Did Sweden get it right?

Sweden might be doing something better than the rest of us?

https://www-nationalreview-com.cdn.ampproject.org/c/s/www.nationalreview.com/2020/04/coronavirus-response-sweden-avoids-isolation-economic-ruin/amp/

New drug from Israel for Rx of coronavirus.

New drug from Israel for Rx of coronavirus.

https://www.jpost.com/HEALTH-SCIENCE/New-Israeli-COVID-19-treatment-seemingly-successful-with-first-two-patients-624722

Hope it works. Be well!

Tired, but still fashionable Doctor.

New fashion for CORONA 2020

Who Is Immune to the Coronavirus?⁸

Opinion

Who Is Immune to the Coronavirus?

Important decisions about this question are being made, as they must be, based on only glimmers of data.

By Marc Lipsitch

Mr. Lipsitch is an epidemiologist and infectious disease specialist.

• April 13, 2020

Credit...Santi Palacios/Associated Press

Among the many uncertainties that remain about Covid-19 is how the human immune system responds to infection and what that means for the spread of the disease. Immunity after any infection can range from lifelong and complete to nearly nonexistent. So far, however, only the first glimmers of data are available about immunity to SARS-CoV-2, the coronavirus that causes Covid-19.

What can scientists, and the decision makers who rely on science to inform policies, do in such a situation? The best approach is to construct a conceptual model — a set of assumptions about how immunity might work — based on current knowledge of the immune system and information about related viruses, and then identify how each aspect of that model might be wrong, how one would know and what the implications would be. Next, scientists should set out to work to improve this understanding with observation and experiment.

The ideal scenario — once infected, a person is completely immune for life — is correct for a number of infections. The Danish physician Peter Panum famously figured this out for measles when he visited the Faroe Islands (between Scotland and Iceland) during an outbreak in 1846 and found that residents over 65 who had been alive during a previous outbreak in 1781 were protected. This striking observation helped launch the fields of immunology and epidemiology — and ever since, as in many other disciplines, the scientific community has learned that often things are more complicated.

One example of “more complicated” is immunity to coronaviruses, a large group of viruses that sometimes jump from animal hosts to humans: SARS-CoV-2 is the third major coronavirus epidemic to affect humans in recent times, after the SARS outbreak of 2002-3 and the MERS outbreak that started in 2012.

Just the latest global statistics.

• минут назад
 
• Dorodny, MD, ND, PhD n/a Victor

COVID-19

APRIL 15, 2020

COVID-19: Daily dashboard

Global case count (as of April 15, 13:33 GMT): 2,018,351 infections; 128,062 deaths (6.3%); 492,176 recovered (24.4%).

The following are the 25 countries with the highest case counts as of April 15, 13:33 GMT.

Country	Infected	Deaths	Recovered	Infected per million	Deaths per million
USA	614,246	26,064	38,820	1,856	79
Spain	177,633	18,579	70,853	3,799	397
Italy	162,488	21,067	37,130	2,687	348
France	143,303	15,729	28,805	2,195	241
Germany	132,210	3,495	72,600	1,578	42
UK	93,873	12,107	0 ^	1,383	178
China	82,295	3,342	77,816	57	2
Iran	76,389	4,777	49,933	909	57
Turkey	65,111	1,403	4,799	772	17
Belgium	33,573	4,440	7,107	2,897	383
Netherlands	28,153	3,134	250	1,643	183
Canada	27,063	903	8,235	717	24
Switzerland	26,336	1,221	14,700	3,043	141
Brazil	25,758	1,557	14,026	121	7
Russia	24,490	198	1,986	168	N/A *
Portugal	18,091	599	383	1,774	59
Austria	14,321	393	8,098	1,590	44
Israel	12,200	126	2,309	1,410	15
Sweden	11,927	1,203	381	1,181	119
India	11,555	396	1,362	8	N/A *
Ireland	11,479	406	77	2,325	82
South Korea	10,591	225	7,616	207	4
Peru	10,303	230	2,869	312	7
Japan	8,100	146	853	64	N/A *
Chile	7,917	92	2,646	414	5

[^ Not updated on Epidemic-Stats.com.]

[* Data not provided on Epidemic-Stats.com.]

[For statistics of other countries, please refer to https://epidemic-stats.com/.]

Reference: https://epidemic-stats.com/

SOURCE: Epidemic-Stats.com

New treatment guidelines for Rx of COVID-19

APRIL 14, 2020

IDSA publishes guidelines on treatment and management of patients with COVID-19

The Infectious Diseases Society of America (IDSA) has published guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19.

According to the IDSA, a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists was formed to develop these evidence-based rapid guidelines. The IDSA added that the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.  

The IDSA noted that recommendations are labeled as “strong” or “conditional” based on the GRADE methodology. It added that the word “recommend” indicates strong recommendations and “suggest” indicates conditional recommendations. Meanwhile, in situations where promising interventions were judged to have insufficient evidence of benefit to support their use and with potential appreciable harms or costs, the expert panel recommended their use in the context of a clinical trial. Further, the guideline panel used the word “only” in recommendations about therapeutic agents with higher uncertainty and/or more potential for harm. According to the IDSA, these recommendations acknowledge the current “knowledge gap” and aim at avoiding premature favorable recommendations for potentially ineffective or harmful interventions.

 The IDSA guideline panel has agreed on the following seven treatment recommendations: 

1. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommendshydroxychloroquine/chloroquine in the context of a clinical trial. (Knowledge gap)
2. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommendshydroxychloroquine/chloroquine plus azithromycin only in the context of a clinical trial. (Knowledge gap)
3. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends the combination of lopinavir/ritonavir only in the context of a clinical trial. (Knowledge gap)
4. Among patients who have been admitted to the hospital with COVID-19 pneumonia, the IDSA guideline panel suggests against the use of corticosteroids. (Conditional recommendation, very low certainty of evidence)
5. Among patients who have been admitted to the hospital with  acute respiratory distress syndrome (ARDS) due to COVID-19, the IDSA guideline panel recommendsthe use of corticosteroids in the context of a clinical trial. (Knowledge gap)
6. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends tocilizumab only in the context of a clinical trial. (Knowledge gap)
7. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends COVID-19 convalescent plasma in the context of a clinical trial. (Knowledge gap)

In the guidelines, the panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19. 

The panel determined that when an explicit trade-off between the highly uncertain benefits and the known putative harms of these therapeutic agents were considered, a net positive benefit was not reached and could possibly be negative (risk of excess harm). The panel acknowledges that enrolling patients in randomized clinical trials  might not be feasible for many frontline providers due to limited access and infrastructure. 

“Should lack of access to clinical trials exist, we encourage setting up local or collaborative registries to systematically evaluate the efficacy and safety of drugs to contribute to the knowledge base. Each clinician can play a role in advancing our understanding of this disease through a local registry or other data collection efforts”, the panel remarked.

Reference: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

SOURCE: Infectious Diseases Society of America

• (4908) 
•  
•  

© 2020 All rights reserved
Terms of Use | Privacy Policy

Jump to navigation

COVID-19

APRIL 13, 2020

Compassionate use of remdesivir for severe COVID-19, decontaminating and reusing N95 respirators, and prolonged viral shedding in feces of children with COVID-19

By Denise Baez

NEW YORK -- April 13, 2020 -- In today’s DG Alert, we cover the use of remdesivir for patients with severe coronavirus disease 2019 (COVID-19), the feasibility of decontaminating and reusing N95 respirators, and the implications of prolonged viral shedding in the feces of paediatric patients with COVID-19. 

In a cohort of patients hospitalised for severe COVID-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 (68%) patients, according to a study published in The New England Journal of Medicine.

Specifically, improvement in oxygen-support status was observed in 68% of patients, and overall mortality was 13% over a median follow-up of 18 days. 

Of the patients administered remdesivir, 64% were receiving invasive ventilation at baseline, including 8% who were receiving extracorporeal membrane oxygenation (ECMO). The mortality in this subgroup was 18% compared with 5.3% in patients receiving non-invasive oxygen support. 

Jonathan Grein, MD, Cedars-Sinai Medical Center, Los Angeles, California, and colleagues stated that, initially, there were 61 patients enrolled in the study, but data from 8 patients could not be analysed (7 with no post-treatment data and 1 with a dosing error). The remaining 53 patients received a 10-day course of intravenous remdesivir (200 mg on day 1, followed by 100 mg/day for the remaining days) between January 25, 2020, and March 7, 2020, in the United States (n = 22), Italy (n = 12), Japan (n = 9), France (n = 4), Germany (n = 2), Austria (n = 1), the Netherlands (n = 1), Spain (n = 1), and Canada (n = 1).

At baseline, 30 (57%) patients were receiving mechanical ventilation and 4 (8%) were receiving ECMO. During a median follow-up of 18 days, 36 (68%) patients had an improvement in oxygen-support class, whereas 8 (15%) showed worsening. Improvement was observed in all 12 patients who were breathing ambient air or receiving low-flow supplemental oxygen and in 5 of 7 (71%) patients who were receiving non-invasive oxygen support (NIPPV; or high-flow supplemental oxygen). It is notable that 17 of 30 (57%) patients who were receiving invasive mechanical ventilation were extubated, and 3 of 4 (75%) patients receiving ECMO stopped receiving it -- all were alive at last follow-up. 

The majority (75%) of patients were male, were older than 60 years, and had coexisting conditions, the most common being hypertension, diabetes, hyperlipidaemia, and asthma. Among patients requiring invasive ventilation, 26% had hypertension, 24% had diabetes, 18% had hyperlipidaemia, and 15% had asthma. Among patients requiring non-invasive oxygen support, 21% had hypertension, 5% had diabetes, none had hyperlipidaemia, and 5% had asthma. 

Of the patients aged younger than 50 years, 6 (18%) required invasive ventilation and 8 (42%) required non-invasive oxygen support. Of those aged 50 to <70 14="" 4="" 70="" 7="" aged="" among="" and="" compared="" invasive="" nbsp="" non-invasive="" older.="" oxygen="" p="" patients="" required="" respectively="" support="" ventilation="" with="" years="">

A total of 25 (47%) patients were discharged, and 7 (13%) died. Mortality was 18% (6/34) among patients receiving invasive ventilation and 5% (1/19) among those not receiving invasive ventilation.

“Interpretation of the results of this study is limited by the small size of the cohort, the relatively short duration of follow-up, potential missing data owing to the nature of the program, the lack of information on 8 of the patients initially treated, and the lack of a randomised control group,” the authors noted. “Although the latter precludes definitive conclusions, comparisons with contemporaneous cohorts from the literature, in whom general care is expected to be consistent with that of our cohort, suggest that remdesivir may have clinical benefit in patients with severe COVID-19.”

In another study, published in The Journal of Hospital Infection, researchers attempted to disinfect N95 respirators using a SteraMist Binary Ionization Technology. 

The main constituent contains 7.8% H2O2 solution which converts to ionized H2O2 (iHP) vapour after passing through a cold plasma arc, and moving like a gas throughout the surface of N95 respirator. The by-product of iHP is oxygen and water in form of humidity.

The experiment was conducted in a well-ventilated room with 6 air-change/per hour inside a biosafety level-2 microbiology laboratory with an operator wearing coverall protection gown. A set of 4 N95 respirators were horizontally hanged up and were inoculated with 10µL each of 3 different concentrations of influenza A virus subtype H1N1 to the outer and inner surfaces. Influenza A virus was chosen because it is an enveloped RNA virus which has similar virological characteristics of coronavirus.

The SteraMist was sprayed in a to-and-fro manner for 3 times at a distance of 24 inches for a total of appropriate 6 seconds treatment time. The influenza A virus inoculated N95 respirators without disinfection were used as positive control. One hour later, the pieces of N95 respirators with virus inoculation were cut out and neutralised. The virus was eluted from the N95 respirators for viral culture in MadinDarby Canine Kidney (MDCK) cell line. 

Cytopathic changes of MDCK cells were observed daily for 7 days by light microscopy. All treated pieces did not demonstrate cytopathic changes suggestive of presence of influenza A virus. They were sub-cultured to MDCK cell line again for another 7 days and no sign of cytopathic changes was observed after 7 days. Immunofluorescence staining confirmed the pieces were negative for the influenza A.

“The level of H2O2 on the inner surface of the N95 respirator was 0.6ppm -- lower than the safety limit of <1ppm --="" 2="" 3="" a="" affected="" air="" and="" at="" authors="" balancing="" be="" benefit="" by="" chemicals="" current.="" dilemma="" disinfection.="" exposure="" from="" h2o2="" he="" healthcare="" hours="" importantly="" in="" inert="" ingredients="" it="" material="" may="" more="" n95="" nbsp="" of="" or="" other="" our="" p="" persistent="" porous="" pose="" potential="" regarding="" release="" require="" respirator.="" respirator="" respirators="" reusing="" risk="" should="" speed="" the="" to="" undetectable="" variable="" well-informed="" which="" who="" with="" without="" workers="" wrote.="">

The authors also stated the importance of testing for the particulate filtration efficiency of N95 respirators to determine the maximum number of disinfection cycle regardless of the method of disinfection. 

Lastly, a study published in the Journal of Microbiology, Immunology and Infectionshowed persistent shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in stools of infected children, raising the possibility that the virus might be transmitted through contaminated fomites.

Yu-Han Xing, MD, the Chinese University of Hong Kong, Hong Kong, China, and colleagues analysed data from 3 children with COVID-19 in Qingdao, Shandong Province, China. Patients were followed-up to March 10, 2020. Clearance of SARS-CoV-2 in respiratory tract occurred within 2 weeks after abatement of fever, whereas viral RNA remained detectable in stools of paediatric patients for longer than 4 weeks. Two children had fecal SARS-CoV-2 undetectable 20 days after throat swabs showing negative, while that of another child lagged behind for 8 days.

“SARS-CoV-2 may exist in children’s gastrointestinal tract for a longer time than respiratory system,” the authors wrote. “Massive efforts should be made at all levels to prevent spreading of the infection among children after reopening of kindergartens and schools.”

None of the children developed severe complications nor required intensive care or mechanical ventilation. All 3 children only presented with fever and mild cough or with no obvious symptom but non-typical radiological abnormalities, and all children showed increased lymphocytes. All children showed good response to anti-viral and supportive treatment including inhalation of interferon and oral ribavirin. 

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2007016

SOURCE: The New England Journal of Medicine, The Journal of Hospital Infection, and Journal of Microbiology, Immunology and Infection

• (6970) 
•  
•  

© 2020 All rights reserved
Terms of Use | Privacy Policy