StemCell Therapy

LEXINGTON, Ky. (April 28, 2020) As the coronavirus lockdown presses on, the impact that it is having on children and families is undeniable. However, the impact varies greatly depending on each child and their familys situation. Children of health care workers, for example, may see their parents less and worry more about them when theyre at work. For younger children, this may be their first time hearing about hospitals, illness and death, which can lead to difficult conversations. Knowing their grandparents are more susceptible can lead to more stress and anxiety. As sports seasons, proms and graduations are canceled, and kids have prolonged separation from friends and extended family, it can be even more difficult to bolster morale, particularly as many parents face financial uncertainty.

We know that children do best on some kind of routine. Many parents stepped up like champions in the beginning in of the COVID-19 crisis; They started managing schoolwork, developing creative projects and planning activities. For the first few weeks, many parents felt that they could manage this arrangement. But as the lockdown has continued for weeks with no official end in sight, many parents have wavered. School is hard under the best of circumstances and kids may find it harder to concentrate at home. Schools, daycares and extended family are key for many families to be able to function, and it becomes harder and harder to manage that routine, especially when parents must also work from home or may be facing financial pressures or losses.

But kids are resilient. We can help our kids through this. Weve learned from other natural disasters that in the long-term, most kids will recover. Most of the challenges are kids are facing are likely temporary. With every challenge our kids face, we have an opportunity to support them and to teach them resiliency.

What can we do to support our kids?

Finally, take care of yourself and reach out for help when you need it for your child or yourself. This is a marathon, not a sprint. Parents need to remember to take care of themselves to be able to continue to support their kids. Many people in your community may be able to offer emotional support or help you find resources to help your family manage current challenges.

Continue reading here:
In the Face of an Unprecedented Crisis, Kids Can Bounce Back - UKNow

A high fever is considered one of the symptoms of COVID-19, the respiratory illness caused the novel coronavirus. However, a new study of New York patients published in the Journal of the American Medical Association revealed that two-thirds of the seriously ill patients did not have a fever. The study also found several commonalities among the previous medical conditions the patients had.

The study was published on Wednesday and studied 5,700 patients hospitalized in New York City, Long Island and Westchester County at hospitals in the Northwell Health system between March 1 and April 4. The most common conditions among the patients were hypertension, obesity and diabetes. Just over half of the patients suffered from hypertension, and 41.7% suffered from obesity. Just over 33% percent had diabetes.

"The most surprising finding to me was that two-thirds of the patients who were seriously ill with an active infection did not have a fever," senior researcher Karina Davidson, M.D., told KTRK-TV. Fever is usually the first symptom doctors check for, but Davidson said some of the sickest patients in the study did not exhibit a high fever. "This is a puzzling infection," she added. "Different people have different symptoms, some of them mild, some of those severe."

Davidson noted that studies of COVID-19 are showing it is more that a lung disease. "It is going to have not just short-term effects that are deleterious on many target organs, but we may be looking at an infection that has long-term consequences," she explained.

Of the patients included in the study, 553 died. As of April 4, 1,151 patients needed mechanical ventilation, and 282 of those died, while 831 were still in the hospital. Men were more likely to die than women in every age group studied. More patients with diabetes developed acute kidney injury compared to those without.

A fever higher than the typical 98.6 degrees Fahrenheit is one of the symptoms of the coronavirus, but experts told CNN patients should not be fixated on a specific number. A person is not usually considered feverish until their temperature hits 100 degrees Fahrenheit.

"There are many misconceptions about fever," Dr. John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, explained to CNN. "We all actually go up and down quite a bit during the day as much as half of a degree or a degree," he said, adding that for many, "99.0 degrees or 99.5 degrees Fahrenheit is not a fever."

Infectious disease expert Dr. William Schaffner, a professor of preventative medicine and infectious disease at Vanderbilt University School of Medicine in Nashville, also explained that taking your temperature early in the morning is not a good idea. "Our temperature is not the same during the day. If you take it at eight o'clock in the morning, it may be normal," Schaffner said. "One of the most common presentations of fever is that your temperature goes up in the late afternoon and early evening. It's a common way that viruses produce fever."

Other symptoms of COVID-19 include shortness of breath, dry cough, chills and body aches, sudden confusion, pink eye, digestive problems, loss of smell and taste, fatigue and headache, sore throat or congestion. Symptoms can appear between two to 14 days after exposure to the coronavirus, according to the Centers for Disease Control and Prevention.

Follow this link:
Doctors Puzzled by Report Claiming Two-Thirds of 'Seriously Ill' COVID-19 Patients Didn't Have Fever - PopCulture.com

The National Institute of Allergy and Infectious Diseases the agency run by Anthony Fauci has launched the first randomized, controlled trial of remdesivir, enlisting about 1,060 patients worldwide. The agency released data from the trial on April 29 that shows the drug shortens time to recovery. Those taking it in the trial recovered after an average of 11 days, compared with an average of 15 days for participants who were given a placebo.

Two Chinese trials were halted this month because of a lack of enrollment, purportedly due to a lack of patients with Covid-19 as Chinas outbreak wanes. Results from a trial in more severe Covid-19 patients were published on April 29 in The Lancet, and did not show statistically significant clinical benefits.

Outside of the trials, Gilead is still allowing patients to access the intravenous drug via a compassionate use program. Its donating 1.5 million doses enough to treat more than 140,000 patients for use in clinical trials and compassionate use programs.

Approved in Japan in 2014 to treat the flu, Fujifilms antiviral brand name Avigan never hit the market because of concerns it could cause birth defects. Its now being tested against the coronavirus in Japan and the U.S. The Japanese government is also stockpiling 2 million treatment courses of the drug, betting that it will be effective because it disrupts the process by which the coronavirus, and related viruses, replicate.

Fujifilm launched a Phase III clinical trial in Japan on March 31 to assess favipiravirs safety and efficacy. The company did not provide any further details on the trials design or duration.

The company also started a Phase II trial this month for about 50 patients at three Boston-area hospitals, including Brigham and Womens Hospital, Massachusetts General Hospital and the University of Massachusetts Memorial Medical Center.

Zhang Xinmin, an official at Chinas science and technology ministry, told the China Daily last month that favipiravir produced encouraging results in clinical trials of 340 patients in Wuhan and Shenzhen.

First approved by the FDA in 2010 to treat rheumatoid arthritis, Roches drug marketed as Actemra blocks a type of severe inflammation, called a cytokine storm, seen in the lungs of some coronavirus patients. Studies from China have shown that neutralizing cytokine storms helps to reduce deaths in severe cases of Covid-19. Last month, China approved the use of Actemra to treat Covid-19, but clinical trials of the drug are continuing.

Results from an open-label trial in France showed improved outcomes for people taking the drug who had moderate or severe Covid-19 pneumonia. The trial compared 65 participants randomly assigned to receive tocilizumab and 64 who were given standard care.

Roche is sponsoring a Phase III trial of 330 hospitalized patients with severe Covid-19 pneumonia in the U.S. and Europe. It will evaluate the efficacy and safety of tocilizumab compared with a placebo in combination with standard treatment. A Roche spokesperson said the results could be released in early summer.

The National Cancer Institute of Naples has enrolled 2,111 people across Italy in a Phase II single-arm trial which means that every patient will receive tocilizumab, and there is no control group. The researcher leading the trial told POLITICO that results are expected in the next three weeks.

At least four other trials are ongoing at hospitals across China, Roche said, but they are not placebo-controlled. Results from one of those studies, which involved 21 patients, showed improved clinical outcomes. The findings were published on April 29 in the Proceedings of the National Academy of Sciences.

Approved by the FDA to treat rheumatoid arthritis, this Eli Lilly drug a.k.a. Olumiant was identified as a potential coronavirus treatment by a U.K.-based artificial intelligence system. Lilly initially expressed caution about using baricitinib in Covid-19 patients because it suppresses the immune system, according to The New York Times, but eventually agreed to test the medication because doctors had started using it off-label. The drug company is working with the National Institute of Allergy and Infectious Diseases to study baricitinib as part of a placebo-controlled trial in the U.S., Europe and Asia that also includes Gileads remdesivir. Data on baricitinib is expected in the next two months, according to Lilly.

AstraZenecas drug, also known as Calquence, is approved to creat a pair of blood cancers: chronic lymphocytic leukemia and mantle cell lymphoma. Now its being eyed as a treatment for coronavirus patients in the grip of cytokine storms. The drug company said last week that it will undertake a randomized, controlled trial of Calquence. NIH Director Francis Collins said this week that he was surprised by the early clinical data, but he also said hell wait for the trial results before drawing any conclusions about the drugs usefulness.

Convalescent plasma is a decades-old treatment that involves giving sick patients the antibody-rich blood plasma of people who have recovered from the same illness. The approach has a mixed track record, but its being tried again with the coronavirus as is a treatment known as hyperimmune globulin, which is derived from convalescent plasma and also contains high levels of antibodies.

New Jersey-based Hackensack University Medical Center is running a Phase IIa study with 55 participants to determine the best dosing for convalescent plasma treatment.

Erasmus University Medical Center in the Netherlands is recruiting 426 patients for a Phase II trial to compare convalescent plasma with the standard of care.

Nine hospitals in Spain will enroll 278 hospitalized patients with Covid-19 to compare convalescent plasma with the standard of care.

The FDA is also helping to coordinate a study of hyperimmune globulin that will be conducted by the National Institute of Allergy and Infectious Diseases.

Hospitals in China have used corticosteroids in an attempt to tamp down inflammation in coronavirus patients, but its not yet clear whether this strategy is effective, according to the Centers for Disease Control and Prevention. The agency has warned against using the drugs to treat Covid-19, because patients with the MERS coronavirus or flu who were given steroids were more likely to die than those didnt get the drugs. Still, there are multiple trials now testing various steroids against the coronavirus.

A U.K. government-funded study of 5,262 Covid-19 patients at 167 sites that began in March is testing four different treatments, including a low dose of the steroid dexamethasone.

Scientists in South Korea are recruiting 144 people to investigate whether the steroid ciclesonide alone or in combination with hydroxychloroquine could help patients with mild Covid-19.

The malaria drugs have been at the center of a media storm, after President Donald Trump and his allies began aggressively promoting them as coronavirus treatments despite a lack of data. Pharmaceutical companies have donated millions of doses to the U.S. Strategic National Stockpile, and almost 100 clinical trials have sprung up since the FDA issued an emergency use authorization in early April to distribute the both drugs to coronavirus patients.

At least one clinical trial of hydroxychloroquine was halted because the drug caused life-threatening cardiac side effects a risk long known to doctors who use the drug to treat lupus and rheumatoid arthritis.

The NIHs National Heart, Lung and Blood Institute is helping to conduct a blinded, placebo-controlled Phase III trial to evaluate the safety and effectiveness of hydroxychloroquine in 510 adults hospitalized with Covid-19. The trial began enrolling patients in Tennessee on April 2, and will extend to 44 sites nationwide. A spokesperson for Vanderbilt University Medical Center said results will come in a couple of months.

The University of Minnesota is conducting a Phase III trial in 3,000 participants to determine if hydroxychloroquine can help prevent or treat Covid-19. Results are expected about two weeks after the trial is fully enrolled, a university spokesperson said.

Trials at the University of Utah and Intermountain Medical Center in Utah are comparing hydroxychloroquine and azithromycin in 300 patients hospitalized with Covid-19. The timing of its results depends on how quickly researchers can enroll participants, said Dr. Samuel Brown, Intermountains director of pulmonary and critical care research.

Three hospitals in New Jersey are conducting a 160-person randomized trial that will compare hydroxychloroquine alone and in combination with the antibiotic azithromycin to a control group that receives standard care for the first six days. After that point, any patients with symptoms of the coronavirus will receive the malaria drug.

The University of Pennsylvania is conducting a three-part trial that includes a randomized, controlled study of hydroxychloroquine as a treatment for home-bound coronavirus patients; a randomized trial testing different doses of the drug in hospitalized patients; and a randomized, controlled trial of low doses of hydroxychloroquine as a preventative treatment for health care workers.

It took just 63 days from the time the company started designing its vaccine to launch the first clinical trial, a rapid pace made possible in part by Modernas use of genetic material called messenger RNA. When that mRNA is injected into a patient, it directs cells to make a protein found on the coronavirus and stimulates the production of antibodies.

No mRNA vaccine for any disease has yet won approval, but the technique has tantalized public health experts because churning out doses using this technology would be cheaper and easier than making traditional vaccines. The U.S. governments Biomedical Advanced Research and Development Authority has pledged up to $483 million to accelerate the Moderna vaccines path to FDA approval.

In March, the Kaiser Permanente Washington Health Research Institute in Seattle began enrolling patients in a Phase I safety trial. Emory University in Atlanta is also enrolling patients in the trial, which is aiming for a total of 45 participants across the two sites. Participants will receive two shots of the experimental vaccine approximately one month apart and will be followed for about one year.

Moderna is already ramping up production of the vaccine for a potential Phase II trial that could begin as early as June. A Phase III trial could begin next fall. If the early data is promising, the company says it could churn out enough doses by next fall to vaccinate health care workers and other priority groups.

This experimental vaccine, developed in China, was created to combat Ebola. It uses an inactivated version of a virus that causes the common cold to carry a gene that causes cells to make a protein found on the coronavirus with the goal of sparking an immune response. Phase I testing began last month in China, and CanSino and the Beijing institute have enrolled almost 300 people with Covid-19. Based on preliminary data, the company says it plans to launch a Phase II placebo-controlled trial with 500 participants.

Johnson & Johnson is working with the Biomedical Advanced Research and Development Authority and Boston-based Beth Israel Deaconess Medical Center on a vaccine that uses an inactivated version of the common-cold virus to carry genetic material into cells. That material prompts the body to pump out proteins found in the coronavirus in the hopes of drawing an immune response. The company expects to kick off human studies by September at the latest. If the vaccine works, J&J says the first batches could be available for emergency use in early 2021.

The two companies one American, one German are partnering on an mRNA coronavirus vaccine. This week, German regulators approved a Phase I/II trial of the vaccine; its first stage will enroll 200 people. Pfizer is paying BioNTech $185 million upfront as part of the collaboration, and the companies said they have the potential to supply millions of doses by the end of 2020 if the vaccine is promising, and scale up to produce hundreds of millions of doses in 2021.

This experimental vaccine combines Sanofi technology that produces a protein found in the coronavirus, which aims to trigger an immune response, with an adjuvant made by GlaxoSmithKline designed to heighten that immune response. The companies plan to begin Phase I trials of their vaccine in the second half of the year, and if the results look good, a vaccine could be available by the second half of 2021. Phase I clinical trials are expected to initiate in the second half of 2020 and, if successful, a vaccine could be available by the second half of 2021.

Go here to see the original:
The drugs and treatments that could stop Covid-19 - POLITICO

Nicole Junkermann, international entrepreneur and investor, and the founder of NJF Holdings explains how AI technology can help win the fight against Coronavirus and transform the future of healthcare.

Coronavirus has pushed healthcare systems to their limits and pushed researchers to rapidly search for solutions. Now is the time to turn to technology and ensure that cutting-edge research in artificial intelligence (AI), machine learning, and health informatics are part of our pandemic response.

From predictive care to precision health testing, many clinicians and hospitals are already using AI to improve day-to-day care. Health AI has become increasingly sophisticated and efficient, and a new wave of investment and research in the wake of the coronavirus crisis could spur even more innovation.

Numerous tech companies, universities, and researchers are stepping up to apply AI technology to pandemic response. Already, Microsoft, Google, and several small start-ups such as BlueDot and OWKIN are tapping into the immense power of combining human teams with machines in order to combat the pandemic.

The solution to COVID-19 is not likely going to come from one person, one company or one country, said Peter Lee, corporate vice president for microsoft healthcare. This is a global issue, and it will be a global effort to solve it.

The most successful interventions will come from human-machine collaboration but we must take great care to implement AI technologies with a clear understanding of how they will interface with people working on the frontlines of the coronavirus crisis.

The Power of Human-Machine teams

More than 7,000 miles away from Wuhan, China, an AI warning system developed by Toronto start-up BlueDot was among the first in the world to identify the emerging risk from COVID-19. In a report by Forbes How AI may prevent the next coronavirus outbreak, BlueDots AI system constantly scans through 100,000 official and mass media sources in 65 languages each day in order to detect outbreaks in real-time. And on the last day of December 2019, the system alerted one of BlueDots human employees to a potential pneumonia-like outbreak in Chinas Hubei province.

That employee was able to recognise parallels to the 2002 SARS outbreak and pursue further modelling of the disease, which led BlueDot to publish the first scientific paper on COVID-19, accurately predicting its global spread.

While diseases spread fast, knowledge can spread even faster, said BlueDot in a blog post. The company argues that traditional disease surveillance, which relies primarily on people, takes a great deal of time and often results in public health officials missing relevant warnings or receiving crucial information when its too late.

Researchers are building AI systems to augment not replace human expertise and capabilities, allowing for more informed healthcare responses and decisions.

At Stanford Universitys Institute for Human-Centered AI, researchers and clinicians are already developing AI-based methods to help hospitals manage the flood of COVID-19 patients. Dr Ron Li, clinical assistant professor at Stanford Medicine, is exploring how to use machine learning to identify patients who will need intensive care before the patients condition deteriorates. Lis team is working to apply an existing machine learning model on patient deterioration to coronavirus patients. The goal is to roll this technology out allowing the decisions taken by hospital clinicians to be augmented by reliable data that is generated with AI.

The benefit of having a machine learning model is that it learns very quickly. It can learn over thousands or hundreds of thousands of patients, whereas as a clinician I can only learn from the limited patient population I see, said Li during Stanfords virtual conference on COVID-19 and AI. Also, it can do things at scale some things that humans cant do.

Stanford professor Binbin Chen is using AI to help develop a COVID-19 vaccine. According to Stanford, Chens team uses AI to examine fragments of SARS-CoV-2 to determine how they might apply to COVID-19 vaccines. By combining immunology principles and machine learning tools, the team can predict immunogenic components of a virus that help scientists get closer to determining what components to include in that viruss vaccine.

Microsoft is also pioneering human-machine teams and announced the launch of its C3.ai Digital Transformation Institute, which will bring together scientists, academics, and private companies to explore AI techniques to mitigate the spread of COVID-19.

In these difficult times, we need now more than ever to join our forces with scholars, innovators, and industry experts to propose solutions to complex problems. I am convinced that digital, data science, and AI are a key answer, said Gwenalle Avice-Huet, executive vice president of ENGIE, an energy company that is part of the new partnership.

AI technology to prepare for the next crisis

The application of AI tools reaches far beyond one virus. As we fight coronavirus, we must also look beyond the current crisis and recognise the great potential this technology has for the future of healthcare.

In the field of neuroscience, Googles DeepMind Health is using machine learning to develop algorithms that mimic the human brain. DeepMind Health also created a mobile medical assistant, which helps doctors and nurses spot serious kidney conditions earlier and helps clinicians deliver better care to patients with acute kidney injuries or sepsis.

Patient care can be improved, and healthcare costs reduced, through the use of digital tools, said DeepMind. Together, they form the foundation for a transformative advance in medicine, helping to move from reactive to preventative models of care.

As technology improves and as investment increases, it becomes clear that AI has the potential to transform healthcare across the board. In order to tackle the biggest challenges facing medicine and public health, we must continue equipping researchers, data scientists, and clinicians with powerful AI tools, as well as improve our implementation of human-machine collaborations in the real-world. These powerful AI tools arent replacing human knowledge or decision-making, but rather giving healthcare professionals more information and models to tackle coronavirus. We must recognise the great potential of AI technology to improve not only our response to this pandemic, but also the future of healthcare in general.

Follow this link:
How AI can help win the fight against Coronavirus - Med-Tech Innovation

1. What are the symptoms ofCOVID-19 infection

Symptoms of COVID-19 vary in severity from having no symptoms at all (being asymptomatic) to having fever, cough, sore throat, general weakness and fatigue and muscular pain and in the most severe cases, severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock, all potentially leading to death. Reports show that clinical deterioration can occur rapidly, often during the second week of disease.

Recently, anosmia loss of the sense of smell (and in some cases the loss of the sense of taste) have been reported as a symptom of a COVID-19 infection. There is already evidence from South Korea, China and Italy that patients with confirmed SARS-CoV-2 infection have developed anosmia/hyposmia, in some cases in the absence of any other symptoms.

Elderlypeople above 70 years of age and thosewith underlying health conditions (e.g.hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer) areconsidered to be more at risk of developing severe symptoms. Men in these groups also appear to be at a slightly higher risk than females.

See links to national guidelines on the treatment of patients with serious and life threatening conditions during COVID-19 under external resources

Children make up a very small proportion of reported COVID-19 cases, with about 1% of all cases reported being under 10 years, and 4% aged 10-19 years. Children appear as likely to be infected as adults, but they have a much lower risk than adults of developing symptoms or severe disease. There is still some uncertainty about the extent to which asymptomatic or mildly symptomatic children transmit disease.

There is limited scientific evidence on the severity of illness in pregnant women after COVID-19 infection. It seems that pregnant women appear to experience similar clinical manifestations asnon-pregnantwomen who have progressed to COVID-19 pneumonia and to date (as of 25 March), there have been no maternal deaths, no pregnancy losses and only one stillbirth reported. No current evidence suggests that infection with COVID-19 during pregnancy has a negative effect on the foetus. At present, there is no evidence of transmission of COVID-19 from mother to baby during pregnancy and only one confirmed COVID-19 neonatal case has been reported to date.

ECDC will continue to monitor the emerging scientific literature on this question, and suggests that all pregnant women follow the same general precautions for the prevention of COVID-19, including regular handwashing, avoiding individuals who are sick, and self-isolating in case of any symptoms, while consulting a healthcare provider by telephone for advice.

There is no specific treatment or vaccine for this disease.

Healthcare providers are mostly using a symptomatic approach, meaning they treat the symptoms rather than target the virus, and provide supportive care (e.g. oxygen therapy, fluid management) for infected persons, which can be highly effective.

In severe and critically ill patients, a number of drugs are being tried to target the virus, but the use of these need to be more carefully assessed in randomised controlled trials. Several clinical trials are ongoing to assess their effectiveness but results are not yet available.

As this is a new virus, no vaccine is currently available. Although work on a vaccine has already started by several research groups and pharmaceutical companies worldwide, it may be many months or even more than a year before a vaccine has been tested and is ready for use in humans.

Current advice for testing depends on the stage of the outbreak in the country or area where you live. Testing approaches will be adapted to the situation at national and local level. National authorities may decide to test only subgroups of suspected cases based on the national capacity to test, the availability of necessary equipment for testing, the level of community transmission of COVID-19, or other criteria.

As a resource conscious approach, ECDC has suggested that national authorities may consider prioritising testing in the following groups:

More here:
Q & A on COVID-19 What is COVID-19? Why should the virus be closely - EU News

Let's face it. There is no perfectly safe way for America to come out of its lockdown. None of the expected panaceas a treatment or a vaccine are in sight. Meanwhile, America is nowhere close to having South Korea's mass testing capacity that allowed that country to "flatten its curve." Worse, the longer America stays hunkered down, the more the goal of herd immunity (even if it were possible) becomes elusive because not enough people are getting exposed and developing resistance to the virus.

Yet the economic devastation from the lockdown is becoming more intolerable, with not just livelihoods but lives on the line.

So what should America do besides praying for a summer miracle? Start thinking of the answer not as a binary choice between "lockdown" or "liberation." We need more targeted approaches to contain high-risk activities and protect high-risk populations while giving ordinary Americans more not less freedom to figure out when and how they want to return to work and some semblance of normal life.

The lockdown was originally imposed because the pandemic caught America by surprise and hospitals were simply not equipped to cope with the onslaught. America already has more than 1,000,000 infected cases and 56,000 dead.

This "achievement" has come at a hefty price. About 27 million Americans have filed for unemployment, basically wiping out all the job gains since the Great Recession. And economic output is down a stunning 30 percent. Clearly, things can't go on this way too much longer before the economic pain becomes intolerable.

Yet, notes Avik Roy, president of the Foundation for Research on Equal Opportunity (FREOPP), every major plan to phase out the lockdown relies on some combination of either a vaccine, a cure, and mass testing. But given that corona is a virus, there is no guarantee that a vaccine will ever emerge and if it does it will probably take a year-and-a-half. A treatment is more likely but is still months away. Meanwhile, America is performing less than 200,000 tests every day and the White House in its much-hyped announcement on Monday promised to ramp that up to only 267,000 by the end of May. Just to get to South Korea's level will require 1,000,000 tests daily not to mention tracing all the contacts of those who test positive and putting them in quarantine. The Harvard Safra Center for Ethics' bipartisan "Roadmap to Pandemic Resilience," co-authored by Nobel laureate Paul Romer, wants five million tests per day by early June and 20 million tests per day before August to perform repeated screening of the population to catch any secondary outbreaks. That would be terrific but seems like wishful thinking right now. As for herd immunity, it's uncertain how long immunity after exposure lasts so it's unclear population-wide immunity can even be achieved.

Yet Americans can't hide forever in their homes. In fact, several more months of a blanket lockdown and we may pile economic catastrophe on top of a health catastrophe. So what should America do?

The first and paramount thing is to prevent health-care facilities hospitals and nursing homes from becoming superspreaders themselves. Even in the absence of a pandemic, patients pick up 1.7 million infections in American hospitals annually and 99,000 of them die.

Writer Jonathan Tepper, founder of Variant Perception, points out in a deeply researched article that in Wuhan, the original epicenter of the disease in China, around 41 percent of the first 138 patients diagnosed in one hospital contracted the virus in the hospital itself. Likewise, one reason why Italy's Lombardy region might have been worse hit than neighboring Veneto was that Lombardy transported 65 percent people who tested positive into hospitals compared to 20 percent in Veneto, exposing the virus to the entire chain of health-care workers, from ambulance drivers to paramedics to doctors. A group of Lombardy doctors wrote in the New England Journal of Medicine, "[H]ospitals might be main COVID-19 carriers."

As for America, it is too early to find reliable stats about coronavirus infections generated from hospitals here but a Wall Street Journal investigation found that nursing homes in just 35 states accounted for 10,783 deaths or over 20 percent of all U.S. fatalities. Data from five European countries shows that nursing care homes account for 42 percent to 57 percent of all coronavirus fatalities.

Meanwhile, in Canada's largest two provinces, Ontario and Quebec, elderly patients in nursing homes make up about three-quarters of all the deaths from COVID-19.

Preventing health-care facilities from becoming the gasoline on the coronavirus flames has implications both for patient care and providers. On the patient end, it is vital to emphasize non-hospital settings for less severe cases and fashioning coronavirus-dedicated hospitals for the more severe ones like South Korea did nation-wide and some hospitals have come around to doing in America.

On the provider end, America must race to procure protective gear masks, gowns, glasses for frontline staff because shortages compromise not only their safety but their patients' too. Similarly, until America can build ubiquitous testing capacity, it will have to prioritize testing medical staff. It is less important to chase down asymptomatic carriers, celebrated-writer-cum-surgeon Atul Gawande points out. South Korea didn't.

Meanwhile, hospitals also need to beef up their hygienic practices and embrace a "checklist" that Gawande has long been crusading for. This simple and powerful idea, which has resulted in a stunning drop of hospital infections when tried, would involve creating a coronavirus-appropriate protocol of hygiene washing hands, disinfecting the patient before touching, wearing masks and gowns and then having physicians attest that they have adhered to every item on it by check-marking each one before interacting with patients.

In addition to this focus on hospitals, any reopening plan has to beware of other super-spreading venues such as mass transit and super-spreading events such as games, concerts, and campaigns.

Furthermore, around 78 percent of the coronavirus deaths are concentrated in those over 65. Indeed, there is a 22-fold difference in the death rate between the 25-54 year and over 65 cohort, with children facing very few deaths. Yet the "flattening the curve" playbook via blanket lockdowns treats everyone as if they are equally affected.

But given the differential impact, Roy recommends a strategy that allows young people to get back to normal life as much as safely possible. This means reopening schools and lifting stay-at-home orders for all but the elderly or those with underlying conditions that make them more susceptible.

Of course, the young and the old are not sealed off populations. Indeed, most young people have high-risk individuals such as elderly relatives among their close circle of loved ones. So there is no denying there will be an all-around increase in risk for everyone after reopening.

However, some increase in risk might be worth taking given that if the economy decays beyond a point, it'll eat into the country's medical capacity to fight the disease not to mention hand costly rescue packages to affected workers.

Also, whatever the downside of the lockdown, its one very great advantage is that it vastly accelerated the national learning curve on radical social distancing and other precautions. That means that even if the lockdown is relaxed, few people will go back to their pre-coronavirus lifestyle. COVID-19-preventative practices have become part of the national fabric. So it is not pollyannish to believe that this, combined with greater precautions against super-spreaders, will diminish the toll from any follow-up outbreaks compared to the initial one.

Rolling back the lockdown will also give businesses the freedom to come up with innovative adaptive strategies. Essential businesses that were allowed to remain open have found all kinds of ways to enhance consumer safety plexiglass spit barriers at grocery store check out counters, disinfecting every cart. There is every reason to believe that "inessential" businesses will do the same when given the chance.

Coronavirus is a cruel microbe. But we will have to find more clever ways of fighting it than mass captivity.

Want more essential commentary and analysis like this delivered straight to your inbox? Sign up for The Week's "Today's best articles" newsletter here.

The rest is here:
There's another way to fight coronavirus - The Week

While Singapore had initially done very well in managing its imported cases and community transmission, it may have in the words of former diplomat Bilahari Kausikan dropped the ball, said Dr Jeremy Lim, medical doctor and co-founder of AMiLi, the regions first microbiome bank and sequencing service.

Dr Lim was one of the panellists in a webinar titled The COVID-19 Crisis: Through Medical, Economic and Legal Lenses.

The webinar was held by the Workers Partys Youth Wing last Sunday (26 April) via video conferencing app Zoom.

Classifying the Governments approach in fighting COVID-19 in a battleground divided into three fronts namely imported cases, community spread and the migrant worker dormitories clusters Dr Lim said that Singapore has been doing very well in the first two fronts.

Singapore, he said, has done all the right things with curbing imported cases through very aggressive testing, large and complex contact tracing, and marrying public health intervention with economic or financial assurance.

The move, he said, has ensured that Chinese tourists would be more forthcoming, knowing that their financials would be taken care of in terms of testing and treatment.

Dr Lim, a board member of non-governmental organisation HealthServe which provides affordable medical care and social assistance to migrant workers said that the current situation at the migrant worker dormitories, however, may have been a cognitive blindspot on the Governments part.

I would not say that the Government overlooked vulnerabilities when it comes to the foreign worker dorms, but it underestimated the velocity and the severity of COVID-19 racing like wildfire, said the former Ministry of Health senior consultant.

The Government, noted Dr Lim, had focused on Singaporeans, and instead issued directives and guidance to dorm operators and employers without setting realistic expectations as to how much they could do in terms of social distancing at the dorms.

Highlighting the astronomical rise of confirmed cases of COVID-19 presently from the fewer than 1,000 cases recorded on 1 April, Dr Lim cautioned that the numbers will be[come] harder and harder to interpret, as the definition of what a COVID-19 positive case is changing due to constraints in testing.

There is a limit to how much complexity and how much sophistication a system can take before we are overwhelmed by this complexity and that has been the major challenge when it comes to the dormitories, he said. Let us have accountability after the crisis and offer constructive feedback at this point.

Dr Lim, who is also theco-director of LIGHT, the global health institute for the NUS School of Public Health, said that the Governments broad strategy has been trying to balance keeping the economy and society functioning as normal as possible while driving public health and various preventative medicine interventions.

Singapore, he said, has been progressively ramping up healthcare capabilities and freeing up bed in public hospitals and developing facilities in places such as Singapore Expo and Changi Exhibition Centre.

Touching on the situation at the migrant worker dormitories again, Dr Lim said that the Government is currently doing everything possible to manage what appears to be Singapores largest humanitarian and public health crisis to date.

The Government is making up its playbook as we go along, he said.

Dr Lim added that he has never seen the Government looking so vulnerable.

But thats actually a good thing, because it opens up the opportunities for private sectors and NGOs to be much more participating in the overall dynamic, he said.

While Dr Lim is confident that Singapore will survive the COVID-19 crisis, subsequent waves of infection seem inevitable due to the Republics porosity as a global transport hub.

At some point, even if we manage the community spread, even if we manage the [migrant] worker dormitories, there will be imported cases, he warned.

Original post:
Dr Jeremy Lim on dorms cluster: S'pore "did all the right things" with imported cases, community transmission but underestimated...

When you buy through our links, we may earn money from our affiliate partners. Learn more.

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

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

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

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

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

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

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

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

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

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

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

Read the original here:
The best telemedicine services for anyone unable to visit a doctor's office in person - Insider - INSIDER

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

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

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

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

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

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

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

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

Get medical attention immediately, the CDC says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CNN's Jacqueline Howard contributed to this report.

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

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

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

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

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

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

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

Shutterstock

Turning urban areas into smart cities

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

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

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

Boosting public safety and monitoring

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

Improving Traffic & public transport monitoring

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

Saving resources through smart metering and billing

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

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

Harnessing the power of data in retail

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

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

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

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

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

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

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

Shutterstock

Healthcare: improving wellness and saving more lives

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

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

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

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

Expanding chronic disease management and preventative medicine

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

Advancing precision medicine research

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

Enhancing pharmaceutical drug supply chain safety

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

Giving manufacturing a competitive edge

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

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

Automating industry

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

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

Improving planning and scheduling

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

Smarter plant safety and security

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

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

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

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

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

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

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

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

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

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

6 United Nations, World Population Ageing (2019)

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

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

9 Dell EMC Global Data Protection Index Survey (2019)

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

Original post:
Driving business opportunities at the Edge - TechHQ

Half Year 2018 Sonic Healthcare Ltd Earnings Call

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

TEXT version of Transcript

================================================================================

Corporate Participants

================================================================================

* Christopher David Wilks

Sonic Healthcare Limited - Finance Director, CFO & Executive Director

* Colin Stephen Goldschmidt

Sonic Healthcare Limited - CEO, MD & Executive Director

* Paul J. Alexander

Sonic Healthcare Limited - Deputy CFO & Company Secretary

================================================================================

Conference Call Participants

================================================================================

* Andrew Goodsall

MST Marquee - Healthcare analyst

* David A. Low

JP Morgan Chase & Co, Research Division - Research Analyst

* David Andrew Stanton

CLSA Limited, Research Division - Former Research Analyst

* David Bailey

Macquarie Research - Research Analyst

* Nicholas Cameron

Watermark Funds Management Properietary Limited - Sector Head of Healthcare

* Sean M. Laaman

Morgan Stanley, Research Division - Australian Healthcare Analyst

* Steven David Wheen

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

* Thomas Godfrey

UBS Investment Bank, Research Division - Analyst

* Victor Windeyer

Citigroup Inc, Research Division - Former VP and Analyst

================================================================================

Presentation

--------------------------------------------------------------------------------

Operator [1]

--------------------------------------------------------------------------------

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

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

Story continues

--------------------------------------------------------------------------------

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

--------------------------------------------------------------------------------

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

================================================================================

Questions and Answers

--------------------------------------------------------------------------------

Operator [1]

--------------------------------------------------------------------------------

Our first question, from David Stanton, CLSA.

--------------------------------------------------------------------------------

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

--------------------------------------------------------------------------------

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

--------------------------------------------------------------------------------

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

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

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

Wet market in Indonesia. IDN PHOTO

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BY KALINGA SENEVIRATNE, IN DEPTH NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr David Glass - MBChB, FCOG (SA)

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

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

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

Specific medications for breast cancer inhibition/prevention:

Non-specific medications for breast cancer inhibition:

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

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

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

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

Kind regards,

Dave Glass

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

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

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

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

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

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

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

The positive impact on patient records

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

How public health is affected

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

The positive impact on patients themselves

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

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

What can patients do if problems occur?

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

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

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

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

Like what you see?Help us bring you more insightful stories.

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

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

So why the about-face?

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

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

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

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

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

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

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

On the health departments coronavirus website, it says:

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

Heres what the science can tell us:

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

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

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

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

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

So why should cloth masks be considered at all?

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

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

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

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

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

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

Why then, the push for cloth masks?

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

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

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

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

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

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

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

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

The solution: Add cloth masks as another option.

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

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

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

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

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

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

But thats the beauty of homemade masks, says Price.

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

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

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

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

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

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

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

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

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

COVID-19 can live on surfaces for hours or even days. In order to kill the virus and prevent people from becoming infected, you have to disinfect. 2nd Lt. Felicia Dreh

By Sgt. Liane Hatch

FORT CARSON, Colo. Considering the COVID-19 pandemic that has led to a statewide stay-at-home order, the 3rd Armored Brigade Combat Team, 4th Infantry Division, preventative medicine team encouraged Soldiers, leaders and Family members to practice thorough cleaning and disinfecting measures at home and in the workplace.

A lot of people think when you just spray the counter with a cleaner and wipe it up with a cloth or paper towel, that youre good to go, said 2nd Lt. Felicia Dreh, an environmental science officer, preventative medicine team, 3rd ABCT.

Dreh explained that many people have questions such as: If I clean something, do I need to disinfect it? Whats the difference? Are they the same? They are not.

Cleaning with just your normal spray cleaners just removes surface dirt, while disinfecting actually kills the bacteria, Dreh continued. COVID-19 can live on surfaces for hours or even days. In order to kill the virus and prevent people from becoming infected, you have to disinfect.

The Centers for Disease Control and Prevention (CDC) recommends a diluted bleach solution to properly disinfect high-traffic surfaces, such as countertops, doorknobs and handles.

Per CDC guidelines, you want to use five tablespoons or capfuls of bleach per gallon of water, or if youre using a spray bottle, you can use four teaspoons of bleach per quart of water, said Sgt. Wilbur Davis, NCO, preventative medicine team, 3rd ABCT. Use a clean sponge to wipe the area then and let that surface air dry.

Davis emphasized when using bleach solutions, its important to wear protective gloves, keep the area well-ventilated and avoid mixing with other cleaning products, especially those containing ammonia.

Both members of the preventative medicine team agreed that taking measures to clean and disinfect common areas should be part of a daily routine, both at work and in the Soldiers home.

You can spread COVID-19 from work to home or vice versa just by touching a doorknob after an infected person has touched it, Davis said. Soldiers should be disinfecting their spaces every day.

Dreh recommends taking the time to clean and disinfect a part of each units daily battle rhythm, preferably at the end of each day. While she acknowledged most leaders already have cleaning measures in place, they need to be sure Soldiers use bleach to disinfect those areas as well.

Commanders can help keep their Soldiers healthy by enforcing daily cleaning and disinfecting requirements, Dreh said. The more you do it, the less time it takes, and it will go a long way toward keeping everyone healthy.

In addition to using good disinfection measures, Soldiers and Family members can prevent the spread of disease and reduce the likelihood of illness by practicing good hand hygiene and avoiding touching their face, mouth, nose and eyes.

For more guidelines on COVID-19 prevention, visit https://www.cdc.gov/, and local procedures at https://www.carson.army.mil/ or follow @USArmyFortCarson on Facebook.

More:
Preventative medicine team works to beat COVID-19 - fortcarsonmountaineer.com

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

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

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

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

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

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

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

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

Get medical attention immediately, the CDC says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CNN's Jacqueline Howard contributed to this report.

Visit link:
Coronavirus symptoms: 10 key indicators and what to do - FOX Carolina

Despite false assertions by the president to the contrary, any potential treatments to counter or prevent COVID-19 are still only at the stage of early investigations, which include one-off treatment with special individual case authorizations, and small-scale clinical examinations. Nothing so far has approached the level of scrutiny needed to actually say anything definitively about their actual ability to treat COVID-19 or the SARS-CoV-2 virus that causes it, but the first large-scale U.S. clinical study for one treatment candidate is seeking volunteers and looking to get underway.

The study will be conducted by the Henry Ford Health System, which is seeking 3,000 volunteers from healthcare and first responder working environments. Depending on response, the researchers behind the study are looking to begin as early as next week. Study lead researcher Dr. William W. ONeil said in a press release announcing the study that the goal is to seek a more definitive scientific answer to the question of whether or not hydroxychloroquine might work as a preventative medicine to help protect medical front-line workers with greater risk exposure from contracting the coronavirus.

Hydroxychloroquine (as well as chloroquine) has been in the spotlight as a potential COVID-19 treatment due mostly to repeated name-check that President Trump has given the drug during his daily White House coronavirus task force press briefings. Trump has gone too far in suggesting that the drug, which is commonly used both as an anti-malarial and in the treatment of rheumatoid arthritis and lupus, could be an effective treatment and should be thrust into use. At one point, he claimed that he FDA had granted an emergency approval for its use as a COVID-19 treatment, but Dr. Anthony Fauci clarified that it was not approved for that use, and that clinical studies still need to be performed to evaluate how it works in addressing COVID-19.

Studies thus far around hydroxychloroquine have been small-scale, as mentioned. One, conducted by researchers in France, produced results that indicated the drug was effective in treating those already infected, particularly when paired with a specific antibiotic. Another, more recent study from China, showed that there was no difference in terms of viral duration or symptoms when comparing treatment with hydroxychloroquine with treatment using standard anti-viral drugs, already a common practice in addressing cases of the disease.

This Henry Ford study looks like it could provide better answers to some of these questions around the drug, though the specific approach of seeking to validate prophylactic (preventative) use will mean treatment-oriented applications will still have to be studied separately. The design of the study will be a true blind study, with participants split into three groups that receive unidentified, specific pills (possibly anti-virals or some equivalent); hydroxychloroquine; or placebo pills, respectively. They wont know which theyve received, and theyll be contacted weekly by researchers running the study, then in-person both at week four and week eight to determine if they have any symptoms of COVID-19, or any side effects from the medication. Theyll get regular blood draws, and the results will be compared to see if theres any difference between each cohort in terms of how many contracted COVID-19.

These are front-line healthcare workers, so in theory they should unfortunately be at high risk of contracting the disease. That, plus the large sample size, should provide results that provide much clearer answers about hydroxychloroquines potential preventative effects. Even after the study is complete, other competing large-scale trials would ideally be run to prove out or cast doubt on these results, but well be in a better position than we are now to say anything scientifically valid about the drug and its use.

Originally posted here:
Henry Ford Health System to conduct first large US study of hydroxychloroquines ability to prevent COVID-19 - TechCrunch

The medical community at large is now faced with a new dimension of medicine they have never encountered. As this health crisis that is ever changing, they find themselves with greater challenges than they have ever imagined. Due to shortages on PPE and expecting greater needs for it, and with the unknown factors of what the coming months may unfold. For independent practices it poses even more obstacles as they do not have the infrastructure of the larger hospitals or a group practice might have. Such is the case of a small town doctor that has chosen a different path of medicine from her start in Olney, Illinois.

Since Dr. Jill Scherer's practice began, some might think her model is unorthodox as she chose not to bill insurance, but operates on a direct billing system instead. Dr. Scherer reports The monthly membership fee has worked well and has been well received. Patients who cannot afford insurance can at least be offered primary care services. Other patients with stellar insurance love that their appointments are on time, for however much time they need, and they have access to their provider. My practice was full within 8 months, so I would say the community.

Scherers innovative thinking brought forth a creative solution to the lack of PPE availability presently. Seeing the medical community using some old phone booth looking devices where the individual was swabbing in the booth and sticking only their arms out to swab the person gave her some insight. It also gave the problem that came from the test itself, as it goes deep into the nasal passage which can cause a reflux reaction, then can trigger a response that can cause risk. Henceforth the tent came up outside her clinic and her brainchild came to life. She gave the basic explanation as such. Notoriously they sneeze or cough, so the plexiglass provides excellent protection. My husband, and engineer, decided, why not make a testing site through the window in my exam room. That way, the patient is outside and I am inside with the barrier of plexiglass. There is a stethoscope and giant rubber gloves that protrude from the plexiglass to examine the patient from the plexiglass to exam the patient with. I can swab a patient and be shielded. Then everything is sanitized with bleach before the next patient. Her ingenuity saves on the precious commodity of PPE, and she can judiciously screen her patients she shared. If needed, patients can still enter the clinic, and proper disinfection is provided. She has used the method of patients if needed remaining in their car as well on occasions.

When asking Dr. Scherer how our local community at large is doing in regards to the recommendations the CDC has given to COVID-19, shared these thoughts in regards to reaching a better outcome. I think we need to really take the shelter in place order seriously. Grocery shop once every 2 weeks. We need to wash our hands diligently. We need to not meet up with friends or have play dates. We are a small community and we dont want to be a hot spot for the virus. While it might not seem as scary because we are not Chicago or New York, we still need to be diligent and adhere to the social distancing, shelter in place, washing hands.

The CDC and other health officials have made recommendations in terms of wearing masks for the general public, Dr. Scherer gave these thoughts in relation to these coming guidelines as well As for fabric masks, I think we will see a change in the recommendations from health officials. Much of Asia uses masks and have much lower transmission than use.

Now we do not have enough commercial grade masks for the healthcare workers let alone enough for the general population, so I do think that cotton masks will be beneficial. As of now, any tightly woven cotton or polyblend cotton will be enough. These masks will prevent the wearer from spreading his/her own germs. It doesnt necessarily protect the wearer from getting the virus, but it does make the wearer conscious of how many times they touch their face. If the wearer coughs and sneezes, it does help prevent the respiratory droplets from being expelled into the air.

As there have been various statements in regards to use of Ibuprofen during this health crisis, and the use of it, in the course of the interview Dr. Scherer her thoughts. Her recommendations were as follows. I have not read any solid data on no ibuprofen or other NSAIDs, but I know that the general recommendation is to not use them if you have fever, coughing, cold symptoms. Stick with acetaminophen. If you are on daily NSAIDs, you should call your doctor for specific recommendations regarding stopping or when to stop

As Dr. Scherer incorporates some holistic approaches to what might she suggest or preventive measures, she gave these insights. Eating a healthy diet with fruits and vegetables will promote the best immune function. Thirty minutes of daily exercise as a minimum. Getting adequate sleep, 7-8 hours per night. Shutting off social media and the news for several hours per day to decrease stress level might also help.

In terms of mental health in general terms these suggestions during these stressful times, she gave some excellent helpful tips that all ages can incorporate to aid in the balance as we are all trying to find a new normal. Find a way, while respecting social distancing, to do something nice for someone else. Practicing mindfulness or meditation can help calm anxious nerves. We know that exercise can be as powerful as antidepressants for anxiety and depression, get out and exercise. Sunshine, when it peaks out of the clouds, can also help with our mood.

Her practice is like many all across the country that are finding new ways to treat their patients. She had already used telemedicine as an option, due to not billing insurance prior to COVID. Her patients are able to call, text, or have video chats routinely as well. She routinely has three platforms she is able to utilize, so if one is not working well, she can use another one that works better for that particular patient.

As COVID-19, is only one area of health concerns for our community, I asked this very down to earth and caring physician how she thought our area could improve the total well being in general. She gave some great input. I stress in my practice, the need for lifestyle medicine. We should be using diet, nutrition, stress management, good sleep to help combat our leading causes of death like heart disease, high blood pressure, and diabetes. My advice is not always welcomed, but at least patients know they have a choice in their health outcomes for a majority of diseases.

When asked for her best advice for our area in terms of addressing this ever changing and concerning health crisis upon us she shared these final insights. My goal right now is to take the best care of my patients especially during COVID19 because the rest of health conditions didnt take a break when COVID-19 got here. There are still ear infections, heart attacks, etc. So my immediate goal is to provide excellent care even with the pandemic. My long term goals

are put on hold right now, I will be patient and see how things are in 6-9 months. I think people should know that I am a small business owner trying to provide the best in a strange situation. I want to protect myself and my patients. I dont want to be a super spreader of COVID-19, and that is why I have changed the way I see people. Yes, their visit will be on the phone, then in the parking lot. Only if truly needed will it be in person and at that time, I will look like I have hazmat gear on. I might look a little nutty, but I want to be alive to care for my patients, I dont want to bring COVID-19 home to my family, and I dont want to spread it to my patients. Direct primary care, membership medicine, allows me to be flexible and keep everyone as safe as possible.

Scherer grew up in Streamwood, Illinois, and attended the University of St. Francis in Joliet, Illinois. After completing her bachelor's of science in Biology, she earned her Doctor of Medicine at Loyola University Stritch School of Medicine. She completed her training at the Waukesha Family Medicine Residency in Waukesha, Wisconsin, specializing in Family Practice. Dr. Scherer most recently practiced at the Richland Medical Center in Richland Center, Wisconsin, providing general family practice, obstetrical care, inpatient hospital care, and urgent care. Her areas of interest are preventative medicine, lifestyle medicine, and lactation/breastfeeding medicine. Her continuing education focuses on lifestyle medicine and she will have board certification in it by fall 2018. She is an International Board Certified Lactation Consultant, IBCLC.

Dr. Scherer and her husband, Mark, recently moved to Olney, Illinois to be closer to his family as they raise their two children. She is thrilled to be practicing in the community and helping to improve the lives of her patients.

It was a rare and refreshing experience, to meet a physician who is dedicated completely to the calling of medicine in its truest sense. She is indeed a great asset to our community. She is accepting patients and can be reached at 618-746-2676 her practice, Whole Family Health Medical Clinic is at 131 Boone St. in Olney, Illinois. The clinic has a facebook page, might note Dr. Scherer, has routine posts on COVID-19 with current updates for the community as well.

Read the rest here:
Small town Doctor...finds solutions to the big issues - Pontiac Daily Leader