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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Agencies
June 7,2020

Moscow, Jun 7: OPEC, Russia and allies agreed on Saturday to extend record oil production cuts until the end of July, prolonging a deal that has helped crude prices double in the past two months by withdrawing almost 10% of global supplies from the market.

The group, known as OPEC+, also demanded countries such as Nigeria and Iraq, which exceeded production quotas in May and June, compensate with extra cuts in July to September.

OPEC+ had initially agreed in April that it would cut supply by 9.7 million barrels per day (bpd) during May-June to prop up prices that collapsed due to the coronavirus crisis. Those cuts were due to taper to 7.7 million bpd from July to December.

“Demand is returning as big oil-consuming economies emerge from pandemic lockdown. But we are not out of the woods yet and challenges ahead remain,” Saudi Energy Minister Prince Abdulaziz bin Salman told the video conference of OPEC+ ministers.

Benchmark Brent crude climbed to a three-month high on Friday above $42 a barrel, after diving below $20 in April. Prices still remain a third lower than at the end of 2019.

“Prices can be expected to be strong from Monday, keeping their $40 plus levels,” said Bjornar Tonhaugen from Rystad Energy.

Saudi Arabia, OPEC’s de facto leader, and Russia have to perform a balancing act of pushing up oil prices to meet their budget needs while not driving them much above $50 a barrel to avoid encouraging a resurgence of rival U.S. shale production.

It was not immediately clear whether Saudi Arabia, the United Arab Emirates and Kuwait would extend beyond June their additional, voluntary cuts of 1.18 million bpd, which are not part of the deal.

BULGING INVENTORIES

The April deal was agreed under pressure from U.S. President Donald Trump, who wants to avoid U.S. oil industry bankruptcies.

Trump, who previously threatened to pull U.S. troops out of Saudi Arabia if Riyadh did not act, spoke to the Russian and Saudi leaders before Saturday’s talks, saying he was happy with the price recovery.

While oil prices have partially recovered, they are still well below the costs of most U.S. shale producers. Shutdowns, layoffs and cost cutting continue across the United States.

“I applaud OPEC-plus for reaching an important agreement today which comes at a pivotal time as oil demand continues to recover and economies reopen around the world,” U.S. Energy Secretary Dan Brouillette wrote on Twitter after the extension.

As global lockdowns ease, oil demand is expected to exceed supply sometime in July but OPEC has yet to clear 1 billion barrels of excess oil inventories accumulated since March.

Rystad’s Tonhaugen said Saturday’s decisions would help OPEC reduce inventories at a rate of 3 million to 4 million bpd in July-August. “The quicker stocks fall, the higher prices will get,” he said.

Nigeria’s petroleum ministry said Abuja backed the idea of compensating for its excessive output in May and June.

Iraq, with one of the worst compliance rates in May, agreed to extra cuts although it was not clear how Baghdad would reach agreement with oil majors on curbing Iraqi output.

Iraq produced 520,000 bpd above its quota in May, while overproduction by Nigeria was 120,000 bpd, Angola’s was 130,000 bpd, Kazakhstan’s was 180,000 bpd and Russia’s was 100,000 bpd, OPEC+ data showed.

OPEC+’s joint ministerial monitoring committee, known as the JMMC, will meet monthly until December to review the market, compliance and recommend levels of cuts. JMMC’s next meeting is scheduled for June 18.

OPEC and OPEC+ will hold their next scheduled meetings on Nov. 30-Dec. 1.

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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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Agencies
July 2,2020

Moscow, Jul 2: Russian voters approved changes to the constitution that will allow President Vladimir Putin to hold power until 2036, but the weeklong plebiscite that concluded Wednesday was tarnished by widespread reports of pressure on voters and other irregularities.

With most of the nation's polls closed and 20% of precincts counted, 72% voted for the constitutional amendments, according to election officials.

For the first time in Russia, polls were kept open for a week to bolster turnout without increasing crowds casting ballots amid the coronavirus pandemic a provision that Kremlin critics denounced as an extra tool to manipulate the outcome.

A massive propaganda campaign and the opposition's failure to mount a coordinated challenge helped Putin get the result he wanted, but the plebiscite could end up eroding his position because of the unconventional methods used to boost participation and the dubious legal basis for the balloting.

By the time polls closed in Moscow and most other parts of Western Russia, the overall turnout was at 65%, according to election officials. In some regions, almost 90% of eligible voters cast ballots.

On Russia's easternmost Chukchi Peninsula, nine hours ahead of Moscow, officials quickly announced full preliminary results showing 80% of voters supported the amendments, and in other parts of the Far East, they said over 70% of voters backed the changes.

Kremlin critics and independent election observers questioned the turnout figures.

We look at neighboring regions, and anomalies are obvious there are regions where the turnout is artificially (boosted), there are regions where it is more or less real, Grigory Melkonyants, co-chair of the independent election monitoring group Golos, told The Associated Press.

Putin voted at a Moscow polling station, dutifully showing his passport to the election worker. His face was uncovered, unlike most of the other voters who were offered free masks at the entrance.

The vote completes a convoluted saga that began in January, when Putin first proposed the constitutional changes.

He offered to broaden the powers of parliament and redistribute authority among the branches of government, stoking speculation he might seek to become parliamentary speaker or chairman of the State Council when his presidential term ends in 2024.

His intentions became clear only hours before a vote in parliament, when legislator Valentina Tereshkova, a Soviet-era cosmonaut who was the first woman in space in 1963, proposed letting him run two more times.

The amendments, which also emphasize the primacy of Russian law over international norms, outlaw same-sex marriages and mention a belief in God as a core value, were quickly passed by the Kremlin-controlled legislature.

Putin, who has been in power for more than two decades longer than any other Kremlin leader since Soviet dictator Josef Stalin said he would decide later whether to run again in 2024.

He argued that resetting the term count was necessary to keep his lieutenants focused on their work instead of darting their eyes in search for possible successors.

Analyst Gleb Pavlovsky, a former Kremlin political consultant, said Putin's push to hold the vote despite the fact that Russia has thousands of new coronavirus infections each day reflected his potential vulnerabilities.

Putin lacks confidence in his inner circle and he's worried about the future, Pavlovsky said.

He wants an irrefutable proof of public support.

Even though the parliament's approval was enough to make it law, the 67-year-old Russian president put his constitutional plan to voters to showcase his broad support and add a democratic veneer to the changes.

But then the coronavirus pandemic engulfed Russia, forcing him to postpone the April 22 plebiscite.

The delay made Putin's campaign blitz lose momentum and left his constitutional reform plan hanging as the damage from the virus mounted and public discontent grew.

Plummeting incomes and rising unemployment during the outbreak have dented his approval ratings, which sank to 59%, the lowest level since he came to power, according to the Levada Center, Russia's top independent pollster.

Moscow-based political analyst Ekaterina Schulmann said the Kremlin had faced a difficult dilemma: Holding the vote sooner would have brought accusations of jeopardizing public health for political ends, while delaying it raised the risks of defeat.

Holding it in the autumn would have been too risky, she said.

In Moscow, several activists briefly lay on Red Square, forming the number 2036 with their bodies in protest before police stopped them.

Some others in Moscow and St. Petersburg staged one-person pickets and police didn't intervene.

Several hundred opposition supporters rallied in central Moscow to protest the changes, defying a ban on public gatherings imposed for the coronavirus outbreak. Police didn't intervene and even handed masks to the participants.

Authorities mounted a sweeping effort to persuade teachers, doctors, workers at public sector enterprises and others who are paid by the state to cast ballots. Reports surfaced from across the vast country of managers coercing people to vote.

The Kremlin has used other tactics to boost turnout and support for the amendments.

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