Health News Archives - Page 19 of 109

Health24.com | Coronavirus saliva tests less invasive, safer, and accurate – but only if done properly

Posted on 26/04/2020 by vrapto26/04/2020

The world’s governments are under pressure to increase testing for the new coronavirus, officially named SARS-CoV-2, which has infected more than 2.6 million people worldwide, according to the Johns Hopkins Coronavirus Resource Centre.

To that end, six researchers sought to look into the potential diagnostic value of saliva, by looking closely at existing studies on saliva and Covid-19. They concluded that saliva swabs can be effective and yield quicker results – if done correctly.

Generation and transmission of saliva droplets

Saliva is a common medium for virus transmission. According to the World Health Organization (WHO), the new coronavirus virus spreads primarily through droplets of saliva or discharge from the nose – which can happen when an infected person coughs or sneezes.

Saliva, the authors of the paper note, is made up of 99% water, with the remaining 1% comprising components for, among others, the purpose of tasting and digesting.

Breathing, talking, coughing and sneezing are all ways saliva droplets are generated. The droplets are formed as particles and consist of a mixture of moisture and droplet nuclei of microorganisms.

The authors further explain: “The amount, distance, and size of saliva droplets vary among people, suggesting the infectious strength and transmission path of saliva droplets differ when [the] same pathogen was contracted.”

They further add that one cough can generate 3 000 saliva droplet nuclei, which is close to the amount generated during a five-minute talk. And, one sneeze that reaches several metres in air can contain up to 40 000 saliva droplets.

However, studies have shown that it is the smaller droplets that can “travel like a cloud over longer distance by air flow”, explain the authors. But unlike tuberculosis (TB), to date there is no solid evidence to suggest that the virus in saliva droplets can survive in airflow for any length of time.

Testing for SARS-CoV-2 via saliva

The official pathogen detection, the authors explain, occurs when there is a confirmation of SARS-CoV-2 nucleic acid from throat swabs. However, throat swabs, they note, have certain downfalls, including the fact that they are invasive, induce coughing and can cause bleeding. Should this occur, it can increase the risk of healthcare workers being infected.

With the nature of saliva specimen collection, however, it is more secure. The authors draw on three existing methods used to collect saliva: coughing, saliva swabs, and directly from the salivary gland duct.

Studies analysed by the authors included deep throat saliva, saliva in oral cavity, and salivary gland. Out of these three, they found that deep throat saliva had the highest diagnosis rate of SARS-CoV-2, making it the most reliable form of saliva testing for the virus.

One study they investigated involved twelve positive patients coughing out saliva a few days after hospitalisation, and 11 of their specimens tested positive for the virus. Another study (from the same group) used self-collected saliva from deep throat Covid-19 patients, and among 23 patients, 20 cases of their saliva showed detectable SARS-CoV-2 RNA.

Current evidence based on the second method, involving oral swabs, show that it is more applicable in early detection of the virus, but cannot be used as discharge criteria for patients. Saliva collected directly from the opening of the salivary gland can also detect SARS-CoV-2 nucleic acid, and, according to the authors, could possibly be a predictive and non-invasive test for patients with severe cases.

SA testing

Despite mass testing campaigns, more and smarter testing with faster results is needed. In South Africa, currently, SARS-CoV-2 is detected via a polymerase chain reaction, or PCR molecular test, notes the National Institute for Communicable Diseases (NICD).

The test is done by health workers taking a swab of a person’s throat and/or nose, which gets placed into a fluid, after which it is sent to a laboratory to look for signs of the virus’s genetic material, explains News24. If the test is positive, repeat testing is required – all of which can take up to four days.

CNBC recently reported on a new study by Yale University researchers that found that testing saliva for the new coronavirus yields results that are at least as accurate as nasal swabs. The Food and Drug Administration (FDA) also granted emergency use authorisation for a new saliva test which requires a person with coronavirus symptoms to spit into a cup, the Washington Times reports. Results are returned within 24 to 48 hours after arriving at labs.

Compiled by Zakiyah Ebrahim

Health24.com | Malaria still kills 1 100 a day. It can’t afford to lose resources to coronavirus

Posted on 25/04/2020 by vrapto25/04/2020

Today, another 1 100 people will die from malaria. The number will be repeated tomorrow, and the day after.

As a public health researcher, I embrace the idea that all lives have equal value. That our goal is much more to delay death than to stop death, as the latter is inevitable. Therefore as we mark this year’s World Malaria Day, we must emphasise the need for stronger health systems and sustained investments to tackle malaria more aggressively.

This message needs to be conveyed even more urgently than usual amid the coronavirus pandemic. Given the situation in Europe, China and the US, it is clear that Covid-19 significantly disrupts health systems and economic growth. There is genuine fear that if it continues spreading in Africa, the impact may be worse given the continent’s weaker health systems. One of the greatest concerns is the likely shift of attention and resources from control programmes of other infections, such as malaria.

Since 2000, Africa has benefited from some of the greatest efforts against malaria. This included a global coalition that has delivered more than 2 billion insecticide-treated nets to countries where malaria is endemic.

Given the extensive health gains, experts increasingly embraced the idea that malaria eradication, though ambitious, is both a feasible and a necessary goal. This remains the aim.

Recently, a strategic advisory panel set up by the World Health Organisation (WHO) five years ago released a report of a three-year study on benefits, future scenarios and feasibility of malaria elimination. Among its key recommendations is improved access to high-quality people-centred health services, adequate financing and resourcing for malaria programmes as well as stronger engagement with communities.

Unfortunately, in the context of Covid-19, many of these recommendations will be unattainable in the short and medium term. Resources will be shifted to tackle the pandemic and community engagement initiatives will be reduced to a bare minimum to achieve social distancing. Moreover, access to health facilities may be reduced for people with other common diseases such as malaria.

This will mean there will be many more deaths from malaria and other diseases.

This has happened before. Evidence from Africa’s fight against Ebola suggests that during outbreaks, many more people are indirectly killed by other diseases such as malaria, HIV and tuberculosis than by the outbreak itself.

African health authorities must therefore earnestly guard against such outcomes, and create a more rational response.

Protecting gains made against malaria

The past 20 years have seen major scientific developments. These have led to malaria deaths being cut from over 1 million to 405 000 a year.

This has been due in part to advances in treatments. Artemisinin-based treatments have replaced previous mono-therapies such as chloroquine. The new drugs have remained effective across Africa, which has largely been unaffected by treatment failures such as those observed in south-east Asia. About 4 million doses of child formulations of these treatments have been delivered, saving another 850 000 lives.

There have also been advances in prevention measures. For example, to mitigate the threat of insecticide resistance in malaria mosquitoes, scientists from private and public institutions have created new types of insecticidal bed nets and new chemical formulations for spraying houses. And countries such as Tanzania are using innovative distribution approaches involving schools so that they can maintain high coverage and access to essential malaria commodities.

But African countries don’t have resilient communities and strong health systems. This means that these past gains need to be protected vigorously.

Not all fevers are Covid-19

Initial symptoms of malaria – such as a high fever – may be similar to those of influenza and other viral infections such as Covid-19.

This underscores the need for malaria programme managers, community leaders and health workers in affected communities to continue to emphasise prompt diagnosis, effective treatment and improved prevention. But health workers and communities should not be put at any risk. Therefore essential information should be provided about both malaria and Covid-19.

In addition, special efforts will need to be made to avert indirect deaths. For example during the Ebola outbreak, a mass drug rollout was put in place in Sierra Leone to prevent malaria deaths.

Similarly, countries will require innovative approaches to ensure continued distribution of insecticide treated nets. The WHO has already sent an advisory to malaria-endemic countries on how to tailor their control efforts during the Covid-19 pandemic. Without this, Africa will bear the combined consequences of both diseases.

Since zero malaria starts with each one of us, we must keep up the malaria fight through this cloud of Covid-19.

Fredros Okumu, Director of Science, Ifakara Health Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

^{Image credit: iStock}

Fredros Okumu

Health24.com | Benefits of physical distancing outweigh economic toll, in US – study

Posted on 24/04/2020 by vrapto24/04/2020

The lifesaving benefits of strict physical distancing rules during the coronavirus pandemic far outweigh their projected harm to the US economy, a new report claims.

“Our benefit-cost analysis shows that the extensive physical distancing measures being adopted in the US likely do not constitute an overreaction,” said lead author Linda Thunstrom, an assistant professor of economics at the University of Wyoming in Laramie.

“Physical distancing saves lives but comes at large costs to society due to reduced economic activity,” she said in a university news release. “Still, based on our benchmark assumptions, the economic benefits of lives saved substantially outweigh the value of the projected losses to the US economy.”

Assuming that physical distancing measures are adopted widely enough to reduce contact between people significantly, their benefits will surpass the economic costs by $5.2 trillion (R99 trillion), according to Thunstrom and colleagues.

A rapid assessment

The findings – published online in the Journal of Benefit-Cost Analysis – are based on the most recent data on coronavirus spread and its impact on economic activity.

Study co-author Stephen Newbold said, “It should be possible to conduct a more detailed analysis after more data are available.” Newbold is an assistant professor of economics.

“But a rapid assessment, based on the best currently available information, adds much-needed rigour to the public discussion about the policy response to this outbreak,” he explained in the news release.

The analysis includes the potential impact of Covid-19 on the US healthcare system. The Wyoming researchers estimated that current physical distancing measures will reduce the average contact rate among individuals by 38%. And that, in turn, will reduce the peak of the infection curve by more than half, helping avoid overwhelming the healthcare system and keeping the death rate below worst-case scenarios.

The analysis didn’t assess how physical distancing will affect specific groups of people.

“It stands to reason that the most vulnerable groups in society will be the hardest hit. For example, the service industry will be disproportionately affected by these policies, which will lead to mass layoffs of low-income workers,” the researchers wrote.

It is also likely that the most economically disadvantaged groups will suffer the worst health consequences from Covid-19, the study authors said.

Painful costs and consequences

In theory, the researchers said, the uneven impact of the pandemic and physical distancing measures could be addressed “with appropriate redistributions of resources.”

The researchers also said the United States needs to better prepare for future disease outbreaks.

“Our analysis suggests that the aggressive physical distancing policies currently promoted in the US probably are justified, given that no good contingency plans were in place for an epidemic of this magnitude,” they wrote. “But the costs and consequences will be painful. To avoid these in the future, there are likely large social benefits to ensuring that we are better prepared for the next pandemic.”

READ | Multiple measures of physical distancing required to slow coronavirus

READ | How 4 US cities helped slow coronavirus spread

READ | Wuhan study shows how social distancing to curb the spread of coronavirus is saving lives

^{Image credit: Sharon McCutcheon, Unsplash}

Health24.com | Tweets show Americans are following Covid-19 precautions

Posted on 22/04/2020 by vrapto22/04/2020

An analysis of Twitter data suggests that Americans are heeding physical distancing and other safety recommendations during the coronavirus pandemic, researchers say.

Officials have told people to limit travel, stay home and distance themselves to slow the spread of the virus.

“The question though is how effective are these policies? Once you tell people to stay home, it doesn’t mean everyone listens,” said research leader Mark Dredze, a computer scientist at Johns Hopkins University in Baltimore.

“It’s important for us to understand on an ongoing basis if people are actually listening to these directives,” he said in a Hopkins news release.

Firm physical distancing

But how do experts know people are staying put? For this study, they used location data from Twitter.

It showed that the movement of Americans between March 16 and 29 was 52% of what it was between 1 January 2019 and 16 March 2020.

People’s movements in some states didn’t fall as much as in other states, particularly states with firm physical distancing measures, according to the researchers.

The analysis of nearly 400 tweets by 3.7 million users found the greatest reductions in movement in Washington, D.C. (63%); Alaska (62.5%); Washington state (58.8%); New Jersey (58.3%), and Maryland (57.6%).

The smallest reductions in movement were in Wyoming (21.5%); Oklahoma (30.9%); Mississippi (35.4%): Iowa (36%), and Idaho (36.4%).

Similar research has been conducted by others, including Google.

Fed up with staying at home

“A key advantage in our analysis is that the underlying Twitter data is publicly available, so others can study additional aspects of physical distancing,” said David Broniatowski, an associate professor in School of Engineering and Applied Science at George Washington University in Washington, D.C.

The researchers plan to update results over the coming weeks and months.

“We want to continue to track this to see if people’s movement will continue to drop or if people will get fed up with staying home and start moving around again,” Dredze said. “Understanding these behaviours will be important for decision-makers and public health researchers.”

READ | Wuhan study shows how social distancing to curb the spread of coronavirus is saving lives

READ | How 4 US cities helped slow coronavirus spread

READ | A funeral, a birthday and 3 deaths: ‘super spreader’ events show why physical distancing is key

^{Image credit: Drew Coffman, Unsplash}

Health24.com | Exhaled ‘aerosols’ spread coronavirus nearly 4 metres. Shoes carry virus too

Posted on 21/04/2020 by vrapto21/04/2020

Recent studies show that people infected with the new coronavirus could be spreading “aerosolised” viral particles as they cough, breathe or talk in a 13ft (4m) radius, and viral particles can also move around on people’s shoes.

But there was also good news from the studies: Standard protective gear appears to effectively shield health care workers from these aerosolised droplets and infection, and even cloth face masks could curb the spread of exhaled droplets.

Reading over the findings, emergency medicine physician Dr Robert Glatter said they are a reminder that any form of physical distancing should help curb new cases of Covid-19.

“The bottom line is that maintaining some distance from others is better than none,” said Glatter, who works at Lenox Hill Hospital in New York City. “Six feet (1.8m) is better than 5ft (1.5m). In the age of coronavirus, the more the better. It really comes down to the likelihood of viral transmission.”

Virus all over floor

In one study, Chinese researchers tracked viral “distribution” in hospital wards in Wuhan, the city where the coronavirus pandemic emerged. From 19 February to 2 March, “we collected swab samples from potentially contaminated objects in the ICU and general ward,” said a team led by Dr Zhen-Dong Guo, of the Academy of Military Medical Sciences in Beijing.

“We also sampled indoor air and the air outlets to detect aerosol exposure,” the researchers explained.

As the doctors noted, when people exhale, heavier droplets (potentially containing virus) tend to drop to the ground because of gravity, whereas lighter droplets can remain suspended in breathable air.

Their tests found that 70% of swab samples from the hospital floor came up positive for coronavirus, “perhaps because of gravity and air flow causing most virus droplets to float to the ground”, the study authors said.

“In addition, as medical staff walk around the ward, the virus can be tracked all over the floor, as indicated by the 100% rate of positivity from the floor in the [hospital] pharmacy, where there were no patients,” the researchers said. “Therefore, the soles of medical staff shoes might function as carriers.”

Not surprisingly, swabs taken of often-touched surfaces – doorknobs, bed rails, trash cans and computer mice – typically came up positive for coronavirus.

Protective gear thwarts infection

And what about the air people breathe? The closer to an infected patient, the more likely an air sample was to come up positive, Guo’s group said. “Virus-laden aerosols were mainly concentrated near and downstream from the patients,” the team reported.

But tiny airborne aerosols could travel farther than the 6 feet (1.8m) now recommended in most physical distancing advisories. In fact, “the maximum transmission distance of [coronavirus] aerosol might be 4m (13ft),” Guo’s group reported. They published their findings online on 10 April in the journal Emerging Infectious Diseases.

The Chinese study did have one good piece of news: Protective gear worn by hospital staff appears to thwart viral infection. “As of 30 March, no staff members at Huoshenshan Hospital had been infected,” despite widespread contamination of air and surfaces, the team noted.

Another study of the aerosolisation of exhaled droplets was published online on 15 April in the New England Journal of Medicine. In that study, a team from the US National Institutes of Health and the University of Pennsylvania used “laser light scattering” technology to track the dispersion of droplets from the mouth during normal speech.

The researchers found that droplets were dispersed into the air, but wearing a “slightly damp washcloth over the speaker’s mouth” effectively stopped most of the dispersion.

In a related commentary on that study, Harvard University molecular biologist Matthew Meselson said it “suggests the advisability of wearing a suitable mask whenever it is thought that infected persons may be nearby”.

Science continues to evolve

For his part, Glatter said that “while 6 feet is certainly ideal based on recommendations by the US Centers for Disease Control and Prevention, we are now learning that aerosolised droplets from coughing or sneezing, which may then be carried by currents indoors and outside, may make this distance less than ideal.”

Still, he said, the science on all of this continues to evolve.

“The truth is this: We don’t know what it truly takes to get infected with the virus, including the amount of virus necessary to actually initiate an infection,” Glatter said. “In fact, it may not require infected surfaces or droplets after all, just aerosols. We just don’t know. Research on this concept continues to expand and evolve.”

Glatter stressed that other factors – including how deeply into the lungs viral particles penetrate, and the strength of a person’s immune system – are also involved in the infection process.

Dr Eric Cioe Pena directs global health at Northwell Health in New Hyde Park, New York. Reading over the Chinese study, he agreed that “the potential for this virus to spread via aerosols is particularly scary, because it’s essentially a hybrid between an airborne and a droplet virus, and that the droplets are able to hang out in the air for an extensive period of time and potentially infect other people”.

READ | Physical distancing might need to be practised intermittently until 2022 – study

READ | Coronavirus: The chloroquine debate: Two experts weigh in

READ | Could a measles vaccine help in the fight against Covid-19?

^{Image credit: Getty Images}

Health24.com | Why remdesivir might be a good bet against Covid-19

Posted on 20/04/2020 by vrapto20/04/2020

New research sheds light on why the experimental drug remdesivir might become the most powerful weapon in the fight against Covid-19: It is highly effective against an enzyme that plays a crucial role in the spread of the new coronavirus.

Remdesivir is one of several drugs being fast-tracked in various coronavirus treatment trials around the world. Just last week, a small, “compassionate use” trial published in the New England Journal of Medicine found the drug improved outcomes for people with Covid-19.

More than two-thirds of 53 severely ill patients showed improvement in oxygen support, the Cedars-Sinai Medical Center researchers said. Seventeen of 30 patients who were on ventilators were able to be taken off the life-support machines, the study showed.

The latest research, published in the Journal of Biological Chemistry, explains how remdesivir, developed in 2014 to fight the Ebola epidemic, works against the new coronavirus.

‘Direct-acting antiviral’

Remdesivir “is a very potent inhibitor for coronavirus polymerases”, and if “you target the polymerase, the virus cannot spread, so it’s a very logical target for treatment”, explained study author Matthias Götte, chair of medical microbiology and immunology at the University of Alberta, in Canada.

Remdesivir tricks the coronavirus by mimicking its building blocks, the investigators found.

“These coronavirus polymerases are sloppy, and they get fooled, so the inhibitor gets incorporated many times and the virus can no longer replicate,” Götte explained.

Evidence from this study and previous research in animals and cell cultures showed that remdesivir can be classified as a “direct-acting antiviral” against the new coronavirus, Götte noted.

This reinforces the promise of clinical trials being conducted worldwide of remdesivir in people with Covid-19.

Almost identical results

While the evidence provided by lab studies justify clinical trials, those results can’t predict how remdesivir will work in human patients, Götte noted.

“We’ve got to be patient and wait for the results of the randomised clinical trials,” he said in a university news release.

In February, Götte’s lab published a study showing how remdesivir worked against the Middle East respiratory syndrome (MERS) virus, which is related to the new coronavirus that causes Covid-19, officially called SARS-CoV-2.

“We were optimistic that we would see the same results against the SARS-CoV-2 virus,” Götte said. “We obtained almost identical results as we reported previously with MERS, so we see that remdesivir is a very potent inhibitor for coronavirus polymerases.”

READ | Coronavirus | The chloroquine debate: Two experts weigh in

READ | Trials begin for potential Covid-19 drug – it was initially developed to treat Ebola

READ | How one patient’s battle with Covid-19 changed US testing protocols

^{Image credit: Getty Images}

Health24.com | Coronavirus morning update: Court action over cigarette sales, prisons problem, and a lifesaving ‘box’

Posted on 19/04/2020 by vrapto19/04/2020

WHAT’S HAPPENING IN SA

Cases update:

The latest number of confirmed cases is 3 034.

The latest recorded deaths in the country is 52.

So far, 108 021 tests have been conducted.

Latest news:

Health Minister Zweli Mkhize has supported the recent banning of sales of cigarettes and alcohol during the lockdown, as they had a negative impact on the health of people who had tested positive for coronavirus.

So far, cigarettes and alcohol sales have been temporarily banned in the country to assist government in curbing the rapid spread of the coronavirus.

To date, a total number of 3 034 people have tested positive in 108 021 tests conducted, and two more deaths have been recorded.

The number of deaths has increased to 52.

As South Africans deal with life under lockdown in the face of the Covid-19 pandemic, government’s ban on alcohol sales as part of the regulations has been one of the major talking points.

Many a South African might have found him or herself relating to American singer Tom Waits when he crooned: “I don’t have a drinking problem, except when I can’t find a drink.”

Is it even legal to ban alcohol sales?

Yes, the Disaster Management Act explicitly states that the sale of alcohol can also be suspended or limited once a state of disaster has been declared.

The Fair-Trade Independent Tobacco Association (FITA) will be approaching the courts to have the ban on the sale of cigarettes under the national lockdown lifted.

In a statement, the organisation said it had been in consultation with its legal team and had taken a decision to pursue court action.

“Over the last few days, we have been consulting with our legal team and we have come to the decision to approach the courts for the appropriate relief, vis-à-vis the ban on the sale of cigarettes. This decision was not taken lightly and we had hoped that a logical solution in the best interests of all concerned would be arrived at without the need for litigation,” FITA chairperson Sinenhlanhla Mnguni said.

The ban had not stopped people from buying cigarettes during the lockdown period and had instead resulted in a number of economic and social concerns, he added. FITA is now calling for the distribution and sale of cigarettes to resume at retail stores, spaza shops and filling stations.

The result came back from the prison official’s coronavirus test: Positive.

But it was already too late. The virus had already invaded her workplace, and was cutting a swathe through prisoners and staff alike.

Over the past two weeks, 56 inmates and 31 workers at the correctional facility in East London have been diagnosed with the potentially deadly disease.

“This is a ticking time bomb,” said Ayanda Botha, whose nephew is serving a 10-year term at the overcrowded jail in the Eastern Cape.

“There is no physical distances in prisons, none at all,” he told AFP. “So how do you expect to contain the spread?”

The May/June matric exam rewrites have been postponed by the Department of Basic Education.

The department announced that the Amended Senior Certificate (old matric) and National Senior Certificate Examination, which were scheduled to start on 4 May, would be postponed due to the national lockdown.

The exams will now take place in November.

The exams were to be written by more than 350 000 part-time candidates. This includes pupils who did not meet the pass requirements in the 2019 final exams, as well as those who had wanted to rewrite to improve their marks.

“I worry a lot about them catching coronavirus,” says Nozakuthini Batyi. “I make my kids stay in my yard or lie in bed throughout the day.”

To obey lockdown regulations, Batyi tries to keep her family inside her corrugated iron shack in Khayelitsha, Cape Town, GroundUp reports.

As a means to ensure her kids stay indoors, she makes them do house chores and school work. “I instruct my kids to scrub the floor, wash the dishes and do laundry to keep them too busy to loiter around,” she says.

Batyi moved her family to the Empolweni informal settlement, located on City-owned land in September last year. Previously, she rented a shack in Section 32, Makhaza, until she broke up with her boyfriend.

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.

Early on Sunday morning, positive cases worldwide were more more than 2 310 000, while deaths are more than 158 000.

The United States had the most cases – more than 726 000, and the most deaths – more nearly 38 000.

Two other countries ad more than 20 000 deaths – Italy, and Spain.

Latest news:

As the coronavirus pandemic continues to spread around the world, some countries’ efforts to slow the spread of infection that have been more successful than others.

Both Australia and New Zealand have reported low numbers of coronavirus infections and deaths, compared to other major industrialised countries. As of Friday local time, Australia has reported 6,462 coronavirus cases and 63 deaths, while New Zealand has recorded 1,401 cases and only nine deaths.

The countries have been hailed for their early mitigation efforts to curb the spread of disease, which has been linked to their smaller-than-average number of cases and deaths among Western nations.

Experts say that early national lockdown efforts, good public adherence to the rules, and widespread testing capabilities may have prevented Australia and New Zealand from being overwhelmed with a wave of infections, similar to what is being seen in hard-hit countries like Italy and the United States.

US President Donald Trump said on that China’s coronavirus deaths were “far higher” than it has admitted after the toll in the city where the pandemic originated was revised up by 50%.

Global criticism is mounting against China over its management of the coronavirus outbreak, which has killed more than 145 000 people worldwide and hammered the global economy since it first emerged in the Chinese city of Wuhan last year.

More than half of humanity – 4.5 billion people – are confined to their homes as governments scramble to contain the virus’s death march across the globe.

World leaders are now looking at when – and how – to ease widespread confinement measures to revive an economy battered by what the International Monetary Fund calls the “Great Lockdown”

LATEST RESEARCH

Eyes narrowed in focus behind her face shield, doctor Jana Du Plessis kept a steady hand as she inserted a tube down the throat of a dummy, working through the lid of a plexiglass box.

Du Plessis, a doctor at Johannesburg’s Charlotte Maxeke public hospital, practised moving around a newly-designed isolation device to protect healthcare workers from coronavirus patients.

The “intubox” is the brainchild of four local doctors inspired by a similar “aerosol box” used in Taiwan for sedated and intubated patients.

The South Africans added holes to the original design as well as covers for the openings, creating a protective, transparent but accessible box intended to shield workers from dangerous respiratory droplets.

“This box will create a seal around the patient so that whatever further procedures are needed will happen inside the box,” she explained, manoeuvering tubes and drips through circular side flaps.

Doctors across South Africa are bracing for a potential surge in critically-ill patients as the number of infections continues to rise.

WATCH | SA doctors design a virus ‘box’ to protect healthcare workers against infection

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.

Health24.com | Covid-19 can trigger serious heart injuries

Posted on 17/04/2020 by vrapto17/04/2020

As the toll of the Covid-19 pandemic grows, it is increasingly clear the infection is more than a lung disease. Many patients are developing heart complications, though the reasons are not fully understood.

People with heart disease or a history of stroke are at increased risk of the coronavirus infection, and of suffering more severe symptoms, according to the American Heart Association (AHA).

But those severe infections are not only damaging people’s lungs. Doctors are also seeing injuries to the heart – from heart attack, to inflammation of the heart muscle, to potentially fatal heart arrhythmias.

The precise causes are still being sorted out. And they could be both “direct and indirect”, said Dr Sahil Parikh, a cardiologist at Columbia University Irving Medical Center in New York City.

Coronavirus may directly infect the heart

Indirectly, he explained, the overall stress of being critically ill – with lung disease that is robbing the body of oxygen – can exact a toll on people with existing heart problems.

On top of that, there may be particular effects of Covid-19, according to Dr Robert Bonow, a cardiologist at Northwestern University Feinberg School of Medicine in Chicago.

The coronavirus has proteins that attach to certain receptors in lungs. As it happens, blood vessel cells have those same receptors, Bonow explained. It’s thought that the infection may sometimes directly damage blood vessels, which can cause blood clots that lead to a heart attack.

Another heart complication seen in Covid-19 is myocarditis, an inflammation of the heart muscle.

The cause is unclear, with some researchers speculating the coronavirus may sometimes directly infect the heart. But at this point, Parikh said, actual evidence of that “isn’t great”.

Another possible culprit is the immune system’s response against the virus. When it fires out of control – a severe inflammatory reaction known as a cytokine storm – it can damage organs throughout the body, including the heart.

‘Cardiac injury’ common in China

How common are heart complications?

In a study published last month in JAMA Cardiology, doctors at a hospital in Wuhan, China, reported that “cardiac injury” was common in their experience. Among 416 patients hospitalised for severe COVID-19, about 20% suffered a heart injury. More than half of those patients died.

Heart injury was defined as very high levels of a protein called troponin, which is released into the bloodstream when the heart muscle is damaged.

In the United States, where hospitals are in the midst of the Covid-19 “peak,” it’s not known whether the numbers are similar to the Wuhan study, according to Parikh.

“It’s hard to say what the percentages are,” he said, “but a similar spectrum [of heart complications] is being seen.”

For the most part, the complications have struck people with established heart disease or risk factors for it, such as high blood pressure.

“It’s rare that these patients have no cardiovascular risk factors,” Parikh said.

Don’t ignore symptoms

In New York City, the nation’s pandemic epicentre, another consequence has emerged: A surge in 911 calls for cardiac arrest – a heart arrhythmia that is quickly fatal without emergency treatment.

Last week, the city’s Fire Department said calls for cardiac arrest had shot up: From 20 March to 5 April, the city averaged 195 cardiac arrest calls per day, compared to 65 per day for the same period last year, NBC News reported.

It’s hard to know, Parikh said, how many of those victims had Covid-19. People fearful of hospitals may decide to “tough it out” if they develop the warning signs that can precede cardiac arrest, like shortness of breath, dizziness and heart palpitations.

“People dying of cardiac arrest at home are victims of Covid-19,” Parikh said, “though not necessarily directly.”

It’s critical that no one – especially people with known heart disease – ignore symptoms, said Dr J. Wells Askew, a cardiologist at the Mayo Clinic in Rochester, Minnesota.

That means calling your doctor if you think you have coronavirus symptoms, like fever and coughing, or 911 if you have difficulty breathing or chest pain.

Limiting invasive procedures

Askew acknowledged that when those patients arrive at the hospital, it can be difficult to know if it’s a heart attack or Covid-19.

Parikh agreed, saying, “A few months ago, we would’ve said if it looks like a duck, then it’s probably a duck.” And that would often mean rushing the patient to the catheterisation lab for an invasive procedure to confirm a heart artery is blocked – and then to clear the blockage.

“Now we’re taking a step back, to evaluate whether this is someone at high risk of Covid-19,” Parikh said.

In general, he noted, New York hospitals are trying to limit invasive procedures to emergency situations, to protect both patients and providers.

There are alternatives, Askew said. Patients’ symptoms and medical history, along with imaging tests like ultrasound, can help doctors figure out whether a heart artery is truly blocked.

Like the pandemic, the understanding of Covid-19’s heart consequences is evolving – with doctors using technology to stay up to date. Parikh said he’s part of a WhatsApp group of about 150 area cardiologists who are continually sharing what they’re learning.

READ | How does a severe coronavirus infection possibly injure the heart?

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Health24.com | Don’t believe the hype: bogus products, coronavirus scams thrive

Posted on 16/04/2020 by vrapto16/04/2020

Can zinc help shorten a coronavirus infection? Will vitamin C or other supplements prevent it?

These claims and plenty more can be found on social media and internet sites, but be advised: There is no pill or treatment that can prevent or cure Covid right now.

“We want to think that there is a quick way to get rid of this. But there is not a product out there that will keep you from getting the coronavirus,” said Rebecca Dutch, a virologist with the University of Kentucky in Lexington.

The pandemic has spawned a wave of products claiming to protect you by boosting your immune system – a simple claim people think they understand, said retired psychiatrist Dr Stephen Barrett, who runs Quackwatch, a website that debunks pseudoscientific claims.

Immune system is complex

“They think, ‘If I can boost my immune system, I’ll be more resistant to the virus,’ but it’s just not that simple,” he said.

“The immune system is quite complex,” Barrett explained. “There’s not even a scientific process called strengthening or boosting the immune system.”

He agreed with Dutch: “There is no product you can take that will prevent or cure Covid,” he said.

Even a group representing supplement makers agreed. Two major industry groups – the Council for Responsible Nutrition and the American Herbal Products Association – recently asked stores selling dietary supplements to refuse to stock or sell any products that claim to treat, cure or prevent Covid-19.

“We are not aware of any clinical research studies that demonstrate the efficacy of using a dietary supplement specifically to prevent or to treat Covid-19,” the trade groups said in a statement.

They said consumers should report such products to the US Food and Drug Administration.

The FDA has already sent warning letters to a number of companies selling fraudulent Covid-19 products. The agency also cautions that there are no approved preventatives or treatments for Covid-19.

Believing in magic?

Given the expert consensus, why are people still buying and trying these products?

Barrett said people “believe what they hear the most” and there’s no organised effort to set the record straight.

“There’s no economic incentive to say, ‘This doesn’t work,'” he said. “There’s no money to be made rebutting false claims.” But there’s a lot of money to be made promoting those false claims, so that’s what people tend to hear over and over, Barrett added.

People also tend to believe something works once they try it, he said. Say, for example, that you’ve recently had colds that lasted about a week. You try a supplement that says it will shorten a cold. If your next cold lasts four days, you’ll think the supplement worked. But most illnesses are self-limiting, Barrett said. It might just be that you caught a virus that tends to last only a few days this time.

Dr Philip Muskin, a professor of psychiatry at Columbia University Medical Center in New York City, also points to the fear factor.

“People are scared and when you’re scared, your judgment may be impaired,” he said. “You just want a solution, and up comes a photo of a beautiful woman or man in a beautiful setting telling you that a certain herbal or vitamin supplement can help you.”

Even though you know it can’t be real, everyone wants to believe in magic, Muskin said.

Older adults more vulnerable

“Older adults are more often socially isolated and maybe a little lonelier, which opens them up to people who want to take advantage,” said Dr William Dale, director of the Center for Cancer and Aging at City of Hope in Los Angeles.

Older people also tend to be more trusting and use their phones more often than most, leaving them vulnerable to phone solicitations, he added.

If you suspect someone has tried to scam an older friend or relative, Dale recommends you ask them what they’ve been told, hear their concerns and then correct misinformation.

“Take them seriously. Don’t be dismissive. Take a kind approach. Remind people that right now, there are no cures for Covid. Try to reset the conversation,” he said.

One way to do this is by mentioning their medications. Ask if they have a good supply on hand or if they need to contact their doctor for refills. “Sometimes the easiest way is to have the conversation about medicines and then say, ‘Oh, this might interfere with your medication. You should ask your doctor if this is safe,'” Dale suggested.

What does help?

It also helps to remind older loved ones that people who don’t have Covid-19 symptoms can still transmit the disease and that physical distancing is important, Dale said.

All of the experts recommend washing your hands often – especially whenever you have been outdoors.

“Regular soap disrupts this virus,” Dutch said. “Any soap is OK, even if it’s not antibacterial. If you have access to a sink and soap, use that. Save your hand sanitiser to use when you’re out.”

Muskin and Dutch both emphasised the importance of staying healthy overall. Exercise, eat a balanced diet, get stress relief from things like meditation and do your best to get enough sleep.

Experts agree that it’s important to consider the source of any health information.

“We’re in an unprecedented time of ‘information’ coming in. Trying to decipher who is the best to listen to and sorting out what makes sense and what doesn’t is harder than ever,” Dale said.

Barrett recommends checking sources you know are reputable, such as the FDA, the US Centers for Disease Control and Prevention, and major universities’ websites.

READ | An expert’s guide to fact-checking coronavirus info online

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Health24.com | Brain, nervous system affected in 1 in 3 cases of severe Covid-19

Posted on 15/04/2020 by vrapto15/04/2020

A study out of China finds that strokes, altered consciousness and other neurological issues are relatively common in more serious cases of Covid-19.

Looking at 214 cases of severe coronavirus illness treated in Wuhan city during the early phase of the global pandemic, doctors reported that 36.4% of patients displayed neurological symptoms.

Sometimes these symptoms appeared in the relative absence of “typical” symptoms of Covid-19 – fever, cough, diarrhoea – the team said.

In such cases, doctors should consider coronavirus infection as a potential cause of the problem “to avoid delayed diagnosis or misdiagnosis”, said a team led by Dr Bo Hu, a neurologist at Union Hospital in Wuhan.

Hu’s team published their findings online in JAMA Neurology.

Absence of typical symptoms

The suspicion that the novel coronavirus could infiltrate and affect the brain and central nervous system is not new. Last month, numerous reports emerged that one key sign of infection was a loss of sense of smell, pointing to the virus somehow affecting nerve pathways.

In the new report, Hu’s team tracked outcomes for more than 200 people treated at three hospitals in Wuhan, the original epicenter of the Covid-19 pandemic. Patients all had disease severe enough to warrant hospitalisation, and were treated between 16 January and 19 February. They averaged about 53 years of age.

Looking specifically at symptoms affecting the brain or central nervous system, the team found that these issues became more common as the severity of illness rose. And, in some cases, typical Covid-19 symptoms were absent.

“Some patients without typical symptoms … of Covid-19 came to the hospital with only neurological manifestation as their presenting symptoms,” the researchers wrote. In some cases, these issues could be life-threatening: there were at least six cases of stroke or brain haemorrhage observed among those studied, Hu’s group reported.

Whether or not infection with the coronavirus directly triggered strokes is unclear, the team said, but in severe Covid-19, a “rapid clinical deterioration or worsening could be associated with a neurologic event such as stroke, which would contribute to its high mortality rate.”

Other neurological issues were also at play. Many patients arrived at the hospital disoriented or confused, or were dizzy or had headaches or even seizures, the Chinese group said. Impairments in taste or smell were also seen.

More specific neuroimaging needed

Older patients, many of whom had other underlying chronic illnesses, were at highest risk for neurological issues tied to Covid-19, the study found.

Dr Rafael Ortiz is chief of neuro-endovascular surgery at Northwell Health Western Region in New York City and Westchester, New York.

Reading over the new report, he said “these findings could be related to direct involvement of the virus in the brain, brainstem and peripheral nerves.” Other symptoms may be due to the stresses put on the body by the illness itself, he added.

The Chinese researchers and Ortiz agreed that this early study may not be the last word on how the new coronavirus affects the brain.

“A prospective, observational study with a larger number of patients that includes more specific neuroimaging and other diagnostic tests is warranted for more conclusive evidence,” Ortiz said.

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