StemCell Therapy

By Shannon Ebrahim is Independent

It is no small feat that Cuba, impoverished for 60 years due to the US economic embargo, has one of the best health systems in the world, with more impressive health indicators than those of the US and many other developed countries. Cubas success is largely due to its unrelenting commitment to prevention and community oriented primary health care.

Cuba has one of the highest ratios of doctors in the world, with 8.2 doctors per thousand people, three times the rate in the US, which has 2.6 doctors per thousand people. South Korea has 2.4 doctors per thousand people, while Italy has 4.1. Cubas mortality rate is equally as impressive with a rate of 4 per 1,000 births, which is lower than that in the US, despite all its resources.

Cuba struggles with shortages of medicine in its pharmacies as a result of the US sanctions regime, but it has found ways to continue improving its universal healthcare for the Cuban population. Cuba spends an impressive 23% of its national budget on healthcare and 30% on education, comprising a total of 53% on education and health, compared to the US which spends 28% on health and education.

It is a shocking double standard that US companies are not allowed to export essential life saving medicine to a critically ill Cuban child if they are the child of a member of the Cuban Communist party. There are medications in the US for particular diseases that cannot be bought in Cuba. US regulations stipulate that US drug companies must certify the end-user if they want to sell medicine to Cubans. The end user cannot be a member of the Communist Party, according to the Helms-Burton Act, which was signed into law by former President Bill Clinton. Most US drug companies find such certification impractical and therefore refuse to export to Cuba.

Cuba has risen above these monumental challenges in acquiring medicine for its people, and these hurdles have actually spurred innovation and medical scientific research in the island nation, with amazing results. Cuba has made huge strides in biotech innovations, and specialises in antiviral drugs such as Interferon Alpha 2B, which is being used to combat Covid-19 in both Cuba and China. Cuba supplies Interferon in its public health system as a preventative measure to elevate the immune system. It is also used in the early stages of infection with Covid-19, whereby it is administered via nebulisation so that it reaches the lungs, and has shown to have a positive impact. It is also administered to positive Covid-19 patients in a critical state through Intramuscular injection. Interferon is now being produced with Cuban technology in Jilin in China at a joint venture facility.

Cubas state owned pharmaceutical industry has been prioritising the production of Covid-19 treatments and therapies, and has 21 other products being used to fight the virus such as antivirals, antiarrhythmics, and antibiotics. Cuba is also using Biomodulin T for recurring respiratory infections in older adults to increase a patients defences.

Cubas successful health system has been an example for the rest of the world. Cuba has the worlds largest medical schools the Havana Latin American School of Medicine which provides free education to 35,000 doctors from 138 countries since 1999. Scholarships to the medical school include full tuition, textbooks, accommodation, meals, and a stipend. Graduates are encouraged to practice on the frontlines in low income and medically underserved communities.

Cuba is committed to producing revolutionary doctors prepared to put their lives on the line both at home and abroad to save lives. Today Cuba has 50,000 doctors working in 61 countries at any one time, which is a feat not even the most developed countries can rival. It is truly remarkable that a tiny island nation which has endured suffocating economic sanctions imposed by the US for over 60 years can have accomplished so much for the betterment of humankind.

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Cuba lauded for one of the best health systems in the world. - stopthefud

Location, location, location. A mantra in real estate and an unfortunate reality for proper access to health care.

In Los Angeles County, those who live in low-income communities are three times more likely to die from COVID-19 than those in wealthier areas. People of color are also disproportionately affected. Black people make up 9% of the Countys population, yet account for a staggering 15% of coronavirus-related deaths.

Regardless, LAs wealthier zip codes have reported significantly higher cases. This is not because such areas are at a higher risk; instead, the numbers are a result of significantly lower rates of testing in lower-income neighborhoods.

Just two weeks ago, Mayor Eric Garcetti expanded free COVID-19 testing to all LA County residents. However, expanding testing is not the same thing as providing equal access to it.

People from underserved communities are more likely to die from coronavirus, due to existing disparities in access to health care and a continued lack of proper prevention and treatment. The county must do more to adequately expand testing to its most vulnerable populations and UCLA can be a part of those efforts. From increasing communication about available resources to easing restrictions on access to testing, LA County and UCLA Health can help by improving testing efforts in the most marginalized neighborhoods.

Coronavirus-related death rates in neighborhoods such as East Hollywood, Pico-Union and Westlake are four times higher than the national average. These are the same areas where more than one-third of housing is overcrowded.

Timothy Brewer, a professor of epidemiology at the UCLA Fielding School of Public Health and Medicine, said there are big differences in the healthcare statistics between areas like West and South LA.

In areas where there are more African Americans in particular, those areas tend to be more crowded they tend to be poorer, Brewer said. They tend to have fewer health care facilities, and the health care facilities tend to be of lesser quality than in high-income areas.

Unfortunately, certain populations are at an extremely high risk simply by virtue of their zip code.

Systemic solutions are necessary to address these disparities, but in the mean time, proper testing and prevention is the least that LA County can provide. One way is to make sure that hospitals and clinics in low-income areas are properly staffed and have adequate resources. Its also important that these communities continue to get proper and updated information.

And UCLA has the resources to help. In early April, UCLA Health initiated testing for all incoming surgical and procedural patients, as well as ER admissions. UCLA can work with clinics in lower-income areas to launch expanded efforts.

Populations that have historically had little to no access to proper health care are just as susceptible to catching the virus, if not more. California Governor Gavin Newsom estimates that 60,000 people experiencing homelessness will become infected. In a county with the second highest rate of unsheltered individuals, these populations might not have access to food or shelter, let alone proper medical care.

These things that create pollutants tend to be much more common in people of color communities and poor communities, said Nina Harawa, a professor-in-residence with the David Geffen School of Medicine at UCLA. Literally the bodies of people in those communities are predisposed to have poor outcomes related to (COVID-19).

In California, Latinos and African Americans are exposed to 40% more pollution than white people making them more susceptible to coronavirus-related complications.

As a massive health care provider with offices spread across the city, UCLA Health can work with LA county to ensure that these populations get the information they need when it comes to accessible testing options and preventative measures.

Furthermore, undocumented workers, many of whom are working essential jobs and are at a greater risk, have no access to employment benefits or paid sick leave, despite being underpaid. They, along with mixed-status families such as DACA recipients or those with immigrant spouses, also wont get access to the stimulus check provided by the CARES Act.

And the Families First Coronavirus Response Act, which covers testing for all uninsured workers, excludes those who are undocumented regardless of the fact that they pay taxes.

And the legacy of the countrys improper treatment of undocumented individuals may heighten fears of deportation if they try to access medical care. ICE agents made arrests on the first day of Californias official lockdown.

They made it seem like you can come get it, you can come get the test, regardless of your immigration status, but (theyre) not thinking about how undocumented folks may still be hesitant and may not trust what they are saying, said Daniela Rodriguez, a fourth-year sociology student.

One major deterrent is the current identification requirement for an individual to receive testing. And while LA County has promised not to use identification for purposes of law enforcement, loosening ID requirements could greatly increase accessibility for low-income and marginalized communities.

Undocumented populations should not have to choose between their health and physical safety. It is vital that the county keeps an open line of communication with the undocumented community, so they can receive the correct information and proper testing.

Granted, LA County has already greatly expanded its testing capacity. However, this is just the tip of the iceberg. With the help of institutions like UCLA Health, the county must now make sure that testing is not just equally available, but equitably delivered. Because although the expansion towards universal testing is expensive, there is no other alternative.

Anyone, regardless of socioeconomic status, race or citizenship can become sick and spread the virus. Selectively ignoring already marginalized populations on the grounds of arbitrary social classifications will only prolong the virus reign and cause more avoidable deaths.

The virus does not discriminate and we cannot afford to either.

Read more:
Universal access is not the same as equitable access when it comes to COVID-19 tests - Daily Bruin

Development of PrEP for COVID-19 Could Allow Country to Open Safely Before a Vaccine Is Available

Development of PrEP for COVID-19 is likely possible in a shorter period of time than a vaccine. Although there are no drugs approved yet for treatment or prevention of COVID-19, expert opinions and computer modeling analysis have been able to identify a set of compounds, both small molecules and biological macromolecules, that could stop severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) from replicating in the body.1

PrEP has already been established as an effective medicine that revolutionized the fight against HIV. Since a vaccine for HIV has not yet been developed after decades of research, PrEP has been able to act as a preventative measure for those vulnerable to the disease.1 As a preventative measure, PrEP has been able to reduce vulnerable populations chance of infection by over 99%.2

Our experience with HIV shows that we cannot pin all our hopes on the development of a vaccine, no matter how optimistic we may be, said James Krellenstein, a co-founder of PrEP4All and member of the COVID-19 Working Group New York, in a press release. Development of PrEP for COVID-19 has the potential to be a major breakthrough until a vaccine is available. But research efforts will fail to deliver unless we take a dramatically different approach.2

Currently, scientists have found that some of the molecules that could block the replication of SARS-CoV-2 are already FDA-approved drugs. However, the United States has not been able to coordinate the necessary processes that would effectively evaluate the antiviral potency of these compounds in vitro. This has resulted in a limited number of them having been tested to prove their efficacy in preventing COVID-19.1

In its report, the PrEP4All Collaboration detailed 3 recommendations to facilitate a centrally coordinated process created by the US National Institutes of Health (NIH), along with industry and international partners, that would support the development of PrEP for COVID-19 prevention1:

PrEP4All has done the world a great service, said Gregg Gonsalves, assistant professor of Epidemiology at the Yale School of Public Health, in a press release. Using antiviral drugs to prevent SARS-CoV2 transmission, just as we use them to prevent HIV, opens up another way to bring this pandemic to an end. Unfortunately, what PrEP4All exposes is an effort just getting off the ground, with no coordination and leadership of key tasks like high throughput screening and prioritization of clinical trials. NIH, FDA, WHO should heedPrEP4Alls recommendations to get this effort on track and scaled-up.2

From prior experience with pandemics such as HIV, according to the report, it has been established that the most efficient method of advancing results is by creating a coordinated process between institutions such as the NIH and WHO, as well as academic and industry partners. Such a process can result in clearer directions regarding basic science and clinical care for a disease.1

In the past, PrEP has been highly effective at fighting pandemics that devastated global populations in a way that seemed uncontrollable. Today, no one knows with certainty the method that will effectively control COVID-19, but it has become necessary to find the most efficient way possible.1

We owe it to the world to explore every possible option in controlling this pandemic, said Krellenstein in a press release. PrEP could be a game-changer for the COVID-19 response and save countless lives, especially among the most vulnerable populations. But that will not happen unless we better coordinate our efforts and urgently prioritize research.2

REFERENCES

See the article here:
Development of PrEP for COVID-19 Could Allow Country to Open Safely Before a Vaccine Is Available - Pharmacy Times

BusinessEvolving health research could catalyse demand for high-end office space in Scotlands cities from the burgeoning life sciences sector, according to Knight Frank.

Tuesday, 12th May 2020, 4:45 pm

The UK Life Sciences report from the property consultancy which has offices in Edinburgh, Aberdeen, Glasgow and Melrose has found that growing collaboration between companies in the industry and the wider tech sector, plus more computational science, will cause seismic shifts in the industrys property requirements.

As medical technology, biopharmaceutical, and digital health companies become more interdependent, property will need to reflect their growing need to cluster in new locations, according to the report. It also highlighted the 750 million expansion plans at Edinburghs BioQuarter and the establishment of the Medicines Manufacturing Centre in Renfrewshire as examples of the trend already taking hold in Scotland.

Knight Frank also said Edinburgh and Glasgow were among the top UK locations for investment in digital health, attracting 30m and 10.5m respectively.Scottish Development International says there are more than 750 life sciences organisations in Scotland, with the sector adding 2.4 billion to the economy, on track to reach turnover of 8bn by 2025.

Lee Elliott, Knight Franks global head of occupier research, said: Covid-19 has brought the growing importance of life science and health research companies to the fore. The needs of the NHS, and other health services, will likely cause an acceleration in the convergence of technology and life sciences, particularly around digital diagnostics and preventative medicine.

The restructuring of life sciences companies will bring a new wave of demand from the sector, particularly in Scotland where [small and medium-sized enterprises] make up the majority of the industry.

Indeed, landlords that are able to provide flexible, cost-effective space to accommodate the rapid growth these companies can achieve and help them track their investment will be well-positioned. So too will facilities that are future-proof and capable of manufacturing advanced therapeutics.

Occupier services partner Simon Capaldi said: The shift towards more computational [research and development] will see an increase in the need for more conventional office space in city-centre locations. It is perhaps no surprise that were seeing more demand from the sector in Edinburgh, which offers a deep pool of data science talent.

Tech, more broadly, has emerged over the past five years or so as a significant source of activity in Edinburghs office market, accounting for around one-third of city centre take-up.

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Evolution of life sciences to spur need for high-end office space in Scots cities - The Scotsman

Tokyo May 14, 2020 (Thomson StreetEvents) -- Edited Transcript of Eisai Co Ltd earnings conference call or presentation Wednesday, May 13, 2020 at 7:30:00am GMT

Eisai Co., Ltd. - CEO, Representative Corporate Officer & Director

Eisai Co., Ltd. - Senior VP & President of Neurology Business Group

Eisai Co., Ltd. - VP and Chief Medicine Creation Officer & Chief Discovery Officer of Oncology Business Group

Daiwa Securities Co. Ltd., Research Division - Research Analyst

It's now time. We would like to begin financial results presentation on fiscal 2019 results. Because of COVID-19 infection situation, today we are live distributing -- streamcasting the financial results presentation.

I would now like to introduce the presenter today, Representative Director and CEO, Mr. Haruo Naito. Without further ado, I would like to -- I'll give the microphone to Mr. Naito.

Haruo Naito, Eisai Co., Ltd. - CEO, Representative Corporate Officer & Director [2]

Naito speaking. Now I would like to give you a presentation on the financial results for fiscal year 2019. Please look at the slide.

Given the current circumstances surrounding COVID-19 pandemic, we are a pharmaceutical company. Therefore, we believe that there are many roles that we should play, out of which, I think, what is most important is described on this page, which is stable supply of our products. Needless to say, each pharmaceutical product is leading to quality of life or lives of patients. Therefore, these are all life-related products. Therefore, the discontinuation of supply is not allowed.

On this slide, we are globally rolling out manufacturing at 9 sites over the world. On the right-hand side in table at each manufacturing site, the state of emergency issuance is different among different manufacturing sites. But currently, at all 9 sites, operation is smoothly ongoing. Therefore, stable supply of our products have been secured.

To maintain stable supply, as we have described at the bottom of this slide, we needed to have sufficient supply of raw materials, API or intermediates or packaging materials. These have to be kept in ample stock. To continue our manufacturing activities, such BCP, business continuity plan, is necessary. Currently, for our main products, on the average, we have ample stock of final products amounting to 4 months to 5 months of stock level.

Needless to say, another important point is at manufacturing sites, of course, we have employees who are operating the plant. We needed to secure the safety of them. We have manual -- internal manual for COVID-19 is utilized in order to implement, in fact, rigorous infection control measures to secure safety of employees. Another role to be played by us is to develop treatments and vaccines for COVID-19.

From that perspective, today, first of all, we'd like to share with you the possibility of eritoran, E5564. Eritoran, as you see at the footnote #1, which is a structural analog of lipid A, which is an activator of endotoxin of bacteria, you can see chemical structure scheme of this compound for the sugar chain. And this was a treatment which was in-house synthesized at Eisai Research Institute of Boston with an aim to get approval of this compound for indication of severe sepsis we conducted until up to Phase III trial. But in 2011, this development of eritoran was discontinued.

E5564, or eritoran, will be studied in hospitalized patients who tested positive with COVID-19 and have worsening symptoms. On the right-hand side, mechanism of action and schema are described. The target of eritoran is found at upstream of cytokine gene expression signaling. The target is TLR4. So this is a TLR4 antagonist. At the very upstream of this cytokine gene expression signaling will be inhibited. Therefore, downstream IL-6, TNF-alpha, IL-1 beta, various cytokines production will be inhibited. So eritoran is going to be tested for indication for certain groups of patients who tested positive with COVID-19.

In the lower bottom left corner, you will see the description of how we are working on this project. In the U.S., there is an international network called REMAP-CAP-COVID for repurposing of drugs. Various multiple drugs are being tested within this framework, where we have participated to explore the possibility of eritoran. Starting from June 2020, global randomized, controlled study will be initiated at domestic investigational sites. In order to prepare such sites, we are making necessary coordination. These investigational drugs are being under preparation with good quality and about 400 subjects to be enrolled in this randomized, controlled study. If everything goes well, at the end of -- around the end of this year, we'll be able to get the result out of the study and -- although the second wave and third wave of infection are anticipated, but there will be possibility to address those second and third waves of infection.

Through countermeasures against NTD, neglected tropical diseases, we have been engaged with Bill & Melinda Gates Foundation for many years. In relation to that, the Gates Foundation is taking a central role in the development of vaccines for COVID-19. As you can see in the bottom left corner, an immunologic adjuvant, E6020, which is already used in practical use, this was internally developed and discovered at Eisai Research Institute of Boston, which we may pursue the possibility as a vaccine. And The Scripps Research Institute is leading the initiative called pandemic response library, where Eisai's very unique natural products compound library has been already provided as regards to the development of treatment.

On the right-hand side, what has been already licensed out to Roivant Sciences, which is gimsilumab, which is a monoclonal antibody in Pennsylvania, Exton, former Morphotek site, has originated this antibody, which is anti-GM-CSF monoclonal antibody. For ARDS, or acute respiratory distress syndrome, Roivant Sciences has initiated trial. Utilizing our site at Exton in the U.S., we are providing API for this investigational agent.

Supporting stakeholders. That is described on this page. In Japan, under the hhc concept, we are collaborating with various groups and associations and organizations so far, for example, at the top, with local governments or medical associations. In total, there are about 167 associations with whom we have formed the partnership agreement for dementia. The second bullet shows the 4 groups of Living Labs. And the patient support groups and patient family advocacy groups over 100 groups as such in the area of dementia, cancer, epilepsy and sleep disorder. With 300 groups in Japan, we have prepared masks or relief goods and providing support goods to these groups. In the U.S., Europe, China, Asia and Africa, we are providing funding, for example, to provide PPE or providing support for the frontline health care professionals. In China, we are -- we have donated donation contribution to Wuhan Charity Federation in China.

Given these initiatives, now we would like to present to you the summary of the consolidated statement of income for fiscal year 2019. Please look at the right-hand side. The characteristics of these results are described in the headline. Operating profit was JPY 125.5 billion and profit for the year was JPY 122.5 billion. The profit for the year attributable to owners of the parent is JPY 121.8 billion, ROE is 18.6%, all of which have been the record-high numbers. In the past, for fiscal year 2010, operating profit reached JPY 113.1 billion or ROE reached 16.4%. But all these numbers exceeded that number in fiscal year 2010.

Revenue was JPY 695.6 billion, up 8% year-on-year, which will be explained in details later. This was driven by global brands, our proprietary brand drove this growth. And the cost of sales due to the mix improvement, given the growth of our in-house developed product, cost of sales ratio in the sales improved by 3.4 percentage points. Gross profit grew by double-digit rate. And R&D expenses were 97% of the previous year on this statement of income. However, including partners' reimbursement, R&D expenses were JPY 203.7 billion, which was up 6% from the previous year. We are one of the most proactive pharmaceutical companies in terms of investment in R&D among global peers.

SG&A expenses. Given the expansion of the business in the previous year, the SG&A expenses grew 12% year-on-year due to the expansion of the shared profits with partners. And operating profit was up 46% year-on-year to reach JPY 125.5 billion and profit for the year was 84% increase from the previous year to JPY 122.5 billion. At the very bottom of this page, net DER, minus 0.29 in terms of financial robustness. Therefore, net cash position was secured. The debt-free management has been maintained. In the meantime, free cash was exceeding the JPY 60 billion, therefore exceeding the amount necessary for paying dividend. Ratio of equity attributable to owners of the parent, or equity ratio, is -- was 63.8%. Given any circumstances, we can say that we have very robust financial structure, which would not be affected by any circumstances, I would say.

Here is the breakdown of changes in revenue. On this graph, as you see, the biggest factor for increasing the revenue was expansion of global brands. There was an increment by JPY 53.2 billion. And what has been obtained from the business in the previous year, that is to say, milestone payments, were recognized, increasing the revenue by JPY 10.6 billion. Given the success the business recorded in the previous year, that was the main driver for the increase in revenue this year under review.

Regarding the LENVIMA-related payments, all milestones -- preset milestones were cleared. Therefore, there was milestone payments in the amount of JPY 10.6 billion. And given the transfer right for the -- transfer of the shares of the Elmed Eisai, there was a negative factor and transfer rights for tazemetostat and the milestone payments were recognized. Therefore, there was an increase by JPY 14.1 billion, an increment in total was JPY 52.8 billion year-on-year to reach JPY 695.6 billion.

Next, breakdown of operating profit migration. The factors contributing to the changes were almost similar to what we saw with revenue and increase of shared profit of LENVIMA paid by Eisai recorded minus JPY 25.5 billion. This was all due to the expansion of LENVIMA business. Therefore, shared profit paid to partner was increased. Therefore, we believe that this is a proactive increase in the expenses. And the operating profit was increased by JPY 39.3 billion year-on-year to reach JPY 125.5 billion, which was a record-high.

On the right-hand side, you can see the R&D expenses. Please look at the column for FY 2019, JPY 140.1 billion, which was recorded on the P&L. Adding JPY 63.5 billion as the reimbursement from partners, that total JPY 203.7 billion was the actual spending in R&D activities, which accounts for about 29% of the revenue compared to the previous year, which was up 6% from a year earlier.

Now turning to LENVIMA. For fiscal 2018, 2019 and 2020, over the 3 years, we have seen a steady and dynamic growth over the years. For the current year under review, revenue was JPY 158.0 billion, which was 41% year-on-year. In the current fiscal year, we are aiming at achieving this. On the right-hand side, Americas, for hepatocellular carcinoma and the combination therapy with KEYTRUDA for endometrial carcinoma, for these indications, developments are being ongoing. And the first-line HCC indication, we are preparing for the launch for this indication, which is currently under review in combination with KEYTRUDA.

Another important market next to Americas is China for LENVIMA as well. New patient assistance program has been introduced. And the number of patients has increased by about 60% from a year earlier. And regarding thyroid cancer indication, launch readiness is being progressed. In Japan, EMEA, Asia, Latin America, endometrial cancer and HCC, the number of countries where these indications have been approved and launched is to be expanded in order to achieve this JPY 158 billion for the year.

For LENVIMA, there have been the guidances recommending this LENVIMA use from various societies. And given this COVID-19 infection risk, oral formulation cancer agents are being recommended. For example, from ILCA, International Liver Cancer Association, issued guidelines -- guidance to recommend oral formulation. And the second one, LENVIMA used to be classified as category 2 but now recommended as category 1.

For RCC, the oral formulation cancer agent has been recommended by issued guidance. And LENVIMA, everolimus combination therapy is recommended. For endometrial carcinoma, in combination with KEYTRUDA, rather than every 3 weeks but every 6-week administration is recommended. Therefore, combination therapy of LENVIMA and KEYTRUDA has been increasingly selected. And the benefit of administration of LENVIMA's oral formulation is being enhanced, given this risk of infection.

Conversion treatment is something that I've reported on past occasions. In hepatocellular carcinoma, when tumor volume is large in patients and it is Barcelona B Classification patient, first, LENVIMA can be administered to shrink the tumor volume. And then curative treatment, such as TACE, may be utilized to achieve cancer-free status in patients. And that is conversion treatment. In Japan, which is one of the most advanced countries in hepatic cancer treatment, TACE and other curative treatment have been developed and such -- correction, conversion treatment has been developed. And the combination therapy with LENVIMA allows for such conversion treatment.

Study 307, Study 309 Phase III studies are underway for combination therapy of LENVIMA and KEYTRUDA. And as for the studies listed here, enrollment of target number of patients has been completed. For Study 307 and Study 309, close to 1,000 patients have been enrolled. And we will make sure that we will make close follow-up of patients and would like to make sure that there will not be a delay -- substantial delay in the conduct of the trials. We will work with Merck to minimize negative impact of COVID-19 by working together and by working flexibly.

I would now like to discuss the topic of neurology area. First, DAYVIGO. This is lemborexant orexin dual inhibitor. In Japan and the United States, approval conditions were all satisfied and it is now ready to go. Once again, orexin biology is shown in this slide in the upper part of the slide. One of the most prominent researchers in Japan, Dr. Yanagisawa had conducted ligand hunting for orphan GPCR. And this is known as the most successful result. Orphan GPCR HFGAN72 ligand was discovered to be orexin, as shown in the middle of the slide. And orexin is a very important substance that controls sleep and wake cycles according to Dr. Yanagisawa.

And at Tsukuba Research Institute, library was built. And as a result, we were able to obtain receptor E2006 or lemborexant. There were 2 large Phase III studies, compared to placebo and compared to zolpidem ER in older patients. In these 2 large Phase III studies, very good results were obtained in sleep latency and quality of sleep. And in 2 healthy subject studies, residual next-morning effect was observed. This is the third blue triangle, and this is reflected in the package insert in the United States. As a result of the 2 studies, in comparison to placebo, there were no meaningful differences in next-day postural stability. So sleep latency, quality of sleep and residual next-morning effects in all of these 3 areas, treatment is achieved by DAYVIGO.

We are now preparing to launch DAYVIGO. Under COVID-19 situation, information communication with the traditional method of medical representatives visiting institutions will be difficult. So as shown at the bottom of the page, we will be centering around digital-centric strategy, including web seminars, digital meetings and remote communication. Centering around digital means, we would like to launch DAYVIGO. We are preparing for launch in June timing in the United States and around July timing in Japan.

Now turning to aducanumab. Towards completion of submission, we are making good progress. In the United States, we now have open BLA and have started to submit modules of the filing. This regulatory filing process, in this process, we are making good progress in open BLA submission modules of the filing. And for that, pre-BLA meeting has been scheduled. Therefore, we expect to complete the filing in Q2 fiscal 2020. We have a very good visibility of that. And at the same time, in Japan and in Europe, we are engaging with regulators. Together with Biogen, Eisai is engaging in very strong collaboration with Biogen. And we are starting to make full-fledged preparations to deliver potentially first therapy to reduce clinical decline in Alzheimer's disease patients.

About BAN2401, final regulatory requirement, Phase III study, Clarity AD, is in the stage of enrolling patients and progress had been made so far. However, because of COVID-19 impact, the pace is slightly slowing down. However, sites in China will soon initiate enrollment and the impact may be such that additional 3 months may be required. Final readout timing is changed from Q1 fiscal 2022 that we announced previously to Q2 fiscal 2022. As for earlier phase of AD, preclinical AD, we have Phase III study AHEAD 3-45. And we are about to be ready to start the study. Home infusion at patient home or assessment to be conducted remotely, these are measures that are being encouraged by the regulators. We would like to make active utilization of these methods to mitigate the impact of COVID-19 as much as possible.

Today, regarding BAN2401, I would like to discuss 201 study, which had already been completed. This is the core study. And at the bottom of the page, the situation of OLE study is described. Of course, 201 study is parallel group comparative study. ADCOMPS is used to measure the slowing of progression of the disease. And various background biomarkers are measured. And slowing of pathophysiological progression was observed through the observation of these biomarkers. And we believe that these support for efficacy clinical symptoms.

As for OLE study, after the end of the core study for 2 years, after the end of the randomized study, there is discontinuation of about 2 years. And this is the baseline for OLE study. CDR-SB is used to assess cognitive function. Between active arm and placebo arm in the core study part, there were differences in clinical symptoms. And that difference is maintained over this discontinuation period. The gap between the 2 arms is maintained. That is what this data suggests.

On the right side, in the first bullet, this is described. When disease modifying effect was demonstrated by a drug, it is considered that suppression of cognitive decline versus placebo continues after administration of drug was continued since neuropathy is reduced. This is one of the strong data suggesting disease-modifying effect. In the middle, for your information, our key drug Aricept data is shown. On the right side, at the end -- after the end of the core study of Aricept, after 6 weeks of discontinuation, cognitive function deterioration in active arm was such that the level declined to the same level as placebo arm. And this is the difference between symptomatic relief and disease-modifying drug as we see it. And that is why I am sharing with you this information on this page.

Earlier, about second-generation -- next-generation Alzheimer's disease drug treatment, I have mentioned that we have started full-fledged effort. And one of the important efforts as a part of that is dementia platform easiit. We have registered the name easiit. easiit dementia platform is shown at the center. And this uses smartphone app. easiit core asset includes Aricept accumulation of AD treatment experiences, AD is also included. And based on external cohort and high-quality data, analysis is carried out and advice can be given as a result of utilizing data. And that is the most important core asset.

Using that -- in order to use this asset, on the left side in daily living domain, to consumers, to patients -- or from consumers, from patients, personal health record can be collected, including data on sleeping, data on walking, data on diet. And from April, to providers, sales of NOUKNOW has been started. NOUKNOW is a digital tool, which allows for convenient checking of cognitive function. And through this, personal health record can be collected. And we will be applying our AI to analyze data. As shown in the arrow on the left at the bottom, we can return the information to make a recommendation of preventive action so that people can practice such action. We would like to encourage people acquiring a habit of practicing such preventative action.

On the right side, in the medical domain, medical data is collected by various medical institutions, including blood test results and medical version of NOUKNOW, Cognigram data. Cognigram uses same algorithm to measure brain performance. Such information can also be input into easiit through medical chart, through medical version of the app. Using AI algorithm, treatment effect can be visualized and side effect detection can be assisted. Such information can be provided. And this will make easier realization of optimal treatment and will also assist in conducting efficient interviews and diagnosis by doctors. So in daily living and in medical area, data can be crafted. And they can be connected and combined on the platform of easiit.

One more thing I would like to discuss about easiit is chasms that I also discussed in the information meeting. Chasm is the gap in disease understanding or barriers that must be overcome so that preventive actions become common practice. These gaps are chasms. As noted in the footnote 2, and at the left part, it shows that total population is about 66 million. Often, smaller number of people understand the disease, 44 million. And people who have acquired common practice of preventative action is even smaller in number, and people who have a common practice of checking cognitive function is even smaller. These are the chasms. And in medical domain, on the right side -- as shown on the right side, convenient diagnostic tool, whether it is prevalent, used frequently or biomarkers usage, the number of population is even smaller.

And monitoring of administration side effect, there is even bigger chasms. In each chasms stage, easiit can be used to reduce and eliminate chasm regarding the lack of understanding of disease. People between the ages of 40 to 50, we can offer content that we develop jointly with influencers through easiit to educate people on the disease. As for the lack of convenient diagnostic tool or -- we would like to provide NOUKNOW. And regarding PET test, CSF examination, easiit can provide information about the utilization rate of these equipments in institutions and offer information of that. And easiit can also help build a network for better cooperation regionally by using easiit. As shown at the very bottom including cognitive checking, lifestyle can be improved, and smooth diagnosis and treatment of dementia can be realized more easily. That is what we would like to achieve.

This is my second from last slide. COVID-19 may bring a new order or as people often call it, new normal. We are facing COVID-19 situation, and we were made to realize that there were 2 principles: first is that human life comes first, and the second is that individual countries cannot stand-alone. If -- even if one's country is okay, if the others are not okay, that is not a good situation. And in this situation, one of the most important keyword is digital transformation. Here, digital and personal should be utilized in combination. New way of communication including easiit on the digital platform, we are able to have direct 2-way communication with many patients. And our field force sales activities can use digital in combination with in-person activities.

And in medical care delivery, it is already happening -- some changes are already happening, including online medical consultation. And remote medicine among health care professionals can be further promoted even in remote areas. In African countries, apps may be utilized to understand disease prevalence. On the right side, there is a box with the title New Logistics. I discussed a stable supply earlier. Climate change will continue to be a problem, and we do not know what we will have as next pandemic. There will be natural disasters. Market may grow or shrink. With AI, we can make forecast. In raw materials procurement to production plan, we are able to better execute this. Global enterprise resource planning should be promoted.

And as shown in the next bullet, from intermediate raw material to final product, manufacturing, more on a regional basis rather than depending on global network, may become more necessary. And new life-related policy business -- and businesses is the right bottom box. It is not only pandemic. AMR and Neglected Tropical Diseases can become a major problem and disease for the whole world. We cannot become complacent and therefore, we have to enhance problem-solving abilities in low-income populations and countries. For example, Universal Health Coverage or UHC benefit level improvement is one of the things that we have to seriously address. And in regulatory approval system, priority review system should be flexibly used in broader scope as people are discussing this issue right now.

This is the PL for the ongoing fiscal 2020. JPY 719 billion is the forecasted level of revenue, 3% up from the previous year. So we expect continuous growth in revenue. And therefore, we will be making expenditures including milestone payments. And LENVIMA, JPY 154 billion of product sales including milestone revenue. LENVIMA business alone will be achieving revenue of JPY 250 billion -- or is achieving JPY 250 billion. It has grown into a very big product. And with the mix of in-house product, we will have a better situation, and we will achieve a growth in gross profit. As for R&D expenses and SG&A expenses, the input of resources -- investment of resources, this is for the investment into the future beyond EWAY 2025 into EWAY future. BAN2401 aducanumab, these AD-related diseases, for both of these, we will have large-scale studies, and we have large-scale studies. And LENVIMA shared profit partners will be increasing. And we also have to prepare to make contribution to patients through next-generation dementia drug. And therefore, we also plan to make investments in these areas.

It is now the time to make these investments. And therefore, operating profit is forecasted to be JPY 88 billion; profit for the year, JPY 67 billion. Return on equity is 9.7%. According to the forecast, equity spread will be ensured in this fiscal year. As for dividend per share, it is noted at the bottom line at the Board meeting earlier today, year-end dividend of JPY 80 was approved. And for fiscal 2020, we expect to pay annual dividend of JPY 160.

An with this, I conclude my presentation on fiscal 2019 results. Thank you for your attention.

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Unidentified Company Representative, [3]

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Now we would like to open the floor for Q&A session. (Operator Instructions)

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Questions and Answers

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Operator [1]

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(Operator Instructions)

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Unidentified Company Representative, [2]

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(Operator Instructions) The first question is from Citigroup Securities, Mr. Yamaguchi. The floor is yours. Are you ready, Mr. Yamaguchi? Can you hear? Yes. We can hear you.

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Hidemaru Yamaguchi, Citigroup Inc, Research Division - MD & Analyst [3]

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My name is Yamaguchi, I'm from Citigroup. My first question. Well, first of all, eritoran, which I have heard after a long interval, data will become available by the end of this year and in development -- rather than development and the sales for the future. Is Eisai leading initiative of sales or this network will be leading the initiatives in future sales? Which is the case?

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Haruo Naito, Eisai Co., Ltd. - CEO, Representative Corporate Officer & Director [4]

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Naito speaking. Mr. Yamaguchi, that point is yet to be considered. Now quality of this investigational drug is being secured, and we are making utmost efforts to provide the drugs to the frontline. We are trying to speed up the clinical trial as soon as possible. That is what we are working hard. But if everything goes well and the commercial production shall be accelerated proactively, of course, we would like to see Eisai taking initiative. But when it comes to specific framework for commercialization, which, I believe, is yet to be determined.

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Hidemaru Yamaguchi, Citigroup Inc, Research Division - MD & Analyst [5]

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Understood. Second question is about aducanumab. Let me clarify one point. It's a open BLA or rolling BLA, I think that is the submission made module by module. And after completion, then review process will start. That consensus in the United States, do you think that there is a delay? Or the play BLA meeting itself, there may have been any negative impact to that process or if there have been any reshuffle of the person in-charge at FDA, I think there are certain uncertainties. And I believe it's difficult for you to make any counterargument under this situation. But from your gut feeling, what is your take once completing this process? And then do you think the development afterwards will be visible?

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Haruo Naito, Eisai Co., Ltd. - CEO, Representative Corporate Officer & Director [6]

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For this point as well, it is related to regulatory filing and the timing of getting approval all to be up to discretion of the regulatory authorities. Therefore, we are not in a position to make any comments on that. But we're thinking about the usual range if the delay is contained within that normal range or some minor hedges. I believe that those are contained to the minor ones. For the fundamental core structure of the processes, we believe that these have not been swayed by this situation at all.

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Hidemaru Yamaguchi, Citigroup Inc, Research Division - MD & Analyst [7]

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Understood. My last question is about LENVIMA LEAP study. Those [116] has been submitted after immediately. And since the inception of the study, until the filing, there have been several studies where the filing process was very speedy. Do you think that this stance approach will be continued and repeated for LEAP study?

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Unidentified Company Representative, [8]

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Thank you very much. From Oncology Business Group, Dr. Owa, who is in-charge of Science is going to respond.

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Takashi Owa, Eisai Co., Ltd. - VP and Chief Medicine Creation Officer & Chief Discovery Officer of Oncology Business Group [9]

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Dr. Owa speaking. Mr. Yamaguchi, thank you for your question. Among LEAP study, I believe that what will be designated as a breakthrough therapy in the United States. If there are any potential, we would like to pursue that process together with Merck. Of course, we are not have a preconception regarding any specific types of cancer, but the universal benefit is expected from this combination of LENVIMA and KEYTRUDA. Therefore, we believe that such breakthrough therapy designation can be utilized in order to pursue the faster track approval. That is my answer.

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Unidentified Company Representative, [10]

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We have Mr. Hashiguchi from Daiwa Securities. Mr. Hashiguchi, please.

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Kazuaki Hashiguchi, Daiwa Securities Co. Ltd., Research Division - Research Analyst [11]

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View original post here:
Edited Transcript of 4523.T earnings conference call or presentation 13-May-20 7:30am GMT - Yahoo Finance

Since the coronavirus pandemic began, Americans have been presented with a series of harrowing portraits of a health care system thrown into chaos. First, there were the awful hypotheticals sketched by epidemiologists: hospitals overwhelmed, halls crammed with the desperately sick, doctors forced to decide whose lives were most worth saving. Then came the real-life chaos as the wave of infections began to crest in hot spots like New York City: nurses breaking down over trying to treat dozens of dying patients at once; corpses being forklifted into refrigerated trucks and buried in mass graves.

With evidence mounting that daily deaths are trending downward in some of the hardest-hit locations, theres reason to hope that the worst is nearing its end. But were only just beginning to see the presence of a second, quieter crisis roiling our health care system, an economic disaster brought on by anti-COVID measures that has pushed untold numbers of doctors and practices to the brink of insolvency.

The hospitals bearing the brunt of Americas COVID-19 treatment have had to deal with several types of shortages over the last month: manpower, test kits, protective equipment. Whats been less of a struggle is money. The federal government has committed huge sums of money to ensure hospitals are adequately reimbursed for every COVID patient they treat. Meanwhile, the rest of the nations hospitals have felt the financial squeeze, as they sit mostly idle following a mad scramble to prepare for the possibility they were about to become COVID triage centers. According to first-quarter GDP numbers released yesterday, cratering spending in the health care industry accounted for nearly half of the economys 4.8 percent GDP shrinkage.

Take Michigan. In the early days of the coronavirus crisis, Gov. Gretchen Whitmer moved fast to shore up the states COVID readiness. Among the steps she took: a March 20 executive order temporarily postponing all non-essential medical procedures. As Detroit began to develop into a major coronavirus hotspot, Whitmers aggressiveness seemed prescient. As the weeks dragged on, however, some of the hospitals in more lightly affected areas began to sound the alarm that they were bleeding out financially.

Yesterday, the CEO of Hillsdale Hospital, a small-town hospital in southern Michigan, penned a letter to Whitmer laying out the dire situation: If elective surgeries were not allowed to resume, many of the states rural hospitals would likely be forced to shut down permanently within just a few months.

That CEO, JJ Hodshire, told The Dispatch that the loss of elective surgeries was starving his hospital of one of the few profitable services on an already tight balance sheet. As a small hospital, Hillsdale Hospital lacks substantial bargaining power and thus is largely at the mercy of the procedure rates stipulated by insurance providers even in good times. This means it relies on elective procedures like joint replacements to stay in the black.

We operate on a shoestring budget, he said. We have struggled like the rest of rural American health care. Weve had some losses year after year, but we understand the importance as a community need, as a not-for-profit hospital, that we need to engage in this, because we know that if theres no local hospital, people die. When your hospitals close, access to care is now limited to a 30, 40, 50 minute drive. And when youre talking about heart attacks, youre talking about strokes, every minute counts.

When Whitmers order first came out, Hodshire said, his hospital scrambled to make a plan to prepare for a possible COVID spike, and also to weather a lengthy loss of revenuea plan that meant laying off 15 percent of the hospitals workforce. That number has now grown to 20 percent, and will grow higher if elective surgeries do not resume. Even if they were to resume right away, the hospital would still be looking at about a $10 million hole in its budget, which federal aid has defrayed only partially.

Its going to have grave consequences for many hospitals around Michigan, because we cannot dip that far into our cash reserves to sustain the model without significant mass layoffs beyond the ones Ive already done, Hodshire said. When you think of Hillsdale, its not shopping malls and great cuisine and those type of things. Its very difficult to recruit physicians to this community. And so if I go shredding their contracts and laying off physicians, its counterproductive to our operations, because those physicians will leave. And then I wont be able to have physicians here to engage in the activity.

As the crisis has dragged on without COVID cases spiking in his area, Hodshire said he has had a hard time justifying the freeze to people clamoring for the banned surgeries who cant afford to wait.

We get calls all the time: When are you starting them up? We need to do thismy insurance is ready to run out, because I lost my job and its only good to the end of the month. Can I get that surgery? he said. Well, no, sorry. Why? The governor said we cant. But I heard you have no COVID patients, you have one. Yep, thats true.

Its hard to explain that when someone needs care.

If small hospitals have it bad, many private practices have it even worse. The coronavirus crisis has put a near-total freeze on Americas use of preventative medicine. Some states have closed dentist offices, and where they are open, people often opt to cancel appointments rather than venture into an office and risk virus infection. Same with well-care visits to family practitioners.

Number one, nobodys coming to the office, Dr. Helen Barold, a private-practice cardiologist in Bethesda, Maryland, told The Dispatch. Were probably 20 percent of what we were at the mostprobably less than that. None of the private practice doctors are taking a salary that I know of. Were all just not taking salary at all.

Instead of her ordinary work, Dr. Barold has found herself transformed into a remote aide to help her regular patients navigate the coronavirus crisiswork that now occupies the bulk of her time but is largely unpaid. Making matters worse is the fact that the CARES Act set aside no special dispensation for private practices like hersto qualify for government assistance, she has been forced to dive into the same depleted PPP loan program serving millions of other small businesses in America. She applied for a loan last week, but has yet to hear anything back.

You know, Im a doctor. I dont know anything about that kind of stuff. Nobody said to us, You should be applying for this immediately, she said. I called my congressperson yesterday Theyre like, Yeah, we cant help you. But they did listen to me cry for 20 minutes about the fact that, of all the people, Shake Shack, Harvard, Mercedes, they do not need this. I feel like we need a TBA: Tiny Business Administration.

If Congress replenishes the PPP fund and Dr. Barolds loan goes through, it will buy her a couple months grace: the loan rules permit her to put the money intended to pay her own salary toward her practices lease instead. If it doesnt, shell be faced with an impossible choice: spending down her own life savings just to get her staff through a couple more uncertain months or closing up shop on the practice that has been the pride of her career.

You know, I talked to my lawyer yesterday: Hey, what if I go bankrupt? she said. Is my house going to go? If I decide Im going to go bankrupt, and I cant pay my lease anymore, and Ive got to give my practice uphow much can they take from me?

This is a practice I built myself. I started from scratch, I started from zero patients. I walked in, I opened the door one day and said, I am here. And, you know, I saved so many lives! And its just gone to shit.

Photograph by Shawn Patrick Ouellette/Portland Portland Press Herald/Getty Images.

Read more here:
Our Other Looming Health Care Disaster - The Dispatch

Hannah Gibson -Apr 30, 2020 / 6:00 am | Story:298702

Photo: Contributed

This is a friendly reminder to call your doctor, get seen and start treatment for whatever ailment, lump, bump, injury or illness youre currently experiencing.

With COVID-19 dominating our news, social media, conversations and thoughts, its unsurprising that we might be thinking of little else. However, your health remains a top priority, regardless of your COVID status.

With so much attention on the pandemic, its understandable that you might have not noticed changes to your health, if youre not experiencing a cough, shortness of breath or fever. Or, you may be anxious about visiting a doctor or hospital for fear of contracting the disease or taking up valuable resources.

My message to you is this; let your doctor be the one to judge your health situation. Almost all family practices are available for appointments in some form; whether thats a telephone or in-person consultation. By sharing your concerns with your physician, they can decide what the best course of action is. It may well be that they advise you to sit tight, but they can at least offer guidance and support for at home measures.

However, your doctor may decide that a referral is necessary, or further tests or scans. In medicine, it is always better to catch things early, and referring you for tests or a second opinion can be vital in getting information about your condition while its still possible to provide effective treatment.

B.C.s chief medical officer, Bonnie Henry, has urged citizens not to ignore urgent medical matters during this time. She also advised parents to continue with their childrens vaccination schedule, at a time where vaccinations have never been more important for safeguarding against infectious disease.

B.C. has actually seen a reduction in the number of visits to the ER since the pandemic has begun. On one hand, this is positive; perhaps people are only coming to the ER when they really need it, rather than using it as a walk-in clinic. However, there is a worrying alternative; that people are too scared to come in, and their health will bear the consequences of that.

So, please take this as a reminder to check in on your, and your familys, health. Is there something that has been bothering you? Have you had all tests and scans that were booked in for you? When was the last time you saw your particular specialist? Is your child up to date with vaccinations?

For any further advice or support, please get in touch with your family medical practice by phone, as they are in the best position to help you. Stay safe and be well!

Hannah Gibson -Apr 16, 2020 / 11:00 am | Story:297398

Photo: Contributed

Boredom eating, stress baking and closed gyms can lead to what people are calling the Quarantine 15 weight gained from our time in isolation.

While I dont want to add another anxiety to an already growing list, your physical health should remain a top priority during isolation.

Although worrying about weight gain isnt helpful or effective, taking steps to look after yourself will boost your mental health as well as keeping weight gain at bay.

Ive put together some ideas to help you keep your mind and body in peak condition during this time.

Identify why

Why is it that you keep going to the fridge or cupboard for more snacks? It is likely boredom, which is understandable. The solution is to keep your mind and body busy; call a friend, do a puzzle or read a book.

If youre still struggling, try snacking on something very low in calories, like celery or carrots. Itll keep your mouth and hands busy and wont be contributing to any weight gain!

Keep track

Use an app like MyFitnessPal to track your calorie intake as accurately as possible. Most of the time, seeing how our calories stack up during the day is enough to put us off eating more than we need.

You can also look at the vitamins and nutrients of what youre eating, and adjust accordingly. The chances are, theres vitamins or fibre that youre missing out on, so you can focus on increasing foods that are rich in these.

Exercise where you can

With closed gyms, parks and outdoor spaces, finding a way to exercise right now can be challenging. The good news is that there are lots of online courses and apps that offer at home workouts, ranging from a good old fashioned HIIT session to at-home ballroom dance or burlesque.

Many companies are offering reductions on courses, or free sample sessions, so make the most of whats out there. This may be the time to find a new passion.

Go low

When grocery shopping and cooking, aim to use low fat and sugar foods, such as dairy, spreads, salad dressings and oil. If the unhealthy snacks arent in the cupboard, you wont be able to eat on them!

Think before you eat

Ask yourself; am I eating this because Im hungry, because Im bored or because its in front of me? If its the latter two, stop.

Suggest a game or a walk to break up the mindless munching, or have a glass of water instead.

Check your mental health

Take time to check in on your mental health.

With your routine out of whack, food, sleep and exercise taking a turn for the worse, financial and work struggles and kids out of school, this is a difficult time for us all.

Its important to cut yourself some slack; this is a stressful time and if chocolate or the odd glass of wine helps you relax, go for it! Its all about finding a balance between healthy living and enjoying life, and only you know whats right for you and your body.

Hannah Gibson -Apr 6, 2020 / 11:00 am | Story:296497

Photo: Iz zy/Unsplash

Many of you may be anxious, stressed or upset with everything going on in the world right now.

Whether you suffer from mental-health issues or not, it is perfectly understandable to be experiencing heightened senses of emotion during such a turbulent time.

I have compiled a list of ideas I think can go some way to helping alleviate the feelings of anxiety and upset right now.

Id love to hear your thoughts on it, or if you have any further ideas that may help others.

Seek Help

Its important to remember that help is still out there for you to access, no matter what issues youre facing. With all the attention on COVID, it can be easy to forget about other health concerns, including your mental health.

Most family practices are still open, with an emphasis on telephone consults or even through online portals. If you have a health query, dont hesitate to seek help. Let your doctor be the one to decide if its a priority.

Seeking help for mental-health support is more important than ever. Kelownas Crisis Response line is still running, and is available to listen whatever you wish to talk about.

CMHA Kelowna is also open, and can signpost you in the direction of further care.

Another great resource is http://www.heretohelp.bc.ca.

Give Help

One of the most amazing feelings is being able to help others, and theres no time like the present. If you are able to, providing help and support in your community is an invaluable use of your time.

Whether its getting groceries for elderly neighbours, or offering childcare support to frontline workers, youll get a huge boost for your own sense of wellbeing by helping those around you.

If youre at risk yourself, you can help from your home by offering your phone number to people who are in self-isolation, so that they can call and have a chat to alleviate the time alone.

Limit News

In a time of 24-hour news on the TV, shared news articles on your social media and news apps on your phone, the influx of information can be incessant.

I find it helpful to limit the amount of news I see in a day; too much and the state of the world can become overwhelmingly stressful.

Create Routine

Most of us have seen a big change in our routines, with working from home or having the kids off school. As creatures of habit, we crave a sense of structure, and so creating a routine for your days will help alleviate the feeling of uncertainty.

Set alarms, have your meals at appointed times, and allocate set breaks from work or schooling. Make sure youre getting showered and dressed properly in the morning; it may seem silly if youre not going out, but the process of getting ready and feeling smart will help your productivity levels no end.

Self Care

Now is an excellent time to focus on your self care.

This means something different for everyone, but the essence is finding something that relaxes you and occupies your mind.

This could be:

Whatever works for you, incorporate it into your daily routine. Along with self care for your mental wellbeing, make sure youre looking after your physical health too.

Eating well, exercising, hydrating and getting enough sleep are all really important in keeping your body and mind healthy.

Connect with Others

If you didnt use video calls before, now is the time to get stuck in. Ive been able to connect with my family back in the U.K. far more than I normally would over the last month, as people are realizing the power of video calls.

Weve done pub quizzes, had long chats about life, played games and seen each others living spaces far more than ever, and despite social distancing I feel more connected than ever to some of my closest friends.

Acknowledge Emotions

Despite all these measures, youre likely to still feel anxious or down from time to time, and thats OK. Talk about how youre feeling with a friend or family member, or on the crisis line.

The chances are, they are feeling the same, and shared emotions are much easier to deal with than facing it on your own. If you feel like crying, let it out. Ive cried a lot in the last few weeks, and every time Ive felt a release of emotion that then lets me get on with my day and put those feelings behind me.

Whatever your situation, I hope you and your friends and family are keeping safe and well during this time. Remember to seek help and give help where you can, and most importantly, stay home to slow the spread.

Hannah Gibson -Mar 19, 2020 / 6:00 am | Story:279469

Photo: Contributed

Forty-five per cent of Canadians regularly take health products, such as vitamins, minerals or herbal remedies.

With annual sales at an estimated $1.4 billion in Canada, I ask:

A recentUniversity of Toronto study looked into the evidence supporting the use of supplements, such as vitamins, minerals and fish oils. Specifically, the study looked at the effect on the risk of heart-related illness.

It foundthere was no significant effect from taking supplements.Supplements dont help to prevent cardiovascular disease, and they come at a cost.

I take a look at the main vitamins and nutrients, and how you can ensure youre getting enough without paying excessively for the benefits.

The government only recommends a few supplements, depending on age. Vitamin D is recommended for all Canadians, because most of us are deficient due to a lack of sun exposure.

Vitamin D helps regulate the amount of calcium and phosphate in the body, and is needed to keep bones, muscles and teeth healthy.

Being deficient in vitamin D can lead to rickets in children, which is a type of bone deformity. In adults, it can cause a condition called osteomalacia, which is a softening of the bones.

During summer, we should be able to get all the vitamin D we need from sunlight. However, as most Canadians are deficient in this vitamin, taking an oral supplement is a good idea.

Vitamin A and C are also recommended for children aged six months to five years old. Vitamin A helps your bodys natural defences, including keeping skin healthy, while vitamin C also helps maintain healthy skin, bone and blood vessels.

Eating a balanced diet full of fruit, vegetables and dairy (or alternatives fortified with vitamins), should ensure that you get all the vitamin A and C needed.

The recommendation to supplement childrens diets is due to the fact that more vitamin A and C are needed for growth and development.

Women trying for a baby, or in the first 12 weeks of pregnancy, are recommended to take folic acid. This nutrient is important in the development of the brain and spinal cord in Fetuses.

Aside from pregnancy, there is no clinical need or benefit to taking folic acid, so it isnt recommended for anyone outside this category.

Other nutrients, such as calcium and iron, are also marketed by pharmaceutical companies as being essential to your health and well being.

While this is true calcium building strong bones, muscles and teeth, and iron essential for carrying oxygen around the body we should be reaching our daily targets if we eat a healthy, balanced diet.

Good sources of iron include meat, liver, beans, nuts, whole grains and green vegetables.

Women need more iron than men due to having periods and losing blood each month. Signs of iron deficiency anemia include feeling tired, out of breath or weak.

If you believe you may be deficient, go to your family doctor to get your blood levels checked.

Taking iron supplements without medical supervision isnt advised; iron can cause nasty side effects.

Calcium is also found in similar foods, as well as dairy products (or fortified alternatives). Taking too much calcium, in the form of supplements, can cause stomach pain and diarrhea, so again is not recommended without a physicians advice.

A few years ago, I challenged myself to eat the Daily Dozen a checklist of 12 types of food that you should incorporate into your diet each day.

I downloaded the app (Dr. Gregers Daily Dozen) and aimed to tick off all the food groups by the end of the day.

This is a great way of making sure youre getting all the right vitamins and nutrients to stay fit and healthy!

The list is as follows:

Download the app, or read of Dr. Gregers book, How Not to Die. Its a really informative read about how to use diet and exercise to prevent all the top causes of death.

Get in touch in the comments below, or via email, if you have any questions about supplements or how to reach your daily targets.

More Health and Happiness articles

Read this article:
It's not all about COVID-19 - Health and Happiness - Castanet.net

By David Williams, CNN

(CNN) -- A North Carolina family's pug may be the first dog in the United States to test positive for coronavirus, according to researchers.

Three members of the McLean family -- Sam McLean, wife Heather and their son, Ben -- contracted Covid-19 last month. Sydney McLean, the couple's daughter, was the only family member to never show any symptoms.

The family found out their dog, Winston, tested positive for the virus too after they participated in a Duke University study about Covid-19 aimed at trying to find potential treatments and vaccines. As part of the study, members of the family under go weekly nasal swabs and give blood samples.

Chris Woods, the principal investigator of the study, said researchers have also been collecting samples from family pets to see how coronavirus spreads in households. Researchers did not use the commercial tests that are in high demand around the world to test the animals.

Although they haven't tested many pets, Winston's sample is the only one that's come back positive. He is believed to be the first dog in the country to test positive for the virus, according to the university.

"His (Winston's) amount of virus that we detected was very low, suggesting that he would not be a likely mechanism or vector of transmission of virus to either other animals or to, to humans in these households," Woods said.

Sam McLean, a researcher and emergency room doctor at the University of North Carolina at Chapel Hill, was the first member of the family to get sick, his wife Heather McLean said. He had treated Covid-19 patients before he got sick.

Winston did show some minor symptoms while his family was also sick.

"He had a small cough for a day or two right in the peak when all of us were sick and he didn't eat his breakfast one morning," Ben McLean told CNN. "But we didn't have any concrete, like, super alarming illnesses where we're like, 'we need to take him to the vet. He's like really sick.'"

Woods said researchers don't know if coronavirus made Winston sick, or if he had an unrelated ailment.

The McLeans have another dog and a cat, whose tests were negative.

Winston tends to lick things and likes to spend more time around his family, Heather McLean said. Their cat is more aloof, and their older pug likes to sleep most of the time.

"Winston is much more affectionate and we hold them all the time," she told CNN. "So if any of the animals were to have a positive viral test, it would be him."

Federal officials announced last week that two cats tested positive for the novel coronavirus in New York.

Eight lions and tigers tested positive for Covid-19 at the Bronx Zoo, but the big cats are all doing well, according to a news release.

Two dogs under quarantine in Hong Kong also tested positive for the virus, according to officials there.

Experts have stressed that there is no evidence that pets play a part in transmitting coronavirus.

"I would not change our, our behaviors with our household animals at this point. They're really an important part of our ongoing mental health as we continue to participate in our social distancing to combat the pandemic," Woods said.

Dr. Anthony Fauci, the nation's top infectious disease specialist, said in a press briefing last week that "there is no evidence whatsoever that we've seen, from an epidemiological standpoint, that pets can be transmitters within the household."

William Schaffner, a professor of preventative medicine and infectious disease at Vanderbilt University School of Medicine in Nashville, said that it is extremely rare for a virus to jump from an animal to a human.

He said the first case in the Covid-19 pandemic was believed to have come from a market in Wuhan, China, but it has spread around the world through human-to-human contact.

"We still don't think this is common and we certainly don't think it's a major route of transmission in either direction," Schaffner said. "It's not common for people to give it to their pets, nor has it been demonstrated ever that anyone's ever gotten this virus from a pet."

Schaffner said it would be a good idea for people who are sick to social distance themselves from their pets, as well as their family members. The Centers for Disease Control and Prevention has made similar recommendations.

Heather McLean said that her family is now out of quarantine and are cleared to go back to work. Her husband has volunteered to work in a special Covid-19 unit in the emergency room, because he thinks he'll be at less risk than colleagues who haven't been infected.

Heather McLean and Ben McLean hope to be able to donate plasma, so their antibodies can help patients.

"We are feeling very grateful that we have the opportunity to participate in this research study," she said. "We are really hopeful that we can donate plasma to be able to help other patients."

She said Winston is also doing well. He is getting lots of walks, and enjoying following his family around the house to keep an eye on what they're doing.

CORRECTION: This story has been updated to correct the spelling of the dog owners' last name.

The-CNN-Wire & 2018 Cable News Network, Inc., a Time Warner Company. All rights reserved.

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A pug in North Carolina may be the first dog in US to test positive for coronavirus - WDJT

The Miami County Health Department is asking residents to complete a survey that should shed more light on how many people in the region are experiencing symptoms related to COVID-19.

Health officials plan to use the results to seek out residents who are currently symptomatic. Those who volunteer to be tested will be able to utilize a new drive-through community sampling clinic set to be established locally by the Miami County Health Department.

A link to the survey can be found on the Miami County Health Departments Facebook page.

This survey is not intended to replace medical care or advice from a medical professional, the health department clarified.

Christena Beer, a disease investigator at the Miami County Health Department, outlined the details of the project in an email to local governmental leaders and health partners Friday, April 24, and the survey was pushed out to the public on Monday, April 27.

We have partnered with the University of Kansas Medical Center Department of Preventative Medicine and Public Health, utilizing their expertise to create and launch a self-reporting survey to residents of Miami County, Beer said.

She added that the plan is to push out the survey through multiple avenues, including social media, websites, school districts and local media.

The survey, which is recommended to be completed for each member of the household, can be filled out in about five minutes, Beer said. It will ask a few questions about the respondents demographic background, current health status, potential COVID-19 symptoms and profession. If the respondent is currently symptomatic, it will also ask if they would like to be tested. If the respondent indicates interest in testing, further demographic information is collected for the purposes of pre-filling laboratory requisitions for more efficient service at the testing site, and if selected, that person will be contacted with a location and time for testing.

Based on the potential need acquired from the survey, we are working on securing supplies to have the ability to test anywhere from 200 to 500 Miami County residents who meet criteria for testing at Kansas Health and Environmental Laboratories, Beer said. We have the ability to oversample certain groups (i.e. profession, geographic location etc.) to ensure that the sample is both representative and meaningful in data collection for the county in its entirety, and we also have the ability to randomize the sample. Once we have more demographic information, as well as number of respondents currently symptomatic, we can better narrow down our sample group(s) based on need.

Dr. Lee Norman, secretary of the Kansas Department of Health and Environment (KDHE), recently stated during a press conference that a rate of five tests per 1,000 persons is needed to really understand whats happening in a certain area.

Beer said Miami Countys rate of testing, as of April 24, is 5.14 per 1,000 persons.

Our rate of testing is not necessarily concerning compared to Kansas counties who have nowhere near the testing availability that Miami County has, but increasing our testing capacity will provide data that gives more information about the prevalence of the virus in our county, and it will also identify people who are infected so case investigation and contact tracing can be completed to minimize potential exposures within the community, Beer said. Increased testing will also provide information on hospital capacities, measure the effectiveness of the interventions, and assist in making data-driven decisions when determining our plan to ease restrictions and the phases that will be recommended to reopen.

A specific location for the drive-through testing clinic has not yet been finalized, but Beer said it will be in Paola at a location that will have the layout and specifications to accommodate drive-through testing.

Depending on the results of the survey, Beer said two to four additional clinics may be set up on future dates if enough residents who are symptomatic volunteer to be tested.

The test will be at no cost to the individual being tested, as we are sending specimens to KHEL, Beer said.

She added that Olathe Health and Miami County Medical Center have offered to support the mission and will provide staff and supplies to assist in the specimen collection and courier service to KHEL.

Sheriff Frank Kelly and Emergency Management Coordinator Mark Whelan have offered to help secure a site, traffic and security needs, as well as provide other needed equipment for the number of people invited.

We all have been compounded by the immensity of the unknowns, and if we knew more about the prevalence of COVID-19, we can remarkably improve our resource allocation, Beer said. Furthermore, in conjunction with Governor Kellys guidance, we can collaboratively make decisions about where, when and how we can safely reopen parts of our economy.

Miami County has had five confirmed cases of COVID-19, with the only active case being a resident in their 30s who was added to the report Saturday, April 25.

The health department reported that multiple close contacts of the individual have been identified and contacted with further instruction and monitoring for any symptoms.

Although the case investigation is still ongoing, no specific exposure has been identified at this time, and it will be classified as a local transmission, the department reported.

The other four cases involving Miami County residents have already recovered.

The department reported that 188 Miami County residents have been tested.

Kansas has 3,328 confirmed cases of coronavirus (COVID-19) in 75 counties that have resulted in 496 hospitalizations and 120 deaths as of 8 a.m. Monday, April 27, according to the Kansas Department of Health and Environment (KDHE).

KDHE reported the state has logged 23,839 negative tests. Wyandotte County has the most cases at 573, followed by Ford County, 516; Johnson County, 440; Seward County, 349; Sedgwick County, 339; Leavenworth County, 184; Finney County, 175; Lyon County, 147; and Shawnee County, 105.

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COVID-19 testing to be ramped up in Miami County - Miami County Republic

SALT LAKE CITY A Cedar Hills man who prosecutors say has been fraudulently marketing silver products as a cure for the new coronavirus, has been ordered by a federal judge to stop selling those items.

On Wednesday, U.S. District Judge David Barlow issued a temporary restraining order against Gordon Pedersen, 60, and his companies, My Doctor Suggests LLC and GP Silver LLC. The injunction comes on the heels of a civil complaint filed Monday in Salt Lake City against Pedersen by U.S. Attorney for Utah John Huber.

The civil complaint alleges that the defendants are fraudulently promoting and selling various silver products for the treatment and prevention of COVID-19, according to a statement from Hubers office. The defendants have made a wide variety of false and misleading claims touting silver products as a preventative for COVID-19, including that having silver in the bloodstream will usher any coronavirus out of the body and that it has been proven that alkaline structured silver will destroy all forms of viruses, (and) it will protect people from the coronavirus.

Pedersen and his companies have promoted silver products as a treatment for various diseases, including arthritis, diabetes, influenza and pneumonia since about 2014, the civil complaint states. These items are marketed under various names such as Silver Solution, Silver Gel, Silver Soap and Silver Lozenge.

In early 2020, Pedersen and My Doctor Suggests started contending that the silver products also cured COVID-19, according to court documents.

Gordon Pedersen falsely claims that My Doctor Suggests silver products can destroy coronavirus, and remove it from the body, assuring the user will never get COVID-19, the complaint states.

In his online sales pitches, Pedersen refers to himself as a doctor and often gives his sales pitch in a white coat with a stethoscope around his shoulders, creating the appearance of a treating physician, even though ... Pedersen does not hold a doctor of medicine degree, and is not licensed as a medical provider in the state of Utah, the complaint alleges.

According to the Silver Health Institute website: Dr. Pedersen holds four doctors degrees. He has a doctorate of naturopathic medicine. He has a Ph.D. from the toxicology program at Utah State University, where he also has Ph.D. degrees in immunology and biology. He is board certified in anti-aging and regenerative medicine and also holds a masters degree in cardiac rehabilitation and wellness.

Defendants are creating a false sense of security that may cause consumers to avoid conventional medical treatment and to ignore travel restrictions and social distancing that slow the spread of COVID-19.Court documents

In one of his YouTube videos promoting a silver hand sanitizer, Pedersen says he is going to go out and shake hands with people, doctors, patients, people who are infected possibly with the flu ... and Im going to have a confidence level that I have protection, court documents state.

In a podcast interview in March, Pedersen claimed, If you have the silver in you, when the virus arrives, the silver can isolate and eliminate that virus, the complaint states. In the same podcast, Pedersen said he could freely travel and was even going on a cruise ship, but was confident he would not catch COVID-19 because of his products.

Prosecutors noted in court documents that the list prices on the My Doctor Suggests website range up to $299.95 for a gallon of the silver solution, a mix of water, sodium bicarbonate commonly known as baking soda and extract from silver wire the companys self-described flagship product.

Prosecutors further noted, There is no recognized cure for COVID-19, and no drug product has been proven safe and effective for the prevention, treatment or cure of COVID-19.

Even Pedersen knows silver products are not a proven cure or treatment for COVID-19, the complaint states. They are also aware that they cannot legally promote My Doctor Suggests silver products for the prevention and/or treatment of COVID-19, and distribute them in interstate commerce. Indeed, defendant Pedersen has stated that, We are not a cure for the coronavirus there is none, and acknowledged that he does not actually know whether the products kill coronavirus.

Prosecutors described Pedersens actions as reckless and harmful to consumers, the complaint says.

Defendants are creating a false sense of security that may cause consumers to avoid conventional medical treatment and to ignore travel restrictions and social distancing that slow the spread of COVID-19, court documents state.

A federal court also froze all of Pedersens and his companies assets on Wednesday.

Even in a time of great uncertainty, there are at least two unchanging realities. There are those who would unlawfully exploit our vulnerabilities, and there are those who will hold such parties accountable, Huber said in a prepared statement. COVID-19 is a dangerous disease, and American consumers must have accurate and reliable information as they make important health decisions.

In issuing the restraining orders, Barlow wrote, There is good cause to believe that immediate and irreparable harm will result from defendants ongoing violations unless they are forced to stop, and that any harm a temporary restraining may cause to Pedersens businesses is greatly outweighed by the threat to the health and safety of individuals relying on defendants products and the representations regarding those products and to the public generally.

A hearing on the preliminary injunction is scheduled for May 12. As of Wednesday afternoon, the My Doctor Suggests website was offline.

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Judge orders Utahn to stop touting silver products as COVID-19 cure - KSL.com

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

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

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

What can we do to support our kids?

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

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In the Face of an Unprecedented Crisis, Kids Can Bounce Back - UKNow

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The drugs and treatments that could stop Covid-19 - POLITICO

1. What are the symptoms ofCOVID-19 infection

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

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

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

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

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

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

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

There is no specific treatment or vaccine for this disease.

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

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

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

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

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

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

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

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

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

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

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

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

The Power of Human-Machine teams

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

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

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

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

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

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

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

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

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

AI technology to prepare for the next crisis

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

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

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

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

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How AI can help win the fight against Coronavirus - Med-Tech Innovation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The best telemedicine services for anyone unable to visit a doctor's office in person - Insider - INSIDER

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

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

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

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

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

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

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

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

Get medical attention immediately, the CDC says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CNN's Jacqueline Howard contributed to this report.

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

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

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

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

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

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

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

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Turning urban areas into smart cities

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

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

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

Boosting public safety and monitoring

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

Improving Traffic & public transport monitoring

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

Saving resources through smart metering and billing

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

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

Harnessing the power of data in retail

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

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

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

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

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

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

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

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Healthcare: improving wellness and saving more lives

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

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

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

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

Expanding chronic disease management and preventative medicine

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

Advancing precision medicine research

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

Enhancing pharmaceutical drug supply chain safety

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

Giving manufacturing a competitive edge

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

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

Automating industry

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

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

Improving planning and scheduling

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

Smarter plant safety and security

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

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

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

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

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

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

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

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

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

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

6 United Nations, World Population Ageing (2019)

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

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

9 Dell EMC Global Data Protection Index Survey (2019)

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

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Driving business opportunities at the Edge - TechHQ