• Restless citizenry; clinical success and failure; holding China to account

    These four major developments on the coronavirus front in the past week caught our eye:

    1. Difficult reopening. More and more countries are moving to reopen their economies, schools, and other parts of society, and each offers a different mix of measures aiming to balance economic recovery, societal (new) normalcy, and health security, with an eye to avoiding a second wave of infections in the fall. They all share one thing: Their citizens are becoming restless.
    2. Clinical success. The FDA om Friday allowed emergency use of remdesivir, the first drug that appears to help some COVID-19 patients recover faster, a milestone in the global search for effective therapies against the coronavirus.
    3. Clinical failure. Hydroxychloroquine and azithromycin have been aggressively promoted by President Trump as possibly “the biggest game changer in the history of medicine.” But in the largest clinical trial yet of the two drugs, they failed to have any benefit for infected patients, while significantly increasing the risk of electrical changes to the heart and cardiac arrhythmias, which could lead to heart attacks, strokes, and death.
    4. The China syndrome. More and more countries are calling for an impartial and credible investigation of China’s conduct regarding the coronavirus between November 2019 and the end of February 2020.

  • U.S. Allows Use of Remdesivir, 1st Drug Shown to Help Virus Recovery

    U.S. regulators on Friday allowed emergency use of remdesivir, the first drug that appears to help some COVID-19 patients recover faster, a milestone in the global search for effective therapies against the coronavirus. Matthew Perrone and Marilynn Marchione write for AP that the Food and Drug Administration cleared Gilead Science’s intravenous drug for hospitalized patients with “severe disease,” such as those experiencing breathing problems requiring supplemental oxygen or ventilators. The FDA acted after preliminary results from a government-sponsored study showed that the drug, remdesivir, shortened the time to recovery by 31%, or about four days on average, for hospitalized COVID-19 patients. Those given the drug were able to leave the hospital in 11 days on average vs. 15 days for the comparison group. The drug may also help avert deaths, but that effect is not yet large enough for scientists to know for sure. The National Institutes of Health’s Dr. Anthony Fauci said Wednesday the drug would become a new standard of care for severely ill COVID-19 patients. Remdesivir, which blocks an enzyme the virus uses to copy its genetic material, has not been tested on people with milder illness. The FDA previously allowed narrow use of a malaria drug, hydroxychloroquine, for hospitalized patients who were unable to take part in ongoing studies of the medication. President Trump touted the drug as a “game changer” and repeatedly promoted it as a possible COVID-19 treatment, but no large high-quality studies have shown the drug works for that and it has significant safety concerns.

  • Timing of Immune Response to COVID-19 May Contribute to Disease Severity

    A new USC study suggests that temporarily suppressing the body’s immune system during the early stages of COVID-19 could help a patient avoid severe symptoms. That’s because the research, just published online in the Journal of Medical Virology, shows that an interaction between the body’s two main lines of defense may be causing the immune system to go into overdrive in some patients. USC notes that the body’s first line of defense, the innate immune response, starts right after an infection, like an infantry going after a foreign invader, killing the virus and any cells damaged by it. The second line of defense, the adaptive immune response, kicks in days later if any virus remains, employing what it has learned about the virus to mobilize a variety of special forces such as T cells and B cells. The researchers say that unlike the common flu, a fast-moving infection which attacks certain target cells on the surface of the upper respiratory system and kills almost all of the target cells within two to three days, the COVID-19 targets surface cells throughout the respiratory system including in the lungs, and it has an average incubation of six days and a much slower disease progression. This leads the adaptive immune response to kick in before the target cells are depleted, slowing down the infection and interfering with the innate immune response’s ability to kill off most of the virus quickly.

  • WHO Extends COVID-19 Emergency; Cases Soar in Brazil, Russia

    The World Health Organization (WHO) COVID-19 emergency committee met yesterday to review the latest pandemic developments, and the WHO’s director-general yesterday accepted the group’s recommendation that the event still warrants a public health emergency of international concern (PHEIC) under the International Health Regulations. The global total rose to 3,329,740 cases yesterday in 187 countries, and at least 237,647 people have died from their infections.

  • Hydroxychloroquine for Treatment of COVID-19 Linked to Increased Risk of Cardiac Arrhythmias

    In a brief report published today in JAMA Cardiology, a team of pharmacists and clinicians at Beth Israel Deaconess Medical Center (BIDMC) found evidence suggesting that patients who received hydroxychloroquine for COVID-19 were at increased risk of electrical changes to the heart and cardiac arrhythmias. The combination of hydroxychloroquine with azithromycin was linked to even greater changes compared to hydroxychloroquine alone. Hydroxychloroquine and azithromycin each can cause an electrical disturbance in the heart known as a QTc prolongation, indicated by a longer space between specific peaks on an electrocardiogram. QTc prolongation denotes that the heart muscle is taking milliseconds longer than normal to recharge between beats. The researchers note that the delay can cause cardiac arrhythmias, which in turn increases the likelihood of cardiac arrest, stroke, or death. “While hydroxychloroquine and azithromycin are generally well-tolerated medications, increased usage in the context of COVID-19 will likely increase the frequency of adverse drug events (ADEs),” said co-first author Nicholas J. Mercuro, PharmD, a pharmacy specialist in infectious diseases at BIDMC. Senior author Howard S. Gold, MD, an infectious disease specialist at BIDMC and an assistant professor of medicine at Harvard Medical School, said: “Based on our current knowledge, hydroxychloroquine for the treatment of COVID-19 should probably be limited to clinical trials.”

  • Epidemic Dictates an Open Exchange of Modeling Knowledge

    It has become increasingly clear that, depending on the computer model used, either we could still be in the midst of the pandemic with rising numbers of cases and deaths or we could be nearing the time to reintroduce society to normal operations. Why such disparity? Because each model works a bit differently and depending on the model used and assumptions added in, the results will change, sometimes dramatically.

  • Coronavirus Models Aren't Crystal Balls. So What Are They Good For?

    Epidemiologists and data scientists have become unlikely heroes during the coronavirus pandemic. Wave-shaped COVID-19 models that present “best” and “worst-case” scenarios for the virus trajectory are now commonplace in news stories and on screens behind governors during press conferences. “Flatten the curve” is scribbled on signs that hang in neighbors’ windows. Local governments are using algorithms to make decisions about stay-at-home orders and supplies. The University of Pennsylvanianotes that during a time of unprecedented uncertainty, it makes sense that we would put stock in these models. We are hoping they will be able to forecast the future and offer a glimmer of sunshine. But math cannot account for the unpredictability of human behavior, and epidemiologists are not in the business of fortune-telling, Levy cautions. “A model isn’t a crystal ball to make predictions,”says Michael Z. Levy, PhD,an associate professor of Epidemiology in the Perelman School of Medicine at Penn. “It’s more like a pensieve — you take what you already have in your brain, you pull it out, and you swirl it around, so that you can better understand the ramifications of your assumptions. That’s all these models are for — to get our head around what’s already going on and what we can do about it.”

     

  • Rutgers Engineer’s Mathematical Model Can Predict Cumulative Deaths in U.S.

    A Rutgers engineer has created a mathematical model that accurately estimates the death toll linked to the COVID-19 pandemic in the United States and could be used around the world. “Based on data available on April 28, the model showed that the COVID-19 pandemic might be over in the United States, meaning no more American deaths, by around late June 2020,” said Hoang Pham, a distinguished professor in the Department of Industrial and Systems Engineering. “But if testing and contact tracing strategies, social-distancing policies, reopening of community strategies or stay-at-home policies change significantly in the coming days and weeks, the predicted death toll will also change.”

  • UN: COVID-19 Deaths for People over 80 Are 5 Times Average

    U.N. Secretary-General Antonio Guterres said Friday that the COVID-19 pandemic is causing “untold fear and suffering” for older people around the world who are dying at a higher rate, and especially for those over age 80, whose fatality rate is five times the global average. Edith M. Lederer writes for AP that the U.N. chief said that beyond the health risks, “the pandemic is putting older people at greater risk of poverty,” with an especially devastating impact on the elderly in developing countries. Guterres issued a 16-page policy briefing on the impact of COVID-19 on older people with several key messages, most importantly that “no person, young or old, is expendable” and “older people have the same rights to life and health as everyone else.”

  • Ways to Address Life Under COVID-19

    An international team of researchers has outlined ways to manage different facets of life under the spread of the COVID-19 virus, ranging from how we can combat racially driven bias and fake news to how we can increase cooperation and better manage stress. “The COVID-19 pandemic represents a massive, global health crisis,” observes Jay Van Bavel, an associate professor in New York University’s Department of Psychology, who led the project with Stanford’s Robb Willer. “Because the crisis requires large-scale behavior change and poses significant psychological burdens on individuals, insights from the social and behavioral sciences are likely going to be very helpful for optimizing pandemic response.”

  • The Data Is in — Stop the Panic and End the Total Isolation

    “Leaders must examine accumulated data to see what has actually happened rather than keep emphasizing hypothetical projections,” Dr. Scott W. Atlas writes. The policymakers should “combine that empirical evidence with fundamental principles of biology established for decades; and then thoughtfully restore the country to function.” He say that the appropriate policy, based on fundamental biology and the evidence already in hand, is to institute a more focused strategy like some outlined in the first place: Strictly protect the known vulnerable, self-isolate the mildly sick and open most workplaces and small businesses with some prudent large-group precautions.

  • COVID-19 and America’s Counter-Terrorism Response

    Since the Sept. 11 attacks, U.S. foreign policy, national security, and law enforcement have been dominated by counter-terrorism considerations, even while a number of counter-terrorism experts have cautioned against overemphasizing the terrorist threat. Lydia Khalil writes that, at the same time, for various reasons, U.S. law enforcement has found it more challenging to deal with the more serious threat of terrorism the United States is facing – far-right domestic terrorism – a threat which now eclipses the threat posed by foreign Islamist jihadists, and which is only going to grow. If anything could ever shake the United States out of its counter-terrorism fixation it would be a crisis of even greater magnitude than 9/11. It seemed like that moment finally came with the COVID-19 pandemic, “[y]et what we have seen so far is the opposite. Instead of reorienting toward other paradigms and reexamining its strategic priorities, the United States continues to reflexively overextend its counter-terrorism tools to deal with some of the more problematic aspects of the virus’ spread,” she writes.

  • Oxford Scientists Take Early Lead in Race to Create Vaccine

    Scientists at Oxford University are racing to develop a vaccine for the coronavirus well ahead of the standard medical timeline. VOA News reports that the scientists have expressed confidence in their ability to do it quickly, raising hopes around the world that a vaccine will not have to wait until next year. The first injections of the vaccine being developed by the university’s Jenner Institute in Britain took place last week. Scientists are planning to massively scale up their testing in a little over a month, a time frame that is currently faster than other vaccine development efforts. The New York Times reported Monday that the scientists plan to test their vaccine on more than 6,000 people by the end of May. 

  • DNA May Hold the Key to Protecting Populations from COVID-19

    Scientists from The University of Western Australia’s Faculty of Science are part of a global team that is developing a new DNA test for COVID-19, which can provide faster and more detailed results than other tests. UWA says that this test can be used to understand how COVID-19 is mutating, aid vaccine development and understand its journey across populations globally – for instance, how it adapts to a new host. It is currently being used for COVID-19 research, but once approved by the US Food and Drug administration it can be used for both the diagnostic testing of patients and to enable a better understanding of the virus. The test is based on technology developed through the DNA Zoo project, a global initiative that analyses DNA from different species to help researchers, leaders and policy-makers better understand species through their DNA as well as threats to their survival.

  • NERVe: A “Stopgap” Ventilator Developed for COVID-19 Use during Medical Supply Shortage

    While hospitals across the U.S. faced a possible shortage of mechanical ventilators due to COVID-19, a self-assembled “skunk works” team at Lawrence Livermore National Laboratory (LLNL) worked tirelessly to prototype a simple ventilator design for quick and easy assembly from available parts. Lawrence Livermore National Laboratory says that the design, dubbed the “Novel Emergency Response Ventilator” (NERVe), is derived from proven concepts and contains parts that are not being used by commercial ventilator manufacturers, to avoid disrupting already thin supply chains. It is designed to meet the functional requirements of COVID-19 patients requiring mechanical ventilation, including a simple user interface, air flow circuits for inhalation and exhalation, and alarms to notify physicians if air pressures get too low. It can operate in a continuous ventilation mode — common for late-stage COVID-19 patients — but can adapt to patients who spontaneously breathe on their own.