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In the mid-2010s, an outbreak of Ebola ravaged West Africa. Between December 2013 and June 2016, the disease officially killed 11,308 people in Liberia, Guinea and Sierra Leone, although the World Health Organisation (WHO) believes the real figure is probably much higher.

Ebola's virulence and lethality it has a mortality rate of around 40 per cent; Covid-19, the disease caused by the novel coronavirus, kills roughly one per cent of sufferers, although the exact number is currently unclear made containing it an international priority. By mobilising labs around the world, a prophylactic Ebola vaccine rVSV-ZEBOV was rushed through development. In December last year, six years after the first cases were discovered in West Africa, and three years after the outbreak was officially deemed over, the Food and Drug Administration (FDA) finally OKed it for use in the US. Compared to the normal timelines for these things, that still represents astonishing speed.

In the wake of the Ebola outbreak, WHO has taken a front-foot approach. Every year it publishes a list of key diseases it sees as the major issues the medical research community needs to tackle. The Blueprint For Diseases, as its called, highlights the diseases that could break out into epidemics in the next 12 months. It's a guide for the research community, an attempt to steer its resources to where they're most required. Currently, Covid-19 tops the list. Lurking at the bottom, as it has been every year since the Blueprint was first published in 2016, is something that sounds like it's been pulled from the pages of a comic: Disease X.

To create a vaccine in 18 months is unprecedented in human history. No vaccine has ever been developed at that speed.

Thats the unknown, brand new pathogen that springs up, says Rachel Grant, of the Coalition for Epidemic Preparedness Innovations. CEPI was formed in 2017, after the Ebola crisis made apparent the lack of a single, coordinating voice in the research and development (R&D) of vaccines. Its founding partners included the nation of Norway, the Gates Foundation, the Wellcome Trust, and the UK Research Foundation. (Since then, Germany and Japan have signed up, too.) What happened with Ebola was the world tragically realised they reacted too late," says Grant. "The whole system was too fragmented to respond in an effective way.

Disease X has long been recognised as an issue. Before coronavirus, the last brand new pathogen to spring up was the mosquito-borne Zika virus, which infected an estimated half-a-million people between 2015 and 2016. At the time of writing, Covid-19 had infected at least 1.5 million people and killed 90,000 (see the most recent numbers at Johns Hopkins Universitys live map of global cases).

The focus of the R&D world is now squarely on Covid-19, and the race is on to develop a vaccine. If the boffins and academics are to succeed, they will have to move at a previously unheard-of pace. Vaccine researchers are used to working on vaccines for decades, but with coronavirus, we cant wait that long. More than 60 teams across the globe are trying to find a way to protect the worlds population up from around 40 two weeks ago and the more optimistic among them think there could be a vaccine ready in 12 to 18 months. That is unprecedented in human history, says Grant. No vaccine has ever been developed at that speed. But they have to try.

Professor Katie Ewer hated immunology when she was an undergraduate. She had been interested in biology since she was a child, fascinated by seemingly endless processes that occur in our cells and organs every second of our lives without us knowing about it. When she didn't get into medical school she trained as a microbiologist instead, and grew fascinated by infectious diseases. Ive always had a real obsession with the human body, anatomy and how it works, she says. Eventually, she came to see immunology as its "ultimate expression". After a PhD in the subject she landed at Oxford University's Jenner Institute, and has spent the 13 years since working on a malaria vaccine, to try and halt the spread of a disease that kills 500,000 people every year.

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Thirteen years may sound like a long time, but vaccines are difficult to develop, especially when they're for diseases that largely impact the poorer parts of the world. A malaria vaccine would save tens of millions of lives, but it would be less profitable than, say, a drug that reverses hair loss or makes you lose weight. So not-for-profits like the Jenner Institute, where Ewer is a senior scientist, do the work that big pharma won't prioritise. According to The Global Fund, $5 billion is needed to keep development of a malaria vaccine on track. In 2018, researchers received $2.8 billion, a drop from the year before. That Covid-19 has spread through the global west has, perversely, probably accelerated the search for its vaccine.

To create a vaccine, you need to know what you're fighting, which is why, on 11 January, researchers in Shanghai leaked the genetic sequence of the coronavirus, after realising that Chinese authorities had no intention of releasing it globally. The next day, their lab was closed for "rectification". Their sacrifice enabled teams around the world to mobilise.

"We go round the lab with a tape measure, measure two metres, work out the number of people who can safely work in a particular area"

Vaccines work by training your body to react in a certain way, like teaching a child to catch a ball. The first time you throw it, it bounces off them. The second time, maybe they put up an arm to protect themselves. Eventually, they'll learn to predict its flight, get their hands in the right place, and time when they should wrap their fingers around the ball. It's become an innate reaction that happens almost without thinking.

In the same way, the first time your body is exposed to a new virus, it doesn't know how to react. Being infected with Covid-19 is like turning a tennis ball launcher on that child before they've learnt to catch they'll be overwhelmed. But introduce a measured, non-fatal dose and our body learns to battle it, even when confronted by a larger amount. This is done by injecting antigens (or small molecules of the virus, which is a pathogen) into the body. The immune system recognises a harmful alien presence and, through a process of trial and error, creates antibodies to battle it. Once it's been destroyed, your body remembers the specific antibodies it needs to produce if the virus returns say, through live infection so it can mobilise more quickly. (This is also why those who've already been infected almost certainly can't catch Covid-19 a second time, unless the virus mutates.)

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Before the advent of genetic medicine, vaccines worked by injecting patients with either a dead form of a virus, so it couldn't replicate inside the body, or a similar but less harmful pathogen (Edward Jenner, for whom the Jenner Institute is named, all-but invented vaccination in the 1790s when he realised that if you deliberately infected someone with the comparatively harmless cowpox virus, they wouldn't catch smallpox). Today, making a vaccine isn't simple, but it is standardised. The actual platform the backbone of the vaccine is always the same, whatever the disease, says Ewer. Researchers just slot in a little bit of the genetic information from the new virus.

The Jenner Institute develops a multitude of different vaccines at any one time, and at the start of the year, Ewers colleague, Professor Theresa Lamb, was handling its coronavirus research. By the middle of February, the Institute had recognised that the early stages of their vaccine production had gone well, and were preparing to test it in a clinical trial. Suddenly the small number of people working on the vaccine under Lamb ballooned. Ewer was drafted to help in the effort, one of around 60 people including doctors and nurses who are screening potential trial participants and laboratory staff developing tests and assays working on the project. Many are working from home: the lab doesnt want people in unnecessarily, in case they contract or spread the disease. We go round [the laboratory] with a tape measure, we measure two metres, work out the number of people who can safely work at that distance in a particular area of the lab, says Ewer. Its really boring, just the same as any other supermarket or shop.

The potential outcome is far from boring. Covid-19 has changed our scientific landscape in terms of how fast things are moving, says Dr Melvin Sanicas, a vaccinologist and medical director at Takeda, a Japanese pharmaceutical company. Since its genetic sequence was released, two teams have got candidate vaccines into clinical trials. One is based on an Ebola vaccine, developed by CanSino Biological Inc, a Hong Kong company, in collaboration with the Beijing Institute of Biotechnology. The other is from a Massachusetts-based pharmaceutical company, Moderna (who declined to speak for this story).

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In the 70 years since the first identified coronavirus infection in humans, no vaccine has ever got beyond Phase II trials, which means labs are taking diverse approaches to finding one now. The Asian plan uses a non-replicating viral vector essentially, the dead vaccine. The Moderna plan uses an RNA vaccine, in which human cells are injected with the disease's RNA a simpler version of DNA, used by cellular organisms like viruses in the hope that it will absorb it and start to produce antibodies. The former isn't so different from Jenner's original method; the Moderna plan is based on science that, so far, is largely theoretical, but which will be much quicker to test and produce than those made by the traditional method. If it works.

But finding a vaccine that defeats a disease is merely step one. You test the vaccine candidates in cell cultures or animal models to see if the vaccine candidate is safe and whether its able to induce an immune response, says Sanicas. The right immune response sees the body fight back against the pathogen, without being overwhelmed by it some candidate vaccines have to be shelved because the virus wins. Get it to work in cell cultures or animal models, and youre through the pre-clinical phase. You can now try and test it in humans.

"With any vaccine there is a risk of rare serious adverse events."

Testing is the time-consuming part. The team at Oxford University recently put out a call for participants across the Thames Valley area, asking for 510 participants in total. More than half will be given the actual vaccine, and 250 will be given a control. Theyll be monitored over the next six months to see how the vaccine is working researchers are looking for an immune response, but also check for side-effects that might be worse than the disease. In exchange, the participants will get up to 625, and the pride of knowing theyre helping save the world. The amount is relatively low (participants in a botched clinical trial in the mid-2000s got 2,000 each), and the risk real: an accompanying document acknowledges with any vaccination there is a risk of rare serious adverse events.

All vaccines entering clinical trials on humans go through three stepped stages. The Oxford trial will test only a few people to start with, to make sure everything works correctly and safely, before increasing the numbers. Well try and get up to vaccinating some quite big numbers of people in a short space of time, says Ewer. In less urgent times, that means thousands of participants over several years, because it can take months for an immune response to show up in healthy subjects.

To progress, a vaccine needs to produce positive results at all three stages. Normally, that means an effectiveness of at least 97 per cent, says Sanicas, although the pandemic is so severe that any potential coronavirus vaccine could be rolled out with results as low as 70 per cent.

Next, you start applying to national regulatory bodies the FDA in the US, the Medicines and Healthcare Products Regulatory Agency in the UK, and the European Medicines Agency in the EU for approval. Once theyve determined the vaccine is safe, effective and made using quality production mechanisms, they approve the vaccine for use, says Sanicas. Getting from identification to commercial vaccine normally takes the best part of a decade.

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Faced with a pandemic, there's always a temptation to cut corners. Every extra day jumping through red tape means thousands of people dead, tens of thousands more infected. But the scientific community has learned that a bad vaccine is worse than no vaccine. In the mid-2000s, trials of an experimental leukaemia drug in London went wrong, seriously damaging six participants without that testing, actual patients could have been given a drug that was more likely to kill them than their disease. And all vaccine development lives in the shadow of a terrible series of events in 1976, when the threat of a swine flu epidemic across the US led the government to instigate mass vaccination. To speed up production, they opted to use a "live" virus, rather than an inactive strain. Of the inoculated, one in 100,000 contracted a neurological disease called GuillainBarr syndrome, in which the bodys immune system attacks its own nerves, causing permanent paralysis. Since then, speed has always come second to safety.

But time can be saved if you can organise people properly. "Getting the regulatory authorities to focus, to come together, to really understand the data, all of that will make a difference to the timeframe for this," says Grant. Medical advances have also sped up the process of getting a vaccine to trial safely. The Oxford team is also changing the way they work, to speed things up without sacrificing safety, says Ewer. Were doing a lot of things in parallel that we would ordinarily do one after the other."

But they arent the only team on the cusp of clinical trials.

A tobacco warehouse in Owensboro, Kentucky may seem like an odd place for a coronavirus vaccine to emanate, but we live in strange times. British American Tobacco (BAT), which some might say is a company best known for killing people, has also entered the race to save lives. Right now, I would hope we could leave the politics of tobacco and smoking to one side," says Kingsley Wheaton, who leads marketing at BAT, "in order that we try and focus on the matter at hand right here, right now, which is solving this Covid-19 problem globally."

A few years ago, recognising it was selling fewer cigarettes every year, BAT invested in a company called Kentucky BioProcessing, to help find new uses for the tobacco plants it was growing but which people weren't smoking. They were especially interested in a protein that could be harvested and processed as animal feed. You take a small, hardy Australian tobacco varietal, and around halfway through its growing cycle impregnate it with an antigen for the protein. It replicates at a tremendous scale. The plant is a mini-factory, if you like, says Wheaton.

It became clear that this might also be a way to produce vaccines quickly and cheaply. Instead of an antigen developing a feedstock protein, Kentucky BioProcessing realised they could develop the antigens of viruses. You could clone in fields, rather than Petri dishes. In 2014, as Ebola was killing people in Africa, Kentucky BioProcessing put its newly acquired company to work. Improbably, Kentucky BioProcessing developed ZMapp, an Ebola drug that the World Health Organisation concluded, in 2018, had benefits [that] outweigh the risks (science has since thrown doubts on its effectiveness, however).

Every year since, Kentucky BioProcessing has worked on a seasonal flu vaccine; this year's was heading into the first stage of clinical trials when the coronavirus began its rampage across the globe. Now, the business has been reoriented to aid Covid-19 vaccine development: 50 staff members are devoted to growing an antigen that can create a vaccine in tobacco plants in a matter of weeks. You extract it, purify it and hey presto theres a vaccine. Results from pre-clinical trials in animals are pending, at which point it will move into clinical trials which may be anything from 12 to 18 months, even with a fair wind, Wheaton says.

What if they all worked together? Wouldnt it get done in half the time? No.

Not that theyre waiting that long. Even if BAT's vaccine is ineffective, its production technique could be a game-changer. Because a pandemic is different from an epidemic, and the need for a vaccine is everywhere and at the same time, youve also got to think about manufacturing capacity, says CEPIs Grant. If youre thinking about developing a vaccine for an epidemic, youre talking millions of doses of whatever it is youve developed. A pandemic, youre talking about billions.

BAT plans to start production on their vaccine even before it knows whether it works, making between one and three million a week, just in case. Wheaton is at pains to point out that if the vaccine isnt approved, it wont be used, but if it turns out our candidate vaccine is the right one, it would be good to have a stockpile of these things.

This is where research diversity becomes so important. People may look at the vast array of organisations, private companies, university laboratories and oddball developers trying to produce different vaccines simultaneously in all four corners of the world and think, What if they all worked together? Wouldnt it get done in half the time? Not so, says Grant, whose list of teams working on a vaccine tops 90. You are always better to have a diversified approach than you are to have a really narrow one, she says. You never want a single point of failure in a situation like this." With vaccines, there are too many potential failure points to count.

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During the West African Ebola crisis, pharma giant Merck was one of the first to get a drug through clinical trials. Its vaccine, rVSV Zebov-GP, had 100 per cent efficacy, but a zero per cent chance of actually being used at scale; it needed to be stored at 80C. You try getting a vaccine supposed to be stored at 80C out to war-torn Democratic Republic of Congo and youve got massive supply problems, says Grant. Which is why it was handy there was investment in another vaccine, by Johnson & Johnson, that wasn't so temperamental.

Most drug research works on a winner-takes-all model: invent Viagra, or Minoxodil, or Oxycontin, and you get a 20-year exclusivity licence (in the US). That means you can charge as much for it as you like. Once the licence lapses, competitors can create generic versions and the price falls. With a pandemic vaccine, the rules of the marketplace make less sense. There's healthy competition, but its against nature, not each other.

"Im trying to do as much as I can do in the working day and then go home and try and be a mum to my kids at home."

That said, there are economic incentives at play: make the vaccine everyone wants and you can at least recoup the costs of developing it. CEPI has ploughed $23 million into the eight programmes it's supporting underway, and estimates it will cost something like $2 billion more to get three of those into clinical testing. Altruism is fuelling initial development, but at some point realism steps in. Still, any CEPI-developed vaccines wont result in a free-for-all (the US government's reported attempts to buy German pharmaceutical group CureVac, to get at its potential coronavirus vaccine first, hint at what could happen with international cooperation). CEPI has a stringent policy on equitable access and believes that work needs to be done now at an intra-governmental level to decide a way for people who need the vaccine most, such as healthcare workers and the vulnerable, to access it first.

Regardless, developers are keen to help in any way they can. Were one of many in that area, but wed also be delighted to take a candidate vaccine and become a fast-scale manufacturer through our plant-based system, says Wheaton.

For those in the labs, competition isn't a concern. They worry about the pressure of getting a vaccine right and getting it quickly. When I ask Ewer if the process of developing a vaccine has been stressful, she replies with one word: "Yes".

I try not to think about it too much, she eventually adds. Shes stopped watching the news; a regular Twitter user, shes now shunning the app. I had to stop engaging with it because if I think too much about it, I get really stressed. If I think too much about what happens if none of this works, then I feel a bit overwhelmed, so Im trying to do as much as I can do in the working day and then go home and try and be a mum to my kids at home, try and keep things as normal for them as possible, because its weird for the family as well as it is for everybody.

"Hopefully one of us will produce a vaccine that is effective. I dont really mind if its ours or anybody elses, as long as one of them works."

It can be easy to forget, as we praise our scientists and our doctors, our nurses and the collective brainpower of the experts working to lead us out of this crisis, that theyre human beings, too. The risks of getting it wrong are real and they feel them every day.

If you ask me whether I want this really quick, or I want a robust process, I would pick the safe and robust process, says Sanicas, who worries were all getting caught up in the hype around 18 months to a vaccine. I dont want this to be just a vaccine you bring quickly to the market but were not sure about the long-term effects. He thinks itll take two years for anything to come to fruition.

Near the end of our conversation, I ask Ewer if theres one thing she wishes the general public who are clamouring for a Covid-19 vaccine as eagerly as they are for sufficient testing capacity knew about her work. I expected her to explain the challenges of the vaccine, or to caution about its progress (she believes the best case scenario is that by autumn this year the Oxford team will have evidence of the vaccine being safe and able to induce a good immune response). I didnt expect her to answer as she did.

I think I would like people to know there are lots of people working very, very hard on this, she explains. Making vaccines is difficult and its expensive, but there are at least 30 different groups around the world, all trying to produce a vaccine against this disease, and hopefully one of us will produce a vaccine that is effective. I dont really mind if its ours or anybody elses, but as long as one of them works, thats the most important thing.

She pauses for a moment, then picks up her train of thought. As long as somebody gets there, we dont mind if its us, or Moderna, or anyone else. As long as one of us gets there, and we can make enough of it quickly enough to make an impact.

The information in this story is accurate as of the publication date. While we are attempting to keep our content as up-to-date as possible, the situation surrounding the coronavirus pandemic continues to develop rapidly, so it's possible that some information and recommendations may have changed since publishing. For any concerns and latest advice, visit the World Health Organisation. If you're in the UK, the National Health Service can also provide useful information and support, while US users can contact the Center for Disease Control and Prevention.

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When Will There Be A Coronavirus Vaccine? - esquire.com

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Advancements in modern medicine have made it so our options for seeking out and receiving medical help aren't limited to physically visiting doctor's offices or urgent care centers. Instead, the rise of telemedicine allows us to connect with doctors without ever having to leave our homes.

This has proven to be invaluable for getting information and advice when other means of medical care aren't accessible. In an increasingly connected world, it also seems like an important tool for the future of healthcare.

By its simplest definition, telemedicine is any service or method that uses technology to allow doctors and patients to interact with one another even when they're not physically in the same location. This allows people to connect with medical specialists who may live in entirely different parts of the planet and to obtain expert advice and diagnoses they typically wouldn't have access to. It also allows both the healthcare provider and the patient to connect without having to travel anywhere themselves.

To be clear, telemedicine is not a new concept. In fact, it's existed in one form or another since the 1950s. Back then, it was the telephone that enabled direct communication between a doctor and a patient, before dedicated video conferencing systems introduced a new level of interactivity.

The biggest shift in telemedicine came via the rise of the internet. The ever-expanding network afforded by the internet helped bring telemedicine to the masses, making it easier than ever to connect to a medical professional via a computer, smartphone, or tablet.

Originally, the idea behind telemedicine was that it would be a convenient way for people living in remote locations to receive medical attention and assistance. Later, that level of convenience extended to others who found it difficult to visit their doctor during regular office hours.

Busy schedules, lack of transportation, mobility issues, and a host of other challenges disappeared by picking up the phone and chatting with a doctor directly. The process wasn't as all-encompassing as an actual in-person check-up or physical, but it did prove successful under certain circumstances.

Thanks to the proliferation of technology into every aspect of our lives, telemedicine's become a reality for so many people. Highly sophisticated systems now allow patients to set up video chats with a health professional at just about any time of day or night.

But the field of telemedicine goes beyond that as well, giving caregivers the ability to remotely monitor a patient using wireless sensors and other equipment. It even allows physicians to quickly and easily share a patient's history and health records, making it easier for healthcare practitioners to collaborate with one another.

The value of using telemedicine is immense for a variety of patients, regardless of whatever illness or issue they face and it's more vital now than ever. As more people start to prefer telemedicine, the number of companies offering their own unique take on the bridge between doctor and patient expands, too.

Below are 12 of the top telemedicine services, offering everything from quick and easy consultations to mental health outreach.

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The best telemedicine services for anyone unable to visit a doctor's office in person - Insider - INSIDER

(CNN) -- Scientists are learning more each day about the mysterious novel coronavirus and the symptoms of Covid-19, the disease it causes.

Fever, cough and shortness of breath are found in the vast majority of all Covid-19 cases. But there are additional signals of the virus, some that are very much like cold or flu, and some that are more unusual.

Any or all symptoms can appear anywhere from two to 14 days after exposure to the virus, according to the US Centers for Disease Control and Prevention.

Here are 10 signs that you or a loved one may have Covid-19 -- and what to do to protect yourself and your family.

Shortness of breath is not usually an early symptom of Covid-19, but it is the most serious. It can occur on its own, without a cough. If your chest becomes tight or you begin to feel as if you cannot breathe deeply enough to fill your lungs with air, that's a sign to act quickly, experts say.

"If there's any shortness of breath immediately call your health care provider, a local urgent care or the emergency department," said American Medical Association president Dr. Patrice Harris.

"If the shortness of breath is severe enough, you should call 911," Harris added.

The CDC lists other emergency warning signs for Covid-19 as a "persistent pain or pressure in the chest," and "bluish lips or face," which can indicate a lack of oxygen.

Get medical attention immediately, the CDC says.

Fever is a key sign of Covid-19. Because some people can have a core body temperature lower or higher than the typical 98.6 degrees Fahrenheit (37 degrees Celsius), experts say not to fixate on a number.

CNN anchor Chris Cuomo, who is battling the virus from his home in New York, is one of those people.

"I run a little cool. My normal temperature is 97.6, not 98.6. So, even when I'm at 99 that would not be a big deal for most people. But, for me, I'm already warm," Cuomo told CNN Chief Medical Correspondent Dr. Sanjay Gupta in a CNN Town Hall.

Most children and adults, however, will not be considered feverish until their temperature reaches 100 degrees Fahrenheit (37.7 degrees Celsius).

"There are many misconceptions about fever," said Dr. John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.

"We all actually go up and down quite a bit during the day as much as half of a degree or a degree," Williams said, adding that for most people "99.0 degrees or 99.5 degrees Fahrenheit is not a fever."

Don't rely on a temperature taken in the morning, said infectious disease expert Dr. William Schaffner, a professor of preventative medicine and infectious disease at Vanderbilt University School of Medicine in Nashville. Instead, take your temperature in the late afternoon and early evening.

"Our temperature is not the same during the day. If you take it at eight o'clock in the morning, it may be normal," Schaffner explained.

"One of the most common presentations of fever is that your temperature goes up in the late afternoon and early evening. It's a common way that viruses produce fever."

Coughing is another common symptom, but it's not just any cough.

"It's not a tickle in your throat. You're not just clearing your throat. It's not just irritated," Schaffner explained.

The cough is bothersome, a dry cough that you feel deep in your chest.

"It's coming from your breastbone or sternum, and you can tell that your bronchial tubes are inflamed or irritated," Schaffner added.

A report put out by the World Health Organization in February found over 33% of 55,924 people with laboratory confirmed cases of Covid-19 had coughed up sputum, a thick mucus sometimes called phlegm, from their lungs.

"The beast comes out at night," said Cuomo, referencing the chills, body aches and high fever that visited him on April 1.

'It was like somebody was beating me like a pinata. And I was shivering so much that ... I chipped my tooth. They call them the rigors," he said from his basement, where he is quarantined from the rest of his family.

"I was hallucinating. My dad was talking to me. I was seeing people from college, people I haven't seen in forever, it was freaky," Cuomo said.

Not everyone will have such a severe reaction, experts say. Some may have no chills or body aches at all. Others may experience milder flu-like chills, fatigue and achy joints and muscles, which can make it difficult to know if it's flu or coronavirus that's to blame.

One possible sign that you might have Covid-19 is if your symptoms don't improve after a week or so but actually worsen.

Speaking of worsening signs, the CDC says a sudden confusion or an inability to wake up and be alert may be a serious sign that emergency care may be needed. If you or a loved one has those symptoms, especially with other critical signs like bluish lips, trouble breathing or chest pain, the CDC says to seek help immediately.

At first science didn't think diarrhea or other typical gastric issues that often come with the flu applied to the noval coronavirus, also known as SARS-CoV-2. As more research on survivors becomes available, that opinion has changed.

"In a study out of China where they looked at some of the earliest patients, some 200 patients, they found that digestive or stomach GI (gastrointestinal) symptoms were actually there in about half the patients," Gupta said on CNN's New Day news program.

Overall, "I think we're getting a little bit more insight into the types of symptoms that patients might have," Gupta said.

The study described a unique subset of milder cases in which the initial symptoms were digestive issues such as diarrhea, often without fever. Those patients experienced delays in testing and diagnosis than patients with respiratory issues, and they took longer to clear the virus from their systems.

Research from China, South Korea and other parts of the world indicate that about 1% to 3% of people with Covid-19 also had conjunctivitis, commonly known as pink eye.

Conjunctivitis, a highly contagious condition when caused by a virus, is an inflammation of the thin, transparent layer of tissue, called conjunctiva, that covers the white part of the eye and the inside of the eyelid.

But SARS-CoV-2 is just one of many viruses that can cause conjunctivitis, so it came as no real surprise to scientists that this newly discovered virus would do the same.

Still, a pink or red eye could be one more sign that you should call your doctor if you also have other telltale symptoms of Covid-19, such as fever, cough or shortness of breath.

In mild to moderate cases of coronavirus, a loss of smell and taste is emerging as one of the most unusual early signs of Covid-19.

"What's called anosmia, which basically means loss of smell, seems to be a symptom that a number of patients developed," CNN Chief Medical Correspondent Dr. Sanjay Gupta told CNN anchor Alisyn Camerota on New Day.

"It may be linked to loss of taste, linked to loss of appetite, we're not sure -- but it's clearly something to look out for," Gupta said. "Sometimes these early symptoms aren't the classic ones."

"Anosmia, in particular, has been seen in patients ultimately testing positive for the coronavirus with no other symptoms," according to the American Academy of Otolaryngology-Head and Neck Surgery.

A recent analysis of milder cases in South Korea found the major presenting symptom in 30% of patients was a loss of smell. In Germany, more than two in three confirmed cases had anosmia.

It has long been known in medical literature that a sudden loss of smell may be associated with respiratory infections caused by other types of coronaviruses, so it wasn't a surprise that the novel coronavirus would have this effect, according to ENT UK (PDF), a professional organization representing ear, nose and throat surgeons in the United Kingdom.

Is there anything you can do at home to test to see if you're suffering a loss of smell? The answer is yes, by using the "jellybean test" to tell if odors flow from the back of your mouth up through your nasal pharynx and into your nasal cavity. if you can pick out distinct flavors such as oranges and lemons, your sense of smell is functioning fine.

For some people, extreme fatigue can be an early sign of the novel coronavirus. The WHO report found nearly 40% of the nearly 6,000 people with laboratory confirmed cases experienced fatigue.

Just a few days into his quarantine, Cuomo was already exhausted by the fevers and body aches the disease brings.

"I'm so lethargic that I can stare outside, and, like, an hour-and-a-half goes by," Cuomo told Gupta on Anderson Cooper 360. "I think I took a 10-minute nap, and it was three and a half hours."

Fatigue may continue long after the virus is gone. Anecdotal reports from people who have recovered from Covid-19 say exhaustion and lack of energy continue well past the standard recovery period of a few weeks.

The WHO report also found nearly 14% of the almost 6,000 cases of Covid-19 in China had symptoms of headache and sore throat, while almost 5% had nasal congestion.

Certainly not the most common signs of the disease, but obviously similar to colds and flu. In fact, many symptoms of Covid-19 can resemble the flu, including headaches and the previously mentioned digestive issues, body aches and fatigue. Still other symptoms can resemble a cold or allergies, such as a sore throat and congestion.

Most likely, experts say, you simply have a cold or the flu -- after all, they can cause fever and cough too.

"At this moment, the current guidance -- and this may change -- is that if you have symptoms that are similar to the cold and the flu and these are mild symptoms to moderate symptoms, stay at home and try to manage them" with rest, hydration and the use of fever-reducing medications, said the AMA's Harris.

That advice does not apply if you are over age 60, since immune systems weaken as we age or if you are pregnant. Anyone with concerns about coronavirus should call their healthcare provider, according to the CDC.

It's unclear whether pregnant women have a greater chance of getting severely ill from coronavirus, but the CDC has said that women experience changes in their bodies during pregnancy that may increase their risk of some infections.

In general, Covid-19 infections are riskier if you have underlying health conditions such as diabetes, chronic lung disease or asthma, heart failure or heart disease, sickle cell anemia, cancer (or are undergoing chemotherapy), kidney disease with dialysis, a body mass index (BMI) over 40 (extremely obese) or an autoimmune disorder.

"Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness," the CDC advises.

To be clear, you are at higher risk -- even if you are young -- if you have underlying health issues.

"People under 60 with underlying illnesses, with diabetes, heart disease, immunocompromised or have any kind of lung disease previously, those people are more vulnerable despite their younger age," Schaffner said.

A history of travel to an area where the novel coronavirus is widespread (and those parts of the world, including the US, are going up each day) is obviously another key factor in deciding if your symptoms may be Covid-19 or not.

If you have no symptoms, please don't ask for testing or add to backlog of calls at testing centers, clinics, hospitals and the like, experts say.

"We do not test people with no symptoms because it's a resource issue," Schaffner said about the assessment center at Vanderbilt. "However, we are emphasizing that people who have this small cluster of important symptoms -- fever and anything related to the lower respiratory tract such as cough and difficulty breathing -- reach out to be evaluated."

If you do have those three signs, where should you go?

"If you have insurance and you're looking for a provider or someone to call or connect with, there's always a number on the back of your insurance card; or if you go online, there is information for patients," Harris said.

"If you don't have insurance, you can start with the state health department or the local community health centers, those are officially known as federally qualified health centers," Harris advised, adding that some states have a 1-800 hotline number to call.

"If there is a testing and assessment center near you, you can go there directly," Schaffer said. "It's always good to notify them that you're coming. Otherwise, you need to call your healthcare provider and they will direct you what to do."

CNN's Jacqueline Howard contributed to this report.

Read more:
Coronavirus symptoms: 10 key indicators and what to do - WFSB

Edge computing presents organizations with a significant leap in business opportunity. Much has been written about the benefits of the Internet of Things (IoT), but it is now clear that these benefits can only be truly realized with Edge computing. Limiting your organization to only adopting central cloud computing simply wont support your future IoT needs. Today, every organization needs to be a digital organization, powered by data, running in a multi-cloud world. Recognizing that multi-cloud actually begins at the point of data creation the Edge the value in the future is in combining Edge computing with IoT.

Today, 90% of all data is created and processed inside traditional centralized data centers or clouds. That is beginning to change. According to Gartner1, by 2025, 75% of data is going to be processed at the Edge.

The Edge exists wherever the digital world and physical world intersect, and data is securely collected, generated and processed to create new value. Edge computing expands IoT by enhancing our ability to analyze IoT data and act on it in real time.

Edge technology is the answer to many of todays pressing business issues: increasing data volumes, costs of data transport, latency and insights that arrive too late to be actionable.

Forrester, in its Edge computing report2, highlights the need to move data analysis to the Edge in order to address barriers to business growth. Forrester found that 49% of firms surveyed identified the need to be able to monitor structured and unstructured data in real time, and a massive 76% stated that identifying the ideal location for data analysis was challenging forward progress.

And, McKinsey, in its report3, identified a total of 107 different use cases for Edge and IoT. The true proof as to how Edge technology can be used to great effect with IoT, in four key sectors on a daily basis all around the world is demonstrated below.

Shutterstock

Turning urban areas into smart cities

According to estimates from the United Nations4, today 55% of the worlds population lives in urban areas, and that number is expected to grow to 68% by 2050.

Edge IoT is helping to make cities healthier, safer and more prosperous, liveable urban environments. Forrester reports2 that 83% of smart cities and government agencies are actively using or exploring Edge IoT, with particular benefits highlighted for transport and utilities.

With so many activities taking place in even the smallest of cities, there are many applications for Edge and IoT. Here are four key use cases:

Boosting public safety and monitoring

Computer vision that depends on cameras as the data collection points at the Edge can help cities monitor the safety of its citizens and, when the need arises, to act immediately. It can help police pinpoint information, both preventing crime and helping to solve cases.

Improving Traffic & public transport monitoring

Data from embedded sensors, video cameras and other sources can help city operators better understand traffic patterns and make adjustments in real time.

Saving resources through smart metering and billing

Smart utility meters can provide consumers and businesses with real-time information on energy consumption, helping to control the use of precious resources.

Making parking and waste management smarterSmart parking can lead drivers right to open spots and cameras can monitor vehicles for parking violations. Sensors on bins can indicate when they need to be emptied, saving unnecessary trips.

Harnessing the power of data in retail

The retail sector is generating unprecedented amounts of data, from both online and bricks and mortar locations. In 2019, global e-commerce retail sales alone amounted to $3.53 trillion and e-retail revenues are projected to grow to $6.54 trillion by 2022 (Statista5). Retailers that have the systems, strategies and analytics tools in process can capitalize on the growing amounts of data produced across all areas of retail.

Edge analytics will be critical to the success of harnessing the power of data. The retail sector has three compelling reasons to move analytics to the Edge:

Some of the key Edge and IoT use cases for in retail are:

Combining data from multiple sources to improve customer experience Edge computing can combine data from a myriad of sources online research and point of sale, loyalty and CRM, in-store sensor and devices, self-checkout, current inventory, historical data and more to help improve customer experience.

Analyzing shopper behaviors to drive personalized shoppingReal-time streaming data from enabled sensors, computer vision, AI and augmented reality can be analyzed more effectively using Edge technology to help create new and immediate personalized shopping experiences.

Advanced loss preventionUsing AI and computer vision, Edge and IoT systems can automatically detect criminal behavior and issue alerts to security personnel on the retail floor.

Predictive inventory and supply chain controlDrone-sweeps of inventory combined with computer vision-based location identification can help predict demand for products and ensure the right products are in the right place at the right time.

Shutterstock

Healthcare: improving wellness and saving more lives

The healthcare industry faces many key challenges: 1 in 6 people will be over 65 by 20506, 75% of older developed world adults present with multiple chronic conditions7, 44% of US physicians report burnout8 and we saw a massive 878% growth in healthcare and life sciences data between 2016 and 20189 and that continues to grow today.

In response to this, the industry has been successfully deploying Edge IoT technologies for several years, and we are now seeing an important shift to IoT, Edge computing and artificial intelligence to better understand and predict care outcomes.

There are many compelling and new advanced use cases for using Edge technology with IoT in healthcare, these are some key examples:

Improving patient safetyComputer vision can monitor patient safety and medical compliance, for example devices that ensure discharge instructions are adhered to, connected pill bottles that confirm correct dosage and telesitters to improve patient safety and reduce fall-risk in post-acute care step-down patients.

Expanding chronic disease management and preventative medicine

Sensors and devices can enable continuous patient monitoring, for example smart mirrors that detect physical changes. Smart wearables can track wellness indicators, such as motion and heart rate, as well as seizure activity, blood sugar levels and the data that builds predictive algorithms in pacemakers.

Advancing precision medicine research

Edge analysis of sensor-generated data can help overcome the prohibitive costs of rare disease treatment, for example the use of wearables in clinical trials can expedite study completion and improve compliance.

Enhancing pharmaceutical drug supply chain safety

Edge and IoT devices and sensors can reduce the risks inherent in the healthcare supply chain, for example RFID sensors that track medication from point of manufacturing to consumption.

Giving manufacturing a competitive edge

To drive business growth, manufacturers need to power their operations with real-time insights from data that is generated across the production process. Computing at the Edge is the only way to facilitate this. In fact, Microsoft recently reported10 that 87% of manufacturers are now adopting Edge and IoT solutions.

The use cases for Edge and IoT solutions in manufacturing have been highlighted in several studies. These are the top four:

Automating industry

Intelligent systems can automatically identity and rectify issues before they become business stoppage problems, for example, if an Edge computing system notices that a feed tank is low, it can slow the machine down and notify the plant operator.

Better quality and complianceEdge computing can maintain the highest levels of product quality, eg automated visual inspection of products, fault detection and ejection from production line.

Improving planning and scheduling

Better production planning and maintenance through Edge computing, enables sensors that monitor temperature and dust levels to deliver real-time insights about machine components.

Smarter plant safety and security

Edge IoT enabled devices and computer vision can help manufacturers protect company property and vehicles, minimize onsite injuries, and reduce loss or damage to facilities.

Dell Technologies is a global leader in Edge IoT technology. It is working with business and organizations across retail, healthcare, manufacturing, transport, digital cities and utilities to leverage the potential of Edge IoT by focusing the power of technology close to the data source. To learn more go to: Edge IoT computing solutions from Dell Technologies and to contact a

Dell Technologies Expert to discuss an Edge solution, or for any other enquiries, go to: Dell Technologies Edge & IoT Solutions.

Businesses looking to embrace the power of Edge and IoT technology need to identify the right partner to unlock the full potential of data and meet their current and future business transformation goals.

Processing data at the Edge creates true business opportunity. Analytics, streaming data, video, cloud services and next-generation applications such as virtual and augmented reality are driving the need to bring computing power and storage closer to the point of creation, closer to the Edge. For nearly all industries, Edge computing is promising to be the next big shift in architecture of distributed computing networks,representing a massive wave of opportunities.

1 Gartner, What Edge Computing Means for Infrastructure and Operations Leaders (2018)

2 Forrester, IoT Deployment Is Driving Analytics to The Edge (2019)

3 McKinsey, New demand, new markets: What edge computing means for hardware companies (2018)

4 United Nations, Revision of World Urbanization Prospects (2018)

5 Statista, Retail e-commerce sales worldwide from 2014 to 2023 (2020)

6 United Nations, World Population Ageing (2019)

7 Marengoni A, Angleman S, Melis R, et al Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev2011;10:4309.doi:10.1016/j.arr.2011.03.003

8 Medscape, National Physicians Burnout & Depression Report cited (2018)

9 Dell EMC Global Data Protection Index Survey (2019)

10 Microsoft, IoT Signals: Summary of Research Learnings (2019)

Original post:
Driving business opportunities at the Edge - TechHQ

Half Year 2018 Sonic Healthcare Ltd Earnings Call

NORTH RYDE , NSW Apr 14, 2020 (Thomson StreetEvents) -- Edited Transcript of Sonic Healthcare Ltd earnings conference call or presentation Wednesday, February 14, 2018 at 11:00:00pm GMT

TEXT version of Transcript

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Corporate Participants

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* Christopher David Wilks

Sonic Healthcare Limited - Finance Director, CFO & Executive Director

* Colin Stephen Goldschmidt

Sonic Healthcare Limited - CEO, MD & Executive Director

* Paul J. Alexander

Sonic Healthcare Limited - Deputy CFO & Company Secretary

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Conference Call Participants

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* Andrew Goodsall

MST Marquee - Healthcare analyst

* David A. Low

JP Morgan Chase & Co, Research Division - Research Analyst

* David Andrew Stanton

CLSA Limited, Research Division - Former Research Analyst

* David Bailey

Macquarie Research - Research Analyst

* Nicholas Cameron

Watermark Funds Management Properietary Limited - Sector Head of Healthcare

* Sean M. Laaman

Morgan Stanley, Research Division - Australian Healthcare Analyst

* Steven David Wheen

Evans & Partners Pty. Ltd., Research Division - Executive Director of Healthcare

* Thomas Godfrey

UBS Investment Bank, Research Division - Analyst

* Victor Windeyer

Citigroup Inc, Research Division - Former VP and Analyst

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Presentation

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Operator [1]

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Hi, good morning. Welcome to Sonic Healthcare's Half Year Results Presentation.

I will now hand you over to our presenter today, Dr. Colin Goldschmidt, CEO of Sonic Healthcare. Go ahead, sir.

Story continues

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Colin Stephen Goldschmidt, Sonic Healthcare Limited - CEO, MD & Executive Director [2]

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Thank you very much, and a very good morning to everyone, and welcome to this half year presentation of Sonic Healthcare's results for the period ending 31 December 2017. I'm joined this morning in Sydney by my colleagues: first of all, Mr. Chris Wilks, who's Sonic's Chief Financial Officer; and also by Mr. Paul Alexander, Deputy CFO of Sonic. I'll give a presentation, as usual, and then we'll probably share the questions when we get to that junction.

I'm going to start the presentation on Slide 3, which is headed "Headlines", and I'm pleased to begin the presentation by giving an update on our market guidance, and we're very pleased to say that we are on track to achieve our full year FY 2018 guidance, and that is after 7 months of trading.

Our headline numbers, if I can put it that way, for the half, we achieved revenue growth of 8% and EBITDA growth of 9%, and the group delivered margin expansion of 20 basis points over the period. This result was achieved on fewer working days and in the prior period, and I'll say a little bit more about that in one of the later slides.

You'll also notice in this result an unusual feature, which we want to draw everyone's attention to, and that unusual feature is seen in our statutory results and it's a one-off net tax benefit of $20 million. This is a noncash benefit of $20 million, which shows up in net profit and EPS lines, and it represents a revaluation of a deferred tax liability flowing from the corporate tax reforms recently enacted in the U.S.A.

In terms of our growth, moving on to the next bullet point, our result shows a healthy mix of solid organic growth but also accretive acquisitions and joint ventures. During the period, we completed the acquisition of Medical Laboratory Bremen in Germany and also completed a joint venture arrangement in New York with NYU, New York University, that commenced in the period as well.

And looking to the future, we have an active pipeline of further acquisition and JV opportunities in train.

In terms of our dividend, the interim dividend increased by $0.01 or 3%, and this does continue our very long-standing progressive dividend policy, which has now been progressive or non-retrogressive for something like 24 or 25 years.

So just giving a summary at the start of this presentation. When we look at the overall picture, Sonic Healthcare is in fairly good shape and very well positioned for ongoing growth and to compete in a modern and changing global health care environment. When we say we have a strong or solid base for future growth, we back that up by that final bullet point on this slide and it's probably in the correct order. We have a very strong culture in Sonic Healthcare, which is very much based around our unique model, a model that we term Medical Leadership. We're very fortunate to have an outstanding global leadership team; and in fact, I'd like to take this opportunity to acknowledge them and even thank them here because I know that many have dialed in to this call from right around the world, some even at crazy hours of the night in Europe.

Our reputation is outstanding. That's been achieved over years, if not decades, of hard work. And we have very modern infrastructure as well, which allows us to provide world's best services and to leverage benefits from our scale. And I guess, we're fortunate to be in an industry which has strong growth dynamics to it, and that includes things like aging of the population, new tests especially in genetics, and also the ongoing focus on preventative medicine.

If we move to Slide 4, and just looking at the table, first of all, you'll notice that we presented these results in statutory form rather than constant currency form. And the reason for that is that there was minimal FX impact over this half. Against the Australian dollar, the slightly weaker U.S. dollar was offset almost entirely by slightly stronger euro over the period. And in fact, I think, the total FX impact for the half was a benefit or tailwind of around $700,000 at the revenue line. So it's less than $1 million on the $2.673 billion for the half.

So looking at the table in statutory form, we present the actual numbers: revenue, $2.673 billion, which is 8% growth; and the EBITDA number of $445 million. And then, we've presented both net profit numbers and EPS numbers to show what's going to be reported, including the one-off tax benefit which shows 16% net profit growth and 15% EPS growth. But in effect, our underlying growth is 10 -- it's 10% less than that. So really it's 6% net profit growth, if you take out that one-off tax benefit; and 5% EPS growth, if you take out the benefit as well.

Now just a few comments about the working days. We don't want to make too much of a deal about this, but it was quite significant on this particular occasion. So you'll see in Germany, we had 3 fewer working days; in Switzerland, 2; and everywhere else, 1 less working day in the period. It is quite significant, and if you quantify it, it works out to about a 1.3% difference at the revenue line. So with equal working days, if we normalize it out, revenue would have been $31 million higher. So we would have got to whatever $31 million on $2.673 billion is. We -- our earnings and margins would have been higher too. We haven't quantified that at all because it's obviously going to depend on how much of that $31 million flow through to the bottom line. But it does give an indication that the numbers representing here, the 6% net profit growth and 5% EPS growth, would have been higher had the working days been equal.

Moving on to the next bullet point, the revenue and earnings growth. Our organic revenue growth for the period is approximately 5%. We've -- say, constant currency there and normalized for working days. However, our growth was further enhanced to get up to that 8% by accretive acquisitions and joint ventures. And the group margin accretion was approximately 20 basis points for the period.

The laboratory division achieved strong margin accretion when you normalize for working days. And just a couple of points on that U.S. tax benefit, which I think I've covered already, this is a revaluation of a net deferred tax liability, bringing it down from the 35% to the 21% tax rate recently announced and it's importantly noncash and one-off.

Moving on to the next slide, which covers our guidance. Just as a recap, in August of last year at our full year results for FY '17, the guidance that we gave at that time was 6% to 8% growth on our underlying FY 2017 EBITDA number of $889 million at constant currency levels, and we said at the time that no regulatory changes were assumed. Our guidance has not changed at all since that period and we are maintaining the guidance of 6% to 8% EBITDA growth, despite the regulatory changes that have been announced in both the U.S. and Germany. So really what we're saying here is that we're not altering our guidance as a result of these fee changes, nor in fact are we guiding to either the upper or lower ends of our guidance range. So in other words, we believe that the fairly strong momentum that's currently present in the company is sufficient to mitigate the impacts of both the fee changes in the U.S. and Germany.

The following 3 major bullet points are a repeat of the guidance that we announced in August last year. Just, I guess, to point out again, the bottom line of that CapEx. We certainly expect our CapEx to be significantly lower this financial year as we tail off a fairly substantial infrastructure spend over the last few years.

Moving on to Slide 6, where we talk about our dividend. As I mentioned earlier, the board has ratified a $0.01 increase to the interim dividend, which is 3.2% higher than the previous period. As we have done over the recent past, a dividend reinvestment plan will operate for the interim dividend. We use this, as we have said before, to fine-tune our capital structure, particularly in light of acquisitions that we have made over the period and, I guess, as a general prudent approach to debt management. As before, this DRP will not be underwritten.

Moving on to Slide 7, which is the pie chart of our revenue presented in statutory form here. There's very little change in this pie compared to 1 year ago. I guess the one small change that's occurred is that the Germany segment has increased slightly. That's due to the strong growth in Germany, which included a number of acquisitions and a little bit of FX tailwind versus the U.S. where there was a little bit of FX headwind. Obviously, the whole pie has expanded with our revenue growth as well. But essentially, it's very similar to a year ago, the breakup.

Moving on to Slide 8, a little bit about Australian Pathology. We achieved 5% organic revenue growth in our Australian laboratory division. Earnings growth was strong with margin accretion ongoing. As we've mentioned before, the collection center cost issue, which has dogged not just Sonic Healthcare but the whole industry for the past years, seems to have stabilized and, I guess as a result of that, we are back to, I guess, our legacy benefit of achieving margin -- marginal accretion on a very healthy and widespread infrastructure around the country. So we can look forward to, I guess, ongoing strong organic growth, earnings growth and margin accretion in this division going forward, and it's an important one given that this is our largest division across the group.

Just wanted to update the market on the National Bowel Cancer Screening contract. This was launched officially on the 2nd of January this year and already volumes are ramping up very strongly. This is a very complex project, which we've put together expertly, if I could say so myself on behalf of our whole team. Complex because it combines logistics, laboratory testing and a lot of IT input as well. We're currently sending out something like 10,000 kits per day to participants around Australia and test volumes are ramping up already at about 4,000 tests per day, hopefully going to 5,000 and even 6,000 and possibly even higher tests per day. That's the receipts that we get from those 10,000 we send out each day.

And just a summary on the Australian Pathology or our laboratory division, it's performing extremely well and we can look forward to ongoing strong performance going forward.

Slide 9 deals with our division in Germany. Revenue growth for the period was 20%, organic growth for the period was 4% when we normalize for working days. Acquisitions occurred during the period. The Staber Laboratory Group was acquired before this period, but very much influences the period in terms of revenue. And there's a lot of activity around the Staber acquisition with what -- the first of a series of internal mergers already completed and the next ones are about to happen as well. Medical Laboratory Bremen was acquired in July of 2017, so at the start of the period, and the integration of this lab into Sonic Healthcare Germany is well underway already. And we do have an active pipeline of further acquisitions in train in Germany.

I'd like to say a few words about the regulatory changes in Germany. We can now confirm that changes are going to occur to the EBM, that's the statutory insurance fees from the 1st of April of this year.

Essentially, changes to the EBM fees have been in discussion now for quite a long time. So for us, they were not unexpected. It's essentially a roughly 2.5% reduction in the EBM fees themselves, and EBM fees represent about 40% of our revenues in Germany.

I guess, if you look at this from the payer's point of view, the intention is to apply a gentle break to what is strong underlying and ongoing growth in the lab industry in Germany.

So I guess, we can look at this in a positive light in a sense that this small fee adjustment wouldn't occur had there not been strong underlying growth of the industry. And I guess, as a general comment, fee adjustments like this have been part and parcel of the lab industry over many years. We're certainly used to them and in Sonic Healthcare we have the scale and we have the capacity to absorb them, and I guess, even to use them to our advantage in terms of the ongoing consolidation that they push forward.

So just quantifying the impact for FY 2018. It's going to be an effect of less than 0.4% on total German revenues for the year. Already, we have strategies in place to mitigate the earnings impact. And just a comment, because we do get asked about the other fee structure, which is the private fee schedule, we do not anticipate any changes to these in the medium term.

Moving on to the U.S.A. Revenue growth was 4.4% for the period, with organic growth at around 2% when we normalize for working days and the 2 hurricanes that occurred during the period, that's Harvey and Irma.

We're very active in the hospital lab joint venture space and 3 of these JVs are now operating successfully for Sonic, the latest of which is the NYU, New York University Hospital joint venture, which commenced during the period in October. We have a pipeline of further hospital JVs coming up into the future as well.

Again, we need to talk about the regulatory situation in the U.S. We have spoken before about the PAMA fee cuts. PAMA stands for Protecting Access to Medicare Act. These have now come into being after several postponements. The commencement date is 1 January of this year. It's important to note that the PAMA changes affect only U.S. Medicare fees, which represent about 20% of Sonic's total revenues. The impact for 2018 on our total revenues we estimate to be about $3 million to $4 million. And like in Germany, we have strategies to mitigate the earnings impact of these fee cuts. I guess, it's very important to know that there is a major industry lawsuit against these changes in train at the moment. This is a lawsuit which is being driven by the largest industry association, ACLA, and we expect the outcome of this litigation around the middle of calendar 2018. If the lawsuit is unsuccessful, one of the, I guess, effects of the PAMA fee cuts will be further consolidation of the industry given that many of the smaller labs have much larger exposure to Medicare fees than our 20%.

Moving on to slide 11, which is Switzerland. Revenue growth of 3% organic, and if you normalize for that working day difference it'll be 5% organic revenue growth. The operations are strong. We completed a small acquisition in Zurich in January, about CHF 3 million in revenue, a small anatomical pathology business that's been completely folded into our business in Zurich called Medica. The regulatory environment in Switzerland is stable and, I guess, I could make a summary statement about Switzerland that our operations are performing exceptionally well.

Slide 12, U.K. and Ireland. 5% organic revenue growth, 6% organic revenue growth if we normalize for the working days. Our operations in the U.K. is stable. We've now fully relocated to the Halo Building that was completed during the period, and we're now at full operational strength in this new location. I do need to keep saying that this is a magnificent facility, an ultramodern lab. We're using cutting-edge equipment and technologies, including Sonic's own in-house total lab automation track system known as GLP Systems. I could say that this is arguably the finest lab in the U.K. and something that we're very, very proud of.

During the period, we've added another NHS hospital contract to our joint venture with UCLH and the Royal Free and that commenced successfully in October 27. This is 2 hospitals, Barnet and Chase Farm, and this addition will add about GBP 12 million in annual revenues to our joint venture. And I can also say that there is an active pipeline of further contract opportunities ahead.

Just briefly about Belgium on page -- Slide 13. 6% revenue growth and 7% if we correct for working days. We have set up in-house our noninvasive prenatal testing. That, together with other initiatives, are driving this strong growth for the period. We're focusing on efficiencies and integrating some of the small acquisitions we've made in the Flemish part of Belgium in the last year or 2. And as far as the regulatory environment goes, we've actually had a fee increase, a small one, which commenced this calendar year. And it's approximately 1% of our total revenues and this was an indexation fee increase. But the outlook is stable, looking forward.

Moving on to Sonic Imaging, Slide 14. Strong organic growth in this division, 9% if we normalize for working days, 8% without, and earnings growth is strong as well. In terms of the operations, we are seeing benefits now flowing from the investments that we've made in equipment and greenfield sites over the past years. And we're certainly leveraging these to drive efficiencies. We're working on cost control. And I think we're very lucky to have a very strong and stable team of radiologists, managers and staff. As far as the regulatory environment goes, I'd say that it is stable to positive. The government is looking to implement partial fee indexation for radiology testing from 2020. We're working with the industry association to try and bring that date forward. And I guess, a summary about Sonic Imaging is that the division is performing exceptionally well.

Moving on to Sonic Clinical Services, which is the last of the divisions, and I'll cover this on Slide 15. Just a reminder that SCS is an amalgam of IPN, our medical Center business and Sonic HealthPlus, which is our national occupational health business. We are the largest primary care operator in Australia and the largest occupational health provider as well. We currently have 233 medical centers and 2,260 GPs working our medical centers right around the country. We achieved 3% revenue growth for the period, 4% if you normalize for working days. Earnings growth was moderate for the period. If we look at operations, our doctor recruitment and retention is successful, as it has been in the past, and that is continuing we're pleased to say. And we're also in the process of, I guess, measured rationalization of our centers to enhance efficiencies. And in fact, if you compare those numbers at the top to 6 months ago, our medical center numbers have decreased by 3 whilst our GP numbers have increased by about 60. So that's a healthy trend and we will continue along those lines. The regulatory outlook is relatively stable, if not stable to positive. The government is implementing fee indexation progressively for GP services over the coming years. I guess, just a final point, on SCS, we now have a strong and stable management team in place, headed up by a relatively new CEO, Dr. Ged Foley. And I have to say that the services that are delivered by both IPN and Sonic HealthPlus are quite amazing and certainly very impressive, and we see the future for SCS as being pretty bright.

Slide 16 is our slide on capital management with numbers for your information. Just, I guess, a couple of points. The total debt has increased slightly due to acquisitions and exchange rate changes, which have been partly offset by strong operating cash flow. Something just to announce that in October during the period, we refinanced a EUR 160 million tranche of our debt with 7- and 15-year tenor periods at 2% fixed rates, which is something very pleasing to achieve, such long-term money at such low fixed rates. And I guess, for information, our current total weighted pretax cost of debt sits at around 2.5%. We have $650 million in headroom before payment of the interim dividend.

Moving on to the final slide. Just repeating that we are on track to achieve our full year guidance after 7 months of trading. When we're looking ahead -- when we look ahead at the long term, we certainly do expect organic revenue growth to sit at around our long-term historical trend of around 5%. That growth is underpinned by industry drivers and well-established Sonic Healthcare brands.

Bolstering that underlying organic growth, we do have an active pipeline of opportunities, that's acquisitions, contracts and joint ventures. These opportunities are being created over the long term and they come about as a result of confidence generated in Sonic Healthcare and in Sonic's culture, in our quality, and I guess, in our excellent reputation as well.

We make the point that the CapEx that we spend on infrastructure is put to good use in the company because not only does it allow us to deliver state-of-the-art services but it also drives revenue and earnings growth.

We're now operating in 8 countries in the world and on 3 continents, and we are always keen to make the point that our geographical diversification does give us protection against, I guess, any sort of regulatory change in one particular market. So it's very much a risk mitigation strategy and gives us opportunities for growth as well.

I've mentioned before that our progressive dividend policy is set to continue. That policy is supported by consistent earnings, strong cash flow as well.

Integral to Sonic Healthcare is our ongoing commitment to corporate responsibility principles and we really want to shout out to the team that put the document together, which really outlines what actually goes on in the company and details of that document can be found on our website under our Corporate Responsibility report.

And I guess finally, and possibly most importantly, the outlook for Sonic as a highly respected global health care company remains pretty positive. And I say that because of a number of factors, but most particularly about our deeply embedded Medical Leadership culture, which serves to bind our global team, which is now sitting at 34,000 people, and it also gives us critical market differentiation.

Thank you very much, Drei. Maybe we'll move on to question time now, if that's all right with you.

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Questions and Answers

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Operator [1]

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Our first question, from David Stanton, CLSA.

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David Andrew Stanton, CLSA Limited, Research Division - Former Research Analyst [2]

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Usually within the presentation, we do get a comment regarding Australian Pathology margins. I know that it's not in there this time, perhaps you could give us some color on where the margins have increased or decreased in the half on PCP.

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Original post:
Edited Transcript of SHL.AX earnings conference call or presentation 14-Feb-18 11:00pm GMT - Yahoo Finance

SYDNEY: A positive outcome of the coronavirus disease 2019 (Covid-19) pandemic could be a better understanding of protecting biodiversity and a global ban on the trade in wild animals for food. The belief that Covid-19 began at a wet market in Wuhan in China, where wild animals were being sold for human consumption, has led to the Chinese government banning the trade in wild animals and a growing international campaign for this to be made into an enforceable international law.

At the Wuhan wet market and in many such markets across China and Vietnam as well, numerous wild animals, including live wolf pups, salamanders, crocodiles, scorpions, rats, squirrels, foxes, civets and turtles are being sold for human consumption.

Wet market in Indonesia. IDN PHOTO

The international medias use of the phrase wet markets, however, is dangerous because such markets exist right across Asia, including squeaky clean Singapore, where wild animals are not sold. Farmed animals, fish and vegetables are sold at these markets and they are named as such because the vendors wash the market stalls every morning for hygienic reasons before the food items are displayed for sale.

Such markets are where the poorer segments of the society come to do their daily shopping because of the low overheads, the food there is less expensive than in supermarkets and often fresher. The International Institute of Environment and Development argued in a recent blog post that rather than pointing fingers at wet markets, we should be looking at the burgeoning trade in wild animals. It is wild animals rather than farmed animals that are the natural hosts of many viruses, state Eric Fvre and Cecilia Tacoli in their blog.

The legal and illegal trade of wildlife for human consumption is a multibillion-dollar industry and recognized as one of the most severe threats to biodiversity. Even before the Covid-19 outbreak, ecologists and virologists had warned about the dangers of destroying biodiversity and the advent of new viruses as humans interact more directly with wild animals by destroying forests for development such as building roads and railways, expanding farmlands and human habitats.

In 2008, a team of researchers from the school of ecology and biodiversity from the University College London identified 335 diseases that emerged between 1960 and 2004, at least 60 percent of which came from animals.

Almost every global pandemic that has occurred in the past three decades were caused by pathogens crossing from animals to humans. Among them are the 1996 Ebola, 2003 severe acute respiratory syndrome or SARS, 2012 Middle East respiratory syndrome or MERS, and 2013 Avian Flu outbreaks in all the virus transmission went from animals or birds to humans.

On February 2, the most powerful arm of the Chinese Community Party, the Politburo Standing Committee headed by President Xi Jinping issued a statement banning the sale of wild animals for human consumptions across China.

We must strengthen market supervision, resolutely ban and severely crack down on illegal wildlife markets and trade, and control major public health risks from the source, the statement said. But recent reports in the international media of some of those wild animals markets reopening have raised concern about the Chinese governments resolve to implement the order.

Meanwhile, an international campaign is gathering steam to ban wild animal markets. A United States-based organization that promotes plant-based, preventative medicine called Physicians Committee for Responsible Medicine, which has a membership of 12,000 physicians, has begun a petition asking both the US government and World Health Organization to ban wild animal markets.

The petition has been signed by 225 physicians, including Eric J. Brandt, cardiologist and lipidologist at Yale University School of Medicine, and Michelle L. ODonoghue, a professor at Harvard Medical School, according to Livekindly Media, an American Vegan-promoting news site.

The petitioners point out that live animal markets arent exclusive to China. They are located around the world, including in Europe and the US. Live animal markets are a welcome mat to coronaviruses, the doctors state in the petition. The failure to close a single live animal market in China led to a pandemic that has closed countless businesses worldwide and led to an enormous death toll and economic havoc.

According to The Guardian of London, Elizabeth Maruma Mrema, the acting executive secretary of the United Nations Convention on Biological Diversity, has also called for a global ban on wildlife markets to prevent future pandemics, but she has cautioned against unintended consequences.

We should also remember you have communities, particularly from low-income rural areas, particularly in Africa, which are dependent on wild animals to sustain the livelihoods of millions of people, she told The Guardian. So, unless we get alternatives for these communities, there might be a danger of opening up illegal trade in wild animals we need to look at how we balance that and really close the hole of illegal trade in the future.

In October 2019, an article in the American Science magazine pointed out that there is a widespread trade in wild animals in biological diverse tropics and up to 8,775 species are at the risk of extinction because of this. It called for proactive, rather than reactive, measures to stop this trade.

In the US, Sen. Lindsey Graham is leading calls for China to keep its wild animal markets closed, as the US media claims these are being reopened. Earlier in April, he called on Senate lawmakers to sign on to a letter he sent to the Chinese ambassador to the US urging the immediate closure of these wet markets for the safety of the world at large.

Australian Prime Minister Scott Morrison, in a radio interview on April 3, called for a global crackdown and ban on what he calls Chinese wet markets. His call came after there was widespread coverage in the Australian media of wild animal markets reopening in China after a national two-month long lockdown to eradicate the virus.

If this trade in wild animals for human consumption is going to be halted across the globe, David Quammen, author of Spillover: Animal Infections and the Next Pandemic, argues that we need to look at the broader picture of human behavior and destruction of biodiversity.

We invade tropical forests and other wild landscapes, which harbor so many species of animals and plants and within those creatures, so many unknown viruses, he said in a recent article published by the New York Times.

We cut the trees; we kill the animals or cage them and send them to markets. We disrupt ecosystems, and we shake viruses loose from their natural hosts. When that happens, they need a new host. Often, we are it.

BY KALINGA SENEVIRATNE, IN DEPTH NEWS

Read the rest here:
Covid-19 could lead to better protection of biodiversity and wild animals The Manila Times - The Manila Times

Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19 Credit: US Centers for Disease Control and Prevention.

In mid-January, shortly after the start of the new coronavirus (COVID-19) outbreak, a number of international airports began to announce preventative safety measures. With governments encouraging their citizens not to travel to China, many global airlines have cancelled flights to and from Chinese airports.

Meanwhile, some countries have introduced temperature checks for incoming travellers, to detect signs of coronavirus-related fever. As of 10th March, there have been more than 115,000 cases of COVID-19 across more than 90 countries, and over 4,000 deaths. The majority of cases are concentrated in the Hubei province of China, where the outbreak began. However, the rest of the world remains on high alert, and the travel restrictions look set to continue for the foreseeable future.

Clearly, international travel is a determining factor in the virus spread, and the restrictions will have gone some way towards containing it. Normally the worlds third-largest aviation market, China has seen a tumble in its air traffic, with two thirds of international flights from China cancelled.

However, some of the other measures in place are less obviously beneficial. While airport screening may help reassure the public, there is little to suggest these procedures are actually making a difference.

Entry screening for COVID-19 involves the use of thermal scanning and/or symptom screening, says Jeanine Pommier of the European Centre for Disease Prevention and Control (ECDC). Scientific evidence does not support entry screening as an efficient measure for detecting incoming travellers with infectious diseases.

She adds that is especially the case when it comes to coronavirus, since the symptoms of the disease are so common. After all, the timing of this outbreak coincides with peak flu season in Europe and China.

Thermal screening at airports has long been controversial. Widely implemented during the 2003 SARS epidemic and later during the 2009 bird flu epidemic, the idea is to detect anyone with elevated body temperature and therefore a possible infectious disease.

Methods include full-body infrared scanners (which measure skin temperature as a proxy for core body temperature), handheld infrared thermometers and ear gun thermometers. The latter two instruments were used in West African airports during the 2014 Ebola crisis, as a form of exit screening for those with unexplained febrile illnesses.

Unfortunately, none of these methods have proven entirely accurate. The risk is that they will flag up passengers who have a different type of infection, while missing those who are truly incubating the virus but havent started to show symptoms yet.

Thermal scanning cannot detect every traveller infected with this new coronavirus.

This was certainly the case during the SARS epidemic. While Canada saw 251 cases of SARS, the countrys intensive border screening failed to flag up a single one. Something similar may apply in the case of COVID-19. According to a CNN investigation, the US authorities had screened more than 30,000 passengers by mid-February without catching any cases. (At least four of these passengers later fell ill with coronavirus.)

At the end of January, a study from the London School of Hygiene and Tropical Medicine (which has not been peer-reviewed) sought to quantify the effectiveness of thermal screening. It found that, out of every 100 infected travellers taking a 12-hour flight, 42 would pass through both entry and exit screening undetected.

This is mostly due to the incubation period of the virus, which can be as long as 14 days. An average incubation period of 5.2 days was assumed for this analysis. On top of that, some cases are mild and even at their peak may not show symptoms.

Billy Quilty, the lead study author, said: Our work reinforces that thermal scanning cannot detect every traveller infected with this new coronavirus. Other policies that can decrease the risk of transmission from important infected individuals, such as providing information on rapidly seeking care if symptoms develop, are crucial.

The ECDC has also completed modelling work to assess the effectiveness of entry screening. Approximately 75% of cases from affected Chinese cities would arrive at their destination during the incubation period and thus remain undetected, says Pommier.

Perhaps unsurprisingly, the World Health Organization does not recommend thermal screening, stating on a January 10th release: It is generally considered that entry screening offers little benefit while requiring considerable resources.

The question, then, is what else can be done to help control the spread of the coronavirus. Pommier believes that, at this stage, the best way to reduce the spread of infection is by rapidly identifying and testing any suspect cases, as well as identifying and monitoring anyone who has come into close contact with them.

The population should be made aware of behaviours reducing the risk of transmission, for example self-isolation at home and seeking medical advice, should symptoms develop after exposure to one of the affected areas or a confirmed COVID-19 case, she says.

Quarantining measures are scientifically very effective, since the person is isolated for the entirety of the potential incubation period. The US military has set up 11 quarantine camps next to major airports, which can accommodate up to 250 people each. And a hotel at Heathrow Airport had been block-booked to serve as a potential quarantine zone for people entering the UK with symptoms.

The population should be made aware of behaviours reducing the risk of transmission.

Basic health information is also very useful. In the US, passengers arriving from China receive a card telling them the symptoms to watch out for, and advising them to take their temperature twice a day. It seems this card may already be serving its intended purposes. In one case, a man (who had been asymptomatic at the airport and passed the screening checks) became ill the day after returning home. After consulting the card, he followed the advice to stay at home and contact his local health department.

In the EU, the authorities are being similarly vigilant. Pommier points out that healthcare settings have strong infection control measures in place, which should be sufficient to prevent any sustained local transmission in Europe. These measures have already proven effective in controlling SARS and MERS (which were both also forms of coronavirus).

However, despite airports and health authorities best efforts, some cases of coronavirus may probably slip through the net.

At this stage, it is likely that there will be additional imported cases in Europe, says Pommier. When that happens, we need to ensure that the virus does not spread any further. ECDC is working with the member states to make sure that they are ready to manage imported cases, with laboratories capable of confirming probable cases and hospitals prepared to isolate and treat patients accordingly.

See original here:
Coronavirus screening at airports: the problem with thermal detection - Airport Technology

Dr David Glass - MBChB, FCOG (SA)

This is the last article in the series on Lifestyle Medicine and breast cancer, basically using the book by Dr Kristi Funk as our main resource. As a breast surgeon who is an expert in breast cancer, she deals with much more than just the lifestyle aspects of the disease, and it is beyond the scope of these blogs to go into the medical, surgical and oncological treatments. They all have a definite place. Let me remind you that Lifestyle Medicine is not against proven medical/surgical/oncological therapies. But it does provide a base for the preventative/health promoting environment of your body to enhance health and often prevent a large part of these diseases that affect our bodies in the first place. However if this fails, and we live in a hostile cancer promoting environment, then by all means utilise the resources available to manage these diseases appropriately.

ALSO READ : Turning the Tide Lifestyle Medicine and Breast Cancer (Part 6)

What we will cover in this article is a brief overview of some of the medications that have been shown to protect the body from either developing breast cancer some which were only discovered long after to benefit in this way; or medications that interfere in the progression of breast cancer.

Specific medications for breast cancer inhibition/prevention:

Non-specific medications for breast cancer inhibition:

Hopefully this series on breast cancer has empowered you to study how you can adopt lifestyle changes to prevent this most common cancer amongst women.

There is so much you can do to avoid this disease that has affected so many women you know.

Next week we will begin a short series on one of the most common cancers of men prostate cancer, and explore how lifestyle medicine can prevent, or even in the early stages reverse prostate cancer.

Until then, dont tire of keeping safe in the face of the Covid-19 threat by social distancing, washing hands frequently, using alcohol-containing hand cleanser, avoiding touching your face, eyes or nose unless you have just washed your hands, and now the latest wearing a cloth face mask when in public.

Kind regards,

Dave Glass

Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

Read more:
Turning the Tide Lifestyle Medicine and Breast Cancer (Part 7) - South Coast Herald

With the NHS long term plan for an increased demand in technology, how will this positively impact the levels of service and care that healthcare professionals provide?

IT offers the health system a chance to give patients a higher quality of care and provide services which are quicker, safer and more convenient to access. But, will this digitalisation make it easier for doctors, nurses and clinicians to know what kind of medicine, post-hospital care and other services patients may need?

The positive impact on patient records

Electronic health records, or EHRs, replacing paper records has been a big step for the medical world. A wide range of professionals, from doctors and nurses to technicians, are responsible for updating medical records. With a digital version, this means that every person in charge of a patients care has access to the most up-to-date information, which is especially crucial where allergies and medication are concerned.

How public health is affected

EHRs provide invaluable data to clinical researchers, helping to advance medical knowledge and the development of treatments for common health problems (like viral outbreaks). A digital health system can also provide important insights into how widespread and outbreak is, helping preventative measures, such as vaccines, to be put into place quicker.

The positive impact on patients themselves

This digital first approach helps to empower patients themselves, giving them more control over the type of care they receive. The digitalisation of medical services will allow those who are vulnerable to take a more proactive approach to monitoring their own health and wellbeing.

By use of these digital systems and services, they will be able to recognise and monitor symptoms as early as possible and manage their response to these. This ownership of care will help to reduce the demand on the ever strained health and care services.

What can patients do if problems occur?

In amongst all of the improvements and changes, things can still go wrong. Unfortunately mistakes do happen and when they do, what kind of help can patients and those most vulnerable receive? If medical negligence of any kind has occurred, there are services and businesses out there who will help those affected claim compensation.

Before making a claim however, its important to remember you will need all the facts and be certain there is a claim there to make. Many of these advice services will talk to you about what has happened, and determine the likelihood of your case succeeding.

With these digital advancements and improvements, we would expect to see a decrease in claims needing to be made. Thanks to systems such as EHRs, patient information should be more accurate and up-to-date, allowing healthcare professionals to provide a higher level of care to those in need.

See the rest here:
The positive effects of digitisation in medical services - East Midlands Business Link

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Wear a cloth face mask in public. Thats the national health departments new recommendation as from April 10.

Before this, we were told to absolutely not wear face masks to prevent ourselves from contracting the new coronavirus, known as SARS-CoV-2 unless we were taking care of an infected person.

So why the about-face?

Well, in some ways the argument is still the same: masks wont protect the person wearing one against getting infected with the virus, the department says. But now that SARS-CoV-2 has started to spread locally as opposed to mainly being imported by people who arrived in South Africa from high-risk countries there is an increasing risk that you could be infected without knowing it and, as a result, spread the virus to others when you cough or talk.

A mask, research in the journal Nature has shown, makes people less likely to release droplets of spit carrying the virus into the air that can infect others.

In short, the new recommendation to wear masks is a sort of a last resort. Because we live in a country where many people arent able to practice social distancing or wash their hands the two main ways to prevent the spread of the virus masks can add another layer of protection.

The health department doesnt want us to wear surgical masks (the ones you can buy in chemists), as health workers need them and theres a global shortage.

Rather, you should make a cloth one, which you can wash after each use.

Research on medical mask use in communities is inconclusive. When it comes to cloth masks, there is even less evidence to show whether they work or not.

With the research so unclear, it comes down to individual countries around the world to decide whats best for them.

On the health departments coronavirus website, it says:

Cloth masks are easy and not expensive to make, reusable and help reduce the transmission of COVID-19 by acting like a shield to contain the respiratory droplets through which the virus spreads.

Heres what the science can tell us:

Earlier this month, the Nature study found surgical masks helped stop people with symptoms from spreading influenza and other coronaviruses similar to SARS-Cov-2. But the research did not look at fabric masks.

The first randomised trial studying cloth mask use (by healthcare workers) was published in the BMJ Open in 2015. The study, set in Vietnam, cautioned against the use of these masks because they led to more infections than in those wearing medical masks.

Fabric masks were more likely to stay wet and hold moisture, plus they didnt filter out as many infectious particles as medical masks and were reused this, the studys researchers argued, all led to increased infections.

But, a 2008 study published in PLoS One, compared cloth masks to surgical masks as well as respirators, or special masks worn by healthcare workers that can filter very small particles. The research found that all three types of masks offered varying degrees of protection to the wearers in human volunteers. In laboratory simulations, the study also showed all three conferred a slightly lesser degree of protection to those around the wearer.

In 2013, research in Disaster Medicine and Public Health Preparedness compared the effectiveness of homemade cloth masks to surgical masks to protect people from the flu. The study found that both masks worked to reduce the spread of particles exhaled by wearers. But surgical masks were three times better at protecting the wearer from the flu virus than self-made fabric masks and scientists recommended that a homemade mask should only be considered as a last resort.

So why should cloth masks be considered at all?

Kerin Begg is a public health specialist at Stellenbosch University and helped draft the Colleges of Medicines in South Africa guidance on the use of cloth face masks that informed the Western Cape health departments policy.

The Colleges of Medicines in South Africa is an oversight body that sets the standard for medical specialisations in the country.

After reviewing the existing research, the Colleges found the evidence too uncertain to make a clearcut recommendation for community use of cloth masks nationally. In spite of this, on 2 April the Western Cape decided to recommend that everyone, including those who were not ill, start wearing masks.

The best time to use face masks would be a bit later [in the outbreak] when the prevalence rates are much higher, Begg says.

She believes it would have been wiser to only have recommended fabric masks once there was widespread community transmission of the virus, with around 10 000 cases, because then there would be more risk to the general public of getting infected by close contacts.

On Tuesday night, South Africa had a total of 2 415 confirmed COVID-19 cases less than a quarter of 10 000.

Why then, the push for cloth masks?

I think people want some sort of visual sign, explains Begg, who herself has been hounded by people wanting a conclusive recommendation that they should wear masks.

It helps people feel better, it reduces anxiety. But I think it may create a false sense of security and that was part of our concern.

Once people wear masks all the time, says Begg, they might drop other preventative steps, such as handwashing. There is also a good chance that people will wear the masks incorrectly and render them pointless. She says incorrect usage can range anywhere from people who touch their face more to adjust the mask to people who put the mask under their chin when it gets uncomfortable.

To Begg, the thought process from a policy standpoint is: If thats [cloth masks] the only thing that can help us, then maybe we just kind of try it anyway.

The most basic steps people should be taking washing hands, maintaining distance from others and good hygiene are not things that can be easily carried out by most South Africans.

Almost half the population doesnt have access to water in their own homes, show 2018 Statistics South Africa data and high levels of inequality in the country means that those living in poorer communities will be disproportionately affected by the outbreak.

These are people that might not be able to practice social distancing or wash their hands regularly.

Although the government has delivered over 6 000 water tanks to those who need them, people living in these communities need a variety of options for how to protect themselves.

The solution: Add cloth masks as another option.

If we were living in a perfect world where we had really great social isolation and physical distancing and we didnt need to use public transport and all of that, I might also go for a higher standard of evidence, says Max Price, former vice-chancellor at the University of Cape Town and part of the ministerial advisory committee on COVID-19.

But given that we dont have that and that people are close together, we should just use whatever we have.

For Price, the debate is not about whether or not cloth masks work, but rather whether the general public should wear masks to reduce infection. The answer to which he believes is a resounding yes.

The fact that we dont have evidence that it works, doesnt mean that we have evidence that it doesnt work, Price reasons. If laboratory evidence suggests that it could work, then we should just use everything we can.

The impact that general use of medical masks would have on the healthcare sector has already been noted, but there is another drawback that has perhaps been overlooked.

The reality is that even if there were enough medical masks for health workers, recommending their use to the public would still disadvantage some people. If youre telling people to wear masks, you need to be sure that everyone has access to one and this, likely, wouldnt have been possible.

But thats the beauty of homemade masks, says Price.

Currently, there is no standard and everyone can make one depending on what they have access to at home.

The only guidelines set out by the national health department are:

Additionally, the department says you should not lower or remove your mask when talking, coughing or sneezing. Do not touch your mask when it is on your face and never touch the inside of the mask. Wash your hands before putting the mask on and after removing it.

Its important not to set the bar so high that people cant meet it, Price explains. The message should be: Use anything that you can to catch droplets and also to prevent yourself from breathing in droplets.

The thicker the better, the tighter the fit the better and there are some designs that may be better than others, but use what works for you. And if what youve got is a scarf or a towel to cut up or a bandana, then thats good.

Previously, the governments recommendation was that only people who have symptoms of COVID-19 should wear a mask, but new evidence has shown that people might be able to transmit the virus even though they show no symptoms of the disease.

According to the World Health Organisations head of emerging diseases Maria Van Kerkhove, the team that collected data on Chinas COVID-19 outbreak found that 75% of people developed symptoms after being classed as asymptomatic. A recent study by the US Centers for Disease Control and Prevention showed similar results at a nursing home where almost half of the 23 positive patients didnt have symptoms at the time of testing.

Price concludes: Now that we take the view that most people are infectious without knowing it and they cant quarantine, we need to find some other method of adding to the physical isolation or physical distancing and masks can be the way of doing that.

Follow this link:
'Everyone should wear a cloth mask.' But do they work? - Bhekisisa

Important update: the photomedicine patent reported on here was mistakenly assigned to Apple. Inventor Dan Anderson has filed the US Patent office for a correction.

Thanks to Dan Anderson for contacting AppleInsider with copies of his correction paperwork. We are leaving the rest of the original story here as it has been widely circulated and so links back to this piece will now show the correction. For completeness, the newly corrected assignee is Topcon Medical Laser Systems Inc.

This isn't something you're going to see added to the Apple Pencil. It's not something Tim Cook is likely to announce at some future WWDC alongside an ARM Mac. But Apple's widespread, wide-scale work on health now includes research into areas more associated with hospital equipment than iPhones.

"Area scanning photomedicine device and method," US Patent No 10,617,564, is a detailed patent application which covers an extremely broad range of medical issues but chiefly does so with one purpose.

"[It is a] system and method for treating a lesion on target tissue," says the patent.

Currently, so-called superficial lesions "[meaning that] the lesion is on or near the surface of target tissue" can be treated using light. The patent lists countless applications including, for instance, photodynamic therapy (PDT) which, typically in combination with a light-sensitive drug, uses a light source to destroy cancer cells.

Light is also used in, for example, "gynecology, gastroenterology, and thoracic surgery," and Apple notes that this is far from an exhaustive list. However, Apple also notes that "although the details of the approaches vary due to the anatomical differences presented, the fundamental underpinnings are the same." And it's these underpinnings that Apple wants to address with this patent.

"[Currently] one must provide treatment light to the targeted lesion," says the patent. "To date, this has been done primarily with broad-brush application of light to the lesion and its surrounding tissue. While this has the advantage of being straightforward, it also limits the ultimate clinical efficacy by increasing the side effect profile."

In other words, the "therapies are not sufficiently site-selective," and this is a problem because the "irradiation of adjacent tissue causes more damage than is necessary." What Apple is ultimately proposing is a new system of much finer accuracy when aiming and using light treatments on lesions.

"The present invention solves the aforementioned problems by providing a multipurpose system for performing a variety of photomedical procedures that is based on contiguous scanning of a continuous wave (cw) or quasi-cw light source," claims the patent.

Apple's plan is for a device that combines different systems. It starts with a "visualization device" for "capturing an image of target tissue containing a lesion." Then when that image is acquired, it has a targeting system that combines a light source, a scanner device that can aim that light, and an overall controller.

The Apple device first captures an image that can show precisely where the boundaries of the lesion extend. Then it projects "treatment pattern onto the target tissue."

Most of the patent application's drawings are either examples of lesion patterns, or block diagrams of the combination of light source and controllers. There's no sketch of a doctor wielding an iPhone. If Apple's patent results in new hardware, it's going to be hospital-grade machinery rather than something that'll be featured in a Today at Apple store demo.

The invention is credited to Dan Anderson and David Mordaunt, each of whom have more than sixty prior patents, the majority of which are in related fields such as Anderson's "System and method for determining dosimetry in ophthalmic photomedicine," or Mordaunt's "Photomedical treatment system and method with a virtual aiming device."

Updated: 15:35 ET with new information from inventor Dan Anderson

See the original post here:
Apple investigating expansion into major health hardware [u] - AppleInsider

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Opthalmology Pacs Market 2020 Global Share, Growth, Size, Opportunities, Trends, Regional Overview, Leading Company Analysis, And Key Country Forecast...

Israeli-based Pluristem has treated its first American patient suffering from COVID-19 complications under the countrys compassionate use program.The news comes days after a report by the company showed that six critically ill coronavirus patients in Israel who are considered high-risk for mortality were treated with Pluristems placenta-based cell-therapy product and survived, according to preliminary data provided by the Haifa-based company.In the US case, the patient was treated with the companys PLX cell therapy at Holy Name Medical Center in New Jersey, where Pluristem is already running a Phase III critical limb ischemia study. Like the patients treated in Israel, this patient was critically ill with respiratory failure due to acute respiratory distress syndrome and was intubated in an intensive care unit for three weeks.The companys president and CEO, Yaky Yanay, said that although Pluristem is focused on a planned multinational clinical trial for the treatment of complications associated with coronavirus, it does hope to expand treatment under compassionate use in other countries at the same time.

Specifically, the US treatment was administered under the US Food and Drug Administrations Single Patient Expanded Access Program, which is part of the US Coronavirus Treatment Acceleration Program - an emergency program aimed at getting treatments to corona patients as quickly as possible.

In Israel, the six patients were treated at three different Israeli medical centers for one week, also under a compassionate use program. They were suffering from acute respiratory failure and inflammatory complications associated with COVID-19. Four of the six patients also demonstrated failure of other organ systems, including cardiovascular and kidney failure.

Pluristems PLX cells are allogeneic mesenchymal-like cells that have immunomodulatory properties, meaning they induce the immune systems natural regulatory T cells and M2 macrophages, the company explained in a previous release. The result could be the reversal of dangerous overactivation of the immune system. This would likely reduce the fatal symptoms of pneumonia and pneumonitis (general inflammation of lung tissue).

Previous preclinical findings regarding PLX cells revealed significant therapeutic effects in animal studies of pulmonary hypertension, lung fibrosis, acute kidney injury and gastrointestinal injury.

We are pleased with this initial outcome of the compassionate use program and committed to harnessing PLX cells for the benefit of patients and healthcare systems, Yanay said.

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Israeli COVID-19 treatment with 100% survival rate tested on US patient - The Jerusalem Post

After an active Sunday, cooler and quieter temperatures are expected for much of the week ahead. In fact, thermometers could dip into the 40s a few mornings!

Sunday Storm Report: An outbreak of severe weather did indeed occur across the Gulf South on Sunday. The local area was largely spared as the outlook and atmosphere changed for the better in the local area. This change was identified and broadcast by the WBRZ Weather Team on Sunday morninga reminder that it is important to stay in touch with the forecast as events near because changes can and do occur; in this case, it was good news. Still there were a few severe weather reports, including damaging wind gusts in Springfield and large hail in Hammond. Several large, violent tornadoes ripped through southeast Mississippi.

THE FORECAST:

Today and Tonight: Drier and cooler air will continue moving into the local area, allowing clouds to rapidly diminish through the morning hours. This will lead to sunny skies into the afternoon with high temperatures peaking near to 76 degrees. Remaining all clear overnight, light northeast winds will guide low temperatures down to 53 degrees.

Up Next: Through much of the week, highs will stay near normal in the mid-to-upper 70s. A rebounding weak warm front will attempt to push onshore Tuesday, which could bring some spotty afternoonshowers into the mix between during the late afternoon and overnight hours. The best chance of finding a shower will be in coastal areas. Once this front kicks to the south, continued cool temperatures could result in a pair of overnight lows in the upper 40s. Showers are set to return closer to the weekend. These will be associated with a frontal systemthat should bring isolated afternoon storms on Saturday that become more scattered in nature by Sunday.

The Mississippi River: At Baton Rouge, major flood stage continues with a level of 42.8 as of Monday morning. The river is expected to fall very slowly through the next two weeks. The high water is primarily an issue for river traffic and river islands, although some inundation will continue for a few spots north and south of Baton Rouge that are not protected by levees. Unprotected low-lying areas will be flooded and agricultural operations will be impacted on the west side of the river. The grounds of the older part of Louisiana State University's campus become soggy. This includes the area around the Veterinary Medicine building, the Veterinary Medicine Annex, the stadium and ball fields. The city of Baton Rouge and the main LSU campus are protected by levees at this level. The level is also high in New Orleans and the U.S. Army Corps of Engineers has opened the Bonnet Carre Spillway.

THE EXPLANATION:

The front associated with Sundays active weather will stall in the Gulf of Mexico on Monday, retreating slightly north on Tuesday. The may serve as a focus for a few showers to develop on Tuesday afternoon through the overnight hoursespecially along the coast. A kicker front will flush this moisture south by Wednesday and the cooler air mass will become entrenched a little farther south. As a result, the coolest period of the week is expected Wednesday morning through Thursday afternoon with lows in the upper 40s and highs in the low 70s. The next frontal system will organize across the Lower Midwest and begin ton affect the local area by Friday. A slow moving warm front could provide isolated showers on Friday and Saturday and the trailing cold front will result in a better chance for showers and a few thunderstorms by Sunday.

--Josh

The WBRZ Weather Team is here for you, on every platform. Your weather updates can be found on News 2, wbrz.com, and the WBRZ WX App. on Apple and Android devices. Follow WBRZ Weather on Facebook and Twitter for even more weather updates while you are on the go.

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Below average temperatures, quieter weather ahead - WBRZ

Press release: Pet Industry Joint Advisory Council

There have been reports of early stage research on the antiparasitic drug ivermectin as a possible treatment for COVID-19.

In animal health, ivermectin is most commonly used as a heartworm preventive in dogs and cats, and well as for treating internal and external parasites in many species.

On behalf of the entire responsible pet care community, we warn the public that they should never use pet care products, or any products, for any purpose other than what the label directs. Products marketed for veterinary use or otherwise not for human consumption should never be ingested or used for self-treatment of COVID-19 or any human medical condition.

The Food and Drug Administration (FDA) Center for Veterinary Medicine has issued a letter to stakeholders warning against humans using ivermectin products intended for animals. FDA is concerned about the health of consumers who may self-medicate by taking ivermectin products intended for animals, thinking they can be a substitute for ivermectin intended for humans. People should never take animal drugs, as the FDA has only evaluated their safety and effectiveness in the particular animal species for which they are labeled. These animal drugs can cause serious harm in people. People should not take any form of ivermectin unless it has been prescribed to them by a licensed health care provider and is obtained through a legitimate source.

FDAs recommendations:

The FDA has established a cross-agency task force dedicated to closely monitoring for fraudulent COVID-19 products that reaches out to major retailers to ask for their help in monitoring online marketplaces. Products that claim to prevent, diagnose, treat, or cure COVID-19 are subject to FDA investigation and potential enforcement action if they have not demonstrated safety and effectiveness for that intended use. The task force has already worked with retailers to remove dozens of these types of product listings online.

Please help us protect public health by alerting FDA of anyone claiming to have a product to prevent or cure COVID-19 and to help safeguard human and animal health by reporting any of these products toFDA-COVID-19-Fraudulent-Products@fda.hhs.govor 1-888-InfoFDA (1-888-463-6332).

The most effective ways to protect yourself and others against COVID-19 are to avoid being exposed to the virus and taking steps to protect yourself as recommended by CDC:

For the latest information and resources about how to protect yourself, your customers, your associates and the animals you care for; mandatory closure orders as they pertain to pet care businesses; and other health and business continuity resources please visitpijac.org/covid19.

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PIJAC Warns About Using Ivermectin to Treat COVID-19 - Pet Age

Immunotherapies have revolutionized treatment for people with a variety of cancers. But when given to those with triple-negative breast cancer (TNBC), a particularly aggressive form of the disease, less than 20% respond.

A big question in the field has been, Why are the rest not responding? says Rumela Chakrabarti, an assistant professor at Penns School of Veterinary Medicine.

In a new paper in Nature Cell Biology, Chakrabarti and colleagues illuminate the molecular details at play. They found a signaling pathway which could be exploited in TNBC patients to better target therapies in the future. Using a mouse model of the disease that mimics key characteristics of human disease, they showed that losing the activity of the protein ELF5 promotes the activity of another protein, interferon-gamma receptor 1. Stabilized Interferon-gamma receptor 1 leads to activated interferon gamma signaling, which in turn leads to increases in tumor aggression and spread, which could be mitigated with therapeutics that block interferon gamma signaling.

This was an eye-opener, says Chakrabarti, because often interferon gamma has a protective effect in cancer and is commonly given as a cancer therapy to some patients. It works well in certain cancer types, but for particular subtypes of triple-negative breast cancer we see that blocking interferon gamma may be the best strategy for patients.

Chakrabarti had a deep familiarity with the biology of the ELF5 protein. She began studying it more than a decade ago as a postdoctoral researcher at the State University of New York at Buffalo, finding that its normal function supported pregnancy and lactation. More recently, in 2012 she and colleagues published a previous report in Nature Cell Biology showing that ELF5 could suppress a key transition that occurs to enable breast cancers to spread.

That earlier work, however, did not focus on TNBC specifically, in part because scientists had lacked an effective mouse model. Over the course of three years, Chakrabartis team developed a preclinical TNBC model that recapitulated two hallmarks of the disease: its propensity to spread and the influx of immune cells that accompanies tumor growth.

In the current study, the researchers found that, when these TNBC mices tumors also lost the function of the ELF5 protein, their disease course resembled that of human patients even more closely. Losing ELF5 made the disease very metastatic and very aggressive, says Chakrabarti.

To elucidate the molecular happenings that resulted in a more dangerous form of TNBC, Chakrabarti and colleagues examined the RNA that was being expressed in tumor cells of the TNBC mice whose tumors lost ELF5 expression. They found increased activity of the interferon-gamma pathway, caused, they believe, by an increase in expression of that proteins receptor. This loss also led to an accumulation of neutrophils, a type of immune cell, which has immune suppressive function. In contrast, normal mammary cells that retained ELF5 had low levels of interferon gamma signaling.

Blocking this signaling using an antibody against the interferon gamma receptor 1, or by genetically manipulating tumor cells to express lower levels of the receptor caused tumors to grow and spread more slowly.

Finally, to determine whether these findings in a mouse model may be relevant to humans, the research team looked at genetic and protein data from patients to determine their level of ELF5 and interferon gamma receptor expression. Patients with lower ELF5 and higher receptor levels, they observed, fared poorer; their cancers tended to spread sooner around their bodies.

The findings, Chakrabarti says, should be considered carefully by clinicians who are using interferon gamma and immunotherapies to treat cancer patients.

This is telling us that we need to target patients more selectively when we treat them, says Chakrabarti. It could be that if someone has low ELF5, they should be given an interferon-gamma signaling blocking therapy in addition to their immunotherapy.

In future work, Chakrabartis group will be diving in deeper into the immunology of TNBC, examining the role that different immune cells are playing in driving cancer metastasis and aggression. They also hope to see whether what they found regarding interferon gamma signaling in TNBC holds true in other tumor types, such as kidney and ovarian cancers.

Rumela Chakrabarti is an assistant professor of biomedical sciences at the University of Pennsylvania School of Veterinary Medicine.

Chakrabartis coauthors on the paper were first author Snahlata Singh, Sushil Kumar, Ratnesh Kumar Srivastava, Ajeya Nandi, Gatha Thacker, Hemma Murali, Sabrina Kim, Mary Baldeon, Mario Andres Blanco, and Serge Fuchs of Penn Vet; John Tobias, Rizwan Saffie, and Luca Busino of Penn s Perelman School of Medicine; Temple Universitys M. Raza Zaidi; and Satrajit Sinha of the State University of New York at Buffalo.

The work was supported by the National Cancer Institute (grants CA193661 and CA237243).

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Tailoring treatment for triple-negative breast cancer - Penn: Office of University Communications

In light of COVID-19 and the associated restrictions on public activity, many people are looking for ways to safely go about their daily lives indoors and online. Luckily, telemedicine supports this goal and allows individuals to ensure their health and the health of their pets, digitally.

Dog laying its head on a keyboardDr. Lori Teller, a clinical associate professor at the Texas A&M College of Veterinary Medicine & Biomedical Sciences, speaks to pet owners about the basics of veterinary telemedicine and how this tool can be especially useful in the midst of a pandemic.

Telemedicine is the exchange of medical information from one location to another using electronic communications to diagnose, treat, or improve a patients health status, Teller said. In most cases, all that an animal owner needs to connect is a smartphone with a working camera, microphone, and chat feature.

A computer or tablet may also be used, provided that it is capable of two-way communication and has internet access. In many cases, a telemedicine appointment will be a real-time, live video and audio exchange.

A veterinarian can evaluate many things via telemedicine, Teller said. The first thing will be to obtain a patients history and determine what the current problem is. If the problem is something that can be visualized, such as a skin lesion or limping, then pictures or videos will be helpful. Behavioral and nutritional problems can often be handled via telemedicine as well.

Telemedicine appointments are most effective when there is an established veterinarian-client-patient relationship (VCPR), as the veterinarian may be able to more accurately make a diagnosis and create a treatment plan. If there is no established VCPR, a veterinarian will still be able to provide general advice. Rules on what the outcome of a telemedicine appointment can be, including the prescription of medications, vary by state.

It is important to note that telemedicine does not replace a physical exam, so there will be times when the veterinarian will tell the client that the patient needs to be seen, Teller said.

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Telemedicine can play a huge role, especially in times of disaster, such as a pandemic or hurricane, in helping a client determine if a trip to the veterinarian is needed and, if so, when is it needed.

If a pet has a life-threatening emergency, difficulty breathing, pale or bluish gums, has ingested a toxic substance or something large enough to cause an obstruction, is unable to urinate or to stand, has increased seizures, is non-responsive, is experiencing difficulty during labor, has vomiting and diarrhea and lethargy, or is experiencing other serious veterinary conditions, they should be brought to a veterinary clinic.

Teller recommends calling ahead of time to let the clinic know youre coming and what the problem appears to be.

Telemedicine is an extremely valuable tool to help provide care for a patient, she said. It is not a substitute for in-person veterinary care that requires a physical exam or diagnostic tests, such as blood work or imaging, but is a way to manage patients in-between visits to the hospital.

During times of disruption, such as the current pandemic, telemedicine can be an excellent way to ensure that your furry friend continues to get the care they need while also following social distancing requirements and staying safely indoors.

Telemedicine is especially valuable during a pandemic because it can be used to help the veterinarian and the client determine if and when the patient needs to be seen in the hospital or if the problem can be managed at home, at least for the short term, Teller said. It also helps conserve PPE (personal protective equipment) and other resources for emergencies and for human health care facilities.

Pet Talk is a service of the College of Veterinary Medicine & Biomedical Sciences, Texas A&M University. Stories can be viewed on the web at vetmed.tamu.edu/news/pet-talk. Suggestions for future topics may be directed to editor@cvm.tamu.edu.

We are making critical coverage of the coronavirus available for free. Please consider subscribing so we can continue to bring you the latest news and information on this developing story.

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PET TALK: Veterinary telemedicine in the age of COVID-19 - New Castle News

Kaitlin Sisk grew up in the town of Erie, Colorado on what she calls a four-acre "family hobby farm." Her mom is a fiber artist, so they had lots of pets including angora rabbits and cashmere goats, and Sisk had her own horse.

Growing up with furry friends helped Sisk focus in on a career path.

"I think it just sort of like fell in my lap," she said. "It just seemed easy to me being around animals and working with them."

The 31-year-old is in her final year of pursuing a Doctor of Veterinary Medicine degree at Colorado State University in Fort Collins. She's studying small animals. In mid-March the veterinary teaching hospital moved all of its classes online.

"That's easy to do for some of those didactic lectures, you know, maybe not as good," said Felix Duerr, a professor who works at the hospital. "If you have a class of a hundred thirty something in front of you, you know, you can do that online as well."

The veterinary medicine program also put medical cases online and created other tools that will be useful to students even after the pandemic ends. This includes conducting daily rounds, where students meet as a group to discuss cases, virtually.

"We would just sit in front of a computer and be like, 'hey, can you point at where you see the abnormality that we're concerned about,''' said Duerr. "Now we just do that online and everybody can do it at the same time."

But the hands-on part of the program is more difficult to duplicate digitally. Take a dog that has lameness, said Duerr. A student can't feel if the knee is warmer or has instability on a computer.

"So that's probably our biggest challenge I would say," he said.

Not only have classes moved online, but the hospital staff is now using telemedicine to treat animals with non-emergency illnesses.

Theresa Wendland is a third-year sports medicine and rehabilitation resident. She uses video to to examine animals and consult with their owners. One of her patients is Oliver, a six-year-old poodle with a torn Achilles tendon.

"I've never done a distance fitting before so I'm going to apologize a little bit here that it might be a little trial and error," Wendland said during the video chat.

Before the statewide stay-at-home order, Oliver was diagnosed in person and a custom brace was ordered for him. But once the hospital closed to non-emergency patients, the brace was shipped to the dog's owner. On the video, Wendland shows her and a friend how to put it on Oliver.

"Move your hand up and give the pad a little squeeze. So that you're squeezing the pad onto his foot. There you go," she said. "Then you're pulling that strap snugly across his foot."

Wendland was a CSU veterinary medicine student and remembers the importance of hands-on clinical rotations. She worries current students are going to miss out on valuable experiences.

"So, we're trying to find ways to teach while also still providing services and help to owners and their pets," Wendland said.

Fourth-year student Kaitlin Sisk is still learning a lot online. She's on a two-week orthopedic rotation and watched Oliver get his brace then walk to make sure the fit was right.

"We still could do like a lot of what they were going to do. It's just it's harder when you can't put your hands on it," said Sisk. "But I think it's still working."

Sisk agrees that it's hard to get clinical hands-on training online. Students watch consults and surgeries remotely and study interactive videos. But Sisk has found a way to get practical experience.

"I think I'm lucky because I have a cat and a dog so I can kind of like go through the video and pause it and palpate my dog and and then keep going," she said. "I think it is like a little bit more active learning, like you have to be motivated to do it."

Overall, remote learning hasn't been too bad for Sisk. Since she can't spend her days in the hospital, she's going outside and exercising more.

Sisk is an extrovert. She worried about being stuck at home and not interacting with the people in her program. But something unexpected happened she feels a lot closer to them now.

"I know that it's kind of weird because you'd think that you wouldn't feel close to them when you're sitting in opposite houses. But like you see their house, you see their animals come up behind them and come say hi," she said. "So, it feels like you get to see a little piece of them and their family, which I think it's something we don't really get at school. We're all business."

Sisk is graduating in May. Then she's planning to move and start a job at an animal hospital in Boulder. But when it comes to mapping out the next couple months, Sisk said, "we'll see what happens."

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Online Courses And Virtual Consults: CSU Vet Teaching Hospital Adapts To Coronavirus - KUNC

Chamberlain University partners with Ascend Learnings ATI Nursing Education business to offer a free course in acute care

As healthcare organizations continue to respond to the COVID-19 pandemic, hospitals and clinics are calling on nurses from all specialties to fill this critical need. To help those practitioners prepare for direct acute patient care, Chamberlain University, in partnership with Ascend Learning, is offering a free online course for all licensed registered nurses.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20200413005115/en/

"As the COVID-19 pandemic sweeps the country, I am in awe of the nursing community as it steps forward in the face of crisis," said Karen Cox, Ph.D., RN, FACHE, FAAN, president of Chamberlain University. "Nurses who havent practiced in acute care recently want to jump in, and hospital leaders want to equip all of their nurses to work on the front lines. As a nurse and an educator, I am honored to assist these healthcare workers in the face of a crisis."

Acute Care Readiness is a review course that is not for academic credit. It covers the knowledge and skills nurses need to help them return to safe clinical practice in acute care settings. These skills include patient assessments, medication administration and complex acute care procedures. Ascend Learning will partner with Chamberlain University to provide online educational expertise.

"As the need and call for more qualified frontline nurses continues to grow, we want to help. We are thankful we can offer free resources to support these courageous and selfless healthcare workers through our ATI Nursing Education solutions as they sharpen their critical care skills and respond to the call to help save lives," said Ascend Learning CEO, Greg Sebasky.

Licensed RNs who may have been working in ambulatory care, long-term care or in non-acute care roles as advanced practice registered nurses (APRNs) would benefit from this course. To learn more about the Acute Care Readiness course, contact Chamberlain Universitys director of professional development at CFE@chamberlain.edu.

This partnership responds to the demand for acute care skills in the U.S. at scale in a manner that can be impactful. This is aligned with Chamberlain Universitys parent company, Adtalem Global Education, in its mission to provide workforce solutions and make positive contributions to the global healthcare community. According to the U.S. Department of Educations most recently published data, Adtalem, through its affiliated schools of Chamberlain University, American University of the Caribbean School of Medicine and Ross University School of Medicine, educates and graduates more doctors and nursing professionals than any other individual school in the U.S. Ascend Learnings ATI Nursing Education business is a leading provider of online instruction for nursing schools across the United States with 98% of nurse educators naming it a leader in the nursing education industry and 93% claiming ATIs solutions improved their students ability to perform as a new nurse, according to a 2019 research solutions survey.

About Chamberlain University

Chamberlain University is a part of Adtalem Global Education (NYSE: ATGE). Chamberlain Universitys mission is to educate, empower and embolden diverse healthcare professionals who advance the health of people, families, communities and nations. Chamberlain University is comprised of the College of Nursing, which offers a three-year Bachelor of Science in Nursing degree program and flexible post-licensure programs such as the RN to BSN online option, Master of Science in Nursing degree program, Doctor of Nursing Practice degree program and graduate certificates, and the College of Health Professions, which offers a Master of Public Health and Master of Social Work degree programs. Chamberlain University is accredited by the Higher Learning Commission http://www.hlcommission.org, a regional accreditation agency recognized by the U.S. Department of Education. For the most updated accreditation information, visit chamberlain.edu/accreditation. To learn more, visit chamberlain.edu.

About Adtalem Global Education

The purpose of Adtalem Global Education is to empower students to achieve their goals, find success, and make inspiring contributions to our global community. Adtalem Global Education Inc. (NYSE: ATGE; member S&P MidCap 400 Index) is a leading global education provider and the parent organization of Adtalem Educacional do Brasil (IBMEC, Damsio and Wyden institutions), American University of the Caribbean School of Medicine, Association of Certified Anti-Money Laundering Specialists, Becker Professional Education, Chamberlain University, EduPristine, Ross University School of Medicine and Ross University School of Veterinary Medicine. For more information, please visit adtalem.com and follow us on Twitter (@adtalemglobal) and LinkedIn.

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About Ascend Learning

Ascend Learning is a leading provider of online educational content, software and analytics serving students, educational institutions and employers. With products that span the learning continuum, Ascend Learning focuses on high-growth careers in a range of industries, with a special focus on healthcare and other high-growth, licensure-driven professions. Ascend Learning products, from testing to certification, are used by frontline healthcare workers, physicians, emergency medical professionals, nurses, certified personal trainers, financial advisors, skilled trades professionals and insurance brokers all along the learning continuum from student through the lifetime career professional. ATI Nursing Education, an Ascend Learning business, uses progressive data analytics and compelling content to help nursing students master core curriculum, develop into a practice-ready nurse, and succeed on the NCLEX. Learn more at http://www.ascendlearning.com.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200413005115/en/

Contacts

Media Contacts: Elizabeth Story815.545.4242Elizabeth.Story@adtalem.com

Rachel Durbin816.529.3134Rachel.Durbin@ascendlearning.com

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Chamberlain University and Ascend Learning launch course to help nurses prepare for COVID-19 care - Yahoo Finance

CHICAGO As the number of confirmed COVID-19 cases continues to surge worldwide, scientists and health experts, including University of Illinois researchers who helped diagnose a New York zoo tiger with the disease, are now looking into how animals are affected by the new coronavirus.

Earlier this week, the Bronx Zoo revealed that a 4-year-old Malayan tiger tested positive for the new coronavirus after she and six other tigers and lions developed a dry cough. And despite the tiger and a few other animals abroad testing positive for the virus, health officials are dispelling fears that people can contract COVID-19 from their pets.

Theres no evidence that pets, including cats and dogs, can spread COVID-19 to people, said Dr. Casey Barton Behravesh, director of the Centers for Disease Control and Preventions One Health Office in the National Center for Emerging and Zoonotic Infectious Diseases.

Barton Behravesh noted that there was no reason to think that the skin or fur of pets can spread the virus to people.

But while health experts say there is no evidence to suggest pets can transmit coronavirus to humans, they are encouraging people who have the disease or are exhibiting symptoms of COVID-19 to remain socially distant from their pets.

If somebody has been diagnosed with COVID-19 in a household, or they have been exposed to someone who was and are in quarantine, they should treat their pet just like any other human in their family, said Dr. Rustin Moore, the dean of Ohio State Universitys College of Veterinary Medicine.

He added, that means maintaining social distancing, no touching, petting, cuddling, or hugging.

Dr. Karen Terio, the chief of the Zoological Pathology Program at the University of Illinois veterinary college, where tests for the Bronx Tiger were done, said she and other scientists are now looking at what other types of animals are susceptible to the virus.

Were trying to understand how this virus might be spread or transmitted between different animal species. and how it might be spread between humans and animals, she said.

Its possible wild cats might be more susceptible to COVID-19 than domestic cats, as other viruses can hit wild cats hard, but not affect domestic cats as much, according to the University of Illinois. But its not yet known what differences there might be in the effect of COVID-10 on house cats and wild cats.

To date, a large number of humans have been infected by the virus and become sick and many people have pet cats, Terio said. The fact that the first confirmed case in an animal in the United States is from a tiger suggests that even among cat species there may be differences in susceptibility to the virus.

Barton Behravesh said the CDC is not recommending routine pet testing.

We dont want a lot of people rushing out to veterinary clinics right now trying to get their pets tested; that would increase the exposure, she said.

Theres a strict criterion that must be met before an animal can get tested by a veterinary lab, Terio said.

Just because we have a test doesnt mean well accept samples from anybodys cat or dog, she said. There has to be approval at multiple levels between both animal and public health officials to have an animal tested.

The Anti-Cruelty Society started reducing their animal population weeks ago in anticipation of needing more cage space to help people across the Chicagoland area who may be quarantined or hospitalized because of COVID-19.

Weve spent the last several weeks preparing for the upcoming weeks to make sure that we have the capacity to have a safe place for peoples animals to go, said David Dinger, vice president of operations for the Anti-Cruelty Society.

And the Anti-Cruelty Societys efforts have been successful.

The societys animal population has reduced from roughly 600 animals to 135 in the last few weeks, Dinger said, which has freed up hundreds of slots for pets that may need a home while their owner has COVID-19.

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With Bronx Zoo tiger catching coronavirus, should pet owners be concerned about COVID-19? Health experts weigh in - Greater Milwaukee Today