Seniors with Covid-19 taking ACE inhibitors have lower hospitalisation risk

‘A Yale-led study suggests that older COVID-19 patients taking ACE inhibitors for hypertension have a lower risk of hospitalization for the novel coronavirus... The use of ACE inhibitors was associated with an almost 40% lower risk of COVID-19 hospitalization for the older, Medicare Advantage patients — but there was no significant difference in risk for the younger, commercially insured patients.’

Read here (Yale, May 27, 2020)

Read original Medrxiv pre-print paper here

Coronavirus: 'Baffling' observations from the front line

“It felt in some ways like we were trying to prepare for the D-Day landings," says Barbara Miles, clinical director of intensive care at Glasgow Royal Infirmary, "with three weeks to get ready and not a great deal of knowledge about what we would be facing". But what arrived in the UK as winter turned into spring took even the most experienced ICU specialists by surprise. Most people infected with the coronavirus have only mild symptoms, or sometimes none at all. But in many thousands of patients who fall critically ill, Covid-19 is a disease of alarming complexity.’

Read here (BBC, May 23, 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)

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)

Covid 19 coronavirus 'cure'? US biotech company claims it's found antibody to block virus

‘A California-based biotech company claims it has found an antibody that completely blocks the new coronavirus. Sorrento Therapeutics said its STI-1499 antibody stopped Covid-19 from entering 100 per cent of healthy human cells in their experiments, Fox News reports. The antibody is one of several the biotech company is planning to combine for a collaboration with Mt Sinai School of Medicine in New York.’

Read here (NZ Herald, May 16, 2020)

Trump Administration announces framework and leadership for ‘Operation Warp Speed’

‘Operation Warp Speed [the administration's national program to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics (medical countermeasures)] is a public-private partnership to facilitate, at an unprecedented pace, the development, manufacturing, and distribution of COVID-19 countermeasures, between components of HHS, including CDC, FDA, NIH, and the Biomedical Advanced Research and Development Authority (BARDA); the Department of Defense; private firms; and other federal agencies, including the Department of Agriculture, the Department of Energy, and the Department of Veterans Affairs. It will coordinate existing HHS-wide efforts, including the NIH's ACTIV partnership for vaccine and therapeutic development, NIH's RADx initiative for diagnostic development, and work by BARDA.’

Read here (HHS, US Department of Health & Human Services, May 15, 2020)

Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care

‘Emergency department volume is down nearly 50% as the United States struggles with the Covid-19 epidemic. There is increasing evidence that patients with medical emergencies are avoiding the emergency department because of fear of contracting Covid-19, leading to increased morbidity and mortality.

‘Here, the authors describe efforts taken in a community hospital to understand and combat this public health concern by using human-centered design. They share interview themes, the brainstorming process, and implementation of prototypes, as well as challenges faced in the early stages of implementation. They show that addressing patient fears by dividing the emergency department into respiratory and non-respiratory pods and through targeted messaging can result in increased visits to the emergency room. Time will tell if this results in improved health outcomes for community members.’

Read here (New England Journal of Medicine Catalyst, May 14, 2020)

Damage to the kidneys, heart, brain — even ‘covid toes’ — prompts reassessment of the disease and how to treat it

‘...many scientists have come to believe that much of the disease’s devastation comes from two intertwined causes. The first is the harm the virus wreaks on blood vessels, leading to clots that can range from microscopic to sizable. Patients have suffered strokes and pulmonary emboli as clots break loose and travel to the brain and lungs. A study in the Lancet, a British medical journal, showed this may be because the virus directly targets the endothelial cells that line blood vessels. The second is an exaggerated response from the body’s own immune system, a storm of killer “cytokines” that attack the body’s own cells along with the virus as it seeks to defend the body from an invader.

‘Research and therapies are focused on these phenomena. Blood thinners are being more widely used in some hospitals. A review of records for 2,733 patients, published Wednesday in the Journal of the American College of Cardiology, indicates they may help the most seriously ill.’

Read here (Washington Post, May 10, 2020)

S’pore’s youngest Covid-19 casualty was declared virus-free a week before she died

‘The husband and three children of Ms Salha Mesbee - the youngest patient here to die from the coronavirus - gathered at her bedside in the intensive care unit (ICU) at the Ng Teng Fong General Hospital just hours before her death.

‘Ms Salha, 58, had been declared virus-free nine days earlier, but the infection had already taken a toll on her body, her daughter told The Straits Times. Her vital organs, including her kidneys and liver, were failing and she was in a bad shape.’

Read here (Straits Times, May 5, 2020)

The invisible pandemic: Our most important task is not to stop spread but to concentrate on giving the unfortunate victims optimal care

‘COVID-19 is a disease that is highly infectious and spreads rapidly through society. It is often quite symptomless and might pass unnoticed, but it also causes severe disease, and even death, in a proportion of the population, and our most important task is not to stop spread, which is all but futile, but to concentrate on giving the unfortunate victims optimal care.’

Read here (The Lancet, May 5, 2020)

Famed HIV researcher on the race to find a Covid-19 treatment

‘David Ho is in a race against time to find a treatment for COVID-19. Fortunately it's the kind of race he's run before. Ho, the famed virologist and director and CEO of the Aaron Diamond AIDS research center at Columbia University, rose to prominence decades ago with his HIV research. Now he's working to develop a drug that can interrupt the coronavirus' ability to replicate, which, if successful, could lead to a treatment for COVID-19. His team is also studying antibody responses to the virus and is among dozens of labs racing to develop treatments.

‘The Jack Ma Foundation recently gave Ho and other researchers at Columbia University a $2.1 million grant to support their efforts to identify antiviral drugs and antibodies that can be used to fight the coronavirus.

‘Ho: My group is not so much working on a vaccine. We're trying to discover small-molecule drugs or develop antibodies that can be used either as prophylactics or therapeutics. We think the timeline for antibodies in particular can be much faster. We know we have the technology to fish out and construct very powerful antibodies that can be used to treat the infection, as well as prevent the infection.’

Read here (NBC News, May 1, 2020)

US launches SPHERES consortium to monitor, conduct genomic research and share information on the Coronavirus

CDC is leading the SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES), a new national genomics consortium to coordinate SARS-CoV-2 sequencing across the United States. Large-scale, rapid genomic sequencing of the virus that causes COVID-19 will allow public health experts to:

• Monitor important changes in the virus as it continues to circulate.
• Gain important insights to support contact tracing.
• Provide crucial information to aid in identifying diagnostic and therapeutic targets.
• Advance public health research in the areas of transmission dynamics, host response, and evolution of the virus.

Read here (US CDC, April 30, 2020)

Bill Gates explains his plan to beat Covid-19

In an interview with Vox's editor-at-large Ezra Klein, Bill Gates covers a wide-ranging number of subjects on his interest and involvement in the prevention of pandemics; from history to the current issues of testing, treatments and vaccines, and from his current work to the conspiracy theories that surround it.

Read here (Vox, April 27, 2020)

US says will not take part in WHO global drugs, vaccine initiative launch

‘The United States will not take part in the launching of a global initiative on Friday to speed the development, production and distribution of drugs and vaccines against COVID-19, a spokesman for the U.S. mission in Geneva told Reuters.

“There will be no US official participation”, he said in an email reply to a query. “We look forward to learning more about this initiative in support of international cooperation to develop a vaccine for COVID-19 as soon as possible.”

Read here (Reuters, April 25, 2020)

Related:

• WHO initiates ACT (Access to Covid-19 Tools) Accelerator. Read here

WHO initiates ACT (Access to Covid-19 Tools) Accelerator

‘Our mission is not only accelerated development and availability of new COVID-19 tools – it is to accelerate equitable global access to safe, quality, effective, and affordable COVID-19 diagnostics, therapeutics and vaccines, and thus to ensure that in the fight against COVID-19, no one is left behind.’

Download here (WHO, April 24, 2020)

Finding effective treatments for COVID-19: Scientific integrity and public confidence in a time of crisis

‘Everyone wants new treatments and vaccines to address the devastation of coronavirus disease 2019 (COVID-19). But, currently, under intense pressure and based on hope and limited data from poorly conducted clinical trials and observational data, many clinicians are embarking on ill-advised and uncontrolled human experimentation with unproven treatments.’

This paper calls for three important considerations:

1. ‘First, the regulatory and research communities owe it to patients, families, and clinicians to quickly learn what treatments are effective... 
2. ‘Second, it is important to optimise treatments that already exist, including supportive critical care. As learned from the Ebola outbreak, mortality can be reduced through identifying best practices...
3. ‘Third, and most important, it is critical to protect the integrity of and resulting public trust in the scientific and regulatory agencies and their advice and decisions. That trust will be needed once vaccines against COVID-19 become available and in future public health emergencies.’

Read here (JamaNetwork, April 16, 2020)

MySejahtera app to help Malaysians manage Covid-19 outbreaks

‘MySejahtera is an application developed by the Government of Malaysia to assist in managing the COVID-19 outbreaks in the country. It allows users to perform health self-assessment on themselves and their family members. The users can also monitor their health progress throughout the COVID-19 outbreak. Also, MySejahtera enables the Ministry of Health (MOH) to monitor users’ health condition and take immediate actions in providing the treatments required.’

• For IOS, click through here 
• For Android, here
• For Huawei, here

Sound advice from a USM medical microbiologist

Besides giving three important points on Covid-19, she said: ‘We know that besides our fallibility from threats like infectious disease, nothing else is certain. But uncertainty is a familiar friend in science and the quest for truth. And as the great physicist Richard Feynman said, “What is not surrounded by uncertainty cannot be the truth.” Pain is inevitable, suffering is optional. There is inevitably pain in uncertainty, and it is unsettling. But instead of suffering, we can choose to view uncertainty with hope. For as long as we acknowledge that we do not know for certain, we can try and find out. That is the scientific truth.’

Read here (The Star, April 12, 2020)

Why blood from coronavirus survivors could be a lifeline for the sick

A growing number of hospitals are investigating antibody testing and blood plasma therapy as a way to combat the new coronavirus in sick patients. WSJ’s Daniela Hernandez explains in a video.

View video here (Wall Street Journal, April 10, 2020)

Infectious Diseases Society of America (IDSA) issues guidelines on the treatment and management of patients with COVID-19

The IDSA have issued 7 recommendations on the treatment and management of COVID-19 patients. These are part of their aim to “develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of [these] patients.”

They recognise the limitations imposed by “the understandable urgency in producing, synthesising and disseminating data during the current pandemic”. In the rush to publish, there has been (1) circumvention of usual research steps (2) limited peer-review process and (3) increased potential for publication bias (in the interest of showing promising data and in the race to achieve recognition).

The recommendations are based on “evidence from the best available clinical studies with patient-important endpoints”. They also discuss trade-offs between “highly uncertain benefits” and “known putative harms”. They cover treatments involving drugs like azithromycin, hydroxychloroquine, lopinavir-ritonavir, corticosteroids and tocilizumab.

Read here (IDSA, March 11, 2020)