StemCell Therapy

Half Year 2018 Sonic Healthcare Ltd Earnings Call

NORTH RYDE , NSW Apr 14, 2020 (Thomson StreetEvents) -- Edited Transcript of Sonic Healthcare Ltd earnings conference call or presentation Wednesday, February 14, 2018 at 11:00:00pm GMT

TEXT version of Transcript

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Corporate Participants

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* Christopher David Wilks

Sonic Healthcare Limited - Finance Director, CFO & Executive Director

* Colin Stephen Goldschmidt

Sonic Healthcare Limited - CEO, MD & Executive Director

* Paul J. Alexander

Sonic Healthcare Limited - Deputy CFO & Company Secretary

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Conference Call Participants

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* Andrew Goodsall

MST Marquee - Healthcare analyst

* David A. Low

JP Morgan Chase & Co, Research Division - Research Analyst

* David Andrew Stanton

CLSA Limited, Research Division - Former Research Analyst

* David Bailey

Macquarie Research - Research Analyst

* Nicholas Cameron

Watermark Funds Management Properietary Limited - Sector Head of Healthcare

* Sean M. Laaman

Morgan Stanley, Research Division - Australian Healthcare Analyst

* Steven David Wheen

Evans & Partners Pty. Ltd., Research Division - Executive Director of Healthcare

* Thomas Godfrey

UBS Investment Bank, Research Division - Analyst

* Victor Windeyer

Citigroup Inc, Research Division - Former VP and Analyst

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Presentation

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Operator [1]

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Hi, good morning. Welcome to Sonic Healthcare's Half Year Results Presentation.

I will now hand you over to our presenter today, Dr. Colin Goldschmidt, CEO of Sonic Healthcare. Go ahead, sir.

Story continues

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Colin Stephen Goldschmidt, Sonic Healthcare Limited - CEO, MD & Executive Director [2]

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Thank you very much, and a very good morning to everyone, and welcome to this half year presentation of Sonic Healthcare's results for the period ending 31 December 2017. I'm joined this morning in Sydney by my colleagues: first of all, Mr. Chris Wilks, who's Sonic's Chief Financial Officer; and also by Mr. Paul Alexander, Deputy CFO of Sonic. I'll give a presentation, as usual, and then we'll probably share the questions when we get to that junction.

I'm going to start the presentation on Slide 3, which is headed "Headlines", and I'm pleased to begin the presentation by giving an update on our market guidance, and we're very pleased to say that we are on track to achieve our full year FY 2018 guidance, and that is after 7 months of trading.

Our headline numbers, if I can put it that way, for the half, we achieved revenue growth of 8% and EBITDA growth of 9%, and the group delivered margin expansion of 20 basis points over the period. This result was achieved on fewer working days and in the prior period, and I'll say a little bit more about that in one of the later slides.

You'll also notice in this result an unusual feature, which we want to draw everyone's attention to, and that unusual feature is seen in our statutory results and it's a one-off net tax benefit of $20 million. This is a noncash benefit of $20 million, which shows up in net profit and EPS lines, and it represents a revaluation of a deferred tax liability flowing from the corporate tax reforms recently enacted in the U.S.A.

In terms of our growth, moving on to the next bullet point, our result shows a healthy mix of solid organic growth but also accretive acquisitions and joint ventures. During the period, we completed the acquisition of Medical Laboratory Bremen in Germany and also completed a joint venture arrangement in New York with NYU, New York University, that commenced in the period as well.

And looking to the future, we have an active pipeline of further acquisition and JV opportunities in train.

In terms of our dividend, the interim dividend increased by $0.01 or 3%, and this does continue our very long-standing progressive dividend policy, which has now been progressive or non-retrogressive for something like 24 or 25 years.

So just giving a summary at the start of this presentation. When we look at the overall picture, Sonic Healthcare is in fairly good shape and very well positioned for ongoing growth and to compete in a modern and changing global health care environment. When we say we have a strong or solid base for future growth, we back that up by that final bullet point on this slide and it's probably in the correct order. We have a very strong culture in Sonic Healthcare, which is very much based around our unique model, a model that we term Medical Leadership. We're very fortunate to have an outstanding global leadership team; and in fact, I'd like to take this opportunity to acknowledge them and even thank them here because I know that many have dialed in to this call from right around the world, some even at crazy hours of the night in Europe.

Our reputation is outstanding. That's been achieved over years, if not decades, of hard work. And we have very modern infrastructure as well, which allows us to provide world's best services and to leverage benefits from our scale. And I guess, we're fortunate to be in an industry which has strong growth dynamics to it, and that includes things like aging of the population, new tests especially in genetics, and also the ongoing focus on preventative medicine.

If we move to Slide 4, and just looking at the table, first of all, you'll notice that we presented these results in statutory form rather than constant currency form. And the reason for that is that there was minimal FX impact over this half. Against the Australian dollar, the slightly weaker U.S. dollar was offset almost entirely by slightly stronger euro over the period. And in fact, I think, the total FX impact for the half was a benefit or tailwind of around $700,000 at the revenue line. So it's less than $1 million on the $2.673 billion for the half.

So looking at the table in statutory form, we present the actual numbers: revenue, $2.673 billion, which is 8% growth; and the EBITDA number of $445 million. And then, we've presented both net profit numbers and EPS numbers to show what's going to be reported, including the one-off tax benefit which shows 16% net profit growth and 15% EPS growth. But in effect, our underlying growth is 10 -- it's 10% less than that. So really it's 6% net profit growth, if you take out that one-off tax benefit; and 5% EPS growth, if you take out the benefit as well.

Now just a few comments about the working days. We don't want to make too much of a deal about this, but it was quite significant on this particular occasion. So you'll see in Germany, we had 3 fewer working days; in Switzerland, 2; and everywhere else, 1 less working day in the period. It is quite significant, and if you quantify it, it works out to about a 1.3% difference at the revenue line. So with equal working days, if we normalize it out, revenue would have been $31 million higher. So we would have got to whatever $31 million on $2.673 billion is. We -- our earnings and margins would have been higher too. We haven't quantified that at all because it's obviously going to depend on how much of that $31 million flow through to the bottom line. But it does give an indication that the numbers representing here, the 6% net profit growth and 5% EPS growth, would have been higher had the working days been equal.

Moving on to the next bullet point, the revenue and earnings growth. Our organic revenue growth for the period is approximately 5%. We've -- say, constant currency there and normalized for working days. However, our growth was further enhanced to get up to that 8% by accretive acquisitions and joint ventures. And the group margin accretion was approximately 20 basis points for the period.

The laboratory division achieved strong margin accretion when you normalize for working days. And just a couple of points on that U.S. tax benefit, which I think I've covered already, this is a revaluation of a net deferred tax liability, bringing it down from the 35% to the 21% tax rate recently announced and it's importantly noncash and one-off.

Moving on to the next slide, which covers our guidance. Just as a recap, in August of last year at our full year results for FY '17, the guidance that we gave at that time was 6% to 8% growth on our underlying FY 2017 EBITDA number of $889 million at constant currency levels, and we said at the time that no regulatory changes were assumed. Our guidance has not changed at all since that period and we are maintaining the guidance of 6% to 8% EBITDA growth, despite the regulatory changes that have been announced in both the U.S. and Germany. So really what we're saying here is that we're not altering our guidance as a result of these fee changes, nor in fact are we guiding to either the upper or lower ends of our guidance range. So in other words, we believe that the fairly strong momentum that's currently present in the company is sufficient to mitigate the impacts of both the fee changes in the U.S. and Germany.

The following 3 major bullet points are a repeat of the guidance that we announced in August last year. Just, I guess, to point out again, the bottom line of that CapEx. We certainly expect our CapEx to be significantly lower this financial year as we tail off a fairly substantial infrastructure spend over the last few years.

Moving on to Slide 6, where we talk about our dividend. As I mentioned earlier, the board has ratified a $0.01 increase to the interim dividend, which is 3.2% higher than the previous period. As we have done over the recent past, a dividend reinvestment plan will operate for the interim dividend. We use this, as we have said before, to fine-tune our capital structure, particularly in light of acquisitions that we have made over the period and, I guess, as a general prudent approach to debt management. As before, this DRP will not be underwritten.

Moving on to Slide 7, which is the pie chart of our revenue presented in statutory form here. There's very little change in this pie compared to 1 year ago. I guess the one small change that's occurred is that the Germany segment has increased slightly. That's due to the strong growth in Germany, which included a number of acquisitions and a little bit of FX tailwind versus the U.S. where there was a little bit of FX headwind. Obviously, the whole pie has expanded with our revenue growth as well. But essentially, it's very similar to a year ago, the breakup.

Moving on to Slide 8, a little bit about Australian Pathology. We achieved 5% organic revenue growth in our Australian laboratory division. Earnings growth was strong with margin accretion ongoing. As we've mentioned before, the collection center cost issue, which has dogged not just Sonic Healthcare but the whole industry for the past years, seems to have stabilized and, I guess as a result of that, we are back to, I guess, our legacy benefit of achieving margin -- marginal accretion on a very healthy and widespread infrastructure around the country. So we can look forward to, I guess, ongoing strong organic growth, earnings growth and margin accretion in this division going forward, and it's an important one given that this is our largest division across the group.

Just wanted to update the market on the National Bowel Cancer Screening contract. This was launched officially on the 2nd of January this year and already volumes are ramping up very strongly. This is a very complex project, which we've put together expertly, if I could say so myself on behalf of our whole team. Complex because it combines logistics, laboratory testing and a lot of IT input as well. We're currently sending out something like 10,000 kits per day to participants around Australia and test volumes are ramping up already at about 4,000 tests per day, hopefully going to 5,000 and even 6,000 and possibly even higher tests per day. That's the receipts that we get from those 10,000 we send out each day.

And just a summary on the Australian Pathology or our laboratory division, it's performing extremely well and we can look forward to ongoing strong performance going forward.

Slide 9 deals with our division in Germany. Revenue growth for the period was 20%, organic growth for the period was 4% when we normalize for working days. Acquisitions occurred during the period. The Staber Laboratory Group was acquired before this period, but very much influences the period in terms of revenue. And there's a lot of activity around the Staber acquisition with what -- the first of a series of internal mergers already completed and the next ones are about to happen as well. Medical Laboratory Bremen was acquired in July of 2017, so at the start of the period, and the integration of this lab into Sonic Healthcare Germany is well underway already. And we do have an active pipeline of further acquisitions in train in Germany.

I'd like to say a few words about the regulatory changes in Germany. We can now confirm that changes are going to occur to the EBM, that's the statutory insurance fees from the 1st of April of this year.

Essentially, changes to the EBM fees have been in discussion now for quite a long time. So for us, they were not unexpected. It's essentially a roughly 2.5% reduction in the EBM fees themselves, and EBM fees represent about 40% of our revenues in Germany.

I guess, if you look at this from the payer's point of view, the intention is to apply a gentle break to what is strong underlying and ongoing growth in the lab industry in Germany.

So I guess, we can look at this in a positive light in a sense that this small fee adjustment wouldn't occur had there not been strong underlying growth of the industry. And I guess, as a general comment, fee adjustments like this have been part and parcel of the lab industry over many years. We're certainly used to them and in Sonic Healthcare we have the scale and we have the capacity to absorb them, and I guess, even to use them to our advantage in terms of the ongoing consolidation that they push forward.

So just quantifying the impact for FY 2018. It's going to be an effect of less than 0.4% on total German revenues for the year. Already, we have strategies in place to mitigate the earnings impact. And just a comment, because we do get asked about the other fee structure, which is the private fee schedule, we do not anticipate any changes to these in the medium term.

Moving on to the U.S.A. Revenue growth was 4.4% for the period, with organic growth at around 2% when we normalize for working days and the 2 hurricanes that occurred during the period, that's Harvey and Irma.

We're very active in the hospital lab joint venture space and 3 of these JVs are now operating successfully for Sonic, the latest of which is the NYU, New York University Hospital joint venture, which commenced during the period in October. We have a pipeline of further hospital JVs coming up into the future as well.

Again, we need to talk about the regulatory situation in the U.S. We have spoken before about the PAMA fee cuts. PAMA stands for Protecting Access to Medicare Act. These have now come into being after several postponements. The commencement date is 1 January of this year. It's important to note that the PAMA changes affect only U.S. Medicare fees, which represent about 20% of Sonic's total revenues. The impact for 2018 on our total revenues we estimate to be about $3 million to $4 million. And like in Germany, we have strategies to mitigate the earnings impact of these fee cuts. I guess, it's very important to know that there is a major industry lawsuit against these changes in train at the moment. This is a lawsuit which is being driven by the largest industry association, ACLA, and we expect the outcome of this litigation around the middle of calendar 2018. If the lawsuit is unsuccessful, one of the, I guess, effects of the PAMA fee cuts will be further consolidation of the industry given that many of the smaller labs have much larger exposure to Medicare fees than our 20%.

Moving on to slide 11, which is Switzerland. Revenue growth of 3% organic, and if you normalize for that working day difference it'll be 5% organic revenue growth. The operations are strong. We completed a small acquisition in Zurich in January, about CHF 3 million in revenue, a small anatomical pathology business that's been completely folded into our business in Zurich called Medica. The regulatory environment in Switzerland is stable and, I guess, I could make a summary statement about Switzerland that our operations are performing exceptionally well.

Slide 12, U.K. and Ireland. 5% organic revenue growth, 6% organic revenue growth if we normalize for the working days. Our operations in the U.K. is stable. We've now fully relocated to the Halo Building that was completed during the period, and we're now at full operational strength in this new location. I do need to keep saying that this is a magnificent facility, an ultramodern lab. We're using cutting-edge equipment and technologies, including Sonic's own in-house total lab automation track system known as GLP Systems. I could say that this is arguably the finest lab in the U.K. and something that we're very, very proud of.

During the period, we've added another NHS hospital contract to our joint venture with UCLH and the Royal Free and that commenced successfully in October 27. This is 2 hospitals, Barnet and Chase Farm, and this addition will add about GBP 12 million in annual revenues to our joint venture. And I can also say that there is an active pipeline of further contract opportunities ahead.

Just briefly about Belgium on page -- Slide 13. 6% revenue growth and 7% if we correct for working days. We have set up in-house our noninvasive prenatal testing. That, together with other initiatives, are driving this strong growth for the period. We're focusing on efficiencies and integrating some of the small acquisitions we've made in the Flemish part of Belgium in the last year or 2. And as far as the regulatory environment goes, we've actually had a fee increase, a small one, which commenced this calendar year. And it's approximately 1% of our total revenues and this was an indexation fee increase. But the outlook is stable, looking forward.

Moving on to Sonic Imaging, Slide 14. Strong organic growth in this division, 9% if we normalize for working days, 8% without, and earnings growth is strong as well. In terms of the operations, we are seeing benefits now flowing from the investments that we've made in equipment and greenfield sites over the past years. And we're certainly leveraging these to drive efficiencies. We're working on cost control. And I think we're very lucky to have a very strong and stable team of radiologists, managers and staff. As far as the regulatory environment goes, I'd say that it is stable to positive. The government is looking to implement partial fee indexation for radiology testing from 2020. We're working with the industry association to try and bring that date forward. And I guess, a summary about Sonic Imaging is that the division is performing exceptionally well.

Moving on to Sonic Clinical Services, which is the last of the divisions, and I'll cover this on Slide 15. Just a reminder that SCS is an amalgam of IPN, our medical Center business and Sonic HealthPlus, which is our national occupational health business. We are the largest primary care operator in Australia and the largest occupational health provider as well. We currently have 233 medical centers and 2,260 GPs working our medical centers right around the country. We achieved 3% revenue growth for the period, 4% if you normalize for working days. Earnings growth was moderate for the period. If we look at operations, our doctor recruitment and retention is successful, as it has been in the past, and that is continuing we're pleased to say. And we're also in the process of, I guess, measured rationalization of our centers to enhance efficiencies. And in fact, if you compare those numbers at the top to 6 months ago, our medical center numbers have decreased by 3 whilst our GP numbers have increased by about 60. So that's a healthy trend and we will continue along those lines. The regulatory outlook is relatively stable, if not stable to positive. The government is implementing fee indexation progressively for GP services over the coming years. I guess, just a final point, on SCS, we now have a strong and stable management team in place, headed up by a relatively new CEO, Dr. Ged Foley. And I have to say that the services that are delivered by both IPN and Sonic HealthPlus are quite amazing and certainly very impressive, and we see the future for SCS as being pretty bright.

Slide 16 is our slide on capital management with numbers for your information. Just, I guess, a couple of points. The total debt has increased slightly due to acquisitions and exchange rate changes, which have been partly offset by strong operating cash flow. Something just to announce that in October during the period, we refinanced a EUR 160 million tranche of our debt with 7- and 15-year tenor periods at 2% fixed rates, which is something very pleasing to achieve, such long-term money at such low fixed rates. And I guess, for information, our current total weighted pretax cost of debt sits at around 2.5%. We have $650 million in headroom before payment of the interim dividend.

Moving on to the final slide. Just repeating that we are on track to achieve our full year guidance after 7 months of trading. When we're looking ahead -- when we look ahead at the long term, we certainly do expect organic revenue growth to sit at around our long-term historical trend of around 5%. That growth is underpinned by industry drivers and well-established Sonic Healthcare brands.

Bolstering that underlying organic growth, we do have an active pipeline of opportunities, that's acquisitions, contracts and joint ventures. These opportunities are being created over the long term and they come about as a result of confidence generated in Sonic Healthcare and in Sonic's culture, in our quality, and I guess, in our excellent reputation as well.

We make the point that the CapEx that we spend on infrastructure is put to good use in the company because not only does it allow us to deliver state-of-the-art services but it also drives revenue and earnings growth.

We're now operating in 8 countries in the world and on 3 continents, and we are always keen to make the point that our geographical diversification does give us protection against, I guess, any sort of regulatory change in one particular market. So it's very much a risk mitigation strategy and gives us opportunities for growth as well.

I've mentioned before that our progressive dividend policy is set to continue. That policy is supported by consistent earnings, strong cash flow as well.

Integral to Sonic Healthcare is our ongoing commitment to corporate responsibility principles and we really want to shout out to the team that put the document together, which really outlines what actually goes on in the company and details of that document can be found on our website under our Corporate Responsibility report.

And I guess finally, and possibly most importantly, the outlook for Sonic as a highly respected global health care company remains pretty positive. And I say that because of a number of factors, but most particularly about our deeply embedded Medical Leadership culture, which serves to bind our global team, which is now sitting at 34,000 people, and it also gives us critical market differentiation.

Thank you very much, Drei. Maybe we'll move on to question time now, if that's all right with you.

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Questions and Answers

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Operator [1]

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Our first question, from David Stanton, CLSA.

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David Andrew Stanton, CLSA Limited, Research Division - Former Research Analyst [2]

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Usually within the presentation, we do get a comment regarding Australian Pathology margins. I know that it's not in there this time, perhaps you could give us some color on where the margins have increased or decreased in the half on PCP.

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Original post:
Edited Transcript of SHL.AX earnings conference call or presentation 14-Feb-18 11:00pm GMT - Yahoo Finance

SYDNEY: A positive outcome of the coronavirus disease 2019 (Covid-19) pandemic could be a better understanding of protecting biodiversity and a global ban on the trade in wild animals for food. The belief that Covid-19 began at a wet market in Wuhan in China, where wild animals were being sold for human consumption, has led to the Chinese government banning the trade in wild animals and a growing international campaign for this to be made into an enforceable international law.

At the Wuhan wet market and in many such markets across China and Vietnam as well, numerous wild animals, including live wolf pups, salamanders, crocodiles, scorpions, rats, squirrels, foxes, civets and turtles are being sold for human consumption.

Wet market in Indonesia. IDN PHOTO

The international medias use of the phrase wet markets, however, is dangerous because such markets exist right across Asia, including squeaky clean Singapore, where wild animals are not sold. Farmed animals, fish and vegetables are sold at these markets and they are named as such because the vendors wash the market stalls every morning for hygienic reasons before the food items are displayed for sale.

Such markets are where the poorer segments of the society come to do their daily shopping because of the low overheads, the food there is less expensive than in supermarkets and often fresher. The International Institute of Environment and Development argued in a recent blog post that rather than pointing fingers at wet markets, we should be looking at the burgeoning trade in wild animals. It is wild animals rather than farmed animals that are the natural hosts of many viruses, state Eric Fvre and Cecilia Tacoli in their blog.

The legal and illegal trade of wildlife for human consumption is a multibillion-dollar industry and recognized as one of the most severe threats to biodiversity. Even before the Covid-19 outbreak, ecologists and virologists had warned about the dangers of destroying biodiversity and the advent of new viruses as humans interact more directly with wild animals by destroying forests for development such as building roads and railways, expanding farmlands and human habitats.

In 2008, a team of researchers from the school of ecology and biodiversity from the University College London identified 335 diseases that emerged between 1960 and 2004, at least 60 percent of which came from animals.

Almost every global pandemic that has occurred in the past three decades were caused by pathogens crossing from animals to humans. Among them are the 1996 Ebola, 2003 severe acute respiratory syndrome or SARS, 2012 Middle East respiratory syndrome or MERS, and 2013 Avian Flu outbreaks in all the virus transmission went from animals or birds to humans.

On February 2, the most powerful arm of the Chinese Community Party, the Politburo Standing Committee headed by President Xi Jinping issued a statement banning the sale of wild animals for human consumptions across China.

We must strengthen market supervision, resolutely ban and severely crack down on illegal wildlife markets and trade, and control major public health risks from the source, the statement said. But recent reports in the international media of some of those wild animals markets reopening have raised concern about the Chinese governments resolve to implement the order.

Meanwhile, an international campaign is gathering steam to ban wild animal markets. A United States-based organization that promotes plant-based, preventative medicine called Physicians Committee for Responsible Medicine, which has a membership of 12,000 physicians, has begun a petition asking both the US government and World Health Organization to ban wild animal markets.

The petition has been signed by 225 physicians, including Eric J. Brandt, cardiologist and lipidologist at Yale University School of Medicine, and Michelle L. ODonoghue, a professor at Harvard Medical School, according to Livekindly Media, an American Vegan-promoting news site.

The petitioners point out that live animal markets arent exclusive to China. They are located around the world, including in Europe and the US. Live animal markets are a welcome mat to coronaviruses, the doctors state in the petition. The failure to close a single live animal market in China led to a pandemic that has closed countless businesses worldwide and led to an enormous death toll and economic havoc.

According to The Guardian of London, Elizabeth Maruma Mrema, the acting executive secretary of the United Nations Convention on Biological Diversity, has also called for a global ban on wildlife markets to prevent future pandemics, but she has cautioned against unintended consequences.

We should also remember you have communities, particularly from low-income rural areas, particularly in Africa, which are dependent on wild animals to sustain the livelihoods of millions of people, she told The Guardian. So, unless we get alternatives for these communities, there might be a danger of opening up illegal trade in wild animals we need to look at how we balance that and really close the hole of illegal trade in the future.

In October 2019, an article in the American Science magazine pointed out that there is a widespread trade in wild animals in biological diverse tropics and up to 8,775 species are at the risk of extinction because of this. It called for proactive, rather than reactive, measures to stop this trade.

In the US, Sen. Lindsey Graham is leading calls for China to keep its wild animal markets closed, as the US media claims these are being reopened. Earlier in April, he called on Senate lawmakers to sign on to a letter he sent to the Chinese ambassador to the US urging the immediate closure of these wet markets for the safety of the world at large.

Australian Prime Minister Scott Morrison, in a radio interview on April 3, called for a global crackdown and ban on what he calls Chinese wet markets. His call came after there was widespread coverage in the Australian media of wild animal markets reopening in China after a national two-month long lockdown to eradicate the virus.

If this trade in wild animals for human consumption is going to be halted across the globe, David Quammen, author of Spillover: Animal Infections and the Next Pandemic, argues that we need to look at the broader picture of human behavior and destruction of biodiversity.

We invade tropical forests and other wild landscapes, which harbor so many species of animals and plants and within those creatures, so many unknown viruses, he said in a recent article published by the New York Times.

We cut the trees; we kill the animals or cage them and send them to markets. We disrupt ecosystems, and we shake viruses loose from their natural hosts. When that happens, they need a new host. Often, we are it.

BY KALINGA SENEVIRATNE, IN DEPTH NEWS

Read the rest here:
Covid-19 could lead to better protection of biodiversity and wild animals The Manila Times - The Manila Times

Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19 Credit: US Centers for Disease Control and Prevention.

In mid-January, shortly after the start of the new coronavirus (COVID-19) outbreak, a number of international airports began to announce preventative safety measures. With governments encouraging their citizens not to travel to China, many global airlines have cancelled flights to and from Chinese airports.

Meanwhile, some countries have introduced temperature checks for incoming travellers, to detect signs of coronavirus-related fever. As of 10th March, there have been more than 115,000 cases of COVID-19 across more than 90 countries, and over 4,000 deaths. The majority of cases are concentrated in the Hubei province of China, where the outbreak began. However, the rest of the world remains on high alert, and the travel restrictions look set to continue for the foreseeable future.

Clearly, international travel is a determining factor in the virus spread, and the restrictions will have gone some way towards containing it. Normally the worlds third-largest aviation market, China has seen a tumble in its air traffic, with two thirds of international flights from China cancelled.

However, some of the other measures in place are less obviously beneficial. While airport screening may help reassure the public, there is little to suggest these procedures are actually making a difference.

Entry screening for COVID-19 involves the use of thermal scanning and/or symptom screening, says Jeanine Pommier of the European Centre for Disease Prevention and Control (ECDC). Scientific evidence does not support entry screening as an efficient measure for detecting incoming travellers with infectious diseases.

She adds that is especially the case when it comes to coronavirus, since the symptoms of the disease are so common. After all, the timing of this outbreak coincides with peak flu season in Europe and China.

Thermal screening at airports has long been controversial. Widely implemented during the 2003 SARS epidemic and later during the 2009 bird flu epidemic, the idea is to detect anyone with elevated body temperature and therefore a possible infectious disease.

Methods include full-body infrared scanners (which measure skin temperature as a proxy for core body temperature), handheld infrared thermometers and ear gun thermometers. The latter two instruments were used in West African airports during the 2014 Ebola crisis, as a form of exit screening for those with unexplained febrile illnesses.

Unfortunately, none of these methods have proven entirely accurate. The risk is that they will flag up passengers who have a different type of infection, while missing those who are truly incubating the virus but havent started to show symptoms yet.

Thermal scanning cannot detect every traveller infected with this new coronavirus.

This was certainly the case during the SARS epidemic. While Canada saw 251 cases of SARS, the countrys intensive border screening failed to flag up a single one. Something similar may apply in the case of COVID-19. According to a CNN investigation, the US authorities had screened more than 30,000 passengers by mid-February without catching any cases. (At least four of these passengers later fell ill with coronavirus.)

At the end of January, a study from the London School of Hygiene and Tropical Medicine (which has not been peer-reviewed) sought to quantify the effectiveness of thermal screening. It found that, out of every 100 infected travellers taking a 12-hour flight, 42 would pass through both entry and exit screening undetected.

This is mostly due to the incubation period of the virus, which can be as long as 14 days. An average incubation period of 5.2 days was assumed for this analysis. On top of that, some cases are mild and even at their peak may not show symptoms.

Billy Quilty, the lead study author, said: Our work reinforces that thermal scanning cannot detect every traveller infected with this new coronavirus. Other policies that can decrease the risk of transmission from important infected individuals, such as providing information on rapidly seeking care if symptoms develop, are crucial.

The ECDC has also completed modelling work to assess the effectiveness of entry screening. Approximately 75% of cases from affected Chinese cities would arrive at their destination during the incubation period and thus remain undetected, says Pommier.

Perhaps unsurprisingly, the World Health Organization does not recommend thermal screening, stating on a January 10th release: It is generally considered that entry screening offers little benefit while requiring considerable resources.

The question, then, is what else can be done to help control the spread of the coronavirus. Pommier believes that, at this stage, the best way to reduce the spread of infection is by rapidly identifying and testing any suspect cases, as well as identifying and monitoring anyone who has come into close contact with them.

The population should be made aware of behaviours reducing the risk of transmission, for example self-isolation at home and seeking medical advice, should symptoms develop after exposure to one of the affected areas or a confirmed COVID-19 case, she says.

Quarantining measures are scientifically very effective, since the person is isolated for the entirety of the potential incubation period. The US military has set up 11 quarantine camps next to major airports, which can accommodate up to 250 people each. And a hotel at Heathrow Airport had been block-booked to serve as a potential quarantine zone for people entering the UK with symptoms.

The population should be made aware of behaviours reducing the risk of transmission.

Basic health information is also very useful. In the US, passengers arriving from China receive a card telling them the symptoms to watch out for, and advising them to take their temperature twice a day. It seems this card may already be serving its intended purposes. In one case, a man (who had been asymptomatic at the airport and passed the screening checks) became ill the day after returning home. After consulting the card, he followed the advice to stay at home and contact his local health department.

In the EU, the authorities are being similarly vigilant. Pommier points out that healthcare settings have strong infection control measures in place, which should be sufficient to prevent any sustained local transmission in Europe. These measures have already proven effective in controlling SARS and MERS (which were both also forms of coronavirus).

However, despite airports and health authorities best efforts, some cases of coronavirus may probably slip through the net.

At this stage, it is likely that there will be additional imported cases in Europe, says Pommier. When that happens, we need to ensure that the virus does not spread any further. ECDC is working with the member states to make sure that they are ready to manage imported cases, with laboratories capable of confirming probable cases and hospitals prepared to isolate and treat patients accordingly.

See original here:
Coronavirus screening at airports: the problem with thermal detection - Airport Technology

Dr David Glass - MBChB, FCOG (SA)

This is the last article in the series on Lifestyle Medicine and breast cancer, basically using the book by Dr Kristi Funk as our main resource. As a breast surgeon who is an expert in breast cancer, she deals with much more than just the lifestyle aspects of the disease, and it is beyond the scope of these blogs to go into the medical, surgical and oncological treatments. They all have a definite place. Let me remind you that Lifestyle Medicine is not against proven medical/surgical/oncological therapies. But it does provide a base for the preventative/health promoting environment of your body to enhance health and often prevent a large part of these diseases that affect our bodies in the first place. However if this fails, and we live in a hostile cancer promoting environment, then by all means utilise the resources available to manage these diseases appropriately.

ALSO READ : Turning the Tide Lifestyle Medicine and Breast Cancer (Part 6)

What we will cover in this article is a brief overview of some of the medications that have been shown to protect the body from either developing breast cancer some which were only discovered long after to benefit in this way; or medications that interfere in the progression of breast cancer.

Specific medications for breast cancer inhibition/prevention:

Non-specific medications for breast cancer inhibition:

Hopefully this series on breast cancer has empowered you to study how you can adopt lifestyle changes to prevent this most common cancer amongst women.

There is so much you can do to avoid this disease that has affected so many women you know.

Next week we will begin a short series on one of the most common cancers of men prostate cancer, and explore how lifestyle medicine can prevent, or even in the early stages reverse prostate cancer.

Until then, dont tire of keeping safe in the face of the Covid-19 threat by social distancing, washing hands frequently, using alcohol-containing hand cleanser, avoiding touching your face, eyes or nose unless you have just washed your hands, and now the latest wearing a cloth face mask when in public.

Kind regards,

Dave Glass

Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

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Turning the Tide Lifestyle Medicine and Breast Cancer (Part 7) - South Coast Herald

With the NHS long term plan for an increased demand in technology, how will this positively impact the levels of service and care that healthcare professionals provide?

IT offers the health system a chance to give patients a higher quality of care and provide services which are quicker, safer and more convenient to access. But, will this digitalisation make it easier for doctors, nurses and clinicians to know what kind of medicine, post-hospital care and other services patients may need?

The positive impact on patient records

Electronic health records, or EHRs, replacing paper records has been a big step for the medical world. A wide range of professionals, from doctors and nurses to technicians, are responsible for updating medical records. With a digital version, this means that every person in charge of a patients care has access to the most up-to-date information, which is especially crucial where allergies and medication are concerned.

How public health is affected

EHRs provide invaluable data to clinical researchers, helping to advance medical knowledge and the development of treatments for common health problems (like viral outbreaks). A digital health system can also provide important insights into how widespread and outbreak is, helping preventative measures, such as vaccines, to be put into place quicker.

The positive impact on patients themselves

This digital first approach helps to empower patients themselves, giving them more control over the type of care they receive. The digitalisation of medical services will allow those who are vulnerable to take a more proactive approach to monitoring their own health and wellbeing.

By use of these digital systems and services, they will be able to recognise and monitor symptoms as early as possible and manage their response to these. This ownership of care will help to reduce the demand on the ever strained health and care services.

What can patients do if problems occur?

In amongst all of the improvements and changes, things can still go wrong. Unfortunately mistakes do happen and when they do, what kind of help can patients and those most vulnerable receive? If medical negligence of any kind has occurred, there are services and businesses out there who will help those affected claim compensation.

Before making a claim however, its important to remember you will need all the facts and be certain there is a claim there to make. Many of these advice services will talk to you about what has happened, and determine the likelihood of your case succeeding.

With these digital advancements and improvements, we would expect to see a decrease in claims needing to be made. Thanks to systems such as EHRs, patient information should be more accurate and up-to-date, allowing healthcare professionals to provide a higher level of care to those in need.

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The positive effects of digitisation in medical services - East Midlands Business Link

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Wear a cloth face mask in public. Thats the national health departments new recommendation as from April 10.

Before this, we were told to absolutely not wear face masks to prevent ourselves from contracting the new coronavirus, known as SARS-CoV-2 unless we were taking care of an infected person.

So why the about-face?

Well, in some ways the argument is still the same: masks wont protect the person wearing one against getting infected with the virus, the department says. But now that SARS-CoV-2 has started to spread locally as opposed to mainly being imported by people who arrived in South Africa from high-risk countries there is an increasing risk that you could be infected without knowing it and, as a result, spread the virus to others when you cough or talk.

A mask, research in the journal Nature has shown, makes people less likely to release droplets of spit carrying the virus into the air that can infect others.

In short, the new recommendation to wear masks is a sort of a last resort. Because we live in a country where many people arent able to practice social distancing or wash their hands the two main ways to prevent the spread of the virus masks can add another layer of protection.

The health department doesnt want us to wear surgical masks (the ones you can buy in chemists), as health workers need them and theres a global shortage.

Rather, you should make a cloth one, which you can wash after each use.

Research on medical mask use in communities is inconclusive. When it comes to cloth masks, there is even less evidence to show whether they work or not.

With the research so unclear, it comes down to individual countries around the world to decide whats best for them.

On the health departments coronavirus website, it says:

Cloth masks are easy and not expensive to make, reusable and help reduce the transmission of COVID-19 by acting like a shield to contain the respiratory droplets through which the virus spreads.

Heres what the science can tell us:

Earlier this month, the Nature study found surgical masks helped stop people with symptoms from spreading influenza and other coronaviruses similar to SARS-Cov-2. But the research did not look at fabric masks.

The first randomised trial studying cloth mask use (by healthcare workers) was published in the BMJ Open in 2015. The study, set in Vietnam, cautioned against the use of these masks because they led to more infections than in those wearing medical masks.

Fabric masks were more likely to stay wet and hold moisture, plus they didnt filter out as many infectious particles as medical masks and were reused this, the studys researchers argued, all led to increased infections.

But, a 2008 study published in PLoS One, compared cloth masks to surgical masks as well as respirators, or special masks worn by healthcare workers that can filter very small particles. The research found that all three types of masks offered varying degrees of protection to the wearers in human volunteers. In laboratory simulations, the study also showed all three conferred a slightly lesser degree of protection to those around the wearer.

In 2013, research in Disaster Medicine and Public Health Preparedness compared the effectiveness of homemade cloth masks to surgical masks to protect people from the flu. The study found that both masks worked to reduce the spread of particles exhaled by wearers. But surgical masks were three times better at protecting the wearer from the flu virus than self-made fabric masks and scientists recommended that a homemade mask should only be considered as a last resort.

So why should cloth masks be considered at all?

Kerin Begg is a public health specialist at Stellenbosch University and helped draft the Colleges of Medicines in South Africa guidance on the use of cloth face masks that informed the Western Cape health departments policy.

The Colleges of Medicines in South Africa is an oversight body that sets the standard for medical specialisations in the country.

After reviewing the existing research, the Colleges found the evidence too uncertain to make a clearcut recommendation for community use of cloth masks nationally. In spite of this, on 2 April the Western Cape decided to recommend that everyone, including those who were not ill, start wearing masks.

The best time to use face masks would be a bit later [in the outbreak] when the prevalence rates are much higher, Begg says.

She believes it would have been wiser to only have recommended fabric masks once there was widespread community transmission of the virus, with around 10 000 cases, because then there would be more risk to the general public of getting infected by close contacts.

On Tuesday night, South Africa had a total of 2 415 confirmed COVID-19 cases less than a quarter of 10 000.

Why then, the push for cloth masks?

I think people want some sort of visual sign, explains Begg, who herself has been hounded by people wanting a conclusive recommendation that they should wear masks.

It helps people feel better, it reduces anxiety. But I think it may create a false sense of security and that was part of our concern.

Once people wear masks all the time, says Begg, they might drop other preventative steps, such as handwashing. There is also a good chance that people will wear the masks incorrectly and render them pointless. She says incorrect usage can range anywhere from people who touch their face more to adjust the mask to people who put the mask under their chin when it gets uncomfortable.

To Begg, the thought process from a policy standpoint is: If thats [cloth masks] the only thing that can help us, then maybe we just kind of try it anyway.

The most basic steps people should be taking washing hands, maintaining distance from others and good hygiene are not things that can be easily carried out by most South Africans.

Almost half the population doesnt have access to water in their own homes, show 2018 Statistics South Africa data and high levels of inequality in the country means that those living in poorer communities will be disproportionately affected by the outbreak.

These are people that might not be able to practice social distancing or wash their hands regularly.

Although the government has delivered over 6 000 water tanks to those who need them, people living in these communities need a variety of options for how to protect themselves.

The solution: Add cloth masks as another option.

If we were living in a perfect world where we had really great social isolation and physical distancing and we didnt need to use public transport and all of that, I might also go for a higher standard of evidence, says Max Price, former vice-chancellor at the University of Cape Town and part of the ministerial advisory committee on COVID-19.

But given that we dont have that and that people are close together, we should just use whatever we have.

For Price, the debate is not about whether or not cloth masks work, but rather whether the general public should wear masks to reduce infection. The answer to which he believes is a resounding yes.

The fact that we dont have evidence that it works, doesnt mean that we have evidence that it doesnt work, Price reasons. If laboratory evidence suggests that it could work, then we should just use everything we can.

The impact that general use of medical masks would have on the healthcare sector has already been noted, but there is another drawback that has perhaps been overlooked.

The reality is that even if there were enough medical masks for health workers, recommending their use to the public would still disadvantage some people. If youre telling people to wear masks, you need to be sure that everyone has access to one and this, likely, wouldnt have been possible.

But thats the beauty of homemade masks, says Price.

Currently, there is no standard and everyone can make one depending on what they have access to at home.

The only guidelines set out by the national health department are:

Additionally, the department says you should not lower or remove your mask when talking, coughing or sneezing. Do not touch your mask when it is on your face and never touch the inside of the mask. Wash your hands before putting the mask on and after removing it.

Its important not to set the bar so high that people cant meet it, Price explains. The message should be: Use anything that you can to catch droplets and also to prevent yourself from breathing in droplets.

The thicker the better, the tighter the fit the better and there are some designs that may be better than others, but use what works for you. And if what youve got is a scarf or a towel to cut up or a bandana, then thats good.

Previously, the governments recommendation was that only people who have symptoms of COVID-19 should wear a mask, but new evidence has shown that people might be able to transmit the virus even though they show no symptoms of the disease.

According to the World Health Organisations head of emerging diseases Maria Van Kerkhove, the team that collected data on Chinas COVID-19 outbreak found that 75% of people developed symptoms after being classed as asymptomatic. A recent study by the US Centers for Disease Control and Prevention showed similar results at a nursing home where almost half of the 23 positive patients didnt have symptoms at the time of testing.

Price concludes: Now that we take the view that most people are infectious without knowing it and they cant quarantine, we need to find some other method of adding to the physical isolation or physical distancing and masks can be the way of doing that.

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'Everyone should wear a cloth mask.' But do they work? - Bhekisisa

COVID-19 can live on surfaces for hours or even days. In order to kill the virus and prevent people from becoming infected, you have to disinfect. 2nd Lt. Felicia Dreh

By Sgt. Liane Hatch

FORT CARSON, Colo. Considering the COVID-19 pandemic that has led to a statewide stay-at-home order, the 3rd Armored Brigade Combat Team, 4th Infantry Division, preventative medicine team encouraged Soldiers, leaders and Family members to practice thorough cleaning and disinfecting measures at home and in the workplace.

A lot of people think when you just spray the counter with a cleaner and wipe it up with a cloth or paper towel, that youre good to go, said 2nd Lt. Felicia Dreh, an environmental science officer, preventative medicine team, 3rd ABCT.

Dreh explained that many people have questions such as: If I clean something, do I need to disinfect it? Whats the difference? Are they the same? They are not.

Cleaning with just your normal spray cleaners just removes surface dirt, while disinfecting actually kills the bacteria, Dreh continued. COVID-19 can live on surfaces for hours or even days. In order to kill the virus and prevent people from becoming infected, you have to disinfect.

The Centers for Disease Control and Prevention (CDC) recommends a diluted bleach solution to properly disinfect high-traffic surfaces, such as countertops, doorknobs and handles.

Per CDC guidelines, you want to use five tablespoons or capfuls of bleach per gallon of water, or if youre using a spray bottle, you can use four teaspoons of bleach per quart of water, said Sgt. Wilbur Davis, NCO, preventative medicine team, 3rd ABCT. Use a clean sponge to wipe the area then and let that surface air dry.

Davis emphasized when using bleach solutions, its important to wear protective gloves, keep the area well-ventilated and avoid mixing with other cleaning products, especially those containing ammonia.

Both members of the preventative medicine team agreed that taking measures to clean and disinfect common areas should be part of a daily routine, both at work and in the Soldiers home.

You can spread COVID-19 from work to home or vice versa just by touching a doorknob after an infected person has touched it, Davis said. Soldiers should be disinfecting their spaces every day.

Dreh recommends taking the time to clean and disinfect a part of each units daily battle rhythm, preferably at the end of each day. While she acknowledged most leaders already have cleaning measures in place, they need to be sure Soldiers use bleach to disinfect those areas as well.

Commanders can help keep their Soldiers healthy by enforcing daily cleaning and disinfecting requirements, Dreh said. The more you do it, the less time it takes, and it will go a long way toward keeping everyone healthy.

In addition to using good disinfection measures, Soldiers and Family members can prevent the spread of disease and reduce the likelihood of illness by practicing good hand hygiene and avoiding touching their face, mouth, nose and eyes.

For more guidelines on COVID-19 prevention, visit https://www.cdc.gov/, and local procedures at https://www.carson.army.mil/ or follow @USArmyFortCarson on Facebook.

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Preventative medicine team works to beat COVID-19 - fortcarsonmountaineer.com

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 - FOX Carolina

Despite false assertions by the president to the contrary, any potential treatments to counter or prevent COVID-19 are still only at the stage of early investigations, which include one-off treatment with special individual case authorizations, and small-scale clinical examinations. Nothing so far has approached the level of scrutiny needed to actually say anything definitively about their actual ability to treat COVID-19 or the SARS-CoV-2 virus that causes it, but the first large-scale U.S. clinical study for one treatment candidate is seeking volunteers and looking to get underway.

The study will be conducted by the Henry Ford Health System, which is seeking 3,000 volunteers from healthcare and first responder working environments. Depending on response, the researchers behind the study are looking to begin as early as next week. Study lead researcher Dr. William W. ONeil said in a press release announcing the study that the goal is to seek a more definitive scientific answer to the question of whether or not hydroxychloroquine might work as a preventative medicine to help protect medical front-line workers with greater risk exposure from contracting the coronavirus.

Hydroxychloroquine (as well as chloroquine) has been in the spotlight as a potential COVID-19 treatment due mostly to repeated name-check that President Trump has given the drug during his daily White House coronavirus task force press briefings. Trump has gone too far in suggesting that the drug, which is commonly used both as an anti-malarial and in the treatment of rheumatoid arthritis and lupus, could be an effective treatment and should be thrust into use. At one point, he claimed that he FDA had granted an emergency approval for its use as a COVID-19 treatment, but Dr. Anthony Fauci clarified that it was not approved for that use, and that clinical studies still need to be performed to evaluate how it works in addressing COVID-19.

Studies thus far around hydroxychloroquine have been small-scale, as mentioned. One, conducted by researchers in France, produced results that indicated the drug was effective in treating those already infected, particularly when paired with a specific antibiotic. Another, more recent study from China, showed that there was no difference in terms of viral duration or symptoms when comparing treatment with hydroxychloroquine with treatment using standard anti-viral drugs, already a common practice in addressing cases of the disease.

This Henry Ford study looks like it could provide better answers to some of these questions around the drug, though the specific approach of seeking to validate prophylactic (preventative) use will mean treatment-oriented applications will still have to be studied separately. The design of the study will be a true blind study, with participants split into three groups that receive unidentified, specific pills (possibly anti-virals or some equivalent); hydroxychloroquine; or placebo pills, respectively. They wont know which theyve received, and theyll be contacted weekly by researchers running the study, then in-person both at week four and week eight to determine if they have any symptoms of COVID-19, or any side effects from the medication. Theyll get regular blood draws, and the results will be compared to see if theres any difference between each cohort in terms of how many contracted COVID-19.

These are front-line healthcare workers, so in theory they should unfortunately be at high risk of contracting the disease. That, plus the large sample size, should provide results that provide much clearer answers about hydroxychloroquines potential preventative effects. Even after the study is complete, other competing large-scale trials would ideally be run to prove out or cast doubt on these results, but well be in a better position than we are now to say anything scientifically valid about the drug and its use.

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Henry Ford Health System to conduct first large US study of hydroxychloroquines ability to prevent COVID-19 - TechCrunch

The medical community at large is now faced with a new dimension of medicine they have never encountered. As this health crisis that is ever changing, they find themselves with greater challenges than they have ever imagined. Due to shortages on PPE and expecting greater needs for it, and with the unknown factors of what the coming months may unfold. For independent practices it poses even more obstacles as they do not have the infrastructure of the larger hospitals or a group practice might have. Such is the case of a small town doctor that has chosen a different path of medicine from her start in Olney, Illinois.

Since Dr. Jill Scherer's practice began, some might think her model is unorthodox as she chose not to bill insurance, but operates on a direct billing system instead. Dr. Scherer reports The monthly membership fee has worked well and has been well received. Patients who cannot afford insurance can at least be offered primary care services. Other patients with stellar insurance love that their appointments are on time, for however much time they need, and they have access to their provider. My practice was full within 8 months, so I would say the community.

Scherers innovative thinking brought forth a creative solution to the lack of PPE availability presently. Seeing the medical community using some old phone booth looking devices where the individual was swabbing in the booth and sticking only their arms out to swab the person gave her some insight. It also gave the problem that came from the test itself, as it goes deep into the nasal passage which can cause a reflux reaction, then can trigger a response that can cause risk. Henceforth the tent came up outside her clinic and her brainchild came to life. She gave the basic explanation as such. Notoriously they sneeze or cough, so the plexiglass provides excellent protection. My husband, and engineer, decided, why not make a testing site through the window in my exam room. That way, the patient is outside and I am inside with the barrier of plexiglass. There is a stethoscope and giant rubber gloves that protrude from the plexiglass to examine the patient from the plexiglass to exam the patient with. I can swab a patient and be shielded. Then everything is sanitized with bleach before the next patient. Her ingenuity saves on the precious commodity of PPE, and she can judiciously screen her patients she shared. If needed, patients can still enter the clinic, and proper disinfection is provided. She has used the method of patients if needed remaining in their car as well on occasions.

When asking Dr. Scherer how our local community at large is doing in regards to the recommendations the CDC has given to COVID-19, shared these thoughts in regards to reaching a better outcome. I think we need to really take the shelter in place order seriously. Grocery shop once every 2 weeks. We need to wash our hands diligently. We need to not meet up with friends or have play dates. We are a small community and we dont want to be a hot spot for the virus. While it might not seem as scary because we are not Chicago or New York, we still need to be diligent and adhere to the social distancing, shelter in place, washing hands.

The CDC and other health officials have made recommendations in terms of wearing masks for the general public, Dr. Scherer gave these thoughts in relation to these coming guidelines as well As for fabric masks, I think we will see a change in the recommendations from health officials. Much of Asia uses masks and have much lower transmission than use.

Now we do not have enough commercial grade masks for the healthcare workers let alone enough for the general population, so I do think that cotton masks will be beneficial. As of now, any tightly woven cotton or polyblend cotton will be enough. These masks will prevent the wearer from spreading his/her own germs. It doesnt necessarily protect the wearer from getting the virus, but it does make the wearer conscious of how many times they touch their face. If the wearer coughs and sneezes, it does help prevent the respiratory droplets from being expelled into the air.

As there have been various statements in regards to use of Ibuprofen during this health crisis, and the use of it, in the course of the interview Dr. Scherer her thoughts. Her recommendations were as follows. I have not read any solid data on no ibuprofen or other NSAIDs, but I know that the general recommendation is to not use them if you have fever, coughing, cold symptoms. Stick with acetaminophen. If you are on daily NSAIDs, you should call your doctor for specific recommendations regarding stopping or when to stop

As Dr. Scherer incorporates some holistic approaches to what might she suggest or preventive measures, she gave these insights. Eating a healthy diet with fruits and vegetables will promote the best immune function. Thirty minutes of daily exercise as a minimum. Getting adequate sleep, 7-8 hours per night. Shutting off social media and the news for several hours per day to decrease stress level might also help.

In terms of mental health in general terms these suggestions during these stressful times, she gave some excellent helpful tips that all ages can incorporate to aid in the balance as we are all trying to find a new normal. Find a way, while respecting social distancing, to do something nice for someone else. Practicing mindfulness or meditation can help calm anxious nerves. We know that exercise can be as powerful as antidepressants for anxiety and depression, get out and exercise. Sunshine, when it peaks out of the clouds, can also help with our mood.

Her practice is like many all across the country that are finding new ways to treat their patients. She had already used telemedicine as an option, due to not billing insurance prior to COVID. Her patients are able to call, text, or have video chats routinely as well. She routinely has three platforms she is able to utilize, so if one is not working well, she can use another one that works better for that particular patient.

As COVID-19, is only one area of health concerns for our community, I asked this very down to earth and caring physician how she thought our area could improve the total well being in general. She gave some great input. I stress in my practice, the need for lifestyle medicine. We should be using diet, nutrition, stress management, good sleep to help combat our leading causes of death like heart disease, high blood pressure, and diabetes. My advice is not always welcomed, but at least patients know they have a choice in their health outcomes for a majority of diseases.

When asked for her best advice for our area in terms of addressing this ever changing and concerning health crisis upon us she shared these final insights. My goal right now is to take the best care of my patients especially during COVID19 because the rest of health conditions didnt take a break when COVID-19 got here. There are still ear infections, heart attacks, etc. So my immediate goal is to provide excellent care even with the pandemic. My long term goals

are put on hold right now, I will be patient and see how things are in 6-9 months. I think people should know that I am a small business owner trying to provide the best in a strange situation. I want to protect myself and my patients. I dont want to be a super spreader of COVID-19, and that is why I have changed the way I see people. Yes, their visit will be on the phone, then in the parking lot. Only if truly needed will it be in person and at that time, I will look like I have hazmat gear on. I might look a little nutty, but I want to be alive to care for my patients, I dont want to bring COVID-19 home to my family, and I dont want to spread it to my patients. Direct primary care, membership medicine, allows me to be flexible and keep everyone as safe as possible.

Scherer grew up in Streamwood, Illinois, and attended the University of St. Francis in Joliet, Illinois. After completing her bachelor's of science in Biology, she earned her Doctor of Medicine at Loyola University Stritch School of Medicine. She completed her training at the Waukesha Family Medicine Residency in Waukesha, Wisconsin, specializing in Family Practice. Dr. Scherer most recently practiced at the Richland Medical Center in Richland Center, Wisconsin, providing general family practice, obstetrical care, inpatient hospital care, and urgent care. Her areas of interest are preventative medicine, lifestyle medicine, and lactation/breastfeeding medicine. Her continuing education focuses on lifestyle medicine and she will have board certification in it by fall 2018. She is an International Board Certified Lactation Consultant, IBCLC.

Dr. Scherer and her husband, Mark, recently moved to Olney, Illinois to be closer to his family as they raise their two children. She is thrilled to be practicing in the community and helping to improve the lives of her patients.

It was a rare and refreshing experience, to meet a physician who is dedicated completely to the calling of medicine in its truest sense. She is indeed a great asset to our community. She is accepting patients and can be reached at 618-746-2676 her practice, Whole Family Health Medical Clinic is at 131 Boone St. in Olney, Illinois. The clinic has a facebook page, might note Dr. Scherer, has routine posts on COVID-19 with current updates for the community as well.

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Small town Doctor...finds solutions to the big issues - Pontiac Daily Leader

As the official U.S. death toll from COVID-19 passed 10,000, Surgeon General Jerome Adams warned that Americans should brace for the hardest and saddest week of their lives. During a press appearance over the weekend, he called the coming days our Pearl Harbor moment, our 9/11 moment. Inside New Yorkarea hospitals, the prospects match his grim tone. In addition to struggling with widely-reported supply shortages, working seemingly endless shifts, and struggling to manage the influx of patients, infectious disease experts say that even as theyre racing to develop an effective vaccine, they are essentially learning on the job.

The infection itself does have some perplexing features, said Dr. Megan Coffee, a clinical assistant professor at the NYU Grossman School of Medicine specializing in infectious diseases and immunology, who coauthored a study about an experimental A.I. tool that predicts which patients with the virus will develop a serious respiratory illness. She listed just a few of the many unanswered questions: We dont yet know what we can do to prevent this immunologic response. We also dont fully understand why some, who are healthy, go on to have severe disease and others, with more risk, do not.

Specific characteristics of the virus likewise remain a mystery. The pandemic of 1918was associated with bacterial as well as viral pneumonia, which does not seem to be the case with the novel coronavirus, said Dr. Joseph M. Vinetz, a professor at Yale School of Medicine who also specializes in infectious diseases. But we still dont know whether coronavirus can lead to secondary or superimposed bacterial pneumonia in addition to [causing] immune damage to the lungs, which is the primary cause of severe illness and death. This coronavirus, he said, is puzzling due to its unique combination of asymptomatic infectiousness, and the delayed onset of severe disease. Very perplexing.

Dr. Sandra Gelbard, a Manhattan-based internist who specializes in preventative medicine and one of the first doctors in New York City to begin COVID-19 testing, described the current epidemic as way, way more concerning than the first two coronavirusesSARS and MERSwhich is surprising because the first two were more lethal. But those viruses were contained. With this novel coronavirus, 25 to 50% walk around without symptoms. It is the right combination of lethality and transmissibility. This makes this virus a real global threat.

Dr. Coffee concurred. This is the disease weve always feared as infectious disease doctorsa respiratory-borne virus that spreads easily person-to-person, but with a high mortality, she said. Those of us who have worked on Ebola and other crises have feared for a while [that] this would be worse than anything we have ever seen.

The results, said Dr. Gelbard, could be more devastating than current predictions suggest. If we did intense social isolation like they did in China and South Korea, the number might have been around [100,000 deaths], but we missed the boat on that, she said. I dont expect it to be 100,000 to 200,000 people dead. It could easily be 1 million.

She added, we really dont know the mortality of this virus. Were assuming at best its somewhere around the 1% mark. We cant know at this point. No one knows.

Meanwhile, as it spreads, the virus is changing. The issue is that [it] is mutating, said a New York Citybased doctor treating COVID-19 patients. We cannot predict what strain it will mutate to, and in some populations strains may be more virulent than others, so all we can do is prepare for the worst. She added, Its scary because it is a disease that is ever-evolving. Just when we think we have figured out the pathophysiology of the disease process and how to manage it effectively, we realize there is a new loophole or nuance that the disease presents us with.

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Worse Than Anything Weve Ever Seen: Frontline Doctors Race to Learn the Mysteries of a Deadly Virus - Vanity Fair

A newly hatched study out of China, so raw that its not yet been peer-reviewed, has some disturbing news for cat lovers.

Our furry feline friends appear to be susceptible to catching COVID-19, the disease caused by the coronavirus called SARS-CoV-2. Even worse, the cats in the study were able to infect each other, although they showed no signs of illness.

Ferrets were also able to catch the virus, although it didnt appear to harm them. Dogs, on the other hand, were not susceptible, according to the study. The virus showed up in the feces of five dogs, but no infectious virus was found. Pigs, chickens and ducks were also not very hospitable places for the virus.

But theres no need for cat or ferret lovers to panic, experts say. Theres no evidence their pets could get very sick or die from the novel coronavirus.

Yes, people should embrace their pets. These researchers squirted the virus down the cats nose in high concentration, which is pretty artificial, said Dr. John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center Childrens Hospital of Pittsburgh.

The lab experiment used a scenario that is completely unrealistic, experts say. First, researchers forced extremely high doses of virus up the nostrils of five 8-month-old domesticated cats.

Cats in our homes or even in the wild would never be exposed to that level of virus.

Thats a whole lot more than an average human would get, said infectious disease expert Dr. William Schaffner, a professor of preventative medicine and infectious disease at Vanderbilt University School of Medicine in Nashville.

So this is an artificial circumstance and we dont know that it happens in nature at all, Schaffner added.

Two of the five cats were euthanized six days later. Researchers found virus particles in their upper respiratory systems.

The remaining three infected cats were put into a cage adjacent to three non-infected cats. One of those three cats later tested positive for the virus, while the other two did not. Still, the researchers felt that showed the virus could be transmitted via respiratory drops.

Or did it? None of the infected cats exhibited signs of illness. And even if they did pass the virus to each other, that doesnt mean they would be able to pass it on to humans.

Thats what happened nearly two decades ago with a sister coronavirus called SARS-CoV, which causes the deadly pneumonia-like respiratory disease called SARS.

Just like now, science found cats could be infected with SARS-CoV and infect other cats. But the virus didnt transmit widely among house cats during the 2002 to 2004 pandemic, nor were there any known cases of transmission to humans.

The study found ferrets were also efficient replicators of the virus meaning that the virus can easily grow and reproduce in their long, slinky bodies.

SARS-CoV-2 can replicate in the upper respiratory tract of ferrets for up to eight days, without causing severe disease or death, the study said. The study did not look at a longer time frame.

Thats good news for researchers looking for a way to test any future vaccines for SARS-CoV-2, also called the novel coronavirus.

Its necessary to have an animal model to do initial tests of vaccines and understand how viruses cause disease. So, this will be useful to the field, Williams said.

Its actually not surprising that ferrets appear to respond to the novel coronavirus. A ferrets lung and airways are strikingly similar to a humans. In fact, biologically and physiologically ferrets are more similar to humans than they are to a mouse or rat.

Ferrets are classical animals in which to study influenza its been done for decades, Schaffner said. If scientists were looking for an animal model, they would reach for the ferrets first.

Will your cat or ferret come down with coronavirus? Highly unlikely, experts say, pointing to the fact that we would certainly have heard of many cases in pets by now, considering the significant spread of the virus in the us and Europe.

Hong Kong has been quarantining animals belonging to people diagnosed with COVID-19 and have found only two cases of positive results in dogs. The dogs showed no signs of illness during the quarantine.

Rare as it may be, it appears one cat in Belgium may have gotten the virus in March from her owner, who was ill with COVID-19 after returning from a visit to Italy. But even though the cat had respiratory problems and high levels of the virus in vomit and feces, researchers arent yet sure if the cat was sick from COVID-19 or another illness.

While 2 dogs (Hong Kong) and 1 cat (Belgium) have been reported to have been infected with SARS-CoV-2, infectious disease experts and multiple international and domestic human and animal health organizations agree there is no evidence at this point to indicate that pets spread COVID-19 to other animals, including people, the American Veterinary Medical Association says on its website.

The AVMA and the us Centers for Disease Control and Prevention recommend taking normal precautions when cleaning litter boxes and feeding animals.

Out of an abundance of caution, the AVMA suggests anyone ill with COVID-19 symptoms limit contact at this time, until more information is known about the virus.

Have another member of your household take care of walking, feeding, and playing with your pet, the AVMA states. If you have a service animal or you must care for your pet, then wear a facemask; dont share food, kiss, or hug them; and wash your hands before and after any contact with them.

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Cats may get coronavirus, but it's nothing to worry about - The Philadelphia Tribune

A new trial led by the Perelman School of Medicine at the University of Pennsylvania will evaluate whether the drug hydroxychloroquine (HCQ) can benefit people infected with COVID-19, as well as whether taking the drug preventatively may help people avoid infection altogether. The study, called Prevention and Treatment of COVID-19 with HCQ (PATCH), is currently enrolling patients in three separate sub-studies (NCT04329923).

PATCH sub-study 1 will evaluate HCQ compared to placebo in infected patients who are quarantined at home. PATCH sub-study 2 will evaluate high dose compared to low dose HCQ in hospitalized patients. PATCH sub-study 3 will evealuate HCQ compared to placebo prophylactically in health care workers working with COVID-19 patients to evaluate whether it can prevent infection. Sub-studies 1 and 3 are double-blind placebo controlled studies, meaning neither the patient nor the doctor will know whether they are taking HCQ or placebo until the end of the study. Importantly, if the patient or health care worker starts getting worse, they can be unblinded, and the trial allows crossover to HCQ if the patient was assigned placebo.

We know HCQ can be an effective anti-viral in a lab setting, but despite recent public conversation, there is no definitive evidence it can work in humans infected with COVID-19. It is our hope that this trial will provide critical evidence as to whether this drug may be effective in combating the current pandemic, said the studys principal investigator Ravi K. Amaravadi, MD, an associate professor of Hematology-Oncology who has spent his career studying HCQ and related compounds.

For this trial, Amaravadi is working with a multidisciplinary team at Penn, including Benjamin S. Abella, MD, MPhil, a professor of Emergency Medicine, and Ian D. Frank, MD, associate chief of Infectious Diseases, as well as colleagues in Pathology and Laboratory Medicine, Cardiology, Statistics, and the Abramson Cancer Center.

The first sub-study of the trial will test HCQ in patients who are infected and are well enough to go home, but who need to be in quarantine. Quarantine can be prolonged for some people who have a worse case of the illness, and can impose significant economic, emotional, and psychological hardship on the patient and his or her family. Family members living with a quarantined COVID-19 patient are at high risk of getting the disease themselves. In order to be released from quarantine, they must meet certain criteria according to the Centers for Disease Control (CDC): patients must go 72 hours without a fever, see their symptoms improve, and go seven days since their symptoms first appeared. The primary goal of PATCH sub-study 1 is to find out whether the drug reduces the number of days the patient stays quarantined. Researchers were forced to overcome unique logistical hurdles, including arranging for virtual consents from patients and home delivery of HCQ doses.

The second sub-study of the trial will test HCQ in patients who are hospitalized with COVID-19 to see if it can reduce the time to discharge. Patients in this group will also be randomized into a high dose or low dose group. No one will receive a placebo. The correct dose of HCQ for treating COVID-19 is not currently known and this study will provide valuable information to answer that question. The third sub-study will test whether HCQ can work as a preventative medicine to stop infection in health care workers at risk of exposure to COVID-19. Researchers plan to enroll 200 workers in the sub-study.

The need for the third sub-study here is critical, as we try to keep the people working on the front lines of this pandemic healthy so they can continue to keep the nations health care infrastructure up and running, Abella said.

Given the rapid spread of the virus, researchers had to work quickly not only to organize the trial and get it approved from a regulatory standpoint, but also to solve practical problems. In the span of less than a month, they were able to secure funding, arrange for a donation of HCQ, and partner with a group to manufacture an appropriate placebo. The researchers say they are grateful to their partners, and also to their leadership for the support that helped it all come together.

This is an unprecedented time, and it will take unprecedented cooperation, resources, and leadership to get through it. This trial shows Penns ability to step up to meet that responsibility and investigate the scientific questions the world desperately needs to answer, said J. Larry Jameson, MD, PhD, dean of the Perelman School of Medicine.

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Hydroxychloroquine evaluated to treat, prevent COVID-19: University of Pennsylvania trial - Outbreak News Today

(CNN) -- A newly-hatched study out of China, so raw that it's not yet been peer-reviewed, has some disturbing news for cat lovers.

Our furry feline friends appear to be susceptible to catching Covid-19, the disease caused by the coronavirus called SARS-CoV-2. Even worse, the cats in the study were able to infect each other, although they showed no signs of illness.

Ferrets were also able to "catch" the virus, although it didn't appear to harm them. Dogs, on the other hand, were not susceptible, according to the study. The virus showed up in the feces of five dogs, but no infectious virus was found. Pigs, chickens and ducks were also not very hospitable places for the virus.

But there's no need for cat or ferret lovers to panic, experts say. There's no evidence their pets could get very sick or die from the novel coroneavirus.

"Yes, people should embrace their pets. These researchers squirted the virus down the cats nose in high concentration, which is pretty artificial," said Dr. John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.

No realistic exposure

The lab experiment used a scenario that is completely unrealistic, experts say. First, researchers forced extremely high doses of virus up the nostrils of five 8-month-old domesticated cats.

Cats in our homes or even in the wild would never be exposed to that level of virus.

"That's a whole lot more than an average human would get," said infectious disease expert Dr. William Schaffner, a professor of preventative medicine and infectious disease at Vanderbilt University School of Medicine in Nashville.

"So this is an artificial circumstance and we don't know that it happens in nature at all," Schaffner added.

Two of the five cats were euthanized six days later. Researchers found virus particles in their upper respiratory systems.

The remaining three infected cats were put into a cage adjacent to three non-infected cats. One of those three cats later tested positive for the virus, while the other two did not. Still, the researchers felt that showed the virus could be transmitted via respiratory drops.

Or did it? None of the infected cats exhibited signs of illness. And even if they did pass the virus to each other, that doesn't mean they would be able to pass it on to humans.

That's what happened nearly two decades ago with a sister coronavirus called SARS-CoV, which causes the deadly pneumonia-like respiratory disease called SARS.

Just like now, science found cats could be infected with SARS-CoV and infect other cats. But the virus didn't transmit widely among house cats during the 2002 to 2004 pandemic, nor were there any known cases of transmission to humans.

Ferrets affected too

The study found ferrets were also "efficient" replicators of the virus -- meaning that the virus can easily grow and reproduce in their long, slinky bodies.

"SARS-CoV-2 can replicate in the upper respiratory tract of ferrets for up to eight days, without causing severe disease or death," the study said. The study did not look at a longer time frame.

That's good news for researchers looking for a way to test any future vaccines for SARS-CoV-2, also called the novel coronavirus.

"It's necessary to have an animal model to do initial tests of vaccines and understand how viruses cause disease. So, this will be useful to the field," Williams said.

It's actually not surprising that ferrets appear to respond to the novel coronavirus. A ferret's lung and airways are strikingly similar to a human's. In fact, biologically and physiologically ferrets are more similar to humans than they are to a mouse or rat.

"Ferrets are classical animals in which to study influenza -- it's been done for decades," Schaffner said. "If scientists were looking for an animal model, they would reach for the ferrets first."

What this means

Will your cat or ferret come down with coronavirus? Highly unlikely, experts say, pointing to the fact that we would certainly have heard of many cases in pets by now, considering the significant spread of the virus in the US and Europe.

Hong Kong has been quarantining animals belonging to people diagnosed with Covid-19 and have found only two cases of positive results in dogs. The dogs showed no signs of illness during the quarantine.

Rare as it may be, it appears one cat in Belgium may have gotten the virus in March from her owner, who was ill with Covid-19 after returning from a visit to Italy. But even though the cat had respiratory problems and high levels of the virus in vomit and feces, researchers aren't yet sure if the cat was sick from Covid-19 or another illness.

"While 2 dogs (Hong Kong) and 1 cat (Belgium) have been reported to have been infected with SARS-CoV-2, infectious disease experts and multiple international and domestic human and animal health organizations agree there is no evidence at this point to indicate that pets spread COVID-19 to other animals, including people," the American Veterinary Medical Association says on its website.

The AVMA and the U.S. Centers for Disease Control and Prevention recommend taking normal precautions when cleaning litter boxes and feeding animals.

"Out of an abundance of caution," the AVMA suggests anyone ill with COVID-19 symptoms limit contact at this time, "until more information is known about the virus."

Have another member of your household take care of walking, feeding, and playing with your pet, the AVMA states. If you have a service animal or you must care for your pet, then wear a facemask; dont share food, kiss, or hug them; and wash your hands before and after any contact with them.

The-CNN-Wire & 2020 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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Study: Cats may get coronavirus, but experts say its nothing to worry about - KSAT San Antonio

During the early days of the coronavirus pandemic, the U.S. Centers for Disease Control and Prevention andWorld Health Organization made it clear that, unless you're sick or are a medical professional, you do not need to wear a face mask.

On February 29th, U.S. Surgeon General Jerome Adams tweeted:"Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!"

Adams' message comes with good intentions. With COVID-19 cases soaring, doctors, nurses and other frontline health-care workers confront a severe shortage of masks and cautioning people against buying them can help offset the problem.

Butother countries have already taken aggressive measures to prevent the spread of COVID-19 by telling citizens to wear masks, even if the masksare homemade.

Last week, George Gao,director-general of the Chinese Center for Disease Control and Prevention, told ScienceMag.comthat the "big mistake in the U.S." is that people aren't wearing masks. "This virus is transmitted by droplets and close contact. Droplets play a very important role," he said. You've got to wear a mask, because when you speak, there are always droplets coming out of your mouth."

Gao has done significant research on virusesthat have fragile lipid membranes called envelopes a group that includes SARS-CoV-2 (the virus that causes COVID-19) and how they enter cells and move between species.

"Many people have asymptomatic or presymptomatic infections," he continued. "If they're wearing face masks, it can [help] prevent droplets that carry the virus from escaping and infecting others."

So far, U.S. health officials have not offered guidelines or regulations around homemade masks and since commercially made ones are almost impossible to find, your last resort is just starting making your own.

You can find a variety of mask designs online, but simple yet promising one comes from a recent study published in the medical journal Disaster Medicine and Public Health Preparedness.

Researchers analyzed 2008 studiesfrom Public Health England(which evaluated a range of household materials that, in the event of a pandemic, could be used by the general public to make masks) to create a D.I.Y. guide.

"These studies found that T-shirts and pillowcases made into a mask using the design [below] may act as a barrier against influenza, or help limit spread by a person with symptoms," according to the study's authors. "We have no data on COVID-19, but it's not unreasonable to assume similarity."

They also stressed that "the wearing of face masks will only offer limitedprotected, and should notbe considered as sufficient protection. Additional preventative measures need to be adopted."

Face mask template:

(Template and instructions C/O:Disaster Medicine and Public Health Preparedness. Click here to enlarge.)

Supplies:

Simplified version of step-by-step instructions:

Important reminders:

Most people have the basic materials tomake a mask right now. It's time to call forth the "can do" American spirit and encourage people stuck at home to start sewing.

Doing so can save existing stock for healthcare professionals as manufacturers ramp up production in the coming months. If you're healthy have any unused commercial or medical-grade masks lying around, consider donating them to local hospitals.

Instead of obsessing over ill-conceived mixed messages, let's starting viewing mask-wearing as an act of solidarity and make it the new norm (at least until this pandemic over).

Nir Eyalis a behavioral psychology expert and instructor at Stanford's Graduate School of Business. He is the author of the best-selling books"Indistractable: How to Control Your Attention and Choose Your Life"and "Hooked: How to Build Habit-Building Products" andhas written for Harvard Business Review, TIME and Psychology Today. Follow him on Twitter @NirEyal.

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Why we should all start making our own face masks during coronavirusand an expert-approved guide on how - CNBC

Dr. Steven Kalkanis, CEO of the Henry Ford Medical Group. (Photo: Courtesy of the Henry Ford Medical Group)

DETROIT According to a news release dated April 2, Henry Ford Health System will lead the first large-scale study in the United States of the effectiveness of an anti-malarial drug in preventing COVID-19 in healthcare workers and first responders who volunteer to participate.

The study of hydroxychloroquine used prophylactically could begin as early as next week, after a plea to the federal government by Detroit Mayor Michael Duggan and Metro Detroit healthcare experts.

This is going to be the first major, definitive study in healthcare workers and first responders of hydroxychloroquine as a preventative medication, said the studys organizer, Henry Ford Health Systems Dr. William W. ONeill, a world-renowned interventional cardiologist and researcher who has pioneered multiple treatments for heart disease. There has been a lot of talk about this drug, but only a small, non-blinded study in Europe. We are going to change that in Metro Detroit and produce a scientific answer to the question: Does it work?

Participation in the study is strictly on a volunteer basis. Greek-American Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System, will oversee this study with Dr. ONeill.

We are glad to see Henry Fords lead on this volunteer study that could help protect medical workers and first responders across southeast Michigan, Mayor Duggan said, acknowledging U.S. Food & Drug Administration Commissioner Dr. Stephen M. Hahn. I also deeply appreciate Dr. Hahns prompt support for this important effort.

Both health care workers and first responders will be enrolled at Henry Ford Hospital Detroit. Currently, there are no FDA-approved therapies to prevent or treat COVID-19. According to the U.S. Centers for Disease Control & Prevention, hydroxychloroquine (also known as hydroxychloroquine sulfate) is an FDA-approved arthritis medicine that also can be used to prevent or treat malaria. It is available in the United States by prescription only. The drug is sold under the brand name Plaquenil and it is also sold as a generic medicine. It is commonly used by patients with arthritis, lupus or other rheumatic conditions.

Metro Detroit has a history of stepping up when things get tough, said Dr. Adnan Munkarah, Henry Ford Health System Executive Vice President and Chief Clinical Officer. We have a commitment to do that right now to look at all options in a scientific way in the face of this worldwide pandemic.

The study, titled WHIP COVID-19 Study, is a 3,000+ subject look at whether the drug prevents front-line workers from contracting the virus. Once they provide a blood sample, the study subjects will receive vials with unidentified, specific pills to take over the next eight weeks: a once-a-week dose of hydroxychloroquine, a once-a-day dose, or a placebo (a pill that looks like the medication, but does not contain any medication or other active ingredients). The study medication was specially procured for this study and will not impact the supply of medication for people who already take the medication for other conditions.

Participants will not know what group they are in. They will then be contacted weekly and in person at week 4 and week 8 of the study to see if they are exhibiting any symptoms of COVID-19, including dry cough, fever or breathing issues, as well as any medication side effects. At eight weeks, they will be checked again for symptoms, medication side effects, and have blood drawn. Results will be compared among the three groups to see if the medication had any effect.

Given our broad clinical trials and translational research infrastructure, we are grateful to bring this type of large-scale effort to the COVID-19 battle, said Greek-American Dr. Steven Kalkanis, CEO, Henry Ford Medical Group and Senior Vice President and Chief Academic Officer of Henry Ford Health System. We see the heroics of the frontline responders in healthcare, public safety and service. Henry Ford Health System is poised to do anything we can to help them stay safe.

The FDA will provide the drug directly to Henry Ford Health System physicians to distribute. Recruiting has not yet begun. More information can be found at http://www.HenryFord.com/whipCOVID19.

The CDC describes hydroxychloroquine, which has been used for 75 years, as a relatively well-tolerated medicine. The most common adverse reactions reported are stomach pain, nausea, vomiting, and headache. These side effects can often be lessened by taking hydroxychloroquine with food. Hydroxychloroquine may also cause itching in some people. Minor side effects such as nausea, occasional vomiting, or diarrhea usually do not require stopping the antimalarial drug. Although rare, serious side effects can occur while taking this medication.

If the study finds the drug effective as a preventative medication for COVID-19, it is possible that the study could expand to include hydroxychloroquine in other COVID-19 treatment options, the doctors said. Henry Ford Health System doctors are prescribing hydroxychloroquine as an off-label treatment for only hospitalized COVID-19 positive patients who meet specific criteria as outlined by the hospital systems Division of Infectious Diseases. As required by the state of Michigans Department of Licensing and Regulatory Affairs, the physicians are documenting the prescribed use in the patients electronic medical record.

Henry Ford, as one of the regions major academic medical centers with more than $100 million in annual research funding, is already involved in numerous COVID-19 trials with partners around the world. Henry Ford is also becoming involved in an Abbott-led study of a rapid, point-of-care test for COVID-19. The equipment, about the size of a toaster, delivers positive results in as little as five minutes and negative results in 13 minutes.

Read more here:
Henry Ford Health System to Lead Nat'l Study of Drug's Effectiveness vs. COVID-19 - The National Herald

By Dr. Hemant Gupta DaYM, BAMS and Amita Nathwani, MA

Last week, Eric Garcetti, the mayor of Los Angeles, gave the people of his city a message regarding masks: if you really must go out on the street, for whatever reason, cover your mouth and nose. This measure was given to begin the first step to protecting ones self from the virus.

As we study the impact of stopping the virus outbreak trajectory, the question remains; what can we, as ordinary citizens do to stay healthy in the midst of the exposure?

Enhancing the bodys natural defense system plays an important role in maintaining optimum health and while there is no medicine for COVID-19 as of now, taking preventive measures to boost our immunity is what is called for in these times.

Ayurvedic Medicine, a 5,000 year-old approach to health, which addresses both pathology and prevention, says it starts in the gut. Without a strong and healthy digestive system, with balanced flora and the necessary enzymes to help break down pathogens, our first line of defense is compromised.

Ayurveda has a number of immune building formulas which are recommended to support the immune system. It is important to note, however, Ayurvedas fundamental approach in using plants as medicine is that the individual person as a whole is who advocates the use of herbs instead of isolating, extracting, and administering active ingredients. Ayurveda supports the synergistic approach as opposed to the reductionist approach of each plant.

Before we get to the considerations of the intake of any formula or supplement capable of increasing immunity or fighting disease, we must stress the importance of starting with supporting a weak digestion. Without this step, the efficacy of the remedies will remain low, and the body will not be able to fully breakdown the needed nutrients.

One of the methods of diagnosis by Ayurveda is to determine its weakness by looking at the tongue. If there is a white coating or film, we recommend the following preemptive steps:

These actions over a period of a couple of days will help to increase digestion and help the body begin its ability to receive therapeutic remedies for building the immune system and fighting pathogens. Without this step, the efficacy of the remedies will remain low, and the body will not be able to fully breakdown the needed nutrients.

The second stage of building immunity is to ensure that you are avoiding all causative factors. Studies show that reducing stress through meditation, staying active, yoga and breathing exercises can significantly reduce inflammation in the body and therefore increase the bodys resistance to pathogens and disease. Healthy eating and getting an adequate amount of sleep is also imperative for the bodys natural resistance to be sustained.

In addition to the recommended CDC guidelines for minimizing exposure, Ayurveda offers help in protecting the nose, mouth or eyes, the first entry point of the COVID-19 virus. It is recommended to follow these simple procedures that can be practiced on a daily basis.

And finally, once the digestion is strong, causative factors are eliminated and preventative measures are in place, we can start recommending herbal formulas.

The classic Ayurvedic formula called Chywanprash, serves as a general tonic to increase what Ayurveda calls Ojas or immune building substance in the body. The formula is broken down into about 50 ingredients that work synergistically. Its primary ingredient is the Amla Berry, or Emblica officinalis, which supports antioxidant activity via the encouragement of collagen and elastic production. This formula is available everywhere online in Ayurvedic stores, in both a fresh and dried form, depending on the health needs of the patient.

In this way, Amla supports both the health of the outer skin and the inner skin that lines the gut, respiratory tract, and all mucus membranes of the body. Amla is also well known as a source for natural Vitamin C. Along with other immuno-modulating active plant ingredients like Ashwagandha, Guduchi and Holy Basil, this formula works synergistically to promote health.

Founding professor of John Hopkins University, Sir William Oslar said it best, Let us not treat the disease, but let us treat the patient who has the disease.

Dr. Hemant Gupta is a renowned scholar, researcher and practitioner of Ayurvedic Medicine. Along with a degree in Natural Medicine, Dr. Gupta completed his Masters in Kayachikitsa (Internal Medicine) from National Institute of Ayurveda in Jaipur.

Amita Nathwani is a practitioner and professor with a Masters in Ayurvedic Medicine. She is an adjunct faculty member with the Dr. Andrew Weil Center for Integrative Medicine and a Public Voices Fellow with the OpEd Project.

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The Ayurvedic approach to immunity and the coronavirus - Thrive Global

ZLIs Save a Billion Birds Campaign to Send Songbirds to Biodiversity Hotspots

NEW YORK, Apr. 06 /CSRwire/ - The Zoological Lighting Institute (ZLI) and its ZLI Save a Billion Birds! Campaign announced plans to offset expected devastation to wildlife due to the inevitable economic pressures stemming from the COVID-19 pandemic. By advocating and offering planning to achieve bird protections in the northern hemisphere, direct exploitation of impoverished biodiversity hotspots in the southern hemisphere will be offset by songbirds sent to these regions. ZLIs Save a Billion Birds! campaign now provides planning services and access to design services, that identify opportunities for corporations, private institutions and public agencies to effectively offset the devastating loss of birds internationally that most likely will, in post-pandemic days, get worse.

ZLI focuses upon the role of natural light in biology. The charity funds research as to how light affects animal physiology, animal senses and the ways in which it influences relationships between animals in space and time. ZLIs Save a Billion Birds! campaign gets a bit more specific, concentrating on these subjects as they matter for birds. As significant research suggests that artificial light at night (ALAN) and exposed transparent/reflective glass kill several billion birds (including birds representing over a thousand species) annually, ZLIs Save a Billion Birds! has expanded from serving as a research funding initiative to include solution facilitating resources <<https://zoolighting.org/subdepartment/zli-wildlife-friendly-design/>>. COVID-19 makes the urgency of such planning more evident than ever, as migratory birds are necessary to keep ecosystems functioning in areas most susceptible to the emergence of zoonotic diseases. The intent is to link corporations and government agencies to wildlife sensitive development, and to include the financial value of ecosystem services (over $44 trillion US Dollars by peer-reviewed estimates) within design and development decisions.

The emphasis is on bird-friendly planning, rather than bird-friendly product. Despite the devastating news of declining bird populations, bird-friendly design has been pursued on a project by project basis, often relying on the ad-hoc adoption of privately tested products. Yet just as preventative medicine requires a coordinated and international approach, preventative wildlife conservation requires planning and public engagement to mitigate and remove the devastating effects of ALAN and exposed glass. A recent study at Cornell University, showed that birds in developed areas are currently at higher risk than those in soon to be over-stressed areas <<https://news.cornell.edu/stories/2018/09/more-4-billion-birds-stream-overhead-during-fall-migration>>. Bird-friendly planning offers community leaders and responsible companies the opportunity to keep seemingly distant biodiversity hot-spots safer by taking meaningful action in our campuses, offices and development here at home. ZLIs Save a Billion Birds! advocacy of planning (rather than product) recognizes the financial realities of development as well, by providing a platform to engage audiences to help fund necessary change. Planning, and recognizing that birds are a resource in kind that can be sent back to over-stressed biodiversity hot-spots, is an underemphasized means of corporate social responsibility.

We have to take our cue from UNEP (the United Nations Environmental Program) and the CBD (Convention on Biological Diversity), offers ZLI Executive Director James Karl Fischer. In times of financial stress, people without substantial resources turn to nature for sustenance. Hunting, fishing, agriculture; all of these provide food from nature when none is available to be had from industrialized sources. But if wild populations arent managed or supported, individuals can do more harm than good. There are many ways to help of course, but it is important to save the animals in those ecosystems because when they are gone, they are gone, and people will starve while also creating future pandemics. No one is as disconnected from this as we like to imagine

Dr. Fischer continuesIn the northern hemisphere, people are connected to global wildlife habitat more than they realize. Many migratory birds that we see in our cities, backyards and parks are the same birds that help to keep local environments going in the southern hemisphere. If they are killed here, they do not contribute to the rainforests or other biodiversity hot-spots there. Losing birds makes it that much more difficult for habitats to recover from improper resource-acquisition damage. With rising likelihood of human suffering due to economic pressures, it is more important than ever to protect birds from meaningless threats in the north. That means paying attention to the billions of birds killed by glass and artificial light, and making the necessary adjustments to our buildings. That is what Save a Billion Birds! has always been about, but it is more important than ever that resourced groups, companies, institutions and governmental agencies take action now through preventative planning.

The United Nations has been clear as to the value of birds to the economy (see links below). The loss of migratory birds destroys ecosystems and lowers environmental quality, while requiring increased financial expenditures to make up for resources that nature would otherwise provide freely. Birds are essential to agriculture, disaster mitigation, and human health care through the ecological services that they provide (such as improved air and water quality). As we have seen, contact with stressed and monolithic wildlife populations enhances zoonotic diseases. Migratory birds face numerous threats as they travel from one nation to another, across the southern to northern hemisphere and back. Billions across the northern hemisphere die by striking glass, and so cannot replenish their value in African, South American and Southeast Asian biodiversity hotspots. Many specific alternatives to exposed exterior bird-killing glass are available to prevent bird deaths, but adoption depends on leadership and a strategy to effect it. ZLIs Save a Billion Birds! campaign seeks to create leaders willing to take on the challenge of protecting birds, and to engage sympathetic audiences and markets through their commitment to public health, safety and welfare.

ZLIs Save a Billion Birds! Send a Songbird Planning Program is available to private, corporate and institutional stakeholders, and is described at greater length at https://zoolighting.org/subdepartment/zli-wildlife-friendly-design/. An upcoming documentary film Save a Billion Birds! describes the need and process of bird-friendly planning, and will begin shooting in California and Chile, (in conjunction with coordinated versions from South Africa to the UK and Thailand to South Korea) as investments and sponsorships are secured. For more information about ZLIs Save a Billion Birds! campaign, and how to engage the charity to ensure that development mitigates biodiversity-loss, please ask to speak with one of ZLIs Save a Billion Birds! Campaign Committee Leaders directly at saveabillionbirds@zoolighting.org.

About The Zoological Lighting Institute:

A unique charitable 501 c(3) with a mission to Support the Sciences of Light and Life through the Arts for Animal Welfare and Wildlife Conservation, The Zoological Lighting Institute embraces the concept of PhotoDiversity, referring to the importance that the diversity of natural light holds for living things, as well as the importance of cultural, social and human diversity has for science and its application. With an international Board of Directors overseeing four departments, including Film & Media, Education, Sustainable Design and the PhotoSciences, The Zoological Lighting Institute is breaking new terrain in the application of science to address the under appreciated realm of light and life.

Current Campaigns include Beached, Bearanoia, Insect Apocalypse, Otohimes Time, Precious Light and Save a Billion Birds!. Please visit http://www.zoolighting.org for more information on Sponsorships, Donor Advisory Fund (DAF) Giving Opportunities and Matching Contribution Programs.

References and Resources:

https://www.unenvironment.org/news-and-stories/video/message-nature-coronavirushttps://www.cbd.int/financial/values/unitedkingdom-valueliterature.pdfhttps://science.sciencemag.org/content/366/6461/120https://www.muhlenberg.edu/academics/biology/faculty/klem/aco/Bird-window.htmlhttps://www.3billionbirds.orghttps://www.birds.cornell.edu/home/bring-birds-back/

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After the Pandemic: Inter-nationalist Wildlife Conservation Initiative - CSRwire.com

Henry Ford is leading a large-scale study on the effectiveness on malaria drugs in preventing COVID-19. // Stock photo

Detroits Henry Ford Health System on Thursday announced it will lead the first large-scale study in the U.S. of the effectiveness of an anti-malarial drug in preventing COVID-19 in health care workers and first responders who volunteer to participate.

The study of hydroxychloroquine used preventatively could begin as early as next week.

This is going to be the first major, definitive study in health care workers and first responders of hydroxychloroquine as a preventative medication, says Dr. William W. ONeill, a world-renowned interventional cardiologist and researcher who has pioneered multiple treatments for heart disease, and the studys organizer at Henry Ford. There has been a lot of talk about this drug, but only a small, non-blinded study in Europe. We are going to change that in metro Detroit and produce a scientific answer to the question: Does it work?

Dr. Marcus Zervos, division head of infectious disease at Henry Ford, will oversee the study with ONeill.

We are glad to see Henry Fords lead on this volunteer study that could help protect medical workers and first responders across southeast Michigan, says Detroit Mayor Mike Duggan, acknowledging U.S. Food and Drug Administration Commissioner Dr. Stephen M. Hahn. I also deeply appreciate Dr. Hahns prompt support for this important effort.

Health care workers and first responders will be enrolled at Henry Ford Hospital Detroit. There are currently no FDA-approved therapies to prevent or treat COVID-19. According to the U.S. Centers for Disease Control and Prevention, hydroxychloroquine, or hydroxychloroquine sulfate, is an FDA-approved arthritis medicine that can also be used to prevent or treat malaria. It is available in the U.S. by prescription only. It is sold under the drug name Plaquenil and is also sold as a generic medicine.

Metro Detroit has a history of stepping up when things get tough, says Dr. Adnan Munkarah, executive vice president and chief clinical officer of Henry Ford. We have a commitment to do that right now to look at all options in a scientific way in the face of this worldwide pandemic.

The study is called WHIP COVID-19 Study and is a more than 3,000-subject look at whether the drug prevents front-line workers from contracting the virus. Once they provide a blood sample, the study subjects will receive vials with unidentified pills to take over the following eight weeks. Participants could be given a once-a-week dose of hydroxychloroquine, a once-a-day dose, or a placebo. The study medicine was specially procured for the study and will not impact the supply of medicine for people who already take the medicine for other conditions.

Participants will not know what group they are in. They will be contacted weekly and in-person at week four and week eight of the study to see if they are exhibiting any symptoms of COVID-19 such as a dry cough, fever, or breathing issues, as well as medication side effects. At eight weeks, they will have blood drawn again. Results will be compared among the three groups to see if the medication had any effect.

Given ourbroadclinical trials and translational research infrastructure, we are grateful to bring this type of large-scale effort to the COVID-19 battle, says Dr. Steven Kalkanis, CEO of Henry Ford Medical Group and senior vice president and chief academic officer of Henry Ford Health System. We see the heroics of the frontline responders in health care, public safety, and service. Henry Ford Health System is poised to do anything we can to help them stay safe.

The CDC describes hydroxychloroquine, which has been used for 75 years, as a relatively well-tolerated medicine. The most common adverse reactions reported are stomach pain, nausea, vomiting, and headache. The side effects can often be lessened by taking hydroxychloroquine with food. Hydroxychloroquine may also cause itching in some people. Minor side effects including nausea, occasional vomiting, or diarrhea do not usually require stopping the drug. Serious side effects are rare but can occur.

If the study finds the drug effective as a preventative measure, it is possible the study could expand to include hydroxychloroquine in other COVID-19 treatment options. Henry Ford doctors are prescribing hydroxychloroquine as an off-label treatment for only hospitalized COVID-19 positive patients who meet specific criteria as outlined by the hospital systems Division of Infectious Diseases.

The FDA will provide the drug to the health system to distribute. Recruiting for the study has not yet begun. More information is available here.

Henry Ford has more than $100 million in annual research funding and is already involved in numerous COVID-19 trials with partners around the world.

The health system is a $6 billion integrated health system comprised of six hospitals, a health plan, and more than 250 other sites. It was established in 1915 and has 32,000 employees.

See the original post:
Detroit's HFHS to Lead First Large-scale Study in US of Effectiveness of Anti-malarial Drug in COVID-19 Prevention - dbusiness.com

A century ago, after the 1918-1919 Spanish influenza pandemic, few Canadians had to be reminded about how deadly a respiratory viral infection could be. Estimates vary, but 50 million to 100 million people worldwide perished in the most devastating pandemic in history an event that, strangely, has largely receded from memory.

Older people will also remember the polio epidemics. The Crippler left in its wake close to 50,000 children, as well as adults, with varying degrees of muscle weakness and paralysis, and over 4,100 dead. These worsened across Canada from the late 1920s through the late 1950s during the years before polio vaccines were widely available.

During the 1980s and 1990s, HIV spread rapidly around the world. Acquired Immune Deficiency Syndrome (AIDS) was lethal until the development of treatment regimes, public education campaigns and other prevention measures.

In 2003, thousands of people fell ill, and many died, during an especially severe outbreak in Toronto that seemed to target hospitals and health care workers. This was SARS (Severe Acute Respiratory Syndrome), a pneumonia-like infection caused by a novel coronavirus (similar to COVID-19) that began in China and was imported into Canada.[3]

But until the COVID-19 pandemic contemporary urbanized societies were no longer especially preoccupied with the threat of widespread infectious disease outbreaks. While this prevailing sense of security is rooted in genuine confidence in public health protections and medical science, it also reveals a kind of social complacency and amnesia about the damage that infectious diseases are capable of inflicting.

SPANISH FLU

Among all of these earlier examples, the Spanish influenza pandemic was unique in its intensity and extent. Its story also offers powerful insights into the impact and aftermath of the COVID-19 pandemic. We understand much more today, but our well-being still depends not just on science, but also on a broad and deep understanding of the stories of past tragedies.

During the Middle Ages and through the 19th century, urban populations in much of Europe and Asia were regularly decimated by pandemics. Bubonic plague was one of the most deadly diseases, transmitted by fleas and parasites. According to the World Health Organization, the bubonic plague also known as The Black Death killed about 50 million people in 14th century Europe and continued to circulate for centuries.

Later on, the conditions of urban life as well as mass migration became key factors driving the rapid spread of highly infectious and deadly diseases such as smallpox, typhus and cholera. Successive epidemics of cholera swept through Europe and spread to North America on ships filled with migrants from Britain. In Canada, cholera arrived in the 1830s and triggered health emergencies in cities like Montreal and Toronto, prompting unprepared authorities to establish the earliest public health boards.

At the time no one knew how most infectious diseases spread from one individual to another. Scientists hadnt yet discovered bacteria or viruses (germs), the microscope hadnt been invented and the concept of vaccination was in its infancy. Colonial governments enacted draconian quarantine laws, but these often failed to be enforced by local officials.

BREAKTHROUGH

A turning point in the containment of infectious disease outbreaks occurred during a cholera epidemic in London, England, in 1854. Tens of thousands of Londoners had died of cholera epidemics in 1849 and 1853. During an 1854 cholera outbreak, a young physician named John Snow came up with the idea of mapping the addresses of victims in a west-end neighbourhood centred on Broad Street. When he analyzed his famous ghost map, he realized that many of the sick and dead lived close to an outdoor water pump that drew on a well contaminated by a nearby privy. Snows empirical observations, considered to be among the first breakthroughs of modern epidemiology, prompted local officials to remove the handle on the Broad Street water pump, a turning point in public health policy.

During the late 19th and early 20th centuries, many public health advocates and governments pushed to implement prevention-oriented improvements geared at limiting the spread of diseases. The mass production of vaccines and the advent of large-scale inoculation campaigns shifted the fight against infectious disease and epidemics into the realm of preventative medicine.

Routine vaccinations have become one of the principal prevention measures against a range of infectious diseases. Smallpox was declared eradicated from the globe in 1979, and polio is close to the same goal.

What are the connections between todays national and global public health practices and the pandemic that ravaged so much of the world in 1918? Epidemiologists today understand more about the vectors of infection because theyve examined how pandemic influenza spread from troops traveling to and from European battlefields. We drew on some of these lessons during and after the SARS pandemic, in 2003, although dramatic evidence thats surfaced during the COVID-19 pandemic about critical shortages of medical supplies and equipment reveal what can happen when shocking events recede from memory.

ABOUT

The Defining Moments Canada website provides a wealth of information about the way Canadians were affected by this pandemic.

Our goal is inoculate ourselves from the lethal consequences of collective amnesia. We seek to remember not just for its own sake, but to ward off the complacency that can leave our communities vulnerable to, and ravaged by, future epidemics.

John Lorinc is Senior Editor, Defining Moments Canada

Excerpted from Defining Moments Canada, published March 30, 2020.

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Infectious disease outbreaks: from The Plague to COVID-19 - Virden Empire Advance