This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/03/18/health/coronavirus-antiviral-drugs-fail.html

The article has changed 29 times. There is an RSS feed of changes available.

Version 14 Version 15
A Promising Treatment for Coronavirus Fails A Promising Treatment for Coronavirus Fails
(about 7 hours later)
Antiviral drugs that had held promise as a potential treatment for the coronavirus did not work in one of the first major studies in seriously ill patients, researchers from China reported on Wednesday.Antiviral drugs that had held promise as a potential treatment for the coronavirus did not work in one of the first major studies in seriously ill patients, researchers from China reported on Wednesday.
“No benefit was observed,” the researchers wrote in The New England Journal of Medicine.“No benefit was observed,” the researchers wrote in The New England Journal of Medicine.
The study tested Kaletra, a combination of two antiviral medicines, lopinavir and ritonavir, that are normally used to treat H.I.V.The study tested Kaletra, a combination of two antiviral medicines, lopinavir and ritonavir, that are normally used to treat H.I.V.
There is no proven drug treatment for the new coronavirus, and doctors around the world have been desperately testing an array of medicines in hopes of finding something that will help patients, especially those who are severely ill. Several antiviral drugs have been considered possible treatments, though so far none has proved effective.There is no proven drug treatment for the new coronavirus, and doctors around the world have been desperately testing an array of medicines in hopes of finding something that will help patients, especially those who are severely ill. Several antiviral drugs have been considered possible treatments, though so far none has proved effective.
Even though the results were disappointing, the researchers said that this one study was not the last word, and suggested that more studies might determine whether the drugs would work if given earlier in the illness or in combination with other medicines.Even though the results were disappointing, the researchers said that this one study was not the last word, and suggested that more studies might determine whether the drugs would work if given earlier in the illness or in combination with other medicines.
The new findings involve a study of 199 adults, ages 48 to 68, who were hospitalized and severely ill with the virus at Jin Yin-Tan Hospital in Wuhan, China.The new findings involve a study of 199 adults, ages 48 to 68, who were hospitalized and severely ill with the virus at Jin Yin-Tan Hospital in Wuhan, China.
For 14 days, half of the patients received standard care alone, and half were given the antiviral drugs plus standard care. Standard care includes the usual treatments for pneumonia, including oxygen if needed, and other medicines needed to keep patients stable and comfortable. The drugs did not shorten the illness or prevent deaths.For 14 days, half of the patients received standard care alone, and half were given the antiviral drugs plus standard care. Standard care includes the usual treatments for pneumonia, including oxygen if needed, and other medicines needed to keep patients stable and comfortable. The drugs did not shorten the illness or prevent deaths.
An editorial published along with the article called the research “a heroic effort,” saying it was proof that useful studies could be done, even in the midst of an overwhelming pandemic.An editorial published along with the article called the research “a heroic effort,” saying it was proof that useful studies could be done, even in the midst of an overwhelming pandemic.
Earlier reports from China showed that doctors were pulling out all of the stops to try to help their patients, dosing them with antibiotics and antiviral drugs to try to fight off the virus and bacterial infections that they feared might complicate the illness. Some patients were also given steroids or other drugs in an effort to tamp down severe inflammation, an overreaction by the immune system that could be fatal.Earlier reports from China showed that doctors were pulling out all of the stops to try to help their patients, dosing them with antibiotics and antiviral drugs to try to fight off the virus and bacterial infections that they feared might complicate the illness. Some patients were also given steroids or other drugs in an effort to tamp down severe inflammation, an overreaction by the immune system that could be fatal.
There is no solid evidence yet that anything works, but the epidemic is moving so fast that doctors are trying approaches where even preliminary data suggests there may be a benefit. Many feel they are on their own to develop treatment protocols. Federal health authorities like the Centers for Disease Control and Prevention recommend supportive care, but have said there is no evidence yet to support antiviral drugs or treatments for inflammation.There is no solid evidence yet that anything works, but the epidemic is moving so fast that doctors are trying approaches where even preliminary data suggests there may be a benefit. Many feel they are on their own to develop treatment protocols. Federal health authorities like the Centers for Disease Control and Prevention recommend supportive care, but have said there is no evidence yet to support antiviral drugs or treatments for inflammation.
“If I’m out in the community and I’ve got somebody who’s dying of course I would do whatever I could to try and help them,” said Dr. Tim Schacker, the vice dean for research and an infectious disease specialist at the University of Minnesota medical school.“If I’m out in the community and I’ve got somebody who’s dying of course I would do whatever I could to try and help them,” said Dr. Tim Schacker, the vice dean for research and an infectious disease specialist at the University of Minnesota medical school.
A number of hospitals were giving coronavirus patients hydroxychloroquine, an old, inexpensive and relatively safe malaria drug that lab studies indicated might keep the coronavirus from invading human cells. Reports of its use in patients in China and in France have suggested that it may help, but there is not enough data to be sure.A number of hospitals were giving coronavirus patients hydroxychloroquine, an old, inexpensive and relatively safe malaria drug that lab studies indicated might keep the coronavirus from invading human cells. Reports of its use in patients in China and in France have suggested that it may help, but there is not enough data to be sure.
Nonetheless, the idea is catching on, so much so that shortages of the drug are being reported.Nonetheless, the idea is catching on, so much so that shortages of the drug are being reported.
In Seattle, many hospitals have signed up to enroll patients in a clinical trial of Gilead’s experimental antiviral drug remdesivir. The trial is a controlled study, meaning that some patients will be picked at random to receive placebos rather than the drug — the gold-standard type of study to determine whether a drug really works.In Seattle, many hospitals have signed up to enroll patients in a clinical trial of Gilead’s experimental antiviral drug remdesivir. The trial is a controlled study, meaning that some patients will be picked at random to receive placebos rather than the drug — the gold-standard type of study to determine whether a drug really works.
Dr. James Town, director of the medical intensive care unit at Harborview Medical Center in Seattle, said that the first choice for most patients would be the remdesivir study. Those not eligible for the study could apply to the Food and Drug Administration for “compassionate use,” special permission sometimes given to receive an experimental drug outside of a study.Dr. James Town, director of the medical intensive care unit at Harborview Medical Center in Seattle, said that the first choice for most patients would be the remdesivir study. Those not eligible for the study could apply to the Food and Drug Administration for “compassionate use,” special permission sometimes given to receive an experimental drug outside of a study.
After remdesivir, Dr. Town said, the next choice would be hydroxychloroquine, as long as the patient did not have abnormalities in heart rhythm, which would make the drug unsafe.
Updated June 22, 2020Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
After remdesivir, Dr. Town said, the next choice would be hydroxychloroquine, as long as the patient did not have abnormalities in heart rhythm, which would make the drug unsafe.
For critically ill patients suffering from intense inflammatory reactions, called a cytokine storm, some centers are trying a drug called tocilizumab.For critically ill patients suffering from intense inflammatory reactions, called a cytokine storm, some centers are trying a drug called tocilizumab.
“That’s the creative juice we need right now, as we try and take care of these patients literally on the run,” Dr. Schacker, from the University of Minnesota, said.“That’s the creative juice we need right now, as we try and take care of these patients literally on the run,” Dr. Schacker, from the University of Minnesota, said.
Dr. Town said: “There are trials going on for some of these things in some areas. All are rapidly enrolling, but their data won’t be back in time for a lot of places to make these decisions.”Dr. Town said: “There are trials going on for some of these things in some areas. All are rapidly enrolling, but their data won’t be back in time for a lot of places to make these decisions.”
The University of Minnesota is conducting three studies, including one on remdesivir for seriously ill patients. A second study will give hydroxychloroquine to people who have been exposed to the coronavirus, because they live in the same household as patients, to see if the drug can prevent them from becoming infected.The University of Minnesota is conducting three studies, including one on remdesivir for seriously ill patients. A second study will give hydroxychloroquine to people who have been exposed to the coronavirus, because they live in the same household as patients, to see if the drug can prevent them from becoming infected.
The third study will use an old, safe drug called losartan, normally given to treat high blood pressure, to find out whether it can prevent mild coronavirus infections from turning more serious. The drug blocks the receptor that the virus uses to get into cells, so researchers think it might stop or slow the illness.The third study will use an old, safe drug called losartan, normally given to treat high blood pressure, to find out whether it can prevent mild coronavirus infections from turning more serious. The drug blocks the receptor that the virus uses to get into cells, so researchers think it might stop or slow the illness.
“We’re trying to ask the question in the midst of the confusion and everything that’s going on, ‘Do these drugs help? Yes or no?’” Dr. Schacker said. “If no, let’s move on.”“We’re trying to ask the question in the midst of the confusion and everything that’s going on, ‘Do these drugs help? Yes or no?’” Dr. Schacker said. “If no, let’s move on.”