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Post by Admin on Mar 1, 2020 6:26:37 GMT
Coronavirus Vaccine In addition to minimizing the threat COVID-19 poses in the U.S., Trump left the misleading impression that a vaccine will soon be available. He said the U.S. is “fairly rapidly” developing a vaccine, and will have it ready “in a fairly quick manner.”
Trump: We’re rapidly developing a vaccine, and they can speak to you — the professionals can speak to you about that. The vaccine is coming along well. And in speaking to the doctors, we think this is something that we can develop fairly rapidly, a vaccine for the future, and coordinate with the support of our partners.
Later in the press conference, he returned to the development of a vaccine.
Trump: You know in many cases when you catch this it is very light — you don’t even know there’s a problem. Sometimes they just get the sniffles, sometimes they just get something where they are not feeling quite right and sometimes they feel really bad but that’s a little bit like the flu. It’s a little like the regular flu that we have flu shots for and we will essentially have a flu shot for this in a fairly quick manner.
The president didn’t say how quickly, but Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said it will take “a year to a year-and-a-half” to develop a vaccine and that hopefully one would be ready if the coronavirus reemerges next year.
“We can’t rely on a vaccine over the next several months to a year,” Fauci said at the president’s press conference. “However, if this virus, which we have every reason to believe it is quite conceivable that it will happen, will go beyond just a season and come back and recycle next year. If that’s the case, we hope to have a vaccine.”
It’s true that the U.S. is working quickly on developing a vaccine. “We have a number of vaccine candidates and one prototype,” Fauci said.
As reported by the Wall Street Journal, the drugmaker Moderna Inc. sent a potential vaccine to the National Institute of Allergy and Infectious Diseases for initial testing, which hopefully would occur within about two months.
“The institute expects by the end of April to start a clinical trial of about 20 to 25 healthy volunteers, testing whether two doses of the shot are safe and induce an immune response likely to protect against infection, NIAID Director Anthony Fauci said in an interview,” the Journal reported on Feb. 24. “Initial results could become available in July or August.”
The next day, at a press conference, Fauci said the prototype is going through the regulatory process and could be in a human trial within a month to a month and a half — if there are no unexpected glitches. But the “phase one trial” is just the first step in a process that even at “rocket speed” will take a year to a year-and-a-half to result in a vaccine.
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Post by Admin on Mar 23, 2020 20:45:05 GMT
Scans of the lungs of the sickest COVID-19 patients show distinctive patterns of infection, but so far those clues offer little help in predicting which patients will pull through. For now, doctors are relying on what's called supportive care that's standard for severe pneumonia. Doctors in areas still bracing for an onslaught of sick patients are scouring medical reports and hosting webinars with Chinese doctors to get the best advice on what works and what hasn't. One thing that's clear around the globe: Age makes a huge difference in survival. And one reason is that seniors' lungs don’t have as much of what geriatrics expert Dr. Richard Baron calls reserve capacity. “At age 18, you have a lot of extra lung capacity you don’t use unless you’re running a marathon,” explained Baron, who heads the American Board of Internal Medicine. That capacity gradually declines with age even in otherwise healthy people, so “if you’re an old person, even a mild form can overwhelm your lungs if you don’t have enough reserve.” Here's what scientists can say so far about treating those who become severely ill. HOW DOES COVID-19 HARM THE LUNGS? The new coronavirus, like most respiratory viruses, is spread by droplets from someone’s cough or sneeze. The vast majority of patients recover, most after experiencing mild or moderate symptoms such as fever and cough. But sometimes the virus makes its way deep into the lungs to cause pneumonia. Lungs contain grapelike clusters of tiny air sacs called alveoli. When you breathe, oxygen fills the sacs and passes straight into blood vessels that nestle alongside them. Pneumonia occurs when an infection -- of any sort, not just this new virus -- inflames the lungs’ sacs. In severe cases they fill with fluid, dead cells and other debris so oxygen can’t get through. If other countries have the same experience as China, about 5% of COVID-19 patients could become sick enough to require intensive care HOW DOES THAT DAMAGE APPEAR? Doctors at New York’s Mount Sinai Health System analyzed 121 chest CT scans shared by colleagues in China and spotted something unusual. Healthy lungs look mostly black on medical scans because they’re full of air. An early infection with bacterial pneumonia tends to show up as a white blotch in one section of one lung. Pneumonia caused by a virus can show up as hazy patches that go by a weird name -- “ground glass opacities.” In people who get COVID-19 pneumonia, that haze tends to cluster on the outside edge of both lungs, by the ribs, a distinctive pattern, said Dr. Adam Bernheim, a radiologist at Mount Sinai. As infection worsens, the haze forms rounder clusters and gradually turns more white as the air sacs become increasingly clogged. HOW TO TREAT THE PNEUMONIA? There are no drugs so far that directly attack the new coronavirus, although doctors are trying some experimentally, including an old malaria treatment and one under development to treat Ebola. “The best treatment we have is supportive care,” said Dr. Aimee Moulin, an emergency care physician at the University of California Davis Medical Center. That centers around assistance in breathing when the oxygen levels in patients’ blood starts to drop. For some people, oxygen delivered through a mask or tubes in the nose is enough. More severely ill patients will need a breathing machine. “The goal is to keep the person alive until the disease takes its course” and the lungs begin to heal, explained Mount Sinai's Dr. Neil Schachter. The very worst cases develop an inflammatory condition called ARDS -- acute respiratory distress syndrome — that floods the lungs with fluid. That’s when the immune system’s attempt to fight infection “is going crazy and itself attacking the lung,” Baron explained. Many things besides the coronavirus can cause the condition, and regardless of the cause, it comes with a high risk of death. WHAT ELSE IS IMPACTED? Severe pneumonia of any sort can cause shock and other organ damage. But in a webinar last week, Chinese doctors told members of the American College of Cardiology to watch for some additional problems in severe COVID-19, especially in people with heart disease. The worst off may need blood thinners as their blood starts to abnormally clot, and the heart itself may sustain damage not just from lack of oxygen but from the inflammation engulfing the body. Another caution: The sickest patients can deteriorate rapidly, something a hospital in Kirkland, Washington, witnessed. Of 21 patients who needed critical care at Evergreen Hospital, 17 were moved into the ICU without 24 hours of hospital admission, doctors reported last week in the Journal of the American Medical Association. Age isn’t the only risk factor. Data from China show regardless of age, 40% of people who required critical care had other chronic health problems such as heart disease and diabetes. DOES COVID-19 LEAVE LASTING LUNG DAMAGE? It’s too soon to know about any lasting trouble when the most severely ill pull through. The WHO has said that it can take three to six weeks to recover from a severe case of COVID-19. But it can take months to get back to normal activity after any form of severe pneumonia, particularly if the person had earlier health problems, too. Recovery in part depends on how long someone was on a breathing machine. “If you’re on a ventilator for four weeks in deep sleep in an intensive care unit, it takes six months to a year to rehabilitate," Dr. Diederik Gommers of the Netherlands Association for Intensive Care told Dutch lawmakers. "It is very debilitating if you are in intensive care for so long.”
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Post by Admin on Mar 23, 2020 22:51:38 GMT
Do you expect COVID-19 to continue to spread?
We can get little glimpses into the future from places that are recently getting infected, places that aren’t infected, but also the places where it all started. And if you go back and look at China right now, they [identified the virus] in early January, they had a full on response, sort of threw everything at it, and it’s middle of March now and they estimate maybe end of March they’ll be coming out of it, so a full three months.
When you look around the world in Europe, North America, the Middle East, you can see that we’re really at the period of exponential growth, we’re still seeing the virus going up very, very rapidly, even in hard hit places like Italy, for example. These countries still have months of this challenge in front of them.
When you look to other parts of the world, like Africa, for example, and parts of the Indian subcontinent you can see that it’s just beginning. Even though they have very, very few cases, if you look carefully at that curve, it’s also in a phase of exponential growth.
What do you think the coronavirus pandemic will look like six months from now?
I expect we will be emerging—still with disease in various parts of the world—but we should be emerging from a bad wave of this disease across a large swathe of the planet. The challenge is we’re going to be back into the flu season. And one of the big questions is, are we going to see a surge of it again at that period?
Looking further into the future, what do you anticipate? Will COVID-19 ever disappear?
What it looks like is that we’re going to have a substantial wave of this disease right through basically the globe unless something very different happens in the southern hemisphere. And the question then is: What’s going to happen? Is this going to disappear completely? Are we going to get into a period of cyclical waves? Or are we going to end up with low level endemic disease that we have to deal with? Most people believe that that first scenario where this might disappear completely is very, very unlikely, it just transmits too easily in the human population, so more likely waves or low level disease.
A lot of that is going to depend on what we as countries, as societies, do. If we do the testing of every single case, rapid isolation of the cases, you should be able to keep cases down low. If you simply rely on the big shut down measures without finding every case, then every time you take the brakes off, it could come back in waves. So that future frankly, may be determined by us and our response as much as the virus.
The U.S. and Europe had quite a head start to get ready for this. Was a major outbreak inevitable, or could it have been stopped?
I don’t like to use the word “squandered,” that’s a big word. But we probably haven’t optimized how we used that time. Now what we’ve done is, we’ve gained time again by putting in place these big shutdowns. All they do is they buy time, they don’t actually stop the virus, they suppress it, they slow it. What you want to do now is use that time well to get the testing in place, to get the systems in place, so that you can actually manage the individual level cases that are going to be fundamental to stopping this.
And the big question right now is “Are countries going to use this time during these shutdown periods optimally?” Because if you just shut it down your societies, your economies and hope for the best… This is guerrilla warfare against a virus, the virus is just going to sit you out, it’ll just circulate quietly among households and then you’re going to let them all go again and phoom there’s no reason it shouldn’t take off again, unless you’re ready for it.
How long do you think this outbreak will impact daily life in the U.S. and western Europe? How long do you think it’ll take for life to return to normal?
You have to compare it to the few examples you have that have been through this, hence you have to go back to China, look at [South] Korea, look at Singapore. These countries in the very early stages, if they were to throw everything at it, probably a solid two months in front of them, if not a bit longer, maybe three months.
What we’re seeing is that they’re throwing bits and pieces at it. Most countries in the west frankly are really struggling with, “Can we really test all these cases? Can we really isolate all the confirmed cases?” They’re struggling with that. So they’re approaching it a bit differently than China did and the big question is going to be: Is that approach going to work and limit it to just a few months, that hard hit China took? Or is it going to drag it out so long that the bigger societal, economic impacts linger longer than anyone want?
Do you think the U.S. lost critical time with its testing rollout issues?
I think every country may not have optimized the use of the time it had available, and for different reasons. Some people just continued to think this might be flu and some cases they may not have had the testing capacity.
Is there reason to be concerned about a second wave of infections in China?
Absolutely, and China is concerned. As we traveled around China, one of the most striking things that I found, especially in contrast to the West, as I spoke to governors, mayors, and their cases were plummeting—in some of the places they were down to single digit cases already—as I spoke to them and I said, “So what are you doing now?” They said, “We’re building beds, we’re buying ventilators, we’re preparing.” They said, “We do not expect this virus to disappear, but we do expect to be able to run our society, run our economy, run our health system. We cannot end up in this situation again.”
Have you seen examples of politics overruling public health or slowing down responses?
No. I know a lot of people will challenge my assessment. The reasons that there have been problems in some countries is they haven’t had a consensus on the severity of the disease, or they haven’t had a consensus around the transmissibility. You have to have that consensus that you’re dealing with something serious and severe and dangerous for your society and individuals. Otherwise you just cannot generate the public support which is fundamental to accepting the measures, but also the implementing.
Why does the fatality rate in Italy looks to be so high?
It’s a combination of factors. If you look at Italy, and the age distribution, it’s the second-oldest country in the world after Japan, people forget that. You have an older population number one, they get the more severe disease and they’re more likely to die.
What countries are in the most vulnerable situation?
Everyone is vulnerable, but the big question of course is what’s going to happen when this really starts to take off in those low-income countries where they don’t have as much medical capacity such as in Africa.
It’s one of those things that you don’t want to imagine because the numbers could be so grave. The population distribution could help. Is the humidity and the temperature going to help make a difference? I would hope so, but look at the situation in Singapore, that’s a hot, humid country. So the situation in these countries could be very difficult.
The WHO is urging countries to “test, test, test.” Are there any countries in particular that you think are not doing enough testing?
That’s much easier answered the other way around. Is anyone doing enough testing? There it’s limited. It’s China, [South] Korea, Singapore.
Is there reason to be concerned that the number of people infected in Iran is higher than the official numbers being reported?
Absolutely. And Iran is concerned for the same reason. When I spoke with the deputy minister last week, one of their concerns was just getting the information from all the facilities, all the provinces. I hear all the time people say, “Oh, this country is hiding cases,” or “This country is not sharing all its data.” Usually the countries are struggling to get meaningful data. The worst thing they could do is go out with guesstimates that they think they have gigantic numbers.
There are reports of people dying of coronavirus who are otherwise healthy. What have your teams seen in terms of who the virus is killing?
One of the things that terrifies me now is, as this is spread in the west is, there’s this sense of invulnerability among millennials. And absolutely not. Ten percent of the people who are in [intensive care units] in Italy are in their 20s, 30s or 40s. These are young, healthy people with no co-morbidities, no other diseases.
We don’t understand why some young healthy people progress to severe disease and even die and others don’t. We don’t have clear predictors.
What would your message be for young people around the world?
This is one of the most serious diseases you will face in your lifetime, and recognize that and respect it. It is dangerous to you as an individual. It is dangerous to your parents, to your grandparents and the elderly in particular and it is dangerous to your society in general. You are not an island in this, you are part of a broader community, you are part of transmission chains. If you get infected you are making this much more complicated and you are putting people in danger, not just yourself.
Never, never underestimate a new disease, there’s just too much unknown. What we do know is it will kill young people, it will make young people sick in large numbers. You’ve gotta respect this.
What should a country’s first priority after locking down be?
Test, test, test, test, test. Not test, test, test, test, test everyone, but test the suspects, test the suspects, test the suspects.
Then, effectively isolate the confirmed cases. The third piece is the quarantine piece.
How do you think this will end?
This will end with humanity victorious over yet another virus, there’s no question about that. The question is how much and how fast we will take the measures necessary to minimize the damage that this thing can do. In time, we will have therapeutics, we will have vaccines, we’re in a race against that.
And it’s going to take great cooperation and patience from the general population to play their part because at the end of the day it’s going to be the general population that stops this thing and slows it down enough to get it under control.
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Post by Admin on Mar 24, 2020 2:25:39 GMT
According to a paper published Friday by Claire Hopkins, PhD, a professor of rhinology at King’s College London, Gobert is far from alone. “There have been a rapidly growing number of reports of a significant increase in the number of patients presenting with anosmia [loss of smell] in the absence of other symptoms,” Hopkins writes in the paper, published by UK ENT (a medical society of ear nose and throat doctors). “This has been widely shared on medical discussion boards by surgeons from all regions...”
Hopkins adds that while early warnings did not mention anosmia as a symptom of the virus, many countries are now reporting it in their patients, including South Korea, China and Italy. In Germany, doctors are reporting than “2 in 3 confirmed cases” of COVID-19 present with anosmia.
Not everyone is ready to declare loss of smell and taste a symptom of COVID-19 at this point. At a press conference Monday morning, the World Health Organization said it had yet to verify the theory. “We've seen quite a few reports about people in the early stages of the disease [that] may lose the sense of smell, may lose the sense of taste," said Maria Van Kerkhove, PhD, part of the WHO's health emergencies program. "But this is something that we need to look into to really capture if this is one of the signs and symptoms of COVID-19."
Still, in an email to Yahoo Lifestyle, Hopkins says that the reports about the loss of smell as a symptom have not only been shared on medical boards but also “closed social media groups for doctors to share experiences of COVID-19.” On one, Hopkins says an Italian doctor shared that “he and many of his colleagues had lost their sense of smell while working in northern Italy dealing with COVID-19 patients.”
Those with loss of smell/taste could be asymptomatic carriers While more research is needed to determine exactly how common it is to experience loss of smell and taste, Hopkins notes that most people with those symptoms had few others, meaning they could be unknowingly passing COVID-19 on. “There is potential that if any adult with anosmia but no other symptoms was asked to self isolate for seven days, in addition to the current symptom criteria used to trigger quarantine, we might be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors,” Hopkins writes in the paper. “It will also be an important trigger for healthcare personnel to employ full PPE [personal protective equipment]...”
Both symptoms are common, and often caused by inflammation It may seem alarming to imagine losing the sense of smell and taste, but both symptoms occur frequently and are most often temporary. “Post-viral loss of smell is quite common — occurring with a common cold and affecting up to 300,000 patients a year in the UK,” Hopkins tells Yahoo Lifestyle. “There is a good chance of recovery with reports from Italy matching the experience of my patients and affected colleagues that recovery often starts within 2 weeks.”
Hopkins says the symptoms were surprising given that COVID-19 does not seem to produce “nasal blockage or runny nose,” but those aren’t necessarily required to hinder those senses. William Schaffner, PhD, an infectious disease specialist at Vanderbilt University, has one theory. “This [has to do with] an area back behind the nose where the virus lurks,” says Schaffner. “So I would think this has to do with some sort of local inflammatory response.”
Sense of smell and sense of taste are intertwined Although Hopkins’ paper focuses primarily on the loss of sense of smell, previous research has shown that loss of taste is deeply connected to smell. Schaffner affirms that the two work in tandem. “We’ve been getting lots of reports of loss of taste. Most people don’t realize that their sense of taste is largely controlled by their sense of smell,” Schaffner tells Yahoo Lifestyle. “So if you lose your sense of smell, you also lose much of your sense of taste.”
The symptom probably isn’t new; doctors just may have missed it For those with fears that the new symptoms signal a mutated virus, Schaffner says there’s another explanation. “This is more likely something that [had] not come to attention sufficiently to be reported,” Schaffner tells Yahoo Lifestyle. “The average doctor — including infectious disease doctors — if we’re taking care of patients who have respiratory infections will not proactively ask about your sense of smell, it just doesn’t occur to ask that. Unless the patient volunteers it, we won’t know about it.”
If you experience loss of taste/smell and feel OK, stay home Now that both anecdotal and medical reports have found the symptoms to be associated with COVID-19, Hopkins and Schaffner say that anyone experiencing those should self-isolate. “If you suddenly lose your sense of smell and taste you may be positive, that’s the message,” says Schaffner. “So stay away from others because you could be positive even if you don’t have other symptoms.”
For the latest news on the evolving coronavirus outbreak, follow along here. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC and WHO’s resource guides.
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Post by Admin on Mar 24, 2020 5:03:23 GMT
Loss of sense of smell as marker of COVID-19 infection
There is new evidence for the loss of smell as a symptom of COVID-19 infection. We are circulating the following intelligence to Public Health England with regards to anosmia. As a result, this information highlights the importance for healthcare personnel to employ full PPE and in turn help stem the rates of infection. Full details can be read below:
Post-viral anosmia is one of the leading causes of loss of sense of smell in adults, accounting for up to 40% cases of anosmia. Viruses that give rise to the common cold are well known to cause post-infectious loss, and over 200 different viruses are known to cause upper respiratory tract infections. Previously described coronaviruses are thought to account for 10- 15% cases. It is therefore perhaps no surprise that the novel COVID-19 virus would also cause anosmia in infected patients.
There is already good evidence from South Korea, China and Italy that significant numbers of patients with proven COVID-19 infection have developed anosmia/hyposmia. In Germany it is reported that more than 2 in 3 confirmed cases have anosmia. In South Korea, where testing has been more widespread, 30% of patients testing positive have had anosmia as their major presenting symptom in otherwise mild cases.
In addition, there have been a rapidly growing number of reports of a significant increase in the number of patients presenting with anosmia in the absence of other symptoms – this has been widely shared on medical discussion boards by surgeons from all regions managing a high incidence of cases. Iran has reported a sudden increase in cases of isolated anosmia, and many colleagues from the US, France and Northern Italy have the same experience. I have personally seen four patients this week, all under 40, and otherwise asymptomatic except for the recent onset of anosmia – I usually see roughly no more than one a month. I think these patients may be some of the hitherto hidden carriers that have facilitated the rapid spread of COVID-19. Unfortunately, these patients do not meet current criteria for testing or selfisolation.
While there is a chance the apparent increase in incidence could merely reflect the attention COVID-19 has attracted in the media, and that such cases may be caused by typical rhinovirus and coronavirus strains, it could potentially be used as a screening tool to help identify otherwise asymptomatic patients, who could then be better instructed on self-isolation. Given the potential for COVID-19 to present with anosmia, and the reports that corticosteroid use may increase the severity of infection, we would advise against use of oral steroids in the treatment of new onset anosmia during the pandemic, particularly if it is unrelated to head trauma or nasal pathology (such as nasal polyps).
There is potential that if any adult with anosmia but no other symptoms was asked to selfisolate for seven days, in addition to the current symptom criteria used to trigger quarantine, we might be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors, not realising the need to self-isolate. It will also be an important trigger for healthcare personnel to employ full PPE and help to counter the higher rates of infection found amongst ENT surgeons compared to other healthcare workers.
Yours sincerely, Prof Claire Hopkins, BMBCh, MA FRCS(ORLHNS) DM(Oxon) President of the British Rhinological Society Professor of Rhinology, King’s College London Consultant ENT Surgeon, Guy’s and St Thomas’ Hospitals Prof Nirmal Kumar, President of ENT UK
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