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Dublin, April 16, 2020 (GLOBE NEWSWIRE) -- The "Precision Medicine Software Market by Delivery Mode (On-premise, Cloud-based), Application (Oncology, Pharmacogenomics, CNS), End User (Healthcare Providers, Research, Academia, Pharma, Biotech) - Global Forecast to 2027 " report has been added to ResearchAndMarkets.com's offering.

The global precision medicine software market is expected to grow at a CAGR of 11.8% from 2019 to 2027 to reach $2.8 billion by 2027.

The growth in the precision medicine software market is mainly attributed to the factors such as paradigm shift in treatment, rising pressure to decrease healthcare costs, scientific & technological advances in the genomics field, and growing focus towards providing companion diagnostics & biomarkers for various therapeutic areas. Moreover, emerging countries and AI in precision medicine provides significant growth opportunities for players operating in the precision medicine software market.

The precision medicine software market study presents historical market data in terms of value (2017, and 2018), current data (2019), and forecasts for 2027 - by delivery mode, application, and end user. The study also evaluates industry competitors and analyzes the market at regional and country level.

On the basis of delivery mode, the on-premise segment accounted for the largest share of the overall precision medicine software market in 2019. However, the web & cloud-based delivery mode segment is expected to grow at the faster CAGR during the forecast period, owing to its benefits, such as on-demand self-serving, no maintenance cost, low storage & upfront cost, and excessive storage flexibility. In addition, the factors such as greater security in private clouds and automated updating features of web and cloud solutions are further expected to support the rapid growth of this segment.

Based on application, the oncology segment accounted for the largest share of the overall precision medicine software market in 2019. However, the pharmacogenomics segment is expected to witness rapid growth during the forecast period. The factors such as increasing incidence of adverse drug reaction, growing focus on genomic-based study, shift from one-size-fits-all approach to personalized approach, and rising pressure on pharmaceutical companies to develop new drugs promote the fastest growth of this segment.

Based on end user, the healthcare providers segment commanded the largest share of the overall precision medicine software market in 2019. However, the pharmaceutical & biotechnological companies segment is expected to witness rapid growth during the forecast period. The factors such as increasing R&D activities related to precision medicine, increasing collaboration between pharma & biotech companies and software vendors, shift from conventional one-size-fits-all-type treatment to precision treatment, and rising R&D costs are the major factors driving rapid growth of this segment.

An in-depth analysis of the geographical scenario of the precision medicine software market provides detailed qualitative and quantitative insights about the five major geographies (North America, Europe, Asia-Pacific, Latin America, and the Middle East & Africa) along with the coverage of major countries in each region.

North America commanded the largest share of the global precision medicine software market in 2019, followed by Europe, Asia-Pacific, Latin America, and the Middle East & Africa. The factors such as well-established healthcare system in the region, rising adoption of technologically advanced products for cancer diagnosis & treatment, growing HCIT investment, government initiatives supporting developments in precision medicine, growing availability of research funding, and higher accessibility to precision medicine software are responsible for the largest share of North America in the precision medicine software market.

The key players operating in the global precision medicine software market are Syapse, Inc. (U.S.), Fabric Genomics, Inc. (U.S.), SOPHiA GENETICS SA (Switzerland), Human Longevity, Inc. (U.S.), Sunquest Information Systems Inc. (U.S.), LifeOmic Health, LLC (U.S.), Translational Software Inc. (U.S.), N-of-One (U.S.), Gene42 Inc. (Canada), PierianDx (U.S.), Foundation Medicine, Inc. (U.S.), and 2bPrecise (U.S.), among others.

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Key Topics Covered

1. Introduction1.1. Market Definition1.2. Market Ecosystem1.3. Currency1.4. Key Stakeholders

2. Research Methodology

3. Executive Summary

4. Market Insights4.1. Introduction4.2. Drivers4.2.1. Paradigm Shift in Treatment4.2.2. Rising Pressure to Decrease Healthcare Costs4.2.3. Scientific & Technological Advances in the Genomics Field 4.2.4. Growing Focus Towards Providing Companion Diagnostics (CDx) & Biomarkers4.3. Restraints4.3.1. Lack of Awareness about Precision Medicine Practices4.3.2. Fragmented Healthcare Systems in Developing Countries4.4. Opportunities4.4.1. Emerging Economies4.4.2. Artificial Intelligence in Precision Medicine4.5. Challenge4.5.1. Lack of Reimbursement for Genetic Testing & Precision Medicine

5. Global Precision Medicine Software Market, by Delivery Mode5.1. Introduction5.2. On-Premise5.3. Web & Cloud-Based

6. Global Precision Medicine Software Market, by Application6.1. Introduction6.2. Oncology6.3. Pharmacogenomics6.4. Other Applications

7. Global Precision Medicine Software Market, by End User7.1. Introduction7.2. Healthcare Providers7.3. Research and Government Institutes7.4. Pharmaceutical & Biotechnology Companies

8. Geographic Analysis8.1. Introduction8.2. North America8.2.1. U.S.8.2.2. Canada8.3. Europe8.3.1. Germany8.3.2. France8.3.3. U.K.8.3.4. Italy8.3.5. Spain8.3.6. Rest of Europe (RoE)8.4. Asia-Pacific8.4.1. Japan8.4.2. China8.4.3. India8.4.4. Rest of Asia-Pacific (RoAPAC)8.5. Latin America8.6. Middle East and Africa

9. Competitive Landscape9.1. Introduction9.2. Key Growth Strategies9.3. Competitive Benchmarking

10. Company Profiles(Business Overview, Strategic Developments, Product & Service Offering, Financial Overview)10.1. 2bprecise LLC (Part of Allscripts Healthcare Solutions Inc.)10.2. Pieriandx, Inc.10.3. Gene42, Inc.10.4. Foundation Medicine, Inc.10.5. N-Of-One, Inc. (Part of Qiagen N.V.)10.6. Translational Software, Inc.10.7. Syapse, Inc.10.8. Fabric Genomics, Inc.10.9. Sophia Genetics S.A.10.10. Human Longevity, Inc.10.11. Sunquest Information Systems, Inc.10.12. Lifeomic Health, LLC

For more information about this report visit https://www.researchandmarkets.com/r/33bn4y

Research and Markets also offers Custom Research services providing focused, comprehensive and tailored research.

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$2.8 Billion Precision Medicine Software Market by Delivery Mode, Application, End-user and Region - Forecast to 2027 - Yahoo Finance UK

It is a massive, unsolved problem. Chronic pain affects an estimated 50 million to 100 million Americans, disabling up to 20 million of them. And its more than just a noxious physical sensation it affects attention, mood and sleep, even someones relationships and identity. Yet despite the enormous need for better treatments, there are few effective drugs to treat chronic pain beyond opioids, which can be dangerous and addictive. Whats the way ahead?

CREDIT: JAMES PROVOST (CC BY-ND)

Yale School of Medicine and VA Connecticut Healthcare System

The search for better drugs is complicated by the fact that chronic pain takes different forms, and affects the brain as well as where the pain is felt. One strategy is to try to stop pain signals at the source: the nerves that sense damage or threats to the body.

For decades, neurologist and neuroscientist Stephen Waxman has been studying proteins called ion channels that allow these nerve cells to send their signals. Mutations in the genes carrying instructions for these channels give rise to rare pain disorders. These disorders and mutations are pointing the way to new medications for common pain conditions. Waxman, of the Yale School of Medicine and the VA Connecticut Healthcare System, recently coauthored an article about work toward this goal in the Annual Review of Neuroscience. He spoke with Knowable Magazine about the hunt for new pain treatments and the challenges of finding them.

This conversation has been edited for length and clarity.

What is pain, and where does it come from?

Pain is a complex phenomenon. Normal, or nociceptive, pain serves a very important protective and instructive role. If you put your finger near a fire, you immediately pull your finger away. We rapidly learn to avoid things that cause pain.

Nociception originates from receptors located in the peripheral nervous system: the nerves that run through our skin and organs. These receptors are activated by strong mechanical stimuli, noxious heat, noxious cold and noxious chemicals, and the signal is transmitted along nerves. These peripheral nerve fibers carry the pain signal to the spinal cord. There are other neurons within the spinal cord that relay the signal upward to the brain, where pain is recognized.

Now under some circumstances, pain is abnormal. There is a set of conditions, which fall under the term neuropathic pain, where these peripheral neurons fire spontaneously, even when theres no threatening stimulus. It occurs in common disorders like diabetic neuropathy, shingles pain and a complication of cancer treatment called chemotherapy-induced peripheral neuropathy. In these disorders, peripheral pain-signaling neurons become hyperactive: They take on a life of their own and fire when they shouldnt.

Theres also a set of pain disorders that we lump together as inflammatory pain. This pain is a result of damage to peripheral tissues, largely due to inflammation there. And again, this triggers inappropriate firing, which results in chronic pain.

How could understanding these nerve signals lead to new pain treatments?

Nerve cells communicate with each other by producing small electrical impulses. Those depend on the presence of a class of protein molecules called sodium channels. In a sense, you can think of them as tiny molecular batteries in the membrane of nerve cells. And these tiny molecular batteries produce tiny electrical currents that sum up and produce nerve impulses.

For many years, the scientific community talked about the sodium channel, as if there was only one type of sodium channel. As the molecular revolution rolled in, it became clear that there are several types of sodium channels, each encoded by a different gene. It turns out there are nine different sodium channels. We call them Nav1.1, 1.2, all the way through to Nav1.9 [Na for sodium and v for voltage-gated].

Painful stimuli are detected by peripheral sensory nerves called nociceptors (left), which send signals through the spinal cord to the brain, where they are recognized as pain.

CREDIT: MARC PHARES / SCIENCE SOURCE

So could those channels be blocked to relieve pain?

When we go to the dentist, we receive a local injection of novocaine or one of its derivatives. These are sodium channel blockers, and when you receive a local injection into or near the nerves innervating a tooth, theres no pain. But if you took that same drug and put it in the form of a pill, you would also block sodium channels in the heart and brain, so you would get side effects in the central nervous system like double vision, loss of balance, sleepiness and confusion.

So early on, the question arose: Might there be a type of sodium channel that plays a key role in our peripheral nerves, particularly the pain-signaling peripheral nerves, but not in the brain? If those existed, you might be able to turn off pain signaling without central side effects. It turns out that there are three sodium channels that meet the criterion of being peripheral sodium channels; those are Nav1.7, Nav1.8 and Nav1.9.

Finding them was a huge focus of pain research, and now we know they exist. But having a target is just the beginning of the pathway to developing a new set of medications.

A lot of your work on these sodium channels involves people with rare diseases. How do they help our understanding?

In my laboratory, we first investigated people with a genetic disorder called inherited erythromelalgia. Its also known as man on fire syndrome, because these people describe their pain as feeling as if hot lava had been poured into their body, or theyd been scorched with a flame thrower. The pain is triggered by mild warmth that most of us would interpret as almost imperceptible, or certainly not painful.

We discovered that individuals with inherited erythromelalgia all carry mutations in the same gene, the gene that encodes Nav1.7. You can think of the Nav1.7 channel as a volume knob on pain-signaling neurons, and in these individuals the volume knob is turned way up their channels are overactive.

A few years after those families were found, the opposite mutations were found: families with loss-of-function mutations of Nav1.7. These people do not make functional Nav1.7 sodium channels, and they sustain painless bone fractures, painless childbirth, painless tooth extraction, painless burns. But these individuals dont have any other apparent abnormalities of the central nervous system.

Scientists are starting to understand the root causes of certain inherited pain abnormalities. People with a rare genetic disease called inherited erythromelalgia feel pain much more intensely than normal because they carry a mutation that increases the activity of the sodium channel Nav1.7 in pain nerve cells. This causes the nerves to fire more readily. Others, with a congenital insensitivity to pain, carry a defective Nav1.7 sodium channel, so the pain nerves dont fire. People with a third mutation, in the potassium channel Kv7.2, are resilient to pain because the mutation reduces the activity of pain nerves.

So that seems to suggest that, first of all, Nav1.7 is crucial for the sensation of pain?

Thats correct.

And secondly, that these sodium channels are found only or mainly in pain-sensing neurons?

In a broad-brush way, thats correct. There may be small numbers of Nav1.7 channels in particular parts of the brain, but very importantly the individuals with the loss-of-function mutations of Nav1.7 dont have any apparent neurologic abnormalities other than the inability to smell. The clinical studies that have been done on drugs that block Nav1.7 thus far have not yielded substantial side effects related to an effect on the brain.

Are there other rare disorders that might help here, too?

We occasionally encounter people with genetic mutations that should cause very, very extreme pain like mutations in the gene for Nav1.7 that cause erythromelalgia and who for some reason are resilient to developing that abnormal pain, although they still feel normal nociceptive pain. Weve begun to study small numbers of such pain-resilient patients, and in those we have found other genetic variants in certain other genes that confer pain resilience. They do this by turning down the pain response and returning it to near normal.

Again, that may have implications for drug development, because by targeting those genes or the molecules produced by those genes, it may be possible to make an individual pain-resilient to develop medications that will, in a sense, mimic pain resilience.

Can you give any hints about what types of molecules or what types of genes are making people pain-resilient?

Were really excited about a gene that encodes a potassium ion channel called Kv7.2. This channel in a sense acts as a brake on neurons. It lowers their ability to produce nerve impulses and decreases the frequency of nerve impulse firing. In that respect, it acts the opposite to the Nav1.7 channel.

Weve studied one individual in great detail. We know that because of her inherited erythromelalgia, she should have very severe pain but her pain is very, very mild, and its because her Kv7.2 channels are overactive. So this opens up Kv7.2 as a potential target.

Why is it so hard to find new medications for pain?

When youre trying to develop a new drug for cancer, you have biomarkers like blood counts, or you can do various types of scans and measure the size of the cancer. We dont have that for pain we ask patients to rate their pain on a scale from 0 to 10. So we dont have objective measurements.

Another point is that animal studies have not produced drugs that work in people. Finally, people with pain can show a striking placebo response, which of course confounds measurements.

And these issues are superimposed on the general issues of how you develop a new medication. Having a molecule that works in the laboratory gets you only partway there. You have to engineer it into a deliverable form, and you have to make sure the side effect profile is acceptable and the drug is safe. You have to deal with things like dosage, all in a world where clinical trials are very costly, so you dont get to do a lot of them.

When you put it all together, the challenge is immense. Despite that, Im optimistic.

Youve been doing this a long time, and there are a lot of challenges. What keeps you working on this problem?

Part of it is self-serving; its a lot of fun to be a biomedical scientist. But theres also a component that serves others. On my wall I have a picture of two children with inherited erythromelalgia. Weve learned so much from these children and their parents; they have been remarkably generous in sharing their DNA and their stories. The picture is to remind me that were part of a pipeline from the laboratory to society, and there are people depending on us.

On the hard days, when things dont go perfectly well in the laboratory and there are hard days I look at that picture, I show it to my colleagues, and I say, Look, the work were doing matters, its important for people who are depending on us. And thats something I find very motivating.

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Chasing the genes behind pain - Knowable Magazine

Scientists in Dubai have uncovered the genetic blueprint of Covid-19, as part of a global effort to understand the virus and develop lifesaving treatments.

Researchers at the Mohammed bin Rashid University of Medicine and Health Sciences (MBRU) completed the first full genome sequencing of the virus to have taken place in the country, after analysing samples taken from a patient in Dubai.

Scientists in other parts of the world have carried out similar work and it is hoped, that by comparing genome sequences from different places, experts will develop an understanding of how the virus mutates and spreads from person to person.

The genetic work will also be invaluable in developing treatments and a vaccine, experts believe.

Scientific research is a critical resource to inform strategies and actions against this virus

Amer Sharif, Mohammed bin Rashid University

Different strains of the virus might behave differently, and this information can also help us put together a picture of how it spreads in the community and throughout the world, Ahmad Abou Tayoun, associate professor of genetics at MBRU, told The National.

We can identify the most prevalent strains and those which require the most surveillance.

Dr Tayoun, who is also director of the Genomics Centre at Al Jalila Childrens hospital in Dubai, said the work could prove especially important in the UAE, given its position as a global travel hub.

In the UAE, we are a meeting point between east and west, so there are multiple different entry points," he said.

"Different viruses have already been sequenced in China, the US and Europe, so it will be interesting to see where we fit in this globally. Do we have just one strain, or all of them?

This work can also help us later on in developing vaccines and making them as effective as possible.

A Civil Defence officer disinfects the streets of Mussaffah using a swivel-mounted high-pressure jet. All photos by Victor Besa / The National

The operation serves two purposes: ensuring traces of the virus, whether on vehicles and dropped masks or gloves, are sterilised, and physically keeping people at home

A police officer asks a resident, who is just out of shot, to go home

Every night for weeks vehicles have sprayed the country with chemicals that kill germs

Abu Dhabi Civil Defence personnel gather for a photo at the start of the night

Crews work all night to cover ground in some of the city's most densely populated areas

Captain Mohammed Al Ahbabi of Abu Dhabi Police speaks to a camera crew from Al Roeya, The National's Arabic-language sister newspaper

Captain Mohammed Al Ahbabi directs a colleague during a sweep of the streets

Civil Defence form the backbone of the street operations

A police officer in a white suit hands out a face mask and gloves to a resident who had none, just before the 8pm curfew begins

The country's leaders have praised public servants for their work around the clock to tackle the virus

The research is important as the genetic blueprint of a virus subtly changes as it mutates.

UK and German researchers have already completed early work on the evolutionary paths of the virus, and have found three distinct "variants" of Covid-19.

The specific strain found in the Dubai patient was most similar to one commonly associated with Illinois, USA, the researchers found.

However, sequencing is to be carried out on virus samples from 240 other patients in the UAE, who became infected at different times in the pandemic, to build a fuller understanding of the situation.

Scientific research is a critical resource to inform strategies and actions against this virus, Amer Sharif, Vice Chancellor of MBRU and head of Dubais Covid-19 Command and Control Centre, said.

We are fortunate to have academic institutions that can join other sectors in Dubai in the fight against Covid-19.

Genome sequencing has increasingly become an important tool for studying disease outbreaks.

The genome of the virus causing Covid-19 consists of 30,000 genetic letters.

Understanding which strain of the virus patients have can help scientists understand how it spreads as, for example, a group of patients found with identical strains are likely to be part of the same cluster.

The work is particularly important as the Covid-19 virus is believed to have originated in animals, and has only recently begun infecting humans.

Scientists believe the virus may still be adapting as part of its shift to infecting people and interacting with human immune systems.

Viruses will accumulate mutations which allow them, for example, to evade immune responses.

"If there is variability in key parts of the virus, it would be incredibly important for vaccine design," Paul Klenerman, a professor at the University of Oxford, recently told the BBC.

In separate studies, the genetics of different people are also being examined to see if this could explain why some coronavirus patients develop no or minor symptoms after becoming infected, while others become critically unwell or die.

In the UAE, the genome research will also look at whether different strains of the disease are more deadly.

This development highlights the critical role of science and the scientific community in enhancing our capacity to fight emerging diseases, said Professor Alawi Alsheikh-Ali, MBRUs provost and a scientific adviser to Dubai authorities.

We will also collect information on the severity of disease in our patients which can help us understand if different strains of the virus are associated with different levels of disease severity.

Updated: April 16, 2020 02:12 AM

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UAE scientists uncover genetic make-up of Covid-19 - The National

The single biggest threat to mans continued dominance on the planet is thevirus. Joshua Lederberg, Nobel Prize in Physiology or Medicine, 1958

One of the most terrifying aspects of the COVID-19 pandemic is that we dont know what makes one person die, another suffer for weeks, another have just a cough and fatigue, and yet another have no symptoms at all. Even the experts are flummoxed.

Ive been puzzled from the beginning by the sharp dichotomy of who gets sick. At first it was mostly older people with chronic disease, and then a young person with low risk would show up. It can be devastating and rapid in one individual but mild in another, said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease on a media webinar.

What lies behind susceptibility to COVID-19? Gender? Genetics? Geography? Behavior? Immunity? All of these factors may be at play, and they overlap.

Comedian Bill Maher blames poor immunity on eating too much sugar, and a thriving industry pitches immune-boosters, but much of the strength or weakness of an individuals immune response arises from specific combinations of inherited gene variants. Thats my take as a geneticist, and Dr. Faucis. Perhaps genetics and the immune response play a role in why one person has a mild response, yet another rapidly deteriorates into viral pneumonia and respiratory failure, he said.

During the first weeks of the pandemic, the observation that many victims were either older, had certain chronic medical conditions, or both, fed a sense of denial so widespread that young people flocked to Spring Break beaches as older folks boarded cruise ships in Florida as recently as early March. And then the exceptions began to appear among the young people.

While clinicians on the front lines everywhere are saving as many lives as possible, researchers are racing to identify factors that the most vulnerable, and the most mildly affected, share, especially the asymptomatic carriers. And as the numbers continue to climb and more familiar possible risk factors are minimized or dismissed age, location, lifestyle habits genetics is emerging as an explanation for why otherwise young, strong, healthy people can die from COVID-19.

Following are possible genetic explanations for why some people become sicker than others. These are hypotheses, the language of science: ideas eventually fleshed out with observations and data. Proof is part of mathematics; in science, conclusions can change with new data. The public is getting a crash course in the scientific method.

The most obvious genetic risk factor in susceptibility to COVID-19 is being male. The details of disease demographics change daily, but males are about twice as likely to die if theyre infected as are women: 4.7% versus 2.8%.

At first people blamed the sex disparity on stereotypes, like the riskier habits of many a male compared to females. But the sex difference comes down to chromosomes.

In humans, a gene, SRY, on the Y chromosome determines sex. Males have one X and a puny Y; females have two Xs. Fortunately, nature takes care of this fundamental inequality of the sexes, which I detailed hereand in every biology textbook Ive ever written.

To compensate for the X deficit of the male, one X in every cell of a female is silenced beneath a coating of methyl groups, an epigenetic change. But which X is silenced differs, more or less at random. In a liver cell, the turned off X might be the one that the woman inherited from her father; in a skin cell, the silenced X might be the one inherited from her mother.

The immune system seems to benefit from the females patchwork expression of her X-linked genes, with a dual response. Gene variants on one X may recognize viruses, while gene variants on the other X may have a different role, such as killing virally-infected cells.

Women also make more antibodiesagainst several viral pathogens. But some of us pay the price for our robust immune response with the autoimmune disorders that we are more likely to get.

People with type O blood may be at lower risk, and with type A blood at higher risk, of getting sick from SARS-CoV-2, according to results of a recent population-based study. But the idea of type O blood protecting against viral infections goes back years.

We have three dozen blood types. Theyre inherited through genes that encode proteins that dot red blood cell (RBC) surfaces, most serving as docks for sugars that are attached one piece at a time. The RBCs of people with type O blood do not have an extra bit of a sugar that determines the other ABO types: A, B, or AB.

The unadorned RBCs of people with type O blood, like me, are less likely to latch onto norovirus (which explains why I rarely throw up), hepatitis B virus, and HIV.

An investigation of ABO blood types from the SARS epidemic of 2002 to 2003 provides a possible clue to the differences. People with blood types B and O make antibodies that block the binding of the SARS viruss spikes to ACE2 receptors on human cells growing in culture. Since the novel coronavirus enters our cells through the same receptors, are people with type O blood less likely to become infected?

Thats what researchers from several institutions in China have found in the new study. They compared the blood types of 2,173 patients with COVID-19 from three hospitals in Wuhan and Shenzhen to the distribution of blood types in the general population in each area.

People with type A blood were at higher risk than people with type 0 blood for both infection and severity of the illness.

In the general population 31% of the people are type A, 24% are type B, 9% are type AB, and 34% are type O. But among infected individuals, type A is up to 38%, type B up to 26%, AB at 10%, and type O way down to 25%.

The researchers conclude that the findings demonstrate that the ABO blood type is a biomarker for differential susceptibility of COVID-19. I think thats a bit strong for a trend, considering the exceptions. But the researchers suggest that their findings, if validated for more people, can be used to prioritize limited PPE resources and implement more vigilant surveillance and aggressive treatment for people with blood type A.

Immunity and genetics are intimately intertwined. Links between mutations both harmful and helpful and immunity to infectious diseases are well known.

Mutations in single genes lie behind several types of severe combined immune deficiencies (SCIDs), like bubble boy disease. Sets of human leukocyte antigen gene variants (HLA types) have long been associated with increased risk of autoimmune conditions such as celiac disease, type 1 diabetes, and rheumatoid arthritis, and were for many years the basis of tissue typing for transplants.

In HIV/AIDS, two specific mutations in theCCR5 gene remove a chunk of a co-receptor protein to which the virus must bind to enter a human cell. The mutation has inspired treatment strategies, including drugs, stem cell transplants, and using CRISPRto recreate the CCR5 deletion mutation by editing out part of the gene.

Might variants of the gene that encodes ACE2, the protein receptor for the novel coronavirus, protect people in the way that a CCR5 mutation blocks entry of HIV? The search is on.

Another clue to possible genetic protection against the novel coronavirus may come from the SARS experience from years ago and parasitic worm diseases in Africa. (This hypothesis I came up with on my own so Im prepared to be shouted down.)

In a human body, the SARS virus disrupts the balance of helper T cells, boosting the number of cells that fight parasitic worms (the Th2 response) while depleting the cells that protect against bacteria and viruses (the Th1 response). The resulting Th2 immune bias, in SARS as well as in COVID-19, unleashes the inflammatory cytokine storm that can progress to respiratory failure, shock, and organ failure.

In subSarahan Africa alone, a billion people have intestinal infections of parasitic worms, the most common of which is schistosomiasis. Its also called snail fever because the worms are released into fresh water from snails and burrow into peoples feet when they wade in the water.

The worms mate inside our blood vessels, releasing eggs that leave in urine and feces into the water supply. Remaining eggs can inflame the intestines and bladder. The infection begins with a rash or itch, and causes fever, cough, and muscle aches in a month or two. A drug treatment is highly effective.

Genetics determines susceptibility, or resistance to, schistosomiasis. And thats what got me thinking about COVID-19.

People who resist the flatworm infection have variants of eight genes that ignite a powerful Th2 immune response that pours out a brew of specific interferons and interleukins. Could the Th2 immune bias of the novel coronavirus SARS-CoV-2 not be as devastating to people who already have the bias, to resist schistosomiasis? If so, then places in Africa where many people are immune to schistosomiasis might have fewer cases of COVID-19.

So far parts of Africa have reported low incidence of the new disease. On April 7, the World Health Organization reported approximately 10,000 cases in all of Africa. Thats similar to the number of deaths in New York City, although Africa could be on track for the exponential growth seen elsewhere. But if the lower number in Africa persists, then maybe those eight genes are protecting people. Adding to the evidence is that the 8-gene set varies more between West Africans and Europeans than do other sets of genes.

Like the ABO blood type study, if the 8-gene signature that protects against schistosomiasis protects against COVID-19, then the signature should be overrepresented among those exposed to the virus who do not get very sick, and underrepresented among those who do. However, its possible that Africa is just behindthe rest of the world in reporting COVID-19 cases. So, a thought experiment for now.

Before researchers zero in on a highly predictive genetic signature of COVID-19 risk, we can think about how the information would best be used:

I hope that discovery of a genetic basis for COVID-19 vulnerability or resistance will not inspire discrimination unfortunately, genetic information has had a legacy of misuse.

Ricki Lewis is the GLPs senior contributing writer focusing on gene therapy and gene editing. She has a PhD in genetics and is a genetic counselor, science writer and author of The Forever Fix: Gene Therapy and the Boy Who Saved It, the only popular book about gene therapy. BIO. Follow her at her website or Twitter @rickilewis

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Can genetics explain the degrees of misery inflicted by the coronavirus? - Genetic Literacy Project

Courtesy of UC Davis Health

UC Davis scientists Marcelo Prado and Katie Zegarski load samples onto trays that will then be placed into a machine to test for coronavirus. It's one example of the vast research ongoing across the UC system to study the coronavirus.

UC Davis scientists Marcelo Prado and Katie Zegarski load samples onto trays that will then be placed into a machine to test for coronavirus. It's one example of the vast research ongoing across the UC system to study the coronavirus.

Researchers at universities across California are playing a major role in the global effort to find a cure and slow down the spread of the novel coronavirus.

The University of California, with five medical centers and major research capacity on its 10 campuses, is well-positioned to contribute to that effort, while private universities like Stanford University, with its ownresearch departments and medical school, are also working to understand and treat the disease.

With non-essential research suspended, many scientists are focused almost exclusively on fighting the virus and are doing so in a variety of ways. Doctors are working to increase the capacity to test individuals for coronavirus while also evaluating drugs to determine if they can be used as effective treatments. Virologists are studying the genetics of the virus to learn more about how it spreads and attacks human cells. There are also more niche efforts, such as a project at UC Berkeley that intends to use artificial intelligence to combat the virus.

There is an urgent need for scientists to learn as much as possible about the virus and slow its spread. Globally, the toll from the coronavirus has surpassed 116,000 deaths, according to a Johns Hopkins University tracker. That includes more than 300 deaths in California.

One of the leading sites for coronavirus research in California is at UC Davis, wheremany researchers have been studying the virus nonstop since February. Thats when the universitys medical center treated the patient who had the first diagnosed case of community spread coronavirus in the United States, meaning the patient, who had not traveled to countries where the virus was common at that time, had been infected from someone in the community.

Researchers took samples from that patient and used them to investigate the virus and begin developing their own in-house test.

The university was equipped to study the virus because of its range of research and medical centers, said Angela Haczku, who, as the associate dean for translational research at UC Daviss School of Medicine, oversees the universitys coronavirus research. The School of Medicine collaborated with the universitys Center for Immunology and Infectious Diseases and the universitys primate research center to create their own tests. The universitys primate center, where experiments are conducted using non-human primates, could also eventually be used to test and develop potential vaccines, officials said.

UC Davis began in-house testing March 19 and is now using an automated testing system that has the potential to produce more than 1,000 tests daily, Haczku said. There is a shortage of coronavirus testing nationally, and experts say that expanding testing would make it easier to slow the spread of the virus since doctors would have a better idea of who is infected.

The automated testing at UC Davis is made possible through a robot called the Roche Diagnostics cobas 6800 System. The machine, which is the size of an SUV, is already producing 400 tests a day for patients at UC Davis Health and that number could increase to up to 1,400 tests daily.

Haczku said she has dedicated almost all of her time over the past month to coronavirus-related research focused on expanding testing and on clinical trials, which involve testing drugs on patients to learn if they can work as effective treatments. UC Davis is currently conducting clinical trials of two drugs: remdesivir, an antiviral drug that was previously tested on patients with Ebola, and sarilumab, which treats arthritis.

Haczkus days start with 7 a.m. meetings with other School of Medicine administrators and end around midnight after connecting with research collaborators in Asia.

Seeing what this virus does to people, there is a motivation to work fast, she said.

Courtesy of UC Davis Health

A scientist at UC Davis tests a patient sample for coronavirus.

The other four University of California medical centers at UCLA, UC San Diego, UCSF and UC Irvine are also either doing their own in-house testing of the coronavirus or plan to soon. The five medical centers hope to combine resources, such as patient databases, to develop better testing and clinical trial capabilities, but they first need to get approval from a UC Institutional Review Board, Haczku said. Institutional Review Boards are regulatory committees that oversee research involving humans to make sure the research is ethical.

Globally, more than 200 clinical trials of different drugs are underway. One of those trials involves all five of the UC campuses with medical centers. They are among dozens of universities conducting a trial of remdesivir, an antiviral drug that scientists believe has potential to be a treatment for the virus. Stanford University is also participating in that trial. In clinical trials, drugs are administered to patients who give consent to participate in the trial after learning about any potential risks.

Dr.Bruce Aylward of the World Health Organization in February called remdesivir the one drug right now that we think may have real efficacy. President Donald Trump has also touted remdesivir, saying in March that the drug seems to have a very good result having to do with this virus.

However, remdesivir is not yet an approved treatment of COVID-19, the disease the virus causes. The Food and Drug Administration has authorized its use in emergency situations for some coronavirus patients, including the first United States patient who was diagnosed with coronavirus and the UC Davis patient who was diagnosed with the first community-acquired case of the virus in the U.S. UC Davis doctors in February gave the drug to that patient, who recovered after receiving remdesivir and has since been discharged, though doctors have warned against drawing conclusions about the drug based on a single patients experience.

Doctors will get a better sense of whether the drug is effective through the clinical trials. Patients will be eligible to be enrolled in the clinical trial if they test positive for COVID-19 and if they are being treated at one of the testing sites, such as one of the UC medical centers or Stanford.

Patients will be randomly assigned to receive either remdesivir or a placebo. The National Institutes of Health, the federal agency that is sponsoring the trial, will analyze results from the different testing sites and determine whether the drug is effective, said Dr. Neera Ahuja, who along with Dr. Kari Nadeau is one of two Stanford doctors conducting the trial.

A major advantage of the study, Ahuja said, is that if remdesivir proves to be ineffective, doctors can continue with the same trial infrastructure and easily switch to testing another drug. Thats because the study has an adaptive trial design, which is meant to make a trial more efficient by allowing changes to the study while it is ongoing.

And so unlike some of the other industry-sponsored trials where its just one drug and thats all they have, we can phase from one to the next to the next until we hopefully find something effective and then be able to hopefully fast track it to FDA approval, Ahuja told EdSource.

Remdesivir is far from the only drug being studied to fight the coronavirus.

Researchers at UC San Franciscos Quantitative Sciences Bioinstitute are looking into dozens of other drugs that could attack the virus in a different way.

While drugs like remdesivir seek to destroy the viruss own proteins, researchers at the Quantitative Sciences Bioinstitute have identified drugs that could potentially treat the virus by blocking it from interacting with proteins in human cells that the virus relies on to survive.

Theres a lot of work ongoing where people are trying to target the viral proteins, which is great. Were taking a different track, Nevan Krogan, the director of the institute, said at a virtual town hall in March.

So far, they have identified 69 drugs that could target the human proteins, including 27 that are FDA-approved.

The reason scientists are studying so many different drugs is because the current coronavirus is new to scientists and there is still much they dont know about it.

Virologists like Mike Buchmeier at UC Irvines Center for Virus Research are attempting to address that dilemma by studying exactly how the virus is spreading.

Buchmeier, who specializes in researching coronaviruses, has been researching the virus since it was discovered in China in December. Officially called SARS-CoV-2, it is a new strain of coronavirus, which is part of a large family of viruses that commonly infect many animals, including cats, cattle and bats.

In rare cases, such as with the current virus, coronaviruses can spread from animals to humans and then spread to other people, according to the Centers for Disease Control and Prevention. Health experts believe the new strain of coronavirus likely originated in bats and first spread from animals to humans at a seafood and meat market in Wuhan, China, where the outbreak began.

Buchmeiers current research, he said in an interview, involves studying the viruss RNA, a single stranded genetic material. (Many viruses have RNA instead of the double stranded DNA genetic material.) Having that information helps Buchmeier and other scientists understand the virus because they can use the genetic material to trace the origins of the virus and how it has spread. The genetic material also allows Buchmeier to better understand how the virus causes damage in humans.

And then we can use that to think about what would be a suitable vaccine, Buchmeier said.

Elsewhere across universities in California, other efforts are underway in response to the virus. For example, UC Berkeley is one of the hosts of a new artificial intelligence research consortium that is seeking research proposals that offer ways to fight the coronavirus.

The consortium, called the C3.ai Digital Transformation Institute, was created by California-based artificial intelligence company C3.ai and will be managed and hosted by UC Berkeley and the University of Illinois at Urbana-Champaign. One of the institutes co-directors is Shankar Sastry, a professor of engineering and computer science at UC Berkeley.

Early results from the research wont be available until June, but the work of other artificial intelligence companies internationally may provide a glimpse into how the technology can be used to fight the virus.

For example, the United Kingdom-based artificial intelligence company Exscientia has a collection of thousands of drugs and is using its technology to try to determine which ones can potentially treat COVID-19. Exscientia plans to use its drug-screening technology to quickly mine through the drugs and identify molecules that may be effective in fighting the coronaviruss proteins and enzymes. The company then hopes to use that information to repurpose one of the existing drugs to treat coronavirus patients.

The Berkeley institute is calling for a wide range of proposals to combat the virus, such as using machine learning to design new drugs or incentivize behavior that mitigates the spread of the virus, like social distancing.

Given the urgency of the challenge, the institute accelerated its timeline by putting out the first call for research proposals in March and asked for the proposals to be submitted by May 1. Awards will be distributed by June, but researchers who submit their proposals by April 15 could be notified of awards earlier than that.

The institute also plans to use a peer-review process that is less rigorous than is customary so it can further expedite the project and share results with the public as soon as possible. The consortium plans to start disseminating results via public forums in June. What wed like to do here is to provide for a certain adventurousness. We wont be afraid to have even a substantial fraction of the research projects fail, he said.

Sastry added that he views the institute as something that could be an intermediary between the computer science world and the public health field.I feel theres a huge new subject of academic inquiry here. And so I think that to have an intermediary between information technologies and all these societal systems, I think thats the intellectual turf of this institute. Thats really a prime excitement to me, Sastry said.

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California university researchers join the global race to fight coronavirus - EdSource

A wide range of University of New Mexico researchers from across main and north campuses are utilizing UNM Center for Advanced Research Computing resources to study COVID-19. Researchers from several departments at UNM, including Anthropology, Biology, Computer Science, Pediatrics, Internal Medicine, and various Health Sciences research centers are studying different aspects of the coronavirus pandemic.

Since the U.S. discovered its first case of COVID-19 on in January, scientists across the country have worked feverishly to understand this new and rapidly spreading disease. A collaborative team of researchers including assistant professor at the UNM Center for Global Health Daryl Domman, assistant professor at the UNM Department of Pediatrics Darrell Dinwiddie, professor at the UNM Division of Translational Informatics Tudor Oprea, and biologists at the Los Alamos National Laboratory have been using advanced computing techniques to study the genetic variations of SARS-CoV-2, the virus that causes COVID-19. By sequencing the genome of SARS-CoV-2 samples taken from positive cases in New Mexico and Wyoming, the team has been able to track mutations in the virus.

Oprea explained, Were trying to understand what the trends are with respect to the viruswhether its the same virus that came from Wuhan, or, does it mutate? How many flavors of the virus are out there? Do they cause different symptoms?

Tracking the locations of precise coronavirus strains allows researchers like Domman to understand exactly how the novel coronavirus is spreading.

What were hoping to do with this information is really understand the spread of the virus within our community, Domman reported. He explains, Traditional epidemiology is about case count datalooking at contact tracing and who might have been exposed. This data is extremely useful but its inherently limited in answering questions about how the virus is spreading.

Looking at which genetic variations of SARS-CoV-2 appear in specific locations can provide additional information beyond counting the number of positive cases in a region. Domman believes that sequencing samples of the novel coronavirus will allow scientists to identify local transmission chains, estimate how long the virus has existed within a community, and estimate how many cases are currently active within a region. Already, this project has revealed important insights into the local spread of coronavirus, including that the vast majority of early COVID-19 cases in New Mexico and Wyoming can be attributed to European travel.

Meanwhile, the New Mexico Decedent Image Database (NMDID), since its website launch in January of this year, has already been a source of valuable information for COVID-19 research. The NMDID is a free resource that gives researchers access to over 15,000 decedent full-body CT scans and a wealth of information about the deceased. CARC houses and maintains the database in collaboration with UNM associate professor of Anthropology and creator of NMDID Heather Edgar. Researchers at Johns Hopkins University have been using NMDID to better understand how COVID-19 affects its victims.

Edgar said, Theyre using about 34 or so CTs of decedents who died of pneumonia and comparing [them] to people who have COVID-19basically looking to see how similar or different the new disease is to the things were used to looking at.

Across campus at the UNM Moses Biological Computation Lab, Computer Science and Biology professor Melanie Moses and research assistant Vanessa Surjadidjaja are using CARC resources to understand how the human lung responds to a viral pathogen like SARS-CoV-2.

Currently, there is much to learn about how our immune systems are responding to the novel coronavirus. Our research aims to understand how the immune system, specifically T cells, find cells infected with SARS-CoV-2 dispersed in the lung, Surjadidjaja explained. Their study uses laboratory data and computer simulations to visualize interactions between immune cells and viruses within the complex structures inside the lung. Their goal is to predict how viral load changes over the course of an infection, an important component of disease severity and transmissibility between people.

All of these studies are ongoing and will continue to develop quickly as scientists do their best to make a positive impact during this tumultuous time.

Oprea captured the current mood of many research teams when he said, Everyone works with a sense of urgency. We are well aware that until a vaccine is found, the world will be in stand-by mode. Were just trying to do our part.

Domman stressed the importance of providing local authorities with the information they need to make prudent policy choices, commenting, In the more immediate, its about providing that actionable data to the folks who will do some good with it.

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UNM researchers use advanced computing to study COVID-19 - UNM Newsroom

Transmission electron micrograph of the SARS-CoV-2 virus. Image credit: NIAID

Scientists have developed an inexpensive new test that can rapidly diagnose COVID-19 infections, a timely advance that comes as clinicians and public health officials are scrambling to cope with testing backlogs while the number of cases continues to climb.

Developed at UC San Francisco and Mammoth Biosciences, the new test officially named the SARS-CoV-2 DETECTR is easy to implement and to interpret, and requires no specialized equipment, which is likely to make the test more widely available than the current crop of COVID-19 test kits. Though the new test has yet to receive formal approval for clinical use from the U.S. Food and Drug Administration, UCSF researchers are clinically validating the test in an effort to fast-track the approval process through a so-called Emergency Use Authorization.

The introduction and availability of CRISPR technology will accelerate deployment of the next generation of tests to diagnose COVID-19 infection, said Charles Chiu, MD, PhD, professor of laboratory medicine at UCSF and co-lead developer of the new test, which is described in a paper published April 16, 2020, in the journal Nature Biotechnology.

The new SARS-CoV-2 DETECTR assay is among the first to use CRISPR gene-targeting technology to test for the presence of the novel coronavirus. Since CRISPR can be modified to target any genetic sequence, the test kits developers programmed it to home in on two target regions in the genome of the novel coronavirus. One of these sequences is common to all SARS-like coronaviruses, while the other is unique to SARS-CoV-2, which causes COVID-19. Testing for the presence of both sequences ensures that the new DETECTR tool can distinguish between SARS-CoV-2 and closely related viruses.

Much like the diagnostic kits currently in use, the new test can detect the novel coronavirus in samples obtained from respiratory swabs. However, the new test is able to provide a diagnosis much more quickly. While the widely used tests based on polymerase chain reaction (PCR) techniques take about four hours to produce a result from a respiratory sample, the new DETECTR test takes only 45 minutes, rapidly accelerating the pace of diagnosis.

Another key advantage of the new DETECTR test is that it can be performed in virtually any lab, using off-the-shelf reagents and common equipment. This stands in stark contrast to PCR-based tests, which require expensive, specialized equipment, limiting those tests to well-equipped diagnostic labs. Plus, the new DETECTR test is easy to interpret: much like a store-bought pregnancy test, dark lines that appear on test strips indicate the presence of viral genes.

The new test is also highly sensitive. It can detect the presence of as few as 10 coronaviruses in a microliter of fluid taken from a patient a volume many hundreds of times smaller than an average drop of water. Though slightly less sensitive than existing PCR-based tests, which can detect as few as 3.2 copies of the virus per microliter, the difference is unlikely to have a noticeable impact in diagnosis, as infected patients typically have much higher viral loads.

The SARS-CoV-2 DETECTR adds to a rapidly growing suite of new COVID-19 diagnostic tests that researchers and clinicians hope will increase testing capacity, including tests for specific antibodies in patients who have recovered from COVID-19 infection.

As researchers work to validate the new DETECTR test for FDA approval, its developers are continuing to make modifications to the test kit so that it can be used for field testing at sites like airports, schools, and small clinics.

Authors: James PBroughton of Mammoth Biosciences and Xianding Deng of UCSF are co-lead authors of the study. Charles Chiu of UCSF and JaniceChen of Mammoth Biosciences are co-senior authors of the study. Additional authors include Guixia Yu, Venice Servellita, Jessica Streithorst, AndreaGranados,AliciaSotomayor-Gonzalez, AllanGopez, ElaineHsu, WeiGu, and SteveMiller, and Kelsey Zorn, of UCSF; Clare LFasching, JasmeetSingh, and Xin Miao of Mammoth Biosciences; and Chao-YangPan,HugoGuevara,and DebraWadford of the California Department of Public Health.

Funding: This work was supported by National Institutes of Health (NIH) grants R33-AI129455 from the National Institute of Allergy and Infectious Diseases and R01-HL105704 from the National Heart, Lung, and Blood Institute; the Charles and Helen Schwab Foundation; and Mammoth Biosciences, Inc.

Disclosures: Chiu is the director of the UCSF-Abbott Viral Diagnostics and Discovery Center (VDDC), receives research support funding from Abbott Laboratories, and is on the Scientific Advisory Board of Mammoth Biosciences, Inc. Chen is a co-founder of Mammoth Biosciences, Inc. Broughton, Fasching, Singh, and Miao are employees of Mammoth Biosciences, Inc. Chiu, Broughton, Deng, Fasching, Singh, Miao and Chen are co-inventors of CRISPR-related technologies.

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.

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New CRISPR-Based COVID-19 Test Kit Can Diagnose Infection in Less Than an Hour - UCSF News Services

For students at the University of Vermont, knowledge knows no bounds. Near or far from campus, they study everything from the most complex micro-ecosystems on the planet to the biggest threats to democracy today; they're engaged year-round, day and night, all in pursuit of knowledge. As this academic year enters its final stretch, we take a look at some of the most exciting research projects UVM students have worked on this year.

Want more? Hundreds of student research projects from every discipline are ready to discover at the Virtual Student Research Conference. Engage with student researchers online from Thursday, April 16, to Thursday, April 23.

According to animal science student Jamie Burke 20, pictured above, the inside of a cows stomach contains one of the most complex micro-ecosystems in the world. She would know, as shes helped create and sustain six artificial cow rumens in Professor Sabrina Greenwoods lab in the College of Agriculture and Life Sciences.

To better understand how introducing amino acid supplements into a cows diet might ultimately improve health and nutrition properties in dairy products, Burkewith guidance from professor Jana Kraftfed and maintained fermenters that mimicked the activity that takes place inside a cow's stomach.She and the research team in Krafts lab specifically analyzed the branched-chain fatty acids (BCFA) in protozoal cell membranes in the artificial rumen ferment.

But they had one hiccup: in a real rumen, most protozoa like to attach to the rumen wall; in an artificial rumen, that hospitable surface doesnt exist. So, Burke 3D printed a filter for the ferment. This 3D-printed support can serve as a model for all continuous culture fermenter systems to promote protozoa retention, maintain fluid flow, and allow for better comparisons of protozoa numbers in different systems, she says.

Preparing for a weekend ahead, Danielle Allen makes sure the cells she's growing in the Thali lab for her HIV research will stay "happy and healthy" until Monday when she returns. (Video: Rachel Leslie)

Viruses are absolutely fascinating, says molecular genetics senior Danielle Allen, who is conducting research on the spread of HIV at the cellular level in Professor Markus Thalis lab at the College of Agriculture and Life Sciences. Allens research is focused on one of the relevant host proteins, EWI-2, active in cell fusion, which can occur when a viral protein in an HIV-infected cell binds to a surface protein on an uninfected cell. EWI-2 is also an active component in other biological functions, including cancer metastasis, sperm-egg fusion and muscle regeneration. But while it is a known fusion inhibitor, the proteins mechanism of fusion inhibition is not well understood.

Thats where Allen set her sights. Using fluorescence microscopy, she determined optimal transfection conditions for EWI-2 mutant plasmids to obtain equal surface expression of each EWI-2. Allen also designed a new fusion assay system that could be used for future fusion assays to further characterize EWI-2s mechanism of fusion inhibition.

By understanding these proteins involved in HIV transmission, we might be able to develop better treatments for HIV, which is really important since the current treatments are intense and there isnt a cure, says Allen. Ive learned a lot of different techniques that I didnt know beforeeverything from growing DNA in E. coli to isolating the DNA, transfecting HeLa cells, a lot of stuff with florescence microscopy and staining cells with antibodiesa lot of stuff you just dont really have time to learn in lectures in undergraduate teaching labs.

Political science and history double major Jason Goldfarb. (Photo: Sally McCay)

Jason Goldfarb 20 grew up hearing about the ways social media connected the world, exposing truths in the Arab Spring and elevating causes like the Black Lives Matter movement. But headlines of Russian propagandists and Cambridge Analytica following the 2016 U.S. election prompted Goldfarb to wonder: is social media helping or harming us? In the seniors thesis project for the College of Arts and Sciences, Scrolling Alone: The Impact of Social Media on American Democracy, he outlines a disturbing finding: Although there is potential for social media to live up to its promise of connecting the world, the present platforms harm civic discourse, Goldfarb says.

A double major in political science and history, his research considers technology through both lenses, drawing parallels between Facebook and other revolutionary technologies throughout time. Think of the automobile, notes Goldfarb. It democratized transportation, revolutionized warfare, and changed the way in which cities are designed. Social media, he argues, has similarly transformed much of todays world, stoking polarization, encouraging distraction, and eroding privacy. The paper was published in the Undergraduate Journal of Politics, Policy and Society in late 2019. Under the guidance of Dr. Amani Whitfield and Professor Bob Pepperman Taylor, its my proudest accomplishment at UVM.

Anthropology major Rose Lillpopp. (Photo: Sally McCay)

From University Row to upscale private events, it seems like food trucks can be found everywhere these days. Though lauded as an entrepreneurial feat for the past decade, College of Arts and Sciences anthropology student Rose Lillpopp 20 says that food trucks have historical roots and repercussions in the street food vending industry that run deep. Her research digs into the positive and negative influences food trucks have on our foodways and social relationships, and grapples with topics like immigration, identity, race, class and public policy.

In addition to sampling the menus of dozens of food trucks, Lillpopp developed relationships with vendors and customers she interviewed about how a vendors authenticity or legitimacy is earned, how their brands are perceived and what customers convey about themselves when they order in public spaces.

For example, Customers patronizing a vegan truck versus a wagyu beef truck are claiming different identities that come with various moral or economic prestige, she explains. Because food trucks have been under-researched and taken for granted, this conflicted history is erased by the fallacy that the gourmet food truck is unattached to these less privileged forms of vending.

Business student Mateo Florez. (Photo: Sally McCay)

While much about the use and effects of e-cigarettes remain unknown, entrepreneurship and marketing student Mateo Florez 20 is searching for answers about why these vaping products are so popular among college students.

For his Grossman School of Business research, he collected data from 750 undergraduate students about their basic demographics, substance use and preferences to run a statistical analysis technique, called a conjoint analysis. Ultimately, the analysis will provide insight on the relative value each respondent places on certain attributes of vapingincluding social context while vaping, substance effect from vaping and health risksand will be able to establish a possible correlation between demographics and e-cigarette use.

E-cigarettes have exploded in popularity during the past couple years, and understanding more about the driving forces behind e-cigarette consumption can provide both policymakers and consumers better insight into the root causes of this trend, he says.

Hannah Sheehy (center) teaches fellow student research assistants about a new rubric she developed to measure the quality of the childrens storytelling. (Video: Janet Franz)

Not all research endeavors result in storybook endings, but for the families that Hannah Sheehy and Provost Patty Prelock collaborated with for a study about Theory of Mind (ToM)the ability to attribute mental states to oneself and others, one of the primary challenges of autism spectrum disorder (ASD)its been just that.

As a research team coordinator for Prelocks study, Sheehy,a communication sciences and disorders senior in the College of Nursing and Health Sciences, assisted three families with ASD children throughout a six-week reading intervention program designed to help bolster their students ToM. The intervention program incorporated parent-led stories and picture books with ToM elements such as visual perspective-taking and emotion recognition, and included scripts to help parents further facilitate discussion with their child about the stories. Sheehy collected and analyzed the data from the program and found that each child improved not only their ToM score, but their own language complexity and story coherence abilities as well.

Pointing out a characters facial expression or asking the child how they think a character is feeling helped the children understand peoples emotions and become stronger storytellers themselves, which is an important social skill, says Sheehy. Ive loved seeing how the study empowers parents to incorporate simple book-reading strategies that scaffold their childs ToM development into their everyday lives and conversations.

Business student Michael Chan. (Photo: Sally McCay)

Recognizing the increasing demand for sustainable and socially responsible businesses and products,Michael Chanwas curious about how that trend found its way into local communities. A double major in business and environmental sciences, Chans research looked to an unexpected source for answers: marginalized small business owners. Small businesses are key change agents in their communitys transformation toward a more sustainable future, he says.

Chan conducted personal interviews with local entrepreneurs of varying genders, geographic locations, races, industries and sizes about how they started and grew their businesses. He then analyzed major trends among their experiences by applying constructivist grounded theory to their narratives. What he noticed was that, despite their identity and industry differences, major themes of family, resilience and care for others emerged, connecting identity groups.

Storytelling is a powerful tool in changing the world around us, Chan says. When it comes to building a more sustainable and socially responsible future, his findings indicate that connecting to the experiences of those deemed other in our communities will increase awareness of our individual purchasing power.

Medical Laboratory Science major Sierra Walters maintains cancer cell lines for genetic experiments. Her work contributes to a project investigating the alterations of a gene associated with lung cancer, the leading cause of worldwide cancer-related mortality. (Video: Janet Franz)

How to tell if a malignant tumor will be responsive to treatment? In her time at UVM, senior Sierra Walters has worked to help researchers better answer that question. Specifically, a team working with College of Nursing and Health Sciences professor Paula Deming and Larner College of Medicine professor David Seward is taking a closer look at a protein, STK11, thats been implicated in certain types of lung cancer and can equate to a poor prognosis. The big picture to this project is to study how different genetic variations in the STK11 gene alter the proteins function, explains Walters, with the hope of someday aiding doctors and labs profiling the tumors of lung cancer patients. Im so grateful to have gotten involved in this project so early in my college career, says Walters, a medical laboratory science major in the College of Nursing and Health Sciences. While the research is on pause during remote instruction, the team still meets weekly. And her time at UVM isnt done; after graduation, Walters will pursue her masters, and work in the microbiology department at UVM Medical Center. Having a hands-on job where Im constantly trying new things and working with other students in the lab helped prepare me for the future.

Writing for this piece contributed by Kaitie Catania, Andrea Estey, Janet Franz and Rachel Leslie. Photos by Josh Brown and Sally McCay. Videos by Janet Franz and Rachel Leslie.

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The Pursuit of Knowledge | UVM Today | The - UVM News

SAN DIEGO, April 16, 2020 (GLOBE NEWSWIRE) -- Turning Point Therapeutics, Inc. (NASDAQ: TPTX), a precision oncology company developing next-generation therapies that target genetic drivers of cancer, today announced the publication of preclinical data and patient case studies from the Phase 1 portion of its TRIDENT-1 clinical study for its lead investigational drug, repotrectinib.

Among the findings published in the American Association of Cancer Research peer-reviewed journal, Clinical Cancer Research, repotrectinib demonstrated potent in vitro and in vivo activity in patient-derived preclinical models compared with proxy chemical compounds for other tyrosine kinase inhibitors (TKIs) against ROS1 and the ROS1 G2032R solvent-front mutation. The central nervous system (CNS) activity of repotrectinib was studied in an in vivo model and demonstrated significant reduction of metastatic brain lesions with longer survival compared to a proxy chemical compound for entrectinib.

Our findings provide encouraging support for repotrectinib as a potential first-line treatment in ROS1-positive non-small cell lung cancer, and later-line use after progression from a prior ROS1 TKI, said Dr.Byoung Chul Cho,Division of Medical Oncology, Yonsei Cancer CenteratSeverance Hospital,Yonsei University College of Medicine,Seoul,Republic of Korea and corresponding author of the paper. In addition, these preclinical data as presented initially at the annual AACR conference in 2019 and now expanded upon in the publication suggest repotrectinib may prevent or delay the emergence of the G2032R solvent-front mutation and subsequent compound mutations, potentially improving clinical outcomes.

In preclinical studies, repotrectinib potently inhibited in vitro and in vivo tumor growth and ROS1-downstream signaling in treatment-nave models compared with proxy chemical compounds for crizotinib, ceritinib, and entrectinib. Compared to a lorlatinib proxy chemical compound in a xenograft model, repotrectinib markedly delayed the onset of tumor recurrence following drug withdrawal. In addition, repotrectinib induced anti-tumor activity in the CNS. Repotrectinib also showed selective and potent in vitro and in vivo activity against the ROS1 G2032R solvent-front mutation.

Patient case studies (from the previously reported July 22, 2019 data cut-off) included in the manuscript highlighted the potential for repotrectinib to prevent or delay ROS1 kinase domain resistance mutations.

The emergence of resistance mutations and disease progression in the CNS are characteristics of ROS1-positive non-small cell lung cancer and represent a high unmet medical need given the lack of approved therapies, said Dr. Mohammad Hirmand, chief medical officer of Turning Point Therapeutics. These findings highlighted in Clinical Cancer Research build on prior preclinical studies of repotrectinib and data we have shown from the Phase 1 portion of TRIDENT-1, and are encouraging for repotrectinib as a potential treatment for both TKI-nave and -pretreated ROS1-positive non-small cell lung cancer patients.

Approximately 50 to 60 percent of crizotinib-resistant mutations are found within the ROS1 kinase, of which the ROS1 G2032R solvent-front mutation is the most common. In addition, it is estimated that approximately 50 percent of patients treated with ROS1-TKIs experience disease progression due to CNS metastases.

The Clinical Cancer Research article may be found online at https://clincancerres.aacrjournals.org/content/early/2020/04/08/1078-0432.CCR-19-2777

More information about the ongoing TRIDENT-1 study of repotrectinib may be found by searching clinical trial identifier NCT03093116 at https://clinicaltrials.gov.

About Turning Point Therapeutics Inc.Turning Point Therapeuticsis a clinical-stage precision oncology company with a pipeline of internally discovered investigational drugs designed to address key limitations of existing cancer therapies. The companys lead drug candidate, repotrectinib, is a next-generation kinase inhibitor targeting the ROS1 and TRK oncogenic drivers of non-small cell lung cancer and advanced solid tumors. Repotrectinib, which is currently being studied in a registrational Phase 2 study in adults and a Phase 1/2 study in pediatric patients, has shown antitumor activity and durable responses among kinase inhibitor treatment-nave and pre-treated patients. The companys pipeline of drug candidates also includes TPX-0022, targeting MET, CSF1R and SRC, which is currently being studied in a Phase 1 trial of patients with advanced or metastatic solid tumors harboring genetic alterations in MET; TPX-0046, targeting RET and SRC, which is currently being studied in a Phase 1/2 trial of patients with advanced or metastatic solid tumors harboring genetic alterations in RET; and TPX-0131, a next-generation ALK inhibitor entering IND-enabling studies. Turning Points next-generation kinase inhibitors are designed to bind to their targets with greater precision and affinity than existing therapies, with a novel, compact structure that has demonstrated an ability to potentially overcome treatment resistance common with other kinase inhibitors. The company is driven to develop therapies that mark a turning point for patients in their cancer treatment. For more information, visit http://www.tptherapeutics.com.

Forward Looking StatementsStatements contained in this press release regarding matters that are not historical facts are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Such forward-looking statements include statements regarding, among other things, the efficacy, safety and therapeutic potential of Turning Point Therapeutics drug candidate repotrectinib, and the results, conduct, and progress of Turning Point Therapeutics TRIDENT-1 clinical study of repotrectinib. Because such statements are subject to risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements. Words such as plans, will, believes, anticipates, expects, intends, goal, potential and similar expressions are intended to identify forward-looking statements. These forward-looking statements are based upon Turning Point Therapeutics current expectations and involve assumptions that may never materialize or may prove to be incorrect. Actual results could differ materially from those anticipated in such forward-looking statements as a result of various risks and uncertainties, which include, without limitation, risks and uncertainties associated with Turning Point Therapeutics business in general, and the other risks described in Turning Point Therapeutics filings with the SEC. All forward-looking statements contained in this press release speak only as of the date on which they were made. Turning Point Therapeutics undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made.

Jim Mazzolajim.mazzola@tptherapeutics.com858-342-8272

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Clinical Cancer Research Highlights Potent Antitumor Activity of Repotrectinib in Treatment-Nave and Solvent-Front Mutation Ros1-Positive Non-Small...

The Oregon State University veterinary laboratory teamed up with a private lab to use its expertise to boost testing and tracking of the COVID-19 virus, even after its offer of help drew scant interest from state health officials.

(CDC file art)

Published by arrangement with The Lund Reporthttps://www.thelundreport.org/

Specialists at Oregon State Universitys veterinary laboratory figured they could help the state ramp up testing for coronavirus. They run a sophisticated facility with state-of-the-art testing equipment, and theyre experts atdiagnostics and tracking viruses.

But they couldnt just start running COVID-19 tests. They faced a tangle of red tape.

So they approached the Oregon Health Authority, and a lawmaker contacted Gov. Kate Browns office for help. That led nowhere. The authority did not give them any support, and Browns office did not follow up with them, according to interviews and documents obtained by The Lund Report.

The labs managers did not give up. They forged ahead, dismantling obstacles without the states help. They joined forces with a commercial medical lab in Corvallis. In a joint effort, the two labs plan to launch their first COVID-19 tests on Wednesday. The project expects to run nearly 1,000 COVID-19 a day, giving Oregon a much-needed boost in its efforts to track the virus. Right now, Oregon tests between 7,000 and 8,000 people a week, Brown said.

Oregons lack of adequate testing infrastructure has dogged the states efforts to contain the virus. State public health officials repeatedly have said the state needs more tests to halt the spread, something that Brown repeated at a news conference on Tuesday."We need to ramp up testing in every region of the state," she said.

Yet state officials did not pursue a homegrown opportunity that taps the expertise of an Oregon university research laboratory.

From the start, testing has lagged in Oregon. Initial kits from the Centers for Disease Control and Prevention were faulty, and there was a lack of supplies. The state expected all tests to be conducted at the public health lab in Hillsboro but has since allowed testing by five hospital systems, two private labs and the University of Washington. Still, the state only has results for about 30,000 people, according to an Oregon Health Authority report on Monday.

The OSU project shines a light on the difficulties faced by entities outside the public health system to help Oregon track and quell the epidemic. The Oregon Health Authority apparently failed to recognize the contribution a veterinary lab could make despite examples in other states.

University veterinary labs in at least two other states Colorado and Oklahoma have been conducting COVID-19 testing for weeks. Each can process hundreds of tests a day. Their veterinary labs unlike OSUs had help from public authorities.

Physicians lack drugs to fight the virus, and it will be a year or more before a vaccine is on the market. The only tool public health officials have right now are tests.

"Testing is an essential pillar of any public health response to a disease outbreak, Dr. Sharon Meieran, a Multnomah County commissioner and emergency room doctor, told The Lund Report in an email. It allows for case identification, contact tracing and importantly, especially in congregate settings, the ability to isolate individuals who are infected so that they do not risk infecting others. Any increase in our capacity to test for COVID-19 will aid in our ability to respond to this disease at both an individual and community level."

Experts say that the more entities that test and the quicker the results, the sooner people will isolate themselves and stop spreading the highly contagious virus.

The lack of testing from the beginning has been one of the leading causes for where we are now," said Chunhuei Chi, director of OSUs Center for Global Health.

Lab Has Diagnostic Track Record

In Oregon, the idea to get the veterinary lab involved came from the medical community in Corvallis, including Good Samaritan Regional Medical Center. Frustrated over long waits for testing results, physicians approached the Oregon Veterinary Diagnostic Laboratory at OSU last month to see if officials there could use their equipment to run COVID-19 tests. The lab was a prime candidate to help.

Any additional testing capacity that they can provide would be welcomed by the region and the state of Oregon, said Dr. Adam Brady, an infectious disease specialist and chairman of the hospitals coronavirus task force, in an email.

The lab, part of the universitys Carlson College of Veterinary Medicine, has a long history of tracking illness, like viruses in sheep and hoof and mouth disease in cattle. It works with state epidemiologists and is part of a U.S. Food and Drug Administration network of about 45 facilities nationwide that specialize in investigating animal diseases. They analyze animal blood, urine, stool and tissue samples for signs of illnesses to help the federal agency investigate complaints about tainted food and drugs.

One of the labs machines extracts genetic material from samples, usually collected via nasal swabs. The other machine analyzes the genetic material and provides the results.

This is just the sort of technology needed to conduct COVID-19 tests.

Mark Ackermann, director of the veterinary lab, wanted to help out but to run human analyses, a lab needs to be certified by the Centers for Medicare & Medicaid Services. His lab lacked that certification.

To obtain it, a lab has to meet federal standards. That process is complicated and takes time, even for a research lab that already meets other federal standards to track diseases in animals.

So Ackermann asked the Oregon Health Authority for help in smoothing the way for the veterinary lab to conduct tests on its own or work with another facility.

Agency officials visited the lab and discussed federal certification requirements, said Jonathan Modie, a spokesman for the agency. But they didnt help. Theysuggested that Ackermann contact clinical laboratories instead.

Early on, Ackermann received support from Sen. Sara Gelser, D-Corvallis, who saw the potential in the idea. On March 26, Gelser tried to enlist the support of Gov. Kate Brown by emailing Browns chief of staff, Nik Blosser, and copying other lawmakers. That email, obtained by The Lund Report, encouraged the governors office to consider an executive order allowing COVID-19 tests at research universities. Gelser pointed out that Oklahomas governor had issued such an order enabling a university veterinary lab there to participate in testing.

Would the governor consider a similar executive order so that OSU could make the same application and hopefully come online immediately, Gelser wrote, calling it a game-changer for containment efforts.

Charles Boyle, a spokesman for Brown, said the office passed along the request to the health authority. He referred a reporter to the health authority for further comment.

Ackermann said he never heard from the governors office.

Partnership Is Formed

But the lab found a way forward on its own.

At the same time that Ackermann was crashing into a regulatory wall, another lab in Corvallis was trying to conduct testing. WVT Laboratory, a commercial lab that normally analyzes toxins in urine and runs drug tests, contacted Benton Countys emergency operations center to see what it needed to do to conductCOVID-19 testing. That contact led to WVT hooking up with OSU through Dr. Bruce Thomson, a retired family physician in Corvallis who does consulting work for the county.

The two labs complemented each other.

WVT Laboratory has the necessary certification from CMS to conduct COVID-19 testing. It also has an approved records system that meets federal privacy regulations for patients. And the veterinary lab has the equipment that WVT needed to run the tests.

Less than a week after they met on April 1, the heads of the two labs decided that OSU would contribute its equipment. The university lab will extract the genetic material from tests and WVT will run the tests. After contacting the county, the pact came together quickly, said Manny Cruz, chief executive officer of WVT, which has a staff of eight people.

In an interview, Thomson gave the Oregon Health Authority credit for visiting Corvallis even though that didnt lead to anything.

I know they were pretty darn busy juggling a lot of things and felt that they just couldnt be of any help to us, Thomson said.

But in an April 4 email to Ackermann and Sen. Brian Boquist, R-Dallas, Thomson criticized the agency.

Our pursuit was not supported in any way by OHA, Thomson wrote. In spite of all the obstacles that OHA enumerated several times during an hour-long pitch by us, it now appears that the lab instrument will be up and running.

The two labs trained together for the first time Friday, with a plan to ramp up testing this week. The lab will not collect samples directly from patients. Instead, local doctors will determine who needs testing, collect samples from patients and send them to the lab for testing.Similar Efforts Elsewhere

The public-private collaboration between OSU and WVT may be unique in the U.S. Other veterinary labs involved in COVID-19 testing have official support. Those states found ways to either obtain the federal certification for the veterinary lab or they hooked the lab up with a partner with federal approval.

Last month, the diagnostic veterinary lab at Colorado State University in Fort Collins forged the path by gaining federal certification through a collaboration with the universitys student health center lab.

Kristy Pabilonia, director of the veterinary lab at Colorado State, said the student health centers lab director had the right qualifications, enabling the veterinary lab to apply for the certification, which requires audits and inspections. Usually, the federal government completes a background check and vets the director. The Colorado lab didnt need that step because the student lab director was already qualified.

The veterinary lab equipment can handle 200 tests a day.

Oklahoma State University is also running COVID-19 tests. It has five machines processing 1,000 tests a day at its diagnostic laboratory, which usually investigates animal diseases and outbreaks. The university could expand to around-the-clock testing if necessary, said Kenneth Sewell, the universitys vice president of research.

Like OSU, the veterinary lab at Oklahoma State lacked CMS certification. But it teamed up with its medical school, which is run by a certified director. The medical schools certification allows the lab to run tests.

The states governor, Kevin Stitt, also helped by signing an executive order that allowed the university to do the tests.

We became an extension or arm of the public health process so the hospitals and health care providers and pop-up specimen collection centers could send specimens to us, Sewell said. It allowed us to relieve the pressure on the department of health.

The Oregon solution came together differently. Ackermann, who avoided criticizing the health authority, said he was grateful that WVT was eager to collaborate.

They were willing to help, so lets go down that road and see where it takes us.

This story is published as part of a collaborative of news organizations across Oregon sharing stories in the public interest. Salem Reporter is part of the collaborative.

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Without state's help, OSU lab found its own way to help COVID-19 testing - Salem Reporter

In the mid-2010s, an outbreak of Ebola ravaged West Africa. Between December 2013 and June 2016, the disease officially killed 11,308 people in Liberia, Guinea and Sierra Leone, although the World Health Organisation (WHO) believes the real figure is probably much higher.

Ebola's virulence and lethality it has a mortality rate of around 40 per cent; Covid-19, the disease caused by the novel coronavirus, kills roughly one per cent of sufferers, although the exact number is currently unclear made containing it an international priority. By mobilising labs around the world, a prophylactic Ebola vaccine rVSV-ZEBOV was rushed through development. In December last year, six years after the first cases were discovered in West Africa, and three years after the outbreak was officially deemed over, the Food and Drug Administration (FDA) finally OKed it for use in the US. Compared to the normal timelines for these things, that still represents astonishing speed.

In the wake of the Ebola outbreak, WHO has taken a front-foot approach. Every year it publishes a list of key diseases it sees as the major issues the medical research community needs to tackle. The Blueprint For Diseases, as its called, highlights the diseases that could break out into epidemics in the next 12 months. It's a guide for the research community, an attempt to steer its resources to where they're most required. Currently, Covid-19 tops the list. Lurking at the bottom, as it has been every year since the Blueprint was first published in 2016, is something that sounds like it's been pulled from the pages of a comic: Disease X.

To create a vaccine in 18 months is unprecedented in human history. No vaccine has ever been developed at that speed.

Thats the unknown, brand new pathogen that springs up, says Rachel Grant, of the Coalition for Epidemic Preparedness Innovations. CEPI was formed in 2017, after the Ebola crisis made apparent the lack of a single, coordinating voice in the research and development (R&D) of vaccines. Its founding partners included the nation of Norway, the Gates Foundation, the Wellcome Trust, and the UK Research Foundation. (Since then, Germany and Japan have signed up, too.) What happened with Ebola was the world tragically realised they reacted too late," says Grant. "The whole system was too fragmented to respond in an effective way.

Disease X has long been recognised as an issue. Before coronavirus, the last brand new pathogen to spring up was the mosquito-borne Zika virus, which infected an estimated half-a-million people between 2015 and 2016. At the time of writing, Covid-19 had infected at least 1.5 million people and killed 90,000 (see the most recent numbers at Johns Hopkins Universitys live map of global cases).

The focus of the R&D world is now squarely on Covid-19, and the race is on to develop a vaccine. If the boffins and academics are to succeed, they will have to move at a previously unheard-of pace. Vaccine researchers are used to working on vaccines for decades, but with coronavirus, we cant wait that long. More than 60 teams across the globe are trying to find a way to protect the worlds population up from around 40 two weeks ago and the more optimistic among them think there could be a vaccine ready in 12 to 18 months. That is unprecedented in human history, says Grant. No vaccine has ever been developed at that speed. But they have to try.

Professor Katie Ewer hated immunology when she was an undergraduate. She had been interested in biology since she was a child, fascinated by seemingly endless processes that occur in our cells and organs every second of our lives without us knowing about it. When she didn't get into medical school she trained as a microbiologist instead, and grew fascinated by infectious diseases. Ive always had a real obsession with the human body, anatomy and how it works, she says. Eventually, she came to see immunology as its "ultimate expression". After a PhD in the subject she landed at Oxford University's Jenner Institute, and has spent the 13 years since working on a malaria vaccine, to try and halt the spread of a disease that kills 500,000 people every year.

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Thirteen years may sound like a long time, but vaccines are difficult to develop, especially when they're for diseases that largely impact the poorer parts of the world. A malaria vaccine would save tens of millions of lives, but it would be less profitable than, say, a drug that reverses hair loss or makes you lose weight. So not-for-profits like the Jenner Institute, where Ewer is a senior scientist, do the work that big pharma won't prioritise. According to The Global Fund, $5 billion is needed to keep development of a malaria vaccine on track. In 2018, researchers received $2.8 billion, a drop from the year before. That Covid-19 has spread through the global west has, perversely, probably accelerated the search for its vaccine.

To create a vaccine, you need to know what you're fighting, which is why, on 11 January, researchers in Shanghai leaked the genetic sequence of the coronavirus, after realising that Chinese authorities had no intention of releasing it globally. The next day, their lab was closed for "rectification". Their sacrifice enabled teams around the world to mobilise.

"We go round the lab with a tape measure, measure two metres, work out the number of people who can safely work in a particular area"

Vaccines work by training your body to react in a certain way, like teaching a child to catch a ball. The first time you throw it, it bounces off them. The second time, maybe they put up an arm to protect themselves. Eventually, they'll learn to predict its flight, get their hands in the right place, and time when they should wrap their fingers around the ball. It's become an innate reaction that happens almost without thinking.

In the same way, the first time your body is exposed to a new virus, it doesn't know how to react. Being infected with Covid-19 is like turning a tennis ball launcher on that child before they've learnt to catch they'll be overwhelmed. But introduce a measured, non-fatal dose and our body learns to battle it, even when confronted by a larger amount. This is done by injecting antigens (or small molecules of the virus, which is a pathogen) into the body. The immune system recognises a harmful alien presence and, through a process of trial and error, creates antibodies to battle it. Once it's been destroyed, your body remembers the specific antibodies it needs to produce if the virus returns say, through live infection so it can mobilise more quickly. (This is also why those who've already been infected almost certainly can't catch Covid-19 a second time, unless the virus mutates.)

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Before the advent of genetic medicine, vaccines worked by injecting patients with either a dead form of a virus, so it couldn't replicate inside the body, or a similar but less harmful pathogen (Edward Jenner, for whom the Jenner Institute is named, all-but invented vaccination in the 1790s when he realised that if you deliberately infected someone with the comparatively harmless cowpox virus, they wouldn't catch smallpox). Today, making a vaccine isn't simple, but it is standardised. The actual platform the backbone of the vaccine is always the same, whatever the disease, says Ewer. Researchers just slot in a little bit of the genetic information from the new virus.

The Jenner Institute develops a multitude of different vaccines at any one time, and at the start of the year, Ewers colleague, Professor Theresa Lamb, was handling its coronavirus research. By the middle of February, the Institute had recognised that the early stages of their vaccine production had gone well, and were preparing to test it in a clinical trial. Suddenly the small number of people working on the vaccine under Lamb ballooned. Ewer was drafted to help in the effort, one of around 60 people including doctors and nurses who are screening potential trial participants and laboratory staff developing tests and assays working on the project. Many are working from home: the lab doesnt want people in unnecessarily, in case they contract or spread the disease. We go round [the laboratory] with a tape measure, we measure two metres, work out the number of people who can safely work at that distance in a particular area of the lab, says Ewer. Its really boring, just the same as any other supermarket or shop.

The potential outcome is far from boring. Covid-19 has changed our scientific landscape in terms of how fast things are moving, says Dr Melvin Sanicas, a vaccinologist and medical director at Takeda, a Japanese pharmaceutical company. Since its genetic sequence was released, two teams have got candidate vaccines into clinical trials. One is based on an Ebola vaccine, developed by CanSino Biological Inc, a Hong Kong company, in collaboration with the Beijing Institute of Biotechnology. The other is from a Massachusetts-based pharmaceutical company, Moderna (who declined to speak for this story).

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In the 70 years since the first identified coronavirus infection in humans, no vaccine has ever got beyond Phase II trials, which means labs are taking diverse approaches to finding one now. The Asian plan uses a non-replicating viral vector essentially, the dead vaccine. The Moderna plan uses an RNA vaccine, in which human cells are injected with the disease's RNA a simpler version of DNA, used by cellular organisms like viruses in the hope that it will absorb it and start to produce antibodies. The former isn't so different from Jenner's original method; the Moderna plan is based on science that, so far, is largely theoretical, but which will be much quicker to test and produce than those made by the traditional method. If it works.

But finding a vaccine that defeats a disease is merely step one. You test the vaccine candidates in cell cultures or animal models to see if the vaccine candidate is safe and whether its able to induce an immune response, says Sanicas. The right immune response sees the body fight back against the pathogen, without being overwhelmed by it some candidate vaccines have to be shelved because the virus wins. Get it to work in cell cultures or animal models, and youre through the pre-clinical phase. You can now try and test it in humans.

"With any vaccine there is a risk of rare serious adverse events."

Testing is the time-consuming part. The team at Oxford University recently put out a call for participants across the Thames Valley area, asking for 510 participants in total. More than half will be given the actual vaccine, and 250 will be given a control. Theyll be monitored over the next six months to see how the vaccine is working researchers are looking for an immune response, but also check for side-effects that might be worse than the disease. In exchange, the participants will get up to 625, and the pride of knowing theyre helping save the world. The amount is relatively low (participants in a botched clinical trial in the mid-2000s got 2,000 each), and the risk real: an accompanying document acknowledges with any vaccination there is a risk of rare serious adverse events.

All vaccines entering clinical trials on humans go through three stepped stages. The Oxford trial will test only a few people to start with, to make sure everything works correctly and safely, before increasing the numbers. Well try and get up to vaccinating some quite big numbers of people in a short space of time, says Ewer. In less urgent times, that means thousands of participants over several years, because it can take months for an immune response to show up in healthy subjects.

To progress, a vaccine needs to produce positive results at all three stages. Normally, that means an effectiveness of at least 97 per cent, says Sanicas, although the pandemic is so severe that any potential coronavirus vaccine could be rolled out with results as low as 70 per cent.

Next, you start applying to national regulatory bodies the FDA in the US, the Medicines and Healthcare Products Regulatory Agency in the UK, and the European Medicines Agency in the EU for approval. Once theyve determined the vaccine is safe, effective and made using quality production mechanisms, they approve the vaccine for use, says Sanicas. Getting from identification to commercial vaccine normally takes the best part of a decade.

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Faced with a pandemic, there's always a temptation to cut corners. Every extra day jumping through red tape means thousands of people dead, tens of thousands more infected. But the scientific community has learned that a bad vaccine is worse than no vaccine. In the mid-2000s, trials of an experimental leukaemia drug in London went wrong, seriously damaging six participants without that testing, actual patients could have been given a drug that was more likely to kill them than their disease. And all vaccine development lives in the shadow of a terrible series of events in 1976, when the threat of a swine flu epidemic across the US led the government to instigate mass vaccination. To speed up production, they opted to use a "live" virus, rather than an inactive strain. Of the inoculated, one in 100,000 contracted a neurological disease called GuillainBarr syndrome, in which the bodys immune system attacks its own nerves, causing permanent paralysis. Since then, speed has always come second to safety.

But time can be saved if you can organise people properly. "Getting the regulatory authorities to focus, to come together, to really understand the data, all of that will make a difference to the timeframe for this," says Grant. Medical advances have also sped up the process of getting a vaccine to trial safely. The Oxford team is also changing the way they work, to speed things up without sacrificing safety, says Ewer. Were doing a lot of things in parallel that we would ordinarily do one after the other."

But they arent the only team on the cusp of clinical trials.

A tobacco warehouse in Owensboro, Kentucky may seem like an odd place for a coronavirus vaccine to emanate, but we live in strange times. British American Tobacco (BAT), which some might say is a company best known for killing people, has also entered the race to save lives. Right now, I would hope we could leave the politics of tobacco and smoking to one side," says Kingsley Wheaton, who leads marketing at BAT, "in order that we try and focus on the matter at hand right here, right now, which is solving this Covid-19 problem globally."

A few years ago, recognising it was selling fewer cigarettes every year, BAT invested in a company called Kentucky BioProcessing, to help find new uses for the tobacco plants it was growing but which people weren't smoking. They were especially interested in a protein that could be harvested and processed as animal feed. You take a small, hardy Australian tobacco varietal, and around halfway through its growing cycle impregnate it with an antigen for the protein. It replicates at a tremendous scale. The plant is a mini-factory, if you like, says Wheaton.

It became clear that this might also be a way to produce vaccines quickly and cheaply. Instead of an antigen developing a feedstock protein, Kentucky BioProcessing realised they could develop the antigens of viruses. You could clone in fields, rather than Petri dishes. In 2014, as Ebola was killing people in Africa, Kentucky BioProcessing put its newly acquired company to work. Improbably, Kentucky BioProcessing developed ZMapp, an Ebola drug that the World Health Organisation concluded, in 2018, had benefits [that] outweigh the risks (science has since thrown doubts on its effectiveness, however).

Every year since, Kentucky BioProcessing has worked on a seasonal flu vaccine; this year's was heading into the first stage of clinical trials when the coronavirus began its rampage across the globe. Now, the business has been reoriented to aid Covid-19 vaccine development: 50 staff members are devoted to growing an antigen that can create a vaccine in tobacco plants in a matter of weeks. You extract it, purify it and hey presto theres a vaccine. Results from pre-clinical trials in animals are pending, at which point it will move into clinical trials which may be anything from 12 to 18 months, even with a fair wind, Wheaton says.

What if they all worked together? Wouldnt it get done in half the time? No.

Not that theyre waiting that long. Even if BAT's vaccine is ineffective, its production technique could be a game-changer. Because a pandemic is different from an epidemic, and the need for a vaccine is everywhere and at the same time, youve also got to think about manufacturing capacity, says CEPIs Grant. If youre thinking about developing a vaccine for an epidemic, youre talking millions of doses of whatever it is youve developed. A pandemic, youre talking about billions.

BAT plans to start production on their vaccine even before it knows whether it works, making between one and three million a week, just in case. Wheaton is at pains to point out that if the vaccine isnt approved, it wont be used, but if it turns out our candidate vaccine is the right one, it would be good to have a stockpile of these things.

This is where research diversity becomes so important. People may look at the vast array of organisations, private companies, university laboratories and oddball developers trying to produce different vaccines simultaneously in all four corners of the world and think, What if they all worked together? Wouldnt it get done in half the time? Not so, says Grant, whose list of teams working on a vaccine tops 90. You are always better to have a diversified approach than you are to have a really narrow one, she says. You never want a single point of failure in a situation like this." With vaccines, there are too many potential failure points to count.

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During the West African Ebola crisis, pharma giant Merck was one of the first to get a drug through clinical trials. Its vaccine, rVSV Zebov-GP, had 100 per cent efficacy, but a zero per cent chance of actually being used at scale; it needed to be stored at 80C. You try getting a vaccine supposed to be stored at 80C out to war-torn Democratic Republic of Congo and youve got massive supply problems, says Grant. Which is why it was handy there was investment in another vaccine, by Johnson & Johnson, that wasn't so temperamental.

Most drug research works on a winner-takes-all model: invent Viagra, or Minoxodil, or Oxycontin, and you get a 20-year exclusivity licence (in the US). That means you can charge as much for it as you like. Once the licence lapses, competitors can create generic versions and the price falls. With a pandemic vaccine, the rules of the marketplace make less sense. There's healthy competition, but its against nature, not each other.

"Im trying to do as much as I can do in the working day and then go home and try and be a mum to my kids at home."

That said, there are economic incentives at play: make the vaccine everyone wants and you can at least recoup the costs of developing it. CEPI has ploughed $23 million into the eight programmes it's supporting underway, and estimates it will cost something like $2 billion more to get three of those into clinical testing. Altruism is fuelling initial development, but at some point realism steps in. Still, any CEPI-developed vaccines wont result in a free-for-all (the US government's reported attempts to buy German pharmaceutical group CureVac, to get at its potential coronavirus vaccine first, hint at what could happen with international cooperation). CEPI has a stringent policy on equitable access and believes that work needs to be done now at an intra-governmental level to decide a way for people who need the vaccine most, such as healthcare workers and the vulnerable, to access it first.

Regardless, developers are keen to help in any way they can. Were one of many in that area, but wed also be delighted to take a candidate vaccine and become a fast-scale manufacturer through our plant-based system, says Wheaton.

For those in the labs, competition isn't a concern. They worry about the pressure of getting a vaccine right and getting it quickly. When I ask Ewer if the process of developing a vaccine has been stressful, she replies with one word: "Yes".

I try not to think about it too much, she eventually adds. Shes stopped watching the news; a regular Twitter user, shes now shunning the app. I had to stop engaging with it because if I think too much about it, I get really stressed. If I think too much about what happens if none of this works, then I feel a bit overwhelmed, so Im trying to do as much as I can do in the working day and then go home and try and be a mum to my kids at home, try and keep things as normal for them as possible, because its weird for the family as well as it is for everybody.

"Hopefully one of us will produce a vaccine that is effective. I dont really mind if its ours or anybody elses, as long as one of them works."

It can be easy to forget, as we praise our scientists and our doctors, our nurses and the collective brainpower of the experts working to lead us out of this crisis, that theyre human beings, too. The risks of getting it wrong are real and they feel them every day.

If you ask me whether I want this really quick, or I want a robust process, I would pick the safe and robust process, says Sanicas, who worries were all getting caught up in the hype around 18 months to a vaccine. I dont want this to be just a vaccine you bring quickly to the market but were not sure about the long-term effects. He thinks itll take two years for anything to come to fruition.

Near the end of our conversation, I ask Ewer if theres one thing she wishes the general public who are clamouring for a Covid-19 vaccine as eagerly as they are for sufficient testing capacity knew about her work. I expected her to explain the challenges of the vaccine, or to caution about its progress (she believes the best case scenario is that by autumn this year the Oxford team will have evidence of the vaccine being safe and able to induce a good immune response). I didnt expect her to answer as she did.

I think I would like people to know there are lots of people working very, very hard on this, she explains. Making vaccines is difficult and its expensive, but there are at least 30 different groups around the world, all trying to produce a vaccine against this disease, and hopefully one of us will produce a vaccine that is effective. I dont really mind if its ours or anybody elses, but as long as one of them works, thats the most important thing.

She pauses for a moment, then picks up her train of thought. As long as somebody gets there, we dont mind if its us, or Moderna, or anyone else. As long as one of us gets there, and we can make enough of it quickly enough to make an impact.

The information in this story is accurate as of the publication date. While we are attempting to keep our content as up-to-date as possible, the situation surrounding the coronavirus pandemic continues to develop rapidly, so it's possible that some information and recommendations may have changed since publishing. For any concerns and latest advice, visit the World Health Organisation. If you're in the UK, the National Health Service can also provide useful information and support, while US users can contact the Center for Disease Control and Prevention.

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

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

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

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

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

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

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

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

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

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

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

Read the original here:
The best telemedicine services for anyone unable to visit a doctor's office in person - Insider - INSIDER

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

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

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

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

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

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

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

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

Get medical attention immediately, the CDC says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CNN's Jacqueline Howard contributed to this report.

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

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

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

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

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

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

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

Shutterstock

Turning urban areas into smart cities

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

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

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

Boosting public safety and monitoring

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

Improving Traffic & public transport monitoring

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

Saving resources through smart metering and billing

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

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

Harnessing the power of data in retail

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

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

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

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

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

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

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

Shutterstock

Healthcare: improving wellness and saving more lives

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

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

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

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

Expanding chronic disease management and preventative medicine

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

Advancing precision medicine research

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

Enhancing pharmaceutical drug supply chain safety

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

Giving manufacturing a competitive edge

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

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

Automating industry

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

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

Improving planning and scheduling

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

Smarter plant safety and security

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

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

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

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

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

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

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

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

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

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

6 United Nations, World Population Ageing (2019)

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

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

9 Dell EMC Global Data Protection Index Survey (2019)

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

Original post:
Driving business opportunities at the Edge - TechHQ

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

================================================================================

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

================================================================================

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.

Read more:
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.

See the rest here:
The positive effects of digitisation in medical services - East Midlands Business Link

Like what you see?Help us bring you more insightful stories.

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