Dr. Jane C. Burns has studied Kawasaki disease for four decades. It took only four months for COVID-19 to turn her life’s work upside down. Unusual numbers of children and teenagers living in COVID-19 hotspots like Lombardy, Italy and New York City have developed an inflammatory condition (officially called Multisystem Inflammatory Syndrome in Children, or MIS-C) that looks a lot like Kawasaki disease. In many cases, the children have also tested positive for COVID-19 antibodies, suggesting the syndrome followed a viral infection. In New York State, 170 inflammatory-disease cases and three related deaths are under investigation. Ninety-two percent of these patients tested positive for COVID-19 or its antibodies, and almost all of them were younger than 20, according to state health department data. As case reports pile up, the world is suddenly paying attention to the rare pediatric syndrome that has stumped Burns and her colleagues for decades, but largely flown under the radar. “I’ve been waiting 40 years to understand in a much clearer way what I’ve been looking at all my life,” says Burns, who directs the Kawasaki Disease Research Center at the University of California, San Diego and Rady Children’s Hospital. “It’s a tragedy to realize that this virus that we thought was going to spare our most vulnerable citizens—our children—is not. But it has suddenly presented the opportunity to actually understand Kawasaki disease.” Kawasaki disease is a mysteryKawasaki disease has a well-defined set of symptoms, including a persistent high fever, bloodshot eyes, redness around the mouth, a body rash and redness and swelling of the feet and hands. Only a few thousands cases of Kawasaki are diagnosed each year in the U.S., mainly in children ages 5 and younger. In part because of its rarity, doctors still don’t know exactly what causes Kawasaki disease—but the dominant theory is that a pathogen, most likely a virus, pushes a child’s immune system into overdrive, resulting in inflammation throughout the body. This inflammation can be successfully brought down with the antibody-based treatment intravenous immunoglobulin, but when left untreated, it can lead to permanent heart damage. Burns thinks Kawasaki disease’s name may have done it a disservice. When it was first discovered in the 1960s, the condition was named Kawasaki “disease” instead of Kawasaki “syndrome,” and that designation has stuck. But a “disease” is something with a determinate cause, whereas a “syndrome” is a collection of symptoms that may not have a single catalyst—which far better characterizes Kawasaki, Burns believes. “Calling it a disease made us think that…there could only be one cause or trigger,” Burns says. More recently, she says, doctors have begun to question that notion. Her research center has found that Kawasaki disease tends to surface in clusters of genetically similar children, and the disease can look slightly different depending on the group’s underlying genetics. That suggests different triggers could cause an inflammatory response in children with certain genetic predispositions, Burns says. It’s possible that SARS-CoV-2, the virus that causes COVID-19, is one of those triggers. But some researchers don’t think viruses are always to blame. Dr. Michael Levin, a pediatric infectious disease specialist at Imperial College London, says bacteria may also trigger the inflammatory response. When clinicians test a nose or throat swab, Levin says, they look for known pathogens. But millions of bacterial strains live in the body, and most aren’t given a second look in the laboratory. “I think the cause of Kawasaki has been sitting in the bin because we don’t know how to identify it,” Levin says. Not knowing exactly what causes Kawasaki also makes it difficult to diagnose, says Dr. Michael Portman, director of pediatric cardiovascular research at Seattle Children’s Hospital. Doctors have to rely on inflammatory markers in the blood, as well observable symptoms, to make a subjective call. Portman is working with blood-testing startup Prevencio to develop a blood test that could detect certain proteins and blood components to give a firm Kawasaki diagnosis. Having a cut-and-dry diagnostic would make it easier for doctors to find the right treatment for patients, Portman says. It could also help answer a question confounding researchers: Is MIS-C a type of Kawasaki syndrome, or something else entirely? Kawasaki disease’s connection to COVID-19Prior to the COVID-19 pandemic, a few papers had suggested other coronaviruses could cause Kawasaki disease. So when the pandemic hit, Portman expected to see an uptick in Kawasaki-like inflammatory disease, he says. But some researchers don’t think SARS-CoV-2 has any connection to Kawasaki disease. That’s because MIS-C and Kawasaki have some clear and crucial differences. Whereas Kawasaki disease is treatable and only leads to significant heart damage in about 25% of cases even when it’s left alone, many MIS-C patients suffer such serious damage to the heart that they go into shock. Others don’t have external symptoms of Kawasaki, but do have a high fever and elevated inflammatory markers. Teenagers and young adults have also been showing up in hospitals with MIS-C, whereas Kawasaki almost exclusively strikes children five and younger. Burns says it’s possible that SARS-CoV-2 affects Kawasaki-prone children differently, depending on their unique genetic blueprints. Some could clear a SARS-CoV-2 infection without any inflammatory response. Others could go on to develop Kawasaki-like illness, while still others might exhibit an inflammatory response slightly different than Kawasaki disease. Burn has applied for a National Institutes of Health grant that would allow her to perform whole genome sequencing on children with different types of MIS-C, as well as children who were diagnosed with Kawasaki disease before the COVID-19 pandemic, to find differences and similarities. But Levin isn’t sure there’s enough similarity to consider MIS-C a relative of Kawasaki. Using data from Burns’ database of pre-COVID-19 Kawasaki patients, Levin compared classic Kawasaki with emerging clinical and laboratory reports of MIS-C. Given the high likelihood that MIS-C results in much more severe symptoms than the typical case of Kawasaki, “the overall spectrum is more different to Kawaski than similar to Kawasaki,” he concludes. He notes that adults with serious cases of COVID-19 are also seeing extreme inflammatory responses; they just manifest differently, causing issues like respiratory distress. It’s possible that MIS-C is the pediatric version of that inflammation, he says. Portman says he’s not sure it matters whether MIS-C is a subset of Kawasaki or its own syndrome, since they both seem to respond to the same treatment. “My general opinion is that we may have to morph these two diseases into one and just give them subclassifications,” he says. Both Portman and Levin are working on gathering the data necessary to figure out how best to treat Kawasaki and MIS-C. Levin is launching a database that will allow clinicians to upload anonymous case details and treatment results until more rigorous randomized control trials can be completed, and Portman has been awarded a research grant to study differences in patients who respond to intravenous immunoglobulin versus those who don’t. What parents need to knowFor scared parents, it can be frightening to know that researchers are still working to understand both Kawasaki disease and MIS-C. But all of the experts interviewed by TIME say parents do not need to panic. Kids are still much less likely than adults to develop a serious COVID-19 infection. Only about 2% of confirmed COVID-19 cases in the U.S. have been among children younger than 18, according to the U.S. Centers for Disease Control and Prevention. Even among kids who do get COVID-19, MIS-C is a very rare complication. About 170 MIS-C cases are under investigation in New York state, compared to thousands of pediatric COVID-19 cases there, and many parts of the country have yet to see a case. Nevertheless, parents should not wait to seek medical attention if they see any symptoms of Kawasaki disease in their children, Burns says. With prompt treatment, most children should recover well, she says. from https://ift.tt/3guYuCk Check out https://takiaisfobia.blogspot.com/
0 Comments
Dr. Mark Sklansky has always hated shaking hands. He can think of about a dozen better ways to greet patients than the icky exchange. “Hands are warm, they’re wet, and we know that they transmit disease very well,” says Sklansky, chief of pediatric cardiology at UCLA Mattel Children’s Hospital. “They’re a phenomenal vector for disease.” He’s also tried to avoid this form of greeting because he knows that some patients don’t want to shake hands for religious or cultural reasons but feel compelled to when their doctor sticks out a hand. For a long time, though, being anti-handshake was fringe thinking. The handshake is such an ingrained part of the doctor-patient relationship that it happens 83% of the time, according to one 2007 analysis of more than 100 videotaped office visits. Sklansky was once nervous to take a stand against the popular gesture. “I honestly didn’t want to admit this to anyone for the longest time,” he says. But in a 2014 paper, Sklansky and his colleagues argued that shaking hands in health care settings can spread pathogens and viruses, and that health care workers can help keep patients safe by keeping their hands to themselves. The blowback was swift. Physicians huffed that getting rid of the handshake would erode the already fragile doctor-patient bond, that the greeting was irreplaceable, and that they could manage to shake hands and wash them without spreading disease, thank you very much. “A lot of people laughed at the idea,” Sklansky says. “But now, people aren’t laughing.” Handshakes are just one form of touch that has evaporated during the global coronavirus outbreak. So have hugs, high fives, fist bumps, back pats, shoulder squeezes and all of the little points of contact we make when we stand closer than six feet apart. And as Americans emerge from their homes and inch closer together to rebuild their social lives, experts are betting that some degree of social touch will disappear permanently, even after the pandemic ends. “I don’t think we should ever shake hands ever again, to be honest with you,” said Dr. Anthony Fauci in an April interview with the Wall Street Journal podcast. If social touch disappears more than just temporarily, there’s no consensus on what will replace it. But one thing is little disputed: Social interactions are about to start feeling really weird. “As we come out of quarantine and isolation, I think we’re going to see some people offering handshakes and some people not wanting to touch them with a 10-foot pole,” says Aaron Smith, a psychotherapist and instructor in the school of social work at Renison University College in Canada who explored the pluses and pitfalls of handshakes in a journal article published in March. “There’s going to be a lot of awkwardness as people try to figure out how to greet somebody, how to professionally welcome somebody, how to meet your daughter’s boyfriend for the first time.” This uncertainty can affect those relationships. “We’re going to start seeing a lot more interpersonal and family-based sorts of conflict,” Smith predicts. If a business colleague attempts a handshake or your mom goes in for the hug, and you pull away, “there’s going to be some pretty big ripple effects in terms of the relational dynamics that we see.” Why we touchEven if you hate being hugged outside of intimate relationships or despise shaking hands, losing social touch completely—as we have during COVID-19—still may not feel normal. “Suddenly, we’re starting to realize all of these touches that are missing,” says Juulia Suvilehto, a researcher at Linköping University in Sweden who studies social bonds. “It feels like there’s this weird gap.” Touching acquaintances and strangers serves an evolutionary purpose. Language is the most obvious way that humans foster social ties with one another, but touch does something similar. “We know that nonhuman primates use social touch a lot through grooming,” Suvilehto says. “The larger the group, the more time they spend on it. It’s a way of making allies and maintaining relationships.” Touch also helps reduce aggression between people, says Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine. “When you’re socially touching someone, it’s very hard to be aggressive towards them.” Conversely, “if you separate two monkeys and they can see, hear and smell each other, but they can’t touch each other, once you remove the plexiglass, they practically kill each other.” Over her career, Field says she has watched touch fall off so sharply in American society that she thinks she’ll have to find something else to study. Social hugging was largely sidelined by the Me Too movement, and smartphones took care of the rest. About a year ago, she and her students observed people as they sat at airport departure gates and recorded how often they touched one another. She expected to see people holding hands with their intimate travel companions and slinging their arms around each other. “We weren’t seeing any touching, even between couples and families who were traveling together,” Field says. “Everyone was on cell phones…just scrolling and texting and gaming.” Field doesn’t think touch will bounce back socially—she suspects the elbow bump will edge out the handshake—but she’s hoping that touch is returning among families who are spending more time together in quarantine. Welcome touch is good for your health; it’s been shown to lower stress and activate the release of oxytocin, which is nicknamed the “love hormone” and helps promote bonding and closeness. Nice to meet you?Shaking hands is probably the most common form of social touch in the U.S., and it’s thought to have originated many centuries ago as assurance that neither party was carrying a weapon. “It signals trust and cooperation,” says Sanda Dolcos, who runs a neuroscience research lab at the University of Illinois with her husband, Florin Dolcos. In the team’s neuroimaging studies, “you can really see in the brain that areas that are involved in processing rewards are activated when people are shaking hands,” Sanda says. Even watching people shake hands is enough to increase activation in the brain’s reward centers, their research has shown. “The expectations that come in terms of social or physical interactions are so hardwired,” Florin says, that he doesn’t expect the handshake to permanently disappear after the pandemic is under control. Neither does Smith. “I would be stunned if a year from now, it was gone,” Smith says. “I would be absolutely shocked because of how commonplace and universal it is. I don’t see it going away overnight.” But even they believe that it will change. People might reserve handshakes and hugs for those who are closest to them and who they trust the most and develop new greetings that don’t involve skin-on-skin contact for those further outside their social circle. There are many alternatives: the elbow bump, a foot tap, a bow, the namaste gesture, a brief nod or head tilt, placing a hand on your heart. It’s unclear which of these will prevail, if any. “You see such a wide range of values and beliefs and political views about all of this stuff,” Smith says. “Underlying all of those are layer upon layer of professional and personal beliefs and values stemming from our childhood, from our religious orientation, from the messages we’ve been taught in school.” We won’t all arrive at the same solution. But research has shown it is possible—to some degree—to embrace touch-free alternatives. Sklansky, the pediatric cardiologist and anti-handshake crusader, conducted an experiment to see if he could eradicate the handshake in two of UCLA’s neonatal intensive care units, where some of the most vulnerable patients are treated. In a 2017 study, he describes setting up handshake-free zones by posting signs depicting two clasping hands, crossed-out, and encouraging the doctors, nurses and residents to try different nonverbal greetings. While about a third of providers were resistant—especially physicians, and especially men—nearly all of the patient families were in favor of not being touched by their doctor. Fewer than 10% said they wanted to be greeted with a handshake. The vast majority preferred instead when health care providers looked them in the eye, smiled, addressed them by name or asked about their wellbeing. The handshake has long been a way for doctors to quickly establish rapport with their patients, but something contactless is now necessary—not only because of the pandemic, but also because of the rise of telemedicine. “We’re not going to have some sort of digital handshake,” says Gregory Makoul, founder and CEO of PatientWisdom, a company that helps health organizations improve patient engagement and communication. Makoul co-authored the 2007 study about how prevalent handshakes are in health care, but he believes that words can also build a bond. “You need to have the kind of conversation that makes that connection.” The future of social touch is hereIf you feel that personal connections are harder to form when talking to someone six feet away or through a screen on Zoom, you’re not alone. “You’re having to verbalize a lot more things that you would normally express with touch,” Suvilehto says. Hugging someone who needs comforting or placing a hand on their shoulder often feels easier and more natural than finding the right words. Being forced to voice these feelings might turn us into better communicators. “But the other option is that people will just stop communicating about emotions,” Suvilehto says. Just as social touch can be a substitute for language, you may have to over-communicate with words the feelings you would once get across through physical contact. Welcome to Sklansky’s world, who’s been taking the long, verbose way around the handshake for years. “When people reach out, I just say, ‘Listen, I’d rather not shake hands. I don’t think it’s a good idea for different reasons.’ I explain why, and I talk about the paper,” he says. He opts instead for the namaste gesture. “People smile and think it’s sort of funny,” he says. “But I think it’s something that over time, people could get used to here.” from https://ift.tt/3epPA7y Check out https://takiaisfobia.blogspot.com/ 265 Million People Could Face Hunger in Unprecedented Crisis World Food Program Expert Warns5/26/2020 The world faces an “unprecedented” food crisis due to the COVID-19 pandemic, which has caused both severe job losses and major disruptions in food supply chains, the U.N. World Food Programme’s Chief Economist warns. “When you have these severe job losses, or you have big lockdowns, that means that those people become vulnerable,” Arif Husain tells TIME. An estimated 265 million people could go hungry in 2020, nearly double the 2019 figures, according to WFP’s projection in April. As millions around the world are losing their jobs or seeing their incomes cut, it’s increasingly difficult for them to afford food, Husain says. At the same time, lockdown measures and trade restrictions are making it harder to transport food from where it’s produced to where it’s needed, resulting in food going to waste in the field. Refugees and people in conflict zones like Yemen, Syria, and Burkina Faso and those already living hand-to-mouth prior to the coronavirus outbreak are particularly vulnerable. They will require humanitarian aid or government assistance that might not have previously been needed, Husain says. The pandemic is also affecting countries that rely on tourism and remittances. Economies where a large portion of the population relies on informal work—as well as those with large service or manufacturing sectors are likely to be hard-hit, as well. The world does not currently have a shortage of food, but global food supplies are at risk of running low if farmers are not able to plant in time or receive fertilizer and other inputs in the coming months. “This is why we need to treat the agricultural sector as an essential sector like health care workers,” Husain says. Farmers in countries like India and the Philippines are struggling to recover from the losses they suffered when strict lockdowns were imposed. Several countries, including Russia, restricted exports of key food commodities at various points in the pandemic, but Husain cautions against trade barriers and urges countries to work together on trade policies when it comes to food. “We need to make sure that countries don’t use artificial barriers like export bans or import subsidies because when they do that, particularly in this environment, when the purchasing power is so severely depressed, they create artificial [price] hikes. They create panic buying,” Husain says. “Starving your neighbor is never a good policy.” from https://ift.tt/2AUxZ99 Check out https://takiaisfobia.blogspot.com/ (GENEVA) — The World Health Organization said Monday that it will temporarily drop hydroxychloroquine — the anti-malarial drug U.S. President Trump says he is taking — from its global study into experimental COVID-19 treatments, saying that its experts need to review all available evidence to date. In a press briefing, WHO director-general Tedros Adhanom Ghebreyesus said that in light of a paper published last week in the Lancet that showed people taking hydroxychloroquine were at higher risk of death and heart problems, there would be “a temporary pause” on the hydroxychloroquine arm of its global clinical trial. “This concern relates to the use of hydroxychloroquine and chloroquine in COVID-19,” Tedros said, adding that the drugs are approved treatments for people with malaria or autoimmune diseases. Other treatments in the trial, including the experimental drug remdesivir and an HIV combination therapy, are still being tested. Tedros said the executive group behind WHO’s global “Solidarity” trial met on Saturday and decided to conduct a comprehensive review of all available data on hydroxychloroquine and that its use in the trial would be suspended for now. Dr. Michael Ryan, WHO’s emergencies chief, said there was no indication of any safety problems with hydroxychloroquine in the WHO trial to date, but that statisticians would now analyze the information. “We’re just acting on an abundance of caution based on the recent results of all the studies to to ensure that we can continue safely with that arm of the trial,” he said. WHO said it expected to have more details within the next two weeks. Last week, Trump announced he was taking hydroxychloroquine although he has not tested positive for COVID-19. His own administration has warned the drug can have deadly side effects, and both the European Medicines Agency and the U.S. Food and Drug Administration warned health professionals last month that the drug should not be used to treat COVID-19 outside of hospital or research settings due to numerous serious side effects that in some cases can be fatal. Hydroxychloroquine and chloroquine are approved for treating lupus and rheumatoid arthritis and for preventing and treating malaria, but no large rigorous tests have found them safe or effective for preventing or treating COVID-19. ___ Maria Cheng reported from London. from https://ift.tt/2TzwnrN Check out https://takiaisfobia.blogspot.com/ Will Rogers, director of a senior softball tournament scheduled to take place in early June in Columbia, Mo., will be hosting an event that seems inherently dangerous. In the midst of the COVID-19 pandemic, you’d be hard-pressed to find a public health expert who thinks a gathering of 60 teams from various states, with players ranging in age from 40 to 70-plus, is a good idea. The data could not be clearer: older Americans are most at risk of suffering fatal consequences of the disease caused by the novel coronavirus. However, Rogers, who will also suit up to play with the 65-and-over Kansas City Kids at the Missouri Open, isn’t spending much time worrying about the potential pitfalls of his event. He says the event will have several safety measures in place, like face coverings for catchers and umpires and mandatory social distancing in the dugouts. “I don’t get nervous,” says Rogers, 67, who’s been in charge of the Missouri Open for some 15 years. “But I’m anxious to get out and compete and play and bullsh*t with the guys.” As shelter in place orders expire throughout the country and many states gradually begin the economic reopening process, many senior softball players are ready to round the bases again. Rogers says he’s had to turn away about 10 teams from the Missouri Open, which is slated to be the first national-level tournament sanctioned by Senior Softball USA to return since the COVID-19 outbreak. After weeks in isolation, older people who play the game are itching to experience some camaraderie. Some 30,000 seniors across the country play tournament-level softball, according to Senior Softball USA, and around 1.5 million Americans over 50 play the game recreationally in church leagues, bar leagues and other local outlets. “There are guys that are a lot more anxious about the coronavirus than I am,” says Rogers. “I’m going to be cautious. I’m not going to lick doorknobs and or the softball. But I feel like I’m fairly safe. I’m in decent health. I never smoke so my lungs aren’t f’d up so I’m at a lower risk of getting pneumonia and those sorts of things.” Senior softball is a uniquely American enterprise: a subculture of elderly sport devotees playing what’s mostly considered a young person’s game. But the fraught balancing act in reopening a niche sport like senior softball during the COVID-19 pandemic will ring familiar to any business across the country. For many seniors, tournaments like the Missouri Open represent a much-needed return to normalcy. Plus, the longer softball remains on the shelf, the economic urgency to relaunch events grows higher. “Even in senior softball,” says Darrell Pinkerton, 80, who manages 65-and-over and 70-and-over teams based in Oklahoma and Arkansas, “a lot of it is about the money.” Senior Softball USA is a 501 c(4) tax-exempt “social welfare organization” generating more than $2.2 million in revenue in 2018, according to its most recent tax filing and the entry fee for the Missouri Open is $400 per team. Cities need the revenues that come along with the 60-team sporting event and hotels are happy to host the players, who represent teams from 10 different states, including Arkansas, Indiana, Minnesota. Weighing on events like the Missouri Open, however, is its customer base: the age group most as risk of dying of the disease. (There are seven 70-and-over teams registered to play in the June tournament. Missouri’s shelter-in-place order expired on May 3). While softball is far from a full-contact sport, tagging on the basepaths is part of the game and collisions on the field are impossible to predict. Well-intentioned social distancing rules and promises to sanitize the softballs can only do so much to prevent the potential spread of COVID-19. Professional baseball won’t return without frequent testing of much younger players, who are much more likely to recover from COVID-19. But an amateur event for senior citizens is slated to start without COVID-19 tests and public health experts are concerned. “It kind of boggles my mind,” says Arthur Caplan, director of the Division of Medical Ethics at New York University’s Grossman School of Medicine, who’s consulting with mayors around the country on the safe reopening of local sports. “It’s not the responsible thing to do.” Seniors, however, insist on playing ball in places that allow it. This Memorial Day weekend, the city of Fountain Hills, Ariz., hosted a 27-team senior softball tournament with social distancing and rules like no spitting and no sunflower seeds; Arizona’s stay-at-home order expired May 15. At least one team came from both California and Las Vegas. Players had to sign a waiver: “I understand the risk associated with COVID-19 and I agree to follow all guidelines and rules set forth to enforce social distancing,” it read. “I acknowledge that I am not ill and to my knowledge I have not been exposed to anyone with COVID-19 within the last two weeks.” Recent CDC guidelines on youth sports put travel tournaments in the “highest-risk” category, given their potential as a COVID-19 vector: children and families could catch the disease on the field, in a hotel or while in transit, and carry it back to their home communities. If the CDC considers youth travel tournaments highest risk, the risk of senior travel tournaments is off the charts. “When it becomes a burden on society to take care of you should you catch the disease, when you’re potentially reopening the disease to people not playing softball, I think you have a different set of obligations,” says Caplan. “I would say to my 70-year-old friends, I know you want to play softball with your buddies. I get that it’s a great social outlet, and important to your quality of life. That’s why you should just enjoy it next summer.”
The CEO of Senior Softball USA, Terry Hennessy, cites several factors driving the return of his organization’s events during the pandemic. First, his players are calling for a resumption of the season. “A lot of the players stuck in their houses for a few months are saying, ‘I want to get out, I want to play,'” says Hennessy, 68. And while Hennessy recognizes the risks, he says he knows of only three of the 30,000 tournament softball players who have died of COVID-19. And they each had preexisting conditions, he says. He anticipated many more fatalities. Hennessy’s also transparent about his business incentives. Most of Senior Softball USA’s eight employees at its Sacramento, Calif., headquarters have been furloughed during the pandemic. “It doesn’t matter what kind of business it is, you have to maintain some kind of revenues flow or you’re not going to have a business,” says Hennessy. “It’s a personal as well as a business decision. You don’t want to put people in danger. You don’t want to risk their health. It’s a tough balance.” Senior Softball USA has drawn up a set of safety guidelines for returning. Postgame handshakes between teams are prohibited. Players must linger out of the dugout and behind any fencing, if necessary, to maintain six-feet of social distancing. Masks in the dugout are encouraged, but not required. Catchers must cover their nose and mouth. Umpires must wear face shields or masks. There won’t be communal water jugs. When asked to pass along any public health professionals he consulted with in drawling up guidelines, Hennessy forwarded contact information for his daughter, Jayme Hennessy, a nurse practitioner in the Boston area. Terry Hennessy said he used CDC recommendations concerning social distancing, face masks, washing hands and disinfecting common surfaces to build the health and safety guidelines. And Jayme Hennessy joined an online conference with umpires-in-chief and tournament directors to discuss their implementation. “I am by no means an expert in infectious diseases, epidemiology or COVID-19,” Jayme Hennessy wrote via email to TIME. “I am a licensed nurse practitioner and practicing clinical nurse. My father asked me to participate in a call to provide a clinical perspective and offer suggestions on mitigating risk for playing softball during the current pandemic. I would also like to say that, as a medical professional, I cannot recommend moving forward with these tournaments. I can’t imagine any person in the medical field would.” Jayme does believe the social distancing measures will help reduce transmission. “This virus scares me,” Jayme writes. “As we all know by now, it is particularly harmful and deadly to people in my father’s age bracket. I would honestly prefer that he stayed at home and quarantined until more treatments became available. But my father loves softball.” The city of Columbia’s “guidance for businesses” allows for limited contact sports, which includes softball. According to a document sent from the Columbia parks department to the city’s health department, all Missouri Open players “will be screened at check in and will have their temperature taken with an infra-red thermometer.” Tournament director Will Rogers, however, tells TIME that although he has purchased an infra-red thermometer for the event, he hasn’t finalized his plan yet for using it. “I could go around and check everybody,” says Rogers. “But that’s going to take forever.” Mike Griggs, director of Columbia’s Parks & Recreation Department, tells TIME that Missouri Open organizers are “expecting the teams that are coming out of state will likely be those men’s 40, the 40-50 years age teams. That the seniors probably won’t travel.” According to the Missouri Open registration sheet, however, 42 of the 60 teams, or 70%, consist of players 55 and over. There are 13 60-and-over teams signed up; nine of the them are 65-and-over and seven of them are 70-and over. Around 65% of these teams are from out of state. The 70-and-over teams are from Arkansas, Illinois, Iowa, Kansas, Missouri, and Nebraska. Four teams in the tournament from the Chicagoland area. (Illinois’ COVID-19 reported case count, which is approaching 108,000, trails that of only New York and New Jersey) “Oh really?” Griggs says when I tell him that 70-and-over teams are registered for the tournament. “Get the heck out of here. Well, that’s something.”
Some senior softball players have mixed feelings about reopening. Mark Smith, an FBI analyst from Overland Park, Kans., and a power hitter for the Oklahoma Relics, hopes the Missouri Open gets called off. “It’s really dangerous for older folks,” says Smith. “We don’t have the immune system to fight this thing off.” He’s worried about staying in a hotel and eating in restaurants during the tournament and potentially bringing COVID-19 home to his wife, who’s already suffering from cancer. “Boy, it just makes me nervous as crud.” Charlie Myers, a retired facility maintenance worker for American Airlines, has made up his mind: he’s going to skip the Missouri Open. Myers, 70, lives in Newark, Texas, and flying to Missouri just isn’t worth it to him. “I go there to have fun,” says Myers, a shortstop for the USA Patriots, a team based in Oklahoma. “To have to be six-feet apart, wearing a mask outside the dugout, and you can’t go out to eat with your team like you normally would … It’s just not the same.” His USA Patriots teammate Mike Seraphin, however, will be taking a plane from Texas to Missouri, despite the travel risks, and despite his age (71). Seraphin, a retired residential real estate appraiser who lives in Benbrook, Texas, thinks he’ll adjust to the Missouri Open restrictions on softball field contact. “I’d probably have to occasionally think twice about it,” says Seraphin. “But we’ve been doing the social distancing, no hand shaking, no church, not this, that or the other. I think it will be part of the normal procedures.” When asked to explain why he’s comfortable flying across the state lines for a softball tournament during the COVID-19 pandemic, Seraphin pauses to consider his words. “Why am I going?” he says. “I am in the age group. But I don’t think I have any of the underlying secondary issues. I don’t see the great risk of going out there any playing. The regular flu is a risk. You drive around and who knows what’s going to happen. Nobody knows when they’re going to die. So just go ahead with it.” from https://ift.tt/3efcXjV Check out https://takiaisfobia.blogspot.com/ (SALT LAKE CITY) — Health investigator Mackenzie Bray smiles and chuckles as she chats by phone with a retired Utah man who just tested positive for the coronavirus. She’s trying to keep the mood light because she needs to find out where he’s been and who he’s been around for the past seven days. She gently peppers him with questions, including where he and his wife stopped to buy flowers on a visit to a cemetery. She encourages him to go through his bank statement to see if it reminds him of any store visits he made. Read more: Here’s How Quickly Coronavirus Is Spreading in Your State Midway through the conversation, a possible break: His wife lets slip that they had family over for Mother’s Day, including a grandchild who couldn’t stop slobbering. “Was there like a shared food platter or something like that?” Bray asks. “There was, OK, yep … sharing food or sharing drinks, even just being on the same table, it can spread that way.’” Suddenly, with a shared punch bowl, the web has widened, and Bray has dozens more people to track down. She is among an army of health professionals around the world filling one of the most important roles in the effort to guard against a resurgence of the coronavirus. The practice of so-called contact tracing requires a hybrid job of interrogator, therapist and nurse as they try coax nervous people to be honest. The goal: To create a road map of everywhere infected people have been and who they’ve been around. While other countries have devised national approaches, a patchwork of efforts has emerged in the U.S. where states are left to create their own program. Bray normally does this type of work to track contacts for people with sexually transmitted diseases. She is now one of 130 people at the Salt Lake County health department assigned to track coronavirus cases in the Salt Lake City area. The investigators, many of them nurses, each juggle 30 to 40 cases, and try to reach everyone the original person was within 6 feet (1.8 meters) of for 10 minutes or more. They stay in touch with some people throughout the 14-day incubation period, and calls can take 30 minutes or more as they meticulously go through a list of questions. Some estimate as many as 300,000 contact tracers would be needed in the U.S. to adequately curtail the spread. While some states like Utah have reported having enough contact tracers, others are hundreds or even thousands of people short. The contact tracers often find themselves in a tangled web of half-truths and facts that don’t match up. Language and cultural barriers arise that require interpreters and taxing conversations that leave the investigators wondering if the person understands what they’re trying to do. They land on occasion into complicated family dynamics where people are reluctant to tell the truth. Health investigator Maria DiCaro found out days into a case that a father was sleeping in his car because he and his wife were separating. The man had stopped returning DiCaro’s calls, and that key information came from his child. “I get people that lie all time,” DiCaro said. “I try to get as much information from the beginning but it’s just not always the case. And time is one of those things you can’t take back when you are trying to prevent and you know do these contact tracing investigations.” Each call is an exercise in good cop, bad cop. She needs people to cooperate, but no one is legally required to answer the questions. Usually kindness works better than strong words. Some people lie because they’re scared, or they forget an outing. Construction workers, housekeepers and others without paid sick time may gloss over symptoms so they can get back to work. Some immigrants without documentation brush off testing because they fear it could lead to deportation. “People sometimes think contact tracing is black and white but there is a lot of gray that goes into it,” said Bray, who often thinks about her parents and 97-year-old grandmother as she works to help stop the spread of the virus. “Our worst fear is that we push too hard and we lose someone. It’s not just their health on the line, it’s the people around them.” Read more: The U.S. Has Flattened the Curve. Next Up Is ‘Squashing’ It — and That’s Not Going Well No matter the tension, Bray and DiCaro give frequent reminders of why it all matters: “Thank you for what you’re doing. You’re helping the community,” DiCaro says during one call. She knows that on the other end of the line, the first call from a tracer can be jarring. Sometimes, DiCaro and Bray have to break the news that someone was exposed or tested positive. “It’s normal to talk to like your doctor, but you don’t ever expect the health department to call you and be like, ‘You were exposed to a serious disease,’” said Anissa Archuleta. The 23-year-old got a call from DiCaro after she, her sister and her mother took a rare break from hunkering down to help organize a drive-by birthday party for a young cousin. They dropped off a present, then caved and accepted an impromptu invitation to go inside to grab some food. What they didn’t know: the father of the birthday boy had the coronavirus, and unknowingly exposed more than a dozen people at the gathering. After that first call, DiCaro checked in every day for two weeks. The fear slowly faded after their tests came back negative and they began building a rapport with DiCaro. She asked about their symptoms and how they were feeling each day and learned about how Archuleta’s mother lost her voice to fibromyalgia. Archuleta would pass along messages her mother whispered in her ear. And after a while, Archuleta began asking DiCaro about her life and how she was holding up. About a week in to their calls, on the daily check-in, Archuleta thanked DiCaro for caring about them and checking in every day. Tears welled up in DiCaro’s eyes. “Ah thanks,” she said as she grabbed a Kleenex to wipe her eyes. After she hung up, she leaned back in her chair and closed her eyes for a few seconds. “When you do this like 10-12 hours a day … It’s nice to get those positive reactions from people that are very grateful who do see the purpose of what we are doing,” said DiCaro. “It’s nice to be appreciated.” from https://ift.tt/2TvZVqk Check out https://takiaisfobia.blogspot.com/ Inside San Franciscos Ambitious Plan to Bring Universal Coronavirus Testing to An Entire U.S. City5/22/2020 Public health experts can’t say it enough: If the U.S. is going to beat COVID-19, the country needs to ramp up testing. But there’s no single blueprint for cities and states to follow as they respond to that call. Some, like Los Angeles, are going big. In late April, L.A. became the first major city to offer free testing to any resident. Others, like San Francisco, are doing things in a more progressive style, with goals that are just as ambitious. The latter is strategizing from a place of strength. Thanks to some of the nation’s earliest stay-at-home orders, San Francisco has, so far, flattened the curve with relative success. Businesses around the city have been allowed to reopen for curbside pickup. And key to continuing on the path back to normality is continually testing residents, city officials say, with a focus on “vulnerability” above all else. Over the past 11 weeks, since San Francisco began analyzing tests at city labs rather than shipping them off to Atlanta, officials have been gradually widening the circle of who is eligible to get one. The decision not to let just anyone sign up was partly about limited resources. It took time for the city to stabilize its supply chain. But public health officials also wanted to prioritize those who were most at risk. At first, data about risk factors were limited, with officials focused on simple criteria like whether someone had traveled to China. Since then, the calculation has gotten more complex. Research and reports suggest that the virus may be exploiting systemic inequalities, and the deep blue city has, unsurprisingly, taken that to heart. Shortness of breath is one indicator of who might need to be tested for COVID-19. According to San Francisco’s public health department, income is too. The need to take people’s circumstances into account is a lesson the city learned in the 1980s, from fighting another then-mysterious virus, HIV. “Who is more likely to be in settings where they’re not able to adequately protect themselves?” says Dr. Susan Philip, the city’s director of disease prevention and control. Answering that question is important from an equity standpoint, she says, “but it’s also very important from the standpoint of protecting the entire city.” The strategy has challenges, like identifying all those who are vulnerable and, on top of that, figuring out how to convince them that getting tested is in their best interest. San Francisco has machines that are capable of analyzing 4,300 tests a day, according to the health department. Currently, they’re analyzing about 1,300, and health officials have set a goal of raising that to between 1,600 and 2,000 in the coming weeks. Among the reasons for that gap are a continuing struggle to get supplies needed to conduct tests, as well as the need to train staff and obtain protective equipment. But officials also don’t want to turn anyone away. In the days following L.A.’s announcement, there were reports that a website for sign-ups crashed and that appointments filled up before some people were able to get them. “What we knew here,” says Philip, “is we wanted to make sure that as we expanded, we didn’t have to contract.” In the beginning, that meant focusing on only the most obvious group: those who feel sick. Initially testing was limited to those who felt ill and who had also traveled to Wuhan, then the Hubei province, then China. By late April, the city had expanded testing to anyone experiencing symptoms—including both the nearly 900,000 residents of S.F. and those who commute in from other places for work. As the city’s capacity for testing continued to increase, officials faced a more complicated exercise in prioritization. Research has made it increasingly apparent that it’s also important to test people who feel well. Some studies suggest that half of those who are positive for COVID-19—and therefore capable of spreading the virus—may be asymptomatic. Knowing resources are still limited and a negative test result is generally not as useful as a positive one, which asymptomatic people do you seek out? One interpretation of “vulnerability” to the coronavirus is that someone is at high risk of dying if they get it. That’s the factor the city relied on when it made the decision, announced on May 1, that testing for residents and workers at skilled nursing facilities would not only be universally available but universally mandatory. On May 19, Dr. Grant Colfax, the city’s health director, announced that about 40% of all S.F. nursing home residents and workers had been tested so far and proudly relayed that the small number of positive test results from one large nursing facility—four out of more than 2,000—had led to swift contact-tracing and isolation, potentially protecting many at-risk seniors and care workers. Another way to interpret vulnerability is to focus on exposure: who is most likely to get infected or to transmit the virus to others? Is it the venture capitalist who has been able to work from home or the bus driver who encounters dozens of strangers every day? “Just thinking it through,” Philip says, “it’s going to be a grocery clerk or a delivery driver.” This led the city’s latest step: expanding testing to all essential workers, regardless of whether they have symptoms, on May 4. (It was also the reasoning behind offering testing to asymptomatic close contacts of people who test positive, which began in late April.) What has the city learned? Of the 50,533 test results that have been reported to the city as of May 22, 6% have been positive. Lower-income neighborhoods, men and Latino residents have been harder hit. The city is not going to expand testing by offering it to any particular race or ethnicity, says Veronica Vien, a public information officer for the department of public health. But the city is setting up testing sites, including a mobile one, in neighborhoods where communities of color are larger, where higher proportions of residents live in poverty, and where people might face more challenges in traveling to healthcare centers. Another vulnerability that’s come into focus is living in crowded settings, and so the city is gearing up to expand universal testing to facilities like homeless shelters. Individuals experiencing homelessness also tend to be older and have underlying health conditions, making them vulnerable in myriad ways. But even as the city looks to the next expansion, it’s still trying to figure out how to penetrate more deeply into the at-risk groups it’s already identified. Philip can’t say exactly how many people are eligible under existing criteria or what portion of them have been tested. But it’s not as many as public health officials would like. “We can’t look at that as a flaw with the population,” she says. “We have to look at it and say: What is it we can do better?” A study done in late April in the Mission District, a historically Latinx neighborhood that struggles with income inequality, offered some clues. In partnership with the city, local activists and other groups, researchers from the University of California San Francisco attempted to test everyone who lives or works in a single census tract, in the Mission. Overall, about 2% tested positive. An overwhelming number of that group, 95%, were Hispanic or Latinx—compared to just 44% of all of those tested. About 90% of those who tested positive reported that they were unable to work from home, and infection rates were higher among those who traveled to the area for their jobs—about 6%—findings that affirmed the city’s decision to expand testing to all essential workers. (UCSF also worked on a companion study in the relatively isolated and predominantly white town of Bolinas, which found zero infections after testing nearly every resident.) However, researchers reached only about half of the population they were trying to test. Dr. Gabriel Chamie, an investigator from UCSF, says that while they don’t have data to explain why some people did not participate—despite door-to-door appeals—they anticipated several reasons. One is that for weeks now residents have been told to stay home, which might reasonably cause people to be afraid of coming out for testing. The neighborhood, like others in San Francisco, is also home to undocumented individuals who might fear having their data collected. Some might worry about economic consequences. “If you test positive,” Chamie says, “that might mean there’s a stretch of time where you need to self-isolate.” And if you’re the sole breadwinner for a household, that may not feel like an option. Then there’s the issue of “being labeled as positive and what that might mean,” an issue Chamie knows well from his background in HIV research. A central lesson San Francisco is applying from its efforts to respond to the HIV epidemic, he says, is that there’s “a human side to what it means to develop an infection. It doesn’t happen in a vacuum.” And so the city has been trying to respond on a human level, spreading the message that it’s safe for undocumented people to get tested (San Francisco is a sanctuary city) and working to provide meals and replacement income for those who couldn’t otherwise shelter in-place for two weeks. Low-income individuals who test positive and are worried about infecting their families—in the Mission study, nearly 90% of those who tested positive lived with three or more people—can be put up in a hotel room for free. In various efforts, government officials are partnering with community organizers who are known and trusted in places they’re trying to reach. That, to Philip, is the key takeaway from decades of experience with HIV. “Community understands how best to gain information that will be helpful in our public health efforts, how to engage people in the research that will be needed to find new breakthroughs,” she says. Outreach teams are papering neighborhoods like the Mission with more than 80,000 flyers, in several languages, that highlight testing opportunities. Teams of Chinese speakers are meanwhile going door-to-door to spread the word among business owners in Chinatown, one of S.F.’s poorest, densest neighborhoods. Public health officials also know that combating shame associated with an infectious disease will help increase the number of people who know their status. To this end, Mayor London Breed announced that she would be going to get tested in the Bayview-Hunters Point neighborhood, an area that has experienced high rates of infection and where the vast majority of residents are people of color. “We also want to make sure we detach the stigma associated with getting tested,” she said at a virtual press conference on May 18. There are more results to come from the Mission study. Researchers not only tested approximately 57% of people in the census tract for active infections but also for the presence of antibodies, which will suggest the cumulative number of cases that have occurred in the area over time and help reveal the footprint of the virus in the city. Results are expected at the end of May. Philip says that while she eagerly anticipates those findings, the public health department is squarely focused on testing for active infections at this point. The reliability of antibody tests is still uncertain, and, even if that weren’t an issue, it’s not known whether people become immune after being infected with the coronavirus and, if so, for how long. “There are a lot of open science and public health questions,” she says. Mayor Breed has said that ongoing testing will be critical to reopening, and the city has stated a goal of providing universal access to testing. But Philip says there’s no set timeline for when the city hopes to have expanded the circle completely. In general, her department is less focused on when every San Franciscan will be able to be tested than on questions like how often high-risk individuals should be. “The reason we test is to have results we can act on,” Philip says. That’s where the public health follow-up happens: the investigation, the contact tracing, the isolation, the quarantine. But resources aren’t limitless. Testing for vulnerable people needs to be routine—someone could get sick in between the time when they got swabbed and got their test results, she says—but it’s not yet clear just how frequent it should be. Because the incubation period of the virus is 14 days, the city is currently using general guidance that groups like essential workers should get tested no more than every two weeks, but is the optimal window every 15 days? Every month? That’s TBD. As the city works to find more answers, and get more results, they’ll be guided by a broader mantra at the public health department. “We all have to be healthy together,” Philip says, “or we’ll all be unhealthy together.” from https://ift.tt/2XnPAhk Check out https://takiaisfobia.blogspot.com/ In the largest observational study thus far investigating the drug hydroxychloroquine as a treatment for COVID-19, researchers found little evidence that it helps, and worrying evidence that the medication may cause harm. In a study published May 22 in the journal Lancet, scientists in the U.S. and Switzerland report on an analysis of more than 96,000 people hospitalized with confirmed COVID-19 in 671 hospitals on six continents. Nearly 15,000 patients were treated with one of the following: chloroquine (which is an older version of hydroxychloroquine), hydroxychloroquine, or either of those drugs in combination with an antibiotic. The remainder did not receive any of these medications and served as the control. People in any of the four treatment groups were more likely to die during their hospitalization than those not treated. People receiving either chloroquine or hydroxychloroquine alone were 16% to 18% more likely to die in the hospital compared to those not receiving the medications, and those treated with these medications in combination with an antibiotic were 22% to 24% more likely to die in the hospital. These risks remained significant even after the researchers controlled for factors such as smoking, underlying heart disease, diabetes, lung disease, or immune conditions. In addition, those receiving the medications had higher risk of developing abnormal heart rhythms — a known risk factor of chloroquine and hydroxychloroquine — compared to people who were not treated with the medications. “However we sliced and diced the data, the results were identical,” says Dr. Mandeep Mehra, chair of cardiovascular medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, who led the study. “There was no evidence of benefit, and a consistent signal of harm — and in particular, harm linked to heart rhythm disturbances.” The findings come as U.S. President Donald Trump claimed to be taking hydroxychloroquine, which he requested from the White House physician, because he “heard a lot of good stories.” Mehra notes that the study included only people diagnosed with COVID-19, while the President has not been reported to be infected. Hydroxychloroquine is approved to treat malaria — replacing chloroquine in many parts of the world after the malaria parasite became resistant to chloroquine — as well as some autoimmune disorders like rheumatoid arthritis and lupus, because of its ability to tamp down inflammation. Doctors started to turn to the drug to treat COVID-19 after a small study in France suggested it might help alleviate some of the disease’s inflammatory symptoms, which can compromise breathing and cause respiratory failure. The evidence for the drug’s effectiveness, however, hasn’t been established, although ongoing rigorous trials randomly assigning patients to receive hydroxychloroquine or placebo are still ongoing (including one headed by the U.S. National Institutes of Health). But there is growing evidence that the medication may not be as helpful as doctors had hoped. In a study of more than 1,300 people admitted to New York Presbyterian-Columbia University Irving Medical Center, for example, people receiving hydroxychloroquine did not show any lower rate of needing ventilators, or a lower risk of dying during the study period than those not getting the drug. Studies from Europe and China similarly failed to find that the drug showed any benefit for patients. Those studies have led the U.S. Food and Drug Administration (FDA) to warn health providers that they should not prescribe hydroxychloroquine off-label for COVID-19 patients unless they are part of a research study or carefully monitored in a hospital setting. In fact, as the evidence continues to suggest that hydroxychloroquine may not provide much benefit, and instead might increase the risk of harm to the heart, Mehra says doctors may shift from considering hydroxychloroquine to other drugs being studied as COVID-19 treatments, like remdesivir. Studies indicate that remdesivir, an antiviral that has not yet been approved to treat any disease, may help people with COVID-19 to recover faster, and the drug received FDA emergency use authorization to treat hospitalized patients. Unlike hydroxychloroquine, remdesivir has not been linked to serious side effects so far, and therefore may be a more attractive option for doctors treating COVID-19 patients. “They may be more likely to try something where there is a better chance of showing a net positive outcome,” says Mehra. “Why would you risk harm when there is so much consistent data showing lack of benefit [with hydroxychloroquine]?” from https://ift.tt/2ynevJo Check out https://takiaisfobia.blogspot.com/ On April 20, the president calls a press conference to announce a breakthrough in the fight against COVID-19. It’s a new use for an old malaria treatment, he says, one that is seeing miraculous results among the country’s most ill patients. It’s so safe that even schoolchildren could take it. In fact, he urges them to do so daily, as a preventative. He admits that he, too, is taking the medicine. No, this is not the President of the United States touting an unproven remedy for a virus that has infected nearly 5 million people worldwide. It is Madagascar’s President Andry Rajoelina, who is just as willing to use the presidential platform to promote a hypothetical treatment as is his American counterpart. To prove the safety of his new discovery, he picks up a bottle placed prominently on the podium and takes a swig of the amber liquid. “This herbal tea gives results in seven days,” he avows. “Tests have been carried out—two people have now been cured by this treatment.” Aides pass bottles of the herbal remedy, labelled “Covid-Organics,” to the assembled diplomats, ministers and journalists. They sip appreciatively, then break into applause as the president of this island nation announces that the first African cure for coronavirus, based on traditional African medicine, will be distributed countrywide, and, eventually across the continent. According to the World Health Organization, there are no medicines that have been shown to prevent or cure COVID-19. That hasn’t stopped people—some of them presidents—from grasping at any potential treatment that might provide a way out of the devastating lockdowns that are collapsing national economies, or stave off the threat of mounting death tolls. The launch of Covid-Organics (CVO for short) in Madagascar last month was no different. Within days, multiple African nations, as well as Haiti, were asking about shipments. And while CVO is not yet available for export, Rajoelina acquiesced by sending samples for free. The promotion of an untested cure sparked consternation among the medical community in Africa, and provoked an unusually sharp rebuke from the WHO, which noted in a statement on May 4 that, “Caution must be taken against misinformation, especially on social media, about the effectiveness of certain remedies. Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy.” The use of such untested products, it continued, “can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing which are cardinal in COVID-19 prevention.” Back in Madagascar, the international uproar was met with bafflement. The use of traditional remedies there is so deeply ingrained that most Malagasies, as they call themselves, would just as likely reach for an herbal cure to treat a headache or a stomach-ache as they would a western pharmaceutical product, says Tiana Andriamanana, the executive director of local conservation NGO Fanamby. Andriamanana’s work often takes her to poor and rural areas where hospitals and pharmacies are hard to find, and conventional medicine is often unaffordable. “A lot of times there isn’t really a choice,” she says. “Traditional medicine is how we roll.” Nor are Malagasies alone in their reliance on traditional medicine: according to the WHO, 87% of African populations use it. And the establishment that developed CVO, the Malagasy Institute of Applied Research [IMRA], is well-respected in the country for its work refining those remedies: some of that research has led to the discovery of internationally recognized pharmaceutical treatments such as Madeglucyl, which can help with diabetes management. It also helped identify the Madagascar periwinkle’s potential in cancer treatment; compounds isolated from the flower are now being used in treatments for breast, bladder and lung cancers. When news first emerged in January of a mysterious influenza-like disease in China that didn’t respond to conventional treatment, IMRA’s director general, Dr. Charles Andrianjara, got to work. Since its founding in 1957, the institute’s researchers have catalogued thousands of medicinal herbs used by Madagascar’s traditional healers. Andrianjara wondered if some of the institute’s herbal knowledge might help fight the emerging viral illness. “Our hypothesis was that if we could treat the cough, the respiratory difficulties, the aches, the fever, then we could treat the virus.” He combed the database, seeking herbs with antioxidant and anti-inflammatory properties, as well as natural cough suppressants and fever reducers. The institute had also been studying artemisia annua, or sweet wormwood, a common anti-malarial that had shown promising signs in the treatment of severe acute respiratory syndrome (SARS), another respiratory disease caused by a coronavirus, which emerged from China in 2002. “COVID and SARS are very similar in terms of their genetic structure,” says Andrianjara, “so our hypothesis was that artemisia might have an effect on COVID-19.” Andrianjara’s team combined artemisia with other ingredients to create an herbal tea, and offered the decoction to patients who had tested positive for the disease. “We started with one, two [patients] and we found that it really reduced their symptoms,” he says. “They recovered quickly.” IMRA has not conducted any formal trials or tests; Andrianjara’s assessment comes only from observing the reactions of a handful of patients outside of a controlled setting. While he says that the patients were not receiving any other treatments at the same time, there is no formal documentation. When President Rajoelina made his announcement, fewer than 20 patients had received the remedy. Such low numbers are meaningless when it comes to a disease that is still so poorly understood and whose effects can range from asymptomatic to massive organ failure, but Andrianjara argues that the remedies themselves can do no harm. “They have been thoroughly tested for toxicity, and they have been on the market for 30 years, so we already know their efficacy.” He likens CVO to common Western treatments like painkillers, which some studies show do not work on everyone. “You can give 20 people paracetamol. It won’t harm any of them, but it won’t cure all of their headaches either. If CVO can cure 60% of the population, to me that’s good. It’s not the best, but it’s good.” It’s impossible for doctors and scientists to validate any of these claims; other than saying that CVO contains 62% artemisia, IMRA has not released the names of the other ingredients, for fear that the formula could be stolen. While President Rajoelina promotes CVO as both a cure and a preventative, it hasn’t been cleared for distribution as a drug by Madagascar’s National Academy of Medicine, which warned in a statement that “It is a medicine for which the scientific evidence has not yet been established and which risks damaging the health of the population, in particular that of children.” In a media briefing on May 14, the WHO stated that there was no scientific evidence to support the safety and efficacy of Covid-Organics. The WHO’s regional director for Africa, Dr. Matshidiso Moeti, said that rigorous testing would be vital for credibility, “So that when we celebrate the discovery of this treatment in Africa it is on the basis of evidence that can be shared around the world.” South Africa-based virologist Denis Chopera sees it as a supplement rather than a cure, telling the Voice of America’s Africa broadcast that “I don’t think there’s any harm, but I don’t think people should expect that it will treat them and cure COVID-19 because that has not been proven scientifically.” Shabir Madhi, professor of vaccinology at the University of the Witwatersrand in Johannesburg, told the Mail & Guardian that he has seen no evidence that the remedy has cured anything, noting that with Madagascar’s low numbers of confirmed cases (405 as of 22 May) it would be impossible to assess efficacy. “The majority of people who have this virus show no symptoms. Of those who develop symptoms, 85% of them have mild illness. You could treat them with water and it would have the same effect.” President Rajoelina slammed skeptics in an interview with France 24, claiming that more than 100 COVID-19 patients in Madagascar had already been successfully treated with Covid-Organics. “When we are in this period of war, what is the proof we can show or give? It is, of course, the healing of our sick,” he said. “I think the problem is that [the drink] comes from Africa and they can’t admit…that a country like Madagascar…has come up with this formula to save the world.” IMRA’s Andrianjara also senses an anti-African bias in the international negative reaction to his remedy. After all, he points out, Madagascar isn’t the only country to embrace untested remedies as a potential cure. “In the United States, President Trump has been promoting [the antimalarial drug] hydroxychloroquine, even though the FDA has warned that it is not a proven treatment and it has dangerous side effects.” Many countries are trying out new treatments without clinical trials, he says, “so why is Madagascar being singled out? Because we are offering a traditional remedy instead of a conventional drug?” Many companies have used the coronavirus pandemic to tout their herbal supplements as immune boosters and health tonics. Few have a president doing their marketing. Rajoelina is rarely seen these days without a bottle nearby, prompting many Malagasies to speculate about where, exactly, the profits are going. But while Madagascar does have one of the largest supplies of artemisia annua in the world, the low cost of the remedy would suggest it is not exactly a goldmine. Madagascar’s government is now in talks with the WHO and the African Union over how to develop a rigorous testing protocol for CVO. The biggest obstacle they face at the moment is the lack of sufficient patients—without enough infected people, it’s impossible to run a controlled study on the curative effects. “What can we do?” asks Andrianjara. “We don’t want more people getting sick, just so we can do more tests.” Meanwhile, researchers at Germany’s Max Planck Institute of Colloids and Interfaces are testing Artemisia annua extracts to determine its effectiveness in speeding recovery from the virus. On the streets of Antananarivo, the Malagasy capital, there is no debate. Covid-Organics can be found in nearly every supermarket and corner shop. The recommended dose is two teas a day, for seven days, and it is sold for the equivalent of 20 cents for a single-serving bottle of tea, or $1.50 for a box of 10 tea bags that can be steeped at home. According to Andriamanana, the executive director of the conservation NGO, it has a mild taste of anise, with a bittersweet finish reminiscent of a strong black tea. Andriamanana is not sure she could drink it twice a day, but a lot of her friends do. “They say it’s working, at least as an immune booster. It invigorates, it takes fatigue away.” Like most traditional remedies, she says, it’s hard to draw the line between science and belief. “Could it work as a cure? Maybe, at least psychologically.” She would love nothing more than to see it put to a scientific test, and pass. “If we can prove that we have the solution, or even a solution, for the coronavirus, we can show that it was not dumb after all to rely on nature and indigenous knowledge.” Andrianjara, of IMRA, says that even if CVO isn’t proven to cure Covid-19 in scientific studies, there are many of other promising remedies in Madagascar’s traditional pharmacopeia that should be explored. “Instead of researching something new that costs a lot of money that we cannot afford, let’s go back and revisit our traditional knowledge. We have a lot of wealth in our traditions and culture, and maybe we don’t exploit it enough.” from https://ift.tt/2TuSksc Check out https://takiaisfobia.blogspot.com/ (London) — British researchers testing an experimental vaccine against the new coronavirus are moving into advanced studies and aim to immunize more than 10,000 people to determine if the shot works. Last month, scientists at Oxford University began vaccinating more than 1,000 volunteers in a preliminary study designed to test the shot’s safety. Those results aren’t in yet but on Friday, the scientists announced they’re expanding to 10,260 people across Britain, including older people and children. If all goes smoothly, “it’s possible as early as the autumn or toward the end of the year, you could have results that allowed use of the vaccine on a wider scale,” predicted Andrew Pollard, head of the Oxford Vaccine Group. But Pollard acknowledged there were still many challenges ahead, including how long it will take to prove the vaccine works — particularly since transmission has dropped significantly in Britain — and any potential manufacturing complications. The Oxford shot is one of about a dozen experimental vaccines in early stages of human testing or poised to start, mostly in China, the U.S. and Europe. Scientists have never created vaccines from scratch this fast and it’s far from clear that any of the candidates will ultimately prove safe and effective. Moving on to such a huge late-scale test doesn’t guarantee the Oxford candidate will reach the finish line, either. Pollard couldn’t provide any data from the first tests, but said an oversight board hasn’t seen any indications of worrisome side effects. A small study in monkeys offers a note of caution: The Oxford team and researchers from the U.S. National Institutes of Health found the vaccine protected against pneumonia but didn’t eliminate the coronavirus in the nose. Pollard said it was still an open question whether the shot could make a dent in how the disease spreads. Another question addressed in the next stage of testing is how the shot will affect older adults, who are at high risk from COVID-19. Pollard noted those over 70 often don’t get as much protection from vaccines as younger people. Earlier this week, drugmaker AstraZeneca said it had secured its first agreements to produce 400 million doses of the Oxford-developed vaccine, bolstered by a $1 billion investment from a U.S. government agency. The AstraZeneca investment hopefully will make the vaccine available globally, including in developing countries, said Lawrence Young of the University of Warwick. But he cautioned the shot’s effectiveness still is unclear, citing the monkey research. “This raises serious questions about the ability of this vaccine to protect against infection in humans and to prevent virus transmission,” he said in a statement. “We need to be urgently exploring other vaccine candidates.” Often, possible vaccines that look promising early fail after testing expands to thousands of people — one reason the crowded field is important. Many of the candidates work in different ways, and are made with different technologies, increasing the odds that at least one approach might succeed. Most of the vaccines in the pipeline aim to train the immune system to recognize the spiky protein that studs the new coronavirus’ outer surface, so it’s primed to attack if the real infection comes along. The Oxford vaccine uses a harmless virus — a chimpanzee cold virus, engineered so it can’t spread — to carry genes for the spike protein into the body. A Chinese company created a similar shot. Other leading vaccine candidates, including one from the NIH and Moderna Inc., and another by Inovio Pharmaceuticals, simply inject a piece of the coronavirus genetic code that instructs the body itself to produce spike protein that primes the immune system. Meanwhile, companies and governments are beginning to scale up production now, aiming for hundreds of millions of doses of the candidates they think might win the vaccine race. It’s a huge gamble that could waste a lot of money if their choices fail and must be thrown away. But if they get lucky and a stockpiled vaccine pans out, it could help mass vaccinations start a few months faster. ___ Neergaard reported from Alexandria, Virginia. from https://ift.tt/2zp7Kr9 Check out https://takiaisfobia.blogspot.com/ |
Authorhttps://takiaisfobia.blogspot.com/ Archives
April 2023
Categories |