Malaria drug Hydroxychloroquine fails to prevent COVID-19 in a rigorous study

News Network
June 4, 2020

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.

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News Network
February 5,2020

Feb 5: Pakistan will buy more palm oil from Malaysia, Prime Minister Imran Khan said on Tuesday, aiming to help offset lost sales after top buyer India put curbs on Malaysian imports last month amid a diplomatic row.

India imposed restrictions on refined palm oil imports and informally asked traders to stop buying from Malaysia, the world's biggest producer of the edible oil. Sources said the move was in retaliation for Malaysia's criticism of India's policy on Kashmir.

Malaysian Prime Minister Mahathir Mohamad said on Tuesday that he discussed palm oil with Khan who was on a visit to Malaysia and that Pakistan had indicated it would import more from Malaysia.

"That's right, especially since we noticed India threatened Malaysia for supporting the Kashmir cause, threatened to cut palm oil imports," Khan told a joint news conference, referring to India's Muslim-majority region of Kashmir.

"Pakistan will do its best to compensate for that."

India is a Hindu-majority country while Malaysia and Pakistan are mainly Muslim. India and Pakistan have been mostly hostile to each other since the partition of British India in 1947, and have fought two of their three wars over competing territorial claims in Kashmir.

Pakistan may have bought around 135,000 tonnes of Malaysian palm oil last month, a record high, India-based dealers who track such shipments told Reuters on condition of anonymity.

The figure is close to estimates of 141,500 tonnes from Refinitiv, which show sales to India in January may have plunged 80% from a year earlier to 40,400 tonnes.

Malaysia will release official export data on Monday.

Pakistan bought 1.1 million tonnes of palm oil from Malaysia last year, while India bought 4.4 million tonnes, according to the Malaysian Palm Oil Council.

Malaysian palm oil futures rose on Tuesday after Khan's comments and on expectations of a steep drop in production in January.

STRONG TIES

India has repeatedly objected to Mahathir speaking out against its move last year to strip Kashmir's autonomy and make it easier for non-Muslims from neighbouring Muslim-majority Bangladesh, Pakistan and Afghanistan to gain citizenship.

At the news conference, Mahathir did not refer to Kashmir but Khan did.

"The way you, PM, have stood with us and spoken about this injustice going on, on behalf of Pakistan I really want to thank you," Khan said.

He also said he was sad he had been unable to attend a summit of Muslim leaders in Malaysia in December. Saudi Arabia did not attend the summit, saying it was the wrong forum to discuss matters affecting the world's Muslims and Khan belatedly pulled out.

Some Pakistani officials, unnamed because they were not authorised to speak to the media, said at the time that Khan pulled out under pressure from Saudi Arabia, a close ally, although local media reported his officials denied that was the reason for his absence.

"Unfortunately our friends, who are very close to Pakistan as well, felt that somehow the conference was going to divide the ummah," Khan said, using the Arabic word for the Muslim community but not mentioning Saudi Arabia by name.

"It is clearly a misconception, as that was not the purpose of the conference."

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News Network
May 6,2020

Singapore, May 6: Oil prices slipped back Wednesday after two days of gains, although Brent crude remained above $30 a barrel, as renewed US-China tensions offset optimism about the easing of coronavirus lockdowns.

Brent, the international benchmark, fell 1.1 per cent to $30.63 a barrel in early Asian trade. On Tuesday, the contract surged 14 per cent and rose above $30 for the first time since mid-April.

US marker West Texas Intermediate slipped 1.9 per cent and was changing hands for $24.13 a barrel.

Oil markets have been battered as the virus strangled demand due to business closures and travel restrictions, with US crude falling into negative territory last month for the first time.

They started rallying strongly this week as countries from Europe to Asia ease curbs and economies start shuddering back to life.

But gains were capped Wednesday as dealers follow a brewing US-China row after Donald Trump hit out at Beijing over its handling of the outbreak, saying it began in a Wuhan lab, but so far offering no evidence.

"Traders are incredibly cautious this morning, weighing all the possible China responses," said Stephen Innes, chief global market strategist at AxiCorp.

"And the one that would hurt the most would be for China to reduce imports of US oil."

This week's rally was in part driven by a deal agreed between top producers to reduce output by almost 10 million barrels a day, which came into effect on May 1.

There have also been signs that the massive oversupply in the market is starting to ease as demand slowly comes back.

Energy data provider Genscape said earlier this week that stockpiles at the main US oil depot in Cushing, Oklahoma had increased by only 1.8 million barrels last week following weeks of major rises.

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Agencies
January 20,2020

For the first time in the 15 years of the Global Risks Report, the climate change and environment risk has occupied all the top five slots.

According to the 15th edition of the World Economic Forum's (WEF) Global Risks Report, the top five risks in terms of likelihood are extreme weather, climate action failure, natural disasters, biodiversity loss and human-made environmental disasters. They all fall in the one category of climate change and related environmental disasters.

WEF President Borge Brende said the world was feeling long-mounting and interconnected risks.

The report also points to how citizens are protesting across the world as discontent rises with failed systems that are creating inequality. The citizens' discontent had hardened with systems that had failed to promote advancement, it said.

"Disapproval of how governments are addressing profound economic and social issues has sparked protests throughout the world, potentially weakening the ability of governments to take decisive action should a downturn occur. Without economic and social stability, countries could lack the financial resources, fiscal margin, political capital or social support needed to confront key global risks," it said.

Listing the grim scenario, Borge said the global economy was faced with "synchronised slowdown", the past five years had been the warmest on record and cyber attacks were expected to increase this year.

The report warns that while the myriad risks were rising, time was running out on how to prevent them.

Borge said the growing palpability of shared economic, environmental and societal risks indicated that the horizon had shortened for preventing "or even mitigating" some of the direst consequences of global risks.

"It's sobering that in the face of this development, when the challenges before us demand immediate collective action, fractures within the global community appear to only be widening," he said.

The report points to grave concern about the consequences of continued environmental degradation, including the record pace of species decline.

Pointing to an unsettled geopolitical environment, the report said today's risk landscape was one in which new centres of power and influence were forming and old alliance structures and global institutions were being tested.

"While these changes can create openings for new partnership structures in the immediate term, they are putting stress on systems of coordination and challenging norms around shared responsibility. Unless stakeholders adapt multilateral mechanisms for this turbulent period, the risks that were once on the horizon will continue to arrive," it said.

Calling it a "an unsettled world", the WEF report notes that powerful economic, demographic and technological forces were shaping a new balance of power. "The result is an unsettled geopolitical landscape in which states are increasingly viewing opportunities and challenges through unilateral lenses," it said.

"What were once givens regarding alliance structures and multilateral systems no longer hold as states question the value of long-standing frameworks, adopt more nationalist postures in pursuit of individual agendas and weigh the potential geopolitical consequences of economic decoupling. Beyond the risk of conflict, if stakeholders concentrate on immediate geo-strategic advantage and fail to re-imagine or adapt mechanisms for coordination during this unsettled period, opportunities for action on key priorities may slip away," the WEF said.

In a chapter on risks to economic stability and social cohesion, it said a challenging economic climate might persist this year and members of the multi-stakeholder community saw "economic confrontations" and "domestic political polarisation" as the top risks in 2020.

The report also warned of downward pressure on the global economy from macroeconomic fragilities and financial inequality. These pressures continued to intensify in 2019, increasing the risk of economic stagnation.

Low trade barriers, fiscal prudence and strong global investment, once seen as fundamentals for economic growth, are fraying as leaders advance nationalist policies. The margins for monetary and fiscal stimuli are also narrower than before the 2008-2009 financial crisis, creating uncertainty about how well countercyclical policies will work.

The strategic partners for the WEF report included Marsh & McLennan and Zurich Insurance Group. The academic advisers were National University of Singapore, Oxford Martin School, University of Oxford and Wharton Risk Management and Decision Processes Center, University of Pennsylvania.

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