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Jun 4: A malaria drug President Donald Trump took to try to prevent COVID-19 proved ineffective for that in the first large, high-quality study to test it in people in close contact with someone with the disease.

Results published Wednesday by the New England Journal of Medicine show that hydroxychloroquine was no better than placebo pills at preventing illness from the coronavirus.

The drug did not seem to cause serious harm, though -- about 40% on it had side effects, mostly mild stomach problems.

 “We were disappointed. We would have liked for this to work,” said the study leader, Dr. David Boulware, an infectious disease specialist at the University of Minnesota.

“But our objective was to answer the question and to conduct a high-quality study,” because the evidence on the drug so far has been inconclusive, he said.

Hydroxychloroquine and a similar drug, chloroquine, have been the subject of much debate since Trump started promoting them in March.

Hydroxychloroquine has long been used for malaria, lupus, and rheumatoid arthritis, but no large studies have shown it or chloroquine to be safe or effective for much sicker patients with coronavirus, and some studies have suggested the drugs may do harm.

Trump took a two-week course of hydroxychloroquine, along with zinc and Vitamin D, after two staffers tested positive for COVID-19, and had no ill effects, according to results of his latest physical released by his doctor Wednesday.

Federal regulators have warned against hydroxychloroquine's use except in hospitals and formal studies because of the risk of side effects, especially heart rhythm problems.

Boulware's study involved 821 people in the United States and Canada living with someone diagnosed with COVID-19 or at high risk of getting it because of their job -- doctors, nurses, ambulance workers who had significant exposure to a sick patient while not wearing full protective gear.

They were randomly assigned to get either the nutrient folate as a placebo or hydroxychloroquine for five days, starting within four days of their exposure. Neither they nor others involved in the research knew who was getting which pills.

After 14 days in the study, 12 per cent on the drug developed COVID-19 symptoms versus 14 per cent in the placebo group, but the difference is so small it could have occurred by chance, Boulware said.

“There's basically no effect. It does not prevent infection,” he said of the drug. Even if it were to give some slim advantage, “we'd want a much larger effect” to justify its use and risk of side effects for preventing illness, he said.

Results were no different among a subgroup of participants who were taking zinc or vitamin C, which some people believe might help make hydroxychloroquine more effective or fight the coronavirus.

There are some big caveats: The study enrolled people through the Internet and social media, relying on them to report their own symptoms rather than having them tracked in a formal way by doctors.

Participants were not all tested for the coronavirus but were diagnosed as COVID-19 cases based on symptoms in many cases. And not all took their medicines as directed.

The results “are more provocative than definitive,” and the drug may yet have prevention benefits if tried sooner or in a different way, Dr. Myron Cohen of the University of North Carolina at Chapel Hill wrote in a commentary in the journal.

Others were glad to see a study that had a comparison group and good scientific methods after so many weaker reports on hydroxychloroquine.

“This fits with everything else we've seen so far which suggests that it's not beneficial," said Dr. Peter Bach, director of a health policy center at Memorial Sloan Kettering Cancer Center in New York.

This study was in younger relatively healthy people, but the results “would make me very discouraged about trying to use this in older people” who are most vulnerable to serious illness from the coronavirus, Bach said.

“If it does work, it doesn't work very well.” Dr. Dan Culver, a lung specialist at the Cleveland Clinic, said there's still a chance that giving the drug sooner than four days after someone's exposure to the virus may help prevent illness.

But the study “takes 'home run' off the table” as far as hopes for the drug, he said.

The study was mostly funded by David Baszucki, founder of Roblox, a California-based game software company, and other private donors and the Minnesota university.

Boulware also is leading a study testing hydroxychloroquine for treating COVID-19. The study is finished and results are being analyzed now.

On Tuesday, the journal Lancet posted an “expression of concern” about a study it published earlier this month of nearly 15,000 COVID-19 patients on the malaria drugs that tied their use to a higher risk of dying in the hospital or developing a heartbeat problem.

Scientists have raised serious questions about the database used for that study, and its authors have launched an independent audit.

That work had a big impact: the World Health Organization suspended use of hydroxychloroquine in a study it is leading, and French officials stopped the drug's use in hospitals. On Wednesday, the WHO said experts who reviewed safety information decided that its study could resume.

The Japan government on Monday decided to lift the state of emergency for COVID-19 in Tokyo and four other prefectures of the country, the only places where the measure implemented to curb the pandemic had remained in force.

The lifting of the alert was backed by the coronavirus advisory panel and will be formally approved by the government later day, the economic revitalization minister and head of the working group to coordinate Japan's fight against COVID-19, Yasutoshi Nishimura, said.

The Japanese authorities made the decision after taking into account the number of infections and the situation of the health system in Tokyo, the three neighbouring prefectures of Chiba, Kanagawa and Saitama and the northern Hokkaido, the only ones where the state of emergency declared more than a month ago to control the pandemic remained in effect, reports Efe news.

The health alert was initially declared in Tokyo and six other prefectures on April 17 and subsequently extended across the country.

It allowed local authorities to ban large-scale public events and close bars and restaurants at night, among other measures, while the government has launched a campaign to encourage teleworking and staying at home.

The government resorted to this measure for the first time in the country's recent history to contain the spread of the virus and is now withdrawing it after a sustained slowdown in infections throughout the archipelago, where around 16,600 confirmed COVID-19 cases and 839 deaths have been recorded, according to the latest data.

The group of experts advising the government appreciated the efforts made by citizens to comply with the recommendations to achieve the target of reducing interpersonal contact by 80 percent, top government spokesperson Yoshihide Suga said at a press conference on Monday.

The recommendation for citizens to avoid unnecessary trips outside and the request for non-essential businesses to close were not mandatory nor accompanied by fines or other penalties for non-compliance, unlike the stricter containment measures implemented in other countries.

The government plans to formally approve the lifting of the state of emergency on Monday after consulting with other political parties in parliament and another meeting with the advisory panel, following which Japanese Prime Minister Shinzo Abe will hold a press conference.

The government had already decided to lift the emergency in 39 prefectures on May 14 after they reported a marked decrease in the number of infections, leaving out the more populated regions such as Tokyo and Osaka.

To avoid new outbreaks of the virus, Abe has urged people to become accustomed to a "new lifestyle" that includes maintaining social distancing, the use of masks outside as well as a series of guidelines for the reopening of shops, restaurants and public facilities.

London, May 20: The current physical distancing guidelines of 6 feet may be insufficient to prevent COVID-19 transmission, according to a study which says a mild cough in low wind speeds can propel saliva droplets by as much as 18 feet.

Researchers, including those from the University of Nicosia in Cyprus, said a good baseline for studying the airborne transmission of viruses, like the one behind the COVID-19 pandemic, is a deeper understanding of how particles travel through the air when people cough.

In the study, published in the journal Physics of Fluids, they said even with a slight breeze of about four kilometres per hour (kph), saliva travels 18 feet in 5 seconds.

"The droplet cloud will affect both adults and children of different heights," said study co-author Dimitris Drikakis from the University of Nicosia.

According to the scientists, shorter adults and children could be at higher risk if they are located within the trajectory of the saliva droplets.

They said saliva is a complex fluid, which travels suspended in a bulk of surrounding air released by a cough, adding that many factors affect how saliva droplets travel in the air.

These factors, the study noted, include the size and number of droplets, how they interact with one another and the surrounding air as they disperse and evaporate, how heat and mass are transferred, and the humidity and temperature of the surrounding air.

In the study, the scientists created a computer simulation to examine the state of every saliva droplet moving through the air in front of a coughing person.

The model considered the effects of humidity, dispersion force, interactions of molecules of saliva and air, and how the droplets change from liquid to vapour and evaporate, along with a grid representing the space in front of a coughing person.

Each grid, the scientists said, holds information about variables like pressure, fluid velocity, temperature, droplet mass, and droplet position.

The study analysed the fates of nearly 1,008 simulated saliva droplets, and solved as many as 3.7 million equations.

"The purpose of the mathematical modelling and simulation is to take into account all the real coupling or interaction mechanisms that may take place between the main bulk fluid flow and the saliva droplets, and between the saliva droplets themselves," explained Talib Dbouk, another co-author of the study.

However, the researchers added that further studies are needed to determine the effect of ground surface temperature on the behaviour of saliva in air.

They also believe that indoor environments, especially ones with air conditioning, may significantly affect the particle movement through air.

This work is important since it concerns safety distance guidelines, and advances the understanding of the transmission of airborne diseases, Drikakis said.