Will have to take military way if India doesn't listen, warns China

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.

Beijing, Jan 21: The Chinese official investigating a pneumonia outbreak stemming from a new coronavirus said the disease can spread from person to person but can be halted with increased vigilance, as authorities on Tuesday confirmed a fourth death.

Zhong Nanshan said there was no danger of a repeat of the Severe Acute Respiratory Syndrome (SARS) epidemic that killed nearly 800 people globally during a 2002-2003 outbreak, which started in China, as long as precautions were taken.

"It took only two weeks to identify the novel coronavirus," state news agency Xinhua quoted Zhong as saying late on Monday.

The outbreak was still in its early stages and China had good surveillance and quarantine systems to help control it, he added.

The outbreak has spread from the central city of Wuhan to cities including Beijing and Shanghai, with more than 200 cases reported so far. Four cases have been reported outside China - in South Korea, Thailand and Japan.

Australia on Tuesday said it would screen passengers on flights from Wuhan amid rising concerns that the virus will spread globally as Chinese travellers take flights abroad for the Lunar New Year holiday starting this week.

Authorities around the globe, including in the United States and many Asian countries, have stepped up screening of travellers from Wuhan.

Chinese authorities confirmed a total of 217 cases of the virus in China as of 6 p.m. (1000 GMT) on Monday, state television reported, 198 of which were in Wuhan.

A fourth person died on Jan. 19, the Wuhan Municipal Health Commission said. The 89-year-old man, who had underlying health diseases including coronary heart disease, developed symptoms on Jan. 13 and was admitted to hospital five days later, it added.

Zhong, who is renowned in China for his work fighting SARS in 2003, confirmed that the virus can pass from person-to-person.

Fifteen medical workers in Wuhan had been diagnosed with pneumonia, with one other suspected case, the Wuhan Municipal Health Commission said. Of the infected staff, one was in critical condition.

In Shanghai, officials on Tuesday confirmed a second case involving a 35-year-man who had visited Wuhan in early January, and said they were monitoring four other suspected cases.

The virus causes a type of pneumonia and belongs to the same family of coronaviruses as SARS. Symptoms include fever and difficulty in breathing, which are similar to many other respiratory diseases and pose complications for screening efforts.

The World Health Organisation (WHO) said on Monday an animal source appeared most likely to be the primary origin of the outbreak and that some "limited human-to-human transmission" occurred between close contacts.

The Geneva-based U.N. agency convened an emergency committee for Wednesday to assess whether the outbreak constitutes an international health emergency and what measures should be taken to manage it.

So far, the WHO has not recommended trade or travel restrictions, but a panel of independent experts could do so or make other recommendations to limit spread.

Washington, Jan 12: The US State Department has described the recent visit of envoys of 15 countries to Jammu and Kashmir as an "important step" but expressed concern over the continued detention of political leaders and restrictions on internet in the region.

Alice Wells, the Acting Assistant Secretary of State for South Asia, tweeted on Saturday that she was "closely following" the visit of the envoys to Kashmir, describing it an "important step".

Wells, who will be visiting India this week, added: "We remain concerned by detention of political leaders and residents and Internet restrictions. We look forward to a return to normalcy."

The group of diplomats made a two-day visit to the Union Territory on Thursday and Friday to see the conditions thereafter Jammu and Kashmir's special constitutional status was removed last August.

While some US politicians and media have criticised the action by Prime Minister Narendra Modi's government, the US has officially appeared to support the abrogation of the Constitution's Article 370 on the special status.

Last October, Wells told the House of Representatives Subcommittee on Asia and the Pacific that the State Department supported the objectives behind it, while not directly mentioning the abrogation.

"The Indian government has argued that its decision on Article 370 was driven by a desire to increase economic development, reduce corruption, and uniformly apply all national laws in Jammu and Kashmir, particularly in regard to women and minorities.

"While we support these objectives, the Department remains concerned about the situation in the Kashmir Valley, where daily life for the nearly eight million residents has been severely impacted since August 5," she had said.

Washington has banked on India's democratic institutions - the judiciary and public debates - being able to steer the country.

Bearing this out, the Supreme Court last week ordered the government to review its decision to shut down the internet in Kashmir, which it declared was a fundamental right, thus taking a step to address Wells's concern.