WHAT’S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 8 895.

According to the latest update, 178 deaths have been recorded in the country.

So far, 307 752 tests have been conducted, with nearly 15 600 new tests.

READ MORE | All the confirmed cases of coronavirus in SA

Latest news:

Only offenders who committed petty crimes will be eligible to be included in the 19 000 inmates who will be released on parole to combat the spread of Covid-19 in prisons.

Justice Minister Ronald Lamola and Correctional Services Commissioner Arthur Fraser briefed the media on Friday on President Cyril Ramaphosa’s announcement that he had authorised the release of low-risk inmates who have already served their minimum sentence, or who would approach this period in the next five years.

Lamola said that approximately 19 000 inmates across the country would benefit from this decision, provided they met requirements of the parole board.

“They will be considered on a case-by-case basis and those who qualify will be placed on parole after all the due processes including Victim Offender Dialogues, have accordingly unfolded,” Lamola said.

The only inmates that are eligible for release are those who were convicted and imprisoned for petty crimes. Fraser described it as crimes of need.

These types of crimes include shoplifting, theft and trespassing.

READ MORE | Covid-19 in prisons: Only inmates convicted of petty crimes will go free, says Lamola

Delays in results have left many fearing infected patients, who should otherwise be self-quarantining, could unwittingly be exposing others to the virus.

“The delay is not only being experienced in the Western Cape,” says provincial health department spokesperson Nomawethu Sbukwana.

“As the Western Cape – and indeed other provinces – ramp up testing, [the National Health Laboratory Services] are finding it challenging to keep up and process these tests, resulting in a nationwide backlog in the results.”

The Western Cape has become the epicentre of South Africa’s outbreak of the coronavirus, known as SARS-Cov-2.

Sbukwana said the department had contacted the National Health Laboratory Services (NHLS) to try to ramp up the testing capacity in the province.

READ MORE | National Covid-19 testing backlog means patients may wait up to 10 days for results

The DA has demanded the minutes of all discussions held by the National Coronavirus Command Council (NCCC), including the decision to continue the ban on tobacco products.

The party’s interim leader, John Steenhuisen, said the DA had filed an application in terms of the Promotion to Access to Information (PAIA) Act to get access to the records that have so far been described as classified.

He railed against the continuation of the “destructive lockdown” in its current form, which turned South Africans into “subjects of an authoritarian state”. 

Steenhuisen was speaking on Friday in an online “announcement of national importance”.

He said when President Cyril Ramaphosa announced South Africa would be placed under lockdown six weeks ago, it was the correct decision.

It was done to give South Africa time to prepare for its response to the pandemic, the DA leader added.

READ MORE | End lockdown now, or South Africans will end it for you – Steenhuisen to Ramaphosa

South Africa’s scaling up of Covid-19 testing in recent weeks appears to have resulted in severe capacity constraints at public sector laboratories, with doctors reporting that it is often taking a week or longer to get results.

“The current turnaround time for COVID-19 tests in Gauteng is around 7 days for outpatients and 3-4 days for in-patients,” says Dr Tom Boyles, an Infectious Diseases specialist at Helen Joseph Hospital in Johannesburg. He says that colleagues from the Eastern and Western Cape have reported similar delays.

A doctor who works at an emergency unit in a public sector hospital in Johannesburg confirmed to Spotlight that they are waiting seven days for Covid-19 test results. The doctor who asked not to be identified, says that the situation is very frustrating for clinicians.

In some of the worst cases, tests sent from their hospital were lost and no results were provided as long as three weeks after initial testing.The doctor says that testing delays are contributing to wards filling up, since they are not getting the results that would give the all-clear for patients to be discharged.

The doctor also suggested that the testing backlog may explain why the official count of confirmed cases in Gauteng is not rising more quickly at the moment. “I think it’s simply because we are not testing enough,” the doctor said.

READ MORE | Covid-19: Doctors concerned about severe testing delays

A few dozen people wearing homemade and medical masks sit waiting for taxis as drivers spray hand sanitiser on commuters and tell them where inside of the ubiquitous South African Toyota Quantum minibus taxis they may sit to keep the appropriate distance. 

The scene on this Friday morning is eerily quiet for Bosman taxi rank, usually one of Pretoria’s busiest and loudest spots. “The mood is very somber”, says Macdonald Makata, public relations officer of the South African National Taxi Council (SANTACO) in Tshwane.

Only about a fifth of the rank is operating, with vehicles filled to a maximum of 70%, sanitised regularly, and deep cleaned twice a week. All commuters are meant to wear masks, although only about half do, says Charles, who has been a taxi driver for about five years.

“It’s very difficult that(sic) but we have to follow,” he says of the regulations. Makata agrees that while the health measures are important, they are not easy to implement, since some commuters do not take them seriously and it is having a great financial impact on the industry. “In a way it is helping to flatten the curve,” he says, “but pocket-wise it is not helpful at all.”

READ MORE | Covid-19: What should public transport look like?

WHAT’S HAPPENING IN THE REST OF THE WORLD 

Cases update:

For the latest global data, follow this interactive map from Johns Hopkins University & Medicine.

Late on Friday night, positive cases worldwide were more than 3.9 million, while deaths were almost 274 000.

The United States had the most cases in the world – more than 1.28 million , as well as the most deaths – close to 77 000.

READ MORE | All the confirmed cases worldwide

Latest news:

A study performed in New York hospitals found no evidence of either harm or benefit from giving the malaria drug hydroxychloroquine to severely ill coronavirus patients.

“The risk of intubation or death was not significantly higher or lower among patients who received hydroxychloroquine than among those who did not,” the authors of the study said.

They said the study, published on Thursday in The New England Journal of Medicine, “should not be taken to rule out either benefit or harm of hydroxychloroquine treatment.”

“However, our findings do not support the use of hydroxychloroquine at present, outside randomised clinical trials testing its efficacy,” they said.

US President Donald Trump has frequently touted the use of hydroxychloroquine as a treatment for coronavirus patients.

READ MORE | No apparent harm or benefit from hydroxychloroquine – study

China said on Friday it supports a World Health Organisation-led review into the global response to the coronavirus outbreak, but only “after the pandemic is over”.

The comments from foreign ministry spokesperson Hua Chunying came as China faces increasing global pressure to allow an international investigation into the origins of the pandemic.

The review should be conducted in an “open, transparent and inclusive manner” under the leadership of WHO chief Tedros Adhanom Ghebreyesus, Hua said at a press briefing.

She added that it should be at an “appropriate time after the pandemic is over”.

But Hua did not say the review should probe the origins of the virus, despite growing calls led by the US and Australia for an international inquiry into the issue, which has become a key flashpoint in deteriorating tensions between Washington and Beijing.

READ MORE | China supports WHO-led review of global pandemic response

LATEST RESEARCH

We can’t help liking llamas with their fluffy faces and spindly legs.

But it seems that the llama has now become significant for a particular reason – its blood contains an antibody that could potentially neutralise SARS-CoV-2.

A new study published in the journal Cell on Tuesday 5 May 2020 stated that these antibodies can help neutralise the novel coronavirus, known for causing Covid-19. 

This comes from research of four years ago. The international research team found that the antibodies from a then nine-month-old llama named Winter could neutralise both SARS-CoV-1 and Mers-Cov over a period of six weeks.

Both these coronaviruses were known for causing outbreaks in 2003 and 2012. Now, SARS-CoV-2 is sweeping across the globe with dire consequences.

READ MORE | How a llama named Winter could help fight Covid-19

With the Covid-19 pandemic placing unprecedented demands on hospitals around the world, health authorities worry about an insufficient supply of ventilators, beds and staff to help those infected.

Countries experiencing a shortage of these include South Sudan, Somalia and Venezuela. And to manage this crisis and establish hospital readiness in South Africa, Trixta, a collaborative low-code platform for business minds and software developers, have launched ReportCovidCase.com – a web app that was built in just 72 hours, and gives hospitals an indicator of how many cases they will have in the near future.

This initiative came after the company was approached by a private GP helping out at a well-known Cape Town hospital, expressing concerns about the lack of information about Covid-19 cases reaching hospitals. 

This prevents healthcare workers from knowing how many ventilators, beds and staff are required.

READ MORE | Local company builds Covid-19 hospital tracking solution in 72 hours

As the current number of Covid-19 cases keeps rising across the globe, researchers aren’t only concerned about finding a vaccine or effective treatment – they also want to track the virus to find out how it spreads, mutates and adapts over time.

A team from Arizona State University (ASU) lead by Efrim Lim, assistant professor at ASU’s Biodesign Institute, traced the trail of the virus across the world by using advanced technology that can decode the entire genetic code of SARS-CoV-2.

Their research was announced in a news release and published in the Journal of Virology.

What is genome sequencing and why is it important?

We’ve been hearing the term “genome sequencing” frequently in coronavirus-related content, but it’s often hard to understand, especially if you are not an expert in epidemiology.

Genome sequencing is the process of “figuring out” the exact order of DNA nucleotides in a virus, almost like letters in a sentence, but without punctuation and capitals.

READ MORE | Research team finds new, unique mutation in coronavirus

HEALTH TIPS (as recommended by the NICD and WHO)

• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing

• Practise frequent hand-washing, especially after direct contact with ill people or their environment

• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus

• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.

READ MORE: Coronavirus 101 

^{Image credit: Getty Images}

When she gets home in the afternoon, physician Dr Arifa Parker disposes of her work clothes in the washing machine. She then has a thorough shower before greeting her three-year-old twin toddlers, Yusra and Haniya, with a hug.

Since January, Parker has served at the coalface of South Africa’s fight against Covid-19. One of three infectious diseases specialists at Cape Town’s Tygerberg Hospital, she treats patients positive for the coronavirus in specially set-up wards; supporting Intensive Care Unit staff, and screenings in a tent set-up on the premises. Meanwhile, she is also gathering information and formulating protocols for how to best tackle this pandemic. 

This week, 39-year-old Parker opened up to Spotlight about being a doctor and a mother in the eye of the Covid-19 storm. Speaking via a Zoom interview, her sentences are laced with laughter, despite the gravity of the task ahead of her.

“I’m very careful,” she says. “I know what the risks are and when I see my patients, I make sure that I wear adequate PPE – personal protective equipment. And that is what I tell the junior staff as well. No one should be seeing patients without adequate protection. We do have enough stock for now, if we use it wisely; and more has been ordered,” Parker says.

“So that makes me feel better going home to my kids. The hospital is frantically working on shower facilities for staff, so we could take a shower and change into normal clothes before going home. For now, I jump into the shower and wash my clothes before giving my little ones a hug. So that is a bit odd, because they usually would jump into my arms immediately when I get home.” 

Fortunately, Parker’s husband Ghaliel, who works in IT, is taking care of their young children during lockdown. “He’s been amazingly, amazingly supportive,” she says. “He’s been working from home via Zoom, with the kids in the background.” 

HIV and TB

Parker’s early training is in HIV and tuberculosis (TB). After completing a medicine degree at Stellenbosch University, she did her internship at GF Jooste Hospital in Manenberg on the Cape Flats, under renowned mentor Professor Graeme Meintjes. This was in 2005, a year after antiretroviral (ARV) drugs were first starting to be rolled out by the state in South Africa, after a lengthy struggle by civil society for access to treatment. 

“At the time it was quite overwhelming because ARVs were not freely available and a lot of young people were dying,” recalls Parker. “Manenberg was my first choice, because it was a hospital in an impoverished community. I wanted to help people. So I ended up doing my community service the following year in Khayelitsha as well,” Parker tells Spotlight. 

“You know, as interns, we used to have to fill in the death certificates. So you would have the deceased patient in front of you, and you’d look at the ID photo and it would show someone so different to the completely ravaged patient. And that’s why I ended up doing internal medicine and infectious diseases, because I wanted to understand a bit more about how the body works and how one would be able to treat these patients better. And fortunately, with the ARV rollout, HIV patients are now doing so much better. And you know, it’s actually quite rewarding to work in the field of HIV medicine. But we still have a lot of work to do; we still have to roll out more ARVs and prevent lots of infections. We still have lots of challenges. TB and everything else.”  

Parker pauses, as her phone rings. She excuses herself to answer it. Then, turning back to the interview, she adds: “And now there’s Covid-19 thrown into the mix, too.”  

On 11 January, Chinese state media reported the first known Covid-19 related death. Since then Parker has “lived and breathed” coronavirus.  

“So Covid didn’t exist to us before January,” she says. “We heard about it mid-January; and then we started having to prepare for cases, having to put procedures and systems in place. So as infectious diseases specialists, we’ve had to educate ourselves, rapidly. We’ve had a steep learning curve and part of that has been adapting to create standard operating procedures for our hospital.  

“Also we don’t know – internationally – what the effect of Covid will be on our HIV-positive patients. There were very few patients in China who had HIV. You know, there are lots of questions.”  

At night, Parker sits in bed next to her husband working and reading; sometimes she works in their kitchen over a cup of tea. They take turns to cook: butter chicken, lamb curry, pasta and salads. The kids go to bed at 7pm, and at 9pm she goes back to the drawing board.  

Days blurred into one

“Since January, my days have all blurred into one,” she says. “Most days I can’t remember what day it is. I start quite early. I haven’t been sleeping much since the start of Covid, I mean this morning I woke up at 4:30 am. As you know, Covid is a new infection, with new data coming out all the time. So the first thing I do is look at my phone. I get lots and lots of messages, so I read the new things and send them on. My workday at the hospital starts at 8 am. At 9 am we have what we call a Covid ops meeting, where all our hospital’s heads meet – you know, radiology, surgery, anaesthetics, ICU, and so on.” 

She gets home at around 5 pm – well, it depends. “For example,” she says, “last Friday at 4 pm, 200 people suddenly rocked up at the hospital’s testing centre at one time. I mean, you can’t just leave junior staff alone. So, a few of us senior staff, the paediatric infectious diseases specialist, our head of clinical medicine, and another internal medicine consultant, stayed behind and helped out and assisted in doing the tests.” 

While Parker cannot comment on patient figures, she says at present Tygerberg has two general wards full, and is ready to activate more. She is quick to deflect praise, crediting her team and colleagues. 

“It’s not just an infectious diseases response,” she says. “We are only three, too few people. It’s been a hospital response from all departments. I feel so privileged to be working with such amazing people at my hospital. If work needs to be done, everybody pitches in. All sorts of hierarchy have flown out the window. For example, we had the head of nephrology (renal medicine) come down and doing swabs on patients. The plastic surgery registrar does shifts; we’ve had radiology specialists coming down to assist with screenings. The anaesthetic department has been very helpful. Intubation of the ill patients is obviously a very high-risk procedure, because you would be in direct contact with the patients’ airways. And they happily put together a call roster of who will assist us should we need to do such procedures, because they are the best trained to do the intubations.”  

Changing demographics

Parker points out that the demographics of the Covid outbreak are changing. Initially, transmission was travel-related. Now healthcare specialists are seeing the early stages of community transmission. Of great concern is increasing transmission to essential workers.  

She notes a spike in infections in Khayelitsha. According to provincial statistics released by Western Cape premier Alan Winde on April 28, there were 205 confirmed Covid-19 positive people in Khayelitsha.

“Last week, my direct boss, Neshaad Schrueder, and I went to Khayelitsha Hospital,” she says. “We were very concerned about the spike in Covid numbers and wanted to see how Tygerberg could support the hospital. Yes, and I think they have an excellent team of staff. They’ve put amazing systems in place; they’ve also started a tent for testing outside the hospital, and within the hospital they’ve identified separate spaces where they can keep persons isolated from each other. So we were able to help with that,” she says.

“We’re also advising hospitals that we need to work together. So, if they are seeing that they are overrun with patients, they shouldn’t hesitate to call us. Because it’s pointless having open beds in one hospital while another is full. Because we know Covid sort-of attacks areas. You’ll have fires of outbreaks; so one area might have more cases, especially at this point in the outbreak.” 

On 29 April, Cape Town community newspaper TableTalk reported that two employees at Checkers Bayside – Sindoswa Msiwa of Khayelitsha and Sylvia Gaxela from Delft – succumbed to Covid-19. The newspaper quoted Msiwa’s brother, Luthando, as saying: “My sister worked on Sunday, 12 April even though she wasn’t feeling well. She called me that evening saying she wasn’t well, and I took her to Khayelitsha Hospital where she tested positive. She was later transferred to Tygerberg Hospital, where she stayed in intensive care. She died on April 12.” 

Asked about Msiwa’s death at Tygerberg, Parker notes that she is not allowed to comment on individual patients due to patient confidentiality. “This is so sad,” she says. “My thoughts are with the family. It’s very sad, but it is inevitable that people will die. I see some of my colleagues are struggling with this, but there is nothing more they can do. As healthcare workers, we shouldn’t be too hard on ourselves.” 

Time to prepare

Can the pandemic still be contained in South Africa? “Um, obviously we’re worried,” says Parker. “I don’t think we can entirely eradicate Covid. I think it will still be a problem, but I think it’s imperative that we try to prevent cases. If we don’t, more people will die and our hospitals will be overrun with cases. So, it’s still very important that we test, test, test, and when we find cases, that we try to isolate. We are obviously very concerned about overcrowded areas, and that is why the country has rolled out community testing.”

While government is under fire from some quarters for its lockdown regulations, Parker insists these measures are crucial. “My personal opinion is that the lockdown was an excellent decision, because it gave our hospital and other hospitals time to prepare, time to make sure that staff are educated on how to use PPE; time to create ward and intensive care space; and to create the documents that we are working on at the moment,” Parker says.

“I am so fortunate that we have had a chance to work on those. I just think of the poor healthcare workers in China and Italy who didn’t have a chance to prepare; they didn’t know what hit them. Fortunately, we have systems that are in place now that can hopefully help to relieve the burden on our healthcare force.” 

She says healthcare workers are rethinking the way they practice medicine in the time of Covid-19. This includes less touch. 

“We have to minimise risk while assessing and managing patients,” she says. “For example, something that would normally take five minutes now takes ten minutes. You need to know exactly what you are going to do for the patient when you go into his or her ward. As physicians, we love to spend time with patients. We love to feel, touch, and to thoroughly examine everything. But I think we need to sort of rethink the way we practise medicine in the time of Covid. Having an additional layer of awareness. We have to touch less and think: ‘If I touch this, is it going to contribute to my management of a patient. If I spend hours listening to every part of the lung, would it give me more information than the chest X-Ray that we already did?’ I would not have said this in December, but now with Covid, obviously we have to change the way we practise medicine, which may be a bit controversial.” 

How do they compensate for a lack of physical interaction? 

“Our patients have been amazing,” says Parker. “I’ve also learned new things about technology, communicating via cellphone, you know, phoning the patients and taking their history like that, asking them if they are okay. I have renewed respect for social media; this is really helping to keep patients in touch with their families. So, you know, somebody mentioned that maybe we should have patients not have their phones with them because they can get contaminated. That’s the worst idea. This is the way they keep in touch with family and friends, despite the lack of interaction.” 

Parker adds that the public and private health sectors are collaborating in the fight. “This has been another amazing thing. We call each other for advice, it’s just been such a different experience as to how medicine normally works. And I really hope that if there is an after-Covid, that we continue this sort of enthusiasm.”

‘Try to fix it instead of complaining about it’

Parker grew up in Cape Town’s northern suburbs in Cravenby – which happens to be near Tygerberg Hospital – where she matriculated at Cravenby Secondary School. “We had amazing teachers, who shaped and opened our minds,” she says. “The motto of the school was ‘aim high’, so, well, we aimed high.”

One of five children, Parker’s youngest brother studied medicine too, and is presently completing an internship at Kimberley Hospital. “Oh, my parents never forced us to do anything,” she says. “My mom’s brother is a doctor, but there’s no real family history of healthcare. My parents did encourage hard work.” 

On her sunny disposition, she says: “I think negativity is a wasted emotion. I think if you find that there are issues or that you find something negative or you’re not happy about something, it may be more constructive to come up with a solution to that problem. That’s just my approach. If something is broken or seems to be broken, try to fix it instead of complaining about it.”

^{*This article was produced by Spotlight– health journalism in the public interest. Sign up for our newsletter and stay informed.}

^{Image credit: CDC, Unsplash}

Biénne Huisman

For many Covid-19 patients battling for their lives in the ICU, a runaway immune system response – known as a “cytokine storm” – is their primary foe.

Doctors have few tools to help tame this hyperinflammatory condition, but early research is suggesting that nanotechnology might safely deliver drugs to affected tissues, quieting the storm.

It’s so far only been tested in mice, but researchers in Brazil and France said the approach could be “a new tool in the fight against the complex and multi-factorial phenomenon of uncontrolled inflammation”. They reported their findings online in the journal Science Advances.

It’s not clear why some young, robust patients experience life-threatening illness from Covid-19, while others have either mild or no symptoms.

The way to successful treatment

But when severe illness does strike, it’s often in the form of an out-of-control immune system response.

Inflammatory processes harm cells at multiple sites throughout the body and, if unchecked, this can lead to organ failure and death, noted a team led by Dr Patrick Couvreur at the Institute Galien Paris-Sud, in France.

Key to the cytokine storm are connections “between inflammation and oxidative stress, both processes contributing to fuel one another, thereby establishing a vicious cycle”, Couvreur’s group explained.

Right now, there’s no therapy to interrupt this dangerous “crosstalk”, they said. For example, anti-inflammatory drugs such as corticosteroids have not worked, because of their negative effects on tissue repair.

But the new findings may point the way to a successful treatment.

In their work, Couvreur’s group focused on an extremely tiny “nanoparticle” formulation of adenosine, an anti-inflammatory compound already produced naturally by the body.

Nanotechnology approach

It’s a powerful anti-inflammatory compound – maybe too powerful. If simply injected into the body, adenosine can trigger serious side effects, the research team said.

But the new nanotechnology approach appears to get around that, they added.

Couvreur’s team created “multi-drug nanoparticles” by adding adenosine to squalene, a type of fat also found naturally in the body. Then they “encapsulated” both in the powerful antioxidant alpha-tocopherol, a type of vitamin E.

Using this nanotechnology approach, the researchers then delivered the compounds to the tissues of mice who were in hyperinflammatory states such as sepsis (blood infection) or an immunological state resembling the typical “cytokine storm” of Covid-19.

The result: A notable decrease in tissues of a key pro-inflammatory cytokine called tumour necrosis factor alpha, along with a concurrent rise in levels of an anti-inflammatory cytokine called interleukin-10, the researchers reported.

These changes were observed in important organs such as the lungs and kidneys just four hours after treatment, Couvreur’s group said.

Still ‘a relatively early stage’

The team added that the combo treatment – adenosine plus tocopherol – appeared more effective than the use of either drug alone.

Of course, this study was conducted in mice, and many therapies that appear promising in animals don’t pan out in humans. But Dr Matthew Heinz, an expert in the fight against infectious diseases, said the findings do “make sense”.

“I’m surprised this was something they were able to do so quickly,” said Heinz, an internist and hospitalist at Tucson Medical Center in Arizona. “It’s pretty encouraging to have evidence that something like this might help some of our more critically ill Covid-19 patients survive the hyperimmune response known as a cytokine storm.”

Heinz previously worked in the Obama administration’s response to the Ebola crisis, and was the former director of provider outreach in the Office of Intergovernmental and External Affairs, at the US Department of Health and Human Services.

Reading over the new findings, he said that “because the research is Covid-related, it’s quite possible this could be moved into human trials a lot quicker than during normal times”.

Heinz added that “this is still a relatively early stage – we have a little ways to go here – but it’s good to see this kind of research already coming out with some very encouraging results on how to approach this tremendously heartbreaking situation that’s killing tens of thousands of people in the United States.”

READ | Some coronavirus deaths caused by extreme reaction from immune system

READ | Coronavirus: Breakthrough as researchers map out how the immune system fights the virus

READ | There may be a solution to the immune system ‘storm’ caused by Covid-19 in some patients

^{Image credit: Getty Images}

Whenever societies are placed under stress, conspiracy theories blaming this or that nefarious agent for secretly fomenting the threat inevitably arise.

It’s no different during the current coronavirus crisis.

Some of the evidence-free hoaxes circulating now include theories that the virus is a military bioweapon created in a Chinese lab; that it was made and even patented by tech billionaire Bill Gates; or that new 5G cellular phone towers are the real villain – either by transmitting the virus or by causing a “weakening” of the immune systems in people nearby.

In all of these conspiracies, the “powers that be” know all about this, but choose to keep silent.

Potentially life-saving behaviours

For the vast majority of Americans who don’t subscribe to these notions, an eye-roll is the most common response. But experts stress that while bogus, conspiracy theories can do real harm to Americans’ health.

In the context of a health crisis, conspiracy theories can lead devotees “to refuse to engage in behaviours that have been scientifically proven to be good for their health and the health of their communities,” explained Joanne Miller. She’s associate professor of political science and international relations at the University of Delaware.

That includes potentially life-saving behaviours such as social distancing, aimed at helping all Americans.

In cities across the United States, people who are convinced that the coronavirus pandemic is a hoax or, at the very least, exaggerated, are gathering in close-knit crowds to protest government restrictions – a sure way to help spread the virus, experts say.

And even when successful interventions against Covid-19 do arrive, conspiracy theorists may avoid them, Miller said.

“Conspiracy theories often, but not always, arise as explanations for an incredibly negative, surprising event, such as a pandemic,” Miller said.

“Such events often make people feel uncertain, anxious, and that they’ve lost some control over their lives,” she explained. “And one way to reduce feelings of uncertainty, anxiety and loss of control is to tie bits and pieces of information about the event into a nice, neat conspiratorial bow.”

Conspiracy theories also reject reality “in favour of some plot involving a group of people with malevolent intent that is deliberately kept secret from the public,” added Dr Joseph Pierre. He’s acting chief of the Mental Health Community Care Systems of the VA Greater Los Angeles Healthcare System.

Importantly, Miller said, those plotters are often pegged as powerful, criminal, and in search of political or personal gain.

Need for control

Both Miller and Pierre agreed that conspiracy theories have been around since the dawn of time. One reason is that they can “make us feel special about being privy to a secret truth that’s hidden from the rest of us ‘sheep’,” said Pierre.

Another is the human tendency to cite “omnipotent forces” to explain natural events, “similar to our collective need to believe in God”, he said.

“And then there’s the need for control, certainty and closure,” he added. “[Because] most of us find that believing that bad things happen randomly for no reason to be pretty unsettling.”

Miller seconded that thought.

“It’s very anxiety-producing to believe the truth about the virus,” she said. “That it occurred naturally, and that we don’t yet know how to stop its spread. So, one way to reduce that anxiety is to believe, for example, that 5G towers are spreading the virus. That gives us something to fight against.”

And that fight isn’t just rhetorical: This week, the Associated Press reported that anti-Covid-19 arsonists set fire to 5G cell towers across the Netherlands, the United Kingdom, Ireland, Cyprus and Belgium. Phone service was interrupted for thousands.

“It’s heart-rending enough that families cannot be there at the bedside of loved ones who are critically ill,” Nick Jeffery, CEO of wireless carrier Vodafone UK, said on LinkedIn, the AP reported. “It’s even more upsetting that even the small solace of a phone or video call may now be denied them because of the selfish actions of a few deluded conspiracy theorists.”

No easy answers

Celebrities can join the conspiracy theory bandwagon, adding to its legitimacy for some.

As noted by the AP, actor Woody Harrelson recently shared a video purporting to show Chinese people taking down a 5G tower. That film clip turned out to be old footage of pro-democracy protestors in Hong Kong pulling down a “smart lamppost” over surveillance fears.

So, what’s the solution? People being what they are, Miller and Pierre agreed that there’s no easy answer.

Conspiracy theorists are often suspicious of bureaucrats or scientists, so the best response to conspiracy theories is to quickly rebut them as they arise, and to try to engage believers in conversations aimed at re-establishing trust.

But, “it’s really difficult to debunk conspiracy theories with factual information,” Miller noted. “For a person who believes the theory, any factual information you provide can be turned on its head and be used as additional evidence for the conspiracy, [as in] ‘look how deep this goes!'”

What about Facebook, Twitter and other social media banning posts citing bogus theories?

“This is a tricky one, because it’s not clear where the line should be drawn,” Miller said. “On the one hand, a large majority of us might agree that certain posts are conspiratorial or push other types of misinformation and are therefore dangerous and should be taken down. But who gets to decide what’s conspiratorial?”

Pierre warned that, unfortunately, “misinformation is big business, whether for profit or for political gain. We also live in a country where free speech is a core national value. Together, that makes limiting the exposure of people to misinformation very challenging.”

READ | ‘I am not the author’ – top doc denies he wrote viral WhatsApp message being attributed to him

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Dozens of drugs are being investigated for their value in treating Covid-19, as desperation drives doctors and researchers to look for something that could battle the virus and save lives.

“There are really no FDA-approved medications for the treatment of Covid-19, unfortunately,” said Ashley Barlow, a pharmacy resident with the University of Maryland Medical Center in Baltimore. “We’re doing the best we can to try and ramp up studies, but since we’re doing it in such a quick period of time there are a lot of flaws we have to take into consideration.”

The Covid-19 drugs being tried and tested fall into two general categories, explained Dr Rajesh Gandhi, director of HIV clinical services and education at Massachusetts General Hospital in Boston:

• Antivirals aimed at limiting the spread of the coronavirus inside the bodies of infected people
• Immune system medications that limit the damage the body does to itself while fighting off the coronavirus

“There are drugs we believe can help pull people through the natural evolution of this infection and can really make a difference,” Gandhi said. “Right now, the jury is still out on some of these things that have been proposed. That’s why we need to have clinical trials that will provide an answer.”

Remdesivir

Many of the drugs proposed to treat Covid-19 are already approved for other conditions, and can be put into immediate off-label use. That’s not the case with one of the most promising potential therapies, an IV drug called remdesivir, originally developed to treat Ebola and MERS (Middle East respiratory syndrome).

“Remdesivir is not an approved drug, so the only way you can get it is if you are in a clinical trial or through a compassionate use programme,” Gandhi noted.

The drug attacks the genetic code of the Covid-19 coronavirus, hampering its ability to replicate, explained Barlow, lead author of a review of potential coronavirus therapies published recently in the journal Pharmacotherapy.

Early studies in small groups have shown benefit in patients, but doctors are still waiting on results from larger clinical trials to verify those findings, Barlow and Gandhi said.

“I would say in the next month we will probably get an answer on remdesivir,” Gandhi said, adding that even partial benefit would be a good result.

“Even if it doesn’t work 100% of the time, then you have something to build upon,” Gandhi explained. For example, remdesivir could be added to a cocktail of drugs, much in the way that researchers developed an effective therapy for HIV, the virus that causes Aids.

Chloroquine and hydroxychloroquine

These anti-malarial drugs have been touted by President Donald Trump and others as one of the great hopes for Covid-19 treatment.

But these drugs have already laid an egg in several major studies, Barlow said. Clinical trials are ongoing for the two drugs, but researchers aren’t holding out much hope.

“We were looking for a promising drug, and unfortunately hydroxychloroquine ends up being not so promising as we originally thought,” Barlow said.

One nationwide study focusing on its use in US veterans’ hospitals found that 28% of patients treated with hydroxychloroquine died versus 11% of those who didn’t get the drug, according to media reports on Tuesday.

Even before these results, doctors had already started turning away from the drugs, Gandhi said.

“A few weeks ago, when it really started getting intense here in Boston, we were using hydroxychloroquine more than we are now,” Gandhi said. “The waters have remained very muddy. It’s very unclear whether it’s been beneficial, and there are more reports of toxicity.”

Tocilizumab/baricitinib

These immune system-modulating drugs originally were developed to treat rheumatoid arthritis and other inflammatory diseases, Barlow said.

Researchers think they could help Covid-19 patients because the coronavirus appears to trigger an overactive immune response in some people, doing a lot of damage to organs and increasing the risk of death, Barlow and Gandhi said.

“They block one of the alarm bells of the immune system, and try to keep the immune response under control,” Gandhi said, comparing the response to the virus as “when there’s a fire and the fire’s been put out, but the firemen keep trying to put it out.”

This “cytokine storm” can fill lungs with fluid, promote a high fever, or drop blood pressure to dangerously low levels, Barlow said.

Clinical trials for tocilizumab and baricitinib are either underway or in preparation, experts said.

Ribavirin

This broad-spectrum antiviral drug, formerly used to treat hepatitis, is being tried as a Covid-19 therapy and really shouldn’t, Barlow said.

The drug inhibits viral replication by interfering with genetic synthesis, but comes with a host of dangerous side effects.

“It is considered a hazardous drug,” Barlow said. “For us as pharmacists, it’s kind of scary to see people use it because of the significant adverse effects that come with it.”

Ribavirin’s inhaled formulation, for example, can be toxic to foetuses and is not indicated either for pregnant women or their male partners, Barlow and her colleagues said. The drug also can cause anaemia and low blood levels of calcium and magnesium, and has the potential to interact dangerously with immune suppression therapies.

Gandhi said, “I haven’t seen a ton of really exciting data” supporting ribavirin’s use.

Lopinavir/ritonavir/nelfinavir

These drugs were all developed as ways to interfere with the viral replication of HIV, and “in MERS and SARS [severe acute respiratory syndrome] – the other human coronaviruses before Covid-19 – there was some interest in lopinavir/ritonavir,” Gandhi said.

Early randomised trials out of China have not shown any particular benefit, but the World Health Organization and others are still including one or more of the drugs in ongoing Covid-19 clinical trials, Gandhi said.

But, Barlow added, “I think a lot of institutions have stopped using this agent because of the lack of benefit seen.”

Interferon alpha

This drug is one of the older antiviral agents, examined as a means of treating hepatitis and some cancers. It’s based on a protein your own body makes to direct immune response, Gandhi said.

“It’s a natural antiviral that our bodies use, but it’s given as a medication to go beyond what our bodies make,” Gandhi said.

However, there’s little laboratory evidence that interferon alpha is effective in treating either SARS or MERS, Barlow and her colleagues noted.

Nonetheless, ongoing studies are assessing whether interferon alpha used in combination with ribavirin could help treat Covid-19 patients, the experts said.

Interferon alpha generally isn’t used to treat chronic infections like hepatitis because it can cause depression and flu-like symptoms, Gandhi said. However, it could be applied to short-lived infections like Covid-19 if the evidence warrants its use.

“It’s one thing to have flu-like symptoms and depression for a year, it’s another to have it for a week,” Gandhi said.

Nitazoxanide

This drug is approved by the US Food and Drug Administration to treat diarrhoea caused by Giardia parasites, and it has been found to also act against cryptosporidium parasites and some bacteria, Barlow and her colleagues said.

The medication could potentially inhibit the expression of proteins found on the surface of the Covid-19 coronavirus that allow the virus to invade human cells, Barlow said.

Nitazoxanide studies in the lab and with animals have shown that the drug can reduce infections of MERS and other coronaviruses. However, a study published late last year in the journal Clinical Infectious Diseases found the drug did not improve coronavirus patients’ outcomes.

“The history of medicine is just littered with things that looked good in test tubes or in animals, but don’t work well in humans,” Gandhi said of nitazoxanide.

Arbidol/favipiravir/baloxavir

These drugs, approved to treat flu in other nations, are being studied as emerging potential therapies for Covid-19, Barlow and her colleagues said.

Favipiravir is being tested in a clinical trial in the United States, Gandhi said, while other countries are testing the other drugs for their potential in fighting the new coronavirus.

The drugs all work by blocking either the virus’ ability to replicate or to enter human cells.

“That is an interesting drug,” Gandhi said of favipiravir. “I think it’s well worth studying.”

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