Daily Archives: May 2, 2020

As the coronavirus spreads rapidly around the world, some European countries have begun flattening the curve of infections. According to numbers by Johns Hopkins collected by the website Worldometers, the start to a flattening is visible in Germany and France, where a total of around 160,000-166,000 cases had been recorded each.

Are European Countries Flattening the Curve?

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In Italy where there are currently more than 200,000 cases, some progress has also been made. Spain has had the steepest curve despite also adhering to a strict lockdown. There are almost 237,000 known infections in the country.

The UK, where the outbreak started later, does not yet show any signs of infections slowing down. The same is true across the pond in the U.S., currently the country with most known infections and a curve that is still pointing upwards. Infections have passed 1 million stateside.

The countries' collective aim is to "flatten the curve" of infections. While South Korea was able to (more or less) stabilize its outbreak at around 10,000 cases - due to widespread free testing (including the now infamous drive-thru testing), quarantine measures and the harnessing of mobile technology for public information - China has stabilized theirs at around 83,000 cases. South Korea hit 100 cases on February 20 and managed to leave the steep upward trajectory around 14 days later. In the case of China, more than 100 cases were first recorded on January 20, and quarantine and testing measure succeeded in breaking the upwards trajectory by February 12 - around three and a half weeks later. Germany began leveling its curve around six weeks into the outbreak, while France started seeing results at around seven weeks.

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COVID-19: Could Europe's countries be flattening the curve? - World Economic Forum

The World Health Organization and the European Investment Bank will boost cooperation to strengthen public health, supply of essential equipment, training and hygiene investment in countries most vulnerable to the COVID-19 pandemic.

The new partnership between the United Nations health agency and the worlds largest international public bank, announced at WHO headquarters in Geneva earlier today, will help increase resilience to reduce the health and social impact of future health emergencies.

"Combining the public health experience of the World Health Organization and the financial expertise of the European Investment Bank will contribute to a more effective response to COVID-19 and other pressing health challenges," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

"WHO looks forward to strengthening cooperation with the EIB to improve access to essential supplies including medical equipment and training, and deliver better water, sanitation and hygiene where most needed. New initiatives to improve primary health care in Africa and support the EU Malaria Fund hint at the potential impact of our new partnership, Dr Tedros concluded.

The world is facing unprecedented health, social and economic shocks from COVID-19. The European Investment Bank is pleased to join forces with the World Health Organization as a key part of Team Europes efforts to address the global impact of the COVID-19 pandemic. The EU Banks new partnership with the WHO will help communities most at risk by scaling up local medical and public health efforts and better protect people around the world from future pandemics. Thisnew cooperation will enable us to combat malaria, address anti-microbial resistanceandenhance public health in Africa more effectively, said Werner Hoyer, President of the European Investment Bank.

The WHO and the EIB will increase cooperation to help governments in low- and middle-income countries to finance and secure access to essential medical supplies and protective equipment through central procurement.

The WHO and the EIB will reinforce cooperation to support immediate COVID-19 needs and jointly develop targeted financing to enhance health investment and build resilient health systems and primary health care to address public health emergencies as well as accelerate progress towards Universal Health Coverage.

The partnership will benefit from the EIBs planned 1.4 billion EUR response to address the health, social and economic impact of COVID-19 in Africa.

This will address immediate needs in the health sector and provide both technical assistance and support for medium-term investment in specialist health infrastructure.

The collaboration envisages rapid identification and fast-track approval of financing for health care, medical equipment and supplies.

The first phase of the collaboration will see public health investment in ten African countries.

The agreement signed today establishes a close collaboration to overcome market failure and stimulate investments in global health, accelerating progress towards Universal Health Coverage. Increased cooperation between the WHO and the EIB will strengthen the resilience of national public health systems and enhance preparedness of vulnerable countries against future pandemics, thanks to investments in primary care infrastructure, health workers and improved water, sanitation and hygiene.

Future cooperation will strengthen the EIBs 5.2 billion EUR global response to COVID-19 outside the European Union.

The two organisations will also cooperate in an initiative to address investment barriers hindering development of new antimicrobial treatment and related diagnostics. Antimicrobial resistance is amongst the most significant global health threats.

The WHO and the EIB are working on a new financing initiative to support development of novel antimicrobials and address the estimated 1 billion EUR needed to provide medium-term solutions to antimicrobial resistance. Other crucial partners have been invited to join this discussion.

Under the new agreement the EIB and WHO will support development of the EU Malaria Fund, a new 250 million EUR public-private initiative intended to address market failures holding back more effective malaria treatment.

In recent years the European Investment Bank has provided more than 2 billion EUR annually for health care and life science investment.

In the context of the COVID-19 pandemic, the EIB is currently assessing over 20 projects in the field of vaccine development, diagnostic and treatment, leading to potential investments in the 700 million EUR range. The EIB will also take part in the EUs rolling pledging effort for the coronavirus global response that is taking place on May 4th.

The European Investment Bank (EIB) is the long-term lending institution of the European Union owned by its Member States. It makes long-term finance available for sound investment in order to contribute towards EU policy goals.

The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with194 Member States, across six regions and from more than 150 offices,to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing. For updates on COVID-19 and public health advice to protect yourself from coronavirus, visit http://www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube

WHOs information site on the COVID-19 pandemic

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WHO and European Investment Bank strengthen efforts to combat COVID-19 and build resilient health systems to face future pandemics - World Health...

While Bismarck has been fortunate to not have large outbreak situations, local public health officials were seeking to learn more about community spread, particularly among front-line retail and grocery store workers, Moch said during a Saturday morning news conference.

Todays testing event will allow us to learn more about the Bismarck-Mandan community, Moch said.

Individuals who test positive for COVID-19 can expect to be notified within 72 hours. Those who test negative will also be contacted, but it may take longer than 72 hours to be notified.

North Dakota National Guard members and members of the Bismarck Fire Department were all part of the drive-up COVID-19 testing at the Bismarck Event Center on Saturday.

Depending on the volume of positive tests, mass testing could return to Bismarck in seven to 10 days, said Maj. Gen. Alan Dohrmann of the North Dakota National Guard.

Mass testing has previously been held in Fargo, Grand Forks, Dickinson, Amidon and Gladstone.

Every time we do one of these, we get a little bit better, Dohrmann said.

Mass screenings are set for Sunday and Monday afternoons at the Fargodome and are reserved for the close contacts of people who have tested positive for COVID-19 and for essential workers.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

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North Dakota reports 24th COVID-19 death as drive-up testing is underway in Bismarck - Bismarck Tribune

The CDC released six new possible symptoms of coronavirus, which include muscle pain and headache. USA TODAY

Doctors are learning more about COVID-19s newest and oddest skin manifestation,dubbed COVID toes, asthe Centers for Disease Control and Prevention adds to the growing list of symptoms associated with the coronavirus.

The American Academy of Dermatology has compiled a registry of skin manifestations associated with COVID-19.About half of the more than 300 total caseson the dermatologicalregistry consist of COVID toes.

The registry is made up of entries by physicians and other health care professionals who fill out a 5-7 minutes survey about patients with confirmed or suspected COVID-19 who develop skin manifestations, as well as patients with existing dermatologicalconditions who develop COVID-19 and patients on dermatological medicationswho developed COVID-19.Entries can not be made by patients themselves.

Dr. Esther Freeman,director of Massachusetts General Hospital Global Health Dermatology and member of the AAD task force on COVID-19,said COVID toes arepinkish-reddish pernio-like lesions that canturn purple over time.

She said this shouldn't be confused with a different medical condition that occurs in critically sickpatients called purpura fulminans.

When she first started the registry with the academy, she was expecting to see viral rashesoften driven by inflammation.

What was more surprising to me was this overwhelming representation of these COVID toes, she said.

The secret to fighting COVID-19 could be in recovered patients. Here's how antibodies could lead to a treatment for those fighting coronavirus. USA TODAY

Where can I get a COVID-19 antibody test?And is it reliable? Here's everything you need to know.

Pernio,also called chilblains,are skinsores or bumps that occur on a patients feet when theyre exposed to cold temperatures. The reason why Freeman calls the new symptompernio-like is because she believes COVID toe lesions arent a result of cold temperatures.

While experts cant confirm why COVID toes appear, they have some educated guesses. One could be inflammation in the toes' tissue, which is similar to pernio. Another hypothesis is inflammation of the blood vessel wall, medically known as vasculitis. And finally, Freeman said it ispossible COVID toes could be caused by small blood clots that form inside the blood vessel.

Doctors at the American Academy of Dermatology have discovered trends studying the registrythat werent previously known about COVID toes. Freeman saysCOVID toes have appeared in some cases of asymptomatic patients. The majority of the toecases manifestedsimultaneously or after more common COVID-19 symptoms, rather than before.

Freeman said some patients test positive for the PCR COVID test when they develop COVID toes, indicating they may still be infectious. Others test negative, suggesting the symptom would appear later in the infection.

The timing is complex and difficult to pin down, she said.

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The majority of COVID toepatients in the registry are younger people in their 20s and 30s, Freeman said, and doctors havent seen a lot cases reportedfrom older people. She also said most patients with COVID toes are healthy and have done well in their clinical course.

I think its important not to induce panic if you were to develop these lesions on your toes, she said. Most of our patients seem to be doing well.

Freeman recommends patients speak to their health care provider if they develop these lesions to assess if they arecaused by a different medical condition, or any other reason.

But if there isnt, then they should talk about COVID testing or isolate or consider other ways to reduce the spread, she said.

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

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Doctors find more cases of 'COVID toes' in dermatological registry. Here's what they learned. - USA TODAY

The novel coronavirus tends to affect men more severely than it does women. Though nobody can yet explain the oddity, researchers are hot on the case.

It's possible that the sex hormones estrogen and testosterone play a role, according to previous research on respiratory illnesses. Or perhaps it's because the X chromosome (which women have two of, but men have only one) has a larger number of immune-related genes, giving women a more robust immune system to fight off the coronavirus, SARS-CoV-2. Or, maybe the virus is hiding in the testes, which has abundant expression of ACE2 receptors, the portal that allows SARS-CoV-2 into cells.

Uncovering the real reason is, of course, imperative because it could help improve patient "outcomes during an active public health crisis," according to an editorial published April 10 in the Western Journal of Emergency Medicine (WJEM).

Related: When will a COVID-19 vaccine be ready?

Since the first known COVID-19 case was reported in China late last year, countless studies have shown that the disease tends to be more severe and deadly in men than in women.

For instance, in an analysis of 5,700 COVID-19 patients hospitalized in New York City, just over 60% were men, according to an April 22 study published in the journal JAMA. What's more, "mortality rates were higher for male compared with female patients at every 10-year age interval older than 20 years," the researchers wrote in the study.

Furthermore, of the 373 patients who ended up in intensive care units, 66.5% were men, the JAMA study reported.

Related: 13 Coronavirus myths busted by science

Results are similar in other studies. When the WJEM editorial was published in early April, the authors noted that between 51% and 66.7% of hospitalized patients in Wuhan, China, were male; 58% in Italy were male; and 70% of all COVID-related deaths worldwide were male. In one large study of more than 44,600 people with COVID-19 in China, 2.8% of men died versus just 1.7% of women.

These COVID-19 sex differences are not unexpected. Other coronavirus outbreaks, including outbreaks of SARS in 2003 and the Middle East respiratory syndrome (MERS) in 2012, had higher fatality rates in men than in women, according to the WJEM editorial. For example, a 2016 study found that men had a 40 percent higher odds of dying of MERS than women did.

Even the comically labeled "man flu" is so named because men tend to have a weaker immune response to respiratory viruses that cause flu and the common cold. As a result, men tend to get more severe symptoms from these viruses than women do, a 2017 review in BMJ found. That review pinned these results on the differences in "sex dependent hormones" in men and women.

A mouse experiment offers clues about this hormonal mystery; when scientists infected both male and female mice of different ages with SARS, the male mice were more susceptible to the infection than females of the same age, according to a 2017 study, which was published in The Journal of Immunology. However, when the female mice had their estrogen-producing ovaries removed or were treated with an estrogen-receptor blocker, they died at higher rates than those with working ovaries and normal estrogen.

"These data indicate that sex hormones produced in female [mice] may help to defend against coronaviruses like SARS and SARS-CoV-2," Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine, who was not involved in the study, told Live Science.

Related: Is 6 feet enough space for social distancing?

To learn more, scientists at Cedars-Sinai Medical Center in Los Angeles and the Renaissance School of Medicine at Stony Brook University in New York are testing estrogen or another sex hormone called progesterone on small groups of people who have COVID-19, Live Science previously reported.

There's another way to look at the COVID-19 sex difference; perhaps the X chromosome is protective because it has more immune-related genes than the Y chromosome does. This may also explain why women are more likely than men to have autoimmune diseases, the authors of the WJEM editorial noted.

The second X chromosome is usually silenced in women, but almost 10% of those genes can be activated, Veena Taneja, who studies differences in male and female immune systems at the Mayo Clinic, told NPR. "Many of those genes are actually immune-response genes," she said. This could give women a "double-dose" of protection, Taneja said, although research is needed to see whether these genes factor into protection against COVID-19.

New research offers yet another idea; men seem to clear SARS-CoV-2 from their bodies more slowly than women do. To explain that possibility, researchers have suggested the virus may have found a hiding place in men: the testes.

In the research, published on the preprint medRxiv database, 68 people confirmed to have COVID-19 in Mumbai, India, were tested with nasal swabs until they tested negative for the virus. At the end of the experiment, scientists found that women cleared the virus from their bodies in an average of 4 days, compared with men's average of 6 days. The same test in three different Mumbai households found similar results.

Related: 13 Coronavirus myths busted by science

"Our collaborative study found that men have more difficulty clearing coronavirus following infection, which could explain their more serious problems with COVID-19 disease," study lead researcher Dr. Aditi Shastri, assistant professor of medicine at the Albert Einstein College of Medicine in New York City and a clinical oncologist at the Montefiore Einstein Center for Cancer Care, said in a statement.

Previous research has shown that SARS-CoV-2 invades certain human cells by plugging into these cells' ACE2 receptors. So, the researchers consulted a database, and found that the testes have high levels of ACE2 expression. In contrast, ACE2 could not be detected in the ovaries, the female equivalent of the testes.

However, the research did not actually look in the testes to see if SARS-CoV-2 is hanging out there, so "it does not tell us whether the virus infects testes or whether it is a reservoir of virus," said Iwasaki, who was not involved in the research.

Other research has suggested that smoking may play a role, as smoking is related to higher expression of ACE2 receptors. But while more men than women smoke in China, that's not true in other countries, which likely puts a kibosh on smoking to explain the sex difference.

"What we saw in Wuhan [with the sex difference] has been replicated in every country around the world where we have accurate reporting," Sabra Klein, a researcher at the Johns Hopkins Center for Women's Health, Sex, and Gender Differences, told NPR. "In countries like Spain, where the percentages of males and females who report smoking is not significantly different, we still are seeing this profound male bias in severity of COVID-19."

Other explanations: Women are simply less likely to engage in health-related risks and are better at washing their hands, studies find, and perhaps that's behind the gender disparity

Sex differences aren't the only factor at play, however. Other groups more vulnerable to COVID-19 include the elderly and people with diabetes, high blood pressure and obesity, Live Science previously reported.

Originally published onLive Science.

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Why are more men dying from COVID-19? - Livescience.com

When major decisions must be made amid high scientific uncertainty, as is the case with Covid-19, we cant afford to silence or demonize professional colleagues with heterodox views. Even worse, we cant allow questions of science, medicine, and public health to become captives of tribalized politics. Today, more than ever, we need vigorous academic debate.

To be clear, Americans have no obligation to take every scientists idea seriously. Misinformation about Covid-19 is abundant. From snake-oil cures to conspiracy theories about the origin of SARS-CoV-2, the virus that causes the disease, the internet is awash with baseless, often harmful ideas. We denounce these: Some ideas and people can and should be dismissed.

At the same time, we are concerned by a chilling attitude among some scholars and academics, who are wrongly ascribing legitimate disagreements about Covid-19 to ignorance or to questionable political or other motivations.

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A case in point involves the response to John Ioannidis, a professor of medicine at Stanford University, who was thrust into the spotlight after writing a provocative article in STAT on Covid-19. He argued in mid-March that we didnt have enough information on the prevalence of Covid-19 and the consequences of the infection on a population basis to justify the most extreme lockdown measures which, he hypothesized, could have dangerous consequences of their own.

We have followed the dialogue about his article from fellow academics on social media, and been concerned with personal attacks and general disparaging comments. While neither of us shares all of Ioannidis views on Covid-19, we both believe his voice and those of other legitimate scientists is important to consider, even when we ultimately disagree with some of his specific analyses or predictions.

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We are two academic physicians with different career interests who sometimes disagree on substantive issues. But we share the view that vigorous debate is fundamental to the existence of universities, where individuals with different ideas who have a commitment to reason compete to persuade others based on evidence, data, and reason. Now is the time to foster not stifle open dialogue among academic physicians and scientists about the current pandemic and the best tactical responses to it, each of which involve enormous trade-offs and unanticipated consequences.

Since Covid-19 first emerged at the end of 2019, thousands of superb scientists have been working to answer fundamental, vital, and unprecedented questions. How fast does the virus spread if left unabated? How lethal is it? How many people have already had it? If so, are they now immune? What drugs can fight it? What can societies do to slow it? What happens when we selectively evolve and relax our public health interventions? Can we develop a vaccine to stop it? Should governments mandate universal cloth masks?

For each of these questions, there are emerging answers and we tend to share the consensus views: Without social distancing, Covid-19 would be a cataclysmic problem and millions would die. The best current estimate of infection fatality rates may be between 0.4% and 1.5%, varying substantially among age groups and populations. Some fraction of the population has already been infected by SARS-CoV-2 and cleared the virus. For reasons that arent yet totally clear, rates of infection have been much higher in Lombardy, Italy, and New York City than in Alaska and San Francisco. To date no drug has shown to be beneficial in randomized trials the gold standard of medicine. And scientists agree that it will likely take 18 months or longer to develop a vaccine, if one ever succeeds. As for cloth masks, we see arguments on both sides.

At the same time, academics must be able to express a broad range of interpretations and opinions. Some argue the fatality rate will be closer to 0.2% or 0.3% when we look back on this at a distance; others believe it will approach or eclipse 1%. Some believe that nations like Sweden, which instituted social distancing but with fewer lockdown restrictions, are pursuing the wisest course at least for that country while others favor the strictest lockdown measures possible. We think it is important to hear, consider, and debate these views without ad hominem attacks or animus.

Covid-19 has toppled a branching chain of dominoes that will affect health and survival in myriad ways. Health care is facing unprecedented disruption. Some consequences, like missed heart attack treatment, have more immediate effects while others, like poorer health through economic damage, are no less certain but their magnitude wont immediately become evident. It will take years, and the work of many scientists, to make sense of the full effects of Covid-19 and our responses to it.

When the dust settles, few if any scientists no matter where they work and whatever their academic titles will have been 100% correct about the effects of Covid-19 and our responses to it. Acknowledging this fact does not require policy paralysis by local and national governments, which must take decisive action despite uncertainty. But admitting this truth requires willingness to listen to and consider ideas, even many that most initially consider totally wrong.

A plausible objection to the argument we are making that opposing ideas need to be heard is that, by giving false equivalence to incorrect ideas, lives may be lost. Scientists who are incorrect or misguided, or who misinterpret data, might wrongly persuade others, causing more to die when salutatory actions are rejected or delayed. While we are sympathetic to this view, there are many uncertainties as to the best course of action. More lives may be lost by suppressing or ignoring alternate perspectives, some of which may at least in part ultimately prove correct.

Thats why we believe that the bar to stifling or ignoring academics who are willing to debate their alternative positions in public and in good faith must be very high. Since different states and nations are already making distinct choices, there exist many natural experiments to identify what helped, what hurt, and what in the end didnt matter.

We believe that the bar to stifling or ignoring academics who are willing to debate their alternative positions in public and in good faith must be very high.

Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics. The tensions between the two policy poles of rapidly and systematically reopening society versus maximizing sheltering in place and social isolation must not be reduced to Republican and Democratic talking points, even as many media outlets promote such simplistic narratives.

These critical decisions should be influenced by scientific insights independent of political philosophies and party affiliations. They must be freely debated in the academic world without insult or malice to those with differing views. As always, it is essential to examine and disclose conflicts of interest and salient biases, but if none are apparent or clearly demonstrated, the temptation to speculate about malignant motivations must be resisted.

At this moment of massive uncertainty, with data and analyses shifting daily, honest disagreements among academic experts with different training, scientific backgrounds, and perspectives are both unavoidable and desirable. Its the job of policymakers, academics, and interested members of the public to consider differing point of views and decide, at each moment, the best courses of action. A minority view, even if it is ultimately mistaken, may beneficially temper excessive enthusiasm or insert needed caveats. This process, which reflects the scientific method and the culture that supports it, must be repeated tomorrow and the next day and the next.

Scientific consensus is important, but it isnt uncommon when some of the most important voices turn out to be those of independent thinkers, like John Ioannidis, whose views were initially doubted. Thats not an argument for prematurely accepting his contestable views, but it is a sound argument for keeping him, and others like him, at the table.

Vinay Prasad is a hematologist-oncologist and associate professor of medicine at the Oregon Health and Science University and author of Malignant: How Bad Policy and Bad Evidence Harm People with Cancer (Johns Hopkins University Press, April 2020). Jeffrey Flier is an endocrinologist, professor of medicine, and former dean of Harvard Medical School.

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Let's hear scientists with different Covid-19 views, not attack them - STAT