Learning to breathe: German clinic helps Covid long haulers

‘Located in Heiligendamm, a north German seaside spa popular since the late 18th century, the clinic specializes in helping people with lung diseases such as asthma, chronic bronchitis and cancer. Over the past year it has become a major rehabilitation center for COVID-19 patients, treating 600 people from across Germany, according to its medical director, Dr. Joerdis Frommhold.

‘Some of her patients came close to death and now have to relearn how to breathe properly, rebuild their stamina and overcome a host of neurological problems associated with severe illness. But Frommhold also treats a second group of patients who experienced mild to medium COVID-19 symptoms, and only spent a short time in the hospital, if at all. “These patients get rebound symptoms after about one to four months,” Frommhold said.

Read here (Associated Press, Apr 20, 2021) 

UK clinical trial confirms SaNOtize’s breakthrough treatment for Covid-19

• Patients with a self-administered nasal spray application found to have reduced SARS-CoV-2 log viral load by more than 95% in infected participants within 24 hours of treatment, and by more than 99% in 72 hours
• Trial concluded that treatment accelerated clearance of SARS-CoV-2 by a factor of 16-fold versus a placebo
• Randomized, double-blind, placebo-controlled trial evaluated 79 confirmed cases of COVID-19, the majority heavily-infected with the UK variant
• No adverse events were recorded in the group
• Submission for Emergency Use in the UK and Canada for the treatment and prevention of COVID-19 is planned immediately

Read here (Business Wire, Mar 15, 2021)

FTTISI:The bedrock of Covid-19 infection control — Dr Musa Mohd Nordin and Dr Mohammad Farhan bin Rusli

‘The key element in the blueprint of action to mitigate this Covid-19 national emergency, must surely be a well executed Find, Test, Trace, Isolate and Support (FTTIS) system recommended by the WHO, which has fallen terribly short in national implementation.

‘The FTTIS system Finds and Tests hotspots of Covid-19 outbreaks. Rapid Isolation of cases and quarantine of close contacts through Tracing is extremely critical. Isolation will only work if the rakyat, especially the B40, receive Support during the MCO period with food security and financial Support.

‘The government through its relevant ministries and agencies must provide this social security net and support to this new policy of home isolation to ensure its success. Otherwise, the rakyat will fail to comply with home isolation, in order to search for and put food on the table and scour for basic home essentials. The government already has in place Low Risk Isolation Centres for households who are unable to effectively isolate at home.

‘Clinical support is also vital for monitoring the health of cases and contacts who are undergoing home isolation in the community.’

Read here (Malay Mail, Jan 15, 2021)

Prevalence and risk factors for delirium in critically ill patients with Covid-19: A multicentre cohort study

‘In this large, international cohort study of more than 2000 patients with severe COVID-19, acute brain dysfunction (coma or delirium) was more common and more prolonged than observed in other studies of patients with acute respiratory failure without COVID-19. Patients with COVID-19 also received treatment with sedatives for a prolonged duration: two-thirds of patients were given benzodiazepines and propofol for a median of 7 days. 

‘As a result of the COVID-19 pandemic, many ICUs were operating in resource-constrained environments, and despite demonstrated efficacy in previous studies, evidenced-based strategies, such as light sedation techniques, spontaneous awakening and breathing trials, avoiding benzodiazepines, early mobility, and family visitation, all occurred on fewer than 1 in every 3 days among patients with severe COVID-19. We found that risk of delirium among patients with severe COVID-19 was lower when benzodiazepine sedative infusions were avoided and family was present, whereas greater severity of illness and greater respiratory support was associated with a higher risk of delirium.’

Read here (The Lancet, Jan 8, 2021)

The mysterious link between Covid-19 and sleep

‘The coronavirus can cause insomnia and long-term changes in our nervous systems. But sleep could also be a key to ending the pandemic... 

‘The newly discovered coronavirus had killed only a few dozen people when Feixiong Cheng started looking for a treatment. He knew time was of the essence: Cheng, a data analyst at the Cleveland Clinic, had seen similar coronaviruses tear through China and Saudi Arabia before, sickening thousands and shaking the global economy. So, in January, his lab used artificial intelligence to search for hidden clues in the structure of the virus to predict how it invaded human cells, and what might stop it. One observation stood out: The virus could potentially be blocked by melatonin...

‘After he published his research, though, Cheng heard from scientists around the world who thought there might be something to it. They noted that, in addition to melatonin’s well-known effects on sleep, it plays a part in calibrating the immune system. Essentially, it acts as a moderator to help keep our self-protective responses from going haywire—which happens to be the basic problem that can quickly turn a mild case of COVID-19 into a life-threatening scenario.’

Read here (The Atlantic, Dec 22, 2020)

Covid-19 blood plasma therapy has limited effect, study finds

‘It has been touted as a breakthrough treatment by Donald Trump, and there are hopes that blood plasma containing coronavirus antibodies may help British patients during the second wave of Covid-19 as well. But a study, which is published in the British Medical Journal (BMJ) on Friday, suggests “convalescent plasma” has only limited effectiveness and fails to reduce deaths or stop the progression to severe disease.

‘The research involved 464 adults with moderate Covid-19 who were admitted to hospitals in India between April and July. Approximately half received two transfusions of convalescent plasma, 24 hours apart, alongside standard care, while the control group received standard care only. One month later, 19% of those who received the plasma had progressed to severe disease or had died of any cause, compared with 18% in the control group. Plasma therapy did, however, seem to reduce symptoms, such as shortness of breath and fatigue, after seven days.’

Read here (The Guardian, Oct 23, 2020)

CRISPR, the gene-editing technology, carries much promise – and peril – amid pandemic

‘As the battle against Covid-19 intensifies, one scientist calls CRISPR ‘our power pellet to help us fight this horrible virus’. The genome-editing tool could indeed bring an end to disease and drastically improve our lives, but with it comes the spectre of bioengineered abomination...

‘It might turn out that CRISPR and its spin-off techno­logies arrive too late to have any effective and lasting impact on the current pandemic. There could be a backlash against CRISPR’s darker potential that undermines the hope for the life-changing good it undoubtedly holds. Fear and scepticism could outmuscle reason and diligent inquiry as the CRISPR saga plays out against a backdrop of polar­isation and bias.

“In the old days, people came to herbs to find new medicine,” says Qi. “In the past century, people turned to chemistry. While human lifespans become longer, the quality of human life still needs to be improved. There are many age-related diseases which simply cannot be addressed using herbs or chemical drugs. The solution is likely in molecules – and CRISPR is probably one of them. One ultimate hope is that CRISPR can help to address ageing, and help people with age-related diseases.”

Read here (South China Morning Post, Sept 5, 2020)  

Steroids can be lifesaving for Covid-19 patients, scientists report: New data in hand, the WHO recommended that doctors give the drugs to critically ill patients worldwide

‘International clinical trials published on Wednesday confirm the hope that cheap, widely available steroid drugs can help seriously ill patients survive Covid-19, the illness caused by the coronavirus. Based on the new evidence, the World Health Organization issued new treatment guidance, strongly recommending steroids to treat severely and critically ill patients, but not to those with mild disease...

‘JAMA published that paper and three related studies, along with an editorial describing the research as an “important step forward in the treatment of patients with Covid-19.” Corticosteroids should now be the first-line treatment for critically ill patients, the authors said. The only other drug shown to be effective in seriously ill patients, and only modestly at that, is remdesivir. Steroids like dexamethasone, hydrocortisone and methylprednisolone are often used by doctors to tamp down the body’s immune system, alleviating inflammation, swelling and pain. Many Covid-19 patients die not of the virus, but of the body’s overreaction to the infection.’

Read here (New York Times, Sept 2, 2020)

WHO ‘living guidance' on corticosteroids for Covid-19:

Download here (WHO)

A supercomputer analysed Covid-19 — and an interesting new theory has emerged: A closer look at the Bradykinin hypothesis

‘Earlier this summer, the Summit supercomputer at Oak Ridge National Lab in Tennessee set about crunching data on more than 40,000 genes from 17,000 genetic samples in an effort to better understand Covid-19. Summit is the second-fastest computer in the world, but the process — which involved analyzing 2.5 billion genetic combinations — still took more than a week.

‘When Summit was done, researchers analyzed the results. It was, in the words of Dr. Daniel Jacobson, lead researcher and chief scientist for computational systems biology at Oak Ridge, a “eureka moment.” The computer had revealed a new theory about how Covid-19 impacts the body: the bradykinin hypothesis. The hypothesis provides a model that explains many aspects of Covid-19, including some of its most bizarre symptoms. It also suggests 10-plus potential treatments, many of which are already FDA approved. Jacobson’s group published their results in a paper in the journal eLife in early July...

‘Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house. Once inside, though, they don’t just take your stuff — they also throw open all your doors and windows so their accomplices can rush in and help pillage more efficiently...’

Read here (Elemental Medium, September 1, 2020)

Evidence for convalescent plasma coronavirus treatment lags behind excitement

‘But so far, there’s little evidence that plasma actually helps patients, and the decision could confound efforts to study its effects, says former FDA commissioner Robert Califf, who now heads clinical policy and strategy at Verily and Google Health in South San Francisco, California... Convalescent plasma has been tested only in small trials without the statistical power to provide firm conclusions... “It’s a potential therapy that could work, and I don’t think it’s out of bounds to make it available” with an authorization, says Califf. “But we ought to be really emphasizing in public-service announcements that participation in randomized trials is a first priority.” 

[This story was written before the US Food and Drug Administration issued an emergency-use authorisation on August 23 to treat COVID-19 with convalescent plasma.]

Read here (Scientific American, August 24, 2020)

WHO cautious on Covid-19 plasma as US issues emergency authorisation

‘The World Health Organisation on Monday (Aug 24) was cautious about endorsing the use of recovered Covid-19 patients' plasma to treat those who are ill, saying that evidence that it works remains "low quality" even as the United States issued emergency authorisation for such therapies. So-called convalescent plasma, which has long been used to treat diseases, has emerged as the latest political flashpoint in the race to find therapies for Covid-19. The US Food and Drug Administration (FDA) on Sunday authorised its use after President Donald Trump blamed the agency for impeding the rollout of vaccines and therapeutics for political reasons.’

Read here (Reuters, August 24, 2020)

US announces major clinical trial of antibody treatment

‘The US has begun late stage clinical trials into a drug formulated to fight Covid-19, officials said Tuesday. The medicine is an antibody against the new coronavirus called LY-CoV555, which was identified in the blood sample of a recovered patient by Canada’s Abcellera Biologics. It was then developed synthetically for mass production by US-based Lilly Research Laboratories in partnership with Abcellera. The Phase 3 trial will initially enrol some 300 volunteers around the world who have been hospitalised with mild to moderate Covid-19 with fewer than 13 days of symptoms.’

Read here (South China Morning Post, August 4, 2020)

What the D614G mutation means for Covid-19 spread, fatality, treatment, and vaccine

‘We are facing the global shift of the SARS-CoV-2 variant — from D614 to G614. The G614 variant is more infectious in laboratory settings; whether it means increased viral spread in humans is unconfirmed. Current evidence says that the G614 variant is not any deadlier than D614. And so, treatment options should not be any more different. Both the D614 and G614 variants should react similarly to vaccines, studies suggest, as the mutation does not change the immunogenic part of the spike protein; that is, the receptor-binding domain (RBD).’

[This is a survey of literature by a young post-grad Malaysian. It gives a rounded picture of the D614G mutation without using too much jargon. Must counter check the accuracy of what's stated against the originals.] 

Read here (Medium, July 31, 2020)

Lessons for Covid-19 from the early days of AIDS

‘Thirty-six years ago, we were, like today, in the midst of a new and still somewhat mysterious global pandemic. In the U.S. alone, more than one million people were infected with HIV, and 12,000 had already died of AIDS. At the time, we were just beginning to understand how the virus worked. But that didn’t stop some leaders from making wildly optimistic claims about an AIDS vaccine being delivered within two years.

‘Now, with COVID-19, we are in a remarkably similar spot: 2.7 million people have been infected across the U.S., and 128,000 have died of the disease. Despite our limited understanding of how the novel coronavirus works and what it does to the human body, many are putting what I consider a disproportionate amount of faith in the possibility of a COVID-19 vaccine by 2021. My feelings today echo my feelings a third of a century ago: yes, a vaccine may be possible, but it is by no means a certainty.’

Read here (Scientific American, July 6, 2020)

Coronavirus autopsies: A story of 38 brains, 87 lungs and 42 hearts

‘Given widespread reports about neurological symptoms related to the coronavirus, Fowkes [an associate professor of pathology who is part of a team at Mount Sinai Health that has performed autopsies on 67 covid-19 patients] said, she expected to find virus or inflammation — or both — in the brain. But there was very little. When it comes to the heart, many physicians warned for months about a cardiac complication they suspected was myocarditis, an inflammation or hardening of the heart muscle walls — but autopsy investigators were stunned that they could find no evidence of the condition.

‘Another unexpected finding, pathologists said, is that oxygen deprivation of the brain and the formation of blood clots may start early in the disease process. That could have major implications for how people with covid-19 are treated at home, even if they never need to be hospitalized.’

Read here (Washington Post, July 2, 2020)

People have stopped going to the doctor. Most seem just fine

‘As stay-at-home orders ease and cities reopen for business, many doctors and hospital administrators are calling for a quick return of health care to pre-pandemic levels. For months now, routine care has been postponed. Elective procedures — big moneymakers — were halted so that hospitals could divert resources to treating Covid-19 patients. Routine clinic visits were canceled or replaced by online sessions. This has resulted in grievous financial losses for hospitals and clinics. Medical practices have closed. Hospitals have been forced to furlough employees or cut pay.

‘Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey, only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.’

Read here (New York Times, June 22, 2020)

Gilead to start testing an inhaled version of remdesivir, making it available to vastly more patients

‘The biotech giant that developed the first effective coronavirus treatment is now looking to expand its impact. Gilead Sciences CEO Daniel O'Day said Monday that the company would start testing an inhaled version of the antiviral drug remdesivir in August. Currently, the drug is given as an intravenous infusion. If remdesivir is effective when given through a nebulizer, that "could have significant implications in helping to stem the tide of the pandemic," O'Day wrote in an open letter.’

Read here (Business Insider, June 22, 2020)

The essential but invisible trade: TRAFFIC sounds alarm over sustainability of wild plants used to treat Covid-19

‘Wild plant species used in herbal treatments of Covid-19 are set to come under heightened harvesting pressure, both as a result of increased demand and because of more people turning to wild harvesting as an alternative source of income during times of high unemployment and economic crisis. The future availability of plant ingredients to support human health—through medicines, food and well-being products—is dependent on prioritising the conservation and sustainable use of their source species in the long-term.’

Read here (Traffic, June 18, 2020)

Hadassah doctors crack the cause of fatal corona blood clots

‘A research team at Hadassah-University Medical Center in Jerusalem’s Ein Kerem discovered that patients who form fatal blood clots have an increased level of alpha defensin protein in their blood... They also say they have a way to treat the cause before it’s too late... At least 30% of patients with coronavirus develop blood clots that block the flow of blood to their kidneys, heart and brain, as well as the lungs, according to international research...

‘Dr. Abd Alrauf Higavi said his team are en route to a solution: administering the drug colchicine to coronavirus patients. Colchicine is an approved drug used in the prevention and treatment of gout attacks, caused by too much uric acid in the blood. Higavi said they have completed testing colchicine on mice and found that it successfully inhibited the release of alpha defensin. Now, they are waiting for the necessary approvals to test it on human coronavirus patients.’

Read here (Jerusalem Post, June 16, 2020)

A pulmonary physician on what it's like to treat Covid-19 patients

‘I did not think much about my risk. Doctors are always at some risk of contracting a disease. However, that changed when I was exposed to a COVID-19-positive patient without my personal protective equipment for a considerable period of time and in close proximity. I questioned my "recklessness" in examining the patient (who did not exhibit any COVID-19 symptoms) and my ability to infect my family and other patients. I felt guilty and foolish for putting myself and my family in such a position. It was not a good day. One of my colleagues had even written a living will, just in case.’ 

Read here (Asia Society, June 3, 2020)