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
April 13,2020

Manila, Apr 13: The Asian Development Bank (ADB) on Monday tripled the size of its response to novel coronavirus disease (COVID-19) pandemic to 20 billion dollars and approved measures to streamline its operations for quicker and more flexible delivery of assistance.

The package expands ADB's 6.5 billion dollars initial response announced on March 18, adding 13.5 billion dollars in resources to help ADB's developing member countries counter the severe macroeconomic and health impacts caused by COVID-19.

The 20 billion dollar package includes about 2.5 billion dollars in concessional and grant resources.

"This pandemic threatens to severely set back economic, social, and development gains in Asia and the Pacific, reverse progress on poverty reduction and throw economies into recession," said ADB President Masatsugu Asakawa.

"Our expanded and comprehensive package of assistance, made possible with the strong support of our board, will be delivered more quickly, flexibly and forcefully to the governments and the private sector in our developing member countries to help them address the urgent challenges in tackling the pandemic and economic downturn," he said in a statement.

ADB's most recent assessment released on April 3 estimates the global impact of the pandemic at between 2.3 and 4.8 per cent of gross domestic product. Regional growth is forecast to decline from 5.2 per cent last year to 2.2 per cent in 2020.

The new package includes the establishment of a COVID-19 pandemic response option under ADB's countercyclical support facility.

Up to 13 billion dollars will be provided through this new option to help governments of developing member countries implement effective countercyclical expenditure programs to mitigate impacts of the COVID-19 pandemic, with a particular focus on the poor and the vulnerable.

Grant resources will continue to be deployed quickly for providing medical and personal protective equipment and supplies from expanded procurement sources.

Some 2 billion dollars from the 20 billion dollar package will be made available for the private sector. Loans and guarantees will be provided to financial institutions to rejuvenate trade and supply chains.

Enhanced microfinance loan and guarantee support and a facility to help liquidity-starved small and medium-sized enterprises, including those run by female entrepreneurs, will be implemented alongside direct financing of companies responding to or impacted by COVID-19.

The response package includes a number of adjustments to policies and business processes that will allow ADB to respond more rapidly and flexibly to the crisis. These include measures to streamline internal business processes, widen the eligibility and scope of various support facilities and make the terms and conditions of lending more tailored.

All support under the expanded package will be provided in close collaboration with international organisations, including the International Monetary Fund, World Bank Group, World Health Organisation, UNICEF, other UN agencies and the broader global community.

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News Network
February 1,2020

Washington, Feb 1: The Indian economy experienced some abrupt slowdown in 2019 due to turbulence in non-banking financial institutions and major reform measures such as GST and demonetisation, but it is not in a recession, IMF Managing Director Kristalina Georgieva has said.

"The Indian economy indeed has experienced an abrupt slowdown in 2019. We had to revise our growth projections, downwards to four percent for last year. We are expecting 5.8 per cent (growth rate) in 2020 and then an upward trajectory to 6.5 percent in 2021," Georgieva told a group of foreign journalists here on Friday.

"It appears that the main reason for this slowdown was the non-banking financial institutions experiencing a turbulence," she said on the eve of Union Finance Minister Nirmala Sitharaman presenting the annual budget in Parliament on Saturday.

She said India had undertaken some important reforms that over the longer term would be beneficial for the country, but they do have some short-term impact.

"For example, coming with the unified tax system, and the demonetisation that took place. These are steps that over time are beneficial, but of course they might, might be somewhat disruptive over short term," Georgieva said in response to a question.

The International Monetary Fund (IMF) Managing Director said that there is not a lot of fiscal space in India. “But we also recognise that the policies of the government on that side, on the fiscal side have been prudent. We will see how the reading of the budget, the submission of the budget goes, tomorrow,” she said.

In the medium-term, she said, the IMF remains optimistic about India. “This is why we see that upswing potential for the growth in the country,” she said.

Georgieva said that the current economic slowdown cannot be described as a recession. "No.... You're far from that. But it is a significant slowdown, not the recession," she said.

The IMF managing Director noted that the consumption in India also slowed down and that contributed to the overall slowdown in the economy. The IMF would be keen to see what India does to get relatively sound macroeconomic fundamentals to pay off in terms of better growth trajectory, she said ahead of the budget.

One thing that is important for India is that budgetary revenue have been below target. "The country knows that. The finance minister knows it. They need to increase budgetary revenue collection so they can improve their fiscal position. I said it's tight on the spending side, but I also want to stress that there is room to improve collection on the revenue side," she said.

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News Network
April 7,2020

London, Apr 7: British Prime Minister Boris Johnson was moved to the intensive care unit of a London hospital after his coronavirus symptoms worsened Monday, just a day after he was admitted for what were said to be routine tests.

Johnson was admitted to St. Thomas’ Hospital late Sunday, 10 days after he was diagnosed with COVID-19, the first major world leader to be confirmed to have the virus.

Downing Street said Johnson was conscious and did not require ventilation, but he was moved into intensive care in case he needs it later, his office said in a statement.

Britain has no official post of deputy prime minister, but Foreign Secretary Dominic Raab has been designated to take over should Johnson become incapacitated.

Hours earlier, Johnson tweeted that he was in good spirits and thanked the National Health Service for taking care of him and others with the disease.

“On the advice of my doctor, I went into hospital for some routine tests as I’m still experiencing coronavirus symptoms,″ Johnson said in the tweet. “I’m in good spirits and keeping in touch with my team, as we work together to fight this virus and keep everyone safe.″

The prime minister's spokesman said earlier Monday that Johnson had spent a comfortable night and remained in charge of government after being admitted to the hospital because his cough and fever persisted.

Johnson's spokesman, James Slack, refused to say what kind of tests Johnson was undergoing. He insisted that "the PM remains in charge of the government."

“He is receiving updates in hospital and is continuing to receive a (ministerial red) box" of files and briefing papers, Slack said.

Prime Minister Narendra Modi on Monday hoped that his British counterpart Boris Johnson, admitted to a hospital for treatment of coronavirus, finds himself in perfect health soon.

"Hang in there, Prime Minister @BorisJohnson! Hope to see you out of hospital and in perfect health very soon," the prime minister wrote on Twitter.

The 55-year-old leader had been quarantined in his Downing Street residence since being diagnosed with COVID-19 on March 26. He continued to preside at daily meetings on the outbreak until Sunday. He released several video messages during his 10 days in isolation urging Britons to stay home and observe social distancing measures to help slow the spread of the virus.

Speaking earlier at the government's daily coronavirus press briefing, Raab said Johnson was being “regularly updated," but said he had not spoken to him since Saturday.

“He's in charge, but he’ll continue to take doctors’ advice on what to do next," Raab said.

Politicians from all parties wished Johnson a quick recovery. Opposition Labour Party leader Keir Starmer tweeted: “Terribly sad news. All the country’s thoughts are with the Prime Minister and his family during this incredibly difficult time."

Johnson's fiancee, Carrie Symonds, who is pregnant, is herself recovering from coronavirus symptoms.

Johnson was admitted to the hospital as a message to the nation from Queen Elizabeth II was being broadcast Sunday evening. The 93-year-old monarch urged the public to show resolve and follow advice to stay inside.

Concerns had been growing about Johnson’s welfare ever since he posted a message Friday saying that he was feeling better, though was still feverish.

The virus causes mild to moderate symptoms in most people, but for some, especially older adults and the infirm, it can cause pneumonia and lead to death.

The government said Monday that 51,608 people had been confirmed to have the coronavirus in Britain, 5,373 of whom have died.

Derek Hill, a professor of medical imaging science at University College London, said that since COVID-19 causes difficulty breathing, one test performed on people with the disease is lung imaging with ultrasound or CT scans to see how badly they might be affected.

Hill said there are various types of breathing help, depending on the person and the difficulties.

“The reasons some people get seriously ill with COVID-19 while others have minor symptoms is not yet fully understood,″ Hill said. “But doctors managing these patients report that more men than women have serious problems, and patients who are overweight or have previous health problems are at higher risk."

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