Category Archives: Pandemic

To save lives, social distancing must continue longer than we expect

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership, Leadership Cares, Leadership Culture, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.washingtonpost.com/outlook/2020/04/08/save-lives-social-distancing-must-continue-longer-than-we-expect/?fbclid=IwAR0mNfbcEn9yfF8wfYRsWX9pufLcaArlhqXc8ETSOeSN3_2VdAob0V7WPYQ

To save lives, social distancing must continue longer than we ...

The lessons of the 1918 flu pandemic.

After weeks of quarantine, school closures and binge-watching movies, Americans are getting restless. In a recent interview on “The View,” California Gov. Gavin Newsom (D) warned that complacency and cabin fever were his biggest concerns, and he urged audiences to “stick with this.”

He is right. More than 100 years ago, during the worst contagious crisis in human history (so far), the influenza epidemic of 1918-1919 took 40 million to 100 million lives worldwide and inspired a huge implementation of social distancing measures such as school closures, bans on public gatherings, isolation and quarantine.

But the experience of 1918 also reminds us that early, layered (i.e., more than one at the same time) and lengthy mitigation measures are the best strategy. For social distancing to work, it must be sweeping and enforced across a wide swath of the community. Essential businesses will, of course, need to continue. All other places where people congregate should cease operations for the time being. In 1918, social distancing measures were kept in place for many weeks, if not months, even if people and businesses did not always support them. But the key lesson: This approach worked.

By now, many have read of the comparisons between St. Louis, where a decisive health commissioner reacted with amazing rapidity to implement sweeping public health orders, and Philadelphia, which chose to stay open, even going ahead with plans for a huge parade.

St. Louis was rewarded with one of the best outcomes of any large U.S. city. Philadelphia’s fateful decision to carry on with its immense Liberty Loan Parade resulted in a massive spike in influenza cases in the days immediately following. The city endured some of the worst numbers of cases and deaths in the United States as a result.

Philadelphia was hardly alone, however. In Baltimore, the health commissioner dragged his feet when a group of physicians requested that the city ban public gatherings. “We do not consider such drastic steps necessary in view of the extreme low civilian death rate in the city,” he told them. More than 4,100 Baltimoreans lost their lives to the epidemic.

In Atlanta, the mayor sided with business interests and reopened the city after just three weeks of closures, over the vocal objections of his Board of Health. When the board predicted that Atlanta’s epidemic peak would not occur for another nine days, the mayor dismissed the science, arguing that there was no way to foretell future conditions. The city health officer sided with the mayor, mistakenly declaring that the peak had passed. It had not, and Atlanta’s fall wave of the epidemic raged on, unchecked, through the end of 1918. “The influenza situation in Atlanta is up to the people themselves,” the Public Safety Committee declared.

Atlanta may be a more extreme example, but its experience was hardly singular. In every city we studied from this era there was public pressure to quit the social distancing measures as soon as the epidemic seemed to peak and then ebb. Thinking that the proverbial coast was clear, many communities lifted social distancing measures before the battle was truly over. After weeks of being denied their usual social outlets, people were eager to return to a life of normalcy, and they did so in one giant rush. In city after city, masses lined up for movie houses and performance theaters, crowds packed into dance halls and cabarets, and throngs flocked to downtown shopping districts, often on the very day that the closure orders were lifted.

The result? Cases and deaths resurged. Most cities closed their schools once again. But the political, economic and social will to issue another round of sweeping business closures and gathering bans had evaporated as people grew weary of the dislocations of social distancing. In some cities, most notably Denver, Kansas City, Milwaukee and even the vaunted St. Louis, this second peak was even deadlier than the first.

Lastly, 1918 teaches us how quickly an unchecked epidemic can overwhelm our health-care infrastructure. Philadelphia had to erect 32 temporary hospitals just to handle its massive number of influenza cases. On a single day in mid-October, 10 trucks were needed to carry the bodies of indigent victims to the city’s potter’s field. Some of the deceased had to be buried in temporary graves until more permanent plots could be dug.

In Pittsburgh, the epidemic grew so bad that a local sporting club had to donate its tents to use as field hospitals. One San Antonio hospital had to rely on 18 student nurses to tend to hundreds of influenza patients; the 12 regular nurses were all sick with influenza themselves. Nashville’s City Hospital was overrun with cases in a single day. These cities, unfortunately, were not alone in their experiences.

Today we have two notable advantages over those in 1918: We know the causative agent of covid-19, and our medical care is far more advanced. In 1918, scientists believed the epidemic was caused by a bacterium, and the influenza virus would not be discovered for another quarter-century. The standard medical treatment for influenza victims in 1918 consisted of little more than propping patients up to prevent them from choking on their sputum. Today, it is only a matter of time before researchers discover pharmaceutical therapies and develop an effective vaccine against the disease. In 2020, physicians have the ability to drive down the fatality rate of this epidemic through the use ventilators and intensive care units — as long as such lifesaving machines are available.

Our health-care system can only do this, however, if we don’t allow our already-taxed hospitals, physicians and nurses to be overrun with cases. That means that, until an effective vaccine can be developed and deployed, we must “flatten the curve.” This will not be accomplished in a week, or even a month. We must implement and coordinate sweeping non-pharmaceutical interventions on a national level and keep these measures in place as long as necessary. These measures are not perfect. They are slow and plodding. They are socially and economically disruptive. They fracture the routines of our daily lives in myriad ways, large and small. They do not magically end epidemics. But they can save lives.

As we all endure the hardships of the covid-19 pandemic and dislocations of social distancing, we can take heart that together we will save lives. Just as our forebears did a century ago.

And that is the most important lesson of 1918.

 

 

 

A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety, Social Distancing, Test-Positivity Rate • Leave a comment

https://www.theatlantic.com/technology/archive/2020/04/us-coronavirus-outbreak-out-control-test-positivity-rate/610132/

A New Statistic Reveals Why America's COVID-19 Numbers Are Flat ...

Few figures tell you anything useful about how the coronavirus has spread through the U.S. Here’s one that does.

How many people have the coronavirus in the United States? More than two months into the country’s outbreak, this remains the most important question for its people, schools, hospitals, and businesses. It is also still among the hardest to answer. At least 630,000 people nationwide now have test-confirmed cases of COVID-19, according to The Atlantic’s COVID Tracking Project, a state-by-state tally conducted by more than 100 volunteers and experts. But an overwhelming body of evidence shows that this is an undercount.

Whenever U.S. cities have tested a subset of the general population, such as homeless people or pregnant women, they have found at least some infected people who aren’t showing symptoms. And, as ProPublica first reported, there has been a spike in the number of Americans dying at home across the country. Those people may die of COVID-19 without ever entering the medical system, meaning that they never get tested.

There is clearly some group of Americans who have the coronavirus but who don’t show up in official figures. Now, using a statistic that has just become reliable, we can estimate the size of that group—and peek at the rest of the iceberg.

According to the Tracking Project’s figures, nearly one in five people who get tested for the coronavirus in the United States is found to have it. In other words, the country has what is called a “test-positivity rate” of nearly 20 percent.

That is “very high,” Jason Andrews, an infectious-disease professor at Stanford, told us. Such a high test-positivity rate almost certainly means that the U.S. is not testing everyone who has been infected with the pathogen, because it implies that doctors are testing only people with a very high probability of having the infection. People with milder symptoms, to say nothing of those with none at all, are going undercounted. Countries that test broadly should encounter far more people who are not infected than people who are, so their test-positivity rate should be lower.

The positivity rate is not the same as the proportion of COVID-19 cases in the American population at large, a metric called “prevalence.”* Nobody knows the true number of Americans who have been exposed to or infected with the coronavirus, though attempts to produce much sharper estimates of that figure through blood testing are under way. Prevalence is a crucial number for epidemiologists, in part because it lets them calculate a pathogen’s true infection-fatality rate: the number of people who die after becoming infected.

But the positivity rate is still valuable. “It’s not a normal metric, but it can be a very useful one in some circumstances,” Andrews said. The test-positivity rate is often used to track the spread of rare but deadly diseases, such as malaria, in places where most people aren’t able to get tested, he said. And if the same proportion of a population is being tested over time, the test-positivity rate can even be used to calculate the contagiousness of a disease.

Because the number of Americans tested for COVID-19 has changed over time, the U.S. test-positivity rate can’t yet provide much detailed information about the contagiousness or fatality rate of the disease. But the statistic can still give a rough sense of how bad a particular outbreak is by distinguishing between places undergoing very different sizes of epidemics, Andrews said. A country with a 25 percent positivity rate and one with a 2 percent positivity rate are facing “vastly different epidemics,” he said, and the 2 percent country is better off.

In that light, America’s 20 percent positivity rate is disquieting. The U.S. did almost 25 times as many tests on April 15 as on March 15, yet both the daily positive rate and the overall positive rate went up in that month. If the U.S. were a jar of 330 million jelly beans, then over the course of the outbreak, the health-care system has reached in with a bigger and bigger scoop. But every day, 20 percent of the beans it pulls out are positive for COVID-19. If the outbreak were indeed under control, then we would expect more testing—that is, a larger scoop—to yield a smaller and smaller proportion of positives. So far, that hasn’t happened.

In an ideal testing regime—and in any of the testing regimes that experts say must exist before the United States can end its lockdowns—anyone with a fever and a dry cough would be tested immediately. A very large portion, if not most, of those people would turn out not to be infected with the new coronavirus, SARS-CoV-2, because humans are susceptible to many other respiratory infections. But when tests are rationed so strictly, only people with severe symptoms make it into the testing pool, ensuring that the positivity rate will be extremely high.

Local rationing rules are not the only reason that Americans are not getting tested. Some people live in a place that’s not doing much testing at all, either because doctors’ offices have no tests to offer or because of an already strained or nonexistent local health-care system. Others avoid the doctor if they’re sick, or never get sick enough to seek a test—but if the U.S. were testing more people, as experts say it must, then general-population surveillance or workplace testing could detect their illness, too.

The test-positivity rate, then, is a decent (if unusual) proxy for the severity of an outbreak in an area. And it shows clearly that the U.S. still lags far behind other countries in the course of fighting its outbreak. South Korea—which discovered its first coronavirus case on the same day as the U.S.—has tested more than half a million people, or about 1 percent of its population, and discovered about 10,500 cases. The U.S. has now tested 3.2 million people, which is also about 1 percent of its population, but it has found more than 630,000 cases. So while the U.S. has a 20 percent positivity rate, South Korea’s is only about 2 percent—a full order of magnitude smaller.

South Korea is not alone in bringing its positivity rate down: America’s figure dwarfs that of almost every other developed country. Canada, Germany and Denmark have positivity rates from 6 to 8 percent. Australia and New Zealand have 2 percent positivity rates. Even Italy—which faced one of the world’s most ravaging outbreaks—has a 15 percent rate. It has found nearly 160,000 cases and conducted more than a million tests. Virtually the only wealthy country with a larger positivity rate than the U.S. is the United Kingdom, where more than 30 percent of people tested for the virus have been positive.

Comparing American states to regions in other countries results in the same general pattern. In Lombardy, the hardest hit part of Italy, the positive rate today stands at about 28 percent. That’s comparable to the rate in Connecticut. But New York, so far the hardest hit state in the U.S., has an even higher rate of 41 percent. And in New Jersey, an astounding one in two people tested for the virus are found to have it.

The prevalence of COVID-19 might be higher in the New York area than anywhere else in the country, but high test-positivity rates are not confined to the mid-Atlantic. Five other states have a positive rate above 20 percent: Michigan, Georgia, Massachusetts, Illinois, and Colorado. They are spread across the country, and they all have obviously serious outbreaks. Each of the eight states with positive rates over 20 percent has, individually, reported more COVID-19 deaths than South Korea.

Hawaii, meanwhile, has tested twice as many people per capita as Illinois, but its positivity rate is only one-tenth as high as the larger state’s. As the outbreak comes under control, more states should have positivity rates closer to Hawaii’s, Andrews, the Stanford professor, said. At the beginning of a pandemic, both the actual number of infections and the number of tests per day shoot up, and the positivity rate is controlled by whichever happens to grow faster, he said. In this case, the faster-growing number appears to have been infections. “As things stabilize, if the testing rate declines and the positivity rate declines, you have some good signal that the epidemic is declining,” he said.   

Not every epidemiologist feels as comfortable drawing conclusions from the test-positivity rate as Andrews. “If you want to interpret [the positivity rate] as a hint to prevalence in a particular location, you have to assume lots of other things stay constant,” Daniel Westreich, an epidemiology professor at the University of North Carolina, told us. He warned that too little was still known about who exactly is getting tested, and how reliable the tests are, to draw large conclusions from the positivity rate alone.

“We just haven’t tested enough people yet,” he said. “If you were doing random screening of the whole population, we just don’t know what you’d see. We don’t know how many asymptomatic viral shedders are out there.” As such, he advised extreme caution in using the rate—but being cautious about data, he added, “is my job.”

We feel confident reporting the U.S. test-positivity rate now for several reasons. First, we know that when states and cities ration tests, they do so by imposing criteria that allow for only the sickest or the most vulnerable people, such as residents of nursing homes, to get tested. We know that in states with a very high test-positivity rate, such as New Jersey, many people are still dying in nursing homes without getting tested. And we know that, even though a wide variety of nose-swab tests are being used across the country, the type of test used—called a polymerase chain reaction, or PCR, test—is generally very reliable. Westreich and Andrews said that any PCR test was “pretty good” at detecting true negatives.

Finally, the test-positivity rate has become much more reliable nationwide over the past few weeks. As recently as the end of March, not all states reported every negative test result from commercial laboratories. Nearly every state now publishes those numbers.

While our numbers still probably do not capture every coronavirus test in the U.S., outside evidence now suggests that our data are fairly complete. When the White House Coronavirus Task Force has reported the number of tests completed nationwide, its numbers have broadly matched the COVID Tracking Project’s. In addition, the largest commercial-test processors, Quest and LabCorp, have released top-line statistics that align with ours at the COVID Tracking Project.

The high positivity rate also suggests that new cases in the U.S. have plateaued only because the country has hit a ceiling in its testing capacity. Looking solely at positives, the U.S. is steaming toward 650,000 confirmed cases, but the number of new cases per day appears to be plateauing or even declining.

Graph of new positive COVID-19 cases from March 1 to April 15

There are several ways to interpret this development. It might suggest, for instance, that the more than 3.2 million tests completed in the U.S. over the past two months have finally captured a good chunk of the people who are actually infected. While it’s clear that the country is not capturing every case, this decline in new positive cases might suggest the country has started to get the virus’s spread under control.

But there is another way to interpret the decline in new cases: The growth in the number of new tests completed per day has also plateaued. Since April 1, the country has tested roughly 145,000 people every day with no steady upward trajectory. The growth in the number of new cases per day, and the growth in the number of new tests per day, are very tightly correlated.

Graph comparing COVID-19 case growth and test growth

This tight correlation suggests that if the United States were testing more people, we would probably still be seeing an increase in the number of COVID-19 cases. And combined with the high test-positivity rate, it suggests that the reservoir of unknown, uncounted cases of COVID-19 across the country is still very large.

Each of those uncounted cases is a small tragedy and a microcosm of all the ways the U.S. testing infrastructure is still failing. When Sarah Pavis, a 36-year-old engineer in New York, woke up on Tuesday, she was out of breath and her heart was racing. An hour of deep breathing failed to calm her pulse. When her extremities started tingling, she called 911. It was her ninth day of COVID-19 symptoms.

New York City’s positivity rate is an astonishing 55 percent. More than 111,000 of the city’s residents have lab-confirmed cases of COVID-19, but Pavis is not among them. When the ambulance arrived at Pavis’s apartment, an EMS worker took her vitals, then explained there was little he could do to help. The city’s hospitals only admitted people with a blood-oxygen level of 94 percent or lower, he said. Pavis’s blood-oxygen reading was 96 percent. That 2 percent difference meant that her illness was not serious enough to merit hospitalization, not serious enough to be tested, not serious enough to be counted.

 

 

 

 

Whole Foods staff protest against conditions as coronavirus cases rise

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Employee Protections, Fear, Health Insurance Coverage Adequacy, High Deductible Health Plans, Infection Control, Infectious Virus, Out of Pocket Expenses, Pandemic, Public Health, Public Safety, Retaliation, Sick Leave, Underinsured, Uninsured, Worker Rights • Leave a comment

https://www.theguardian.com/business/2020/apr/15/whole-food-protests-coronavirus-working-conditions-sickout

Coronavirus workplace conditions spur protests at Whole Foods, Amazon

Workers say too little is being done to enforce social distancing in stores, and some are not given masks or training on cleaning.

Whole Foods workers across the US are planning to hold another sickout protest on 1 May, as the number of confirmed cases of coronavirus infections at the supermarket chain continues to rise and workers charge the Amazon-owned company is doing too little to help them.

Workers complain too little is being done to enforce social distancing in stores; it is difficult, and sometimes impossible, to qualify for sick pay; and some are not given masks or training on cleaning. In the meantime, Whole Foods is reportedly recording record sales.

Dan Steinbrook, an employee at Whole Foods in Boston, said: “The bottom line is we don’t think Whole Foods or Amazon is doing nearly enough as they could be to protect both employees and customers at the store in terms of personal safety and public health.”

Steinbrook, who also participated in a sickout protest on 31 March organized by Whole Worker, a worker activism group said: “Grocery stores are one of the only places open to the public so they’ve become a significant public health concern in terms of stopping the spread of this disease. Any transmission we can stop at the grocery stores is extremely important for saving a lot of lives.”

Whole Foods workers have become increasingly concerned over the confirmed cases of coronavirus at Whole Foods stores. Employees have tested positive for coronavirus at Whole Foods locations across the country including West Orange, New Jersey; Sudbury, Massachusetts; Brookline, Massachusetts; Arlington, Massachusetts; Hingham, Massachusetts; Cambridge, Massachusetts; San Francisco, California; New York City, New York; Fort Lauderdale, Florida; New Orleans, Louisiana; and Allentown, Pennsylvania.

The Guardian spoke to several Whole Foods workers across the US about working conditions and the company’s policies. The workers requested to remain anonymous for fear of retaliation.

“I haven’t felt safe going into work because Whole Foods hasn’t really done anything to combat the amount of Amazon shoppers in the stores,” said a Whole Foods employee at Bowery Place in New York City, the center of the coronavirus pandemic in the US. “The store has been closing earlier, but they still want us to stay until 11pm to clean, and we aren’t trained to clean or given masks or anything.”

Whole Foods workers have noted some stores where a worker has tested positive for coronavirus have yet to be publicly reported in the media.

“Team members are being told there was a deep clean overnight and not to worry,” said a Whole Foods worker in West Bloomfield, Michigan. “I’m scared to work. I have three immune sensitive people living in my house and I don’t want to get them sick, but I can’t lose my only income.”

A worker at Whole Foods in Chapel Hill, North Carolina, said there have been two positive cases at their store. “It has been almost impossible to maintain basic social distancing practices. We’ve seen huge sales ever since the outbreak and it’s been all hands on deck. As of 1 April, there were no limits on the number of customers allowed in at a given time,” said the employee.

In Minnesota, a Whole Foods employee is currently on unpaid leave after experiencing coronavirus symptoms when their roommate was advised by their doctor to self-quarantine.

“When I talked to my HR department they told me I would need to take a two week leave as well, but unless I test positive for Covid-19, I do not qualify for the ‘guaranteed two weeks paid time off’ corporate is saying they are offering,” said the worker. “Everyone knows tests are limited and unavailable to most people unless they are showing severe symptoms, and as retail workers, many of us cannot afford to go to the doctor unless we’re in desperate need of medical attention.”

A Whole Foods employee in Massachusetts is also currently taking unpaid leave after experiencing coronavirus symptoms.

“I’m in a situation where I can’t get tested or afford a doctor. At first I was told I wouldn’t be eligible for sick pay without a positive test. Later I was told that I might qualify, that pay was being disbursed on a case by case basis. My case has been pending for over a week with no response and I ran out of paid time off,” said the worker.

“My parents lent me money, so I’ll be able to finish quarantine and still afford groceries. Money was tight before bills were due, and those fears kept me from reaching out to a doctor. My symptoms were mild, but I don’t know what I would have done if they got serious.”

A Whole Foods spokesperson told the Guardian: “The safety of our team members and customers is our top priority and we are diligently following all guidance from local health and food safety authorities. We’ve been working closely with our store Team Members, and are supporting the diagnosed Team Members, who are in quarantine.

“Out of an abundance of caution, each of these stores performed an additional deep cleaning and disinfection, on top of our current enhanced sanitation measures. As we prioritize the health and safety of our customers and Team Members, we will continue to do the following to help contain the spread of Covid-19.”

 

 

 

 

Early peek at data on Gilead coronavirus drug suggests patients are responding to treatment

Posted on by • Posted in Clinical Research, Clinical Testing, Coronavirus, Pandemic, Remdesivir • Leave a comment

Early peek at data on Gilead coronavirus drug suggests patients are responding to treatment

Gilead data suggests coronavirus patients are responding to treatment

A Chicago hospital treating severe Covid-19 patients with Gilead Sciences’ antiviral medicine remdesivir in a closely watched clinical trial is seeing rapid recoveries in fever and respiratory symptoms, with nearly all patients discharged in less than a week, STAT has learned.

Remdesivir was one of the first medicines identified as having the potential to impact SARS-CoV-2, the novel coronavirus that causes Covid-19, in lab tests. The entire world has been waiting for results from Gilead’s clinical trials, and positive results would likely lead to fast approvals by the Food and Drug Administration and other regulatory agencies. If safe and effective, it could become the first approved treatment against the disease.

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

Her comments were made this week during a video discussion about the trial results with other University of Chicago faculty members. The discussion was recorded and STAT obtained a copy of the video.

The outcomes offer only a snapshot of remdesivir’s effectiveness. The same trials are being run concurrently at other institutions, and it’s impossible to determine the full study results with any certainty. Still, no other clinical data from the Gilead studies have been released to date, and excitement is high. Last month, President Trump touted the potential for remdesivir — as he has for many still-unproven treatments — and said it “seems to have a very good result.”

In a statement Thursday, Gilead said: “What we can say at this stage is that we look forward to data from ongoing studies becoming available.”

Gilead had said to expect results for its trial involving severe cases in April. Mullane said during her presentation that data for the first 400 patients in the study would be “locked” by Gilead Thursday, meaning that results could come any day.

Mullane, while encouraged by the University of Chicago data, made clear her own hesitancy about drawing too many conclusions.

“It’s always hard,” she said, because the severe trial doesn’t include a placebo group for comparison. “But certainly when we start [the] drug, we see fever curves falling,” she said. “Fever is now not a requirement for people to go on trial, we do see when patients do come in with high fevers, they do [reduce] quite quickly. We have seen people come off ventilators a day after starting therapy. So, in that realm, overall our patients have done very well.”

She added: “Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn’t have to be 10 days. We have very few that went out to 10 days, maybe three,” she said.

Reached by STAT, Mullane confirmed the authenticity of the footage but declined to comment further. In a statement, the University of Chicago Medicine said “drawing any conclusions at this point is premature and scientifically unsound.” 

Asked about the data, Eric Topol, director of the Scripps Research Translational Institute, described them as “encouraging.”

“The severely hit patients are at such high-risk of fatality. So if it’s true that many of the 113 patients were in this category and were discharged, it’s another positive signal that the drug has efficacy,” he said, adding that it will be important to see more data from randomized controlled studies.

Gilead’s severe Covid-19 study includes 2,400 participants from 152 different clinical trial sites all over the world. Its moderate Covid-19 study includes 1,600 patients in 169 different centers, also all over the world.

The trial is investigating five- and 10-day treatment courses of remdesivir. The primary goal is a statistical comparison of patient improvement between the two treatment arms. Improvement is measured using a seven-point numerical scale that encompasses death (at worst) and discharge from hospital (best outcome), with various degrees of supplemental oxygen and intubation in between.

The lack of a control arm in the study could make interpreting the results more challenging. 

A lack of data has led to yo-yoing expectations for the drug. Two studies in China had enrollment suspended partway through because there were not enough patients available. A recent report of patients given the drug under a special program to make it available to those who are very ill generated both excitement and skepticism.

In scientific terms, all the data are anecdotal until the full trial reads out, meaning that they should not be used to draw final conclusions. But some of the anecdotes are dramatic.

Slawomir Michalak, a 57-year-old factory worker from a suburb west of Chicago, was among the participants in the Chicago study. One of his daughters started feeling ill in late March and was later diagnosed with mild Covid-19. Michalak, by contrast, came down with a high fever and reported shortness of breath and severe pain in his back.

“It felt like someone was punching me in the lungs,” he told STAT.

At his wife’s urging, Michalak went to the University of Chicago Medicine hospital on Friday, April 3. His fever had spiked to 104 and he was struggling to breath. At the hospital, he was given supplemental oxygen. He also agreed to participate in Gilead’s severe Covid-19 clinical trial.

His first infusion of remdesivir was on Saturday, April 4. “My fever dropped almost immediately and I started to feel better,” he said.

By his second dose on Sunday, Michalak said he was being weaned off oxygen. He received two more daily infusions of remdesivir and recovered enough to be discharged from the hospital on Tuesday, April 7.

“Remdesivir was a miracle,” he said. 

The world is waiting to find out if it is really so.

 

 

 

Researchers stop COVID-19 drug trial after 11 patients die

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Chloroquine, Clinical Research, Clinical Testing, Coronavirus, Food and Drug Administration (FDA), Hydroxychloroquine, Pandemic, Prescription Drugs, Side Effects • Leave a comment

https://bigthink.com/coronavirus/covid-treatment-deaths

COVID-19 chloroquine trial cut short after 11 patients die - Big Think

  • Scientists around the world are currently experimenting with chloroquine and hydroxychloroquine as potential treatments for COVID-19.
  • Despite some early reports suggesting that these antimalarial drugs may help prevent and treat the disease, there’s still no solid evidence showing that they’re a safe and effective treatment.
  • The recent trial in Brazil suggests that high doses of chloroquine are toxic and should be avoided.

A small clinical trial in Brazil suggests that one potential treatment for COVID-19 comes with life-threatening side effects.

As the world searches for effective COVID-19 treatments, some nations have authorized doctors to give patients antimalarial drugs as part of experimental clinical trials. These trials show some indication that the drugs, chloroquine and the closely related hydroxychloroquine, may be effective at treating and preventing COVID-19.

Early reports from China and France, for example, suggested that the drugs may help improve patients’ conditions. But health experts have cautioned against overhyping the results, flagging methodological issues in the research like not including a control group or having a small sample size. To date, there’s no solid evidence showing that these drugs effectively treat COVID-19 or block coronaviruses from infecting cells.

What is clear, based on previous research and the new trial in Brazil, is that these drugs can cause serious side effects, particularly among those with heart conditions.

“The antimalarial medication hydroxychloroquine and the antibiotic azithromycin are currently gaining attention as potential treatments for COVID-19, and each have potential serious implications for people with existing cardiovascular disease,” the American Health Association notes in a statement.

“Complications include severe electrical irregularities in the heart such as arrythmia (irregular heartbeat), polymorphic ventricular tachycardia (including Torsade de Pointes) and long QT syndrome, and increased risk of sudden death.”

In the recent Brazil trial, researchers gave chloroquine to 81 COVID-19 patients in a hospital in Manaus. The study involved two groups: One received a high dose of 12 grams of chloroquine over 10 days, the second group received 2.7 grams over five days. Both groups also received the antibiotic azithromycin, which poses its own heart risks.

By the sixth day of the trial, 11 patients had died, and the researchers decided to stop giving the drug to the high-dose group.

“Preliminary findings suggest that the higher chloroquine dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards. Such results forced us to prematurely halt patient recruitment to this arm,” the team wrote in a preprint paper.

The high-dose group had an especially high risk of suffering heart arrhythmias, a finding also observed in a separate trial on hydroxychloroquine conducted in a hospital in France, which cut the trial short.

“To me, this study conveys one useful piece of information, which is that chloroquine causes a dose-dependent increase in an abnormality in the ECG that could predispose people to sudden cardiac death,” Dr. David Juurlink, an internist and the head of the division of clinical pharmacology at the University of Toronto, told The New York Times.

Still, it’s possible that some combination of chloroquine, hydroxychloroquine and azithromycin may be effective at preventing and treating COVID-19. The researchers behind the Brazil trial said more research is “urgently needed,” but warned doctors against using high dosages.

“We therefore strongly recommend that this dosage is no longer used anywhere for the treatment of severe COVID-19, especially because in the real world older patients using cardiotoxic drugs should be the rule.”

One major problem in searching for COVID-19 treatments is that it’s currently difficult to conduct clinical trials in a normal and methodologically sound manner. Despite increasing demand for drugs like chloroquine, many health experts are warning that more research is needed to understand their effects and risks.

“The urgency of COVID-19 must not diminish the scientific rigor with which we approach COVID-19 treatment,” Robert A. Harrington, M.D., FAHA, president of the American Heart Association said in a recent statement. “While these medications may work against COVID-19 individually or in combination, we recommend caution with these medications for patients with existing cardiovascular disease.”

 

 

 

Cartoon – Unemployment Today

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Social distancing in the unemployment line: Political Cartoons ...

The Front Line: Visualizing the Occupations with the Highest COVID-19 Risk

Posted on by • Posted in Coronavirus, Employee Protections, Health System, Healthcare Providers, Hospital, Hospital Industry, Infection Control, Infectious Virus, Nurses, Pandemic, Physician, Worker Rights • Leave a comment

The Front Line: Visualizing the Occupations with the Highest COVID-19 Risk

Visualizing the Occupations with the Highest COVID-19 Risk

 

 

Social distancing may be needed through 2022, Harvard researchers say

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https://www.beckershospitalreview.com/public-health/social-distancing-may-be-needed-through-2022-harvard-researchers-say.html?utm_medium=email

The U.S. could be looking at social distancing measures into 2022 ...

Social-distancing measures for COVID-19 may need to continue through 2022, according to new projections from Harvard researchers published in Science. 

Researchers from Boston-based Harvard T.H. Chan School of Public Health used mathematical modeling to predict various scenarios for the pandemic.

The researchers projected that the SARS-CoV-2 virus will return every winter, prompting more outbreaks after the initial pandemic wave ends. Prolonged social-distancing strategies could help limit the strain on healthcare systems and make quarantine and contact-tracing a feasible response strategy.

“Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available,” the researchers said.

They acknowledged that even intermittent social distancing will have profound economic, social and educational consequences. Even after the “apparent elimination” of COVID-19, viral surveillance should continue through as late as 2024 to prevent an outbreak resurgence, researchers said.

The researchers said their modeling should not be taken as an endorsement of certain response policies, but instead be used to identify helpful interventions and spur new ideas to achieve long-term control of the pandemic.

To view the full study, click here.

 

 

 

 

More than 9,000 healthcare workers have contracted COVID-19 as of last week, CDC says

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https://www.healthcarefinancenews.com/node/139992?mkt_tok=eyJpIjoiTWprMk5XVmlOVFV5T0RNMyIsInQiOiJ6dFdBNXNaYUVKdER0RXQzckFKMVpmanhyRjRBMjVSdHFrajR0UnBJSlkyWG50SzNtalp5a3FXXC9HUFl2ZndYcEZ2TVdyd1VvdGxLRWUrZkRCTXB6U3AxRTQzTXRtWTJoUDN3QytSbVwvV1IzZXg5QnpYdWp0SDhXV2tjQ25UTDNiIn0%3D

Healthcare Finance News

CDC warns the data may not reflect the true scope of the problem, as uneven reporting of confirmed cases likely underestimates the impact.

Healthcare workers who treat patients infected with the COVID-19 coronavirus are at risk of contracting the disease themselves due to frequent exposure and proximity to such patients.

New figures from the U.S. Centers for Disease Control and Prevention detail the extent to which this is true, finding that 9,282 healthcare workers across the country are confirmed to have been infected.

Of those confirmed cases, 27 have died, according to numbers culled from February 12 to April 9. About 55% of all healthcare personnel who were infected only had contact with COVID-19 patients within the healthcare setting.

The vast majority of confirmed positive healthcare workers – 90% – were not hospitalized. Up to 5% of those who were hospitalized ended up in intensive care, while 10 of the 27 deaths were among those workers 65 years old or older.

The CDC warned that the data may not reflect the true scope of the problem, as uneven reporting of confirmed cases across the country has resulted in figures that likely underestimate the number of healthcare workers infected.

WHAT’S THE IMPACT?

The number of coronavirus cases among healthcare workers is expected to rise. While this is due in part to more communities experiencing widespread transmission, the nature of working in the healthcare field understandably contributes to the risk: About 45% of workers who tested positive lived in households or communities in which the virus was present, meaning they risk exposure on two fronts, both inside a healthcare setting and outside of it.

Compounding the problem is that transmission can come from unrecognized sources, including those who are asymptomatic or presymptomatic. Because of that, contact tracing after occupational exposures will likely fail to identify many healthcare workers who are at risk for developing COVID-19.

As with the general population, the higher a healthcare workers’ age, the more likely they were to experience a severe outcome, although severe outcomes – including death – are possible at any age.

Preventative measures meant to staunch the spread among healthcare personnel include screening all workers for fever and respiratory symptoms at the beginning of their shifts, prioritizing such workers for testing, and discouraging working while sick by offering flexible and non-punitive medical leave policies.

The CDC said older healthcare personnel, or those with underlying health conditions, should consult with their healthcare provider and employee health program to better understand their risks. On hospitals’ part, they should consider the enhanced likelihood of severe outcomes among older personnel when mobilizing retired workers to increase surge capacity, especially in light of a shortage of personal protective equipment. One consideration would be preferential assignment of retired workers to lower-risk settings such as telehealth, administrative assignments or clinics for non-COVID-19 patients.

THE LARGER TREND

PPE shortages, insufficient tests, slow results and a dearth of ventilators are all factors that contribute to risk of infection among healthcare workers, and these challenges play off each other in a toxic cycle, an Office of the Inspector General report found last week.

Hospitals said their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe. Severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff, and widespread shortages of PPE are putting both groups at risk. Hospitals also said they were not always able to maintain adequate staffing levels or to offer staff adequate support.

 

 

 

Covid-19 is rapidly becoming America’s leading cause of death

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https://www.washingtonpost.com/outlook/2020/04/16/coronavirus-leading-cause-death/?arc404=true&utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

Outlook - The Washington Post

In just weeks, covid-19 deaths have snowballed from a few isolated cases to thousands across the country each day.

The U.S. surgeon general had warned that last week would be like Pearl Harbor as he attempted to create context for the threat — but it turned out that more than five times as many Americans died from covid-19 last week than were killed in the World War II raid.

You can grasp the scale when you compare a single week’s pandemic deaths with how many people die of major causes in a typical week.

In early and mid-March, when America began widespread closures, quarantines and social distancing, covid-19 caused many fewer deaths than other common causes — fewer in a week than chronic liver disease or high blood pressure, and far fewer than suicide or the common flu. By the end of March, the toll was closer to the average weekly deaths from diabetes and Alzheimer’s disease. Into April, weekly covid-19 deaths climbed past those from accidents and chronic lower respiratory disease. And last week, covid-19 killed more people than normally die of cancer in this country in a week. Only heart disease was likely to kill more people that week.

All of those comparisons include only confirmed cases. This week, New York City said it considered an additional 3,700 people who had passed away over the previous weeks to have died of covid-19, even though there were no lab tests proving it. Those deaths have not been added to official state and national counts, though.

Some experts had predicted that the deaths could peak last week, but this week is shaping up to be no better, with new high death tolls Tuesday (2,369) and Wednesday (2,441). Covid-19 is on pace to be the largest single killer of Americans this week, given the normal number of deaths in an April week.

Covid-19 is not killing at the same pace everywhere: In the worst-hit areas, it is killing at an unparalleled rate.

The weekly total of covid-19 deaths in New York state and New York City has dwarfed the scale of normal causes of death — explaining why hospitals are struggling to cope. And although the outbreaks in other cities aren’t as bad, Louisiana and the District of Columbia also had more covid-19 deaths than any typical cause of death last week. In places that started social distancing and restrictions on businesses earlier, the deaths per week are lower: Washington state suffered an early burst of the disease, but covid-19 did not kill as many people there last week as in other hot spots.

California has been spared the intensity of many other states. Covid-19 deaths there last week were well below the national rate.

These charts all compare covid-19 deaths with the normal numbers of deaths at this time of year in the country or in each particular state or city, according to the Centers for Disease Control and Prevention. The death counts are averages from that month over the last five years of data. It will take more than a year for epidemiologists and statisticians to calculate the final official toll of covid-19 and put it into perspective. Measured against typical deaths, however, covid-19 is already the greatest killer in many parts of the country.