cases, representing an entire country’s experience.

‘It was featured in The Lancet, arguably the most prestigious and influential medical journal in the world. Titled “Clinical characteristics and risk factors for severe Covid-19 infections in Malaysia: A nationwide observational study”, it was written by Benedict Lim Heng Sim, Suresh Kumar Chidambaram, Xin Ci Wong, Mohan Dass Pathmanathan, Kalaiarasu M Peariasamy, Chee Peng Hor, Hiu Jian Chua, and Pik Pin Goh. It provides a detailed picture of the disease’s spread in Malaysia from Feb 1 till May 30, 2020.

Ethnic mix: ‘Malays account for 58.4% of all cases and 70.0% of all severe cases, while the Chinese account for 6.7% of all cases and 12.1% of severe cases and Indians account for 2.3% of all cases and 4.5% of severe cases. The ratio of severe cases to all cases of almost 2 to 1 for Chinese and Indians might be due to their slightly older-skewing population. Other nationalities account for 23.8% of all cases but only 4.9% of all severe cases – a ratio of almost 5 to 1. This, again, could be due to the foreign worker population which generally skews younger and so has a reduced chance of developing a severe instance of the disease.’

Co-morbidities: ‘Those with hypertension are the most at risk at 48.6%, followed by diabetes mellitus at 39.1% and chronic cardiac disease at 14.0%. Surprisingly enough, being an active smoker does not indicate an elevated risk of developing a severe infection. Smokers account for 9% of all cases and 7% of severe cases...’

Read here (FreeMalaysiaToday, Dec 2, 2020)

Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study

Read here (The Lancet, Nov 17, 2020)

One in 5 Covid-19 survivors will develop mental illness, a new study found—So we asked an expert why

‘Covid-19 is an infectious disease that causes respiratory illness, but its effects can go way beyond that. A large study from Oxford University in the UK found that survivors are at a higher risk of developing mental illness, such as anxiety and depression. They are also more likely to develop dementia, according to the research, which was published in The Lancet Psychiatry on November 9.

‘The researchers analyzed electronic health records of 69 million people in the US, including more than 62,000 people who had COVID-19. They found that 20% of those infected with the coronavirus were diagnosed with a psychiatric disorder within 90 days—about twice as likely as for other groups of patients with other illnesses in the same time frame.’

Read here (Health, Nov 11, 2020)

Non-pharmaceutical intervention (NPI) measures that work, lag time, population compliance and more: The Lancet

‘A recently published article in Lancet Infectious Diseases has taken a look at potential associations between country-level reproduction numbers (R) and non-pharmaceutical interventions introduced and lifted throughout the course of the pandemic.

‘Increases in R were associated with relaxing of the following measures: school closures, public event bans, bans on gatherings greater than ten people, stay-at-home orders and other movement restrictions. However, the only significant associations for increases in R above 1 were school reopening and lifting bans on gatherings over 10 people. 

‘Authors noted that the full effect of introducing or lifting non-pharmaceutical interventions took 1-3 weeks on average from the date of implementation. Authors made further recommendations regarding the use of non-pharmaceutical interventions by national governments, noting that other factors, such as population compliance, also influence the success of non-pharmaceutical interventions and may not be fully captured in the study.’

Read here (The Lancet via Johns Hopkins University, Oct 22, 2020)

Covid reinfection: Man gets Covid twice and second hit 'more severe'

‘A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report. The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body. Reinfections remain rare and he has now recovered. But the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.’

Read here (BBC, Oct 13, 2020)

Offline: Covid-19 is not a pandemic -- It is a syndemic: Richard Horton

‘The most important consequence of seeing COVID-19 as a syndemic is to underline its social origins. The vulnerability of older citizens; Black, Asian, and minority ethnic communities; and key workers who are commonly poorly paid with fewer welfare protections points to a truth so far barely acknowledged—namely, that no matter how effective a treatment or protective a vaccine, the pursuit of a purely biomedical solution to COVID-19 will fail. Unless governments devise policies and programmes to reverse profound disparities, our societies will never be truly COVID-19 secure. 

‘As Singer and colleagues wrote in 2017, “A syndemic approach provides a very different orientation to clinical medicine and public health by showing how an integrated approach to understanding and treating diseases can be far more successful than simply controlling epidemic disease or treating individual patients.” I would add one further advantage. Our societies need hope. The economic crisis that is advancing towards us will not be solved by a drug or a vaccine. Nothing less than national revival is needed. Approaching COVID-19 as a syndemic will invite a larger vision, one encompassing education, employment, housing, food, and environment. Viewing COVID-19 only as a pandemic excludes such a broader but necessary prospectus.’

Read here (The Lancet, Sept 26, 2020)

Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly

Executive summary: ‘The Lancet COVID-19 Commission was launched on July 9, 2020, to assist governments, civil society, and UN institutions in responding effectively to the COVID-19 pandemic. The Commission aims to offer practical solutions to the four main global challenges posed by the pandemic: suppressing the pandemic by means of pharmaceutical and non-pharmaceutical interventions; overcoming humanitarian emergencies, including poverty, hunger, and mental distress, caused by the pandemic; restructuring public and private finances in the wake of the pandemic; and rebuilding the world economy in an inclusive, resilient, and sustainable way that is aligned with the Sustainable Development Goals (SDGs) and the Paris Climate Agreement. Many creative solutions are already being implemented, and a key aim of the Commission is to accelerate their adoption worldwide.’

Download full statement here (Sept 14, 2020)

Child malnutrition and Covid-19: The time to act is now

‘The Lancet recently published a call to action co-authored by the directors of UNICEF, the Food and Agriculture Organization, the World Food Programme, and the WHO. The statement addresses the growing threat of childhood malnutrition due to downstream effects of the COVID-19 pandemic and associated response policies and operations, particularly in low- and middle-income countries. The statement listed 5 “urgent actions” to support children's right to adequate nutrition during the pandemic. Specifically, the authors call on national governments and private donors to support efforts to ensure access to nutritious, safe, and affordable diets; maternal and child health; early detection and treatment for child wasting; nutritious school meals for vulnerable children; and safe access to food and essential services. These priorities must be integrated more completely into the COVID-19 response.’ -- Center for Health Security, John Hopkins University

Read here (The Lancet, July 27, 2020)

Lancet says scapegoating China for pandemic ‘not constructive’

‘Prestigious scientific journal The Lancet has praised aspects of China’s response to Covid-19, while pushing back against political rhetoric blaming the country for the pandemic.

‘An editorial published on Friday for the journal’s latest edition acknowledged that China had been “widely criticised for its role and responsibilities during the pandemic because of censorship, transparency, and human rights concerns”, but said the rest of the world could still learn from its disease control successes.’

Read here (South China Morning Post, July 24, 2020)

Download The Lancet editorial PDF here

Scathing Covid-19 book from Lancet editor — rushed but useful

‘Now [Richard] Horton has a book of his own. The COVID-19 Catastrophe is a sort of history, diagnosis and prescription, in real time. It is wide ranging, querying the changing role of international cooperation and the fallout of austerity economics, and taking a deeper dive into China’s scientific and political response to the crisis than most Western media have offered. But the book returns again and again to the catastrophe in both the United Kingdom and the United States. It is haunted by the question: how did two of the richest, most powerful and most scientifically advanced countries in the world get it so wrong, and cause such ongoing pain for their citizens?’

Read here (Nature, June 18, 2020)

Scathing Covid-19 book from Lancet editor — rushed but useful

‘Since the coronavirus crisis began, Richard Horton, editor-in-chief of leading medical journal The Lancet, has been tearing across the British public sphere. Here he is on the BBC, the national broadcaster, there in the pages of The Guardian newspaper — taking the government to task for failures that have left the United Kingdom with the world’s second-highest per capita COVID-19 death toll so far (Belgium is top). Horton has never shied away from controversy (his journal published the retracted, fraudulent paper by Andrew Wakefield that alleged a non-existent link between vaccines with autism) or crusades (against the Iraq war and for political action on climate change). In coronavirus, he has found a cause that matches his energy: the Lancet journals are pumping out both the latest research and his pointed critiques of government policy; and last month, he reviewed a new book by the Slovenian Marxist philosopher Slavoj Žižek that imagines economic and social worlds after COVID-19.

‘Now Horton has a book of his own. The COVID-19 Catastrophe is a sort of history, diagnosis and prescription, in real time. It is wide ranging, querying the changing role of international cooperation and the fallout of austerity economics, and taking a deeper dive into China’s scientific and political response to the crisis than most Western media have offered. But the book returns again and again to the catastrophe in both the United Kingdom and the United States. It is haunted by the question: how did two of the richest, most powerful and most scientifically advanced countries in the world get it so wrong, and cause such ongoing pain for their citizens?’

Read here (Nature, June 18, 2020)

Lancet editor spills the beans and the unfolding of a pharmaceutical scandal

‘In a videotaped interview on May 24, 2020, Dr [Philippe] Douste-Blazy provided insight into how a series of negative hydroxychloroquine studies got published in prestigious medical journals. He revealed that at a recent Chatham House top secret, closed door meeting attended by experts only, the editors of both, The Lancet and the New England Journal of Medicine expressed their exasperation citing the pressures put on them by pharmaceutical companies... [Douste-Blazy is a cardiologist and former French Health Minister who served as Under-Secretary General of the United Nations. He was a candidate in 2017 for Director of the World Health Organization]

‘The alarming findings and serious negative impact of the Lancet report led numerous scientists around the globe to scrutinise the report in detail. That scrutiny by legitimate, independent scientists has led to many serious questions about the integrity of the study, the authenticity of the data, and the validity of the methods the authors used... [many details are provided in this story]

Demonisation of favourable HCQ-AZ treatment studies: ‘Since publishing favourable reports about a treatment combination of two cheap, widely prescribed medicines: hydroxychloroquine and the antibiotic azithromycin, as a treatment of choice against Covid-19, Dr [Didier] Raoult has become the subject of intense demonisation by the corporate-influenced medical establishment, the media, and the [sic] who resort to this tactic whenever they lack evidence or legitimate grounds to support public health policies that cause people harm.’

Read here (Health Impact News, received on June 13, 2020)

The pandemic's first major research scandal erupts

‘The controversy is an unfortunate distraction, says Miguel Hernán, a Harvard epidemiologist and co-investigator on an ongoing trial of hydroxychloroquine in Spain and Latin America. “If you do something as inflammatory as this without a solid foundation, you are going to make a lot of people waste time trying to understand what is going on.” Chaccour says both NEJM and The Lancet should have scrutinized the provenance of Surgisphere's data more closely before publishing the studies. “Here we are in the middle of a pandemic with hundreds of thousands of deaths, and the two most prestigious medical journals have failed us,” he says.’

Read here (Science Magazine, June 5, 2020)

Governments and WHO changed Covid-19 policy based on suspect data from tiny US company

‘The World Health Organization and a number of national governments have changed their Covid-19 policies and treatments on the basis of flawed data from a little-known US healthcare analytics company [Surgisphere], also calling into question the integrity of key studies published in some of the world’s most prestigious medical journals [The Lancet and New England Journal of Medicine].

‘Data it claims to have legitimately obtained from more than a thousand hospitals worldwide formed the basis of scientific articles that have led to changes in Covid-19 treatment policies in Latin American countries. It was also behind a decision by the WHO and research institutes around the world to halt trials of the controversial drug hydroxychloroquine. On Wednesday, the WHO announced those trials would now resume.’

Read here (The Guardian, June 3, 2020)

WHO temporarily pauses hydroxychloroquine study due to safety concerns

‘The World Health Organization has temporarily halted studying hydroxychloroquine as a potential Covid-19 treatment due to safety concerns, WHO Director-General Tedros Adhanom Ghebreyesus said during a media briefing in Geneva on Monday.

‘The decision was made after an observational study published Friday in the medical journal The Lancet described how seriously ill Covid-19 patients who were treated with hydroxychloroquine and chloroquine were more likely to die. Tedros said that an independent executive group is now reviewing the use of hydroxychloroquine in WHO's Solidarity Trial. The executive group represents 10 of the participating countries in the trial.’

Read here (CNN, May 25, 2020)

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of Covid-19: A multinational registry analysis

‘Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

’We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.’

Read here (The Lancet, May 22, 2020)

First human trial of COVID-19 vaccine finds it is safe and induces rapid immune response

‘These results represent an important milestone. The trial demonstrates that a single dose of the new adenovirus type 5 vectored COVID-19 (Ad5-nCoV) vaccine produces virus-specific antibodies and T cells in 14 days, making it a potential candidate for further investigation,’ says Professor Wei Chen from the Beijing Institute of Biotechnology in Beijing, China, who is responsible for the study. ‘However, these results should be interpreted cautiously. The challenges in the development of a COVD-19 vaccine are unprecedented, and the ability to trigger these immune responses does not necessarily indicate that the vaccine will protect humans from COVID-19. This result shows a promising vision for the development of COVID-19 vaccines, but we are still a long way from this vaccine being available to all.’

Read here (Science Daily, May 22, 2020)

This is the original report in The Lancet. Read here (The Lancet, May 22, 2020)

Vitamin-D and Covid-19: Do deficient risk a poorer outcome?

‘A role for vitamin D in the response to COVID-19 infection could be twofold. First, vitamin D supports production of antimicrobial peptides in the respiratory epithelium, thus making infection with the virus and development of COVID-19 symptoms less likely. Second, vitamin D might help to reduce the inflammatory response to infection with SARS-CoV-2. Deregulation of this response, especially of the renin–angiotensin system, is characteristic of COVID-19 and degree of overactivation is associated with poorer prognosis. Vitamin D is known to interact with a protein in this pathway—angiotensin-converting enzyme 2 (ACE2)—which is also exploited by SARS-CoV-2 as an entry receptor. While SARS-CoV-2 downregulates expression of ACE2, vitamin D promotes expression of this gene.’

Read here (The Lancet, May 20, 2020)

Trump threatens to permanently pull funding from WHO and 'reconsider' US membership

‘President Donald Trump is escalating his threats against the World Health Organization, telling the agency he will permanently pull US funding if it does not "commit to major substantive improvements in the next 30 days."

‘Trump's letter -- in which he included a false description of when information about the virus was published in The Lancet, prompting the prestigious medical journal to publicly dispute his claims on Tuesday -- is the latest action he's taken against the WHO following his decision last month to temporarily halt US funding to the group.’

Read here (CNN, May 19, 2020)

Read response by The Lancet here (Twitter, May 19, 2020)

Reviving the US CDC

‘But punishing the agency by marginalising and hobbling it is not the solution. The Administration is obsessed with magic bullets—vaccines, new medicines, or a hope that the virus will simply disappear. But only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency. The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today's complicated effort.’

Read here (The Lancet, May 16, 2020)

Study warns 1.1 million children, 56,000 mothers, could die as pandemic interrupts access to food & medical care

A new report finds 1.1 million children under 5 could die, and 56,700 maternal deaths occur, in the next six months from secondary impacts of the pandemic, like disruptions to health services and access to food... ‘Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1,157,000 additional child deaths and 56,700 additional maternal deaths.’

Read here (The Lancet, May 12, 2020)