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
June 10,2020

Islamabad, Jun 10: The World Health Organization has told Pakistan it should implement "intermittent" lockdowns to counter a surge in coronavirus infections that has come as the country loosens restrictions, officials said.

Since the start of Pakistan's outbreak in March, Prime Minister Imran Khan opposed a nationwide lockdown of the sort seen elsewhere, arguing the impoverished country could not afford it.

Instead, Pakistan's four provinces ordered a patchwork of closures, but last week Khan said most of these restrictions would be lifted.

Health officials on Wednesday declared a record number of new cases in the past 24 hours. The country has now confirmed a total of more than 113,000 cases and 2,200 deaths -- though with testing still limited, real rates are thought to be much higher.

"As of today, Pakistan does not meet any of the pre-requisite conditions for opening the lockdown", the WHO said in a letter confirmed by Pakistan officials on Tuesday.

Many people have not adopted behavioural changes such as social distancing and frequent hand-washing, meaning "difficult" decisions will be required including "intermittent lockdowns" in targeted areas, the letter states.

Some 25 percent of tests in Pakistan come back positive for COVID-19, the WHO said, indicating high levels of infection in the general population.

The health body recommended an intermittent lockdown cycle of two weeks on, two weeks off.

Responding to the WHO's letter, Zafar Mirza, the prime minister's special advisor for health, said the country had "consciously but gradually" eased lockdowns while enforcing guidelines in shops, mosques and public transport.

"We have to make tough policy choices to strike a balance between lives and livelihoods," Mirza said Wednesday.

Punjab's provincial health minister Yasmin Rashid, who received the WHO's letter, said the provincial government had already given "orders to take strict action against those violating" virus guidelines.

Hospitals across Pakistan say they are at or near capacity, and some are turning COVID-19 patients away.

WHO Director-General Tedros Adhanom Ghebreyesus said Monday that 136,000 cases had been reported in the previous 24 hours, "the most in a single day so far", with the majority of them in South Asia and the Americas.

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Agencies
July 7,2020

Washington, Jul 7: The US military "will continue to stand strong” in relationship to a conflict between India and China or anywhere else, a top White House official said on Monday, after the navy deployed two aircraft carriers to the South China Sea to boost its presence in the region.

"The message is clear. We're not going to stand by and let China or anyone else take the reins in terms of being the most powerful, dominant force, whether it's in that region or over here,” White House Chief of Staff Mark Meadows told Fox News.

“And the message is clear. Our military might stands strong and will continue to stand strong, whether it's in relationship to a conflict between India and China or anywhere else,” Meadows said in response to a question.

He was told that India banned Chinese apps because Indian soldiers were killed by Chinese troops last month and asked what's mission of the two aircraft carriers - the Ronald Reagan and the Nimitz - and what's America's mission.

The troops of India and China are locked in an eight-week standoff in several areas in eastern Ladakh including Pangong Tso, Galwan Valley and Gogra Hot Spring. The situation deteriorated last month following the Galwan Valley clashes that left 20 Indian Army personnel dead as the two sides significantly bolstered their deployments in most areas along the LAC.

The Chinese military on Monday began withdrawing troops from the Galwan Valley and Gogra Hot Spring after National Security Advisor Ajit Doval and Chinese Foreign Minister Wang Yi held lengthy talks on Sunday. Doval and Wang are also the special representatives on the India-China boundary talks.

The United States has sent two of its aircraft carriers to the South China Sea. “Our mission is to make sure that the world knows that we still have the preeminent fighting force on the face of the globe,” Meadows said.

President Donald Trump has invested more in the US military, more in not only the hardware, but the men and women who serve so sacrificially each and every day, he said. “He (Trump) continues to do so,” he added.

China is engaged in hotly contested territorial disputes in both the South China Sea and the East China Sea. Beijing has built up and militarised many of the islands and reefs it controls in the region. Both areas are stated to be rich in minerals, oil and other natural resources and are vital to global trade.

China claims almost all of the South China Sea. Vietnam, the Philippines, Malaysia, Brunei and Taiwan have counter claims over the area.

Appearing on the same Fox News on Monday talk show with host Brian Kilmeade, influential Republican Senator Tom Cotton said that the US aircraft carriers are headed to the South China Sea to thwart off any Chinese misadventure against Taiwan or other countries in the region.

"That's one of the reasons why we have those aircraft carrier groups in the South China Sea. I mean, look what China did in the southwest. It's essentially invaded India over the last few weeks and killed Indian soldiers,” Cotton said.

"No country on China's periphery, right now, is safe from Chinese aggression. All those countries want a close relationship with the United States. We ought to have one,” Cotton said.

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News Network
March 28,2020

Berlin, Mar 28: The number of confirmed coronavirus infections worldwide topped 600,000 on Saturday as new cases stacked up quickly in Europe and the United States and officials dug in for a long fight against the pandemic.

The latest landmark came only two days after the world passed half a million infections, according to a tally by John Hopkins University, showing that much work remains to be done to slow the spread of the virus. It showed more than 602,000 cases and a total of over 27,000 deaths.

While the U.S. now leads the world in reported infections — with more than 104,000 cases — five countries exceed its roughly 1,700 deaths: Italy, Spain, China, Iran and France.

“We cannot completely prevent infections at this stage, but we can and must in the immediate future achieve fewer new infections per day, a slower spread,” German Chancellor Angela Merkel, who is in quarantine at home after her doctor tested positive for the virus, told her compatriots in an audio message. “That will decide whether our health system can stand up to the virus.”

The virus already has put health systems in Italy, Spain and France under extreme strain. Lockdowns of varying severity have been introduced across Europe. Merkel's chief of staff, Helge Braun, said that Germany — where authorities closed nonessential shops and banned gatherings of more than two in public — won't relax its restrictions before April 20.

As the epicenter has shifted westward, the situation has calmed in China, where some restrictions on people's lives have now been lifted. Six subway lines restored limited service in Wuhan, where the virus first emerged in December, after the city had its official coronavirus risk evaluation downgraded from high to medium on Friday. Five districts of the city of 11 million people had other restrictions on travel loosened after their risk factor was downgraded to low.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But for others, especially older adults and people with existing health problems, the virus can cause more severe illness, including pneumonia, and lead to death.

More than 130,000 people have recovered, according to Johns Hopkins' tally.

In one way or another, the effects of the COVID-19 outbreak have been felt by the powerful and the poor alike.

On Friday, British Prime Minister Boris Johnson became the first leader of a major country to test positive for the virus. He said he would continue to work from self-quarantine.

Countries are still scrambling bring home some citizens stranded abroad by border closures and a near-shutdown of flights. On Saturday, 174 foreign tourists and four Nepali nationals on the foothills of Mount Everest were flown out days after being stranded on the only airstrip serving the world's highest mountain.

In neighboring India, authorities sent a fleet of buses to the outskirts of the capital to meet an exodus of migrant workers desperately trying to reach their home villages during the world's largest lockdown.

Thousands of people, mostly young male day laborers but also families, had fled their New Delhi homes after Prime Minister Narendra Modi announced a 21-day lockdown that began on Wednesday and effectively put millions of Indians who live off daily earnings out of work.

In a possibly hopeful sign, the U.S. Food and Drug Administration cleared a new rapid test from Abbott Laboratories, which the company says can detect the coronavirus in about 5 minutes. Medical device maker Abbott announced the emergency clearance of its cartridge-based test Friday night, saying the test delivers a negative result in 13 minutes when the virus is not detected.

While New York remained the worst-hit city in the U.S., Americans braced for worsening conditions elsewhere, with worrisome infection numbers being reported in New Orleans, Chicago and Detroit.

New Orleans’ sprawling Ernest N. Morial Convention Center, along the Mississippi River, was being converted into a massive hospital as officials prepared for thousands more patients than they could accommodate.

In New York, where there are more than 44,000 cases statewide, the number of people hospitalized with COVID-19 passed 6,000 on Friday, double what it had been three days earlier.

Gov. Andrew Cuomo called for 4,000 more temporary beds across New York City, where the Jacob K. Javits Convention Center has already been converted into a hospital.

The struggle to defeat the virus will take “weeks and weeks and weeks,” Cuomo told members of the National Guard working at the Javits Center.

President Donald Trump invoked the Defense Production Act on Friday, ordering General Motors to begin manufacturing ventilators. Trump had previously rejected Cuomo's pleas for tens of thousands more of the machines and the governor's calls to implement the Korean War-era production law.

Trump signed a $2.2 trillion stimulus package, after the House approved the sweeping measure by voice vote. Lawmakers in both parties lined up behind the law to send checks to millions of Americans, boost unemployment benefits, help businesses and toss a life preserver to an overwhelmed health care system.

Dr. John Brooks of the U.S. Centers for Disease Control and Prevention warned Americans remained “in the acceleration phase” of the pandemic and that all corners of the country were at risk.

"There is no geographic part of the United States that is spared from this," he said.

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