Celebration in Liberia slum as Ebola quarantine lifted

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.

Seoul/South Korea, Apr 27: North Korean leader Kim Jong Un is "alive and well", a top security adviser to the South's President Moon Jae-in said, downplaying rumours over Kim's health following his absence from a key anniversary.
"Our government position is firm," said Moon's special adviser on national security Moon Chung-in, in an interview with CNN on Sunday. "Kim Jong Un is alive and well."

The adviser said that Kim had been staying in Wonsan -- a resort town in the country's east -- since April 13, adding: "No suspicious movements have so far been detected."

Conjecture about Kim's health has grown since his conspicuous absence from the April 15 celebrations for the birthday of his grandfather Kim Il Sung, the North's founder -- the most important day in the country's political calendar.

Kim has not made a public appearance since presiding over a Workers' Party politburo meeting on April 11, and the following day state media reported him inspecting fighter jets at an air defence unit.

North Korean leader Kim Jong Un was not gravely ill, two South Korean government sources said on Tuesday, following reports he had undergone a cardiovascular procedure and was now in "grave danger."

His absence unleashed a series of unconfirmed media reports over his condition, which officials in Seoul previously poured cold water on.

"We have nothing to confirm and no special movement has been detected inside North Korea as of now," the South's presidential office said in a statement last week.

South Korea's unification minister Kim Yeon-chul reiterated Monday that remained the case, adding the "confident" conclusion was drawn from "a complex process of intelligence gathering and assessment".

'Grave danger'

Daily NK, an online media outlet run mostly by North Korean defectors, has reported Kim was undergoing treatment after a cardiovascular procedure earlier this month.

Citing an unidentified source inside the country, it said Kim, who is in his mid-30s, had needed urgent treatment due to heavy smoking, obesity and fatigue.

Soon afterwards, CNN reported that Washington was "monitoring intelligence" that Kim was in "grave danger" after undergoing surgery, quoting what it said was an anonymous US official.

US President Donald Trump on Thursday rejected reports that Kim was ailing but declined to state when he was last in touch with him.

On Monday, the official Rodong Sinmun newspaper reported that Kim had sent a message of thanks to workers on the giant Wonsan Kalma coastal tourism project.

It was the latest in a series of reports in recent days of statements issued or actions taken in Kim's name, although none has carried any pictures of him.

Satellite images reviewed by 38North, a US-based think tank, showed a train probably belonging to Kim at a station in Wonsan last week.

It cautioned that the train's presence did not "indicate anything about his health" but did "lend weight" to reports he was staying on the country's eastern coast.

Reporting from inside the isolated North is notoriously difficult, especially regarding anything to do with its leadership, which is among its most closely guarded secrets.

Previous absences from the public eye on Kim's part have prompted speculation about his health.

In 2014 he dropped out of sight for nearly six weeks before reappearing with a cane. Days later, the South's spy agency said he had undergone surgery to remove a cyst from his ankle.

Feb 26: Looking out over the world’s largest cricket stadium, the seats jammed with more than 100,000 people, India’s prime minister heaped praise on his American visitor.

“The leadership of President Trump has served humanity,” Prime Minister Narendra Modi said Monday, highlighting Trump’s fight against terrorism and calling his 36-hour visit to India a watershed in India-U.S. relations.

The crowds cheered. Trump beamed.

“The ties between India and the U.S. are no longer just any other partnership,” Modi said. “It is a far greater and closer relationship.”

India, it seems, loves Donald Trump. It seemed obvious from the thousands who turned out to wave as his motorcade snaked through the city of Ahmedabad, and from the tens of thousands who filled the city’s new stadium. It seemed obvious from the hug that Modi gave Trump after he descended from Air Force One, and from the hundreds of billboards proclaiming Trump’s visit.

But it’s not so simple.

Because while Trump is genuinely popular in India, his clamorous and carefully choreographed welcome was also about Asian geopolitics, China’s growing power and a masterful Indian politician who gave his American visitor exactly what he wanted.

Modi “is doing this not necessarily because he loves Trump,” said Tanvi Madan, the director of the India Project at the Brookings Institution in Washington, D.C. “It’s very much about Trump as the leader of the U.S. and recognizing what it is that Trump himself likes.”

Trump likes crowds — big crowds — and the foot soldiers of India’s political parties have long known how to corral enough people to make any politician look popular. In a city like Ahmedabad, the capital of Modi’s home state of Gujarat and the center of his power base, it wouldn’t take much effort to fill a cavernous sports stadium. It was more surprising that a handful of seats remained empty, and that some in the stands had left even before Trump had finished his speech.

For India, good relations with the U.S. are deeply important: They signal that India is a serious global player, an issue that has long been important to New Delhi, and help cement an alliance that both nations see as a counterweight to China’s rise.

“For both countries, their biggest rival is China,” said John Echeverri-Gent, a professor at the University of Virginia whose research often focuses on India. “China is rapidly expanding its presence in the Indian Ocean, which India has long considered its backyard and its exclusive realm for security concerns.”

“It’s very clearly a major concern for both India and the United States,” he said.

Trump isn’t the first U.S. president that Modi has courted. In 2015, then-President Barack Obama was the first American chief guest at India’s Republic Day parade, a powerful symbolic gesture. Obama also got a Modi hug, and the media in both countries were soon writing about the two leaders’ “bromance.”

Trump is popular in India, even if some of that is simply because he’s the U.S. president. A 2019 Pew Research Center poll showed that 56% of Indians had confidence in Trump’s abilities in world affairs, one of only a handful of countries where he has that level of approval. But Obama was also popular: Before he left office, he had 58% approval in world affairs among Indians.

The Pew poll also indicated that Trump’s support was higher among supporters of Modi’s Hindu nationalist party.

That’s not surprising. Both men have fired up their nationalist bases with anti-Muslim rhetoric and government policies, from Trump’s travel bans to Modi’s crackdown in Kashmir, India’s only Muslim-majority state.

And Trump’s Indian support is far from universal. Protests against his trip roiled cities from New Delhi to Hyderabad to the far northeastern city of Gauhati, although those demonstrations were mostly overshadowed by protests over a new Indian citizenship law that Modi backs.

Modi, who is widely popular in India, has faced weeks of protests over the law, which provides fast track naturalization for some foreign-born religious minorities — but not Muslims. While Trump talked about ties with India on Tuesday, Hindus and Muslims fought in violent clashes that left at least 10 people dead over two days.

In some ways, Modi and Trump are powerful echoes of each other.

They have overlapping political styles. Both are populists who see themselves as brash, rule-breaking outsiders who disdain their countries’ traditional elites. Both are seen by their critics as having authoritarian leanings. Both surround themselves with officials who rarely question their decisions.

But are they friends?

Trump says yes. “Really, we feel very strongly about each other,” he said at a New Delhi press briefing.

But many observers aren’t so sure.

“The question is how much of this is real chemistry, as opposed to what I’d call planned chemistry” orchestrated for diplomatic reasons, said Madan. “It’s so hard to know if you’re not in the room.”

Certainly, Modi understands America’s importance to India. While the two countries continue to bicker about trade issues, the prime minister organized a welcome that impressed even India’s news media, which have watched countless choreographed mass political rallies.

“There is no other country for whose leader India would hold such an event, and for which an Indian prime minister would lavish such rhetoric,” the Hindustan Times said in an editorial.

“The spectacle and the sound were worth a thousand agreements.”