'Trump Calls This Drug a ‘Game Changer.’ Doctors Aren’t So Sure.' diff viewer (7/8)

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Trump Calls This Drug a ‘Game Changer.’ Doctors Aren’t So Sure.	Trump Calls This Drug a ‘Game Changer.’ Doctors Aren’t So Sure.
2020-06-17 05:09:23 UTC	2020-06-17 13:36:43 UTC (about 8 hours later)
Just a month ago, Dr. Bushra Mina had no playbook to treat patients who were arriving with coronavirus at Lenox Hill Hospital in Manhattan.	Just a month ago, Dr. Bushra Mina had no playbook to treat patients who were arriving with coronavirus at Lenox Hill Hospital in Manhattan.
His first encounter was with an older man whose health declined quickly. No drugs were approved to treat this highly infectious virus, and there was little Dr. Mina could do but provide supportive care.	His first encounter was with an older man whose health declined quickly. No drugs were approved to treat this highly infectious virus, and there was little Dr. Mina could do but provide supportive care.
Weeks later, Dr. Mina, the chief of pulmonary medicine at Lenox Hill, is on the 16th revision of guidelines shared among doctors as they assess the ways the virus is emerging and advancing in patients, and what possible treatments should be applied.	Weeks later, Dr. Mina, the chief of pulmonary medicine at Lenox Hill, is on the 16th revision of guidelines shared among doctors as they assess the ways the virus is emerging and advancing in patients, and what possible treatments should be applied.
Now most Covid-19 patients at Lenox Hill who are not on the verge of dying receive a five-day regimen of hydroxychloroquine, the long-used malaria drug that President Trump has repeatedly promoted as a “what have you got to lose” remedy. While his own top health officials are more cautious — noting there is limited evidence about the drug’s benefits — doctors across the country have been prescribing the drug for weeks.	Now most Covid-19 patients at Lenox Hill who are not on the verge of dying receive a five-day regimen of hydroxychloroquine, the long-used malaria drug that President Trump has repeatedly promoted as a “what have you got to lose” remedy. While his own top health officials are more cautious — noting there is limited evidence about the drug’s benefits — doctors across the country have been prescribing the drug for weeks.
Dr. Mina doesn’t know if the hydroxychloroquine is helping his patients. He is well aware that there are no rigorous clinical trials showing that the drug works. But he can’t wait for the evidence to come in, he said, when people are dying.	Dr. Mina doesn’t know if the hydroxychloroquine is helping his patients. He is well aware that there are no rigorous clinical trials showing that the drug works. But he can’t wait for the evidence to come in, he said, when people are dying.
“I think it’s a battle, and your options are very limited,” Dr. Mina said. “You’re really looking for what you can do with whatever evidence you have.”	“I think it’s a battle, and your options are very limited,” Dr. Mina said. “You’re really looking for what you can do with whatever evidence you have.”
Hydroxychloroquine and a related drug, chloroquine, have been used for decades to treat and prevent malaria, and hydroxychloroquine has been used by people with lupus and rheumatoid arthritis because it is known to calm the immune system. In laboratory tests, it has been shown to block the coronavirus from invading cells, although it hasn’t been proven in human trials. The drugs are not recommended for people who have abnormal heart rhythms because it can make them worse.	Hydroxychloroquine and a related drug, chloroquine, have been used for decades to treat and prevent malaria, and hydroxychloroquine has been used by people with lupus and rheumatoid arthritis because it is known to calm the immune system. In laboratory tests, it has been shown to block the coronavirus from invading cells, although it hasn’t been proven in human trials. The drugs are not recommended for people who have abnormal heart rhythms because it can make them worse.
Almost overnight, the hard-to-pronounce drug has become a litmus test for support of the president. Conservative talk show hosts and supporters like his personal lawyer, Rudy Giuliani, praise the drug’s potential, while political opponents have scoffed at what they see as another way that Mr. Trump has undermined scientific inquiry.	Almost overnight, the hard-to-pronounce drug has become a litmus test for support of the president. Conservative talk show hosts and supporters like his personal lawyer, Rudy Giuliani, praise the drug’s potential, while political opponents have scoffed at what they see as another way that Mr. Trump has undermined scientific inquiry.
For weeks now, doctors around the country have been giving the drug to patients at various stages of the disease, and as a preventive measure to some if they’ve been exposed by family members or in health care settings. But even after treating hundreds of patients with the antimalarial drug, the doctors interviewed did not report clear results or remarkable recoveries that can be traced to the drug.	For weeks now, doctors around the country have been giving the drug to patients at various stages of the disease, and as a preventive measure to some if they’ve been exposed by family members or in health care settings. But even after treating hundreds of patients with the antimalarial drug, the doctors interviewed did not report clear results or remarkable recoveries that can be traced to the drug.
In addition to Lenox Hill, other major hospitals in outbreak hot spots are using hydroxychloroquine as part of their protocol. They include Massachusetts General Hospital in Boston and Rush University Medical Center in Chicago, which each recommend it on a case-by-case basis and when clinical trials are not feasible, and Ochsner Health in Louisiana, which administers it routinely to coronavirus patients.	In addition to Lenox Hill, other major hospitals in outbreak hot spots are using hydroxychloroquine as part of their protocol. They include Massachusetts General Hospital in Boston and Rush University Medical Center in Chicago, which each recommend it on a case-by-case basis and when clinical trials are not feasible, and Ochsner Health in Louisiana, which administers it routinely to coronavirus patients.
This week, researchers in China made public the results of another study of hydroxychloroquine, of 150 hospitalized patients. The study, which has not been peer-reviewed, found that patients who were given the drug did not fare significantly better than those who did not receive it, nor did they experience more serious side effects.	This week, researchers in China made public the results of another study of hydroxychloroquine, of 150 hospitalized patients. The study, which has not been peer-reviewed, found that patients who were given the drug did not fare significantly better than those who did not receive it, nor did they experience more serious side effects.
Some medical societies have recently recommended against its regular use. The Infectious Diseases Society of America recently advised that use of hydroxychloroquine be limited to clinical trials, as did the American Thoracic Society.	Some medical societies have recently recommended against its regular use. The Infectious Diseases Society of America recently advised that use of hydroxychloroquine be limited to clinical trials, as did the American Thoracic Society.
At the Henry Ford Health System in Detroit, researchers are beginning a 3,000-person clinical trial that will test whether hydroxychloroquine can prevent infection in health care employees and other front-line workers. But they have also given it to sick patients, outside of a trial, when there is little other hope.	At the Henry Ford Health System in Detroit, researchers are beginning a 3,000-person clinical trial that will test whether hydroxychloroquine can prevent infection in health care employees and other front-line workers. But they have also given it to sick patients, outside of a trial, when there is little other hope.
“In many ways we feel driven to help patients who are in front of us — today — in the hour of their greatest need,” said Dr. Steven Kalkanis, the chief academic officer of Henry Ford Health System. “And there is a clamoring to use whatever we have at our disposal.”	“In many ways we feel driven to help patients who are in front of us — today — in the hour of their greatest need,” said Dr. Steven Kalkanis, the chief academic officer of Henry Ford Health System. “And there is a clamoring to use whatever we have at our disposal.”
But outside of a clinical trial, it can be hard to assess the drug’s value, especially when it is being given to a variety of patients, of different ages and medical conditions, and at different points in their disease. Based on the hospital’s experience, Dr. Kalkanis said, the drug’s benefits do not appear to be a slam dunk.	But outside of a clinical trial, it can be hard to assess the drug’s value, especially when it is being given to a variety of patients, of different ages and medical conditions, and at different points in their disease. Based on the hospital’s experience, Dr. Kalkanis said, the drug’s benefits do not appear to be a slam dunk.
“For every anecdotal success story, we hear one where a patient unfortunately died,” he said. “It’s not coalescing around, ‘Oh my gosh, this is the answer.’”	“For every anecdotal success story, we hear one where a patient unfortunately died,” he said. “It’s not coalescing around, ‘Oh my gosh, this is the answer.’”
The drug has generated excitement because a laboratory study, with cultured cells, found that chloroquine could block the coronavirus from invading cells, which it must do to replicate and cause illness. But drugs that show promise in the laboratory do not always translate to success in the human body, and other studies have found that it failed to prevent or treat influenza and other viral illnesses.	The drug has generated excitement because a laboratory study, with cultured cells, found that chloroquine could block the coronavirus from invading cells, which it must do to replicate and cause illness. But drugs that show promise in the laboratory do not always translate to success in the human body, and other studies have found that it failed to prevent or treat influenza and other viral illnesses.
Early reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients. But the studies were small and did not use proper control groups — patients carefully selected to match those in the experimental group but who are not given the drug being tested. Research involving few patients and no controls cannot determine whether a drug works.	Early reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients. But the studies were small and did not use proper control groups — patients carefully selected to match those in the experimental group but who are not given the drug being tested. Research involving few patients and no controls cannot determine whether a drug works.
At most hospitals in the Ochsner Health system in Louisiana, including those in New Orleans, infected patients are routinely given a course of hydroxychloroquine. Patients in the intensive care unit are also given the drug if they have not received it earlier in their illness.	At most hospitals in the Ochsner Health system in Louisiana, including those in New Orleans, infected patients are routinely given a course of hydroxychloroquine. Patients in the intensive care unit are also given the drug if they have not received it earlier in their illness.
Dr. Leo Seoane, the chief academic officer at Ochsner Health, said the health system had declined to participate in research trials that included a placebo arm, in which some patients would be selected not to receive the drug. “We didn’t think it was ethical at this point in the crisis to withhold the therapies that could be beneficial,” he said.	Dr. Leo Seoane, the chief academic officer at Ochsner Health, said the health system had declined to participate in research trials that included a placebo arm, in which some patients would be selected not to receive the drug. “We didn’t think it was ethical at this point in the crisis to withhold the therapies that could be beneficial,” he said.
But he acknowledged that even though the hospital gives the drug to nearly everyone who is admitted, the percentage of people who end up in the intensive care unit — about a third of those admitted — is similar to reports in other places where the drug is not used. “From a gut feeling, it’s hard for me to know that it is having an impact,” said Dr. Seoane, who is also a pulmonologist and critical care physician.	But he acknowledged that even though the hospital gives the drug to nearly everyone who is admitted, the percentage of people who end up in the intensive care unit — about a third of those admitted — is similar to reports in other places where the drug is not used. “From a gut feeling, it’s hard for me to know that it is having an impact,” said Dr. Seoane, who is also a pulmonologist and critical care physician.
Dr. Sarah Doernberg, an associate professor of infectious disease at UCSF Medical Center in San Francisco, said she was selective about which patients were given the drug. “It’s not an established therapy that everyone should get,” she said. “I feel pretty strongly about that.”	Dr. Sarah Doernberg, an associate professor of infectious disease at UCSF Medical Center in San Francisco, said she was selective about which patients were given the drug. “It’s not an established therapy that everyone should get,” she said. “I feel pretty strongly about that.”
A study of its effects in a clinical trial, versus a placebo, was needed, she said. “We can figure out the answers to this question, so that when people get sick months from now, we’ll know whether it will work.”	A study of its effects in a clinical trial, versus a placebo, was needed, she said. “We can figure out the answers to this question, so that when people get sick months from now, we’ll know whether it will work.”
Updated June 16, 2020	Updated June 16, 2020
	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.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.	Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
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.)
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.	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.	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’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.