StemCell Therapy

CHAPEL HILL, N.C., May 27, 2020 /PRNewswire/ --Leading thrombosis specialists from the International Society on Thrombosis and Haemostasis(ISTH) and World Thrombosis Day(WTD) Steering Committee recommend administering either standard preventative or larger doses of heparin (blood thinning medicine) to combat excessive clotting in all hospitalized COVID-19 patients from the time of hospital admission, unless they have contraindications to those medications.

This proposed "universal" intervention strategy is a change from the current practice of using only preventative levels of such medications after individual venous thromboembolism (VTE) risk assessment of hospitalized patients.

The recommendations are published in a new paper, titled "Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19," published on May 27, 2020 in the Journal of Thrombosis and Haemostasis (JTH). The peer-reviewed paper outlines new practical guidance on the prevention and treatment of VTE in hospitalized patients with COVID-19.

The recommendations were developed by a multidisciplinary panel of thrombosis experts as a response to widespread clinical reports of unusual, difficult-to-control clotting in COVID-19 patients."Early reports suggest COVID-19 is one of the most thrombotic disease states we've ever seen," said lead author Alex Spyropoulos, M.D., member of the WTD Steering Committee. Co-authors include leading scientists from six countries (see below for list).

In issuing new guidance, the authors analyzed reports from colleagues around the world who observed that patients hospitalized with COVID-19 had a high incidence of thrombotic events (blood clots). The authors caution that the data are based on anecdotal reporting rather than rigorous scientific research. Thus, guidance may change as data improves, though the scientists generally agree the recommendations are sufficiently supported to be adopted into practice.

"We consider this a living document," Spyropoulos said. "This is a very fast-moving target. The data are important, but even more important is our need to take care of patients now. We see this correlation with clotting, and we must act."

"In the United Kingdom, we are seeing high rates of blood clots in our patients even as they receive standard doses of blood thinners," said Professor Beverley Hunt, M.D., OBE, WTD Steering Committee Chair. "These patients seem to need larger doses than other sick patients. We need to know the best doses going forward."

Additional research is in development in the UK at this time, via a clinical trial named REMAP-CAP, to capture the response of COVID-19 patients to different dosing levels of blood thinning medications. This will provide more guidance for healthcare professionals globally, Hunt said.

While much remains unknown, the authors have concluded that patients with severe cases of COVID-19 develop VTE at a much higher rate than severely ill patients in general. VTE is a condition in which blood clots form (most often) in the deep veins of the leg (known as deep vein thrombosis or DVT), and can travel in the circulation to lodge in the lungs (known as pulmonary embolism, or PE). The development of this condition in hospitalized COVID-19 patients results in a much higher risk of death, particularly in patients with preexisting cardiovascular disease.

COVID-19 patients in the intensive care unit (ICU) are three to six times more likely to experience DVT than a patient in ICU for some other reason, such as congestive heart failure.

The authors also noted that the clots exhibit particular characteristics. Clots that lead to cardiac events, such as heart attacks and strokes, are typically large. In COVID-19 patients, however, in addition to the usual large clots seen in these patients, smaller clots (microthrombi) are also present in the lungs.

Clinicians have not identified a specific cause of blood clotting in COVID-19 patients, but believe it is due to the extreme immune response to COVID-19 that causes very sticky blood. Early research on COVID-19 found that blood clots are playing a role in a significant percentage of all COVID-19 deaths in the United States. Patients in the United States, however, are not routinely given blood thinners, in contrast to patients in the United Kingdom.

For more information on the paper, "Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19," visit https://onlinelibrary.wiley.com/doi/abs/10.111/jth.14929.

Co-authors include: Jerrold H. Levy (United States), Walter Ageno (Italy), Jean Marie Connors (United States), Beverley J. Hunt (United Kingdom), Toshiaki Iba (Japan), Marcel Levi (United Kingdom), Charles Marc Samama (France), Jecko Thachil (United Kingdom), Dimitrios Giannis (United States), and James D. Douketis (Canada)

SOURCE International Society on Thrombosis and Haemostasis

http://www.isth.org

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Leading Thrombosis Specialists Issue Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients...

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Letter to the editor: Can they hate Trump any more? - TribLIVE

(Reuters) - The anti-malarial drug hydroxychloroquine, which U.S. President Donald Trump says he has been taking and has urged others to use, was tied to an increased risk of death in hospitalized COVID-19 patients, a large study published on Friday showed.

In the study https://www.thelancet.com/lancet/article/s0140673620311806 that looked at more than 96,000 people hospitalized with COVID-19, the respiratory disease caused by the novel coronavirus, those treated with hydroxychloroquine or the related chloroquine had higher risk of death and heart rhythm problems than patients who were not given the medicines.

The study, published in the Lancet medical journal, showed no benefit for coronavirus patients taking the drugs.

Demand for the decades-old hydroxychloroquine has surged as Trump repeatedly promoted its use against the coronavirus, urging people to try it. "What have you got to lose?" he asked.

Trump said this week he has been taking hydroxychloroquine as a preventative medicine despite a lack of scientific evidence.

The Lancet study authors suggested that hydroxychloroquine and chloroquine should not be used to treat COVID-19 outside of clinical trials until studies confirm their safety and efficacy in such patients.

There is a frantic search for drugs to treat COVID-19 at the same time that multiple research teams pursue a safe and effective vaccine to combat a pathogen that has killed more than 335,000 people worldwide and sickened millions more.

The U.S. Food and Drug Administration has allowed healthcare providers to use the drugs for COVID-19 through an emergency-use authorization, but has not approved them to treat it.

Dr. Mandeep Mehra, one of the study's authors, said the research shows that the FDA should withdraw that authorization.

"That will help move this towards more, stronger evidence because it will then force the use of these drugs only in the setting of control trials," Mehra said in an interview. "That would be an extremely wise decision."

The FDA has said that, for safety reasons, hydroxychloroquine should be used only for hospitalized COVID-19 patients or those in clinical trials. The drug has been tied to dangerous heart rhythm problems.

The Lancet study looked at data from 671 hospitals where 14,888 patients were given either hydroxychloroquine or chloroquine, with or without an antibiotic, and 81,144 patients were not given such treatments.

Both drugs have shown evidence of effectiveness against the coronavirus in a laboratory setting, but studies in patients had proven inconclusive. Several small studies in Europe and China spurred interest in using hydroxychloroquine against COVID-19, but were criticized for lacking scientific rigor.

Several more recent studies have not shown the drug to be an effective COVID-19 treatment. Last week, two studies published in the medical journal BMJ showed that patients given hydroxychloroquine did not improve significantly over those who were not.

Hydroxychloroquine is used to treat lupus and rheumatoid arthritis as well as malaria.

Hospitalized patients tend to have a more severe version of COVID-19. Some proponents of the drugs for COVID-19 argue that they may need to be administered at an earlier stage to be effective.

There are ongoing randomized, controlled clinical trials to study the drug's effectiveness in preventing infection by the coronavirus as well as treating mild to moderate COVID-19. Some of those may yield results within weeks.

(Reporting by Ankur Banerjee and Manas Mishra in Bengaluru and Michael Erman in New York; Editing by Saumyadeb Chakrabarty, Bill Berkrot, Jonathan Oatis and Will Dunham)

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Drug Touted by Trump as COVID-19 Treatment Tied to Increased Risk of Death: Study - The New York Times

WASHINGTON - Malaria drug hydroxychloroquine, which U.S. President Donald Trump says he has been taking, is tied to increased risk of death in COVID-19 patients, according to a study published in medical journal Lancet.The study which observed over 96,000 people hospitalized with COVID-19, showed that people treated with the drug, or the closely related drug chloroquine, had higher risk of death when compared to those who had not been given the medicine.Demand for hydroxychloroquine, a drug approved decades ago, surged after Trump touted its use as a coronavirus treatment in early April. Earlier this week, he surprised the world by admitting he was taking the pill as a preventative medicine.The Lancet study authors suggested these treatment regimens should not be used to treat COVID-19 outside of clinical trials until results from clinical trials are available to confirm the safety and efficacy of these medications for COVID-19 patients. The authors said they could not confirm if taking the drug resulted in any benefit in coronavirus patients.Weeks ago, Trump had promoted the drug as a potential treatment based on a positive report about its use against the virus, but subsequent studies found that it was not helpful. The U.S. Food and Drug Administration in April issued a warning about its use.The Lancet study looked at data from 671 hospitals, where 14,888 patients were given either hydroxychloroquine or chloroquine, with or without the antibiotic macrolide, and 81,144 patients were not on any of the treatment regimens.

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Drug Touted by Trump as COVID-19 Treatment Tied to Increased Death Risk, Study Finds - Voice of America

In mid-March, filmmaker Robert Cibis at the time best known for a 93-minute documentary about a master piano tuner uploaded a short interview with the German physician and socialist politician Wolfgang Wodarg to YouTube. In the video, Wodarg alleges that the Covid-19 pandemic is a hype drummed up by sensationalist virologists and spread by scientists who want to be important in politics because they need money for their institutions.

Within days, the Wodarg interview had been viewed hundreds of thousands of times (the total now tops 2 million on YouTube), and Cibis and his production company, Oval Media, started raising money for a documentary, called Corona.film. Featuring Wodarg and other scientists, the film is billed as an exploration of the coronavirus and its media influence. On the crowdfunding platform IndieGoGo, hundreds of people have chipped in donations totaling about $105,000 to keep the project going.

The trailer for Corona.film features a high-profile scientist alongside Wodarg: John Ioannidis, a professor of medicine, epidemiology, and population health at Stanford University. Ioannidis co-directs a major center at Stanford that pushes for more rigorous biomedical research; a 2010 Atlantic magazine profile argued that he may be one of the most influential scientists alive. During the current pandemic, while praising public health officials, Ioannidis has criticized the lockdowns as based on too-thin evidence a position that has earned him fierce, albeit respectful,criticismfrom many colleagues. (The pushback intensified this week over a new Ioannidis analysis that many of his colleaguespilloriedonline, with somecitingoversights and inconsistencies in the data included in the study.)

In the teaser, after Wodarg calls for a closer look at the coronavirus epidemic that we allegedly are having right now, Ioannidis explains that, while elements of the pandemic are serious, he thinks there is a very high chance we are exaggerating the risk of the novel coronavirus.

Asked about Corona.film, Ioannidis told Undark he had never heard of it.

As SARS-CoV-2, the coronavirus that causes Covid-19, has swept across the globe, killing hundreds of thousands of people and overwhelming medical systems in the United States, Italy, Ecuador, and other countries, the pandemic has also nurtured a rich ecosystem of digital backlash. To be sure, some people have raised serious and reasonable questions about whether global lockdowns are worth the economic and social cost, which could be especially devastating in some developing countries. But many more hew to unfounded theories that the pandemic is, for example, caused by 5G towers; that it emerged from a lab in China; or that it is the result of a conspiracy by global leaders and plutocrats, especially billionaire Bill Gates.

The story of how footage of the Stanford professor ended up in Corona.film is just one example of how, amid the confusion of the pandemic, the views of serious scientific dissenters are being swiftly metabolized by a sprawling world of ideologues and conspiracy theorists. The tale runs through an independent film distribution company, and it involves a New York-based filmmaking team that has found millions of viewers online through an interview project that features a rich mix of marginal perspectives and pedigreed academics, Ioannidis most prominent among them.

The scientists in the films are not conspiracy theorists, theyre not anti-vaxxers theyre not like us, says one of the filmmakers, John Kirby, who suggested, without citing specific evidence, that the pandemic has been engineered by a global elite seeking to expand itscontrol over the world. But they are incredibly eminent, respected people who are thankfully independent enough to raise a question.

Before the Covid-19 pandemic began, Kirby and his filmmaking partner, Libby Handros, were working on a documentary about the assassinations of the 1960s, including the 1963 murder of President John F. Kennedy, which some people have long-maintained was the result of a government conspiracy. Media coverage of the coronavirus, Kirby told Undark, sounded similar to how they see coverage of the Kennedy assassination: an obfuscation of a deeper, more frightening truth. We sensed a rollout, a very large rollout, Kirby said.

We just want to keep bringing out alternative, sometimes overlapping opinions from experts and journalists.

The filmmakers approached Ioannidis for an interview, producing an hourlong video in which he analyzes the Covid-19 response, speaking in detail about the difficulty of pinning down precise data about a fast-moving pandemic. With the Ioannidis interview in hand, Handros and Kirby pitched the series to Journeyman Pictures, an independent film distributor in the United Kingdom that works with hundreds of documentaries each year.

We saw it as something interesting which would give, exactly as we called it, Perspectives on the Pandemic a broader perspective than we were getting from the increasingly controlled and narrow line being fed to us by the mass media every day, said Mark Stucke, the founder and managing director of Journeyman Pictures.

Journeyman signed Handros and Kirby up and began sharing the Ioannidis video with its 1.4 million YouTube subscribers. Off we went, Stucke said. And boom! It did go boom.

The interview soon picked up hundreds of thousands of views. Thousands also tuned into a conversation with David L. Katz, a physician, former Yale professor, and expert in preventative medicine who has drawn attention for a New York Times op-ed arguing that the negative effects of the lockdowns could outweigh the benefits.

Millions more people watched a viral interview with Knut Wittkowski, a former biostatistician at Rockefeller University who argues that the virus should be allowed to spread unchecked among healthy people until enough people become immune a strategy, widely criticized by experts, that has been partly adopted by the chief epidemiologist in Sweden.

Follow-up conversations with Wittkowski and Ioannidis, in which the latter described the results of his controversial study of Covid-19 prevalence in California, brought hundreds of thousands more views.

In a wide-ranging interview, Kirby and Handros spoke with Undark about the Kennedy assassination, Handros clashes with Donald Trump in the 1990s over a film she made, and Kirbys opposition to current vaccine policies, as well as his suspicion that Bill Gates is planning and manipulating the pandemic response. Most people are not ready to understand that this is not just sort of a public health crisis that governments are doing their best to respond to and maybe screwed up, Kirby said, without offering clear evidence. We just want to keep bringing out alternative, sometimes overlapping opinions from experts and journalists, he added, noting that they may start covering a range of topics. We want to ease people into some of the harder-to-appreciate stuff.

Some of the content in Perspectives on the Pandemic veers more directly into anti-government politics. In the first interview with Wittkowski, published in early April, the scientist said: Im not paid by the government, so Im entitled to actually do science. He also suggested that, left unchecked, the virus could exact a death toll of 10,000 in the U.S. and disappear on its own.

Today, the official U.S. death count is above 90,000, with cases rising in much of the country. In a phone conversation and follow-up emails, Wittkowski defended his projections, arguing that, while specific predictions may not bear out, he was correct to question lockdowns, and that the current death count was dramatically overstated. (There is growing evidence that it is actually an underestimate.) He claimed that the course of the pandemic was as predictable as the effects of gravity. Social distancing is a strategy for the government to reduce the democratic rights of the people, he wrote.

The idea that the Covid-19 pandemic is the result of a conspiracy is ludicrous.

Rockefeller University has publicly distanced itself from Wittkowski, explaining in a statement that comments about discouraging social distancing he has made do not represent the views of The Rockefeller University, its leadership, or its faculty. But his videos for Perspectives on the Pandemic have received widespread attention, including in the New York Post and The Epoch Times an outlet, analysts say, that has been instrumental in pushing the thus-far-unfounded claim that the SARS-CoV-2 virus originated in a Chinese lab and the American Institute for Economic Research, a right-leaning think-tank. Wittkowski has also appeared on an internet talk show hosted by Del Bigtree, a prominent anti-vaccination activist.

Earlier this month, YouTube removed one of Wittkowskis interviews for Perspectives on the Pandemic, citing unspecified violations of its policies. This week, YouTube removed Wittkowskis other interview, as well as the first, long, interview with Ioannidis.

According to YouTube, the Ioannidis video violated the platforms Covid-19 Medical Misinformation Policy, which, among other rules, states that YouTube doesnt allow content that spreads medical misinformation that contradicts the World Health Organization (WHO) or local health authorities medical information about Covid-19. A YouTube spokesperson did not respond to a request on Friday afternoon for specific details about how the Ioannidis interview had violated that policy.

Journeyman Pictures is asking YouTube for clarification regarding the decisions.

After watching the Ioannidis interviews, Cibis approached Journeyman about using the footage in his Covid-19 documentary. The distributor had worked with Oval Media on a previous documentary, also featuring Wodarg, that alleges corruption at the WHO. Stucke agreed, which is how Ioannidis ended up featuring prominently in a trailer for the film, alongside Wodarg, who has continued to argue, despite the mounting global death toll, that the pandemic is largely a fabrication.

Cibis told Undark that he had been surprised and a little frightened by the strong reactions to his original interview with Wodarg, acknowledging that it may have been just naive to publish the video without any research or context. But he rejected characterizations of Wodarg as a conspiracy theorist. His new film, he said, will have diverse perspectives although he added that he has concerns about using footage from one high-ranking Italian public health official who has warned that the virus is particularly dangerous, because Cibis feels it was unscientific and just fear-making.

Stucke, meanwhile, said that while he was aware that Handros and Kirby fit comfortably at the conspiratorial end of the world of journalism, he thought their project seemed sound, and that they were speaking with qualified sources. The Wittkowski interview, though, ultimately gave him pause. He said that if he had seen this interview first and as a standalone piece, rather than in the context of other interviews in the series, I would have probably thought twice about saying Yes, go for it. He admitted to knowing little about certain details of the Cibis project.

Some participating scientists, too, seemed surprised about the context in which their interviews were being presented. Asked whether he was aware of the conspiracy-oriented side to the Perspectives on the Pandemic project, Yale Universitys Katz replied No in an email, adding that the idea that the Covid-19 pandemic was the result of a conspiracy is ludicrous.

The interview was long-form, meaning I could speak my full views so it seemed a good venue, Katz wrote.

All that I really count on the production side to do, he added, is (a) not alter my views by editing them or taking them out of context; [and] (b) give me an audience.

Ioannidis said he was unaware that Journeyman had licensed footage of his interview to the German filmmakers. He also expressed surprise that there might be a conspiracy-oriented dimension to the Perspectives on the Pandemic series. I am clearly not aware of that, he said. Ive talked with John Kirby for two hours during these interviews. None of these questions arose.

People with different conflicts of interest, they will probably use ammunition from perspectives or data or science that has nothing to do with their agenda. It is a concern, Ioannidis said. I do share that concern, but its impossible to censor science, or to, lets say, factor every possible crazy perspective into account before you say, well, These are my data, and this is what I think about them.

But Leah Ceccarelli, a scholar of rhetoric and communication the University of Washington who studies scientific controversy, was skeptical about that line of argument.

Of course, the scientist wants to present the ethos of the disinterested searcher for truth, she said. As a scientist, Im just telling you the way that it is, and its not my job to think about the politics of this.

But that, Ceccarelli said, is totally naive.

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In Online Covid-19 Videos, A Mix of Science and Conjecture - Undark Magazine

The first UK frontline NHS worker will today enrol in a new study designed to test the potential of hydroxychloroquine to prevent infection with novel coronavirus.

COPCOV is the largest multi-national interventional clinical study into the prevention of COVID-19 using hydroxychloroquine, which will involve around 40,000 healthcare workers.

The study has launched at Brighton and Sussex University Hospitals and the John Radcliffe Hospital in Oxford, which are the first of 20 UK hospitals set to participate.

Researchers hope to determine whether hydroxychloroquine/chloroquine can be used to effectively protect frontline medical staff, allowing them to undertake their vital roles more safely.

Accord Healthcare, a UK-based medicines manufacturer, has donated over two million tablets to enable this landmark trial to go ahead.

Based on the known pharmacology of hydroxychloroquine, coupled with the emerging knowledge surrounding SARS-CoV-2 viral replication and COVID-19 pathophysiology, we were very keen to test the effectiveness of this molecule in a preventative, rather than late-stage treatment setting, said Dr Anthony Grosso, VP & head of Scientific Affairs, Accord Europe & MENA.

A large-scale, prospective, randomised, double-blind clinical trial in a high-risk setting is the only way to robustly determine if this medicine can lessen or prevent human infection. Previous studies have not adequately tested this hypothesis; the results of COPCOV are therefore of critical importance to public health.

Even though lock-down measures appear to have significantly reduced the current rate of infection in the UK, healthcare workers will continue to be at risk of contracting COVID-19, especially as measures are relaxed, added Professor Martin Llewelyn, Brighton and Sussex Medical School and lead COPCOV UK Investigator.

Whilst we wait for an effective and widely available vaccine, the race is on to find a well-tolerated preventative treatment. The results from COPCOV are expected later this year and, if they show that hydroxychloroquine can reduce the chances of catching COVID-19, this would be incredibly reassuring for myself and my frontline colleagues.

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First UK healthcare worker to enrol in COVID-19 prevention trial - PharmaTimes

The buck arguably stops with Dr. Wilma Wooten as the San Diego region starts to reopen its economy amid the worst pandemic in a century.

Wooten, the countys public health officer, cleared the way this week for resuming in-person dining at restaurants, as well as shopping at retail stores and swap meets. Her plan, which received state approval on Wednesday, makes San Diego the largest county in California to move ahead on Gov. Gavin Newsoms official timeline for easing lockdown conditions.

So far, the region has fared notably well under Wootens leadership when it comes to fending off the new coronavirus. Hospitals have not been overwhelmed with sick patients, and while its taken time, testing capacity and contact tracing appear to be ramping up.

Still, the largest challenge for the 63-year-old Alabama native may lie ahead. As corporate heavyweights and small business owners push for commerce to resume, health experts have said hospitals should brace for a spike in illnesses and deaths.

Wooten is a widely respected medical professional who received high praise for her handling of the 2009 swine flu outbreak that started in San Diego, but her political skills could be tested. Four years ago, she was thrust into the spotlight when a rash of hepatitis A cases ripped through the local homeless community. A state audit found she mishandled the crisis by not forcing the city to deal with the outbreak sooner and more forcefully.

A spate of new COVID-19 cases could force Wooten into a faceoff with elected leaders eager to please their out-of-work constituents something she says shes prepared for.

It will be difficult to dial back, but we will have to if things get out of hand, she said during an interview Thursday. This is a challenge of all health officers across the nation.

So far, disagreements over tackling the coronavirus pandemic have been relatively minor, such as when conservative Supervisor Jim Desmond recently downplayed the seriousness of the coronavirus outbreak by pointing out that all but six of the countys fatalities involved underlying health conditions.

Dr. Wilma Wooten, San Diego County public health officer

Wooten quickly rebutted the supervisors comments at one of the countys regular press briefings, saying that the lives of those with existing medical conditions were no less valuable than others.

Still, Desmond is not alone in his push to loosen restrictions far beyond what Newsom and his team in Sacramento have called for. San Diego Mayor Kevin Faulconer and the entire Board of Supervisors save its lone progressive, Supervisor Nathan Fletcher have called for reopening the economy far beyond what the state and the health officer appear comfortable with.

Wooten, with Fletchers support, has repeatedly called for following the guidance of state leaders as well as the Centers for Disease Control and Prevention.

We are very sensitive of the importance to balance protection of the publics health with economic viability, and we are following the governors guidance, she said.

That message comes in contrast to a letter recently penned by San Diego Mayor Kevin Faulconer and Supervisor Greg Cox urging the governor to allow local jurisdictions to control the speed at which they reopen.

Our businesses are ready to thoughtfully reopen and adapt with necessary protective measure, but they need to be provided that opportunity, the letter reads in part.

Wooten grew up with what she described as meager means in Thomaston, Ala., a rural town of fewer than 1,000 people and one streetlight.

Raised by her great grandparents, she and her brother spent a lot of time helping the local elderly community. She said the experience helped her develop an enduring sense of public service, and from a young age, she knew she wanted to get into medicine.

Valedictorian of her high school class, she attended Spelman College in Atlanta. Before graduating from the historical black college for women in 1978, she met Roslyn Crisp, who would become her lifelong friend.

Crisp, a 63-year-old pediatric dentist from North Carolina, said they mostly avoided parties and focused on their academic careers. They still see each other a few times a year and regularly vacation together.

She has the qualities that I think anybody would want in a friend, Crisp said of Wooten. Shes very compassionate. Shes understanding. Shes a good listener.

If she gives you an opinion, honestly, I really feel like she has thought it out, and shes done her homework.

Wooten went on to attended the University of North Carolina School of Medicine, where she graduated with a degree in medicine in 1986. She did her residency at the recently closed Providence Hospital in Washington, D.C.

She came to San Diego in 1989 to do her residency in preventative medicine at San Diego State University under Dr. Kevin Patrick, now a professor emeritus of family medicine and public health at the UC San Diego School of Medicine.

A year later on Patricks advice, Wooten applied to work at UCSD and was hired to, among other things, research family and preventive medicine.

She was very practical in her approach to things and very hard working, Patrick recalls. Obviously, she cares for the community. I think the social justice component was really important for Wilma.

Wooten was hired by San Diego County in 2001 to serve as deputy health officer. At the time, she was also volunteering on medical trips to Jamaica, Kenya and Ghana to treat and educate patients vulnerable to communicable diseases, such as AIDS.

In 2007, she was elevated to public health officer, overseeing the countys Public Health Services agency, which currently has about 500 employees and a $100 million budget. She currently makes a salary of $270,836 a year.

Her first big challenge came in 2009, when San Diego became ground zero for the countrys H1N1 swine-flu epidemic. Wooten would later win a national Public Health Heroes award for her work.

She is one of my public-health heroes, said Dr. Ron Chapman, public health officer for Californias Yolo County. He serves with her on the Public Health Accreditation Board. Dr. Wooten is brilliant, insightful, caring, and a strategic thinker.

Dr. Wilma Wooten showed the proper way to cough during a 2009 briefing on the H1N1 flu death of a county resident.

In March 2017, Wooten declared an outbreak of hepatitis A, which was infecting homeless people and illegal drug users through feces. Nobody knew at the time, but it would become the countrys worst eruption of the disease since a vaccine was introduced in 1995.

What happened over the next six months led to intense media scrutiny and finger pointing between county officials and San Diego Mayor Kevin Faulconers team.

While the county would later suggest the city dragged its feet on sanitation, the mayors team faulted the county for not taking charge during the outbreak.

This is a dark stain on our communitys civic record, said Assemblyman Todd Gloria, D-San Diego. Hepatitis is a disease that we know a lot about, that we have tests for, that we have a vaccine for. The fact that it killed 20 people and infected over 500 more was a real indictment of our public health infrastructure.

At the time, the city much like other parts of Southern California that experienced simultaneous, albeit smaller outbreaks of hepatitis A had long been entwined in a debate about whether homeless communities had adequate access to toilets and proper sanitation.

Advocates had routinely criticized Faulconer for not increasing the number of public toilets downtown, citing grand jury reports from 2010 and 2015 that warned unsanitary conditions in the city could lead to an outbreak of disease.

The issue became a political hot potato, with residents and local business owners complaining that public toilets invited unsavory behavior. In 2015, the mayor removed one of two metal toilets downtown, known as Portland Loos, which had cost the city roughly $560,000. The second loo was then removed at the height of the hepatitis outbreak.

Assemblyman Todd Gloria, D-San Diego

Wooten issued the first public health directive of her career on Aug. 31, 2017, calling on the city of San Diego to expand access to public restrooms and hand-washing stations, as well as to ramp up street-cleaning efforts.

The next day she declared a health emergency, and Faulconer made his first public statements on the issue, despite that fact that the city had quietly warned its own workers for months about the danger of infection.

Nobody wanted to take the lead, recalled Michael McConnell, a prominent local advocate for the homeless. Nobody wanted to be in charge of this thing, and on the ground it was just a train wreck.

Wooten and her team ramped up a vaccination program that eventually helped stem the outbreak.

However, California State Auditor Elaine Howle released a report in 2018 that found they should have acted faster. It faulted both the city and the county for not tackling sanitation earlier, but called out the county for being too lenient with Faulconers team.

The county health officer did not issue a directive sooner because she wanted to collaborate with the city instead of mandating its compliance, the report read. However, by exercising her legal authority before August 31, 2017, the county health officer likely would have prompted the city to implement the important sanitation measures sooner.

Gloria and Assemblywoman Lorena Gonzalez, D-San Diego, co-authored a bill in response to the audit report that cemented a local health officers authority to compel other government agencies to take action to curb the spread of disease.

According to the audit report, the countys own legal counsel questioned Wootens authority to issue Faulconer the health directive.

Neither Wooten nor Faulconer want to relitigate the hepatitis A crisis, citing the need to collaborate during the current pandemic.

That happened, and were in a different place now, and we have a great relationship with actually all of the municipalities that are in San Diego County, Wooten said.

Wooten has been much more visible in the current crisis, and the stakes are much higher due to the weeks-long shutdown of the economy and pressure to reopen it. She and other officials are giving regular video updates on Facebook and Twitter concerning issues that intimately impact the lives of nearly everyone in the county, from wearing face masks to opening local beaches.

The relationships been a bit rocky at times.

Wooten, for example, suggested in a press briefing this month that she would block casinos on tribal lands from reopening, saying: We feel that the health officers order does extend to our tribal nations in this particular situation.

Wooten reversed her position the next day after meetings with tribal leaders, acknowledging that, Tribal nations have sovereign authority, so our plan is to provide guidance and advice where possible.

In an appearance at the Rock Church on March 15, Wooten dismissed the idea that the virus could be spread by those without symptoms.

Oh, I heard that it was that you could without symptoms, said Pastor Miles McPherson during an exchange.

There are a lot of rumors and misinformation out there, Wooten responded. Even if theyve been exposed to someone who did have symptoms, if they do not have symptoms, others who have come in contact with that individual should be at low or no risk for developing the disease.

At the time, evidence of asymptomatic transmission was just starting to percolate. Its now believed that has played a significant role in spreading the virus. Wooten was not technically wrong about the state of research at the time, as shes quick to point out.

That was not a misstep, Wooten told the Union-Tribune. That was based on the facts that we had that day.

County public health officer Wilma Wooten M.D., and other officials, provide the latest updates on COVID-19 Coronavirus at the County Operations Center on February 14, 2020 in San Diego, California.

(Eduardo Contreras/The San Diego Union-Tribune)

Now Wooten has taken another bold leap into the unknown.

On Tuesday, she submitted a plan to the state for reopening restaurants, retail businesses and swap meets. Officials in Sacramento approved the plan the next day, making San Diego a test case for lifting stay-at-home orders in a highly urbanized area.

While Los Angeles County doesnt currently appear to meet the states requirements for reopening such businesses, several Bay Area counties seemingly do but have chosen to remain under lockdown, including Marin, San Mateo, Contra Costa, Sonoma and San Francisco.

San Diego has fared reasonably well during the pandemic, with about 6,300 cases and about 240 deaths as of Friday. Still, the decision to reopen comes at a time when the region is barely meeting the states benchmarks for doing so.

For example, the state has required as a condition for reopening such businesses that San Diego County be testing at least 4,950 people for the virus a day, or 1.5 people per 1,000 residents. The county reports that its currently testing only about 4,000 people a day on average, although it expects to meet or exceed the states benchmark by June.

The state has also called for counties to have enough open hospital beds to accommodate a surge in COVID-19 patients of roughly 35 percent. San Diego County currently has just enough free space across its 24 hospitals to meet the requirement, according to the report.

Theres also a question about whether the San Diego has enough contact tracers to be able to isolate infection clusters before they get out of control.

The state has called on counties to have at least 15 contact tracers for every 100,000 residents in order to open shops and eateries. That would be roughly 500 trained professionals for the San Diego region. Currently, the county reports that it has only 87 tracers, although its says the county has hired another 329 tracers that are currently completing their training. San Diego State University will also provide another 100 tracers at some point, according to the county.

Still, Wootens plan for reopening certain businesses appears to have the support of the local medical community. UC San Diego Health CEO Patty Maysent called the plan on Tuesday incredibly thoughtful.

I think it addresses the main issues that we need to follow, she said. The metrics that are laid out in the plan are in my mind pretty factually based.

The plan also has the backing of Fletcher, who appears to be Wootens firewall against politicians who would swing the doors open on the economy tomorrow if they could.

Dr. Wooten is one of the hardest-working public servants that Ive encountered in my time working in government, he said. She works on these issues of public health every single day, seven days a week, all day long.

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Meet Dr. Wilma Wooten, who wrote the plan to open San Diego restaurants and shops - The San Diego Union-Tribune

Naoki Yuda,1 Miyuki Tanaka,1 Koji Yamauchi,1 Fumiaki Abe,1 Izumi Kakiuchi,2 Kyoko Kiyosawa,2 Mitsunaga Miyasaka,2 Naoki Sakane,3 Masahiko Nakamura4

1Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan; 2Department of Nursing, Matsumoto Junior College, Matsumoto, Nagano, Japan; 3Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; 4Matsumoto City Hospital, Matsumoto, Nagano, Japan

Correspondence: Naoki YudaFood Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 1-83, 5-Chome, Higashihara, Zama, Kanagawa, JapanTel +81 46 252 3051Fax +81 46 252 3017Email n-yuda@morinagamilk.co.jp

Background: Preventative measures have recently been taken to reduce the incidence of Alzheimers disease worldwide. We previously showed that Met-Lys-Pro (MKP), a casein-derived angiotensin-converting enzyme inhibitory peptide with the potential to cross the bloodbrain barrier, attenuated cognitive decline in a mouse model of Alzheimers disease. However, the effect of MKP on cognitive function improvement in humans remains unknown. This exploratory study sought to investigate whether MKP intake could improve cognitive function in adults without dementia.Methods: A total of 268 community-dwelling adults without dementia participated in this 24-week randomized controlled trial. Participants were randomly allocated to the MKP (n = 134) or placebo (n = 134) group. The MKP group received four tablets daily, each containing 50 g MKP, while the placebo group received four dextrin tablets containing no detectable MKP for 24 weeks. Scores on the Japanese version of the cognitive subscale of the Alzheimers Disease Assessment Scale (ADAS-cog) were used as the primary outcome to compare cognitive function between the MKP and placebo groups. The study products were also evaluated for safety.Results: The intention-to-treat analysis showed that there was no significant difference between the groups in terms of the ADAS-cog total score. Orientation, as measured by the respective ADAS-cog subscale, was significantly improved compared to placebo at 24 weeks post-MKP administration (P = 0.022). No serious adverse events due to MKP intake were observed.Conclusion: To the best of our knowledge, this is the first study to report the effects of MKP on human cognition. These preliminary results suggested the safety of daily MKP intake and its potential to improve orientation in adults without dementia. Further clinical studies are needed to confirm the present findings and the benefits of MKP on cognitive function.

Keywords: humans, MKP, cognition, cognitive dysfunction, orientation, Alzheimers disease

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Effect of the Casein-Derived Peptide Met-Lys-Pro on Cognitive Function | CIA - Dove Medical Press

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New Delhi: The Indian Council of Medical Research (ICMR), the countrys apex body in the field, has found that consuming the drug hydroxychloroquine reduces the chances of getting infected with Covid-19.

As a result, ICMR released an advisory Friday to expand the usage of HCQ an anti-malarial drug as a preventive treatment against the novel coronavirus.

The conclusion has been drawn on the basis of three studies conducted by the ICMR.

The advisory suggests surveillance workers, paramilitary and police personnel, as well as medical staff working in non-Covid hospitals and blocks to start consuming the pill as preventive therapy.

ICMR had issued an advisory to begin using HCQ in March, but it had drawn criticism for lacking scientific evidence that the drug works against the novel coronavirus.

Also read: How the humble hydroxychloroquine has become Indias unlikely new global strategic asset

According to the advisory, the premier health body undertook investigation at three central government hospitals in New Delhi. While it did not reveal the names of the hospitals, it said the investigation indicates that amongst healthcare workers involved in Covid-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it.

The advisory also states that the National Institute of Virology in Pune has found in laboratory testing that HCQ reduces the viral load.

The ICMR also analysed data collected previously, known as retrospective case-control analysis, and found a significant relationship between the number of doses taken and frequency of occurrence of Covid-19 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection.

It further said the benefit was less pronounced in healthcare workers caring for a general patient population.

Another observational study was conducted among 334 healthcare workers at the countrys largest public hospital, New Delhis All India Institute of Medical Sciences (AIIMS). The 248 workers who took HCQ as preventive drug for an average of six weeks had lower incidence of the infection than those not taking the pill.

Based on the findings of the studies, the government has decided to administer the drug as a prophylaxis or preventive therapy to asymptomatic healthcare workers working in non-Covid hospitals as well as non-Covid blocks of hospitals earmarked for Covid treatment.

Asymptomatic frontline workers, such as surveillance workers deployed in containment zones, as well as paramilitary and police personnel involved in Covid-related activities will be asked to pop HCQ pills.

Until now, only high-risk individuals, including asymptomatic healthcare workers involved in containment and treatment of Covid-19 patients, and asymptomatic household contacts of laboratory-confirmed cases, were being administered the drug. They will continue to consume the drug.

While the dosage will remain the same as before, eight weeks, the ICMR advisory suggests that it can be used beyond that period as well, but with close monitoring.

With available evidence for its safety and beneficial effect as a prophylactic drug against SARS-CoV-2 during the earlier recommended 8 weeks period, the experts further recommended for its use beyond 8 weeks on weekly dosage with strict monitoring of clinical and ECG parameters, which would also ensure that the therapy is given under supervision, it stated.

In clinical practice, HCQ is commonly prescribed in a daily dose of 200mg to 400mg for treatment of diseases such as rheumatoid arthritis and systemic lupus erythematosus for prolonged treatment periods with good tolerance, the advisory added.

The ICMR had earlier announced that some side effects, such as abdominal pain and nausea, have been observed in healthcare workers who were administered HCQ.

The anti-malaria drug isoften blamed for triggering irregular heartbeat.

However, in the final results of the studies (HCQ prophylaxis among 1,323 healthcare workers), the ICMR found mild adverse effects such as nausea in 8.9 per cent workers, abdominal pain in 7.3 per cent, vomiting in 1.5 per cent, low blood sugar (hypoglycaemia) in 1.7 per cent and cardio-vascular effects in 1.9 per cent.

The advisory states the drug should be discontinued if it causes the rare side effects related to the heart, such as cardiomyopathy, a disease which makes it harder for heart to pump blood to the entire body, and heart-rate disorders.

The advisory mentions that HCQ, in rare cases, can cause visual disturbance, including blurring of vision, which is usually self-limiting and improves on discontinuation of the drug.

ICMR has clarified that for the above cited reasons heart and vision the drug has to be given under strict medical supervision with an informed consent.

Also Read: Ashwagandha the new HCQ? Modi govt begins study to see if herb keeps coronavirus away

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HCQ breakthrough: ICMR finds its effective in preventing coronavirus, expands its use - ThePrint

Mallons distrust of Baker was not an isolated incident: trust in public health was unevenly distributed among communities, Conis says. For instance, many immigrants came from countries where government-enforced vaccinations were unheard of. The power Baker wielded as a municipal authority was wholly unfamiliar.

Stereotypes about immigrant communities including those to which Baker herself subscribed further hampered trust in public health.

In her autobiography, Baker frequently refers to Irish immigrants en masse as shiftless, and says of the Irish in Hells Kitchen that they were altogether charming in their abject helplessness, wholly lacking in any ambition and dirty to unbelievable degree. In Bakers view, the only other group who could match the Irish distinction of living in the most squalor was Russian Jews, who managed to survive out of thrift.

For communities so frequently maligned and stereotyped, trust was not easily given just because someone with Bakers authority asked for it.

What Baker never seemed to understand about the immigrant communities she served was that when her advice was ignored, it often wasnt a failure of understanding. Rather, it was that those, like Mallon, who she explained the science of germs to, had little control over their own lives and circumstances.

Even though Baker retired from the Bureau of Child Hygiene in 1923, her work extended beyond the health department. She was prolific writer, publishing hundreds of journal and newspaper articles on public health and five books on child health and hygiene for non-experts. She also founded the American Child Hygiene Association, of which she became president in 1917, and served as president of the Womens Medical Association in 1935.

Baker spent the last years of her storied life on a farm in New Jersey with her partner, the novelist and screenwriter Ida Wylie, and their friend, physician Louise Pearce. She died of cancer in 1945.

While she went to greater lengths than any other public health official to learn the needs of tenement residents, Baker never seemed to quite understand why some greeted her and her municipal authority with scepticism. Nor did she reflect on the role she may have played in perpetuating that distrust.

Had she done so, its easy to imagine how many more lives she could have saved. As it is, however, she deserves a reputation as one of the earliest and most influential crusaders for preventative public health and provides an example of not only what to do, but what not to do, when it comes to public health.

--

Missed Genius

Ask people to imagine a scientist, and many of us will picture the same thing a heterosexual white male. Historically, a number of challenges have made it much more difficult for those who dont fit that stereotype to enter fields like science, math or engineering.

There are, however, many individuals from diverse backgrounds who have shaped our understanding of life and the Universe, but whose stories have gone untold until now. With our new BBC Future column, we are celebrating the missed geniuses who made the world what it is today.

--

Portrait of S. J. Baker by Emmanuel Lafont.

Join one million Future fans by liking us onFacebook, or follow us onTwitterorInstagram.

If you liked this story,sign up for the weekly bbc.com features newsletter, called The Essential List. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.

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SJ Baker: The woman who transformed public health - BBC News

(Reuters) - Here's what you need to know about the coronavirus right now:

Senate grilling

U.S. Treasury Secretary Steven Mnuchin and Federal Reserve Chair Jerome Powell testify on Tuesday before the Senate Banking Committee and are expected to answer questions about actions still needed to keep the world's largest economy afloat and missteps in rolling out some $3 trillion in aid so far.

Two months into the United States' fight against the most severe pandemic to arise in the age of globalization, neither the health nor the economic war has been won. Many analysts fear the country has at best fought back worst-case outcomes.

In remarks broadcast Sunday night, Powell outlined the likely need for three to six more months of government financial help for firms and families and said "medical metrics" were the most important data for the U.S. economy right now.

Glimmer of hope

An experimental COVID-19 vaccine made by Moderna Inc , the first to be tested in the United States, produced protective antibodies in a small group of healthy volunteers, according to very early data released by the biotech company on Monday.

The vaccine has gotten the green light to start the second stage of human testing. In this Phase II, or midstage, trial designed to further test effectiveness and find the optimal dose, Moderna said it will drop plans to test a 250 mcg dose and test a 50 mcg dose instead.

Reducing the dose required to produce immunity could help spare the amount of vaccine required in each shot, meaning the company could ultimately produce more of the vaccine.

Empty middle seat?

As air travel restarts, travellers, airlines and airports are grappling with a hodgepodge of rules put in place during the pandemic that will make flying different in almost every country.

On planes, one of the biggest debates has been over whether middle seats should be empty. That would limit airplanes to two-thirds of their normal capacity, not enough for most airlines to make a profit without increasing fares.

Eating with your mask on

Israeli inventors have developed a coronavirus mask with a remote control mouth that lets diners eat food without taking it off, a device they say could make a visit to a restaurant less risky.

A squeeze of a lever, much like a cyclist operating a handbrake, opens a slot in the front of the mask so that food can pass through.

The process could get messy with ice cream or sauces, but more solid morsels can be gobbled up in a flash a la Pac-Man in the arcade game.

(Compiled by Karishma Singh; Editing by Christopher Cushing)

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What You Need to Know About the Coronavirus Right Now - The New York Times

Amphibious assault ship USS Makin Island (LHD-8) underway in the eastern Pacific on April 20, 2020. US Navy Photo

When a COVID-19 outbreak hit USSKidd (DDG-100) last month, the Navy sent a medical team with specialized lab equipment to the guided-missile destroyer to test for novel coronavirus among the crew. An outbreak at sea could easily and quickly overwhelm a warships small medical department, in this case an independent-duty corpsman and two hospital corpsmen in a crew of about 330.

Fortunately forKidd, amphibious assault ship USSMakin Island(LHD-8) was training in the Southern California Operating Area when the Navy on April 23 ordered it to rendezvous withKiddand escort it to San Diego.

Extra medical help was on its way. AboardMakin Islandwere four members of Fleet Surgical Team 1, who were training with the ships medical staff during the at-sea operations.

Withindays, as both ships headed toward California,15Kiddcrew members suspected of being infected by the virus were flown toMakin Islandto be monitored for the virus.

The big-deck amphibious ships medical department is among the largest, most-advanced treatment facilities in the fleet, aside from the Navys two hospital ships operated by Military Sealift Command. It has large treatment spaces, including a 15-bed intensive-care unit and a 45-bed ward designed to treat combat-wounded Marines.

Along with the four members already embarked onMakin Island, the San Diego-based FST-1 sent an additional four a certified registered nurse anesthetist, critical-care registered nurse, respiratory therapy technician and laboratory technician to the ship to help treat theKiddsailors. When deployed, a Navy fleet surgical team generally has about 15 medical personnel and provides Role 2, or resuscitative damage control surgery and mental health, care to naval amphibious forces.

Navy Counselor 2nd Class Caileigh Almazo, assigned to the guided-missile destroyer USS Kidd (DDG-100) on April 28, 2020. US Navy Photo

Once we were notified that there was a possibility that we would be helping the USSKidd, we decided to bring onboard four additional team members, just based on the possibility of getting patients, Lt. Jose PonceVega, the FST-1 division officer and medical regulating control officer, told USNI News.

As soon as we heard that call, we decided we were going to bring those people, said PonceVega. So within an hour, we called our staff and said, Hey, pack your bags, youre coming with us, and they were onboard within four hours.

They arrived the same dayMakin Islandgot directed to assist. The team had two-and-a-half days to prepare before the 15 sailors arrived. They workedwith Makin Islands medical department to treat the patients and handle necessary laboratory work and X-rays en route to San Diego.Our goal was to provide basically observation on the patients, based on their medical condition and based on the symptoms they were displaying, he said. The patients remained aboard theBremerton, Wash.-based shipuntil San Diego.

FST-1 sent one of its independent-duty corpsmen, who have specialized training including in preventative medicine, to theKiddtoassist the destroyers crew, PonceVega said. He is very experienced and very knowledgeable, so him going to that ship really helped out the crew and their medical staff.

On the trek to San Diego,Kiddgot extra support including fuel, protective masks and other medical supplies fromMakin Islandin air deliveries flown by Navy Helicopter Sea Combat Squadron 23, according to an Expeditionary Strike Group 3 news story. A MH-60R from Helicopter Maritime Strike Squadron 75, embarked aboardKidd, transferred the patients fromKiddtoMakin Island, which instituted quarantine and decontamination measures to prevent the spread of any coronavirus.

We were standing by and able to bring those sailors toMakin Islandwhile still maintaining isolation and quarantine of them and the medical professionals that we have onboard who treated them, said Capt. Chris Westphal, the ships commander, said in the news story. We took every precaution to ensure the safety of bothMakin IslandandKiddsailors, and to ensureKiddreturned to San Diego safely, and we were proud to be able to help our fellow shipmates.

The emergent mission put FST-1 members to the test. This was definitely new for us. I think with the spirit of protecting our people, we had made some plans to care for COVID-positive patients at some point, PonceVega said. As soon as we got out of the pier and started doing normal operations in the SoCal area, we started making plans for that. But we didnt expect to employ those plans right away. So we planned for it, but we didnt think it would happen so soon. So we learned a lot through that process.

FST-1 leaned on the Naval Health Research Center and the Navy Environmental Preventative Medicine Unit for information and lessons learned from similar missions.

USS Kidd (DDG-100) arrives in San Diego on April 28, 2020. US Navy Photo

One thing that weve learned the most is about how to use our protective personnel equipment, our PPE, said PonceVega. When youre taking care of a patient, you dont typically wear a mask and face shield, so just getting used to using that and putting it on and taking it off appropriately is a learning experience itself. So they practiced in drills using the protective gear enroute to theKidd.

They took measures to limit interactions of medical staff with each patient, at least until they knew whether the sailor was infected with the coronavirus. You dont need everybody to have close contact with a positive patient right away, PonceVega explained. So you assess the patient and figure out what you need, then if you need additional staff to support the care that youre going to provide, then you bring them in.

That ability to scale your staff, based on the needs of the patient, was definitely something we learned, he said. Also from the perspective from the administrative requirements of moving the patient from one ship to the other and tracking them through the levels of care, that was something we paid close attention to to make sure we got it right.

We had developed plans what to do with patients if we ha positive patients onboard. Our initial plans were to get the patient to a medical facility to get the care they need. But in this situation obviously we had to keep the patient longer than expected, he said, so coordinating that care to make sure that once you get to a location that they get to the right facility for care.

The Navys primary mission is to protect our people, he added, so we pride ourselves on being able to provide care to our sailors and be ready to respond to whatever the needs are of the fleet.

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How USS Makin Island, Fleet Medical Team Responded to COVID-19 Outbreak on USS Kidd - USNI News

Many residents are doing their part to help flatten the curve by sheltering in place and reducing visits to local businesses during the COIVD-19 pandemic. But when they dont got to an emergency department because of an illness or injury, the delay could be life threatening.

Bunch

At Riverview Health, Lynne Bunch, the program director of the Fishers and Hazel Dell ER/Urgent Care facilities, said she worries daily that people are waiting too long to see a doctor for fear of coronavirus exposure.

People are afraid to come out to the ER, and it leads to a much higher acuity level, or sickness, with people who dont have a choice and have to come, and thats dangerous for all kinds of reasons, Bunch said.

Delays in seeking care can make otherwise treatable medical conditions worse.

Preventative medicine is shut down, too, right now, so thats an issue in delaying diagnosis, Bunch said. I have several examples of people waiting, and our acuity is much higher than it has been because when they do come in, they are much sicker than they would be.

Bunch said if someone is second-guessing whether or not to seek care, the answer is to seek it.

If you have an acute illness, go to an emergency department. Our facility is a unique model because if you are urgent level care, you are billed urgent level care and you will still see an ER physician and ER-trained staff, Bunch said. If you do need to be an ER patient based on what ails you, we can do that right there, too, and you wont have to be transferred.

Fry

Ascension St. Vincent is noticing a similar downturn in its non-COVID-19 patients.

Our experience has been same as pretty much everywhere around country. The number of patients presenting with stroke and heart attack are down significantly, said Dr. Edward Fry, chair of cardiology atAscensionSt. Vincent. Initially, people were embracing that as a good thing, a silver lining to isolation. Maybe people were not stressed and sleeping more, exercising and eating better, but what we are really finding out is people are fearful.

We are seeing the same phenomenon where people are deferring care and staying home.

Fry said a recent patient had a prolonged episode of chest pain and eventually visited the hospital a week later, where it was discovered he had had a heart attack.

He was lucky enough to survive, Fry said. There are a lot of examples of that. We are trying, through many different ways, to connect to patients to reassure them that every precaution to keep them safe is being put in place and to not forget their original health problem they had in the first place, especially for things like heart attack and stroke where time is of the essence in terms of treatment. If someone presents in a short timeframe of having a stroke, they can often be treated and reverse the effects of that stroke. Otherwise, it can be disabling lifelong. Thats similar with a heart attack.

Fry said heart attack cases are down by approximately 50 percent as of early March, but he doesnt believe that means heart attacks arent happening.

Hoeppner

IU Health has seen similar examples of patients delaying treatment and is taking steps to ensure patients feel safe enough to visit the ER.

We are separating folks based on screening in the emergency department, Director of the Medicine Service Line Christen Hoeppner said. If people are worried about sitting next to somebody who possibly has COVID, we are physically separating them with a wall.

There are two areas of the department, two entrances, all of that.

IU Health Emergency Dept. Physician Megan Crittendon said IU Healths emergency department when the pandemic began but has slowed since then.

Crittendon

I would say the evolution of this thing has been really interesting, she said. Initially, people were coming in just like regular when it first started, and people were concerned they had COVID, and so we were very busy because of it. It then reached this steady state where people started dropping off and not coming in except only for COVID, and we were seeing people in the extremes of illness. They were waiting until they reached the extremis. It has kind of become apparent that people were concerned that they were going to get coronavirus or have exposure or use valuable resources, so we werent seeing a lot of minor stuff, but we also werent seeing serious stuff, stuff people get admitted for. People were coming in extremely sick because they waited such a long time, so we have mitigated that risk by dividing the emergency department and waiting rooms into a cold side and hot side, as we call it, a side for COVID-exposed or concerned and a side of not concerned.

We still treat everybody with the upmost precaution. We mask everybody to mitigate the risk of spread.

Like other hospitals, Community Health has seen a steep downturn in patients.

Ross

Statistics have indicated overall numbers (of non-COVID-19 patients) are down significantly, and those illnesses obviously dont wait for the COVID-19 pandemic to go away. They happen, regardless, said Dr. Chris Ross, a Community Health emergency medicine physician. The overall emergency department volumes (that are) down significantly makes me concerned patients arent seeking care when they need help.

Ross said delaying a visit can result in serious health problems, including death.

We have seen people who have had pretty significant permanent injury because of the wait and also people who have had deaths, he said. We see that directly attributed to waiting to be seen because of coronavirus. Family members are afraid to come to the emergency department because they are concerned of getting the coronavirus, but unfortunately that (non-COVID) illness (and waiting to seek treatment) made them pass away.

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The extremes of illness: Delaying a visit to the emergency room could be life-threatening for non-COVID-19 patients - Current in Carmel

For the one in four men who dont have a primary care doctor in the U.S., the coronavirus pandemic should be a wake-up call. With a virus circulating the globe that mostly targets the elderly but also indiscriminately strikes young, healthy people, having a doctor who knows you and who you can call on without walking into a clinic is crucial for personal health. It also makes hospitals and emergency rooms safer and more effective. Its time to add one to your roster. Well wait.

Right now, the most obvious benefit of a primary care doctor has to do with social distancing. Their offices are typically less crowded than clinics, and most visits can take place by phone or online. With far fewer people walking in the door, many offices are set up for patients to go straight into the exam room, and others have removed chairs in their waiting rooms to ensure ample personal space.

Nowadays, primary care doctors only see patients in-person for rare, medically-necessary visits (like removing sutures or for wound care) virtually all docs are holding appointments online or by phone. That hasnt always been the case. Before the pandemic, telemedicine wasnt on our radar, says Dr. Ada Stewart, a family physician at Cooperative Health in South Carolina and president-elect of the American Academy of Family Physicians. Now its wide open. Were all doing it, she says.

The same is true in practices across the country. Weve all been hoping for telemedicine for a long time, adds Dr. James Heckman, a primary care doctor and assistant medical director at Healthcare Associates in Boston. COVID kind of forced the issue.

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A relationship with a primary care doctor goes beyond annual appointments or drop-in sick visits. They can be a trusted resource for medical questions, COVID-related, or otherwise. Once you have a primary care doctor, you have a doctor on retainer, says Dr. Olveen Carrasquillo, chief of general medicine at the University of Miami Health System. If you hear a dubious medical claim, you can just shoot your doctor an email or give them a call. We get that all the time, Hey, I just saw this on TV, what do you think about it? Dr. Carrasquillo says.

Another benefit primary care doctors offer has to do with preventative medicine. Your doctor is there to help you figure out if youre at risk for certain diseases, pick up signs of depression or anxiety, and manage other chronic conditions. They provide flu shots, tetanus shots (you should get one every ten years), colonoscopy exams (screenings should start at age 50, for most people), regular physical exams, and when the vaccine for the coronavirus finally rolls out, your primary care doc will have those too.

Were going to be on the front lines being the ones that are able to offer this, says Dr. Stewart. And encouraging patients to be vaccinated, just as we do with other vaccines that are out there.

If you get a primary doctor now, your first appointment is almost certainly going to be virtual. That first visit is about reviewing your medical history, figuring out a health care plan, and beginning a new relationship. Most of that can be done over the phone or with a video visit, says Dr. Heckman, of Healthcare Associates. Once were able to provide safe in-person care for routine things, well bring you in to do a physical exam and do the handshake, which is the most important thing.

But there are a few ways you can prepare. Start by writing down your medical and surgical history. (People forget a lot of stuff, says Dr. Carrasquillo.) Have your pill bottles on hand, so you can be sure of the names and dosages of your medications. Take note of what issues you want to address, and try to carve out a private place where you feel comfortable talking with your doctor. Finally, have your insurance information ready, or if you dont have insurance, have a social security or unemployment statement, advises Dr. Stewart.

And for patients who need their vitals taken or lab work done, your doctor will help you work out a plan. They can arrange a visit to a nearby commercial lab, or figure out creative ways to monitor your breathing or check your blood pressure. Dont worry about not having what you need, reiterates Dr. Heckman. Well troubleshoot. The best thing to do is just call usreach out to us.

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Its Time to Get a Primary Care Doctor - Fatherly

Close observers of gun politics might be surprised to learn that decades-long Chicago gun control advocate and Catholic priest Father Michael Pfleger is in fact capable of some logic.

An Agence France-Press piece on the continuing violence in Chicago amidst the COVID-19 lockdown shared Pfleger's thoughts on the Windy City's crime problem. Eschewing the notion that the ongoing lockdown could have ever stemmed the violence, AFP reported,"Pfleger argued that someone who was prepared to commit murder was unlikely to be too bothered about observing a stay-at-home order."

Pfleger's key insight will be familiar to gun rights supporters. Second Amendment activists have long understood that gun laws do not stop violent criminals. Simple logic dictates that an individual willing to commit criminal violence will give little thought to violating gun control laws. In bumpersticker form, this reads: When guns are outlawed, only outlaws will have guns.

Despite Illinois's stringent gun control laws, Chicago criminals have little trouble securing firearms. A 2015 study published in Preventative Medicine titled, "Sources of guns to dangerous people: What we learn by asking them," queried inmates in the Cook County Jail about where they obtained firearms. The overwhelming source was "family, fellow gang members, or other social connections." Discussing the efficacy of Illinois's firearms licensing system, an inmate opined, "All they need is one person who got a gun card in the hoodand everybody got one.In fact, the authorities can't even keep guns out of the Cook County jail.

It's unfortunate that this simple deduction only came to Pfleger in his 70s, as it might have spared Chicagoans some of the priest's more inane antics.

In 2007, Pfleger teamed up with social justice gadfly Jesse Jackson to protest a gun store in the Chicago suburb of Riverdale for having the temerity to sell guns to those who had already complied with Illinois's onerous licensing procedure. Pfleger and Jackson were arrested after trespassing on the gun store's property. Seeming to set aside the sixth commandment, during the incident the priest said about the gun store owner, "We're going to find you and snuff you out."

Following the landmark U.S. Supreme Court decision in District of Columbia v. Heller, the handgun prohibitionist joined then-Illinois Governor Rod Blagojevitch (a one-time Firearm Owner's Identification card holder) to condemn the ruling.

Pfleger's anti-gun foolery seems to be too much even for his Chicago comrade Barack Obama. In 2016, then-President Obama held a CNN "town hall" on guns. During the contrived presentation, Pfleger asked Obama why the federal government won't institute full firearms registration. Obama shot down the priest's tired proposal, stating, "Issues like licensing, registration, that's an area where there's just not enough national consensus at this stage to even consider it. And part of it is, is people's concern that that becomes a prelude to taking people's guns away."

Now that Pfleger has demonstrated a rudimentary understanding of the criminal mind and a capacity for reason, one would hope the priest could apply this basic knowledge to his activism. Don't hold your breath.

Originally posted here:
Father Pfleger's Selective Reasoning - NRA ILA

Researchers need 30,000 health care workers from around the world to join the clinical trial to see if chloroquine can help prevent the novel coronavirus

ST. LOUIS A global study based in St. Louis launched Monday. The clinical trial will look at how 30,000 health care workers from around the world respond to a possible COVID-19 prevention medication.

"The world is a global village. We cannot successfully fight and defeat COVID-19 just in St. Louis, Missouri," explainedDr. Michael Avidan with Washington University's School of Medicine.

Dr. Avidan is leading a team of investigators from the U.S., U.K., South Africa, Ireland, Peru and many more countries on nearly every continent. The researchers will follow 30,000 health care workers who volunteer to be part of the study.

"They're at higher risk than the average person for developing this disease," explained fellow Washington University School of Medicine Professor Mary Politi.

Health care workers also are critical for public care. The researchers are hopeful that by testing preventative treatments like chloroquine they can fight COVID-19 more effectively.

"If you combine human ingenuity, if you put all of our efforts together, if we're collaborative and not competitive, there is no question in my mind that we will defeat this pandemic and future pandemics," Dr. Avidan told 5 On Your Side.

And that's exactly what he hopes to do with the group of international investigators called the "COVID-19 Research Outcomes Worldwide Network Collaborative," or CROWN for short.

CROWN rolled out the plan for its randomized study on Monday, May 18. Researchers will look at the effectiveness of three doses of chloroquine compared to a placebo in health care workers who are healthy and not previously affected with a novel coronavirus.

Avidan said chloroquine can decrease the replication of the COVID-19 in cells. It can treat pulmonary hypertension, high blood pressure of the blood vessels in the lungs.

He said the drug can be also helpful in treating pneumonia and it can prevent the harmful immune reaction of the body that can occur with COVID-19.

It's important to note, the drug CROWN is working with is chloroquine, not the similar but more frequently referenced hydroxychloroquine.

"My suspicion is that what we will land on is not a single drug, but a combination of therapies will be most efficacious," Dr. Avidan explained. "And chloroquine will probably be one of the drugs that will be helpful, although we don't know that for sure. We need to find that out one way or the other."

Now, all his team needs is 30,000 health care workers from all over the world to sign up for the trial.

Dr. Avidan said no matter the clinical trial, participation is vital.

"We encourage you, all of you, to participate in a clinical trial, sign on and be enthusiastic. Because the more people we have participating in the research that we're doing, the more quickly we can answer these foundational questions that we have to figure out, as a society," he said.

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Washington University leads global COVID-19 treatment study for health care workers - KSDK.com

Ground-breaking new study shows the efficacy of a long-acting injectable to prevent HIV

GENEVA, 19 May 2020UNAIDS warmly welcomes the announcement that the long-acting injectable cabotegravir is safe and effective in preventing HIV among gay men and other men who have sex with men and transgender women. The HIV Prevention Trials Network (HPTN) 083 study enrolled almost 4600 HIV-negative people from across more than 40 sites in North and South America, Asia and Africa.

This is a breakthrough that will have a significant impact on the lives of gay men and other men who have sex with men and transgender women when they are at higher risk of HIV infection. said Shannon Hader, UNAIDS Deputy Executive Director, Programme. We are particularly pleased that the study met its targets to recruit substantial numbers of younger black men who have sex with men and transgender women, the very people for whom accessing effective HIV prevention still remains a huge challenge.

In 2018, UNAIDS estimates that there were 1.7 million new HIV infections, 54% of which were among key populations, including gay men and other men who have sex with men, transgender women, sex workers, people who inject drugs and people in prison.

Pre-exposure prophylaxis (PrEP)HIV-negative people using antiretroviral medicine to prevent HIV infectionis an important element in the HIV combination prevention toolkit. PrEP allows people to reduce their risk of becoming infected with HIV, particularly during periods of increased risk in their lives. It may also provide reassurance and reduce anxieties when the risks are uncertain.

Once it has passed regulatory approval, and when production of affordable cabotegravir can be scaled up, gay men and other men who have sex with men will have the choice of three highly effective ways to use PrEP to prevent HIV infection: daily pills, pills taken before and after sexual activity (event-driven PrEP) or an injection every two months. Transgender women will be able to choose between injections or daily pills, since the World Health Organization does not recommend event-driven PrEP because of possible drug interactions with some hormones. Injections of cabotegravir every two months are an important option for people who find it hard to take a pill every day, yet remain vulnerable to HIV infection.

The trial was scheduled to continue for at least another year, but the first interim analysis of the data was brought forward a few weeks because of the potential disruption that the COVID-19 pandemic might cause to high-quality clinical trial procedures. The Data and Safety Monitoring Board (DSMB) in the United States of America reviewed the data up to March 2020 and found that there was already clear evidence that cabotegravir was highly effective and not inferior to the currently recommended oral PrEP regimen.

Half of the study group were given oral PrEP and were injected with a placebo; the other half were given a cabotegravir injection and took a placebo pill. The study found a total of 12 HIV infections in the group using the injectable compared to 38 in the group taking the daily pill. The side-effects of both treatments were relatively mild, with only 2.2% of people in the injection group choosing to stop having the injections because of painful reactions. The DSMB therefore recommended that the study be halted and that all participants be notified of the result. The participants will be able to choose which regimen they wish to continue on.

Despite good adherence in the oral group and very few discontinuations in the injection group, the overall incidence of HIV infection in the study was 0.79 per 100 person-years. Planned analyses will explore why those 50 infections occurred among the 4565 trial participants.

An additional study (HPTN 084) is ongoing to establish the efficacy of the long-lasting injectable in non-transgender women. To date, more than 3000 sexually active women in seven African countries have enrolled in the study. Those results are expected in November.

We are eagerly awaiting the results of the ongoing HPTN 084 study among African women, said Dr Hader. We hope that by the end of this year there will be equally good news for women around the world.

HTPN 083 was conducted by the HPTN and funded by ViiV Healthcare and the United States National Institute of Allergy and Infectious Diseases. Cabotegravir has not yet been approved for the treatment or prevention of HIV as a single agent by regulatory authorities anywhere in the world. ViiV Healthcare plans to use the data from HPTN 083 for future regulatory submissions.

UNAIDS congratulates the research teams and urges continued investment in research and development for HIV vaccines, diagnostics, preventative medicines, treatment and a cure.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizationsUNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bankand works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

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UNAIDS welcomes new tool for HIV prevention for gay men and other men who have sex with men and transgender women - UNAIDS

As one of the most destructive business sectors, the fashion industry is poised for change, and COVID-19 might just be the catalyst it needs to become a more sustainable and ethical industry.

The COVID-19 pandemic has shed light on bad practices and unsustainable business models across industries, but one sector in particular has found itself at the forefront of this exposurethe fashion industry.

As one of the worlds most destructive business sectors, fashion is the worlds second worst offender when it comes to water pollution, according to the 2019 Global Wellness Trends Report, and is responsible for approximately 10 percent of all carbon emissions. Not to mention, with overproduction running 30 to 40 percent each season, more than 70 percent of clothes end up in a landfill and an estimated $500 billion value is lost every year due to clothing being barely worn and rarely recycled, The Business of Fashion reports.

As weve seen the crisis unfold, the issues of resilience, or lack thereof, and various aspects of the supply chain have come to the fore within both the fashion and apparel space, said Niall Murphy, CEO and cofounder of EVRYTHING, a tech platform providing digital identities for the worlds consumer products and a pioneer in bringing transparency to the fashion industry. And in other categories, weve seen businesses called out, actually, with dependencies in their source materials, their raw materials, their components within their supply chain that they didnt realize that they had because they dont have sufficient level of visibility across the supply chain.

Last week, Murphy was joined by Vanessa Barboni Hallik, founder and CEO of sustainable fashion brand Another Tomorrow; e-commerce pioneer Julie Wainwright, founder and CEO of The RealReal; and Kathleen Entwistle, private wealth advisor at UBS, for a discussion with Worth CEO Juliet Scott-Croxford about how the business of fashion is changing amidst COVID-19 and how sustainability, brand values and innovative technology will play a larger role in how consumers choose their apparel in a post-pandemic world.

Weve had challenge after challenge in both going fromwe couldnt hire fast enough to now we have to lay people off, Wainwright said. Weve boarded up all of our stores. Hopefully, we can start doing curbside pickup at some point, but its been tough. On the flip side, the company and the team have shown tremendous innovation. The management team, the directors, the entire company has innovated beyond scope. And so, were going to end up in a really unique position when we pull out of this, which were starting to see some light.

But as supply chains have globalized over the last several years, the issues facing the fashion and apparel industry cut much deeper than just the current crisis. I think fashion and sustainability has been a hard sell historically, Barboni Hallik said, noting that this unique moment could be seen as a test for the fashion industry because it really has allowed so many people in so many critically vital areas of the economy to become seen in a way and create that empathy.

All of the panelists agree that consumer education is critical. I do think the first thing is understanding and having the information out there and available to people, UBS Entwistle said.

One of the things that I think is challenging, in terms of getting consumers to think about clothing as an asset, is this really disruptive sales cycle that the industry is in, Barboni Hallik added. And I think its really positive to see that some of the world is changing, but its very difficult to train a customer to think about clothing as an asset, when the retail price is only the retail price for a month, two months at best. And then its 40, 50, 60 percent off. So, I think thats really challenging. I do think that the education piece and the communication piece is so important to actually enable customers to make better decisions. It was one of the major reasons why I started Another Tomorrow, because I found it just so incredibly frustrating to actually get any level of procurement information about how a product was made. Youre pretty much lucky to know what country its manufactured in, let alone how it was made.

But even more important than education alone is that education, at least according to Wainwright, is turned into policy.

Until laws change, even COVID isnt going to change some of the practices, Wainwright explained. So, laws have to change. We cant continue to produce so many goods that end up in landfill. Theres a truckload a second going into landfill as we speak; 50 percent of whats made doesnt sell. A lot of the luxury brands are still burning their bags because they can. Theyre still burning their things because they can. Burberry stopped. Burberry partnered with The RealReal. Were in conversations with other large brands. But until the governments really force it, COVID is not going to force sustainability. We view this as a serious issue.

Look, consumers, its going to be tough, Wainwright continued. Were at this pivotal point where what governments do to help their people get back to work and also their focus on getting a vaccination and preventative medicine, how much effort is going to determine every countrys economy, and thats a weird thing to say. As an entrepreneur, you like to think you chart your own destiny, but this is bigger than whatever any of us are doing here. Governments are going to help get people back on their feet. Theyre also going to help science help give us some form of living with this horrible situation.

I do think that Julies point is right, that theres a macro situation thats much bigger than any of us, Murphy added. And weve got to keep our eyes on how those things affect us. But I am tremendously motivated by the degree of collaboration, and just conversations like this, thats going on every day across industries where people are trying to work out how to find paths to solution. And that bodes well, thats what you want to see in humanity, is collaboration and working out how we solve each others problems together. And Im pretty optimistic about the fact that were going to dig ourselves out of this hole. Were going to dig ourselves out of this hole well.

An indispensable guide to finance, investing and entrepreneurship.

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How the Current Crisis Could Impact the Future of Fashion Forever - Worth

NewsDeepMind's AI system can spot both the presence of age-related macular degeneration in eyes and predict its progression

Tuesday, 19th May 2020, 9:57 am

Google's DeepMind research lab has developed a form of artificial intelligence (AI) that is not only capable of detecting the presence of a sight-threatening eye condition but predicting its progression over six months.

The research, conducted in partnership with Moorfields Eye Hospital and Google Health, concentrated on age-related macular degeneration (AMD), the UK's most common cause of sight loss.

While around three-quarters of patients with the condition have a relatively mild, early form called "dry" AMD, a further 15 per cent will develop exudative or "wet" AMD - which can cause permanent vision loss as a result of blood vessels leaking fluid under the eye's retina.

Early detection of wet AMD allows ophthalmologists to treat the condition, lowering the likelihood of permanent loss of a patient's central vision.

Interventional and preventative tool

The researchers developed an AI system capable of predicting whether a patient will develop wet AMD within six months, which could be a useful interventional and preventative tool.

The model was trained on an anonymised dataset of 2,795 patients who had been diagnosed with wet AMD in one of their eyes and were being regularly assessed using 3D optical coherence tomography (OCT) images of the retina.

It used two neural networks informed by raw 3D scan of a patient's eye and different tissues within the retina to develop a prediction system capable of estimating a patient's likelihood of developing wet AMD in the next six months.

When testing against the assessment skills of experts three retinal specialists and three optometrists, the system performed as well as, and in some cases better than, the clinicians in predicting the progression of wet AMD.

The findings, published in medical journal Nature Medicine, could inform doctors in developing and studying preventative treatments for eye diseases.

More data required

While the system shows promise, it would be subject to robust clinical trials and regulatory approvals before it could be considered as a tool for doctors, Google Health said.

"The sample was representative of practice at multiple sites of the worlds largest eye hospital, but more work is needed to understand the model performance in different demographics and clinical settings," it said.

"Such work should also understand the impact of unstudied factorssuch as additional imaging teststhat might be important for prediction, but were beyond the scope of this work."

The British Medical Journal recently warned that many studies claiming AI is superior or as good as human experts at interpreting medical images may exaggerate machines' diagnoses ability and pose a potential risk to patient safety.

It cautioned that overpromising language "leaves studies susceptible to being misinterpreted by the media and the public, and as a result the possible provision of inappropriate care that does not necessarily align with patients' best interests".

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DeepMind: Google AI can predict the progression of sight-threatening eye conditions - inews

In the ongoing battle against the novel coronavirus, health care providers have recently started considering a type of patient that was previously overlooked: children.

While medical experts previously thought that COVID-19 was confined primarily to adults, they are now learning it is not exclusive to those older than 21. In the past few weeks, as New York City is just starting to move past the peak of the outbreak, upwards of 130 children have reportedly been treated in the states hospitals with symptoms of what the U.S. Centers for Disease Control and Prevention is now calling multisystem inflammatory disease in children (or MIS-C), an illness that doctors believe springs from exposure to COVID-19 and causes an inflammation in at least two of the patients organ systems. Florida recently confirmed its first two cases.

Although Florida has not seen the number of children that New York has reported, cases are beginning to emerge in children in 18 other states and throughout Europe. So, pediatricians at the University of Miami are on high alert, said Dr. Judy Schaechter, chair of the Department of Pediatrics at the Miller School of Medicine and chief of service in child health at Jackson Health Systems. In her role, Schaechter teaches in the Miller School and sees patients at Jacksons Holtz Childrens Hospital, as well as in an outpatient setting at the Universitys Mailman Center for Child Development. She recently completed a two-week rotation in the COVID-19 unit at Holtz Childrens Hospital.

Schaechter shared what to look for in monitoring children for signs of this illness.

What do we know so far about multisystem inflammatory syndrome, this COVID-19 spinoff that is affecting children?

We are still learning about this condition, but what we do know is that it is associated with a positive coronavirus test (or past exposure to it), along with a persistent high fever (over 100.4 degrees for at least 24 hours) and the involvement of at least two organ systems in distress. That might be gastrointestinal disease (which could mean abdominal pain, diarrhea, or vomiting), cardiac problems, respiratory symptoms, skin findings like a rash or swelling, headaches, fatigue, or other issues.

In addition, this syndrome seems to be presenting three to four weeks after the local community peak of COVID-19 occurs. In Miami-Dade, our COVID-19 cases peaked in April, and then we hit a plateau. We have seen a sustained number of coronavirus cases for more than a month, so we are on alert to watch for MIS-C and we are prepared to care for any child with this condition.

While Miami physicians are looking out for it and are in touch with our colleagues throughout the country, we encourage parents to take care of their children as they always would with any illness concerns. If you think your child is sick, call the doctor and discuss your concerns and any symptoms.

Moving on to COVID-19 in children. News reports seem to indicate there is a larger range of symptoms among children than adults. Are the symptoms of COVID-19 in children different?

It is still true that most children seem to be resilient to the new coronavirus. A majority of those infected will be asymptomatic. Still, if a parent is concerned a child is sick with anything, its okay to call the pediatrician. Because what were learning is coronavirus may present in children in atypical ways, or at least in ways that are distinct from the signs in adults.

The pandemic is evolving in front of us, so theres a lot we still dont know. Some kidsincluding teensmay present very much like adults in terms of respiratory symptoms like shortness of breath and inflammatory markers. (These are indications in the blood that organs are struggling.) In general, everything youve heard of what happens to adults (dry cough, muscle aches, fever, and shortness of breath) can happen in kids; but so far, it is less often. The research out there tells us that children experience less fever and cough than adults, so the presentation of COVID-19 in kids may be milder. For example, among children who were hospitalized for COVID-19 in China, only 48 percentless than halfhad a fever. Some hospitalized kids also experience rapid heart rate or rapid breathing; some have the loss of taste and smell. But based on what we know now, the vast majority of children will be asymptomatic and dont need any special treatment.

In the past few months, many parents have been afraid to take their children to the pediatricians office because they feel it may risk exposing their family to COVID-19. In this situation, what would you advise them to do?

If your child has a fever and looks sick, then you need to call and consult with a pediatrician. If they need to come in, get them that help and dont delay.

We know how to protect the people around uspatients, families, and staffin a health care setting. Pediatricians offices are using masks, practicing physical distancing, and separating the well-children from sick children in our offices. We do not have crowded waiting rooms, and we are disinfecting surfaces and using proper hand hygiene. Im confident that its much better to get the care a child needseither preventative care or care for a symptom by calling a physician and going into their officerather than for a child to be staying at home without a physician involved when care is needed.

I also want to urge parents to get children their regular vaccines. We dont want an outbreak from something preventable, such as measles or pertussis, because we are not vaccinating our kids. And we dont want kids to have more complicated disease because we delayed their care.

As things begin reopening in Miami, do you think its safe to send children to day care facilities?

This is a family by family decision. Up to 20 percent of childcare centers have stayed open in Miami-Dade, including our on-campus facility. Lets remember that the vast majority of childrenif they have COVID-19dont get sick. Also, children do not seem to be the ones primarily transmitting the virus to others, and children over the age of two can wear masks. So, for people who need to go back to work and who want to see their children get the great social benefits from being in school, I wouldnt fault them. But I also would not fault parents who want to keep their children at home and have a way to do so.

Coronavirus is going to be with us for a while, so itll be important to figure out how we live, work, and educate ourselves in this new normal. That means making it routine to wear a mask, practicing frequent hand hygiene, observing social distancing, and keeping away from others if you are having any symptomseven if you think it may be nothing. We have to be sure our culture is also about protecting others. If your child is sick, keep him or her at home.

What would you tell parents who are anxiously watching the headlines about this syndrome?

The numbers are small, and the chance that this will happen in your family is not something to panic about. We have the resources to take care of children here [at UHealth]. So, if your child is sick, let us know. We will thoroughly assess your child and provide the care that is needed. Still, remember this is very rare.

Its important to remember what hasnt changed: Dont worry about what you cant control. On the other hand, if your child has a fever, isnt eating, or otherwise seems ill, call your doctorjust as you would have before the pandemic.

Also, focus on what we can control. We can physically distance, use masks ourselves, and teach young children about the importance of wearing a mask for their protection and to protect others. We can all make sure we are washing our hands often and well.

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Illness that is a by-product of COVID-19 affects children - University of Miami