Experts make weak recommendation for remdesivir in severe COVID-19

In The BMJ today, a panel of international experts make a weak recommendation for the use of remdesivir in patients with severe covid-19, and strongly support continued enrolment of patients into ongoing clinical trials of remdesivir.

Their advice is part of The BMJ‘s Rapid Recommendations initiative—to produce rapid and trustworthy guidelines for clinical practice based on new evidence to help doctors make better decisions with their patients.

The antiviral medication remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19 and is already being used in clinical practice.

Today’s recommendation is based on a new evidence review comparing the effects of several drug treatments for covid-19 up to 20 July 2020.

It shows that remdesivir may be effective in reducing recovery time in patients with severe covid-19, although the certainty of the evidence is low. But remdesivir probably has no important effect on the need for mechanical ventilation and may have little or no effect on length of hospital stay.

The authors stress that “the effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations.”

After thoroughly reviewing this evidence, the expert panel says that most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement.

But given the low certainty evidence, and allowing for different patient perspectives, values, and preferences, they issued a weak recommendation with strong support for continued recruitment in trials.

They suggest that future research should focus on areas such as optimal dose and duration of therapy, and whether there are specific groups of patients most likely to benefit from remdesivir.

The authors also sound a note of caution about the potential opportunity cost of using remdesivir while the evidence base is still uncertain. As a relatively costly drug that is given intravenously, use of remdesivir may divert funds, time, attention, and workforce away from other potentially worthwhile treatments.

The study that today’s recommendation is based on is called a living systematic review.

In a linked editorial, The BMJ editors explain that living systematic reviews are useful in fast moving research areas such as covid-19 because they allow authors to update previously vetted and peer reviewed evidence summaries as new information becomes available.

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Flu researchers say we should make a NEW antiviral to stop coronavirus

Flu researchers say we should make a NEW antiviral to prevent coronavirus from replicating throughout the body and stop focusing on repurposing old drugs

  • Researchers looked an older treatment for the flu, Tamiflu, and a newer treatment, Xofluza, the first new type of flu drug in 20 years
  • Xofluza limited the amount of time a person was sick by quickly stopping the virus from replicating and spreading throughout the body
  • The team says the same approach needs to work for coronavirus, creating a new drug that stops the virus from multiplying rather then repurposing old drugs
  • In the US, there are more than 1.8 million confirmed cases of the virus and more than 105,000 deaths
  • Here’s how to help people impacted by Covid-19

A new antiviral drug should be created to stop the novel coronavirus rather than repurposing old medication, a new study suggests.

Researchers compared an older antiviral treatment that most flu patients know compared to a newer one.

The newer treatment cut the amount of time people were sick with the flu, which limited the spread of the virus, because it stopped the disease from multiplying within an infected person. 

The team, from the University of Texas at Austin, says creating a drug that does the same for the coronavirus in early-stage patients would be more beneficial that trying to get existing drugs to treat late-stage patients.

A newer treatment fro flu Xofluza (blue) limited the amount of time a person was sick by quickly stopping the virus from replicating and spreading throughout the body rather than the older treatment of Tamiflu (green)

The team says the same approach needs to work for coronavirus, creating a new drug that stops the virus from multiplying rather then repurposing old drugs. Pictured: COVID-19 patients are taken into to the Wakefield Campus of the Montefiore Medical Center in the Bronx, New York, April 6

For the study, published in Nature Communications, the team looked at influenza and its implications for COVID, the disease caused by the virus.

Researchers first looked at the effects of Tamiflu, or its generic oseltamivir, one of three drugs the Centers for Disease Control and Prevention has endorsed to treat the flu.  

Then they looked at baloxavir, which is sold under the brand name Xofluza, the first new type of flu drug in 20 years.

The new treatment from the same company that developed Tamiflu, was shown in past studies to cut the amount of time people were sick and reduce the length of a fever. 

While Xofluza didn’t work faster than Tamiflu, it did reduce the level of the virus in patients’ nose and throat quicker. 

The new study showed that the newer treatment limited the amount of time a person was sick by quickly stopping the virus from replicating and spreading throughout the body. 

‘We found that treating even 10 percent of infected patients with baloxavir shortly after the onset of their symptoms can indirectly prevent millions of infections and save thousands of lives during a typical influenza season,’ said Dr Robert Krug, a professor emeritus of molecular biosciences, in a blog that accompanied the paper.  

Krug and his team say that a similar antiviral treatment would help to prevent thousands of infections and deaths from the coronavirus    

‘Imagine a drug that quashes viral load within a day and thus radically shortens the contagious period,’ said Dr Lauren Ancel Meyers, a professor of integrative biology.

‘Basically, we could isolate COVID-19 cases pharmaceutically rather than physically and disrupt chains of transmission.’

Most drugs being researched to treat COVID-19 have focused on existing antivirals that can be given to critically ill patient.

But the team says research should shift towards developing a new antiviral for the coronavirus that is used early on in infection and stops the virus from replicating,  , just as baloxavir does for the flu.

‘It may seem counterintuitive to focus on treatments, not for the critically ill patient in need of a life-saving intervention, but rather for the seemingly healthy patient shortly after a COVID-19 positive test,’ Krug said. 

‘Nonetheless, our analysis shows that the right early-stage antiviral treatment can block transmission to others and, in the long run, may well save more lives.’

In the US, there were more than 1.8 million confirmed cases of the virus and more than 105,000 deaths.

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These Children's Books Featuring Adopted/Foster Kids Will Make You Cry

Foster care adoptions reached a record high in 2020 — so why aren’t more kids and parents talking about fostering, or adoption in general, as a key process that has led to so many families being built? Of course, raising these topics with your kids isn’t easy; our words and even our tone can shape adopted and foster kids’ experiences and have a lasting impact on their mental and emotional health. But there are some amazing children’s books featuring adopted or foster kids that can help — teaching both kids and adults how to have thoughtful conversations about adoption and foster homes, and tackling subjects like grief, sadness, confusion, adaptation, and love.

That’s why we’ve gathered some of the most beautiful books out there that are suitable for young children and teens and which center on adoption and foster care. These are beautiful, relatable stories guaranteed to open up discussions and let kids know that they’re not alone in their feelings or experiences.

The Story of My Open Adoption

This heartwarming story, from solo mom by choice (and SheKnows writer!) Leah Campbell, is about Sammy Squirrel who is adopted at birth by the bunny family. A perfect option for teaching kids about the ever-more common open adoption process.

I’ve Loved You Since Forever

We love a lot of things about Hoda Kotb, and her children’s book about adoption is pretty high on the list. Kotb has two adopted daughters, Hope and Haley, whom we just know she has loved since forever. Although Kotb penned this book in response to adopting her eldest daughter, its themes of enduring love apply to any family, adopted or otherwise.

Tell Me Again About the Night I Was Born

Many children have questions about their birth, but what happens when a child’s parents weren’t there to recount all of the details? Tell Me Again About the Night I Was Born, written by Jamie Lee Curtis and illustrated by Laura Cornell, tells the story of one young girl who loves to hear about the night her parents brought her into their family. This sweet book acknowledges that adopted children have an array of different stories and reminds readers that their births — and all of the moments since — are valuable and cherished by their families.

Morris and the Bundle of Worries

The adoption and foster care processes can be stressful for children who don’t always understand why their situations are changing. Sadly, these experiences can lead to increased risk for poorer physical and mental health in the long run, including depression and anxiety, according to a study commissioned by the American Academy of Pediatrics. Too often, these children will internalize their feelings as they may not believe they can confide in a trusted adult.

Morris and the Bundle of Worries, written by Jill Seeney and illustrated by Rachel Fuller, tells the story of Morris the Mole who hides his worries from his loved ones. Throughout the book, Morris’ friends help him to understand that they care about his feelings and want to help him face his problems. With their assistance, Morris learns that while it’s normal to feel worried sometimes, he doesn’t have to experience any of his emotions alone.

Elliot

Placing a child into adoptive or foster care can be a complex and emotionally wrought decision for parents. Often, it can be just as confusing and challenging for children, who don’t understand why their lives are changing or why their parents may not be equipped to provide them with the care they need.

Elliot, written by adoptive mother Julie Pearson and illustrated by Manon Gauthier, is the story about a young rabbit whose parents believe another family could better care for him. Throughout the story, a social worker named Thomas helps Elliot navigate the foster care system in hopes of finding a family who can love and care for Elliot the way he deserves.

While the book has received a lot of positive recognition, some readers have said they felt the book seemed to place blame on Elliot for his changing circumstances because he cries and has outbursts. If you want to read this book with kids, you might want to explain that there’s nothing wrong with Elliot, or any other children in adoptive or foster care, and they are all worthy of love.

Maybe Days: A Book for Children in Foster Care

Maybe Days is a fantastic resource for children who have questions about why they are in foster care and how the process works. Author Jennifer Wilgocki breaks down what kids can expect from their parents, social workers, foster families, and more in ways they can easily digest, while illustrator Alissa Imre Geis’ drawings help younger children visualize various scenarios. The book, published by the American Psychological Association, also helps children get in touch with and better understand their feelings.

Picnic in the Park

No two families are the same, and that’s a reason to celebrate! Picnic in the Park introduces kids to different family dynamics — including families with LGBTQ parents, single parents, adoptive parents, and foster parents — so that they can grasp the beauty and importance of diversity at a young age. Together, author Joe Griffiths and illustrator Tony Pilgrim highlight that while families vary, the one thing they often share in common is love.

And Tango Makes Three

This delightful book from authors Justin Richardson and Peter Parnell and illustrator Henry Cole introduces children to adoption and LGBTQ couples by following penguins Roy and Silo on their journey to become parents. The story is based on the real Roy and Silo, two male chinstrap penguins, who lived together at the Central Park Zoo and raised a penguin named Tango. (Sadly, Roy and Silo are no longer a couple in real life, which may be a discussion you want to have with kids another day.)

Sam’s Sister

Navigating the adoption process can be stressful, especially for those who arrange to have their children adopted by other parents. But the process can also be hard on the adopted child’s siblings, who may not understand why their parents don’t feel they can adequately care for another child. Sam’s Sister, written by Juliet C. Bond, LCSW and illustrated by Linda Hoffman Kimball, invites readers into Rosa’s world as she questions why her parents chose to find another family for her baby brother, Sam, and how she, ultimately, learns to accept a new family into her life.

The Great Gilly Hopkins

This award-winning classic from author Katherine Paterson is an excellent read for middle school-aged kids. Eleven-year-old Gilly Hopkins has moved between foster homes for most of her life. She’s smart, she’s driven, and now that she’s moved into her most recent house with the Trotters, Gilly has devised a plan to escape. The story is at once funny and heart-wrenching, as Gilly tries to reconnect with her biological mother and learns that love and acceptance sometimes come from the least expected places.

After kids have finished reading, they can watch the adapted film, which features Julia Stiles, Glenn Close, Kathy Bates, Octavia Spencer, and Sophie Nélisse.

The Story of Tracy Beaker

The Story of Tracy Beaker is the first in a series of books told from 10-year-old Tracy’s viewpoint written by Jacqueline Wilson. In this book, readers meet Tracy, a young girl who lives in a children’s residential home that she likes to call “The Dumping Ground.” As you can tell, Tracy isn’t too fond of her current situation.

To cope with her feelings, Tracy makes up elaborate stories and tales about her mother, whom she dreams will raise her again one day. While these tales help Tracy feel better in the short-term, she often finds herself feeling sad and angry with her current situation and doesn’t understand why she can’t fit into a conventional family. Throughout the book, Tracy warms up to new possibilities and learns to love herself.

Please note that this book does tackle issues like neglect, abuse, and violence. It may not be suitable for children under age nine.

Three Little Words: A Memoir

Ashley Rhodes-Courter’s memoir, Three Little Words, revisits her childhood experiences living in 14 different foster homes. In the book, Rhodes-Courter recounts her feelings of loneliness, her frustrations with the system, and the painful memories of her mother and abusive foster parents. The book, while at times heartbreaking and difficult to read, highlights Rhodes-Courter’s strengths as she discovered her self-worth and her voice.

This book is best suited for teens and adults.

A version of this story was originally published in May 2019.

For more great reads with your kids, check out these diverse children’s books featuring girls of color.






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