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Malaria Drug Helps Virus Patients Improve, in Small Study Malaria Drug Helps Virus Patients Improve, in Small Study
(2 months later)
The malaria drug hydroxychloroquine helped to speed the recovery of a small number of patients who were mildly ill from the coronavirus, doctors in China reported this week.The malaria drug hydroxychloroquine helped to speed the recovery of a small number of patients who were mildly ill from the coronavirus, doctors in China reported this week.
Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug. The authors of the report said that the medication was promising, but that more research was needed to clarify how it might work in treating coronavirus disease and to determine the best way to use it.Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug. The authors of the report said that the medication was promising, but that more research was needed to clarify how it might work in treating coronavirus disease and to determine the best way to use it.
“It’s going to send a ripple of excitement out through the treating community,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.“It’s going to send a ripple of excitement out through the treating community,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.
The study was small and limited to patients who were mildly or moderately ill, not severe cases. Like many reports about the coronavirus, it was posted at medRxiv, an online server for medical articles, before undergoing peer review by other researchers.The study was small and limited to patients who were mildly or moderately ill, not severe cases. Like many reports about the coronavirus, it was posted at medRxiv, an online server for medical articles, before undergoing peer review by other researchers.
But the findings strongly support earlier studies suggesting a role for the drug, Dr. Schaffner said.But the findings strongly support earlier studies suggesting a role for the drug, Dr. Schaffner said.
“I think it will reinforce the inclination of many people across the country who are not in a position to enter their patients into clinical trials but have already begun using hydroxychloroquine,” he said.“I think it will reinforce the inclination of many people across the country who are not in a position to enter their patients into clinical trials but have already begun using hydroxychloroquine,” he said.
Previous reports from China and France that the drug seemed to help patients, along with enthusiastic comments from President Trump, have created a buzz around hydroxychloroquine and the closely related chloroquine, which are decades-old drugs used to treat malaria and autoimmune diseases like lupus and rheumatoid arthritis. A resulting spike in demand has led to hoarding and shortages, and left patients who rely on the drugs for chronic diseases wondering whether they will be able to fill their prescriptions.Previous reports from China and France that the drug seemed to help patients, along with enthusiastic comments from President Trump, have created a buzz around hydroxychloroquine and the closely related chloroquine, which are decades-old drugs used to treat malaria and autoimmune diseases like lupus and rheumatoid arthritis. A resulting spike in demand has led to hoarding and shortages, and left patients who rely on the drugs for chronic diseases wondering whether they will be able to fill their prescriptions.
With no proven treatment for the coronavirus, many hospitals have simply been giving hydroxychloroquine to patients, reasoning that it might help and probably will not hurt, because it is relatively safe.With no proven treatment for the coronavirus, many hospitals have simply been giving hydroxychloroquine to patients, reasoning that it might help and probably will not hurt, because it is relatively safe.
The earlier reports from France and China drew criticism because they did not include control groups to compare treated versus untreated patients. Researchers called the reports anecdotal, and said the lack of controls made it impossible to determine whether the drugs worked.The earlier reports from France and China drew criticism because they did not include control groups to compare treated versus untreated patients. Researchers called the reports anecdotal, and said the lack of controls made it impossible to determine whether the drugs worked.
Among health officials who declined to endorse the drugs, and who called for clinical trials, were some members of the president’s coronavirus task force — including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr. Stephen Hahn, commissioner of the Food and Drug Administration.Among health officials who declined to endorse the drugs, and who called for clinical trials, were some members of the president’s coronavirus task force — including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr. Stephen Hahn, commissioner of the Food and Drug Administration.
The new study, of 62 patients with an average age of about 45, did have a control group. It was conducted at the Renmin Hospital of Wuhan University, in Wuhan, China. The patients were carefully chosen to exclude people with medical problems that could be made worse by hydroxychloroquine, like abnormal heart rhythms, certain eye diseases, and liver or kidney problems.The new study, of 62 patients with an average age of about 45, did have a control group. It was conducted at the Renmin Hospital of Wuhan University, in Wuhan, China. The patients were carefully chosen to exclude people with medical problems that could be made worse by hydroxychloroquine, like abnormal heart rhythms, certain eye diseases, and liver or kidney problems.
Half the subjects — the controls — received just the usual care given to coronavirus patients, and half had usual care plus hydroxychloroquine. The usual care included oxygen, antiviral drugs, antibiotics and other treatments.Half the subjects — the controls — received just the usual care given to coronavirus patients, and half had usual care plus hydroxychloroquine. The usual care included oxygen, antiviral drugs, antibiotics and other treatments.
Their disease was considered mild, even though all had pneumonia that showed up on CT scans. After giving informed consent, they were assigned at random to either the hydroxychloroquine or the control group. They were treated for five days, and their fevers and coughing were monitored. They also had chest CT scans the day before the study treatment began, and the day after it ended.Their disease was considered mild, even though all had pneumonia that showed up on CT scans. After giving informed consent, they were assigned at random to either the hydroxychloroquine or the control group. They were treated for five days, and their fevers and coughing were monitored. They also had chest CT scans the day before the study treatment began, and the day after it ended.
Coughing and fever eased a day or so earlier in the patients who received hydroxychloroquine, and pneumonia improved in 25 of 31, as opposed to 17 of 31 in the controls.Coughing and fever eased a day or so earlier in the patients who received hydroxychloroquine, and pneumonia improved in 25 of 31, as opposed to 17 of 31 in the controls.
Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
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.
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.
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.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
The illness turned severe in four patients — all in the control group.The illness turned severe in four patients — all in the control group.
Two patients had minor side effects from hydroxychloroquine: One had a rash and another had a headache.Two patients had minor side effects from hydroxychloroquine: One had a rash and another had a headache.
Dr. Schaffner cautioned that the results applied only to patients with relatively mild illness, like the ones in the study, and could not be generalized to advanced cases.Dr. Schaffner cautioned that the results applied only to patients with relatively mild illness, like the ones in the study, and could not be generalized to advanced cases.
“If you want to treat people who are already seriously ill, we don’t know how well this will work,” he said.“If you want to treat people who are already seriously ill, we don’t know how well this will work,” he said.
If the drug is helping, it is not clear how. There are two possible ways. In laboratory studies, it can stop the virus from invading cells. But hydroxychloroquine can also dial back an overactive immune system, which is why it can treat autoimmune diseases. And a powerful immune reaction to the coronavirus is suspected of playing a role in some of the severest cases of the disease.If the drug is helping, it is not clear how. There are two possible ways. In laboratory studies, it can stop the virus from invading cells. But hydroxychloroquine can also dial back an overactive immune system, which is why it can treat autoimmune diseases. And a powerful immune reaction to the coronavirus is suspected of playing a role in some of the severest cases of the disease.
“We don’t know which of the pharmacologic aspects of hydroxychloroquine are most active, the antiviral part, or the immunomodulatory part,” Dr. Schaffner said. “We don’t know, but it does reinforce the notion, as the authors say briefly, it reinforces the thinking about the nature of many of these pneumonias we are seeing, which seem to have an immune basis, as opposed to being secondary bacterial pneumonia, which we see so often in influenza.”“We don’t know which of the pharmacologic aspects of hydroxychloroquine are most active, the antiviral part, or the immunomodulatory part,” Dr. Schaffner said. “We don’t know, but it does reinforce the notion, as the authors say briefly, it reinforces the thinking about the nature of many of these pneumonias we are seeing, which seem to have an immune basis, as opposed to being secondary bacterial pneumonia, which we see so often in influenza.”