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Health24.com | What pregnant women with high blood pressure need to know about the new coronavirus

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High blood pressure during pregnancy can put mother and baby at risk during normal circumstances. But with the new coronavirus spreading rapidly, many are wondering how this highly contagious threat may affect them.

The good news is, thus far, nothing researchers have learned about Covid-19 raises additional concerns for pregnant women – even if their blood pressure runs high, or if they have been diagnosed with problems such as gestational diabetes. The bad news is, because the virus is new and relatively unstudied, there’s still a great deal researchers don’t know.

“Researchers are still learning how Covid-19 affects pregnant women,” said Dr Lisa Hollier, chief medical officer for Texas Children’s Health Plan and a past president of the American College of Obstetricians and Gynecologists, known as ACOG. “It’s important for women who have medical complications to stay in very close touch with their OB-GYN and other health care professionals who are taking care of them during their pregnancy.”

ACOG guidelines for pregnant women are no different than for anyone else trying to avoid infection from the coronavirus that causes Covid-19, a respiratory illness with symptoms that can include cough, fever and, in more severe cases, difficulty breathing. However, because respiratory infections can be harmful to pregnant women and their unborn children, ACOG does consider pregnant women an at-risk population.

A leading cause of maternal death

“They need to be doing all of the things that all other women are doing to be sure that they reduce their risk of getting Covid-19 – washing their hands often, using hand sanitiser, not touching their faces,” Hollier said. “For all pregnant women, we are recommending you stay in touch with your healthcare professional about the best ways to continue prenatal care. Some visits can be done online with video.”

The Centers for Disease Control and Prevention cautions that people who have underlying conditions such as heart disease, severe obesity or diabetes are at greater risk for severe illness from Covid-19. And researchers know that high blood pressure disorders during pregnancy are one of the leading causes of maternal death worldwide – suggesting further investigation is warranted. The University of California in San Francisco is currently registering pregnant and postpartum women diagnosed with or being evaluated for Covid-19 to study how the virus affects them. The study will include women with hypertension and pre-eclampsia, a dangerous condition characterised by high blood pressure and protein in the urine.

Thus far, neither the CDC nor ACOG has separate Covid-19 guidelines for pregnant women with conditions such as gestational hypertension, gestational diabetes, chronic hypertension or pre-eclampsia.

“What little we do know comes from a small number of reports that have come out of China,” said Dr Elizabeth Langen, clinical associate professor in the University of Michigan’s department of obstetrics and gynaecology.

Hard to say anything definitive

“They were the first who had to take care of women who had coronavirus during pregnancy. Unlike the flu, which is really dangerous to pregnant women, this virus does not appear to be any more dangerous to pregnant women with similar risk factors. Most people will have more mild symptoms and recover.”

But with so little data, it’s hard to say anything definitive, warns Hollier. “It’s certainly possible that it affects them worse. We just don’t have all of the data we need to give anyone firm answers.”

What should a pregnant woman with hypertension, pre-eclampsia or other complications do if she thinks she has Covid-19?

“If you have both pregnancy and something that affects how your heart is functioning,” Langen said, “if you are symptomatic, we are going to want you to go in and be seen.”

AHA News for HealthDay 

READ | Pregnant women need to guard against coronavirus

READ | A parent’s guide to fighting coronavirus stress

READ | Babies are spared severe symptoms of the new coronavirus

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Health24.com | ‘Necrotising pneumonia’ may be new vaping hazard

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E-cigarettes were initially thought to be a safer alternative to traditional cigarettes, but a recent outbreak of serious lung illnesses and deaths linked to the nicotine delivery devices called that belief into question.

Now, a new case report details another type of lung illness in a 15-year-old girl who regularly used e-cigarettes: necrotising pneumonia.

Necrotising pneumonia is an uncommon complication of pneumonia. It destroys areas of lung tissue, and can occur even if someone has been treated with antibiotics, according to a previous review in Biomed Central.

“It’s pretty unusual for a generally healthy person to get an invasive pneumonia like this, but not impossible,” said Dr Ravi Kalhan, a professor of medicine and preventive medicine in the division of pulmonary and critical care medicine at Northwestern Feinberg School of Medicine in Chicago. Kalhan was not involved in the current case, but is familiar with the new report.

A setup for severe pneumonia

He said experts can’t know for sure if vaping caused this particular illness, but animal studies have suggested impaired immune defences in the lungs.

“The idea that in this case vaping created a setup for severe pneumonia in an individual is a reasonable hypothesis, but a single case does not prove it,” Kalhan said.

What is already known, however, is that more than 2 800 people across all 50 states have been hospitalised with life-threatening respiratory dysfunction tied to recent e-cigarette use, according to the US Centers for Disease Control and Prevention. Sixty-eight of those patients died.

Research strongly suggests that an additive called vitamin E acetate, sometimes used in pot-laced vapes, may be triggering these illnesses.

But health experts have also raised a more general alarm about soaring rates of e-cigarette use among teens. A CDC report from November reported that about one in every five high school students had used e-cigarettes within the past month.

Lung tissue damage

The new case report, written by Dr Joseph Domachowske and colleagues from Upstate Medical University, State University of New York in Syracuse, revealed that the teen patient had a habit of daily nicotine vaping. She used e-cigarettes several times each hour, and had done so for the past nine months. Like many people who use e-cigarettes, the girl used flavoured nicotine, including apple, mango, cotton candy and birthday cake flavours.

She said she used both disposable and refillable pen-like vape devices. She said she hadn’t altered the devices in any way. The girl admitted to occasionally smoking marijuana, but not with an e-cigarette.

In September 2019, she went to the hospital complaining of difficulty breathing. She had been sick for about a week prior.

Imaging of her lungs showed that lung tissue damage had occurred.

Luckily, she responded well to treatment and was released after more than a week in the hospital, including six days in the ICU.

But she has yet to fully recover. Before this report, the doctors had seen the teen one month after she completed a three-week course of antibiotics. She still couldn’t climb more than a flight of stairs without getting out of breath. She also couldn’t walk quickly from one class to another without getting winded.

A risky behaviour

Dr Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, was not part of the study, but said this appeared to be “yet another horror story of vaping.”

He added that this unusual case seems to represent a previously undescribed cause of vaping-related pneumonia.

Kalhan said that this report, published in the journal Pediatrics, and the many previous lung injury cases, suggest one thing.

“I think it’s clear that vaping is definitely not good for you,” he said.

“Inhaling anything but air is a risky behaviour. We don’t know at all what the true short- and long-term effects are of vaping, and speculation that it’s safe [or safer than cigarettes] is just that – speculation. The effects have not been carefully studied and need to be. In the meantime, I’d just remind people that the lungs were designed to inhale AIR, and that’s it. Not anything else,” Kalhan advised.

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Health24.com | At the barbershop: a trim – and a diabetes screening

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Hundreds of black men recently discovered they could get more than a trim at their local barbershops. They were offered diabetes testing, too.

A new study offered customers diabetes screenings at eight New York City barbershops. Among those who took the test, 10% learned they had average blood sugar levels that indicated type 2 diabetes. And almost 30% appeared to have prediabetes.

“For a long time, barbershops have been a place of trust, especially for black people. Because we had the barbers on board with us, people trusted us. Barbers are often important health advocates,” said the study’s senior author, Dr David Lee. He’s an assistant professor of emergency medicine at the NYU School of Medicine.

Lee and his colleagues said it’s important to reach out to black men in this way because their diabetes diagnosis is often delayed, and black men have significantly higher rates of diabetes complications once diagnosed. Black men are also less likely to live into their 70s than are men in other racial and ethnic groups.

A gathering place for men

Dr Anthony Clarke, an internal medicine doctor in Detroit, said, “Not seeking medical care is a common problem in men, and it’s worse in the black community. With a lot of men in general, they think, if you don’t know about a problem, it’s OK. A lot of men tell me, ‘My wife made me come in.'”

Clarke, of Detroit Medical Center’s Harper University Hospital, was not involved in the current study.

“I think the barbershop was a good way to do this. If patients aren’t coming to you, you go where the patients are. The barbershop is a gathering place for men,” Clarke said.

Some don’t want to know

The researchers partnered with eight Brooklyn barbershops, all owned by black people. The neighbourhoods were chosen because they had a higher prevalence of poor blood sugar control.

From September 2017 through January 2019, nearly 900 black men were offered the free finger-stick blood test for diabetes.

The researchers ended up testing 290 men. Their average body mass index (BMI) was 29.3. BMI is a rough estimate of body fat based on height and weight measurements. A BMI between 24.9 and 29.9 is considered overweight. A BMI of 30 or more is considered obese.

Of those who had undiagnosed diabetes, about 62% were obese, the study found. The average age of the men with undiagnosed diabetes was 41.

More than half of the men who didn’t take the test were willing to tell the researchers why. About half said they knew their health status or had been checked by their doctor, and 35% said they were healthy or they didn’t want to know their status. Eight percent said they were afraid of needles, Lee’s team noted.

Earlier detection needed

“The symptoms of type 2 diabetes are relatively few. A lot of people feel fine and think they’re healthy. Other research has shown that if you find diabetes from a screening test rather than symptoms, you’ll have half the premature mortality rate than those who find out later,” Lee said.

“I usually meet people late in the disease process at the [emergency department]. We need to start figuring out ways to detect chronic diseases like diabetes earlier,” he added.

Lee said he’s not sure if this approach would work in other cities or in more rural areas.

The study results were published as a letter in the online edition of JAMA Internal Medicine.

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Health24.com | 10 new weapons in the war on migraines

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There is no cure for migraines – a headache disorder that can cause sensory disturbances and nausea – but several new treatments may help people with the debilitating condition, a neurologist says.

“Ten new treatments for migraines have been approved by the US Food and Drug Administration [FDA] over the past six years,” said Dr Stephen Ross, from Penn State Health Neuroscience Institute, in Hershey, Pennsylvania.

About 38 million Americans experience migraines – some many times per month. These episodes are most common from the teens through the 40s, but can occur at any age. About 20% of women and 6% of men are affected.

Treatment doesn’t work for everyone, but “people can go into remission, with no attacks for months or even years”, Ross said in a Penn State news release.

Prevention better than cure

And many of the newer treatments offer moderate to significant benefits for patients, he added. These treatments include calcitonin gene-related peptide (CGRP) inhibitors; medical devices; a serotonin 1F receptor agonist; and Botox.

CGRP inhibitors are preventive treatments that disrupt a protein called CGRP, which is particularly active in people with migraines.

“They block the flow of CGRP to the brain, disrupting the signal that causes migraines,” Ross explained.

Unlike traditional migraine meds, such as sumatriptan (Imitrex), CGRP inhibitors don’t constrict blood vessels, so they’re safe for people who’ve had a stroke, heart attack or vascular disease.

Three CGRP inhibitors – erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab-gnlm (Emgality) – are injected once a month. A fourth – eptinezumab-jjmr (Vyepti) – was approved in February. It’s the first drug for migraine prevention through IV infusion.

Two other CGRP inhibitors – ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) – are pills designed to stop a migraine when it occurs. Both received FDA approval last month, according to the news release.

Botox effective for chronic migraine

In addition, three new, non-invasive medical devices are available for migraine patients.

Cefaly is placed on the forehead to stimulate a nerve that impedes migraine pathways. SpringTMS is a magnetic stimulator placed on the back of the head to disrupt migraine signals in the brain. Both can be used as prevention or when a migraine strikes.

A third device called gammaCore is placed at the front of the neck and stimulates the vagus nerve. It’s used when a migraine occurs.

In addition to these remedies, Lasmiditan (Reyvow) is the first in a brand-new class of drugs that stimulate the serotonin 1F receptor, believed to be involved in causing migraines.

“These medications slow down the body’s pain pathways,” Ross explained.

Botox isn’t a new treatment, but is effective in people with chronic migraine, according to Ross. It’s delivered through a quarterly series of scalp injections.

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Health24.com | Coronavirus pandemic puts healthcare workers’ mental health on the line

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Doctors and nurses are trained to deal with life-and-death situations, to be calm in the face of crisis. But whether it’s in hard-hit New York or places where Covid-19 has yet to surge, medical workers say the pandemic is straining their mental health like nothing before.

“The stress is probably 100 times what you could have imagined it was in the past,” said Judy Davidson, a nurse scientist at University of California, San Diego Health. Davidson, whose research shows nurses were at higher risk for suicide than the general population even before the coronavirus struck, said delivering psychological support to health care workers will be as crucial as providing protective gear.

Stories from some of those on the front lines make clear why.

“To me, it’s almost like going into a battlefield, where every enemy is a sniper,” said Poppy Strochine, a nurse in Cincinnati. “You don’t see him. You don’t know where it’s going to come from. And you don’t have the supplies that you need to keep yourself safe to actually do the battle.”

‘I’d never forgive myself’

As a wound care specialist, she visits people in home after home, unsure of what they might have been exposed to. Strochine has yet to encounter a case of Covid-19 – that she knows of. But “I’m right up against the patient dealing with the wounds. If they cough or sneeze or even touch me, I’m infected.”

The coronavirus, she said, “basically puts you on an island where you are there by yourself”.

She particularly misses the physical touch of her family. “I really can’t do that. Because at any point in time, you don’t know if you’ve got it. And to pass it along to them – I’d never forgive myself.”

Dr Mitchell Elkind, professor of neurology and epidemiology at Columbia University in New York City, has seen the strain.

Much of it stems from uncertainty about how to fight the illness, said Elkind, president-elect of the American Heart Association. “We are constantly learning and updating our recommendations, and I think that makes people a bit uncomfortable.”

Adding to those unknowns: fears about shortages of protective gear and the potential decisions healthcare workers face about who lives and who dies if vital equipment isn’t available.

Nurses ‘on edge’

Elkind also worries about exposing his family to the virus. He’s careful about changing out of his scrubs at the office and showering as soon as he gets home. But he wonders, “Is that overkill? Is it not enough? Should I be staying in a hotel instead of going home? These are the kinds of decisions that we’re making without very much information at all.”

And he’s concerned about the doctor trainees whose careers have been put on hold as they are pressed into service. “It’s interrupted their lives,” he said. “And hopefully, they don’t end up paying for it with their lives.”

Mirna Eads, a floor nurse at a nursing home in Fort Thomas, Kentucky, is on edge because people around her don’t seem to understand what she and her colleagues are up against. Some visitors refuse to comply when asked to wash their hands or wear a mask. Shoppers scowl when she wears a mask at the grocery store. “I get looks like, ‘Really? You’re taking this awful serious, don’t you think?'”

Nela Hadzic, a New Jersey-based union organiser with the Northeast Nurses Association, said nurses have been stressed by the lack of gear, administrators who won’t communicate openly and, again, those fears of infecting loved ones.

“That’s the stuff that’s making nurses cry,” she said.

Davidson said health care employers urgently need to be paying attention to workers’ mental health. “Organisations need to have psychological support systems in place right now,” she said. “This is not an option. It just has to be.”

Solace in humour

She listed several approaches that have been shown to work. Her facility adapted its Healer Education Assessment and Referral (HEAR) programme, designed as a suicide prevention tool, to focus on workers affected by the pandemic. Code Lavender, a Cleveland Clinic programme, uses trained teams to respond to workers who say they’re having a mental health emergency. A University of Missouri program uses “emotional first aiders”, to look out for people who might be having a bad day. And Ohio State University’s MINDBODYSTRONG offers a series of classes that build resilience.

Workers need to be watching out for one another, too, and take action. Know the number of your employee assistance programme and keep the number of The South African Depression and Anxiety Group (SADAG) handy. 

“If you’re with a co-worker that you have identified as high-risk, stay with them through that moment,” Davidson suggested. “Do not leave them. Tell them that you recognise they need help, you want them to get help, and you’re not going to leave them.”

Strochine, the wound care nurse, finds solace in humour, and in getting out to the creek near her house. “I’ll sit beside the creek for hours on end and just meditate and relax. And that seems to help.”

She and Elkind both said people can support medical workers by doing something simple: staying home.

“It’s so hard to conceive of how staying at home is a benefit, because you feel like you’re not doing anything,” Elkind said. “People want to get out there and do something positive. They don’t want to stay back and not do something. But in this case, the paradox is that staying home and staying away from people really is of great benefit.”

READ | Looking after your mental health during the coronavirus crisis

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

READ | An expert’s guide to fighting coronavirus stress

AHA News for HealthDay

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Health24.com | An expert’s guide to fighting coronavirus stress

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The new coronavirus is not just a physical health threat. The stress, anxiety, fear and isolation that go along with it also take a toll on your mental well-being.

“One of the basic tenets of how to manage your mental health in a crisis like this is to ensure that you’re taking care of your own basic needs – taking breaks, having rest and sleep, getting adequate nutrition, exercising and having compassion for yourself and others,” said Dr Itai Danovitch. He’s chairman of the department of psychiatry and behavioural neurosciences at Cedars-Sinai in Los Angeles.

Danovitch suggested creating a daily schedule with separate blocks of time to work, relax, play and eat.

“It helps to ensure that the day doesn’t get consumed by worrying, because our fear and our worries, when we don’t have control over them, can sometimes have the effect of overtaking other activities,” Danovitch said.

Trustworthy news sources

He said it’s important to acknowledge your emotions – it’s OK to worry and it’s OK to have fear.

“On the other hand, we want to try to put a container around them so that they don’t consume all the other components of the day,” Danovitch said in a Cedars-Sinai news release. “We want to be deliberate about trying to have those other experiences that we talked about – self-care and connection.”

When seeking news and information about the pandemic, be sure it’s from trustworthy sources, such as your local public health agencies and the US Centers for Disease Control and Prevention.

“Getting accurate information includes accepting areas where there is uncertainty,” Danovitch said. “It also includes responding to areas where there’s very clear direction from trusted authorities and experts.”

Optimism and compassion are vital. Consider calling or video-chatting with people who are isolated or otherwise at risk for mental health struggles. He said listening with empathy and compassion is very powerful.

“Bearing witness to what they’re going through, by connecting with them and letting them know that we are there for them, even if we’re not there physically, I think we help each other out,” Danovitch said.

READ | Looking after your mental health during the coronavirus crisis

READ | How to keep coronavirus anxiety at bay

WATCH | Coronavirus lockdown: ‘It’s really important that you keep the social connections going’

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Health24.com | Neurological ailments in some coronavirus patients – what could this mean?

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As Covid-19 causes complications and death in patients globally, experts are attempting to find out exactly how the virus attacks the body.

While medical experts reported acute respiratory distress syndrome (ARDS) as one of the main symptoms of Covid-19, it has been shown that it can also affect the heart. But now, according to an article in New York Times, and reports by clinicians, neurological symptoms such as confusion, seizures and an altered mental state have also been observed.

But what does this mean?

Virus doesn’t only attack the lungs

In an earlier Health24 article, we discussed the Covid-19 virus’s ability to adhere to several kinds of human cells, not only those of the lungs. This means that patients may present with atypical symptoms such as diarrhoea, apart from the textbook fever, cough and shortness of breath.

Now there are reports of patients who show no signs of pneumonia or respiratory distress, but instead confusion, strange behaviour and sometimes seizures.

There are a couple of hypotheses that might explain why the Covid-19 virus has a neurological effect on some patients. A paper published in the Journal of Medical Virology showed that the virus is not only confined to the respiratory system and therefore affect the neurological system, which explains symptoms such as headaches and vomiting.

Too early to tell

Dr Robert Stevens, a neurologist at the John Hopkins School of Medicine states that all observations in this regard should be handled as hypotheses for now, as it’s too early to define the specific mechanics of how exactly the virus affects the neurological system.

He says that the explanation could be as simple as low levels of oxygen in the blood, resulting from respiratory failure and a sudden increase in carbon monoxide, which can impact the brain’s normal function, hence the lethargy and confusion.

Some experts also believe that the brain can be damaged by a viral infection when the immune system causes an overproduction of cytokines as a reaction to the virus. This may have occurred after a woman who tested positive for Covid-19 developed a rare brain disease known as acute necrotising encephalopathy, a condition that can also be triggered by influenza.

A journal article published in The Lancet explains how cytokines are overproduced in the case of Covid-19, causing severe complications.

This case study of the patient who suffered this rare brain condition while testing positive for Covid-19 was published in Radiology on 31 March 2020.

What this means for those who treat Covid-19

According to Dr Elissa Fory, a neurologist from Henry Ford, clinicians need to consider how those with severe neurological disease will be incorporated into the treatment paradigm as these complications can be just as devastating and deadly as lung complications.

Medical professionals should also not dismiss atypical symptoms such as mental confusion, sudden, severe lethargy and seizures. This, however, doesn’t mean that the slightest headache or bout of fatigue should be an immediate alarm bell for Covid-19, but that the spectrum of symptoms caused by the virus may be broader than initially realised. 

READ | Undetected cases may be driving coronavirus spread

READ | Mild coronavirus cases often appear with only gastro symptoms

READ | Pink eye could be a less common symptom of the new coronavirus

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READ MORE | READ MORE | 8 strains of coronavirus circulating around the world

READ MORE | Could an age-old TB vaccine help in our fight against coronavirus?

READ MORE | Three countries have kept coronavirus in check; here’s how they did it

Compiled by Marelize Wilke

Health24.com | New finding challenges old notions about dyslexia

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The cerebellum does not affect reading ability in people with dyslexia, according to a study that challenges a controversial theory.

The cerebellum is a brain structure traditionally involved in motor function.

This new study disputes that theory and could lead to improved treatment of dyslexia, according to scientists from Georgetown University Medical Center in Washington, D.C.

“Prior imaging research on reading in dyslexia had not found much support for this theory … but these studies tended to focus on the cortex,” explained study first author Sikoya Ashburn, a PhD candidate in neuroscience.

Evidence never very strong

“Therefore, we tackled the question by specifically examining the cerebellum in more detail. We found no signs of cerebellar involvement during reading in skilled readers or differences in children with reading disability,” Ashburn said in a Georgetown news release.

In the study, the researchers used functional MRI to monitor brain activation in 23 children with and 23 children without dyslexia while they read. The results showed that the cerebellum is not engaged during reading in typical readers and does not differ in children who have dyslexia.

“The evidence for the cerebellar deficit theory was never particularly strong, yet people have jumped on the idea and even developed treatment approaches targeting the cerebellum,” said senior study author and neuroscientist Guinevere Eden, She is a professor in the Department of Pediatrics at Georgetown and director of its Center for the Study of Learning.

The study was published in the journal Human Brain Mapping.

The findings could help refine models of dyslexia and assist parents of children who are struggling with reading to make informed decisions about which treatment would be best for their children, the researchers said.

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NEXT ON HEALTH24X

Health24.com | Coronavirus morning update: SA cases top 1 500, life returning to Wuhan, and 8 strains of the virus

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WHAT’S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 1505.

Gauteng, KwaZulu-Natal, and the Western Cape continue to account for the majority of the cases.

According to the NICD, more than 50 000 tests have been conducted so far.

READ MORE |All the confirmed cases of coronavirus in SA

Latest news:

The South African government is prepared to spend any amount of money it takes to save lives.

This was the battle cry from Health Minister Zweli Mkhize on Friday afternoon.

“It does not matter how much money we spend. It will be worth it  We have seen the devastation in other parts of the world.”

The minister is determined South Africa will do everything in its power to prevent similar carnage.

Mkhize was speaking at a media briefing at Khayelitsha District Hospital in Cape Town.

READ MORE | 10 people are in ICU as SA’s coronavirus cases break the 1 500 mark

The Department of International Relations and Cooperation has welcomed the successful repatriation of 16 South Africans who were stranded in Dubai and Doha.

“The group is currently under quarantine as per regulations. Another group of about 16 citizens stranded in Germany is expected to return from Frankfurt over the weekend,” the department said in a statement. 

It added they arrived back in the country on Thursday, following President Cyril Ramaphosa’s announcement allowing for the relaxation of restrictions to allow citizens stranded abroad to return home. 

The department said with more countries requesting the repatriation of their citizens from South Africa, it would use the opportunity to bring back more South Africans using chartered flights.

READ MORE | 16 South Africans who were stranded in Dubai and Doha return home

Former State prosecutor and current DA MP Glynnis Breytenbach has questioned the legality of the ban on the sale of cigarettes, saying that the regulations are open to interpretation. 

Breytenbach’s comments come after the minister of police Bheki Cele called out the Western Cape government for lifting the ban.

Cele lambasted the provincial administration for allowing the sale of cigarettes.

On Thursday, Cele urged businesses in the province “not to listen to people who tell them wrong things”, after the DA-led province said on Wednesday that cigarettes could be bought at supermarkets, along with essential goods.

Western Cape Premier Alan Winde has since written to President Cyril Ramaphosa for clarity on the proper interpretation of the lockdown regulations

READ MORE | Ban on cigarettes: Nothing ‘legally’ wrong with selling cigarettes, says Breytenbach

More than 17 000 people have been arrested countrywide over the last week for various crimes and contravening lockdown regulations.

Of those, 2 005 were released on a warning by the police and ordered to appear in court, 124 were granted police bail and 7 450 fines and 16 court summons were issued, according to Police Minister Bheki Cele’s spokesperson, Brigadier Mathapelo Peters. 

Offences committed included breaking lockdown regulations, and varied between transport- and liquor-related offences as well as general non-compliance.

“What has been a dampener since the beginning of the lockdown has been the consistently high number of people arrested for violating lockdown regulations,” said Cele.

READ MORE | More than 17 000 people arrested since lockdown kicked off

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 close to 1 090 000, while deaths were more than 58 000.

The Unites States had more than 270 000 cases, while Italy and Spain both had more than 115 000.

Italy had more than 14 500 deaths.

READ MORE | All the confirmed cases worldwide

Latest news:

Cars are back on city streets and shoppers are strolling in malls again as life slowly returns to Wuhan. But the cradle of the global coronavirus pandemic remains under the shadow of the contagion.

The city of 11 million people – along with tens of millions more throughout the rest of Hubei province – was locked down in late January in an unprecedented and ultimately failed bid to contain the pathogen.

Hubei and its provincial capital Wuhan have accounted for the majority of China’s officially reported 3 322 coronavirus deaths and 81 620 overall cases.

But with new infections now virtually nil – according to the much-questioned Chinese government figures – authorities have begun loosening restrictions on movement within the city and easing its isolation from the rest of the country.

READ MORE | Light at coronavirus tunnel’s end: Wuhan’s cautious reawakening

A discussion between two top French doctors on live TV left viewers horrified when they proposed that Africa should become a giant laboratory for coronavirus vaccines testing because the continent lacks the resources to defend against the infections.

In the segment broadcast on the on French TV channel LCI, Jean-Paul Mira and Camille Locht raised the idea of testing new vaccines on impoverished African populations.

Mira is head of the intensive care department at the Cochin Hospital in Paris, while Locht is research director at the French National Institute of Health and Medical Research (INSERM).

“If I can be provocative,” said Mira, “shouldn’t we do this study in Africa where there are no masks, no treatment, no intensive care? A bit like we did in some studies on AIDS. We tried things on prostitutes because they are highly exposed and do not protect themselves.”

READ MORE | 2 top French doctors said on live TV that coronavirus vaccines should be tested on poor Africans

LATEST RESEARCH

While racing to fully understand the structure of the new coronavirus, scientists around the world have discovered that there are eight specific strains affecting the globe.

These strains are all extremely similar and the virus shows only slow mutation – which buys time for those under pressure to develop a vaccine or effective treatment.

According to reports, scientists have been using advanced technology to rapidly sequence the genome of the virus from test samples. This shows that the difference between the eight strains worldwide are minute and that none of them is necessarily weaker or worse than the other.

Scientists used their knowledge to compile a genetic sequence map at nextstrain.org, an open access website which shows how the virus travelled across the globe and how various strains developed. According to Charles Chui, infectious disease physician and clinical microbiologist, scientists have the ability to do genomic sequencing almost in real-time to see what strains or lineages are currently circulating.

READ MORE | 8 strains of coronavirus circulating around the world

HEALTH TIPS (as recommended by the NICD and WHO)

• Avoid contact with people who have respiratory infections 

• 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 

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Health24.com | Mild coronavirus cases often appear with only gastro symptoms

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When most people think of the new coronavirus, they imagine symptoms such as a dry cough and high fever. But new research out of China shows that a minority of cases appear with gastrointestinal symptoms only.

In about one-quarter of patients in the new study, diarrhoea and other digestive symptoms were the only symptoms seen in mild Covid-19 cases, and those patients sought medical care later than those with respiratory symptoms.

“Failure to recognise these patients early and often may lead to unwitting spread of the disease among outpatients with mild illness, who remain undiagnosed and unaware of their potential to infect others,” said a team from Union Hospital and Tongji Medical College in Wuhan, China, the original epicentre of the coronavirus pandemic.

“The data in this study highlight the presence and features of this important subgroup of Covid-19 patients and should be confirmed in larger international studies,” the researchers concluded.

Virus throws a curveball

One US expert agreed.

“We are only now learning the varied spectrum of symptoms for patients who present with Covid-19,” said Dr Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City.

“This virus has thrown a curveball at us, as we now realise that gastrointestinal symptoms may be the initial signs of the disease, even without cough, fever, or difficulty breathing,” he said. “The good news is that the majority of patients with gastrointestinal symptoms typically have mild disease.”

In the new study, the research team tracked data from 206 patients with mild Covid-19. Nearly one-quarter (48) had digestive symptoms only, 69 displayed both digestive and respiratory symptoms, and 89 had respiratory symptoms only.

Of the patients with digestive symptoms, 67 had diarrhoea, the study found. Of those, about one in five had diarrhoea as the first symptom in the course of their illness.

Patients with digestive symptoms ill for longer

Diarrhoea lasted between one to 14 days, with an average duration of more than five days and a frequency of about four bowel movements a day.

About one-third of patients with a digestive symptom did not have a fever, the investigators found.

Patients with digestive symptoms took longer to seek medical care than those with respiratory symptoms (16 days versus 11 days), a finding that was consistent with previous research.

The new study also found that patients with digestive symptoms had a longer total time between the start of symptoms and being clear of the coronavirus, were more likely to have coronavirus in their faeces (73% versus 14%), and were ill longer than those with respiratory symptoms.

The study was recently published online in the American Journal of Gastroenterology.

Study considered ‘vital’

The Chinese team stressed that of course there are many illnesses circulating in the community that can trigger gastrointestinal symptoms, “and most instances of new-onset diarrhoea, nausea, vomiting, or low appetite are not from Covid-19.”

Still, “clinicians should recognise that new-onset, acute digestive symptoms in a patient with a possible Covid-19 contact should at least prompt consideration of the illness,” the researchers explained.

Dr Brennan Spiegel is co-editor-in-chief of the journal. He called the study “vital because it represents the 80% or more of patients who do not have severe or critical disease. This is about the more common scenario of people in the community struggling to figure out if they might have Covid-19 because of new-onset diarrhoea, nausea, or vomiting.”

Glatter agreed.

“It’s vital to recognise this key aspect of how the disease presents, since it can trigger the need for self-quarantine,” he said.

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