FDA Approves First Ebola Treatment: What to Know

  • The Food and Drug Administration approved a new treatment for Ebola virus disease, which could help control ongoing and new outbreaks.
  • The treatment is called Inmazeb and made by Regeneron Pharmaceuticals.
  • It’s a combination of three monoclonal antibodies.

Last week, the Food and Drug Administration (FDA) approved the first treatment for Ebola virus disease in adults and children.

The treatment, called Inmazeb, is a combination of three monoclonal antibodies made by Regeneron Pharmaceuticals. The drug is approved to treat Zaire ebolavirus, one of six known types.

The average case death rate of Ebola is around 50 percent, according to the World Health Organization, although it has ranged from 25 percent to 90 percent in past outbreaks.

Inmazeb, along with a vaccine approved by the FDA last year, offers a new way to fight Ebola.

“Until now, we have not had much to offer in the way of treatment for this deadly virus other than supportive care and attempts to prevent spread to others,” said Dr. Katie Passaretti, medical director of infection prevention at Atrium Health.

“The approval of Inmazeb is an important step forward and offers hope as we face current and future outbreaks,” she said.

Triple antibody cocktail improves survival

The monoclonal antibodies included in Inmazeb target a glycoprotein on the surface of the Ebola virus.

The virus uses this glycoprotein to attach to human cells and fuse its own membrane with that of the host cell. This allows the virus to enter the cell and cause an infection.

By binding to the glycoprotein, the three antibodies can block the virus from attaching to and entering the host cell.

Leah Lipsich, PhD, who heads Regeneron’s global program for infectious diseases, told the Associated Press that using three monoclonal antibodies reduces the risk that the virus will become resistant to the drug.

The drug, which is given as a single intravenous dose, was tested alongside three other drugs in a randomized, controlled trial conducted during a 2018-19 Ebola outbreak in the Democratic Republic of Congo (DRC).

Of 155 people given Inmazeb, 33.5 percent died after 28 days, compared with 51.3 percent of 154 people who received another experimental triple monoclonal antibody drug.

The most common symptoms experienced by those who received Inmazeb included fever, chills, fast heart rate, fast breathing, and vomiting. These are also common symptoms of an Ebola infection.

Another group of participants received a single monoclonal antibody derived from an Ebola survivor. Of 174 people who received this drug, 35.1 percent survived after 28 days.

A fourth group of participants received Gilead Sciences’ broad-spectrum antiviral remdesivir. About half of them died from Ebola.

Remdesivir had shown better promise initially as a treatment for COVID-19. The FDA issued an emergency use authorization for it earlier this year for use against the new coronavirus.

But this month, a study from the World Health Organization found no evidence it prevented deaths.

When President Trump was hospitalized this month with COVID-19, he received several treatments, including remdesivir and a two-monoclonal antibody cocktail developed by Regeneron.

“Among a number of agents being studied to combat COVID-19, one of those received by President Trump recently was a monoclonal antibody like Inmazeb,” said Dr. Charles Bailey, medical director for infection prevention at St. Joseph Health and Mission Hospital in Orange County, California.

“As yet, we do not have a directly acting antiviral drug for Ebola to compare to the other drug received by President Trump: remdesivir,” he said.

New tools in fight against Ebola outbreaks

Ebola is highly contagious. It mainly spreads through the bodily fluids of a person who is sick or has died from the disease.

Symptoms include fever, fatigue, muscle pain, headache, and sore throat. Later symptoms include vomiting, diarrhea, and sometimes internal and external bleeding.

The FDA approved the first vaccine against the Ebola virus, Ervebo, in December 2019.

A preliminary analysis earlier this year found that the vaccine was 97.5 percent effective in people who were exposed to the virus at least 10 days after being vaccinated.

While the Ebola vaccine can help prevent future outbreaks, Inmazeb can be used to treat ongoing outbreaks, such as the one in Équateur Province of Congo. As of early September, this outbreak had reached 110 cases, with 47 deaths.

The Ebola virus was first identified in 1976 in the Democratic Republic of Congo. The largest outbreak occurred in West Africa between 2013 and 2016, and led to more than 28,000 cases and more than 11,000 deaths.

During this outbreak, 11 people were treated for Ebola in the United States.

In addition, two healthcare workers in Texas contracted Ebola infections after treating a man with Ebola who had traveled from Africa to the United States. The man died; both healthcare workers recovered.

The Associated Press reports that drugmakers commonly first seek FDA approval for tropical diseases such as Ebola because this can make it easier to get regulatory approval in Africa.

Parallels with search for COVID-19 vaccine

The U.S. government helped provide funding for the development of Inmazeb, reports the Associated Press, even though the risk of Ebola in the United States remains low.

However, ignoring highly infectious diseases just because they aren’t “knocking on our door” right now can lead to unnecessary illness and deaths, as we’ve seen with the COVID-19 pandemic.

“Future Ebola outbreaks are inevitable, and there are ongoing cases in the DRC as we speak,” Passaretti said. “With international travel and the interconnectedness of our world, we need to continue to maintain vigilance for this and other highly infectious diseases.”

The Ebola vaccine approved by the FDA in late 2019 took years to develop.

The Operation Warp Speed program — a partnership between pharmaceutical companies and the U.S. federal government — aims to shorten that timeline for a COVID-19 vaccine.

Bailey says the much larger impact of the COVID-19 pandemic — more than 40 million cases and more than 1 million deaths worldwide — compared to Ebola may help speed things up.

“Hopefully, a COVID vaccine or vaccines will become available around the 1-year anniversary of the first Ebola vaccine, Ervebo, last December,” Bailey said. “If so, it would be a remarkably rapid such accomplishment compared to the timeline for Ervebo and other vaccine development historically.”

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Leaders in US, Europe divided on response to surging virus

Virus cases are surging across Europe and many U.S. states, but responses by leaders are miles apart, with officials in Ireland, France and elsewhere imposing curfews and restricting gatherings even as some U.S. governors resist mask mandates or more aggressive measures.

The stark contrasts in efforts to contain infections come as outbreaks on both sides of the Atlantic raise similar alarms, including shrinking availability of hospital beds and rising deaths.

Governors of states including Tennessee, Oklahoma, Nebraska and North Dakota are all facing calls from doctors and public health officials to require masks.

In Utah, a spike in cases since school reopened has created a dynamic that Republican Gov. Gary Herbert has called “unsustainable.”

But schools remain open and Herbert, who has been pressured by an outspoken contingent of residents opposed to masks, has resisted a statewide mandate. Instead, he announced last week that they would be required only in six counties with the highest infection rates, while leaving it to others to make their own rules. Meanwhile, many hospitals are being pushed to the breaking point.

“We are not just managing COVID. We are also managing heart attacks and strokes and respiratory failure and all those other things that need ICU-level care,” said Dr. Kencee Graves, chief medical officer for inpatient care at the University of Utah Health hospital in Salt Lake City. The hospital’s intensive care unit was filled by the end of last week, forcing the reopening of a backup intensive care unit.

“The sooner we take care of each other, wear masks, physically distance, the sooner we can have some gatherings in a safe way,” Graves said.

In Oklahoma, where the number of people hospitalized for the virus has reached record levels, doctors have called on officials to do more.

“We need face mask mandates to protect more of our Oklahoma citizens,” Dr. George Monks, the president of the Oklahoma State Medical Association, said in a tweet Sunday.

But Gov. Kevin Stitt has said repeatedly he has no plans to do so, citing concerns about how such a mandate would be enforced.

Oklahoma health officials reported a record high of 821 people hospitalized Tuesday with the virus or under investigation for the infection. Wyoming also reported a record high number of patients hospitalized for the virus.

New virus cases in the U.S. have surged in recent weeks from a daily average of about 42,000 in early October to about 58,000—the highest level since late July, according to Johns Hopkins University.

In one of the most troubling outbreaks, 10 residents of a nursing home in northwest Kansas have died from the virus, health officials said. All 62 residents of the Andbe Home in Norton County, as well as an unspecified number of employees, have tested positive for the infection.

The surge in new cases prompted a change of heart Monday from the mayor of North Dakota’s largest city, in favor of a mask mandate.

Tim Mahoney, who in addition to being Fargo’s mayor is also a general surgeon, has been largely supportive of Republican Gov. Doug Burgum’s approach of leaving management of the virus to local officials.

Mahoney, himself, cast the deciding vote against a mask mandate at a recent meeting of city officials. But with North Dakota leading the nation in new cases and up to one in four city residents now testing positive, Mahoney said a statewide change is in order.

The dynamic contrasts sharply with Europe, where national officials are battling a similar spike with measures including new lockdowns and smart phone apps that track the virus’ spread.

In Ireland, Prime Minister Micheal Martin announced a lockdown starting at midnight Wednesday that will close all non-essential stores, limit restaurants to carryout service and require people to stay within three miles (five kilometers) of their homes, while banning visits to other households.

It marks a near-return to restrictions imposed by the government in March, although schools, construction sites and manufacturing industries will remain open. If people comply with the restrictions, which will be in place until Dec. 1, the country will be able to celebrate Christmas “in a meaningful way,” Martin said.

But as cases surge, some decisions by European leaders to impose new restrictions are facing stiff opposition at the local level. After a tense faceoff, Britain’s government said Tuesday it had failed to reach agreement with Greater Manchester Mayor Andy Burnham, who has rejected tough new measures without money to support the workers and businesses that will be most affected.

Britain’s Communities Secretary Robert Jenrick expressed disappointment with Burnham, saying the mayor “has been unwilling to take the action that is required to get the spread of the virus under control.” Prime Minister Boris Johnson said Tuesday he would impose the restrictions, drawing criticism from Burnham.

“It cannot be right to close people’s place of work, to shut somebody’s business, without giving them proper support,” Burnham said. He said Manchester had sought 90 million pounds ($117 million) from the national government to help people get through the winter. It was unclear how much the city would receive.

In the Netherlands, which has one of the highest infection rates in Europe, a judge in The Hague rejected an appeal by more than 60 Dutch bars and restaurants to overturn a government four-week closure order.

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Older Adults Turning to Pot for Common Health Problems

TUESDAY, Oct. 20, 2020 — Marijuana is fast becoming a favorite medication among older Americans, a new study finds.

Cannabis is being used to ease problems such as pain, sleep disturbances and psychiatric conditions like anxiety and depression, researchers say.

Among more than 550 patients surveyed, 15% had used cannabis within the past three years, and 50% of users said they used it regularly and mostly for medical purposes.

“Pain, insomnia and anxiety were the most common reasons for cannabis use and, for the most part, patients reported that cannabis was helping to address these issues, especially with insomnia and pain,” said researcher Christopher Kaufmann. He’s an assistant professor in the Division of Geriatrics and Gerontology in the Department of Medicine at the University of California, San Diego (UCSD).

Also, 61% of the patients who used cannabis had started using it after age 60.

“Surprisingly, we found that nearly three-fifths of cannabis users reported using cannabis for the first time as older adults. These individuals were a unique group compared to those who used cannabis in the past,” said researcher Kevin Yang, a third-year medical student at UCSD.

“New users were more likely to use cannabis for medical reasons than for recreation. The route of cannabis use also differed with new users more likely to use it topically as a lotion rather than by smoking or ingesting as edibles. Also, they were more likely to inform their doctor about their cannabis use, which reflects that cannabis use is no longer as stigmatized as it was previously,” Yang said in a university news release.

The report was published online recently in the Journal of the American Geriatrics Society.

“There seems to be potential with cannabis, but we need more evidence-based research,” Kaufmann added. “We want to find out how cannabis compares to current medications available. Could cannabis be a safer alternative to treatments, such as opioids and benzodiazepines? Could cannabis help reduce the simultaneous use of multiple medications in older persons?

“We want to find out which conditions cannabis is most effective in treating,” Kaufmann said in the release. “Only then can we better counsel older adults on cannabis use.”

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New anatomical study of the human precuneus with geometric models

Emiliano Bruner, a paleoneurologist at the Centro Nacional de Investigación sobre la Evolución Humana (CENIEH), has just published a paper on the morphology of the precuneus in adult humans, which concludes that the variations in its length, height and thickness in the cerebral cortex are independent, suggesting that different cortical areas are involved in its growth, as well as in the differences between individuals that can be observed.

These differences are apparently related to the development of the cortical surface of the brain itself, and not to a deformation of the cranial cavity due to spatial constraints on the cranium. In the paper, this evidence is discussed within the framework of possible anatomical correspondences between human brain areas and the same areas described in other primates, whose functions and similarities still remain to be clarified.

To conduct this analysis, magnetic resonance scans of 50 individuals of both sexes and spatial models of cerebral geometry were used.

More developed in humans

The precuneus is the most medial region of the superior parietal lobules. It is particularly variable in its shape and size among adult individuals, and is much more highly developed in humans than in other primates. “The corresponding areas are also better developed in our species when we compare ourselves with other extinct hominids,” states Bruner.

At the cognitive level, the precuneus is principally involved in integrating the somatic information of the body with visual information, coordinating the body at the physical, chronological and social levels, and generating a virtual space involved in the imagination and the capacity for simulation.

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Invasive mosquito species could bring more malaria to Africa’s urban areas

A species of mosquito that can carry malaria—known as Anopheles stephensi – has invaded eastern Africa and is quickly moving across the region. Moina Spooner, from The Conversation Africa, asked Jeremy Herren and Clifford Mutero to provide insights into why this invasion is happening and what can be done to protect people from it.

How did Anopheles stephensi come to Africa?

This mosquito species, Anopheles stephensi, is widespread in South-East Asia and parts of the Arabian Peninsula. It is common in India, Pakistan, Iran, Iraq and Afghanistan. In the last couple of years there have been increasing reports of it in Africa. It was initially reported in Djibouti in 2013.

Recent reports indicate that it is spreading rapidly through the Horn of Africa. It was reported in Ethiopia in 2016 and in Sudan in 2017 and is likely being spread along major transportation routes. As a result, the World Health Organization has issued an alert for intensified surveillance to track the spread. We expect that it’ll eventually be found in other major African cities.

Surveillance data is needed to confirm further spread but, based on the timeline of its travel to Ethiopia and Sudan, we speculate that three years is how long it would have taken to reach Kenya and Tanzania. They are now within that risky time-frame.

Kenya and Tanzania may be at a particularly high risk due to their close proximity to the Horn of Africa. They also have large coastal cities whose weather conditions (warmer and more humid) are similar to the mosquitoes’ native range. Other cities further away, including some in West Africa, are also deemed to have a suitable environment for Anopheles stephensi.

Generally the spread of mosquitoes to new areas is facilitated by by people through ground, air and ocean transport systems. Increased international travel and human migration leads to vectors and pathogens emerging or re-emerging in regions where they’d diminished or been eradicated.

In what ways is this mosquito different from the ones that exist on the continent?

There are over 100 species of Anopheles mosquitoes in Africa, but only six species are considered “primary” vectors of malaria.

Anopheles stephensi is very effective at transmitting malaria. What’s worrying is that it also thrives in urban areas, unlike the various African Anopheles species.

Anopheles mosquitoes require water to complete their life cycle: a female mosquito lays its eggs on the surface of a water source, where they hatch and finally develop into adult mosquitoes. Female mosquitoes suck blood from people and other hosts to enable them to lay eggs. It is the blood-feeding that enables mosquitoes to transmit parasites—such as malaria—from one person to another.

Typically, the main African Anopheles vector species are found in rural landscapes—which is why the majority of Africa’s malaria cases are also in rural areas. They breed in various water habitats such as puddles, footprints and hoof prints along the edges of ponds, and irrigated farmland. These habitats do also occur in some urban areas, but they’re often polluted and less suitable for these mosquitoes. Reports do now indicate, though, that some African Anopheles are becoming more adapted to these conditions.

By contrast, while they can also survive in rural areas, Anopheles stephensi thrive in urban areas—such as plastic and cement containers that hold water. This means that this species poses a threat both in cities and in rural areas.

What new challenges does it present?

The main issue is that if the invasion becomes widely established, malaria could become more prevalent in African cities and this would put many more people at risk of infection. Consequently, malaria control efforts will be spread even thinner on the continent as malaria expands into cities.

There are already many challenges—such as a lack of resources. Currently, about half of the US$6.5 billion needed to meet the 2030 malaria targets is available. There were an estimated 219 million cases of malaria in 2017 and 92% of these occurred in the WHO African region. The funding shortfall is likely to grow if the Anopheles stephensi increases malaria cases in Africa.

Another major challenge is that both Anopheles stephensi and African malaria vectors are developing resistance to some of the insecticides used against them. These insecticides are deployed on bed-nets or used for indoor spraying.

Finally, the Anopheles stephensi presents a new challenge because it’s harder to access mosquito breeding and resting sites in urban areas and deploy control measures. In particular, it is more challenging to identify and map breeding sites in urban areas, which makes it more difficult to control larvae. In addition, indoor residual spraying is less straightforward due to the high density of dwellings and challenges accessing them all.

Has a mosquito invasion like this happened in the past? If so, what happened then?

The spread of Anopheles stephensi is reminiscent of a similar invasion by Anopheles gambiae, a mosquito species commonly found in Africa, which spread to Brazil in the 1930s and 1940s and caused devastating malaria outbreaks. For example, over a period of just eight months there were 150,000 cases of malaria and 14,000 deaths. This was recognized as one of the most serious threats to health in the Americas and an aggressive eradication campaign was initiated.

The Brazilian government reacted with an integrated control program. Insecticide spraying targeted larvae and adult insects. Cars or trucks leaving endemic areas were sprayed and there was a massive effort to improve drainage and remove the stagnant water that provided breeding sites. This concerted effort is an important example in successful vector control and resulted in the species being eradicated in South America by the 1940s.

Is there anything that can be done to stop the spread?

Action is needed immediately if there is to be a chance of curtailing the spread of Anopheles stephensi. The longer we leave it the harder it will be to contain, and unfortunately there seems to have already been significant spread with reports from across the Horn of Africa. Though mosquitoes can travel long distances and are dispersed on high altitude winds, the pattern of Anopheles stephensi spread suggests the importance of human transportation routes.

Vector surveillance is key. We need to know where Anopheles stephensi has spread and then quickly and strategically focus resources on restricting spread and locally eliminating Anopheles stephensi before it establishes a foothold. Surveillance should be carried out by National Vector and Malaria Control Programs with support from research institutions.

Overall, a combination of environmental management to eliminate larval habitats and eco-friendly biopesticides to control adult and larval stages of the mosquito is considered the most effective strategy for control of Anopheles stephensi.

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This Face Mask Was a Best-Seller on Amazon Prime Day — and There Are Options for Kids, Too

With the number of COVID-19 cases rising in the United States, the Centers for Disease Control and Prevention continues to recommend all Americans over the age of 2 wear a face covering in public settings to help slow the spread. So it should be no surprise that face masks were one of the most-shopped products on Amazon Prime Day last week. While many people stocked up on disposable masks, this reusable style from Safe-Mate x Case-Mate was also very popular.

Not only are the masks currently the best-seller in Amazon's Launchpad — a marketplace that lets customers find innovative products by smaller businesses or emerging brands — but they were also one of the most popular products PEOPLE readers purchased during the retailer’s two-day extravaganza. According to our data, readers bought over 12,000 face masks from the brand (a majority of which were in adult sizes).

But parents having trouble keeping little ones protected during the pandemic should consider the brands’ smaller face masks for kids. They’re made from a soft, washable cotton fabric that’s designed to wrap securely and comfortably around the nose and chin and feature a pocket for an optional filter (which can be purchased separately). Its contoured shape and soft elastic ear loops provide a more flexible fit that reviewers say is comfortable enough to wear for longer periods of time, like when they’re in school.  

“Bought two packs for 8 and 11 year olds as they are required for school,” one wrote. “They fit them well and they don't complain about comfort.”

Buy It! Safe-Mate x Case-Mate Kids’ Face Mask in Pink Pack of 3 for Ages 3-6, $19.99; amazon.com

“These fit well on kids, especially 5 or younger,” another commented. “My 3-year-old wears it when necessary without complaints. The enclosed filters are a nice bonus. Works well with clip-on lanyards. The masks are quality made, not too thick or too thin.” 

Phone accessories brand Case-Mate recently launched its own personal care brand, Safe-Mate, to help create in-demand essentials like face masks, mask filters, and no-contact thermometers — all of which are available on Amazon. What’s great about its protective gear is that it comes in a range of sizes for adults and kids (because one size doesn’t always fit all faces). There’s a youth mask for ages 3 to 6, along with an option for ages 7 to 11 that are available in a variety of colors and patterns. And parents can get one for themselves in sizes small-medium or large-extra large. 

While the masks are no longer at their Prime Day price, they’re still very reasonably priced. You can get a single kids' mask for $9 or a pack of three kids’ masks for $20, which you may want to have on hand for when the others are being cleaned.

Buy It! Safe-Mate x Case-Mate Kids’ Face Mask in Cheetah for Ages 3-6, $8.99; amazon.com

Buy It! Safe-Mate x Case-Mate Kid’s Face Mask in Tie Dye for Ages 7-11, $8.99; amazon.com

Buy It! Safe-Mate x Case-Mate Kids’ Face Mask in Black Pack of 3 for Ages 7-11, $19.86; amazon.com

Below, we also rounded up a few more top-rated face masks for kids that you can buy on Amazon, including this 50-pack of colorfully-printed disposable ones that have racked up over 3,200 five-star reviews. 

Shop More Top-Rated Kids’ Face Masks on Amazon:

  • EnerPlex Premium Kids Face Mask, $18.95 
  • Cubcoats Kids Face Mask 2-Pack, $8.49 with coupon (orig. $9.99)
  • Kids Single Use Disposable Face Mask Pack of 50, $34.99
  • Vanecia Disposable 3-Layers Earloop Face Masks for Kids Pack of 30, $13.99

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Virus, what virus? India gets back to work

India is on course to top the world in coronavirus cases, but from Maharashtra’s whirring factories to Kolkata’s thronging markets, people are back at work—and eager to forget the pandemic for festival season.

After a strict lockdown in March that left millions on the brink of starvation, the government and people of the world’s second-most populous country decided life must go on.

Sonali Dange, for instance, has two young daughters and an elderly mother-in-law to look after. She was hospitalised this year in excruciating pain after catching the coronavirus.

But after the lockdown exhausted the family’s savings, the 29-year-old had to return to work at a factory where she earns 25,000 rupees ($340) a month.

“Now that I have recovered, I am no longer so scared of the disease,” she told AFP amid the din of machinery at the Nobel Hygiene plant east of Mumbai.

Worst since 1947

The pandemic’s confirmed fatality rate has been heaviest in richer nations with older populations—the US death toll is double that of India despite having only a quarter of the population.

Poor countries have suffered far worse economic pain, with the World Bank predicting 150 million people could fall into extreme poverty worldwide.

Many children in the developing world are now working to help their parents make ends meet, activists say, while thousands of young girls have been forced into marriage.

In Varanasi in northern India, 12-year-old Sanchit no longer attends school and instead collects cloth discarded from bodies before cremation on the city’s ghats.

“On a good day, I earn around 50 rupees (70 US cents),” the boy told AFP.

The IMF projects India’s GDP will contract by 10.3 percent this year, the biggest slump of any major emerging nation and its worst since independence in 1947.

Lockdown catastrophe

When India went into lockdown, it was a human catastrophe, leaving millions in the informal economy jobless, penniless and destitute almost overnight.

No one wants to go back to that, said Gargi Mukherjee, 42, as she shopped in the New Market area of Kolkata, thronging with festival-season customers, many without face masks.

“For survival, people have to come out and do their jobs. If you don’t earn, you cannot feed your family,” she told AFP.

Experts caution that the October-November season—when Hindus celebrate major festivals such as Durga Puja, Dussehra and Diwali—may trigger a sharp increase in infections, as consumers crowd markets to snap up big-ticket items on discount.

“Of course corona is to be feared. But what can I do? I can’t miss the moments of Durga Puja,” said housewife Tiyas Bhattacharya Das, 25.

“Durga Puja comes once in the year, so I cannot miss the enjoyment of the shopping.”

Hunger or virus

Sunil Kumar Sinha, principal economist at the Mumbai-based India Ratings and Research agency, said Indians faced a stark choice.

“People have to choose whether to die of hunger or risk getting a virus that may or may not kill you,” he told AFP.

Indeed India’s relatively low mortality rate—about 1.5 percent of its more than seven million cases—has surprised many who warned coronavirus would lay waste to its crowded cities, beset by poor sanitation and crumbling public hospitals.

Even accounting for some likely undercounting, it is evident that the nightmare scenario of dead bodies piled in the streets as seen during the 1918 flu pandemic has mercifully not materialised.

‘Foot off the brake’

The unexpected reprieve has given Prime Minister Narendra Modi leeway to resist a fresh lockdown, with the human toll—and political cost—of another shutdown higher than seeing case numbers soar.

But Bhramar Mukherjee, an epidemiologist at the University of Michigan, warned the government should not simply let the virus run its course.

“In order to open up, you need to intensify public health measures… If you completely take your foot off the brakes, the virus will take off too,” Mukherjee told AFP.

Last month, the Indian Medical Association slammed the Modi government for its “indifference” to the sacrifices of front-line staff in one of the world’s worst-funded health care systems.

“It appears that they are dispensable,” it said.

Back in Kolkata, bookseller Prem Prakash, 67, was philosophical.

“You have to leave some things to fate,” he told AFP.

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Untreated sleep apnea is associated with flu hospitalization

As we approach flu season, adults with obstructive sleep apnea may want to take extra precautions. A study published online as an accepted paper in the Journal of Clinical Sleep Medicine is the first to find that patients with sleep apnea who did not use CPAP therapy were more likely to be hospitalized with the flu.

Results of the retrospective study show that 61% of patients (17 of 28) who either weren’t prescribed CPAP to treat their sleep apnea or weren’t adherent to their CPAP treatment were hospitalized with the flu, compared with 24% of patients (6 of 25) who were adherent to CPAP therapy. Statistical analysis found that the patients who were non-adherent to CPAP were nearly five times more likely to be hospitalized with a flu infection, despite having a higher rate of flu vaccination.

“Our study would suggest that among patients with obstructive sleep apnea, those who use CPAP are less likely to be hospitalized because of an influenza infection than those who do not use CPAP,” said study coinvestigator Dr. Glen Greenough, associate professor of medicine, psychiatry and neurology at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

Greenough said the study provides further evidence that sleep is essential to health.

“These results would suggest that use of a treatment, CPAP, that improves sleep quality reduces the severity of influenza infection as determined by rate of hospitalization,” he said. “This might suggest that treating sleep apnea and thereby improving sleep quality has a beneficial effect on the immune system. It also suggests that treating sleep apnea with CPAP could help reduce hospitalizations thereby reducing health care costs.”

Nearly 30 million adults in the U.S. have obstructive sleep apnea, a chronic disease that involves the repeated collapse of the upper airway during sleep. Common warning signs include snoring and excessive daytime sleepiness. A common treatment is CPAP therapy, which uses mild levels of air pressure, provided through a mask, to keep the throat open during sleep.

The researchers at Dartmouth-Hitchcock Medical Center analyzed the medical records of 53 patients who had sleep apnea and a confirmed case of the flu between 2016-2018. The 28 patients categorized as non-adherent to CPAP treatment had a mean age of 63 years and were 54% male; the 25 CPAP-adherent patients had a mean age of about 60 years and were 52% male. CPAP use was assessed by data download, with adherence defined as usage of at least four hours per night for at least 70% of nights.

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Rheumatoid arthritis treatment: The herbal supplement shown to ease swollen joints

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Rheumatoid arthritis, which affects more than 400,000 people in the UK, is an autoimmune disease. An autoimmune disease happens when the body’s natural defence system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. “In rheumatoid arthritis, the body’s immune system targets affected joints, which leads to pain and swelling,” explains the NHS.

When the joints come under attack from the immune system, it can cause joint pain, swelling and stiffness.

According to the NHS, it may also cause more general symptoms, and inflammation in other parts of the body.

The symptoms can vary in their intensity but you may experience flares when your condition deteriorates and your symptoms become worse, says the health body.

Regular flare-ups can greatly diminish your quality of life, impeding your ability to perform even basic tasks.

Unfortunately, there is no cure for rheumatoid arthritis, but this doesn’t mean you have to live with the symptoms.

Evidence has identified a number of natural solutions that can ameliorate the effects of rheumatoid arthritis.

Borage seed oil, which is extracted from the seeds of the borage plants native to the Mediterranean region, has been supported by two notable studies.

In the first trial, 37 people with rheumatoid arthritis were randomly assigned to receive either borage seed oil containing 1.4 grams of GLA or a placebo of cotton seed oil daily for 24 weeks.

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GLA is an essential fatty acid that is found in borage seed oil.

According to Versus Arthritis, the essential fatty acid is important for maintaining a joint’s cell structure and function.

Compared to the placebo group, who showed no improvement during the trial, participants who received borage seed oil showed an improvement in:

  • Joint tenderness
  • Number of swollen joints
  • Morning stiffness.

In the second trial, 56 participants with rheumatoid arthritis were randomly assigned to take either a daily dose of borage seed capsules containing 2.8 g GLA or placebo capsules of sunflower seed oil for six months.

By the end of the study, 64 percent of those on borage seed oil showed improvement in joint tenderness and morning stiffness, compared to only 21 percent of those on placebo treatment.

There was a significant difference in the treatment outcome of the two patient groups in favour of borage seed oil.

General self-help tips

Engaging in regular exercise can also help to alleviate the symptoms associated with rheumatoid arthritis.

How? “Exercising regularly can help relieve stress, help keep your joints mobile, and strengthen the muscles supporting your joints,” explains the NHS.

As the health body explains, exercise can also help you lose weight if you’re overweight, which can put extra strain on your joints.

According to the National Rheumatoid Arthritis (NRAS), you should talk to a member of your rheumatology team or your GP about what exercise(s) you are considering.

“Think about a goal that exercise may help you to realistically achieve and reward yourself when you achieve your goal,” says the NRAS.

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Criteria to predict cytokine storm in COVID-19 patients identified

Like a cold front that moves in, setting the stage for severe weather, coronavirus infection triggers showers of infection-fighting immune molecules—showers that sometimes escalate into a chaotic immune response known as a cytokine storm. About 20 to 30 percent of patients hospitalized with COVID-19 develop severe immune manifestations, in some instances leading to cytokine storm, with life-threatening organ damage and high risk of death.

Predicting which COVID-19 patients will develop cytokine storm is challenging, owing to the many variables that influence immune function. But now, in breakthrough work, researchers at the Lewis Katz School of Medicine at Temple University (LKSOM) have developed and validated predictive criteria for early identification of COVID-19 patients who are developing hyperimmune responses, raising the possibility for early therapeutic intervention.

“If we can anticipate cytokine storm, we can apply treatment sooner and possibly decrease mortality,” explained Roberto Caricchio, MD, Chief of the Section of Rheumatology, Director of the Temple Lupus Program, Professor of Medicine and Microbiology and Immunology at LKSOM, and lead author on the new report.

The report, published online in the Annals of the Rheumatic Diseases, is the first to identify criteria that can be readily used in clinical practice to potentially head off the worst of the hyperimmune attack against COVID-19.

The breakthrough is the result of an extensive collaboration between researchers and clinicians across multiple departments in the Lewis Katz School of Medicine and Temple University Hospital, constituting the Temple University COVID-19 Research Group.

According to Dr. Caricchio, large numbers of COVID-19 patients have been treated at Temple since the pandemic emerged in the United States. “We have a significant amount of data in terms of variables to predict cytokine storm,” he said.

Since early March, every patient admitted to Temple University Hospital (TUH) has had data on more than 60 different laboratory variables collected daily until the time of recovery or time of death. Among variables measured every day are factors like white blood cell count, metabolic enzyme activity, and markers of inflammation and respiratory function. Importantly these markers are commonly used in hospitals across the globe and therefore are readily available.

The research group carried out statistical analyses on laboratory data for 513 COVID-19 patients hospitalized at TUH in March and April, 64 of whom developed cytokine storm. A genetic algorithm was used to identify cut-off values for each individual laboratory variable to define the predictive requirements for cytokine storm. Genetic algorithms mimic the processes of natural selection and evolution in analyzing the data, and in this case, over multiple iterations, the algorithm turned up variables indicating which patients are most likely to develop cytokine storm.

Overall, the analyses yielded six predictive criteria comprising three clusters of laboratory results relating to inflammation, cell death and tissue damage, and electrolyte imbalance. In particular, patients in cytokine storm exhibited a proinflammatory status and elevated levels of enzymes indicating significant systemic tissue damage. Moreover, patients who met the criteria had extended hospital stays and were at increased risk of death from COVID-19, with almost half of patients who experienced cytokine storm meeting all criteria within the first day of hospitalization.

The researchers validated the criteria in a subsequent cohort of 258 patients admitted to TUH for COVID-19 infection. “The algorithm correctly predicted cytokine storm in almost 70 percent of patients,” Dr. Caricchio said.

“The ability to reproduce our results in a second cohort of patients means that our group of variables are effective criteria for cytokine storm diagnosis in COVID-19 patients,” he added. The final step now is to have the criteria validated by other centers where COVID-19 patients are admitted for care.

Dr. Caricchio noted that the criteria could be applied to COVID-19 patients at any hospital or level of hospitalization anywhere in the world. “This makes the criteria very valuable for guiding decisions about how to treat COVID-19 patients worldwide,” he said. Applied more broadly, the criteria could greatly facilitate early diagnosis and intervention, helping save many lives.

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