Dhaka Courier

Pandemonium

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The International Olympic Committee on Tuesday postponed this summer’s Tokyo Games for a year as coronavirus deaths mounted around the world and U.S. lawmakers closed in on a nearly $2 trillion deal to help cushion the economic damage from the crisis.

The IOC acted on the recommendation of Prime Minister Shinzo Abe, adding the Olympics to a long roster of sports events canceled because of the deadly outbreak.

In Washington, top congressional and White House officials said they expected to reach a deal Tuesday on a measure to shore up businesses and send relief checks to ordinary Americans. Ahead of the resumption of talks, U.S. stock futures rose sharply.

President Donald Trump urged swift action, tweeting: “Congress must approve the deal, without all of the nonsense, today. The longer it takes, the harder it will be to start up our economy.”

Meanwhile, Spain started storing bodies in an ice rink converted to a morgue, and the World Health Organization warned that infections around the globe are expected to increase “considerably.”

Some 85% of new infections came from Europe and the United States, according to the WHO, with Spain registering a record daily increase of 6,584 new infections and a leap of 500 in the death toll to 2,696.

In Madrid, vans driven by workers in protective suits and masks brought bodies to the Palacio de Hielo — Ice Palace — mall to store at its indoor skating rink until they can be buried or cremated after other facilities became overwhelmed.

The Spanish capital last week adapted two hotels to serve as emergency hospitals to help with the overflow of COVID-19 patients. It plans to convert five more. The city has also set up a field hospital.

As health care workers worked around the clock, they also struggled with scarce supplies.

“All over the country, you see examples of workers inventing homemade suits using plastics,” said Olga Mediano, a lung specialist at a hospital in Guadalajara, a city east of Madrid. “The protective suits are fundamental because without health workers we won’t be able to do anything.”

More than 387,000 people worldwide have been infected by the new coronavirus and more than 16,700 have died, according to Johns Hopkins University.

For most people, the coronavirus causes only mild or moderate symptoms, such as fever or coughing. But for some older adults and people with existing health problems, it can cause more severe illness, including pneumonia. More than 101,000 people have recovered, including more than 60,000 in China.

In Geneva, WHO spokeswoman Margaret Harris cited a “glimmer of hope” in hard-hit Italy after two days of slight declines in the number of new cases and deaths, while cautioning it’s “early days yet” — and the trend needed to be monitored.

In another positive sign, Chinese authorities said they would finally end a two-month lockdown in hard-hit Hubei province where the coronavirus outbreak first began.

Still, Harris said the scope of the global outbreak was “enormous” and that cases were expected to increase “considerably.”

“Just to put it in proportion: It took two years in the worst Ebola outbreak we ever had, the West African outbreak, to reach 11,000 deaths,” Harris said.

There have been more than 46,000 infections and 530 deaths in the U.S. as the virus continues to spread.

In New York, now one of the world’s biggest virus hot spots, authorities rushed to set up the thousands of hospital beds they will need in just weeks to protect the city’s 8.4 million people.

In Italy, Spain and France, the pandemic has already pushed national health systems to their breaking points.

The outbreak has killed more than 6,000 Italians, the highest death toll of any country. Officials said Monday the virus had claimed just over 600 more lives, down from 793 two days earlier.

Amid the spiking numbers in Spain, relatives of elderly people and retirement homes’ workers are expressing growing concern about the situation in retirement homes across Spain, especially in Madrid.

“We live in anguish, we have no information whatsoever,” said Esther Navarro, whose 97-year-old mother with Alzheimer is at the Residencia Usera in Madrid where some of the cases have been identified.

Spanish prosecutors are launching a judicial probe after Spanish army troops disinfecting elderly nursing homes discovered elderly people living among death bodies of those who had allegedly contracted the new coronavirus.

Confusion rippled through Britain on the first morning after Prime Minister Boris Johnson ordered a three-week halt to all nonessential activity. The government has told most stores to close, banned gatherings of three or more people and said everyone apart from essential workers should leave home only to buy food and medicines or to exercise. But photos showed crowded trains Tuesday on some London subway lines.

“I cannot say this more strongly: we must stop all non-essential use of public transport now,” London Mayor Sadiq Khan tweeted. “Ignoring these rules means more lives lost.”

The Philippine Congress approved a bill declaring a national emergency and authorizing President Rodrigo Duterte to launch a massive aid program and tap private hospitals and ships to help as the virus outbreak starts to take hold in the Pacific nation, which has reported 552 cases.

Pakistan ordered its railways shutdown in an attempt to slow the spread of the virus as cases climbed to 903. Bangladesh, with only 39 infections, also shut down all passenger rail as a precaution and suspended all domestic flights.

In contrast to other European nations, German health authorities offered some hope that the country has flattened the exponential spread of the virus, which has already infected some 30,000.

Chancellor Angela Merkel’s government approved a massive new aid package to cushion the economic fallout of the outbreak, offering more than 1 trillion euros ($1.1 trillion) to tide over small companies and entrepreneurs and pump capital into bigger companies.

The death rate in Germany has been low, with 130 recorded so far, and Germany has taken in patients from France and Italy for treatment.

Bangladesh: On a wing and prayer

Three more persons, all men, died of COVID-19 and the number of infected cases detected in Bangladesh also jumped this week. As we went to press, the death toll stood at 4 and number of infected people to 39.

Among the first 33 COVID-19 patients, 20 did not have any travel history abroad. The Institute of Epidemiology, Disease Control and Research said that 13 had travel history abroad and 20 were infected by other patients. IEDCR, however, did not disclose details about how the 20 people got infected.

Experts said that COVID-19 already spread in communities, though the IEDCR denied the community transmission till Sunday and skipped the issue at Monday’s news briefing.

On Saturday, March 21, a man died of COVID-19 in the capital’s Tolarbagh area having no travel history — neither his family members nor he had travelled recently. Another man died in the same neighborhood a day later with symptoms of COVID-19 and this second man and his family members also did not have any travel history. Both men were mosque-goers and mixed with people socially. A doctor who treated the first man also got infected with COVID-19 and was hospitalised on Sunday.

Lockdown in Tolarbagh area was tightened further on Monday, a day after the second death from coronavirus infection was confirmed. Mosque and most shops, except groceries and pharmacies, remained shut and public announcement system was used to instruct residents to stay at home. Residents informed that Dhaka North City Corporation used chlorine water to disinfect streets and buildings’ garage of Tolarbagh area of Mirpur. Police were seen guarding at the main entry gate of the residential area and preventing outsiders from entering the area.

The IEDCR is yet to find out how the second person who died got infected, officials admitted.

Iqbal Abdullah, son of the second victim, now quarantined, wrote on Facebook: "None of our family member recently visited us. I asked my father whether he came into contact with any potential Covid-19 patients. He said no. We don't know how he got infected."

According to WHO, ‘Community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories)’.

IEDCR director Meerjady Sabrina Flora said Sunday that they were trying to trace the cases in Tolarbagh. She said that they were testing people in different communities having symptoms of pneumonia and found no evidence of COVID-19 among them. But she said that only 40 people were tested so far from the communities where deaths occurred, which, according to experts, too small a number to draw a conclusion on community transmission.

Many experts and practitioners are of the view that it is already evident that community transmission has occurred. They believe IEDCR or The Health Directorate should admit that community transmission occurred and take measures to identify the potential spreaders — the infected persons.

The race for a cure

On Friday, March 20 the World Health Organization (WHO) announced a large global trial, called SOLIDARITY, to find out whether any can treat infections with the new coronavirus for the dangerous respiratory disease. It’s an unprecedented effort—an all-out, coordinated push to collect robust scientific data rapidly during a pandemic. The study, which could include many thousands of patients in dozens of countries, has been designed to be as simple as possible so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate.

With about 15% of COVID-19 patients suffering from severe disease and hospitals being overwhelmed, treatments are desperately needed. So rather than coming up with compounds from scratch that may take years to develop and test, researchers and public health agencies are looking to repurpose drugs already approved for other diseases and known to be largely safe. They’re also looking at unapproved drugs that have performed well in animal studies with the other two deadly coronaviruses, which cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Scientists have suggested dozens of existing compounds for testing, but WHO is focusing on what it says are the four most promising therapies: an experimental antiviral compound called remdesivir; the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir; and that same combination plus interferon-beta, an immune system messenger that can help cripple viruses. Some data on their use in COVID-19 patients have already emerged—the HIV combo failed in a small study in China—but WHO believes a large trial with a greater variety of patients is warranted.

Enrolling subjects in SOLIDARITY will be easy. When a person with a confirmed case of COVID-19 is deemed eligible, the physician can enter the patient’s data into a WHO website, including any underlying condition that could change the course of the disease, such as diabetes or HIV infection. The participant has to sign an informed consent form that is scanned and sent to WHO electronically. After the physician states which drugs are available at his or her hospital, the website will randomize the patient to one of the drugs available or to the local standard care for COVID-19.

The design is not double-blind, the gold standard in medical research, so there could be placebo effects from patients knowing they received a candidate drug. But WHO says it had to balance scientific rigor against speed. The idea for SOLIDARITY came up less than 2 weeks ago, Henao Restrepo says, and the agency hopes to have supporting documentation and data management centers set up next week. “We are doing this in record time,” she says.

Here are the treatments that SOLIDARITY will test:

Remdesivir

The new coronavirus is giving this compound a second chance to shine. Originally developed by Gilead Sciences to combat Ebola and related viruses, remdesivir shuts down viral replication by inhibiting a key viral enzyme, the RNA-dependent RNA polymerase.

Researchers tested remdesivir last year during the Ebola outbreak in the Democratic Republic of the Congo, along with three other treatments. It did not show any effect. (Two others did.) But the enzyme it targets is similar in other viruses, and in 2017 researchers at the University of North Carolina, Chapel Hill, showed in test tube and animal studies that the drug can inhibit the coronaviruses that cause SARS and MERS.

Chloroquine and hydroxychloroquine

At a press conference on Friday, President Donald Trump called chloroquine and hydroxychloroquine a “game changer.” “I feel good about it,” Trump said. His remarks have led to a rush in demand for the decades-old antimalarials. (“It reminds me a little bit of the toilet paper phenomenon and everybody’s running to the store,” Caplan says.)

The WHO scientific panel designing SOLIDARITY had originally decided to leave the duo out of the trial, but had a change of heart at a meeting in Geneva on 13 March, because the drugs “received significant attention” in many countries, according to the report of a WHO working group that looked into the drugs’ potential. The widespread interested prompted “the need to examine emerging evidence to inform a decision on its potential role.”

Ritonavir/lopinavir

This combination drug, sold under the brand name Kaletra, was approved in the United States in 2000 to treat HIV infections. Abbott Laboratories developed lopinavir specifically to inhibit the protease of HIV, an important enzyme that cleaves a long protein chain into peptides during the assembly of new viruses. Because lopinavir is quickly broken down in the human body by our own proteases, it is given with low levels of ritonavir, another protease inhibitor, that lets lopinavir persist longer.

The combination can inhibit the protease of other viruses as well, specifically coronaviruses. It has shown efficacy in marmosets infected with the MERS virus, and has also been tested in SARS and MERS patients, though results from those trials are ambiguous.

Ritonavir/lopinavir and interferon-beta

SOLIDARITY will also have an arm that combines the two antivirals with interferon-beta, a molecule involved in regulating inflammation in the body that has also shown an effect in marmosets infected with MERS. A combination of the three drugs is now being tested in MERS patients in Saudi Arabia in the first randomized controlled trial for that disease.

But the use of interferon-beta on patients with severe COVID-19 might be risky, Herold says. “If it is given late in the disease it could easily lead to worse tissue damage instead of helping patients,” she cautions.

Source: Science

  • Pandemonium
  • Vol 36
  • Issue 38
  • Courier Briefing
  • DhakaCourier

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