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| New U.S. Treatment Guidelines for Covid-19 Don’t See Much Progress | New U.S. Treatment Guidelines for Covid-19 Don’t See Much Progress |
| (3 days later) | |
| The federal agency led by Dr. Anthony Fauci issued guidelines on Tuesday that stated there is no proven drug for treating coronavirus patients, a finding that essentially reinforces Dr. Fauci’s dissent from President Trump’s repeated promotion of certain drugs without evidence to support their use. | The federal agency led by Dr. Anthony Fauci issued guidelines on Tuesday that stated there is no proven drug for treating coronavirus patients, a finding that essentially reinforces Dr. Fauci’s dissent from President Trump’s repeated promotion of certain drugs without evidence to support their use. |
| The report echoed what frustrated doctors already know: Not enough is known about the highly infectious virus or how to combat it. | The report echoed what frustrated doctors already know: Not enough is known about the highly infectious virus or how to combat it. |
| Months into the pandemic, a panel of experts convened by the research center Dr. Fauci leads, the National Institute of Allergy and Infectious Diseases, concluded that whenever possible, drug therapy should be given as part of a clinical trial, so that data can be collected to determine whether treatments work. | Months into the pandemic, a panel of experts convened by the research center Dr. Fauci leads, the National Institute of Allergy and Infectious Diseases, concluded that whenever possible, drug therapy should be given as part of a clinical trial, so that data can be collected to determine whether treatments work. |
| At the White House briefing, Mr. Trump said he had not seen the panel’s guidelines. Dr. Fauci, who often attends the briefings, was not there on Tuesday. | At the White House briefing, Mr. Trump said he had not seen the panel’s guidelines. Dr. Fauci, who often attends the briefings, was not there on Tuesday. |
| Dr. Fauci has repeatedly pushed back at the president’s enthusiasm over the malaria drugs hydroxychloroquine and chloroquine, sometimes disagreeing in public with Mr. Trump. | Dr. Fauci has repeatedly pushed back at the president’s enthusiasm over the malaria drugs hydroxychloroquine and chloroquine, sometimes disagreeing in public with Mr. Trump. |
| For weeks Dr. Fauci has stressed the lack of scientific evidence to back up any potential treatment, and this new document, which includes the expertise of more than a dozen federal agencies and professional groups, underscores his reasoning. | For weeks Dr. Fauci has stressed the lack of scientific evidence to back up any potential treatment, and this new document, which includes the expertise of more than a dozen federal agencies and professional groups, underscores his reasoning. |
| In a separate interview before the guidelines were released, Dr. Fauci said there were many clinical trials underway. “Right now, it is premature to say if something is going to be a home run or not,” he said. “Right now there are no early indications of a home run anywhere. There’s nothing that has been dramatic at all.” | In a separate interview before the guidelines were released, Dr. Fauci said there were many clinical trials underway. “Right now, it is premature to say if something is going to be a home run or not,” he said. “Right now there are no early indications of a home run anywhere. There’s nothing that has been dramatic at all.” |
| Clinical trials are monitored by safety boards that can stop a trial early if a treatment shows a powerful effect. So far, none of the trials have been halted, Dr. Fauci said. | Clinical trials are monitored by safety boards that can stop a trial early if a treatment shows a powerful effect. So far, none of the trials have been halted, Dr. Fauci said. |
| Experts have collected insufficient data to recommend either for or against the use of any antiviral drug or medication that affects the immune system in patients with Covid-19 who have mild, moderate, severe or critical illness, according to the guidelines. | Experts have collected insufficient data to recommend either for or against the use of any antiviral drug or medication that affects the immune system in patients with Covid-19 who have mild, moderate, severe or critical illness, according to the guidelines. |
| The decision by the National Institutes of Health panel not to recommend either for or against a treatment included the antiviral remdesivir, which is being studied in several trials in the United States and around the world. Data is also lacking about the use of so-called convalescent plasma donated by coronavirus survivors to provide antibodies that might help patients fight the disease. | The decision by the National Institutes of Health panel not to recommend either for or against a treatment included the antiviral remdesivir, which is being studied in several trials in the United States and around the world. Data is also lacking about the use of so-called convalescent plasma donated by coronavirus survivors to provide antibodies that might help patients fight the disease. |
| But the expert panel did specifically advise against several treatments unless they were given in clinical trials. One was the combination of the malaria drug hydroxychloroquine plus the antibiotic azithromycin, which Mr. Trump has repeatedly promoted despite the lack of evidence that they work. | But the expert panel did specifically advise against several treatments unless they were given in clinical trials. One was the combination of the malaria drug hydroxychloroquine plus the antibiotic azithromycin, which Mr. Trump has repeatedly promoted despite the lack of evidence that they work. |
| Those drugs should be used only in clinical trials “because of the potential for toxicities,” the experts said. | Those drugs should be used only in clinical trials “because of the potential for toxicities,” the experts said. |
| The panel also had cautionary advice about hydroxychloroquine and the closely related drug chloroquine, even when given without azithromycin, saying that patients receiving them should be monitored for adverse effects, particularly an abnormality in heart rhythm called prolonged QTc interval. | The panel also had cautionary advice about hydroxychloroquine and the closely related drug chloroquine, even when given without azithromycin, saying that patients receiving them should be monitored for adverse effects, particularly an abnormality in heart rhythm called prolonged QTc interval. |
| A study of the records of 368 Veterans Affairs patients, posted on Tuesday but not yet peer-reviewed, found that hydroxychloroquine, with or without azithromycin, did not help patients avoid the need for ventilators. And hydroxychloroquine alone was associated with an increased risk of death. | A study of the records of 368 Veterans Affairs patients, posted on Tuesday but not yet peer-reviewed, found that hydroxychloroquine, with or without azithromycin, did not help patients avoid the need for ventilators. And hydroxychloroquine alone was associated with an increased risk of death. |
| But the study was not a controlled trial, and patients who received the drugs were sicker to begin with. The authors wrote, “These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.” | But the study was not a controlled trial, and patients who received the drugs were sicker to begin with. The authors wrote, “These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.” |
| Updated June 5, 2020 | |
| 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. |
| 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. | 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. | 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. | 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. | 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. |
| At Tuesday’s White House briefing, Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, described the study as small and retrospective, adding, “what F.D.A. will require is data from randomized clinical trials.” | At Tuesday’s White House briefing, Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, described the study as small and retrospective, adding, “what F.D.A. will require is data from randomized clinical trials.” |
| Even so, he said, “This is something a doctor would need to consider in the decision to write a prescription for hydroxychloroquine.” | Even so, he said, “This is something a doctor would need to consider in the decision to write a prescription for hydroxychloroquine.” |
| The N.I.H. panel also said that combined H.I.V. drugs lopinavir and ritonavir (sold as Kaletra), and other drugs known as H.I.V. protease inhibitors, should not be given outside of clinical trials, because trial data so far has shown no benefit and some unfavorable effects. | The N.I.H. panel also said that combined H.I.V. drugs lopinavir and ritonavir (sold as Kaletra), and other drugs known as H.I.V. protease inhibitors, should not be given outside of clinical trials, because trial data so far has shown no benefit and some unfavorable effects. |
| Drugs known as interferons should also not be used outside trials, the group advising the infectious disease institute said, because they did not help patients with the other coronavirus diseases SARS and MERS. The same advice applies to a class of drugs called janus kinase inhibitors (the drug baricitinib is one example) because they broadly suppress the immune system. | Drugs known as interferons should also not be used outside trials, the group advising the infectious disease institute said, because they did not help patients with the other coronavirus diseases SARS and MERS. The same advice applies to a class of drugs called janus kinase inhibitors (the drug baricitinib is one example) because they broadly suppress the immune system. |
| The guidelines also contain detailed advice for health care providers about the care of infected children and pregnant women, and the use of oxygen, ventilators and steroid drugs in very sick patients. | The guidelines also contain detailed advice for health care providers about the care of infected children and pregnant women, and the use of oxygen, ventilators and steroid drugs in very sick patients. |
| All the advice will be updated as new data emerges. | All the advice will be updated as new data emerges. |