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31

Public Health / Coronavirus: WHO advises to wear masks in public areas

« on: June 07, 2020, 08:16:52 PM »

The World Health Organization (WHO) has changed its advice on face masks, saying they should be worn in public where social distancing is not possible to help stop the spread of coronavirus.

The global body said new information showed they could provide "a barrier for potentially infectious droplets".

Some countries already recommend or mandate face coverings in public.

The WHO had previously argued there was not enough evidence to say that healthy people should wear masks.

However, WHO director-general Dr Tedros Adhanom Ghebreyesus said on Friday that "in light of evolving evidence, the WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments".

The organisation had always advised that medical face masks should be worn by people who are sick and by those caring for them.

Globally, there have been 6.7 million confirmed coronavirus cases and nearly 400,000 deaths since the outbreak began late last year, according to data compiled by Johns Hopkins University.

What is the WHO's advice?

The organisation said its new guidance had been prompted by studies over recent weeks.

Dr Maria Van Kerkhove, the WHO's technical lead expert on Covid-19, told Reuters news agency the recommendation was for people to wear a "fabric mask - that is, a non-medical mask".

Fabric masks should consist of "at least three layers of different material" in order to be effective, the WHO says.

However, those aged over-60 and with underlying health risks should wear medical masks in areas where there is community transmission.

At the same time, the WHO stressed that face masks were just one of a range of tools that could be used to reduce the risk of transmission - and that they should not give people a false sense of protection.

"Masks on their own will not protect you from Covid-19," Dr Tedros said.

This is a big shift in the WHO's guidance on when the public should cover their faces. For months, the organisation's experts stuck to the line that masks would encourage a false sense of security and would deprive medical professionals of badly needed protective equipment.

Those arguments have not gone away but at the same time the WHO acknowledges that new evidence has emerged on the risks of transmission.

It points to recent research that people can be highly infectious in the few days before they show symptoms and that some people catch the virus but never show symptoms at all, as I reported last weekend.

So where distancing is not possible, such as on public transport and in locations as varied as shops and refugee camps, it is suggested that faces are covered with homemade masks to avoid passing on the infection.

Over 60s with underlying health conditions should go further, the WHO said, and wear medical-grade masks to give themselves better protection.

In Brazil, President Jair Bolsonaro threatened to pull the country out of the WHO unless it ceased to be a "partisan political organisation". The leader, who had initially dismissed the virus as a "little flu", has been critical of the lockdown policies recommended by the agency to tackle the spread of the disease.

Last week, US President Donald Trump said he would end ties with the WHO, saying it had failed to hold China - where the outbreak begun - to account over coronavirus.

In the UK, the government announced on Friday that hospital visitors and outpatients would be required to wear face coverings, and that hospital staff would have to wear medical masks, even if they were not in a clinical setting.

The guidance will come into force on 15 June, as more businesses open up and more pupils return to school. Also on Friday the UK became the second country to record more than 40,000 coronavirus-related deaths, after the US.

What are the latest key developments globally?

The court of appeal in New South Wales, Australia, overturned a ban on a Black Lives Matter protest, which was imposed due to coronavirus concerns. Thousands flooded the streets of Sydney to commemorate African American George Floyd, who died in US police custody.

In other news:

The EU commissioner for home affairs said member states should reopen their internal borders by end of June
Coronavirus is largely retreating in those US states that acted quickly to lock down, but is persisting and even rising sharply in states that locked down later and are already starting to ease restrictions, the Washington Post reports
California will allow film, television and music production to restart on 12 June if conditions allow
Portugal will start reopening its beaches later on Saturday
In Poland, gyms, swimming pools and amusement parks will reopen
In Austria, the Vienna Philharmonic, one of the most celebrated orchestras in the world, gave its first live performance since the lockdown.Source:BBC Health

32

Public Health / Coronavirus: Influential study on hydroxychloroquine withdrawn

« on: June 06, 2020, 02:59:27 PM »

An influential article that found hydroxychloroquine increases the risk of death in coronavirus patients has been retracted over data concerns.

Three of the study's authors said they could not longer vouch for its veracity because Surgisphere, a healthcare firm behind the data, would not allow an independent review of its dataset.

Its findings led the WHO to suspend its testing on the anti-malaria drug.

But leaders including US President Donald Trump continue to tout its use.

Surgisphere chief executive Sapan Desai, the study's fourth author, told The Guardian newspaper he would co-operate with an independent audit but said transferring the data would "violate client agreements and confidentiality requirements".

What did the study say?

Research for the article, published last month in medical journal The Lancet, involved 96,000 coronavirus patients across 671 hospitals worldwide. Nearly 15,000 were given hydroxychloroquine - or a related form, chloroquine - either alone or with an antibiotic.

It concluded that the drug showed no benefits against coronavirus and increased the risk patients developing irregular heart rhythms and dying.

Mandeep Mehra, a Harvard University professor who led the study, together with Frank Ruschitzka of the University Hospital Zurich and Amit Patel of the University of Utah, said in a statement that they had tried to arrange for a third-party peer review of the data, but Surgisphere had refused to co-operate.

"We deeply apologize to you, the editors, and the journal readership for any embarrassment or inconvenience that this may have caused," the group added.

Is there any evidence the drug works against coronavirus?

There is concern in the scientific community about using such drugs to treat coronavirus.

Hydroxychloroquine is safe for treating malaria, and conditions like lupus or arthritis, but so far no clinical trials have recommended it for use against Covid-19.

Results from one clinical trial at the University of Minnesota have shown that hydroxychloroquine is not effective at preventing coronavirus.

The WHO said on 3 June that it would resume its trials after halting them last month.

Other studies are also taking place in several countries including the UK, US and Senegal.

In March, the US Food and Drug Administration granted an "emergency use" authorisation for its use on a limited number of hospitalised cases. But the following month, it issued a warning about its use because of reports of heart problems in some patients.

Why has it gained prominence?

Despite concerns for its safety and efficacy, US President Donald Trump revealed in May that he was taking hydroxychloroquine as a preventative measure against Covid-19, but later said he'd stopped.

Mr Trump has repeatedly referred to its potential. At a press conference in April, he said: "What do you have to lose? Take it."

Following Mr Trump's comments, there was a sharp increase reported in prescriptions in the US for both hydroxychloroquine and the related drug, chloroquine.

Brazilian President Jair Bolsonaro has also claimed in a video that "hydroxychloroquine is working in all places." This was removed by Facebook for breaching its misinformation guidelines.

There has also been a global surge in demand for them.Source:BBC Health

33

Public Health / Coronavirus: The mystery of 'silent spreaders'

« on: May 31, 2020, 02:33:47 PM »

As the crisis has unfolded, scientists have discovered more evidence about a strange and worrying feature of the coronavirus. While many people who become infected develop a cough, fever and loss of taste and smell, others have no symptoms at all and never realise they're carrying Covid-19.

Researchers say it's vital to understand how many are affected this way and whether "silent spreaders" are fuelling the pandemic.

When people gathered at a church in Singapore on 19 January, no-one could have realised that the event would have global implications for the spread of coronavirus. It was a Sunday and, as usual, one of the services was being conducted in Mandarin. Among the congregation at The Life Church and Missions, on the ground floor of an office building, was a couple, both aged 56, who'd arrived that morning from China.

As they took their seats, they seemed perfectly healthy so there was no reason to think they might be carrying the virus. At that time, a persistent cough was understood to be the most distinctive feature of Covid-19 and it was seen as the most likely way to transmit it. Having no symptoms of the disease should have meant having no chance of spreading it.

The couple left as soon as the service was over. But shortly afterwards, things took a turn for the worse, and in a wholly confusing way. The Chinese wife started to become ill on January 22, followed by her husband two days later. Because they had flown in from Wuhan, the epicentre of the outbreak, that was no big surprise.

But over the following week, three local people also came down with the disease for no obvious reason, leading to one of Singapore's first and most baffling coronavirus cases. Working out what had happened would lead to a new and disturbing insight into how the virus was so successfully finding new victims.

Mobilising 'disease detectives'

"We were extremely perplexed," says Dr Vernon Lee, head of communicable diseases at Singapore's Ministry of Health. "People who didn't know each somehow infected each other," while showing no sign of illness. This new batch of cases simply did not make sense, according to what was known about Covid-19 back then.

So Dr Lee and his fellow scientists, along with police officers and specialist disease trackers, launched an investigation, generating detailed maps showing who was where and when. This involved the very best of the process known as contact tracing - a version of which is getting under way now in the UK. It's seen as a vital system for tracking down everyone involved in an outbreak and helping to stamp it out, and Singapore is renowned for the skill and speed with which this is carried out.

Amazingly, within a few days, investigators had spoken to no fewer than 191 members of the church and had found out that 142 of them had been there that Sunday. They quickly established that two of the Singaporeans who became infected had been at the same service as the Chinese couple.

"They could have spoken to each other, greeted each other, during the usual activities of a church service," says Dr Lee.

That was a useful start and would explain in theory how the infection could have been passed on, apart from one key factor. It did not answer the crucial question of how the virus could have been transmitted by the two Chinese people when at that stage they had shown no indication of having the disease.

And on top of that was an even greater puzzle. It was confirmed that the third Singaporean to become infected, a 52-year-old woman, had not been at the same service as the others. Instead she had attended another event in the same church later that day, so how could she have picked up the virus?

Evidence no-one expected

Investigators resorted to going through the CCTV recordings made at the church that Sunday to search for clues. And they stumbled across something completely unexpected - the woman who'd attended the later service, after the Chinese couple had left, had sat in the seats they had used several hours earlier.

Somehow, despite having no symptoms and not feeling ill, the Chinese husband and wife had managed to spread the virus. Maybe they'd had it on their hands and touched the seats, maybe their breath carried the infection and it landed on a surface, it's not clear, but the implications were huge.

For Dr Lee, piecing everything together, there was only one possible explanation - that the virus was being passed by people who had it without even realising. This was a revelation that would be relevant the world over because the central message of all public health advice on coronavirus has always been to look out for symptoms in yourself and others.

But if the virus was also being spread by people without symptoms, silently and invisibly, how could the disease be stopped? He remembers the moment, while working in his office, when the reality dawned on him. "Every time you make a scientific discovery, it is like a 'eureka' moment when you realise that this is something important that you've uncovered, through the hard work of many individuals and teams."

Spread before symptoms show


What was revealed was what's known as "pre-symptomatic transmission" where someone is unaware of being infected because the cough, fever and other classic symptoms have yet to begin.

Along with many others, this study highlighted a critical period of 24-to-48 hours before the visible onset of the disease in which people can be highly infectious, perhaps even their most infectious.

Being aware of that is potentially invaluable, because as soon as you realise you're ill then everyone you've been in close contact with can be warned to stay at home.

That would mean that they would be isolating during the key phase of infection before their own symptoms start. But exactly how the disease can be transmitted without a cough to project droplets containing the virus is still open to debate.

One option is that simply breathing or talking to someone can do the job. If the virus is reproducing in the upper respiratory tract at that time then it's possible that some of it will emerge with each exhalation. Anyone close enough, especially indoors, could easily pick it up.

And another potential form of transmission is by touch - the virus gets onto someone's hands and they touch another person or a door handle - or a seat in a church. Whatever the route, the virus is clearly exploiting the fact that people are bound to be less vigilant if they're not aware that they might be infected.


Some people never show symptoms

This is an even more mysterious scenario, and one that scientists simply have no definitive answer to. It's one thing to know that people can be infectious before their symptoms show, quite another when they become infected but never have any sign of it.

This is what's known as being "asymptomatic" because you are a carrier of the disease but do not suffer in any way yourself. The most famous case is that of an Irish woman who was working as a cook in New York at the beginning of the last century.

Wherever Mary Mallon was employed, in house after house, people became ill with typhoid and at least three, maybe many more, died of it, but she was completely unaffected. Eventually a connection was established and it was confirmed that she was the unwitting spreader of the disease.

Reporters dubbed her "Typhoid Mary", a label she always resented, but the authorities took no chances and kept her in confinement for 23 years until her death in 1938.

Assumptions undermined

Staff nurse Amelia Powell was shocked when she found out that she is asymptomatic. She was at work on her hospital ward at Addenbrooke's Hospital in Cambridge in April when a doctor rang to give her the result of a swab test.

She had been feeling normal and safe behind the personal protective equipment she had to wear while caring for patients with Covid-19. But suddenly all those assumptions were undermined because, to her horror, she had tested positive.

"It was a bit like hearing that someone in the family had passed, it was surreal. "I thought, 'This can't be right, not me, I'm absolutely fine,'" says 23-year-old Amelia.

She had to leave her post straightaway to go into isolation at home.

"I was worried because I've seen the other side, with patients deteriorating very quickly with it, so I did wonder if this would happen to me." But, to her surprise, at no point did she feel unwell. "I had nothing, literally - I was exercising indoors, eating normally, sleeping normally."

At the moment it's impossible to know how many cases of infection exist but remain hidden from view.

The discovery that Amelia was infected was only revealed because she was part of a study of all the staff at her hospital. It produced the surprising result that as many as 3% of more than 1,000 people were positive while showing no symptoms at the time of the test.

An even greater proportion of asymptomatic cases was found on the Diamond Princess cruise ship which had been sailing off the coast of Japan earlier this year. Later branded "a petri dish for infection", it had around 700 cases.

Researchers found that three quarters of the people who had tested positive had no symptoms.

And at a care home in Washington state more than half the residents were positive but had no sign of the illness.


'No single reliable study'

Different studies suggest a huge range of possibilities for how many cases are asymptomatic stretching from 5% to 80% of cases. That was the conclusion of an analysis by Prof Carl Heneghan of the University of Oxford and colleagues who looked at 21 research projects.

The upshot, they said, was that "there is not a single reliable study to determine the number of asymptomatics". And they said that if the screening for Covid-19 is only carried out on people with symptoms - which has been the main focus of UK testing policy - then cases will be missed, "perhaps a lot of cases".


The risk of 'silent spreaders'

The biggest concern of Amelia, the nurse, was that she might have unwittingly transmitted the virus either to those she works with or to the patients who depend on her help.

"I don't think I passed it on because all the colleagues I work with tested negative but it was worrying to think how long I'd been positive for," she says. "But we still don't know if people who are asymptomatic are contagious or not - it's very bizarre and the information about it at the moment is minimal."

One study in China which found that the number of asymptomatic cases was actually greater than those with symptoms had a warning for the authorities. "As 'silent spreaders'," the scientists wrote, "asymptomatic carriers warrant attention as part of disease prevention and control."

he team that studied that Diamond Princess reckoned that asymptomatic cases were likely to be less infectious than people with symptoms but even so they're estimated to have caused a significant number of cases.


The 'dark matter' of asymptomatic infection

To try to get an answer, scientists in Norwich are pushing for the population of the entire city to be tested.

"Asymptomatic cases may be the 'dark matter' of the epidemic," according to Prof Neil Hall, head of the Earlham Institute, a life science research centre, who's leading the initiative. Dark matter is the invisible substance believed to make up most of the matter in the universe, and it's yet to be identified.

Prof Hall worries that asymptomatic cases may actually be driving the pandemic, keeping it going despite public health measures. "If you have people who don't know they're ill while using public transport and health care facilities, inevitably that's going to increase transmission," he says.

"Any intervention that's only based on people coming to primary health care when they have symptoms will only deal with half the problem."

A team of scientists in California believes that not knowing who's carrying the virus without symptoms is the "Achilles Heel" of the fight against the pandemic.

In their view, the only way to stop the disease from spreading is to find out who's infected regardless of whether they think they are or not. That was also the recommendation of MPs on the Commons Science and Technology Committee in a letter to the Prime Minister Boris Johnson.

They wrote that the risk of asymptomatic transmission has "a profound consequence for the management of the pandemic". And they said that anyone looking after vulnerable people - such as health workers or care workers - should be given regular testing.

A similar approach is being adopted on a far larger scale in the Chinese city of Wuhan, where the pandemic is thought to have begun.

As many as 6.5 million people there were tested in as little as nine days in a mass screening programme designed to detect the disease - including in those showing no symptoms.

Easing of lockdown

As lockdown measures are eased and more people start to use public transport, return to work or go shopping, getting to grips with the invisible risk matters more than ever. At the moment, there is no way of telling who among the growing crowds may be carrying the virus without knowing.

That's why governments the world over say it's essential that everyone cooperates with efforts to trace the contacts of anyone infected and then quickly self-isolates. They also advise that the best defence remains social distancing - to keep apart wherever you can. But where that isn't possible, the recommendation is to cover your face, even with a mask that's homemade.

When the US government announced this policy, it highlighted the discoveries made in the church in Singapore back in January. The logic is that this is not about protecting yourself, it's about protecting others from you, in case you're infected but don't know it.

Many health professionals worry that masks might distract people from hand washing or social distancing, or increase the risk of contamination if they're clumsily handled. But more and more governments, most recently that of the UK, have become convinced of the benefits.

Not that face coverings will halt the pandemic on their own. But because there's still so little we know about asymptomatic transmission, almost anything is worth a try.

You may also be interested in:

When you talk to intensive care doctors across the UK, exhausted after weeks of dealing with the ravages of Covid-19, one phrase emerges time after time: "We've never seen anything like this before."

They knew a new disease was coming, and they were expecting resources to be stretched by an unknown respiratory infection which had first appeared in China at the end of last year.

"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".Source: BBC Health

34

Public Health / InfraTec Responds to the Effects of the Corona Pandemic

« on: May 30, 2020, 10:22:57 PM »

Special Times Call for Special Measures – InfraTec Responds to the Effects of the Corona Pandemic

With the current corona crisis, the world is facing a multitude of challenges. First and foremost is the protection of public health.

The SARS-CoV-2 virus known as "Coronavirus" causes an infection of the respiratory tract. At present, only the symptoms, but not the disease itself, can be treated. To combat the pandemic, the availability of medical equipment, especially respiratory equipment, is of enormous importance.

As a manufacturer and supplier of systematically relevant sensor components for ventilation technology, InfraTec must, therefore "take special measures to be able to meet the extreme global demand in the short term", says Dr. Matthias Heinze, Managing Director of InfraTec GmbH.

In order to meet this demand, at the beginning of April extra shifts were introduced.

Ventilation equipment is used to control a patient's breathing as a function of time, volume or pressure. Thus, it is necessary that the device monitors and analyses these parameters. Respiratory gas analyses are used for this purpose, for which various sensors are used.

Pyroelectric detectors from InfraTec, which are integrated into an infrared gas analyzer, measure, for example, the existing carbon dioxide concentration in the respiratory flow. This allows the detection of changes in respiration and consequently the optimization of ventilation settings.

As a result of the current situation, the global demand for ventilation technology has risen dramatically in recent months. The USA alone needs more than 100,000 new ventilators.

In addition to very short delivery times, this requires a significant increase in the production of ventilators and their components. Therefore, InfraTec, as a manufacturer of essential components, has an important role to play in the current situation.

InfraTec is taking targeted measures to cover the enormous demand and to avoid supply bottlenecks. The production of CO2 detectors, which are required for the manufacture of ventilation technology, has top priority.

At the end of March, procurement, production, and product testing immediately adjusted to the extreme demand for these products in the second and third quarter. Supporting measures and a high level of employee motivation are the basis for doing so,"

Dr. Matthias Heinze

Since then, the detectors have been manufactured in a two-shift operation from Monday to Friday until 11:30 pm and additionally on Saturdays. InfraTec expresses its thanks to all its employees for their understanding and hard work during this special time.

Since its foundation in 1991, InfraTec has developed into a global specialist in the field of an infrared sensor and measurement technology and now has locations in Dresden (Germany), Dallas (USA), Chesterfield (England) and Shanghai (China).

The pyroelectric detectors of the Sensor division are mainly used in safety and medical technology. In this context, InfraTec has become an important supplier for companies that develop, produce, and distribute medical products. These include respiratory protection and ventilation equipment, which is currently of particular relevance.

The thermographic cameras of the Infrared Measurement Technology division are used, for example, in industry and science for the thermal optimization of assemblies and elements but also for security applications such as detection of elevated body temperatures.

Screening measures help to quickly and easily detect elevated body temperatures, which could be an indication of possible viral infection of persons. Such evidence must, of course, always be followed by other examination methods that provide a reliable positive or negative statement about the disease and trigger the appropriate measures.

Highly frequented areas with high-risk potential, such as first aid stations, hospitals, and nursing homes, but also schools, shopping centers, large companies, sports stadiums, and theatres as well as transport hubs such as airports, seaports, railway, and long-distance bus stations are only a few examples where screening measures are applied.Source:Web

35

Nutrition and Food Engineering / High doses of vitamin D supplementation

« on: May 29, 2020, 11:29:49 AM »

High doses of vitamin D supplementation has no current benefit in preventing or treating COVID-19

Scientists from the UK, Europe and the USA, including experts from the University of Birmingham, have published a vitamin D consensus paper warning against high doses of vitamin D supplementation.

According to the study, there is currently insufficient scientific evidence to show vitamin D can be beneficial in preventing or treating Covid-19. Its authors advise that the population adhere to Public Health England guidance on supplementation.

Following unverified reports that high doses of vitamin D (higher than 4000IU/d) could reduce the risk of contracting Covid-19 and be used to successfully treat the virus, the new report published in the journal BMJ, Nutrition, Prevention and Health, investigated the current scientific evidence base on the vitamin and its use in treating infections. Vitamin D is a hormone, produced in the skin during exposure to sunlight, and helps regulate the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy.

Professor Sue Lanham-New, Head of the Department of Nutritional Sciences at the University of Surrey and lead author of the study, said: "An adequate level of vitamin D in the body is crucial to our overall health, too little can lead to rickets or the development of osteoporosis but too much can lead to an increase in calcium levels in the blood which could be particularly harmful."

Examining previous studies in this field scientists found no evidence of a link between high dose supplementation of vitamin D in helping to prevent or successfully treat Covid-19 and cautioned against over supplementation of the vitamin, without medical supervision, due to health risks. Scientists concluded that assertions about the benefit of the vitamin in treating the virus are not currently supported by adequate human studies and are based on findings from studies that did not specifically examine this area.

Claims of a link between vitamin D levels and respiratory tract infections were also examined by scientists. Previous studies in this area have found that lower vitamin D status is associated with acute respiratory tract infections however limitations of the findings of these studies were identified. Findings from the majority of studies were based on data gathered from population groups in developing countries and cannot be extrapolated to populations from more developed countries due to external factors. Scientists believe that there is currently no firm link between vitamin D intake and resistance to respiratory tract infections.

Professors Carolyn Greig and Martin Hewison from Birmingham University, are co-authors on the paper. Professor Greig says: "Most of our vitamin D comes from exposure to sunlight, however for many people, particularly those who are self-isolating with limited access to sunlight during the current pandemic, getting enough vitamin D may be a real challenge. Supplementing with vitamin D is recommended but should be done under the current UK guidance.

"Although there is some evidence that low vitamin D is associated with acute respiratory tract infections, there is currently insufficient evidence for vitamin D as a treatment for COVID-19 and over-supplementing must be avoided as it could be harmful."

Professor Judy Buttriss, Director General British Nutrition Foundation and also a co-author of the paper said: "In line with the latest Public Health England guidance on vitamin D, we recommend that people consider taking a vitamin D supplement of 10 micrograms a day during the winter months (from October to March), and all year round if their time outside is limited.

"Levels of the vitamin in the body can also be supplemented through a nutritionally balanced diet including foods that provide the vitamin, such as oily fish, red meat, egg yolk and fortified foods such as breakfast cereals, and safe sunlight exposure to boost vitamin D status."Source:Web

36

Public Health / Coronavirus: The human cost of virus misinformation

« on: May 28, 2020, 10:16:23 PM »

A BBC team tracking coronavirus misinformation has found links to assaults, arsons and deaths. And experts say the potential for indirect harm caused by rumours, conspiracy theories and bad health information could be much bigger.

"We thought the government was using it to distract us," says Brian Lee Hitchens, "or it was to do with 5G. So we didn't follow the rules or seek help sooner."

Brian, 46, is talking by phone from his hospital bed in Florida. His wife is critically ill - sedated, on a ventilator in an adjacent ward.

"The battle that they've been having is with her lungs," he says, voice wobbling. "They're inflamed. Her body just is not responding."

After reading online conspiracy theories, they thought the disease was a hoax - or, at the very least, no worse than flu. But then in early May, the couple caught Covid-19.

"And now I realise that coronavirus is definitely not fake," he says, running out of breath. "It's out there and it's spreading."

Dangerous misinformation

A BBC team has been tracking the human toll of coronavirus misinformation. We've investigated dozens of cases - some previously unreported - speaking to the people affected and medical authorities in an attempt to verify the stories.

The effects have spread all around the world.

Online rumours led to mob attacks in India and mass poisonings in Iran. Telecommunications engineers have been threatened and attacked and phone masts have been set alight in the UK and other countries - all because of conspiracy theories.

And in Arizona, a couple mistakenly thought a bottle of fish tank cleaner contained a preventative medicine.

Poisoned by cleaning products

It was late March when Wanda and Gary Lenius started to hear about hydroxychloroquine.

The couple noticed a similar-sounding ingredient on the label of an old bottle that was lying around their house in Phoenix.

Hydroxychloroquine may have potential to fight the virus - but as research continues, it remains unproven. On Monday, the World Health Organisation halted its use in trials after a recent study suggested it could actually increase the risk of patients dying from Covid-19.

Speculation about its effectiveness started circulating online in China in late January. Media organisations, including Chinese state outlets, tweeted out old studies where it was tested as an anti-viral medicine.

Then a French doctor claimed encouraging results. Although doubt was later cast on that study, interest in hydroxychloroquine surged. It was mentioned, with various degrees of scepticism, by a variety of media outlets and influential people including Tesla chief executive Elon Musk and Brazilian President Jair Bolsonaro.

"What do you have to lose?" he said on 3 April. "Take it." In mid-May, he went further - saying that he'd been following his own advice. Each comment resulted in big spikes in social media chatter about the drug, according to data from online monitoring tool CrowdTangle.

Overdoses of the drug are rare, but the anxiety produced by the pandemic has driven people to extreme measures.

In Nigeria, hospital admissions from hydroxychloroquine poisoning provoked Lagos state health officials to warn people against using the drug.

And in early March, a 43-year-old Vietnamese man was admitted to a poison control clinic in Hanoi after taking a large dose of chloroquine. He was red, trembling and unable to see straight. The clinic's director, Dr Nguyen Trung Nguyen, said the man was lucky he received treatment quickly - or else he might have died.

Gary Lenius was not so fortunate. The cleaner he and Wanda gulped down contained a different chemical, and was poisonous.

Within minutes, both started feeling dizzy and hot. They vomited and struggled to breathe. Gary died, and Wanda was hospitalised.

Wanda later explained why the couple drank the concoction.

"Trump kept saying it was pretty much a cure," she said.

Alcohol poisoning

In Iran, authorities say hundreds have died from alcohol poisoning after viral rumours about its curative effects.

The total was put at 796 by the end of April by Kambiz Soltaninejad, an official from Iran's Legal Medicine Organisation, who said it was the result of "fake news on social media."

The truth behind the number is murky in a country where alcohol is banned in Iran and bootleg moonshine is routinely contaminated.

However in this case, BBC journalists did see rumours of the supposed "cure" spreading on the messaging app Telegram before the official announcement.

Shayan Sardarizadeh of BBC Monitoring's disinformation team notes that the announcement was potentially embarrassing to the Iranian authorities and, if anything, the number could be an underestimate.

In one case we verified, a 5-year-old boy went blind after his parents plied him with illegal booze in an attempt to fight the disease.

"We know that bad information can ruin lives," says Clare Milne, deputy editor of UK fact-checking organisation Full Fact. "There's such great potential for harm."

'My friend ate soap'

President Trump has speculated on a number of other cures beside hydroxychloroquine. In late April, he opined that ultraviolet rays could neutralise the virus.

"And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?"

Trump later said his comments were sarcastic. But some Americans didn't see it that way, and poison control hotlines received calls asking about the advice. Officials at one in Kansas said they heard from someone who said his friend swallowed disinfectant soap after the president's briefing.

Dr Duncan Maru, a doctor at Elmhurst Hospital in New York, says his colleagues have treated patients who have become acutely ill after ingesting disinfectant.

"These ingestions also can have long-term consequences, like cancers and gastrointestinal bleeding," he says.

Arsons, assaults and conspiracies

Social networks have also been fertile ground for conspiracy theories. One particular coronavirus-related one - there are many circulating online - has resulted in arsons and assaults.

Across the UK, more than 70 phone masts have been vandalised because of false rumours that 5G mobile phone technology is somehow to blame for the virus.

In April, Dylan Farrell, an engineer for Openreach, was driving his van in Thurmaston near Leicester. It had been a long day and he was thinking about what he might have for tea as he pulled up to a roundabout. That's when he started to hear shouting.

At first, he thought it was directed at someone else. But when he heard "5G!" being screamed through his passenger side window, he realised the shouting was meant for him.

"You've got no morals!" a man shouted. "5G is killing us all!"

"I have no doubt he would have tried to get inside and physically attack me had I not locked the doors straight away," Dylan says. "It was so frightening."

He drove away quickly. There have been no arrests in connection with the incident.

"We've seen a lot of conspiracies which have been online for a long time now about 5G," says Claire Milne of Full Fact. "Those have evolved to be connected to the new coronavirus."

Racial tensions and violent attacks

In March, WHO Director General Tedros Adhanom Ghebreyesus warned that the pandemic would lead to a flare up of a "dangerous enemy".

He was referring to racism against people from Asia and China, but the virus has exacerbated tensions in several countries.

In April, three Muslim men were violently attacked in separate incidents in Delhi. They were beaten up after rumours circulated that Muslims were spreading the virus.

In Sisai, a small village in eastern India, rival gangs clashed. It came after an attack on a Muslim boy, again linked to false rumours suggesting Muslims were spreading disease. One young man lost his life and another was seriously injured.

False reports have circulated within ethnic communities as well. In Bradford, England, rumours circulated that non-white patients were being left to die.

And in Indore, a city in west-central India, doctors on a mission to track down someone who might have been exposed to the virus were attacked with stones. Misleading WhatsApp videos claimed that healthy Muslims were being taken away by health care workers and injected with the virus.

Two doctors were left with serious injuries after the incident in early April.

Critically ill from conspiracies

Online disinformation can have direct consequences, and social media platforms such as Facebook said they'll remove coronavirus posts that pose an immediate threat.

But it can also have indirect or delayed effects.

"I hope she pulls through," says Brian Lee Hitchens, the patient in Florida who got sucked in by coronavirus conspiracy theories. "But if I do lose her, she'll be in a better place."

Brian and his wife didn't have one firm belief about the disease - instead they oscillated between thinking that the virus was a hoax, linked to 5G, or a real but mild ailment.

So they carried on as normal despite official warnings. Brian went to work as a taxi driver in his hometown of Jupiter. He went shopping and picked up his wife's medications. Despite his wife's sleep apnoea and asthma, he didn't bother with social distancing or wearing a mask.

Catching the virus brought Brian back to reality. He turned to social media, this time to warn people off of misinformation and conspiracy theories.

Experts say posts like Brian's may be more useful in combating conspiracies than news articles and fact checks.

"One of the most effective ways of trying to correct the record," says Full Fact's Claire Milne, "is by getting the person who made the original claim to do it themselves."

'We lose so many lives because of misinformation'

Brian's may be an extreme case, but with the sheer amount of information circulating - the WHO has called it an "infodemic" - many other people have been misled by what they read online.

They're not killing themselves by taking fake cures. Instead, they're lowering their chances of survival by not thinking coronavirus is real or serious.

On an unusually cold Friday in May, two men in their forties arrived at an emergency hospital in the New York borough of Queens. They were roommates, working long shifts and sharing a single bed, and both were seriously ill.

Within hours, Dr Rajeev Fernando saw one die in front of his eyes. The other was put on a ventilator.

Dr Fernando asked the men why they hadn't come to hospital sooner. They explained to him that they read somewhere online that the virus wasn't very serious.

"They try alternative therapies," Dr Fernando says. "They think this is just like the flu."

The men were in at-risk groups - but Dr Fernando believes they would have fared better if they had ignored the misleading advice and sought help sooner.


Professor Martin Marshall, chair of the Royal College of General Practitioners, says he and his colleagues in the UK have seen patients taking tips from posts they see online - including holding their breath in an attempt to "diagnose" themselves or thinking that drinking hot drinks will fight off the virus. Some have cited President Trump's statements about disinfectant.

Dr Maru, the doctor at New York's Elmhurst Hospital, calls the numbers who have potentially delayed treatment "staggering."

He knows of neighbours who have caught the disease and died because they believed that social distancing is ineffective or that coronavirus is a hoax. And he says that he and his colleagues spend precious time trying to debunk misinformation when they could be treating patients.

But as he spoke on the phone, exhausted and preparing to return to Elmhurst for another shift, Dr Maru was also quick to shift the blame away from the patients themselves.

"Misinformation is a structural problem," he says. "Blaming somebody for ingesting bleach or for staying at home and dying is akin to blaming somebody who is walking down the street and gets hit by a drunk driver."

In response to the wave of misinformation, social media companies have drawn up new rules. In a statement, Facebook said: "We don't allow harmful misinformation and have removed hundreds of thousands of posts including false cures, claims that coronavirus doesn't exist, that it's caused by 5G or that social distancing is ineffective." The company also says it has put warning labels on 90 million pieces of content.

YouTube says it does not allow content promoting dangerous so-called cures and has a range of policies against Covid-19 misinformation, including disputing the existence of the disease or suggesting that it is caused by 5G.

What lies ahead

But as research continues into a coronavirus vaccine, many anti-vaccination and conspiracy-minded groups and accounts have seen their numbers swell. They pose a potential health threat - albeit not an immediate risk.

What some doctors we spoke to fear the most is that the development of a coronavirus vaccine - something that would be a human achievement for the ages - could be completely undermined by misinformation.


The future is scary, medical professionals say, because of what they're seeing right now.

"We lose so many lives. They come in very late," says Dr Fernando in New York. He's just finished a night shift, and as we talk on Skype, a protective mask dangles from his ears. "And we just watch them die in front of our eyes."

Brian, the coronavirus patient in Florida, has a message for the people who still believe in the conspiracy theories he endorsed just a few days ago.

"Don't be foolish like I was," he says, "and the same thing won't happen to you like it happened to me and my wife."Source:BBC Health

37

Public Health / Coronavirus seems to reach the brain. What could this mean for us?

« on: May 27, 2020, 03:05:25 PM »

From loss of smell to stroke, people with covid-19 are reporting strange neurological issues that challenge our understanding of the disease – and how to treat it

JENNIFER FRONTERA has been treating people in intensive care for years. But she has never experienced anything like covid-19 before. “These patients are absolutely among the sickest any of us have ever encountered,” says the New York-based doctor. But the strange thing is, Frontera isn’t a lung disease specialist or a virologist, she is a neurologist. And it is the possible impact of the coronavirus on our brains that is worrying her.

It was early in the outbreak in New York that Frontera and her colleagues began to notice neurological symptoms in those with covid-19. People were passing out before they were hospitalised. Once in hospital, some of them started having unusual movements. Some had seizures and others had strokes.

Similar reports are coming in from hospitals around the world. Some neurological symptoms appear to be mild, such as the loss of smell and taste. At the other end of the spectrum, a few people have developed encephalitis – a potentially fatal inflammation of the brain.

It is a surprising discovery in a disease that was generally considered to attack the airways, and one of pressing concern. One big question is how the new coronavirus is causing these kinds of symptoms. Growing evidence suggests that the virus may work its way into the brain, directly attacking neurons. If that is the case, we may need to reconsider some of the treatments being developed for covid-19. And we must also prepare for potential long-term and chronic neurological conditions in some survivors.Source:Web

38

Public Health / Coronavirus may never go away, World Health Organization warns

« on: May 17, 2020, 02:59:52 PM »

The coronavirus "may never go away", the World Health Organization (WHO) has warned.

Speaking at a briefing on Wednesday, WHO emergencies director Dr Mike Ryan warned against trying to predict when the virus would disappear.

He added that even if a vaccine is found, controlling the virus will require a "massive effort".

Almost 300,000 people worldwide are reported to have died with coronavirus, and more than 4.3m cases recorded.

The UN meanwhile warned the pandemic was causing widespread distress and mental ill health - particularly in countries where there's a lack of investment in mental healthcare.

The UN urged governments to make mental health considerations part of their overall response.

What did WHO say?

"It is important to put this on the table: this virus may become just another endemic virus in our communities, and this virus may never go away," Dr Ryan told the virtual press conference from Geneva.

"HIV has not gone away - but we have come to terms with the virus."

Dr Ryan then said he doesn't believe "anyone can predict when this disease will disappear".

There are currently more than 100 potential vaccines in development - but Dr Ryan noted there are other illnesses, such as measles, that still haven't been eliminated despite there being vaccines for them.

WHO Director-General Tedros Adhanom Ghebreyesus stressed it was still possible to control the virus, with effort.

"The trajectory is in our hands, and it's everybody's business, and we should all contribute to stop this pandemic," he said.

WHO epidemiologist Maria van Kerkhove also told the briefing: "We need to get into the mindset that it is going to take some time to come out of this pandemic."

Their stark remarks come as several countries began to gradually ease lockdown measures, and leaders consider the issue of how and when to reopen their economies.

Dr Tedros warned that there was no guaranteed way of easing restrictions without triggering a second wave of infections.

"Many countries would like to get out of the different measures," the WHO boss said. "But our recommendation is still the alert at any country should be at the highest level possible."

Dr Ryan added: "There is some magical thinking going on that lockdowns work perfectly and that unlocking lockdowns will go great. Both are fraught with dangers."Source:BBC

39

Public Health / Contact tracing must balance privacy and public health

« on: May 16, 2020, 12:15:20 PM »

Contact tracing armies in California and New Jersey. Rapid-response contact tracing in Washington. Track and trace in Connecticut. Across the country, governors are putting contact tracing — the tried-and-true public health practice of finding individuals who were in contact someone with an infectious disease — front and center in their Covid-19 reopening strategies.

This is excellent news. Contact tracing, paired with widespread testing, is an essential component of the toolbox for containing a disease outbreak. This is especially true for a disease like Covid-19, which can be spread by people who have no symptoms. Robust contact tracing is one of the reasons why Germany, South Korea, and China have so far fared better than the U.S. in the Covid-19 pandemic.

In the digital age, contact tracing comes with a modern twist: the ability to use smartphones and devices to do the work of walking back through weeks of our lives to find out where we have been, who we have been with, and how widely we may have spread a virus. Digital contact tracing is moving fast. Google and Apple are making test versions of their tracing software available to public health agencies, and Australia’s government already has a contact tracing app called COVIDSafe up and running. Three million Aussies downloaded it in the first three days.

It’s important to acknowledge that contact tracing of any stripe is intrusive. Professional contact tracers will sit with an individual to review his or her social media, text messages, credit card statements, public transportation records, and more to find anyone they could have exposed. Those contacts receive unexpected calls from strangers asking them to potentially upend their lives for weeks to self-isolate or get tested for potential exposure to an infectious disease.

We have allowed these intrusions into our privacy for centuries to combat old killers like tuberculosis and syphilis and more recent ones like swine flu (H1N1). There is no way to contain infectious public health threats without these measures. But until now we have had the reassurance that the public authorities collecting this information would protect our privacy and had no financial interest in the information.

Adding big technology companies into the equation changes that dynamic. For them, data is currency, and their track record of protecting the privacy of consumers is checkered at best.

Nevertheless, we may want to move forward with digital contact tracing. That’s because it seems likely that the ideal approach to containing the current pandemic will involve a combination of new-age apps and old-style contact tracing — a mix that will be economically and socially beneficial. Person-to-person contact tracing is expensive; technology can do some of the work and save vital public health dollars. Meanwhile, person-to-person tracing can do things tech cannot, such as reach high-risk people who don’t have smartphones.

We must move fast. The consequences of falling behind on containing SARS-CoV-2, the virus that causes Covid-19, are all too apparent: thousands of Americans dead, hospitals overwhelmed, millions out of work, and more. Yet we cannot sacrifice privacy in our response to this crisis. All digital contact tracing apps should adhere to a robust standard of obtaining explicit permission to operate, limiting data collection to the bare minimum, securing that information against sophisticated threats, and storing sensitive information on devices instead of central servers.

Apple and Google’s announcement of a common “exposure notification” system is a welcome first step. This system would limit data collection and safeguard sensitive information through privacy-preserving technologies. However, to fully restore public trust and attain broad adoption of contact tracing apps, sound and powerful privacy principles should be backed by the law. A federal consumer privacy law that sets clear and enforceable privacy protections for all Americans at all times is long overdue.

Technology is not a substitute for a robust, traditional public health contact tracing system. Substantial new investments are needed to build the necessary workforce to do that — perhaps 100,000 or more — for keeping track of new Covid-19 cases and their contacts and shepherding them into quarantine. And knowing who has gotten sick — the fundamental requirement for both traditional and digital contact tracing — requires the still-missing capacity for accessible, widespread, and fast testing.

The tension between our privacy and our responsibilities as members of a civil society is always present in American life. But the Covid-19 pandemic has put it in stark relief. If we move ahead with contact tracing in the right way — appropriately balancing privacy and public welfare and using all the tools, new and old, at our disposal — we can stop the spread of this deadly virus, which itself threatens our life, liberty and pursuit of happiness.Source:Web

40

Public Health / Chasing the elusive dream of a COVID cure

« on: May 15, 2020, 10:46:37 PM »

Although scientists and stock markets have celebrated the approval for emergency use of remdesivir to treat COVID-19, a cure for the disease that has killed nearly 260,000 people remains a long way off — and might never arrive.

Hundreds of drugs are being studied around the world, but "I don't see a lot of home runs right now," said Dr. Carlos del Rio, a professor of infectious diseases at the Emory University Rollins School of Public Health. "I see a lot of strikeouts."

Researchers have launched more than 1,250 studies of COVID-19. Pharmaceutical companies are investing billions to develop effective drugs and vaccines to help end the pandemic.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was cautious when announcing the results of a clinical trial of remdesivir last week, noting it isn't a "knockout." Although remdesivir helped hospitalized COVID-19 patients recover more quickly, it hasn't been proved to save lives.

"This [drug] is opening the door," Fauci said. "As more companies and investors get involved, it's going to get better and better."

Researchers have already announced that they will combine remdesivir with an anti-inflammatory drug, baricitinib — now used to treat rheumatoid arthritis — in the hope of improving results.

But COVID-19 is an elusive enemy.

Doctors treating COVID patients say they're fighting a war on multiple fronts, battling a virus that batters organs throughout the body, causes killer blood clots and prompts an immune system overreaction called a "cytokine storm."

With so many parts of the body under siege at once, scientists say, improving survival rates will require multiple routes of attack — and more than one drug. While some of the experimental medications target the virus, others aim to prevent the immune system from inflicting collateral damage.

"There are so many pieces of this, and they will all require different therapies," said Dr. Lewis Kaplan, president of the Society of Critical Care Medicine, whose doctors provide intensive care.

High-tech approaches include using stem cells, virus-specific T cells and synthetic antibodies to neutralize the coronavirus.

Scientists are also taking a fresh look at existing medications that might be repurposed to fight COVID-19. These include antivirals for influenza, arthritis drugs, estrogen patches and even antacids. If repurposed drugs are successful, they could reach patients relatively quickly, because doctors are already familiar with their side effects and safety concerns.

Some doctors are skeptical that drugs for heartburn or hot flashes have any chance of treating a killer like COVID-19.

Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, said he fears that hype over unproven products will harm patients, even if it temporarily boosts company stock prices. Patients who demand antacids or antimalarial drugs being studied in COVID-19 could be harmed by side effects, for example. Those who hoard drugs — on the hope of protecting themselves from COVID-19 — could deprive other patients of medications they need to stay healthy. Some people may refuse to participate in clinical trials because they fear being given a placebo.

"This rush to get every imaginable treatment into a study, it's not prudent," Nissen said. "It's not good medicine. It's an act of desperation."

Other experts say scientists should cast a wide net.

"I don't think we want to rule anything out because it sounds out of the ordinary," said Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.

Antivirals in the spotlight

Antivirals such as remdesivir aim to prevent viruses from replicating, said Dr. Peter Hotez, a professor at Baylor College of Medicine in Houston.

That doesn't always work. A small Chinese study of remdesivir, published last month in The Lancet, found no benefit to severely ill COVID-19 patients. Remdesivir had previously failed when tested against Ebola.

Antivirals tend to be most helpful in the early stages of infection, when most of the harm to the patient is caused by the virus itself, rather than the immune system, Hotez said.

Remdesivir is just one of many antivirals being tested against COVID-19.

International researchers are studying the antiviral favipiravir, developed to fight the flu.

The antimalarial drugs chloroquine and hydroxychloroquine — which have been heavily touted by President Donald Trump — also have antiviral effects. Although the Food and Drug Administration approved forms of those drugs for emergency use against COVID-19, the agency later warned that they could cause dangerous heart rhythm problems.

A study in the New England Journal of Medicine likewise found no benefit in giving two antivirals used to treat HIV -a combination of lopinavir and ritonavir, sold as Kaletra— in adults hospitalized with severe COVID-19.

Harnessing the immune system

One of the therapies generating excitement is also one of the oldest: antibody-rich blood from COVID survivors.

The immune system produces antibodies in response to invaders such as viruses and bacteria, allowing the body to recognize and neutralize them. Antibodies also recognize and neutralize the virus the next time that person is exposed.

Doctors hope that patients who develop antibodies against the novel coronavirus will become immune, at least for a few years, although this hasn't been proved.

Scientists developing this "convalescent plasma" are studying whether COVID-19 survivors can share this immunity with others by donating their plasma, the liquid part of blood that contains antibodies, said Dr. Shmuel Shoham, an associate professor of medicine at the Johns Hopkins University School of Medicine.

In addition to treating people who are already sick, donated plasma could potentially prevent people exposed to the virus — such as health care workers — from developing symptoms.

Donated antibodies - and any immunity they might provide — don't last forever, said Dr. William Schaffner, a professor at the Vanderbilt University Medical Center. The body destroys aging antibodies as part of its routine maintenance, he said. In general, half of donated antibodies are eliminated in about three weeks.

The use of convalescent plasma goes back more than a century. It was used during the 1918 flu pandemic and was shown to improve survival during the 2009-10 H1N1 pandemic.

Doctors don't know yet whether convalescent plasma will benefit people with COVID-19.

In general, convalescent plasma is expected to be more effective in preventing illness than in treating it. It may be less likely to help someone in intensive care, Shoham said.

Researchers are also studying the use of prepackaged plasma, called intravenous immunoglobulin, in COVID patients. This product, known as IVIG, is taken from healthy donors in the general population and has long been used to help patients with weakened immune systems fight off infections. Hospitals keep it in stock and some are already using it to treat COVID patients.

Although the antibodies in prepackaged IVIG don't specifically target the coronavirus, researchers hope they will tamp down the immune response.

In a third form of immune therapy, researchers are trying to identify the specific antibodies that are most important for neutralizing the coronavirus, then reproduce them as drugs called monoclonal antibodies. Monoclonal antibodies are already used to treat a variety of conditions, from cancer to rheumatoid arthritis and migraines.

"When we give people an antibody, they are immediately at least partially immune to that specific virus," said Dr. James Crowe, director of the Vanderbilt Vaccine Center, who hopes to have antibodies ready for a clinical trial in a few months. "We're moving the immune system from one person to another."

Ideally, doctors would develop a very potent monoclonal antibody or a cocktail of antibodies for COVID-19 patients, to ensure the best chance of success, Crowe said. But manufacturing these drugs can be complicated, expensive and time-consuming.

"Making two antibodies would be at least twice as complicated as making one," Crowe said. "A cocktail might be preferred, but cocktails are harder to move quickly."

Calming the immune system

In most cases of COVID-19, the immune system neutralizes the coronavirus and patients recover without going to the hospital.

For reasons that doctors don't totally understand, the immune system of some COVID-19 patients becomes hyperactive, attacking not just the virus but the patient's own cells. A "cytokine storm," in which the immune system floods the body with inflammatory chemicals, can do more damage than the virus itself.

In an effort to calm the immune system, researchers are testing immune-suppressing drugs, including monoclonal antibodies already used to treat autoimmune diseases such as rheumatoid arthritis, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Health care giant Roche is conducting large clinical trials of its drug, Actemra, in the hope of preventing cytokine storms, which can cause organ failure and a life-threatening condition called sepsis. Actemra is designed to lower levels of an inflammatory chemical, interleukin-6, which has been found to be elevated in some COVID-19 patients.

Scientists are also studying similar drugs, anakinra and siltuximab.

Another immune suppressant from Regeneron and Sanofi, called Kevzara, has had disappointing results in clinical trials. The manufacturers plan to continue studying the drug to see if it can help certain types of patients.

Dr. Anar Yukhayev, a New York OB-GYN who was hospitalized with COVID-19 on March 16, agreed to join a clinical trial of Kevzara.

"I was having so much trouble breathing that I was desperate for anything to help," said Yukhayev, 31, who was treated at Long Island Jewish Medical Center.

About 36 hours after receiving an infusion, as Yukhayev was being treated in intensive care, his symptoms began to improve. He was able to avoid being put on a ventilator. Doctors didn't tell him if he received Kevzara or a placebo, but his liver enzymes also began to rise, suggesting the organ was under stress. Elevated liver enzymes are a known side effect of Kevzara.

Yukhayev made a full recovery and went back to work full time April 13. He donated his plasma to researchers.

Until vaccines and other preventive medicines are developed, the best way to prevent coronavirus infections is to maintain social distancing, Adalja said.

"Social distancing is a blunt tool," he said, "but it's all that we have."Source:Web

41

Public Health / Coronavirus mutations: Scientists puzzle over impact

« on: May 12, 2020, 02:13:40 PM »

Researchers in the US and UK have identified hundreds of mutations to the virus which causes the disease Covid-19.

But none has yet established what this will mean for virus spread in the population and for how effective a vaccine might be.

Viruses mutate - it's what they do.

The question is: which of these mutations actually do anything to change the severity or infectiousness of the disease?

Preliminary research from the US has suggested one particular mutation - D614G - is becoming dominant and could make the disease more infectious.

It hasn't yet been reviewed by other scientists and formally published.

The researchers, from the Los Alamos National Laboratory in New Mexico, have been tracking changes to the "spike" of the virus that gives it its distinctive shape, using a database called the Global Initiative on Sharing All Influenza Data (GISAID).

They noted there seems to be something about this particular mutation that makes it grow more quickly - but the consequences of this are not yet clear.

The research team analysed UK data from coronavirus patients in Sheffield. Although they found people with that particular mutation of the virus seemed to have a larger amount of the virus in their samples, they didn't find evidence that those people became sicker or stayed in hospital for longer.

'Mutations not a bad thing'

Another study from University College London (UCL) identified 198 recurring mutations to the virus.

One of its authors, Professor Francois Balloux, said: "Mutations in themselves are not a bad thing and there is nothing to suggest SARS-CoV-2 is mutating faster or slower than expected.

"So far, we cannot say whether SARS-CoV-2 is becoming more or less lethal and contagious."

A study from the University of Glasgow, which also analysed mutations, said these changes did not amount to different strains of the virus. They concluded that only one type of the virus is currently circulating.

Monitoring small changes to the structure of the virus is important in understanding the development of vaccines.

Take the 'flu virus: it mutates so fast that the vaccine has to be adjusted every year to deal with the specific strain in circulation.

Drug development
Many of the Covid-19 vaccines currently in development target the distinctive spikes of the virus - the idea is that getting your body to recognise a unique element of the spike will help it to fight off the whole virus. But if that spike is changing, a vaccine developed this way could become less effective.

At the moment this is all theoretical. Scientists don't yet have enough information to say what changes to the virus's genome will mean.

Dr Lucy van Dorp, UCL study co-author, said being able to analyse a large number of virus genomes could be "invaluable to drug development efforts".Source:BBC News

42

Public Health / What Can You Do With a Public Health Degree?

« on: May 10, 2020, 03:54:54 PM »

Graduates of public health programs can find a range of jobs in both the private and public sectors.

CIVIC-MINDED individuals who are eager to enter a service career should think about pursuing a public health degree.

Public health is an academic discipline that focuses on preventing and mitigating disease outbreaks, such as the coronavirus pandemic, and confronting systemic health challenges that affect multiple people at once, such as environmental pollution.

Though there are numerous aspects of public health that college students can concentrate on, one similarity among all the specializations is the mission to optimize community health outcomes, experts say.

In contrast to clinical health care providers like physicians or pharmacists, public health professionals do not concentrate on the health of a specific individual, since they are primarily concerned with collective well-being, explains Dr. Robert W. Amler, dean of New York Medical College's School of Health Sciences and Practice.

"In public health, the focus is not so much on treating people when they are sick, but assuring the conditions in which they can be healthy," Amler says. Numerous factors are essential for optimal health, including access to clean water and workplace safety measures, Amler adds.

Big-picture thinking skills and data analysis competencies are extraordinarily valuable in public health, since the field involves identifying factors that have the most significant influence on population health, according to experts. Another desirable quality for professionals in this field is a creative and strategic mindset, since public health workers are often asked to propose solutions to major problems like the opioid crisis.

Cheryl Healton, dean of the New York University School of Global Public Health, suggests that a public health job can be very meaningful and satisfying because it allows someone to provide significant assistance to a large number of people.

"I've very rarely met anybody in public health who wasn't happy with their career," says Healton, who has a doctorate in public health. She adds that it's rare for individuals employed in the public health sector to leave before they retire unless they decide to pursue an unconventional personal interest, such as the desire to become a novelist.

The Significance of Public Health Work

People typically become public health workers because they are keenly interested in helping others and improving society, Healton says, adding that there is something deeply rewarding about the conviction that "you left the world a better place."

She notes that public health initiatives have an enormous impact on everyday living, since these initiatives ensure that people can perform routine tasks safely. "Public health is affecting your life in so many ways before you have your lunch. You wake up, you brush your teeth and you don't die from it. You turn the tap on and you drink a glass of water. You don't die from that either. You have breakfast. You don't have food poisoning, and on and on. ... It's the most omnipresent, invisible field imaginable."

Public health degree recipients say the COVID-19 outbreak underscores the value of their training, as they play a vital role in fighting the spread of disease. These public health professionals note that the coronavirus crisis has exacerbated a shortage of public health workers, and they say newcomers would be welcomed in the profession.

"There is no time like the present" to enter the public health field, Dr. Sylvia Owusu-Ansah, a physician with a master of public health degree, says.

"With the repercussions of COVID, we're going to need more public health specialists in developed and developing societies," says Owusu-Ansah, an assistant professor of pediatrics and the emergency medical services medical director for UPMC Children's Hospital of Pittsburgh. "We're trying to restructure our society (and) restructure our health care system."

Experts say one public health concentration that is particularly relevant nowadays is epidemiology, a branch of medical science that involves the study of disease patterns and health trends within a particular population. Epidemiologists can make informed predictions and recommendations about prevalent illnesses.

David M. Claborn, a public health scholar with a doctorate in public health, says he hopes the COVID-19 crisis will spur curiosity about public health science.

"The nation's experience demonstrates the need for good and complete data in the establishment of public health policy," says Claborn, director of the master of public health program at Missouri State University. "This need will require people who understand how to collect reliable public health data and how to analyze and interpret that data correctly. An emphasis on advocacy without an understanding of the underlying science can result in well-meaning but dangerous policy."

Branches of the Public Health Field and Types of Public Health Careers

Aspiring public health professionals who pursue a degree in this subject typically have multiple tracks as options, observes Bethann Wittig, an MPH student who expects to receive her degree from Rutgers University in New Jersey this year. According to Wittig, the following fields are areas where students can gain expertise:

* Epidemiology.
* Biostatistics.
* Environmental and occupational health.
* Health education and behavioral science.
* Infectious disease.
* Public policy.
* Global health.
* Nutrition.
* Maternal and child health.

Public health school grads can fill a variety of positions, including "scientists, behavioralists, managers, leaders, coordinators and educators," Wittig wrote in an email. "Public health professionals are needed in government, public, private, academia and non-profit settings."

Public health sector experts note that it is common for people in this field to work for governments at the local, state, federal and multinational levels. Public health professionals may also work for private nonprofit and for-profit organizations that relate to the health care system, ranging from advocacy organizations to pharmaceutical corporations.

Salaries for people with public health credentials vary widely depending on what field they specialize in and what type of employer they work for, experts say. Kristi Mitchell, a public health professional with an MPH degree who is based in the District of Columbia and is pursuing a doctorate in public health at George Washington University, says a public health salary could range from under $60,000 to more than $200,000.

Amler at the New York Medical College identified the following examples of public health jobs:

* Epidemiologist.
* Biostatistician.
* Health educator.
* Sanitarian.
* Public health adviser.
* Public health nurse.
* Program director.
* Environmental health scientist.
* Toxicologist.
* Industrial hygienist.
* Health administrator.
* Health economist.
* Health analyst.
* Demographer.
* Medical administrator.
* Health director.
* Health commissioner.
* Minister of health.
* Surgeon general.

Dr. Tista Ghosh, a physician and public health professional based in Denver, suggests that aspiring public health workers choose a career that aligns with their personality. Public health workers who focus on infectious disease need to enjoy the adrenaline rush of coping with crises and surprises, alongside the thrill of quickly resolving pressing problems, says Ghosh, senior medical director with the Grand Rounds digital health company.

Many individuals in the public health sector are subject matter experts on chronic diseases like diabetes, work that necessitates a focus on long-term results. "You need a more steady personality and a patient personality in order to stay with it, because you're not going to get a short-term reward," Ghosh says. "You're not going to fix the obesity epidemic in a month."

Public Health Degree a Plus but Not Required for Public Health Jobs

Experts note that it is possible to work in the public health space without a public health degree, and that a variety of mathematical, social science, policy and professional degrees are relevant to public health.

"Public health is a very diverse field, and many people with different training can find a home in a public health career," says Dr. Charlene Brown, a physician who has medical and public health degrees.

"It just matters what their interest is, what their passion is and what skills they bring to the table," explains Brown, the CEO and founder of CaregiverJobsNow, an online job marketplace for health care professionals.

Mitchell, practice director with the Center for Healthcare Transformation at the Avalere Health consulting firm, says co-workers have degrees in fields besides public health, like public administration and public policy. Graduate school is not mandatory in the public health field, she adds.

Nevertheless, individuals affiliated with public health schools say that a degree in the field is highly marketable.

Carol Gee, a former administrator with the public health program at Emory University in Georgia, says the program's alumni found a variety of fascinating career opportunities. For example, Emory public health students went on to jobs at insurance companies, Planned Parenthood, the American Cancer Society and the Centers for Disease Control and Prevention, Gee says.

David Simmons, an associate professor with both the school of public health and the department of anthropology at the University of South Carolina, says alumni of the school's undergraduate public health program who want to go straight to the workforce tend to get desirable jobs relatively quickly. They are also usually competitive candidates for grad schools if they choose to apply, he says.

Simmons – who completed a National Science Foundation postdoc at Harvard Medical School in the Department of Social Medicine, Program in Infectious Disease and Social Change – says public health programs are becoming increasingly popular, most likely because "it is an incredibly exciting field to be in." He notes that public health's interdisciplinary approach makes it attractive to a wide range of students, from those with a passion for math to those with an interest in natural science or social science.

"The toolkit that public health provides you for understanding complex phenomena is something you won't find most other places," he says. "And so I encourage students to go into public health, because it's a practical discipline to go into. Most public health majors don't have problems finding jobs."Source:Web

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Public Health / Why study public health

« on: May 09, 2020, 04:09:01 PM »

Public health expert Dr. David Claborn explains.

The study of public health focuses on preventing and mitigating disease outbreaks such as the coronavirus pandemic. It also deals with tackling systemic health challenges that affect multiple people at once such as environmental pollution.

A public health degree leads to a service career in both the public and private sectors.

Dr. David Claborn, master of public health program director at Missouri State University, tells U.S. News & World Report Education why he hopes COVID-19 will draw more students to consider this field of study.Source:Web

44

Public Health / Coronavirus: More worried about boredom, stress and anxiety than general health

« on: May 08, 2020, 03:10:11 PM »

People in lockdown are more worried about their mental wellbeing than their general health, an Office for National Statistics survey suggests.

Just under two-thirds of 16- to 69-year-olds surveyed were most affected by boredom, stress and anxiety, and the inability to make plans.

And those aged over 70 were even less likely (6%) than the under-70s (13%) to say their overall health was affected.

Most of the under-70s did worry about their loved ones' health.

But, in general, those surveyed were considerably more worried about their friends and family's mental wellbeing.

And the over-70's were much more likely to be worried about their family's work (62%) being affected than their health (27%).

Living costs

Their own access to groceries, medication and other essentials was another major worry for the over-70s.

But the under-70s were more concerned about the impact on their work.

Just under three-quarters of all the people surveyed said the pandemic had reduced their household income.

Just over a third said they were using savings to cover their living costs.

And when asked how the pandemic was affecting their own wellbeing, more people expressed concern about the future than other, more immediate, worries such as being alone, strain on personal relationships or challenges working from home.

Key workers

More than 85% said they had enough information to protect themselves from the virus.

But only about half said they had enough information about the UK government's plan for dealing with it.

Although there were high levels of support for and compliance with lockdown measures, only 24% of those self-isolating for the past seven days had not left their home for the whole period.

The survey, conducted among households in England and Wales, excluded people staying in hospitals, care homes or other residential facilities.

The results were weighted to reflect the make-up of the population of Britain, including the proportions of key workers and people with health conditions.

The proportion of adults with high levels of anxiety fell from a high of 50% at the end of March to 37% between 17 and 27 April.

But a separate survey, by University College London, suggests it has risen again in the past week.

"Life-satisfaction ratings had been returning to pre-Covid-19 levels but this improvement has now halted," it says, linking this to the uncertainty created by speculation around exiting lockdown.

One in 12 of the 80,000 people surveyed by UCL was worried about their future and twice as many about their finances.

And these figures were even higher among those under the age of 60, with lower household incomes or a mental-health diagnosis.Source:BBC UK

45

Public Health / Opinion: Public Health Trumps Privacy in a Pandemic

« on: May 06, 2020, 10:24:44 PM »

If governments were to use SARS-CoV-2 antibody tests to manage who can re-enter the workplace, society must accept a sacrifice of privacy.

We propose an “ethical precautionary principle” in response to how governments should restart the economy from this pandemic. We define an ethical precautionary principle as a strategy used when approaching potential ethical harm under conditions where extensive scientific knowledge and data are lacking. In this situation, we propose an antibody certification process to identify those individuals who could safely return to work even though this process may violate ethical rights of privacy and confidentiality. Those with low or no titers of antibodies against SARS-CoV-2, the virus that causes COVID-19, will not be allowed to return to work until there is herd immunity or they are vaccinated.

Presumably, there will be extensive diagnostic testing of our population to establish who has sufficient protective antibody titers against SARS-CoV-2. In the short term, an in vitro test that measures neutralizing anti–SARS-CoV-2 antibodies may be sufficient to estimate what levels of antibody titers are protective. Measuring neutralizing antibodies in patients takes time and is expensive. Therefore, we can assume, like with measles titer diagnostics, that people who exhibit high levels of polyclonal antibodies against SARS-CoV-2 will also have sufficient neutralizing antibodies. The medical challenge here is to develop a standardized antibody titer test that is accessible to all and is scientifically accurate. This will take months to develop.

As our nation starts to ease quarantines and stimulates the economy, we face ethical threats to valued rights of privacy and confidentiality. Privacy refers to the individual’s ability to control personal information that belongs solely to that individual. Confidentiality is the obligation that professionals owe to the individual to maintain and protect their information. The right to privacy is a highly protected ethical mandate that is used in many landmark decisions, such as patient-physician relationships (HIPAA) and Roe v. Wade. How then do privacy rights apply to the COVID-19 crisis? How would society enforce that only antibody-protected workers can return to the workplace?

Technology such as contact tracking can be extended to include the identification of antibody-protected individuals. (Contact tracing, in contrast, is an invasive process that involves identifying and following all contacts of an exposed or infected person.) Antibody positive or negative test results could be linked to cell phones via an app that can be tracked. One could envision that employers could gain access to this information to ensure that only protected workers who are ID-tagged can return to their jobs. Now, the question is, should this information also be accessible to the general public? For example, before entering a supermarket, one could check whether this public area is a “safe” zone (that is, all the people alongside you are immune) or an unsafe danger zone, where there are people nearby who have no antibody certificate or who are antibody negative.

Does revealing antibody protection information violate personal privacy issues? Is knowing that your co-worker and a neighbor do not have high anti–SARS-CoV-2 titers infringe on their privacy? The duty to maintain confidentiality is not absolute and can be loosened under circumscribed conditions, such as when protecting one person’s confidentiality endangers another’s welfare or public health.

Decisions to breach confidentiality must be tempered by restraint in public health ethics. Health providers and government officials should always employ the least invasive, least coercive means necessary to achieve a vital public health goal. In general, we believe that diminishing the spread of the SARS-CoV-2 virus is a vital health objective that should trump respecting privacy and confidentiality, if necessary.

It must be noted that minority populations are less likely to be antibody tested, even if they contracted SARS-CoV-2 and were symptomatic, because there are limitations and barriers to their access to testing. It will be unfortunate and an unintended consequence if minorities will not have the documentation that allows them to return to work. This will further exacerbate the disparities confronting our society. It is unethical to create a two-tiered society of the haves and have nots. People will accept the privacy right infringement if there is equal access to testing for all.

We are not advocating contact tracing for COVID-19, though it is of proven benefit for mitigating the spread of diseases such as tuberculosis and Ebola, because it is much more invasive of privacy rights. Rather, we advocate for antibody identification and certification using a voluntary app with the understanding and acceptance that we give up some of our rights to privacy.

In fact, our annual flu vaccination protocols also involve giving up some of our rights to privacy. At major hospitals around the country, hospital workers are usually mandated to receive yearly flu vaccinations and on each of their ID badges a sticker is placed indicating that they have been vaccinated. Those who choose not to be vaccinated are required to wear protective masks when entering the hospital. Moreover, many airports use temperature monitoring systems to screen passengers who may carry a transmittable flu-like disease.

The proposed concept of an “ethical precautionary principle” is not a panacea. Given our current crisis, the ethical precautionary principle allows us to violate certain ethical principles such as privacy and confidentiality to facilitate our ability to return to some degree of economic and social stability before a COVID-19 vaccine is in place.

Making a special case for SARS-CoV-2 antibody titers to be openly accessible might induce additional anxiety among our citizens. Therefore, it is critical that public health officials and political leaders provide a transparent, well-supported rationale for antibody testing as we enter the recovery stage of COVID-19. In this crisis, our precautionary principle states that the need to promote the general physical, mental, and economic health of society outweighs the valued ethical rights to protect privacy and maintain confidentiality.Source:Web