Coronavirus (COVID-19): What You Need To Know

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NHE
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Re: Coronavirus (COVID-19) News

Post by NHE » Fri May 01, 2020 12:51 pm

jimmylegs wrote:
Fri May 01, 2020 10:36 am
re spelling, they're not alone. probably english is not the authors' first language.
The naming of molecules in organic chemistry follows a set of standards known as International Union of Pure and Applied Chemistry (IUPAC) Nomenclature. Being international, it doesn't matter what country you're in, a molecule's name remains the same.

For example, 1,2,3,4,5,6-hexamethoxy-7,7-dimethyl-1,3,5-cycloheptatriene will still be the same no matter where you are.

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Re: Coronavirus (COVID-19): What You Need To Know

Post by vesta » Fri May 01, 2020 1:33 pm

NHE wrote:
Fri May 01, 2020 8:52 am
Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19
https://www.medrxiv.org/content/10.1101 ... 20065920v2
  • BACKGROUND: Despite limited and conflicting data on the use of hydroxychloroquine in patients with Covid-19, the U.S. Food and Drug Administration has authorized the emergency use of this drug when clinical trials are unavailable or infeasible. Hydroxychloroquine, alone or in combination with azithromycin, is being widely used in Covid-19 therapy based on anecdotal and limited observational evidence.

    METHODS: We performed a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers until April 11, 2020. Patients were categorized based on their exposure to hydroxychloroquine alone (HC) or with azithromycin (HC+AZ) as treatments in addition to standard supportive management for Covid-19. The two primary outcomes were death and the need for mechanical ventilation. We determined the association between treatment and the primary outcomes using competing risk hazard regression adjusting for clinical characteristics via propensity scores. Discharge and death were taken into account as competing risks and subdistribution hazard ratios are presented.

    RESULTS: A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively. Compared to the no HC group, the risk of death from any cause was higher in the HC group (adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group (adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72). The risk of ventilation was similar in the HC group (adjusted hazard ratio, 1.43; 95% CI, 0.53 to 3.79; P=0.48) and in the HC+AZ group (adjusted hazard ratio, 0.43; 95% CI, 0.16 to 1.12; P=0.09), compared to the no HC group.

    CONCLUSIONS: In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.
That"s a pointless study, hydroxychloroquine needs to be administered BEFORE hospitalization when the virus still resides in the throat. Today I watched an interview in France of Prof Raoult who discovered the use of chloroquine to treat a coronavirus. He finds the opposition to chloroquine hysterical, it's benign and has been easily prescribed for the past 50 years, even 80 years. That only in rich countries of Western Europe and US is there a high death rate, because it is NOT being treated, just let people get sick, get intubated and die. Costa Rica is another country added to the list of chloroquine use. I just discovered that the EU is setting up a study of 5 drugs to treat Covid 19 to hospitalized patients which again is pointless in the case of chloroquine, designed to fail. And worse, in accordance with this "study" the French govt has forbidden French MDs to prescribe it and pharmacists to fill an Rx if one comes. This basically is a death sentence for me should I fall ill with Covid 19. I'll have only 5 days from overt symptoms to obtain the RX. What am I supposed to do, persuade my husband to hold up a Pharmacy? The French MDs are up in arms that they can't treat their patients with the only medication known to work.

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Fri May 01, 2020 2:11 pm

re spelling, looks like a few countries didn't get the memo https://tr.intl.chemicalaid.com/info/ch ... und=C6H8O4

may 5 update re questionnaire treatment groupings:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604695/
"The newer immunotherapies for multiple sclerosis (fingolimod, natalizumab, dimethyl fumarate, teriflunomide, alemtuzumab) offer advantages of efficacy or tolerability over the injectable therapies of the 1990s. But they also have greater risks."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002664/
"Mitoxantrone is currently the only chemotherapeutic agent approved for treatment of MS in the United States... Other chemotherapeutics that have been tested in MS to date include cyclophosphamide, methotrexate, cladribine, and the mAbs alemtuzumab and rituximab. While there has been varying evidence of efficacy for these compounds, each appears to be associated with serious risks that require careful consideration and management."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126913/
"Alemtuzumab reduces GvHD and TRM after SCT. Use of alemtuzumab requires awareness and strict management of the risk of opportunistic infections and of an increased risk of disease recurrence."
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Sun May 03, 2020 6:40 am

  • PSW death sheds light on risk facing health-care workers, home care patients (May2)
    https://www.ctvnews.ca/health/coronavir ... -1.4922566

    'TORONTO -- The death of an Ontario health-care provider who not only worked in senior care facilities, but also went home to home looking after people in their own residences, is highlighting the risks facing home care patients during the COVID-19 pandemic.

    ...The Services Employees International Union Healthcare (SEIU) has called for better protection for Ontario personal support workers and front-line health care workers.

    It's not just caregivers who are scared, but the hundreds of thousands of Canadians who normally rely on receiving care in their homes.

    “A little more than half our clients have cancelled services or suspended services,” said Ryan Jershey, who owns a private home care agency in Windsor, Ontario.

    He said the drop in clients is due to those in high-risk groups being afraid of getting the novel coronavirus from health workers.

    But some home care clients, like Diane Sims, who has multiple sclerosis, have no choice but to take the risk.

    "There's no way I can cancel services,” she told CTV News. “My life depends on these workers."

    Until recently, she said that many PSWs came to her home without proper PPE — exponentially frightening considering she has to see up to five different support workers every day.

    Ontario's rule limiting PSWs to one care home doesn't apply to home care, meaning that a single worker could be visiting various clients in different homes.

    “I question whether they should be going hither and yon, or whether they should have a set number of clients,” Sims said.

    But for Sims and others like her with critical needs, there is no other option.'
:O i can't imagine. i can't even wrap my head around the national death toll here in Canada. condolences to all who have lost loved ones this year, for any reason. pretty fortunate and insulated here. so far...
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19) News

Post by NHE » Mon May 04, 2020 6:27 pm

jimmylegs wrote:
Sun May 03, 2020 6:40 am
:O i can't imagine. i can't even wrap my head around the national death toll here in Canada. condolences to all who have lost loved ones this year, for any reason. pretty fortunate and insulated here. so far...

There have been 247,329 covid19 fatalities globally at this time. This is the equivalent of roughly four 737 Max 800 jets falling out of the sky every day for a year. 8O

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Tue May 05, 2020 2:59 am

  • COVID-19 pandemic and the risk of infection in multiple sclerosis patients on disease modifying therapies: “what the bleep do we know?” (May 1)
    https://ejnpn.springeropen.com/articles ... 20-00177-0

    '... 1. Safe to start or continue. Patients who are being started or already on interferon beta 1a, interferon beta 1b, glatiramer, teriflunomide, and dimethyl fumarate should continue it.

    2. Safe to start or continue with highest efficacy. Natalizumab may be considered a highly effective and safe choice in the perspective of COVID-19. It may be considered in patients with high-disease activity.

    3. Moderate risk. Fingolimod may increase the risk of acquiring COVID-19 or presenting with severe form of the disease; however, stopping it may get a rebound, so in these patients, benefits of continuing outweigh the risk. We do recommend these patients should be explained of these risks.

    4. Significant risk. Alemtuzumab, ocrelizumab, rituximab, and Cladribine may increase the risk of acquiring and severity of COVID-19. They should be carefully considered before starting in new patients and those who are scheduled for their next infusions.

    5. Could pose a significant risk. Ofatumumab and siponimod are not yet available in the UK or Ireland but might pose a significant risk.

    Hematopoietic stem cell transplantation
    Undertaking HSCT may pose a significant risk to the patient and should be deferred at present considering the risk of serious COVID-19-related infection (https://cdn.ymaws.com/www.theabn.org/re ... OVID19.pdf).

    Active COVID-19 infection
    In relation to active COVID-19 infection, a discontinuation or delay of any form of disease modifying therapy should be considered (https://cdn.ymaws.com/www.theabn.org/re ... OVID19.pdf).'
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Wed May 06, 2020 4:00 am

  • Coronavirus Plasma Treatment Recipient Dies From Virus (May 5)
    https://www.cpr.org/2020/05/05/coronavi ... rom-virus/

    ' Kaplan, 43, had multiple sclerosis and was diagnosed with COVID-19 in late March. He received plasma from a donor who recovered from COVID-19 on April 5.

    "... Scott responded so well to the plasma that they truly thought he was going to walk out of there," Denise said in an email to CPR News. "Complications from the clots and bleeds related to the virus made that impossible." '
very sad news. stay safe and be well, all.
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Wed May 06, 2020 5:25 am

  • COVID-19 infection in a patient with multiple sclerosis treated with fingolimod (May 5)
    https://nn.neurology.org/content/7/4/e753

    "We present a patient with MS treated with fingolimod who was diagnosed with COVID-19 and had a favorable outcome.
    ...
    On March 1, 2020, she started experiencing the symptoms
    ...
    She sought medical attention on March 5 ... Initial laboratory investigations were notable for C-reactive protein of 76 mg/L and erythrocyte sedimentation rate of 46 mm, raising suspicious for an underlying infectious etiology. There was also a decrease in absolute lymphocyte count (601.6/μL), which was attributed to fingolimod.

    On March 7, she developed dry cough, dyspnea, and fever (38.7°C). She also had tachycardia (122), increased respiratory rate (30), and slight decrease in blood pressure (100/70 mm Hg) and in oxygen saturation (89%) with a decrease in lymphocyte counts to 440.8/μL. Fingolimod was stopped because of concern for sepsis.
    ...
    She was transferred to the special COVID ward and received a combination of hydroxychloroquine, oseltamivir (to cover for influenza), and piperacillin/tazobactam, whereas ceftriaxone and azithromycin were discontinued.
    ...
    Three days later (11th March), she felt well and vital signs were stabilized, and she became afebrile and the lymphocyte counts increased to 510.3/μL.

    On March 12, the COVID-19 test was reported positive, and all other medications except hydroxychloroquine were discontinued.
    ...
    She was discharged after a 13-day admission and started on glatiramer acetate to avoid potential MS rebound after the discontinuation of fingolimod (lymphocyte count: 1,000.5/ul).

    Until the last televisit (30 March), she has been self-quarantined at home with no respiratory or neurologic symptoms."
is it just me, or does this info come across superficially as favourable COVID outcome *with* fingolimod, vs the actual scenario, on closer reading, having taken place *without* fingolimod...
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Thu May 07, 2020 5:22 am

  • Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod (May 6)
    https://www.sciencedirect.com/science/a ... 482030256X

    Highlights
    • First case report of coronavirus disease 2019 (COVID-19) in a multiple sclerosis patient under fingolimod treatment [well, it was true until May 5]
    • The patient revealed severe bilateral interstitial pneumonia on chest CT scan, but recovered rapidly.
    • It is important to further investigate potential risks and therapeutic effects of fingolimod in COVID-19 patients

    "By end of March 2020, the patient presented to a primary care hospital reporting dyspnea, fever and dry cough that started to occur 7 days [prior].
    ...
    On admission (day 0), physical examination revealed fever (39.5°C) and a respiratory rate of 28/min. Laboratory tests showed CRP elevation (2.7mg/dL [<0.5]) and peripheral lymphopenia typical for fingolimod treatment (total lymphocytes 0.39/nL [1.22-3.56], T-lymphocytes [CD3+] 0.31/nL [0.7-1.2]...

    Oropharyngeal swab specimens were positive for SARS CoV-2 ... No bacterial (co)infection or influenza were detected. Fingolimod medication was stopped. ... Over the following two days, oxygenation improved.
    ...
    On day four the patient had a normal respiratory rate
    ...
    On day five, we transferred the patient to a normal ward.
    ...
    fingolimod may be of value to control severe respiratory disease, and a clinical trial has been proposed in COVID-19 patients..."
i don't know much about DMTs, but this conclusion and proposed next steps are counter-intuitive to my eye...
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19): What You Need To Know

Post by jimmylegs » Thu May 07, 2020 7:03 am

given these recoveries described above and this recent related recommendation

Patients With MS Should Not Stop DMT Because of Pandemic, Experts Say (April 30)
https://www.ajmc.com/newsroom/patients- ... xperts-say

it will be interesting to see what comes of any trial investigating fingolimod as a COVID treatment option.
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Emergency Food Assistance (US)

Post by jimmylegs » Fri May 08, 2020 1:51 pm

Emergency Food Assistance (May 8 )
https://teamrubiconusa.org/applynow/
"Team Rubicon and Patient Advocate Foundation have partnered to provide emergency food assistance to those who have cancer, Multiple Sclerosis or Rheumatoid Arthritis, and have been affected by COVID-19."
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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B-cell depleting DMTs - COVID insights

Post by jimmylegs » Thu May 14, 2020 10:43 am

preprint: B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with Multiple Sclerosis during the early COVID-19 epidemic in Iran (May 13)
https://www.sciencedirect.com/science/a ... 4820302716

"...Methods
Because the prior reports of an association between B-cell depleting antibodies (Luna et al., 2019), fingolimod (Cohen et al., 2010)and natalizumab (Polman et al., 2006) with increased risk of infections, we categorized the DMTs into four groups:
B-cell depleting antibodies (rituximab and ocrelizumab),
immune-cell trafficking inhibitors (fingolimod and natalizumab),
other DMTs (including glatiramer acetate, interferons, dimethyl fumarate and teriflunomide) and
no DMT group.
... Results
Results
Out of 712 patients, 34 (4.8%) fulfilled our criteria for being in the COVID-19-suspect group. Only two patients required hospitalization. No patient required intensive care. ... Patients on B-cell depleting antibodies had 3.6 times higher risk of being in the COVID-19-suspect group as compared to patients on none-lymphocyte-depleting and non-cell trafficking inhibitor DMTs ..."
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Mayo Clinic COVID Q & A

Post by jimmylegs » Sat May 16, 2020 10:52 am

some good tips here, for pwms and for caregivers:

Mayo Clinic Q And A: COVID-19 and people with disabilities (May 16)
https://medicalxpress.com/news/2020-05- ... ities.html
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

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Re: Coronavirus (COVID-19) News

Post by NHE » Tue May 19, 2020 12:30 am

FDA green lights phase II trial for Moderna's mRNA coronavirus vaccine.
https://www.npr.org/sections/coronaviru ... ited-trial

A vaccine manufacturer is reporting preliminary data suggesting its COVID-19 vaccine is safe, and appears to be eliciting in test subjects the kind of immune response capable of preventing disease.

Moderna, Inc., of Cambridge, Mass., developed the vaccine in collaboration with the National Institute of Allergy and Infectious Diseases. The results reported Monday come from an initial analysis of a Phase I study primarily designed to see if the vaccine is safe.

The company reports no serious side-effects; however, modest side-effects included redness at the injection site, headache, fever and flu-like symptoms, although none of these lasted more than a day.

The first 45 volunteers for the vaccine trial were divided into three groups, with each group getting a different dose of the vaccine. All groups got an initial shot, followed by a booster shot a month later.

In addition to safety, the company also looked at the vaccine's ability to induce antibodies to the coronavirus — what's known as its immunogenicity. It did, for all subjects at all dose levels. In addition, eight of the subjects were tested for the presence of neutralizing antibodies that prevent the virus from infecting cells in the laboratory. All eight did.

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Re: Coronavirus (COVID-19) News

Post by NHE » Mon May 25, 2020 7:41 pm

WHO Halts Hydroxychloroquine Trial Over Safety Concerns

https://www.npr.org/sections/coronaviru ... y-concerns

The World Health Organization says it is temporarily halting its clinical trials that use hydroxychloroquine to treat COVID-19 patients over published concerns that the drug may do more harm than good.

The move comes after the medical journal The Lancet reported on Friday that patients getting hydroxychloroquine were dying at higher rates than other coronavirus patients.

https://www.thelancet.com/pdfs/journals ... 1180-6.pdf

The WHO has 3,500 patients from 17 countries enrolled in what it calls the Solidarity Trial. This is an effort overseen by the WHO to find new treatments for COVID-19. The patients in the trial have been randomly assigned to be treated with hydroxychloroquine which is a common malaria drug, or 3 other experimental drugs for treating COVID-19 in various combinations. Only the hydroxychloroquine part of the trial is being put on hold.

"The review will consider data collected so far in the Solidarity Trial and in particular robust, randomized available data to adequately evaluate the potential benefits and harms from this drug [hydroxycholoroquine]," WHO Director General Tedros Adhanom Ghebreyesus said during an online press conference from Geneva on Monday.

The WHO's chief scientist, Soumya Swaminathan, says the review was prompted by the article in The Lancet, which was not a randomized control trial but still large.

"While it was still a reporting of observational data," Swaminathan says, distinguishing it from the gold-standard randomized controlled trial, "it came from multiple registries and quite a large number of patients, 96,000 patients." She says the WHO hasn't yet seen data that showed a problem with hydroxychloroquine in its own study but The Lancet article raised questions among many of the investigators involved in the WHO's trial.

"The steering committee met over the weekend, in the light of this uncertainty," Swaminathan says. "We decided we should be proactive, err on the side of caution and suspend enrollment temporarily into the hydroxychloroquine arm [of the Solidarity trial]."

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