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  1. A DIWALI SPECIAL! HOSTED BY THE ISRAELI EMBASSY IN INDIA & THE ISRAELI CONSULATES IN MUMBAI & BANGALORE. 52 MINUTES OF JOY! ++ + = PEACE! https://www.facebook.com/watch/live/?v=690160238582562&ref=watch_permalink Reply Like (0)Report More
  2. The Flu Vaccine, Inflammatory Arthritis, and COVID-19: What You Need to Know This year, the flu vaccine is more important than ever. Here’s what you need to know about getting vaccinated safely when you have inflammatory arthritis like rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis. Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones. Getting a flu vaccine is important every single flu season, especially if you have a form of inflammatory arthritis such a rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) — but in the midst of the COVID-19 pandemic, it’s even more critical. While experts are hoping that COVID-related prevention practices like mask wearing, social distancing, and ramped-up hygiene will translate into less influenza spread this season, rheumatology experts are still urging patients to get vaccinated. The good news is that many people with chronic illness don’t need convincing. According to a recent survey of members of the CreakyJoints and Global Healthy Living Foundation’s COVID-19 Patient Support Program (a free program that provides information, advice, and support to help people with underlying health issues navigate the pandemic), 85 percent of 780 respondents said they were planning to get a flu vaccine this fall. About 10 percent said they did not plan to, and 5 percent did not know if they would get the flu vaccine this fall. “As we are getting ready to enter flu season, and with COVID-19 continuing to spread throughout our communities, I think it is extremely important for people to get the flu vaccine this year,” says Justin Owensby, PharmD, PhD, a research pharmacist in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham (UAB). “As the novel coronavirus has severely stressed our health care system/resources, having even a mild flu season will further tax the system,” which may lead to even more strain on the hospitals and health care workers who will help you if you end up needing emergency care because of flu complications such as pneumonia. Here’s more about why, when, and how to get your flu vaccine safely this year. Why You Need the Flu Vaccine, Period First, simply having inflammatory arthritis increases your chances of getting the flu — and, if you do catch it, your risk of serious infection and severe complications is greater. “Compared to the general population, people living with inflammatory arthritis are at substantially higher risk of getting a vaccine-preventable infection, such as the flu or pneumonia, and consequently more complications and hospitalizations from those infections,” explains Dr. Owensby. For example, RA patients have nearly a three times greater risk of getting the flu than healthy patients in the same age group, according to a 2012 analysis of 46,030 RA patients and an equal number of healthy controls, published in the journal BMC Musculoskeletal Diseases. Yet another study, presented as an abstract at the American College of Rheumatology conference in 2018, found that RA patients who get influenza experience increased hospital stays as well as higher costs compared to healthy controls. Inflammatory arthritis decreases your body’s natural immune defenses and some disease-modifying medications used to manage your condition can also weaken your immune response. “The flu shot is designed to strengthen your immune system by allowing it to recognize and fight off an influenza infection,” says Owensby. “Flu vaccines have been shown to reduce the risk of flu illness, hospitalization, and death.” COVID-19 and Flu Coinfection As if that’s not convincing enough, here’s yet another reason to roll up your sleeve: “People can get coinfected with influenza and COVID-19, says Jeffrey Curtis, MD, MS, MPH, professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham (UAB). “You can have both infections at the same time, and if that happens, the severity will be much worse.” While the flu shot won’t protect you from getting COVID-19, it may help reduce the risk of spreading COVID. “If you have the flu, and you’re coughing and sneezing, common sense says you’re more likely to transmit COVID,” says Dr. Curtis, “so if you can decrease the incidence and transmission of influenza, then you it’s possible that you can decrease the transmission to COVID.” More research is needed to confirm this effect, however. When Should I Get the Flu Vaccine? The CDC recommends getting your flu shot before influenza spreads within your area; ideally by the end of October. However, getting vaccinated anytime during the flu season, even in January or later, can protect you. Dr. Curtis says it’s important to remember that it takes about two weeks after vaccination for antibodies that protect against flu to develop in the body — and that immunity doesn’t always last the entire season. “There is some temporariness to the duration of protection of the flu vaccinations, so if you get the flu shot in September, it might not offer the same protection in March,” he says. Yet if putting it off until November means you might just put it off forever, Dr. Curtis urges patients to get it done and over with it when it’s top of mind. If you suspect you may have been exposed to COVID-19 or have a confirmed diagnosis of COVID-19, the CDC suggests delaying the flu shot until you’re no longer showing signs and symptoms, adds Owensby. This isn’t because there’s evidence that having COVID affects the effectiveness of the flu vaccination, but rather because you don’t want to unnecessarily expose others to COVID-19. What’s the Best Place to Get the Flu Vaccine? For people with inflammatory arthritis who have been staying at home as much as possible and limiting their outings to minimize exposure to COVID-19, the idea of heading to a doctor or pharmacy to get a flu shot may seem scary. You can find reassurance in the fact that the CDC has given guidance to local pharmacies, grocery stores, and doctor’s offices for safe vaccination practice during the COVID-19 pandemic, including: Screening patients for COVID-19 symptoms or exposure to COVID-19 prior to arrival Limiting the overall number of patients at any given time Providing specific appointment times to manage patient flow and avoid crowding Ensuring staff wear medical face masks and use eye protection Limiting and monitoring points of entry to the facility and installing barriers, such as clear plastic sneeze guards, to limit physical contact with patients Implementing policies for wearing cloth face coverings and practicing respiratory hygiene, cough etiquette, and hand hygiene Setting up a one-way flow through the site and using measures to direct patient traffic and ensure physical distancing Arranging a separate vaccination area or separate hours for persons at increased risk for severe illness from COVID-19, when feasible Ensuring a minimum distance of 6 feet between patients in line, in waiting areas for vaccination, between vaccination stations, and in postvaccination monitoring areas Other safe places to get your flu shot this year may include: Drive-through immunization services Curbside clinics Mobile outreach units Home visits “It doesn’t matter where as long as you get one,” says Dr. Owensby. He recommends using VaccineFinder.org to find where flu vaccines are available near you. “[And] when going to get a flu vaccine, be sure to practice everyday preventive actions.” If you’re not sure whether a local pharmacy or clinic is following COVID-19-related precautions, ask around and get feedback and recommendations from family and friends. You can also call ahead to ask about how crowded the facility is and find out the times of day when it’s likely to be emptiest. What Type of Flu Shot Is Best? Dr. Curtis says there are three considerations for people with inflammatory arthritis: Is it a live vaccine? A live vaccine, such as the nasal spray, can cause side effects in people with inflammatory arthritis who have weakened immune systems. Instead, opt for the flu shot, which is made from inactivated (or killed) influenza virus, which cannot cause illness. Is it quadrivalent? This means that it’s a four-component vaccine, which this year protect against the following four flu strains: A/Hawaii/70/2019 (H1N1) pdm09-like virus; A/Hong Kong/45/2019 (H3N2)-like virus (updated); B/Washington/02/2019; (B/Victoria lineage)-like virus (updated), plus B/Phuket/3073/2013-like (Yamagata lineage) virus. The trivalent vaccine, which offers protection against three strains, does not include the fourth virus, B/Phuket/3073/2013-like (Yamagata lineage) virus. Is it high-dose? This is a more potent type of flu vaccine, and while it’s generally reserved for adults 65 and older, it is beneficial for people with inflammatory arthritis who may have a weaker response to the flu vaccine than people without these health conditions. In fact, research published in The Lancet Rheumatology reported that the high-dose flu shot (Fluzone) substantially improved the immune response in seropositive RA patients compared to the standard-dose flu shot. However, many high-dose vaccines are trivalent, and don’t protect against B/Phuket/3073/2013-like (Yamagata lineage) virus. Talk with your rheumatologist about the best type of flu vaccine for you, and be sure to check with your insurance to see if it’s covered, says Dr. Curtis. If you’re under 65, the high-dose shot may not be covered. Do I Need to Adjust My Arthritis Medications? While the decision to adjust your medications should be between you and your rheumatologist, there are studies showing that some medications, including high doses of steroids, methotrexate, and the biologic rituximab, reduce the body’s immune response to flu vaccine, says Dr. Owensby. Rituximab Treatment with the infused drug rituximab has been shown to decrease the response to the flu shot, says Dr. Owensby, so your doctor may recommend delaying the time between vaccine and your next infusion. Methotrexate Recent studies have shown that a brief, two-week discontinuation of methotrexate after receiving the flu shot can boost your immune response to it, says Dr. Owensby. Although researchers have also found that people taking methotrexate or TNF inhibitor biologics — like etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) — do have an acceptable response to the flu vaccine, the response isn’t as strong as it is in healthy individuals who are not taking immunosuppressants. Your best bet is talk to your doctor about the the pros and cons of skipping a dose of your medication around the time you get your flu shot. Dr. Curtis emphasizes that people should not “stop taking medication prematurely,” without consulting their doctors. Can the Flu Shot Increase My Risk of Getting Sick? “To my knowledge, there is no evidence suggesting getting a flu shot will make you more susceptible to COVID-19,” says Owensby. “Although they are both contagious respiratory illnesses, they are caused by different viruses.” COVID-19 is caused by SARS-CoV-2 and flu is caused by different strains of influenza viruses. Similarly, getting the flu shot will not give you the flu, says Dr. Curtis. In fact, those mild flu-like symptoms you may experience after the shot — headache, achiness, malaise, low-grade fever — are all signs of your immune system revving up to protect against the flu, he explains. Keep Practicing Mask Wearing, Social Distancing, and Good Hygiene While experts agree that you need to get a flu shot, it doesn’t mean you should stop taking other precautions to stay healthy this flu season. “Even after receiving the flu shot, it’s still important to take all the steps you can to avoid getting the flu,” says Owensby. So, get vaccinated, amp up your efforts to eat well and exercise, prioritize sleep, manage stress, and of course, practice a whole lot of hand washing and sanitizing. https://creakyjoints.org/living-with-arthritis/coronavirus/daily-living/flu-vaccine-inflammatory-arthritis-covid-19/?utm_source=CreakyJoints&utm_campaign=d589052654-cj-list_september-2020-newsletter_non-psp&utm_medium=email&utm_term=0_2a31b3d2f0-d589052654-232962794
  3. CBD may improve steroid therapy in autoimmune, Covid-19 patients Israeli startup Stero Therapeutics says cannabis component could enhance steroid treatment or enable reduced steroid dosage to avoid negative effects. By Brian Blum JUNE 18, 2020, 8:30 AM Cannabis component CBD may enhance effects of steroids. Image by HQuality via Shutterstock.com Can cannabis help treat Covid-19? Israeli canna-tech startup Stero Therapeutics wanted to find out. But unexpectedly good news threw a hitch in those plans. At the height of the corona crisis, the Bnei Brak-based company was set to launch a clinical trial with 10 Covid-19 patients at Rabin Medical Center in Petah Tikva when the hospital ran out of patients. Rabin and several other Israeli medical centers closed their coronavirus wards as the number of new cases slowed to a trickle. Stero is now turning its attention toward Europe, where there is, unfortunately, still no shortage of people suffering from the virus. With cases spiking again in Israel, though, a clinical trial closer to home is no longer out of the question. While Covid-19 has occupied Stero’s interest for the past two months, it was never the company’s main focus. The overlap was steroids. Stero aims to determine if CBD, the non-psychoactive component in cannabis, can enhance the effect of corticosteroids — the first line of treatment for autoimmune illnesses like inflammatory bowel disease and lupus — or enable reducing steroid dosage while maintaining or improving its therapeutic effects. Stero founder and CEO David Bassa. Photo: courtesy Stero founder and CEO David Bassa’s previous company, Talent Biotech, had developed expertise in using CBD to prevent and treat graft vs. host disease (GvHD), a life-threatening immune condition that can occur following an organ transplant. In GvHD, immune cells from the donor attack the recipient’s tissues. The primary therapy for GvHD is also steroids. Talent had reached Phase 2b trials when Canadian cannabis company Kalytera bought the company for $10 million in 2017 — the Israeli cannabis industry’s first major “exit.” Kalytera has taken Talent’s technology toward Phase 3 trials with an eye on FDA and European CE approval as early as the end of this year. Now no longer with Kalytera, Bassa set his sights on an even bigger medical goal: whether CBD could reduce, improve and possibly even replace steroids as a first line of treatment in just about any kind of immune system overreaction. Crohn’s, hives… and Covid? Bassa established Stero after receiving a broad US patent covering 130 autoimmune and inflammatory diseases, including Crohn’s disease, hepatitis, arthritis and chronic urticaria (hives). “The patent covers botanic and synthetically produced CBD, at any dosage and in combination with other drugs,” Bassa tells ISRAEL21c. Stero chose two indications to start with – Crohn’s and urticaria. They had enrolled Crohn’s disease patients in a clinical trial and were just starting with urticaria when Covid-19 upended everything. Steroids are also used to fight off Covid-19’s most deadly effect in acute infections: an immune system over-response known as a cytokine storm. Cytokines are a signalling molecule released in response to a virus. They activate inflammation as a way of containing and eradicating the pathogen. In a cytokine storm, the immune system releases too many of these molecules. The result is often more collateral damage than the virus itself would have caused. In a landmark UK trial, researchers found that use of dexamethasone, a type of steroid, reduced deaths for COVID-19 patients on ventilators by a third and cut deaths for those receiving just oxygen by 20%. The researchers say that if the drug had been used at the beginning of the pandemic, up to 5,000 British lives could have been saved. Stero had proposed to investigate whether CBD can boost the therapeutic effectiveness of steroids in Covid-19 patients. For its trials with Crohn’s and urticaria research, the aim is to see if CBD can reduce the need for high dosages of steroids with all the negative side effects they cause. Meanwhile, the Medical Cannabis Research and Innovation Center at Rambam Health Care Campus in Haifa has proposed a trial of its own to determine if certain strains of cannabis can save severely ill Covid-19 patients from cytokine storms. Four-month trial Stero’s first focus is the approximately 30 percent of Crohn’s disease patients who are steroid dependent, Bassa explains. In the four-month randomized, double-blind trial, half the patients will get CBD oil and half will get a lookalike placebo. In the first month, the steroid dosage will be reduced while the CBD (or placebo) is introduced. If a patient has a major Crohn’s flareup and is receiving the placebo, he or she will be dropped from that arm of the trial and given CBD instead. Patients who flare up while receiving CBD will be put back on their regular dose of steroids. Bassa cautions readers with inflammatory conditions against experimenting at home. The amount of CBD in the trial is 300 mg a day – about 10 times the amount usually used by consumers of CBD as a wellness product where it’s legal. Stero’s CBD is synthetically produced, making it more expensive than CBD from plants, but Bassa says synthetic CBD “assures us a clearer eventual path with the FDA.” Serendipity and a promise The CBD-steroid connection was discovered by accident. Dr. Moshe Yeshurun, Stero’s senior medical adviser, directs the bone marrow transplantation unit at Rabin Medical Center. He had GvHD patients “who were suffering very much and he wanted to ease their pain by giving them medical cannabis,” Bassa tells ISRAEL21c. But the patients also started to get better and show less signs of disease. Bassa’s story has a similar unexpected twist. He was a successful software entrepreneur when his mother was diagnosed with multiple myeloma, a deadly blood cancer. In looking for a drug that could help her, he discovered that Prof. Moshe Mittleman, from Tel Aviv Sourasky Medical Center, was investigating whether off-label use of erythropoietin, a molecule generally used to boost blood hemoglobin, could ease multiple myeloma. Bassa’s mother began taking erythropoietin. “She lived another 11 years instead of the three that was predicted,” Bassa says. Bassa’s mother made him promise to “take the solution that worked for her to the world,” he recalls. He raised $2 million to build a company to commercialize erythropoietin for blood cancer, but he was ultimately not successful. “Luckily for patients, there are newer treatments today that have already replaced erythropoietin,” he explains. What he couldn’t do for erythropoietin he is trying to do in the cannabis space. Cannabis Innovation Center Stero, which has raised $1 million, is one of a half-dozen companies Bassa operates out of his Cannabis Innovation Center in Bnei Brak. He has a partnership with Clalit, Israel’s largest HMO. Indeed, most of Bassa’s team of 20 works in Clalit hospitals and clinics. Mor Research Applications, the technology-transfer office of Clalit, is Stero Biotech’s main shareholder. Bassa’s other companies include CannaLean Biotechs, which is exploring whether CBD can help lower cholesterol; CannaMore, which is studying CBD’s potential role in treating bronchiolitis obliterans, a pulmonary disease; and BioSeedXL, a tech incubator for cannabis companies. For more information on Stero Biotechs, click here. https://www.israel21c.org/cbd-may-improve-steroid-therapy-in-autoimmune-covid-19-patients/ https://www.israel21c.org/13-promising-covid-treatments-emerging-from-israel/
  4. Some autoimmune diseases are work of overzealous T cells, researchers say Scientists at Israel’s Weizmann Institute find that these protective cells combat excess hormones in certain organs; when they misread the situation, illness results By SHOSHANNA SOLOMON 26 May 2020, T cells attacking a cancer cell (frentusha; iStock by Getty Images) Israeli researchers say they have found that autoimmune diseases, such as diabetes or thyroid dysfunctions, are generated by immune cells that become overzealous in their protective mission and end up causing harm — and they created a mathematical model that demonstrates this. In a study published in Immunity, scientists at Rehovot’s Weizmann Institute of Science, decided to find out why some organs are susceptible to autoimmune diseases while others are not. For example, the thyroid gland is often attacked by the autoimmune disease thyroiditis — an inflammation of the thyroid gland that can cause fatigue, weight gain, confusion and depression — while other organs, like the parathyroid gland, in charge of regulating the amount of calcium in the blood and bones, are almost never hit by autoimmune diseases. “Our model suggests that immune cells play an important role in healthy people, because they clear away mutant cells that secrete too many hormones,” said Yael Korem Kohanim, a research student who led the study. “It is when this process goes wrong that people develop an autoimmune disease.” Korem Kohanim works in the lab of Prof. Uri Alon in the Institute’s Molecular Cell Biology Department. Illustrative image of a woman checking blood sugar levels; type-1 diabetes is an autoimmune disease that affects one organ (Ta Nu; iStock by Getty Images) Autoimmune diseases can be divided into two types: systemic ones like lupus that attack many organs in the body, and the ones like type-1 diabetes that affect just one organ. One of the biggest questions about this second, organ-specific type of autoimmune disease is why some organs get the diseases while others do not. These organ-specific autoimmune diseases tend to follow a similar pattern: They are found in children or young adults and they involve the destruction of cells that secrete hormones that are essential to good health. In people with autoimmune disease, immune cells called T cells somehow identify these essential hormone cells as dangerous and eradicate them on contact. In their study, Korem Kohanim, Alon and other researchers decided to find out why this is and if T cells, in charge of protecting us from diseases by regulating our immune response, are tasked naturally to kill these cells. Yael Korem Kohanim, research student at the Weizmann Institute (Courtesy) They hypothesized that T cells may act as an extra layer of protection to make sure that the amounts of essential hormones secreted by the cells stay within narrow limits: both too little and too much of these hormones, such as insulin, thyroid hormones, and cortisol, can be damaging. When demand for the hormone rises — for example, a demand for insulin when glucose is sensed in the blood — cells not only increase production of the hormone, they ramp up cell division to help meet that demand. But cell division carries risks, as a certain percentage of the new cells is likely to carry mutations. Most such mutations are harmless, but if somehow a cell misreads the demand for insulin as high instead of low, the result can be deadly: the cell will continue not only to pump out extra hormones, it will divide again and again to produce new cells with the same mutation, which will then divide again and produce even more of the hormone. The role of T cells thus could also be to curb the over-secreting cells in healthy organs, by removing cells that threaten to secrete too much hormone. The scientists thus hypothesized that in the case of autoimmune diseases, the T cells might be primed to accomplish the task of curbing the hormones but get “overzealous” and kill off non-mutant cells as well. To determine if their hypothesis was reasonable, the researchers created a mathematical model for the functioning of healthy organs in which T cells help to keep hormone levels where they should be. The model backs up the hypothesis, and shows that the organs stay fit and productive as long as the T cells continue to be highly selective and most of their targets are mutated cells. When they are too active, the organs are stricken by an autoimmune disease, the model shows. Illustrative image of a weighing scale, balance (artisteer; iStock by Getty Images) Thus, the researchers say, autoimmune diseases could be the result of a trade-off: on one hand T cells are meant to prevent the overproduction of hormones, but on the other hand they could cause a reduced production in some people, if they become too active. “We think that autoimmune diseases do not come out of nowhere,” said Korem Kohanim. “They are a malfunction, but one of a physiological system that is already in place.” Some people are more prone to this T cell over-activity, she said, due to a variety of risk factors like viral inflammations or genetics. The scientists also looked at whether organs that do not develop autoimmune diseases do not have T cell protection. And indeed they don’t. That is why these organs don’t get autoimmune diseases, but they do suffer from illnesses due to the hyper-secretion of hormones. The parathyroid gland, for example, explained Korem Kohanim, doesn’t get autoimmune diseases but does get a disease called primary hyperparathyroidism in which a benign tumor of parathyroid cells secretes too much of the hyperparathyroid hormone. Now the scientists want to see via experiments if their claims can be proven. https://www.timesofisrael.com/some-autoimmune-diseases-are-work-of-overzealous-t-cells-researchers-say/?utm_source=The+Weekend+Edition&utm_campaign=weekend-edition-2020-05-31&utm_medium=email
  5. Benlysta Treatment Lowers Disease Activity for SLE Patients, Real-world Data Shows MAY 29, 2020 BY INES MARTINS, PHD Treatment with Benlysta (belimumab) induces meaningful and long-lasting reductions in systemic lupus erythematosus (SLE) disease activity, helping a significant proportion of patients achieve durable remission or a status of low disease activity, a study in a real-world Italian population shows. Patients diagnosed in the prior two years, with low damage accrual and lower disease activity scores, were the ones who benefited the most from this treatment, the research revealed. The study, “Early disease and low baseline damage predict response to belimumab in patients with systemic lupus erythematosus,” was published in the journal Arthritis and Rheumatology. Benlysta, developed by GlaxoSmithKline, is approved in the U.S., the European Union and Japan as an add-on biologic treatment for people 5 years and older with active SLE. The therapy has shown consistent safety and effectiveness in clinical practice, leading the European League Against Rheumatism (EULAR) to recommend its use for people who failed standard care treatments. As with most other SLE therapies, the ultimate goal of Benlysta is to help patients achieve remission or a state of low disease activity, both associated with a lower risk of flares, reduced organ damage, and a better prognosis overall. Researchers in Italy set out to investigate the factors that predict responses, remission, low disease activity, damage, and treatment discontinuation in SLE patients receiving Benlysta in a real-world setting. According to the investigators, they studied the largest nationwide group of European patients aimed at investigating Benlysta in SLE. The team retrospectively examined patients treated from January 2013 to March 2019, and included in the Belimumab in Real Life Setting Study (BeRLiSS). Physicians prescribing Benlysta at Italian reference centers were invited to participate and to provide data regarding specific outcome measures at pre-determined time intervals. For their study, the team of scientists included 466 participants with active SLE, 77 of whom had been diagnosed within the prior two years (classified as early lupus). All patients received Benlysta via an into-the-vein infusion at 24 centers. Patients were followed for a median of 18 months. During that time, researchers assessed the proportion of patients who achieved remission and low disease activity — based on the SLE Disease Activity Index (SLEDAI) scores and medication use — and those who experienced clinically meaningful responses to treatment, defined as an improvement of four or more points in the SLEDAI score (a measure called SLE Responder Index 4 (SRI4). The team also examined changes in disease flares, organ damage, and treatment discontinuation, and conducted statistical analyses to predict which factors were associated with better outcomes. Results demonstrated that nearly half of patients (49.2%) achieved SRI4 after six months on treatment, a proportion that kept increasing for the first two years — 61.3% at one year, 69.7% at two years — and remained constant in the next two years (69.6% at three years and 66.7% at four years on Benlysta). Predictors of response varied at each time point, but those with greater disease activity always were significantly more likely to respond to treatment. Patients with early disease were nearly two times more likely to respond to Benlysta at six months and almost four times more likely at two years, while those without organ damage at treatment initiation (baseline) also were more likely to respond within the first year. Notably, smoking significantly reduced the likelihood of a late response. A significant proportion of patients (66.1%) spent at least half of their follow-up time in a low disease activity state and 44.3% were in remission at least 25% of the time. The team found that having lower disease activity and no organ damage at baseline were significant predictors of being on remission and low disease activity for these long periods. Patients with high numbers of flares and kidney involvement at baseline were less likely to achieve remission. Benlysta treatment significantly reduced the incidence of flares, and only 9.4% of patients experienced new damage events while on treatment. The team found that being at least half of follow-up time on low disease activity was protective from further damage, while having increased damage at baseline was predictive of further damage accrual. Regarding safety, there were no deaths or severe infusion reactions among more than 10,000 Benlysta infusions. A total of 271 patients reported adverse side effects, with the most common being infections. Also, 165 patients discontinued treatment within the first year, either due to an adverse event, inadequate response, pregnancy or remission. The researchers noted that discontinuation due to lack of effectiveness was associated significantly with a higher rate of flares before treatment. “Our study provided novel evidence of a remarkable achievement of remission or LDA [low disease activity] during treatment, which were also likely to persist over time, and confirmed previous results on real-life use of belimumab [Benlysta],” the researchers wrote. “At present, belimumab is frequently used as the last option in SLE treatment. Based on our data, we suggest that an earlier use of belimumab in patients with active SLE may maximize its efficacy,” they concluded. Ines Martins, PhD Inês holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in blood vessel biology, blood stem cells, and cancer. Before that, she studied Cell and Molecular Biology at Universidade Nova de Lisboa and worked as a research fellow at Faculdade de Ciências e Tecnologias and Instituto Gulbenkian de Ciência. Inês currently works as a Managing Science Editor, striving to deliver the latest scientific advances to patient communities in a clear and accurate manner. Fact Checked By: Jose Marques Lopes, PhD José is a science news writer with a PhD in Neuroscience from Universidade of Porto, in Portugal. He has also studied Biochemistry at Universidade do Porto and was a postdoctoral associate at Weill Cornell Medicine, in New York, and at The University of Western Ontario in London, Ontario, Canada. His work has ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease. https://lupusnewstoday.com/benlysta-lowers-disease-activity-organ-damage-sle-patients-real-world-data?utm_source=LUP+NEws+E-mail+List&utm_campaign=5d7643d560-RSS_WEEKLY_EMAIL_CAMPAIGN_US&utm_medium=email&utm_term=0_50dac6e56f-5d7643d560-71887989
  6. Israeli invention turns tap water into antiviral solution It sounds like magic, but Bar-Ilan University researchers say the environmentally friendly disinfectant may be used daily to kill bacteria and viruses on all kinds of surfaces. By Abigail Klein Leichman APRIL 26, 2020, 8:42 AM Illustrative photo via Shutterstock.com Bacteria and viruses can be killed effectively through a new method that instantly turns ordinary tap water into a powerful, environmentally friendly disinfectant on demand. The technology was developed by chemists at Bar-Ilan University in Ramat Gan and patented last year by the university’s BIRAD Research and Development Company. Disinfectant solutions made with this technology previously were proven for their bacteria-killing abilities in hospital tests done in Israel. Recently, the disinfectant also proved effective in neutralizing corona-type viruses in tests conducted in the lab of Prof. Ronit Sarid of BIU’s Mina and Everard Goodman Faculty of Life Sciences. “We examined the ability of these materials to impair herpes simplex virus type 1 infection and human coronavirus OC43,” said Sarid. “Both viruses were completely eliminated when exposed to the disinfectants for different periods of time. The structural characteristics of OC43 are similar to those of recent SARS-CoV-2, suggesting that this virus will also be easily eliminated with this disinfectant.” Researchers Eran Avraham and Izaak Cohen developed the technology for the water-to-disinfectant solution in the laboratory of Prof. Doron Aurbach, an international electrochemistry expert from BIU’s Institute of Nanotechnology and Advanced Materials Chemistry. Prof. Doron Aurbach of Bar-Ilan University’s Institute of Nanotechnology and Advanced Materials Chemistry. Photo: courtesy Their novel method involves mixing water with nanometer-shaped electrodes that have unique surface properties. The combination of these compounds creates an effective antibacterial against bacteria, viruses and spores. Unlike many other disinfectants, such as chlorine bleach, this water-based solution is safe for skin and does not contaminate groundwater, the researchers say. “The antiseptic capability is 100 times more effective than bleach and therefore low concentrations of between 50 and 200 milligrams of the active materials per liter are enough to disinfect — unlike bleach, which by contrast requires between 5,000 and 20,000 mg per liter,” the scientists explained. “They are also much more environmentally friendly and do not cause burns or dry skin. They don’t cause corrosion, and most importantly, with the very low concentration of 50 mg they eliminate all kinds of viruses.” Many possible applications The technology could be used for a variety of disinfectant products, such as spray aerosols for disinfecting surfaces, appliances, beds, closets and bathrooms; containers for immersing hands, shoes or devices; disinfectant wipes; dry fog air-purifiers and others. “The ability to produce electrodes in a variety of shapes and textures makes the technology suitable to almost any application – from a ‘cassette’ in an air conditioner, a container for washing fish and meat, to disinfection and removal of pesticides from vegetables and fruit, a device for manufacturing disposable antibacterial cloths and many other applications – even masks and gloves,” Avraham said. Through his startup, AqooA Solutions: Eco Sanitizing Technologies, Israeli entrepreneur Barak Dror Wanderman is working toward final development and production of portable devices that will produce the disinfectant liquids on demand from potable water. Bar-Ilan University researchers Izaak Cohen and Eran Avraham flank Barak Dror Wanderman, an entrepreneur seeking to commercialize the water-based disinfectant. Photo by Yair Sagi “Imagine a situation in which you are at a busy mall and are interested in using the public bathroom,” says Avraham. “All you have to do is take out the compact spray bottle, access the nearest tap, and press the power button. Now you have a disinfectant that will allow you, with a simple spray, to sterilize the toilet and bathroom space and be protected.” Packaged in special containers, the disinfectants can remain effective for two months and may be sold in recyclable bottles. For reusable bottled products, a fairly simple process can be applied to enable long-term use, the researchers added. “There are many antibacterial disinfectants on the market, but this material is based on water so it is cheaper, three times more effective, seven times less toxic for humans, preserves these capabilities for much longer and covers a large variety of bacteria,” said BIRAD VP of Business Development Frances Shalit. “We are on the brink of a revolution by making the most effective green disinfectant available to the entire population and medical institutions,” said Wanderman. “This technology will save many lives, save the economy a lot of money, and eliminate the use of hazardous chemicals that harm the environment.” https://www.israel21c.org/israeli-invention-turns-tap-water-into-antiviral-solution/
  7. Everything you need to know about coronavirus at a glance: From how to avoid the virus to survival while self-isolating and knowing the difference between the flu and Covid-19 The death toll from the coronavirus reached almost 6,000 worldwide last night Across Europe, countries have become crippled and placed in lockdown In Britain, the number of dead doubled, to 21, with new measures coming soon Coronavirus symptoms: what are they and should you see a doctor? By DAILY MAIL REPORTER PUBLISHED: 00:32 GMT, 15 March 2020 | UPDATED: 01:01 GMT, 15 March 2020 WORLD IN LOCKDOWN The death toll from the coronavirus reached almost 6,000 last night with another 400 lives lost worldwide over the past 24 hours. In Britain, the number of dead doubled, to 21, with the Government set to announce a series of tough emergency measures to try to contain the disease. Across Europe, countries have become crippled and placed in lockdown. In Spain, cases soared from 1,500 to 5,700 and ministers declared an unprecedented two-week state of emergency. France has ordered non-essential locations to close and several nations have closed their borders or shut their airports. With the travel plans of millions already affected, US President Donald Trump last night decreed that all flights from the UK to America are to be banned from tomorrow, in addition to the 26 EU nations previously announced. +13 Covid chic: Naomi Campbell posted this picture of herself wearing a white suit and mask at the airport IS MY COUGH A COLD OR COVID-19? Experts such as Professor Jonathan Ball, virologist at the University of Nottingham, say data suggests that in as many of 70 per cent of cases, coronavirus has symptoms similar to a common cold. Meanwhile, official advice is that if you have a temperature above 37.8C, feel hot to touch on your chest or back, or if you have a new, persistent cough, you should stay home for seven days. Other cold-like symptoms may be indicators and some offer this chart (below) as a rough guide… +13 HOW BEST TO AVOID VIRUS Health experts can't stress enough: WASH YOUR HANDS OFTEN with soap and running water for 20 seconds. Also use hand sanitiser. Cover your mouth and nose with disposable tissues when you cough or sneeze. Put tissues into a disposable rubbish bag and immediately wash your hands. Avoid close contact with people who are unwell. A minimum distance of 6ft 6in (2 metres) is recommended. Do NOT touch your face, especially mouth, nose or eyes, as this is one way the virus enters your system. There's no firm evidence that most face masks cut the risk of infection. But they might reduce hand-mouth contact. HOME-WORKING IN PYJAMAS? As comfortable as your pyjamas may seem, it's wise to get properly dressed and adopt a regular routine by differentiating between 'work' and 'down' time. Also, take care of your diet as blood sugar levels affect mood and energy levels. Video conference calls with work colleagues can help stop loneliness. Towards evening, put away your work equipment and change clothes to help psychologically mark the shift to personal time. ELDERLY MOST AT RISK The death rate for over-80s who contract the virus has been assessed at nearly 15 per cent, according to Chinese data. Anyone over 60 is advised to avoid crowds because the risk of infection may increase in closed settings with little air circulation. In coming weeks, the old and vulnerable may be asked to self-isolate, regardless of symptoms. Children, though, seem relatively unaffected – the vast majority have only mild symptoms. But since they tend to come into contact with far more people, they can spread the virus much more widely. MORE DIE FROM WINTER FLU Since the virus was first reported, at least ten times as many people have died from winter flu, while other diseases have claimed substantially more lives – as our graph shows. +13 SELF-ISOLATING? AN ESSENTIAL SURVIVAL GUIDE If self-isolating, like Health Minister Nadine Dorries, avoid direct human contact. Instead, use video conferencing and social media. If self-isolating, like Health Minister Nadine Dorries (pictured), avoid direct human contact Move around as much as possible. If you have a garden, get fresh air regularly but do NOT leave your property. Drink plenty of water and take paracetamol to help alleviate the symptoms. Plan what you'll need – food, medicines etc – and arrange how they can be obtained. Sign up to online services if you haven't already. Keep busy with activities. Keep your distance from others you live with, and sleep alone. Use separate towels. Also use a separate bathroom, if possible – but if you can't, clean it thoroughly after using it. BORIS'S 'SOMBRERO' PLAN +13 CLEAN YOUR PHONE DAILY Experts believe the virus can survive on flat surfaces for days unless they're disinfected. They advise cleaning your phone with alcohol wipes twice a day. Or use water and soap with a slightly wetted cloth. Don't use kitchen cleaners, window cleaners or paper towels, which can leave debris and scratch the surface. +13 Experts believe the virus can survive on flat surfaces for days unless they're disinfected Troops on the streets in the fight against coronavirus: Government plans to draft in Army to keep hospitals and supermarkets secure, escort food convoys and build tented field wards next to care homes to cope with crisis as deaths almost double in 24 hours Key personnel such as RAF Typhoon pilots would be quarantined at work to ensure UK's continued protection The Government is also expected to tell people over 70 to stay in strict isolation at home for four months Ministers will also get powers to make compulsory purchases of land to free up room for extra graveyards Ministers have drawn up plans to put troops on the streets to help deal with the coronavirus crisis after the number of deaths almost doubled within 24 hours. With the death toll jumping from 11 to 21 and the number of confirmed UK cases leaping by almost 40 per cent, Downing Street accelerated plans to ban large public events and implement the self-isolation of entire households where any member has succumbed to the illness. In a bid to 'shield' the most vulnerable, the Government is also expected to tell people over 70 to stay in strict isolation at home or in care homes for four months. Under emergency legislation to be put before MPs within days, safeguards introduced after the scandal involving serial killer Dr Harold Shipman will also be suspended in order to speed up cremations and burials. +13 Ministers have drawn up plans to put troops on the streets to help deal with the coronavirus crisis after the number of deaths almost doubled within 24 hours (Boris Johnson pictured in Downing Street on Saturday) +13 In preparation for the worst-case scenario, defence sources told The Mail on Sunday that Army units were stepping up their training for public order roles – including the guarding of hospitals and supermarkets (file photo) +13 In a bid to 'shield' the most vulnerable, the Government is also expected to tell people over 70 to stay in strict isolation +13 The UK's death rate has doubled overnight as a further ten patients died from the coronavirus. The total number of cases in the UK leapt from 820 this morning to 1,145 this afternoon +13 A woman is pictured wearing a mask on Oxford Street Saturday. Commuters around the country said train stations, carriages and car parks seemed deserted compared to normal PM urges people with minor symptoms not to call 111 but to self-care Loaded: 0% Progress: 0% 0:00 Previous Play Skip Mute Current Time0:00 / Duration Time0:29 Fullscreen Need Text Ministers will also get powers to make compulsory purchases of land to free up room for extra graveyards. In preparation for the worst-case scenario, defence sources told The Mail on Sunday that Army units were stepping up their training for public order roles – including the guarding of hospitals and supermarkets. The Royal Logistics Corps are preparing to be used to escort food convoys and the Royal Army Medical Corps is poised to build tented field hospitals next to care homes. Troops trained in chemical, biological and nuclear warfare will deep-clean empty public buildings in case they need to be turned in to hospitals or morgues. And the Army has also drawn up contingency plans to keep petrol stations topped up with fuel when the country reaches 'peak virus'. The number of confirmed UK cases rose yesterday to 1,140, up from 820. And globally, there have now been 153,585 reported cases with 5,802 deaths. In another day of dramatic developments: The Scientific Advisory Group for Emergencies told the Government that it will soon need to start shielding the most vulnerable members of society and isolating entire households; President Donald Trump announced the US travel ban would be extended to the UK from tomorrow; Hundreds of Britons, many of them elderly, were stuck aboard a cruise ship in the Caribbean where five people have tested positive for the virus; Spain and Poland closed their borders, stranding thousands of British holidaymakers, and France closed all non-essential public spaces such as cafes and cinemas; Boris Johnson asked UK manufacturers to support the rapid, wartime-style production of essential medical kit, particularly ventilators, while the NHS will buy up beds in private hospitals; Panic-buying led to extraordinary scenes at supermarkets across the country, prompting stores to plead with consumers to 'work together'; World Health Organisation spokesman Dr Margaret Harris questioned the British Government's strategy of delaying 'social distancing', arguing that it risked infecting millions; Chancellor Rishi Sunak met insurance leaders amid a growing row over who will foot the bill for cancelled holidays; It emerged that care homes and hospitals are likely to be 'cocooned' when the Easter lockdown comes into effect; Three patients tested positive for Covid-19 at a hospital close to the Queen's Norfolk estate; Downing Street underwent a 'deep clean' following a visit by Tory MP Nadine Dorries, who subsequently tested positive for the virus – but the Prime Minister has not been tested; A group of Dutch scientists claimed to have found an antibody that may help detect and prevent the coronavirus from being able to infect people; Experts predicted the Government could be forced to effectively nationalise airlines and train companies. +13 Shoppers were scrambling for food and hygiene products as mass hysteria gripped the nation amid the worrying pandemic +13 Coronavirus panic-buying unleashed carnage on British supermarkets today as hoards of shoppers gutted the nation's food and toilet roll aisles (Tesco in Colney Hatch, London, pictured) First look at government's new $30million coronavirus health advert Loaded: 0% Progress: 0% 0:00 Previous Play Skip Mute Current Time0:00 / Duration Time0:30 Fullscreen Need Text +13 President Donald Trump has banned flights to the US from the UK and Ireland amid the coronavirus pandemic Trump confirms government is considering domestic travel restrictions Loaded: 0% Progress: 0% 0:00 Previous Play Skip Mute Current Time0:00 / Duration Time0:21 Fullscreen Need Text Defence sources told this newspaper that under the contingency plans, 38 military liaison officers would work with local councils to brief civil servants on how the Armed Forces could help combat the crisis. The most essential staff, such as RAF Typhoon pilots, would be quarantined at work to ensure the UK's continued protection and the SAS's stand-by squadron would be held in the UK, rather than be deployed overseas. If the crisis deepens, hundreds – possibly thousands – of troops could be deployed. Hundreds of members of the Armed Forces hold HGV licences and are trained in transporting hazardous loads such as fuel. Members of the Royal Military Police would also support local constabularies, while troops could also be used to drive ambulances and fire engines. Meanwhile, the Prime Minister will tomorrow issue a Churchillian call to leading British manufacturers to join a national effort to combat the spread of the virus. In particular he will urge the construction of more ventilators, which the Government will vow to buy. NHS chief executive Sir Simon Stevens said: 'The scale of the challenge we face means we can't do this alone... we need every part of society and every industry to ask what they can do to help the effort.' Amid criticism of the Government's strategy, Chief Scientific Adviser Patrick Vallance and Chief Medical Officer Chris Whitty said they will publish the statistical models on which the 'shielding and isolating' response was based. https://www.dailymail.co.uk/news/article-8113211/Everything-need-know-coronavirus-glance.html?ito=social-twitter_mailonline
  8. Stopping Immunosuppressant Medication During an Infection? Sick-Day Planning for the Coronavirus Outbreak Now is the time to talk to your doctor about what you might do if you were to develop infection symptoms. DO NOT STOP TAKING YOUR MEDICATION WITHOUT YOUR DOCTOR'S KNOWLEDGE! As the coronavirus becomes more widespread across the U.S. and the world, it will be important (not to mention reassuring during these high-anxiety times) to have a sick-day plan in place for people who are immunocompromised or who have underlying chronic illnesses that increase the risk for complications. (Plus, cold and flu season isn’t over yet — it’s been known to linger into May.) In addition to washing your hands, practicing other smart prevention habits, staying away from crowds and public places, and getting your flu, pneumonia, and shingles vaccines (it’s not too late to get vaccinated), experts say now is the time to talk to your doctor about what you might do if you were to develop infection symptoms. Many CreakyJoints members have been asking questions specific to the immunosuppressing medications they take to manage inflammatory arthritis and related conditions, such as disease-modifying antirheumatic drugs, injectable and infused biologic medications, and oral targeted medications such as JAK inhibitors. The main theme: Do I stop taking these medications to help “boost” my immune system? The general consensus among the many rheumatologists CreakyJoints has spoken with is this: Healthy patients should not preemptively stop taking medications. According to a message about COVID-19 from the American College of Rheumatology on its website, “all patients should talk to their rheumatologist or rheumatology professional prior to discontinuing any of their medications” and “while there are no data on the influence of these medications on COVID-19, providers should follow their current practice for interrupting therapy during episodes of infection.” If patients become sick with an infection, then a decision about whether to stop certain immunosuppressing medications is made on a case-by-case basis by you and your health care provider. Do NOT make the decision to take a “drug holiday” alone. “Communication is key,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida and CreakyJoints medical advisor. “The best strategy is to work with your rheumatologist to make a decision.” If You Are Experiencing Signs of Infection If you have signs of a respiratory infection during the coronavirus outbreak, you should call your health care provider before visiting in person, as directions on what to do next can vary from place to place. Your provider may have you go to a hospital for testing. If they have you come in to the office, calling ahead will allow them to take steps to keep other people from getting infected or exposed. If you’re experiencing any of the following symptoms, call your doctor: Fever Congestion Persistent cough Diffused body aches Profound fatigue Cough with yellowish green sputum Difficulty breathing, wheezing, or shortness of breath “A simple viral infection can trigger bacterial pneumonia or even sudden deterioration of respiratory status, so it’s very important to keep vigilant,” says Dr. Domingues. Immunosuppressants and Your Risk of Infection Many of the medications that treat inflammation in inflammatory arthritis and autoimmune conditions can make you more susceptible to infections of all kinds — viral, fungal, bacterial. Drugs like corticosteroids, some DMARDS (disease-modifying antirheumatic drugs like methotrexate), JAK inhibitors, anti-TNF biologics, and other biologics each affect/suppress your immune system in certain ways. This can make it more likely for patients to contact infections — from the common cold to COVID-19 to tuberculosis to shingles — and make it harder to recover from an infection if you do contract one. Combinations of these medications can also impact your chances of getting sick. According to a study in the Journal of Translational Medicine, adding biologics to a DMARD doubled the infection risk of the DMARD alone; biologics and corticosteroids increased it even further. While you could assume that these medications might also increase your chances of catching the coronavirus or experiencing complications from it, no one knows this for sure. Research is underway and there are many more questions than answers. The American College of Rheumatology message states: “Currently, there are no specific data on [the coronavirus] in patients with rheumatologic disease or immunosuppression.” Corticosteroids and Infection Risk You may have seen information from the CDC stating that patients with a coronavirus infection avoid taking corticosteroids, which are commonly prescribed to people with inflammatory arthritis, “because of the potential for prolonging viral replication as observed in MERS-CoV patients, unless indicated for other reasons.” However, this does not necessarily mean that “healthy” patients should stop taking corticosteroids that are part of their current treatment regimen. Your doctor may think that the benefits of remaining on a corticosteroid outweigh the risks of stopping it unless you develop an active infection. Also, keep in mind that these medications should not be stopped suddenly. They need to be tapered on a specific schedule. Why You Should Not Stop Taking Immunosuppressive Medications on Your Own Depending on your type of inflammatory arthritis or chronic illness, stopping medications without consulting your doctor could mean more flares, pain, and potentially other organ manifestations, such as lungs, kidneys, skin, eyes, says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee. “Poor adherence to medication in inflammatory arthritis could also lead to increasing problems with arthritis symptoms, which could require steroids for disease control, which could increase infection risk, as well as lead to other side effects like weight gain and increased fracture risk,” says Dr. Smith. Plus, “if you don’t tell your physician that you stopped [the medication] and come to the office with swollen joints, we’ll assume the medication is no longer working,” says Dr. Domingues. Questions to Ask for Sick-Day Planning As part of your sick-day planning, it’s a good idea to discuss the following with your rheumatologist: How do my specific medications impact my immune system? When would I (or should I not) stop taking my medications? Would I need to start antibiotics preventively? What should I do to treat infection symptoms — for example: rest, hydration, minimize physical activity, take an analgesic (Tylenol) or decongestant? What steps should I take if a loved one in my home is sick? What are signs to look for that I need urgent medical care? Guidelines for Stopping Immunosuppressants Coronavirus outbreak aside, it is a common practice to at least consider temporarily stopping immune-suppressing medications when patients have infections. The thinking is that doing so can help strengthen your immune system to shorten the infection and help avoid complications. Keep in mind that because COVID-19 is a new virus, there are no proven guidelines for what to do regarding stopping immune-suppressing medications with this particular virus. That may sound unsettling, so it’s all the more reason to work with your doctor and to call with any questions or worries. Generally speaking, rheumatologists say that the decision to stop medications during an infection is individualized for each patient. “Whether you hold or continue your medication depends on the medication, how well the disease has been controlled, and how severe the disease was prior to starting the medication,” says Jean Liew, MD, a senior fellow at the University of Washington in Seattle. Whether or not a patient has other comorbidities, such as lung disease, kidney disease, and heart disease, may also play a role. “This is all based on your rheumatologist’s understanding of your individual risk/benefit profile.” “I’m not currently suggesting to my patients to hold/stop their DMARDs — there is evidence that uncontrolled inflammatory disease also results in increased risk of infection,” rheumatologist Paul Sufka, MD shared during a recent #CreakyChats Twitter chat. Dr. Domingues advises many of his patients to stop medications that are immunosuppressive during an active infection and resume them once the infection has cleared. “If they get a cold or virus, I typically recommend they hold their medication a week or so. If you are on weekly methotrexate, you would hold off a week or two, if you’re etanercept (Enbrel) or adalimumab (Humira), basically the same thing,” he says. “The idea is that you will diminish the chance that your immune system is downgraded.” In general, medications that are given daily or every one to two weeks are easier to discontinue temporarily when someone becomes sick. Daily oral medications like JAK inhibitors, such as tofacitinib (Xeljanz) or upadacitinib (Rinvoq), have a much shorter half-life — they’re eliminated out of your system within 72 hours. Monthly injections and infusions remain in the body much longer, notes Dr. Domingues. It’s more challenging when the medications are administered less frequently, says Dr. Smith. For example, if you take a biologic infusion once a month and get sick two weeks after taking your medication, you would be unable to hold the medication as it is already in your system. “However, if you were still sick at the time of the next dose, then you could hold that dose and resume the medication when you were no longer sick.” As you can see, stopping immunosuppressant drugs is far from simple. The key take-home message is this: Do not stop taking any medication without talking to your doctor Do not stop taking any medication unless you have an active infection If you have an active infection, do not stop taking medication unless your doctor suggests it as part of your sick-day plan. If you’re feeling fine, what you should be doing right now is this: Follow the directions that your rheumatologist provided you when you started your medication, says Dr. Liew. “Contact your rheumatologist [or drug manufacturer] for updates and clarifications on these instructions if necessary,” she adds. For ongoing coronavirus coverage and to be part of our community conversation about this, visit creakyjoints.org/coronavirus. Keep Reading Coronavirus Facts: What You Need to Know If You Have Chronic Illness or Are Immune-Compromised Coronavirus Anxiety: Key Advice for Chronic Illness Patients from Health Psychologists ‘Stay Home as Much as Possible’: The New CDC Advice for Those at High Risk of Coronavirus Complications https://creakyjoints.org/treatment/stopping-immunosuppressing-medication-during-infection/?utm_source=CreakyJoints&utm_campaign=784b063f31-coronavirus-articles-march10&utm_medium=email&utm_term=0_2a31b3d2f0-784b063f31-232962794
  9. Coronavirus Facts: What You Need to Know If You Have Chronic Illness or Are Immune-Compromised People with chronic illness that affects the immune system, such as many forms of inflammatory arthritis, are understandably worried — if not downright freaking out — about the spread of this new virus. Here’s what infectious disease experts and rheumatologists want you to know. This article has been updated to reflect new information as of March 8, 2020. Being immunocompromised during cold and flu season is stressful enough without having to worry about the coronavirus (COVID-19). The U.S. Centers for Disease Control and Prevention (CDC) is now urging Americans to start preparing for “when, not if” the U.S. will experience community spread, but what exactly does this mean if you have a chronic illness like inflammatory arthritis? “I personally am feeling alarmed at this point,” CreakyJoints member Rene M. shared on Facebook. She is worried that the U.S. seems unprepared. “I’m keeping an eye on it and, in the meantime, limiting my time in crowded places, washing my hands often, not touching my face while I’m out. My next step will be wearing a mask. It feels like that is all we can do at this point.” “Generally I avoid situations when I know people are ill, but then so many people go to work, shop, etc. when they are ill, it’s tough,” agreed Judy F. “I do have concerns. I’m not sure there is much to do other than continue to follow good hygiene, maybe stay off planes if travel isn’t necessary. It is a concern but since “the experts” don’t even seem to know what it is or what to do or can come up with a good and consistent diagnostic system or reporting, I’m not sure my doctor can shed any more light on it.” CreakyJoints spoke with multiple rheumatologists and infectious disease experts to try to track down answers and advice that are as specific to this community as possible. Here’s what we have learned so far. We will update this story as necessary if critical information changes. Coronavirus Concerns for Immune-Compromised Patients “It is certainly concerning for everyone, especially those who are immunocompromised,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas. For people with inflammatory arthritis, your immune system tends to focus on attacking your own body rather than outside threats like the coronavirus. And some of the medications used to manage these diseases also suppress the immune system, which can make patients more vulnerable to infection. “We need to exercise more caution and be more alert with these patients,” says Dr. Bose. Yet we’re just beginning to learn about COVID-10, which is part of an extended family of viruses that include 229E (alpha coronavirus), NL63 (alpha coronavirus), OC43 (beta coronavirus) HKU1 (beta coronavirus), and MERS-CoV, SARS-CoV. Here’s what we do know: The coronavirus outbreak, which originated in Wuhan, China in 2019, is moving its way around the world, with a total of more than 105,000 detected cases around the world so far and 3,500 deaths. According to the latest CDC data, the U.S. now has more than 400 confirmed cases across at least 28 states. There have been at least 19 deaths linked to the virus in the U.S. Patients with inflammatory arthritis are probably more susceptible to the coronavirus and at higher risk of complications like pneumonia, but “we don’t have data available to quantify this risk at this time,” says rheumatologist Jean Liew, MD, a senior fellow at the University of Washington in Seattle. “In general, those on medications that suppress the immune system are going to be at heightened risk for infection, as well as getting more severe symptoms from infection if they do get it.” This doesn’t mean you should panic, but you should pay attention to your local news, stay aware of your surroundings, practice prevention, and prepare for potential isolation. Here are more steps you can take to stay healthy and be ready for a potential community spread of coronavirus. NEW INFORMATION: Stay home as much as possible The CDC issued new guidelines on March 5, 2020 for people at higher risk of COVID-19 that encourage them to stay home as much as possible. The CDC describes this group as “older adults and people who have severe chronic medical conditions like heart, lung or kidney disease” but we consider those with inflammatory autoimmune conditions and anyone taking immune-suppressing medications in this group as well. The CDC also recommends that if you do need to go out, try to avoid crowds and gatherings with large numbers of people. Know the symptoms The symptoms of COVID-19 are similar to those of influenza, says William Schaffner, MD, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee. These include: Fever Cough Shortness of breath Fatigue Sometimes vomiting and diarrhea Aches and pains Complications like pneumonia “Coronavirus is a respiratory illness and spread very readily through close contact,” Dr. Schaffner explains — for instance, if an infected person coughs or sneezes three to six feet away from you. It may also be spread through an airborne route, which, according to Johns Hopkins, means “that tiny droplets remaining in the air could cause disease in others even after the ill person is no longer near.” Experts aren’t sure if COVID-19 can be spread by touching an object or surface contaminated with the virus and then touching your mouth, nose, or eyes. Symptoms usually appear within two to 14 days of being exposed to the virus. While coronavirus is easy to catch, it is not found everywhere, like cold and flu viruses are. “It’s important to listen to the news and advice of local health officials,” says Dr. Schaffner. “If there was an importation in Maine, it won’t affect people in Missouri; you need to be aware of your neck of the woods.” The CDC recommends testing for the coronavirus in patients who: Have fever or symptoms of lower respiratory illness (cough or shortness of breath) AND who have had close contact with someone who’s had lab-confirmed coronavirus Have fever or symptoms of lower respiratory illness AND who have recently traveled to an area with widespread virus transmission (China, Japan, Italy, South Korea, or Iran) Have fever with severe acute lower respiratory illness (e.g., pneumonia, respiratory distress) that requires hospitalization and who do not have an alternative possible diagnosis (such as flu) At this time, there is no vaccine (although manufacturers are working on it) and no specific antiviral treatment for COVID-19, but medical care can help relieve and monitor symptoms. Keep in mind that because coronavirus symptoms are very similar to flu or other respiratory infections, you shouldn’t necessarily panic if you develop them. What you should do is call your rheumatologist or primary care doctor right away to determine next steps. “If patients experience worrisome symptoms suggestive of coronavirus — or influenza — they should see their PCP/urgent care/ED immediately,” says Dr. Bose. Be your healthiest self Right now the regular seasonal flu is a still a greater threat than coronavirus for patients with inflammatory arthritis, says Dr. Schaffner. And, luckily, the lifestyle habits that help your immune system to function optimally during cold and flu system are important for fending off the coronavirus, too. You should make sure you have your annual flu vaccine as well as practice these habits: Regular hand washing Staying hydrated Eating healthy Exercising Managing stress Getting adequate sleep “One of the easiest things to say and the hardest things to do is to sleep well,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida. “People who are sleep-deprived are at much higher risk of contracting a virus.” Another thing to keep in mind is to avoid taking “immune booster supplements,” says rheumatologist Doug Roberts, MD, an assistant clinical professor of medicine at the University of California Davis Medical School. “Some of these may interfere with the immunomodulating effects of your DMARDs [disease-modifying medications].” It’s always a good idea to get your doctor’s approval for any over-the-counter supplements. Stop the spread of germs Hand washing (for at least 20 seconds with soap and water) is the hands-down (pun intended) winner when it comes to preventing the spread of germs. Here’s a video from the World Health Organization that shows proper hand washing techniques — it may be more involved than you think. The CDC also advises common sense measures like avoiding touching your mouth, nose, and eyes, avoiding people who are coughing and sneezing, cleaning and disinfecting frequently touched objects and surfaces, and avoiding large crowds. In other words, “don’t be afraid to be the person on the plane with disinfecting wipes,” says Dr. Domingues. At this time, the CDC does not recommend wearing a face mask to protect yourself from COVID-19. There is no scientific basis that they help prevent infection, says Dr. Schaffner. “The average face mask is too thin and fits too loosely around the face,” he notes, adding “though there is a small psychological benefit; you feel more comfortable and others know you have them in mind and are in this together.” If you do choose to invest in a face mask, Dr. Domingues recommends the N95, which the FDA has cleared for use by the general public in public health medical emergencies. Mind your meds Unfortunately, some of the same medications that treat your condition — such as corticosteroids and disease-modifying drugs including biologics — suppress the immune system and make patients more prone to contracting infections and/or having a more severe infection, says Dr. Bose. While our experts do not recommend stopping your medication or changing doses, it’s important to stay in contact with your rheumatologist’s office. “Predinose at higher doses [20 mg or more] can be severely immunosuppressive but they cannot be tapered off fast,” explains Dr. Bose. “Biologics can be paused in patients who have an active infection and restarted once they have recovered.” If you think you have symptoms of a respiratory infection like coronavirus, your doctor may recommend stopping or lowering medications that are immunosuppressive during an active infection and then resuming them once your infection has cleared. Never make any changes to your medication regimen without first discussing them with your doctor. “More study is essential on whether medication regimens should be adjusted [just yet],” says Dr. Roberts. Start thinking about preparation for a worse outbreak Again, we’re not there yet, but it’s important to start mentally preparing if there comes a time when local public authorities say we have to stay home, says Dr. Schaffner. “Think it through and give some thought about what you might do.” Consider the following: Do I have enough food/water? Do I have an adequate supply of medication? Are my labs up to date? Can I seek medical care through a telehealth system? Is working from home a possibility? Can I skip events that put me in contact with large groups of people (religious services, sporting events, concerts, etc.)? Can I postpone travel? Do I have a plan in place with family members and/or caregivers? The bottom line: Although the coronavirus can certainly cause added stress for patients living with inflammatory arthritis or other chronic conditions, keeping your immune system healthy, practicing regular infection prevention, and having an emergency plan in place can go a long way toward helping you stay calm and healthy. https://creakyjoints.org/living-with-arthritis/coronavirus-facts-for-chronic-illness-patients/
  10. LIVING WITH ARTHRITIS ‘Stay Home as Much as Possible’: The New CDC Advice for Those at High Risk of Coronavirus Complications Here’s more on what these recommendations mean for people with chronic illness and weakened immune systems. The CDC is finally issuing some specific recommendations for coronavirus prevention for those at high risk for complications: Stay at home as much as possible. Make sure you have access to several weeks of medications and supplies in case you need to stay home for prolonged periods of time. When you go out in public, keep away from others who are sick, limit close contact and wash your hands often. Avoid crowds. Stay up to date on CDC Travel Health Notices. “If you are at increased risk for COVID-19 complications due to age or because you have a severe underlying medical condition, it is especially important for you to take actions to reduce your risk of exposure,” the CDC says. Defining People at High Risk from Coronavirus Complications People at higher risk include: Age 60 or older Those with weakened immune systems Those with heart disease Those with lung disease Those with kidney disease Those with diabetes Those with other underlying health problems People who are pregnant These groups should avoid activities such as traveling by airplane, going to movie theaters, attending family events, shopping at crowded malls, and going to religious services, William Schaffner, MD, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee, told CNN. “The single most important thing you can do to avoid the virus is reduce your face to face contact with people,” he said. Schaffner, who is over age 60, told CNN that he and his wife are going grocery shopping during off-hours when the stores are likely to be less crowded. Social Distancing vs. Quarantine vs. Isolation According to the U.S. Department of Health and Human Services, the definition of social distancing is a way to keep people from interacting closely or frequently enough to spread an infectious disease. Schools and other gathering places such as movie theaters may close, and sports events and religious services may be cancelled. On the other hand, a quarantine separates and restricts the movement of people who have been exposed to a contagious disease to see if they become sick. It lasts long enough to ensure the person has not contracted an infectious disease. And a third term, isolation, refers to separating people who are sick from those who are not in order to help prevent the spread of an infectious disease. It lasts as long as the disease is contagious. What Does Social Distancing Mean in Everyday Life? Social distancing can take many forms depending on your lifestyle and family and work situation. Remember that the goal is to try to minimize your exposure to environments and situations that could allow for the spread of an infectious disease like coronavirus. But it’s also easy for the concept of social distancing to feel overwhelming or create a lot of anxiety. If you have any questions about how far to take your social distancing and pre-emptive ‘self-quarantining,’ you should speak to your health care provider. They may be able to provide stress-relieving guidance about situations that are important to you — say, an important family event or attending religious services — based on your specific risks and medical history. Social distancing can include the following habits and steps: Avoid handshaking, hugging, and other intimate types of greetings Avoid non-essential travel (your health care provider may have specific guidance for your situation here) Avoid crowds, especially in poorly ventilated spaces Work from home if this is possible for your work situation Avoid unnecessary errands — consider ways to have essential items, like food and other household supplies, brought to your house through online delivery services or through family or social networks Preparation for Staying Home as Much as Possible The CDC advises the following for high-risk patients: Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home. Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time. Contact your health care provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time. We have heard that some patients in our community may be experiencing issues accessing extra supplies of necessary medication. If this is happening to you, we would like to know about it. Email info@creakyjoints.org and let us know. Current Advice for High-Risk People in Seattle and King County This may not apply to your situation, but here is some of the public health advice issued to high-risk people in Seattle and King County, where the coronavirus has been more widespread. “These measures can potentially impact the spread of the disease,” officials said KingCounty.gov. People at higher risk of severe illness should stay home and away from large groups of people as much as possible, including public places with lots of people and large gatherings where there will be close contact with others. Workplaces should enact measures that allow people who can work from home to do so. If you can feasibly avoid bringing large groups of people together, consider postponing events and gatherings. All people should not go out if they are sick. Avoid visiting hospitals, long term care facilities, or nursing homes to the extent possible. If you need to go, limit your time there and keep six feet away from patients. For ongoing coronavirus coverage and to be part of our community conversation about this, visit creakyjoints.org/coronavirus. Keep Reading Coronavirus Facts: What You Need to Know If You Have Chronic Illness or Are Immune-Compromised Coronavirus Anxiety: Key Advice for Chronic Illness Patients from Health Psychologists A Chronic Illness Patient’s Guide to Coronavirus https://creakyjoints.org/living-with-arthritis/social-distancing-high-risk-coronavirus-complications/
  11. So you think you’re about to be in a pandemic? Posted on February 25, 2020 by Ian M Mackay, PhD and Katherine E Arden PhD The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 [1]) has spread to over 30 countries and regions outside mainland China. Currently, disease spread in Singapore is being slowed by their expertise but new case numbers in South Korea, Italy and Iran, and the wide national distribution of cases in Japan are all signs that the virus is ahead of our efforts to contain it. Let’s go shopping. But bit by bit – not in a rush. Photo by Daria Volkova on Unsplash We’re not in a pandemic now For now, you are more than likely not living in an area experiencing widespread community transmission of SARS-CoV-2. If more cases of coronavirus disease 2019 (COVID-19) keep rapidly appearing, and more of them can’t be traced to existing transmission chains, the efforts in some countries to contain COVID-19 will have failed. At some point, we’ll be in the main phase of a pandemic; epidemics of an efficiently transmitting pathogen spreading widely within the community of two or more countries, apart from the first one to report it.[1] A pandemic doesn’t necessarily mean the disease is severe. Also, this word may bring to the attention an event that some still manage to ignore when softer words are used. And let’s face it if we don’t start using this possibly scary word and talking about and planning for the possibilities now – how much more panic and fear will result because we were taken totally by surprise? For once, let’s get ahead of what’s coming. Assumptions and severity This post is based on the assumption that a pandemic will occur at some point and that Wave 1 will impact us, wherever we live, in the coming weeks and months. We don’t know for certain how severe a COVID-19 pandemic will be. We may be able to assume it’s a mild or perhaps moderate pandemic, not a severe one, according to definitions in the Australian Health Management Plan for Pandemic Influenza scenarios.[4] But we won’t know for sure until we see spread in countries that ask questions, define cases, and test for SARS-CoV-2 in the same way that we do. From AHMPPI.[4] We know that SARS-CoV-2 is effectively transmitted among humans but it may take longer for symptoms to show up in the next infected person than it does for seasonal influenza (“silent” or unnoticed shedding may happen). We also know there are no antivirals or vaccines at the time of writing and we are pretty sure that our entire population is likely to be vulnerable to infection because it doesn’t have any immunity to their new virus. Planning now and doing something means we can control how well we cope with some of what may be coming. If we see events cancelled or schools closed we can rest assured that this is to slow down spread, not something scarier. Hopefully, this will be clearly explained by authorities at the time. While closures and cancellations are possible, they are by no means a sure thing. We don’t know how mild or severe SARS-CoV-2 will be, and each region will make their own – probably slightly differing – decisions about what is appropriate – and enforceable. Having a think now about how we might respond in these situations will help decisions come faster if we get to that point. Thanks to the expert commentary of Dr Jody Lanard and Dr Peter Sandman, in the last post, we already have some excellent ideas about what information we should be listening for, from health authorities communicating to the wider community. What we might see happen if many get sick If we enter into a pandemic, large numbers of people will be sick. Even if that’s just staying home with a fever and bad cough for a week. If COVID-19 is more severe, that will have a greater impact. And when one family member is sick, one or more others may be involved in their care, removing more people from the workplace. The same effect may result if children being excluded from school. In a worst-case scenario, widespread illness may mean too few workers to drive trucks and trains, buses and taxis, run water treatment, electricity or other government services, teach at schools or staff hospitals. This didn’t happen in Australia during the 2009 H1N1 “swine flu” pandemic. But supply chains may be impacted in a number of ways. Authorities will try to slow the speed of COVID-19 to prevent hospitals – which are essential to care for the sickest people – from being overloaded. Public gatherings – sports events and concerts – as well as schools and childcare centres, could be postponed or closed. All of which aims will be to keep people apart, making it harder for the virus to spread quickly. Again, these decisions will differ between places, and may not even have to be made. Measures which slow the peak (1) and “flatten the curve” (2) will delay and spread out the pressure on essential healthcare function and supply chains. [3] Once we have a vaccine, we can mitigate the impact of SARS-CoV-2, but we’re quite some way from having a safe vaccine. Planning for everything A lot of the planning that is going on in many places worldwide right now revolves around supporting essential services, using the numbers we have to predict the load on hospitals and to model a myriad of impacts on daily life; planning for the worst and hoping for the best. Everyone knows the precise numbers of cases and deaths are not as precise as we’d like them to be. This is where modelling gives the authorities options – from most likely to happen, to least likely. From least concerning outcomes to the most devastating ones. And we plan accordingly. In this process, a lot of guidelines and plans and documents get written, but few of them are of use to you (or us) as members of the wider community. It seems to take a while to get to around talking to the community about what they can do. Part of that’s because of how consumed with work many are right now because this epidemic is still only 8 weeks old; an infant, yet one that moves like a teenager who just discovered caffeine. And yet, late last week and over the weekend, the signal fires of pandemic awareness and increased communication started to light. But what can we plan for and do? Let’s break this into two main categories. Reducing our risk of being infected Reducing the chance we will run out of essential foods and goods Reducing our risk of being infected We can do a few things and we’ve probably heard them all before. They won’t guarantee to protect us from infection, but they can reduce our risk of infection. These are just as useful for avoiding influenza (flu) virus infection during flu season and for dodging SARS-CoV-2, once your local community is known to have it circulating. REMEMBER: As long as the virus circulates, and as long as you have never been infected, you are susceptible to infection resulting in COVID-19. This will be the case for the rest of your life until you have been infected which should protect you from severe disease. COVID-19 is mostly a mild illness but can cause severe pneumonia in approximately 20% of cases, leading to hospitalization for weeks and in a portion of these cases, to death. World Health Organization.[2][5] These are things we can do to reduce our risk of SARS-CoV-2 infection. Stay at least 2m away from obviously sick people. We’re trying to avoid receiving a cough/sneeze in the face, shaking hands, or being in the range of droplet splatter and the “drop zone” Wash your hands with room temperature water for 20 seconds or alcohol-based hand sanitiser & do this more frequently than you do now Soap and water and then dry, or an alcohol-based hand rub after you walk out of eth lift, drag your hand along that handrail, held onto the bus for that trip, and air dry Try not to touch your face. There is a chance your unwashed fingers will have a virus on them and if you touch/rub your mouth, nose or eyes, you may introduce the virus and accidentally infect yourself. Practice this; get others to call you out when you forget. Make it a game. Keep air circulating with a fan or open a window-good for flu too This helps spread out any floating droplets – just in case they are a risk. This reduces any chance of being exposed to enough to cause illness While a mask seems like a good idea, and when used by professionals it does protect from infection, it can actually give inexperienced users a false sense of security. There isn’t a lot of good evidence (still!) that shows a mask to reliably prevent infection when worn by the public at large. They are useful to put on a sick person to reduce their spreading of the virus. If you or a loved one becomes sick, follow the practices of the day. Call ahead before going to a Doctor, fever clinic or hospital and get advice on what to do. Hopefully, this message is already out there and we’ll see it more once transmission of the virus is widespread. Reducing our risk of running short of food and important goods – the 2-week list What we’re looking at here is trying to minimize the impact of any shortages of goods we rely on having at the grocery store or at the end of an online ordering system. Dried fruit. It lasts and is nutritious. Photo by VisionPic .net from Pexels But don’t panic buy and don’t hoard! Most of the world is not seeing any widespread ongoing transmission of SARS-CoV-2, so now is a great time to make list, label up a “Pandemic Stash” box, and begin to slowly fill it with items that won’t go off and that you won’t touch unless needed. Buy a few of the things each weekly shop. Don’t buy things you won’t eat later, don’t hoard and don’t buy more than you’ll need for a 2 week period. We’re not talking zombie apocalypse and we very probably won’t see power or water interruptions either. Our household is trying to get food that fulfil a need for carbohydrate, protein, and fibre. We also want supplies for caring for the sick (or for when sick yourself) and cleaning supplies to try to reduce the spread. Below we list things we’ll need to have in case of a more major interruption to supply; a stock that will last two weeks. This is a figure based on other professional sites like the New South Wales Government in Australia and Ready.gov in the United States. Local authorities may have some more detailed advice in the future. Stay tuned. Some of the items in the list below will last much longer and include items that may not be a top priority for authorities to keep stocked: Extra prescription medications, asthma relief inhalers Some of these may be a problem, so talk to your doctor soon. Over-the-counter anti-fever and pain medications paracetamol and ibuprofen can go a long way to making us feel less sick Feminine hygiene products Family pack of toilet paper Vitamins In case food shortages limit the variety in your diet Alcohol-containing hand rub and soap Household cleaning agents Bleach, floor cleaner, toilet cleaner, surface cleaning spray, laundry detergent Tissues, paper towel Disposable nappies Cereals, grains, beans, lentils, pasta Tinned food – fish, vegetables, fruit Oil, spices and flavours Dried fruit and nuts Ultra-heat treated or powdered milk Ian is not drinking black coffee, no matter what Batteries for anything that needs batteries, powerbanks Think about elderly relative’s needs Their medications, pets, pandemic stash, plans for care (see later) Pet food and care Dry and tinned food, litter tray liners, medicines, anti-flea drops Soft drink or candy/chocolate for treats The last-minute fresh list In a more severe pandemic, supply chain issues may mean fresh food becomes harder to get. So this list is an add-on to the one above, and its items should be the last things to buy if you have a hint of when supplies might slow or stop for a (hopefully short) time. Bread, wraps Meat for freezing Milk Eggs Yogurt Vegetables, fruit Fuel for your car The elderly and COVID-19 To date, looking at data from China (below), most (94%) deaths from COVID-19 have occurred in those aged over 50 years of age, with more than half (51%) in those aged over 70 years. The age group most at risk for death are those aged over 80 years. Older people with comorbidities have experienced higher proportions of death than those with no comorbidities. Most cases identified in mainland China – 80.9% of them – even with the more severe case catching that China has favoured – have been classified as mild. This is good news although 20% is still a lot of “severe” disease. Mild cases recover in about 2 weeks from the time they showed symptoms, while severe cases can take 3 to 6 weeks to recover. Infographic of the largest study of cases from China.[1] Because of this, we may see a big impact on our elderly population, both in terms of hospitalisation and death. Residential aged care is likely to suffer and visits to loved ones may be restricted to keep them safe. If you have loved ones in an aged care facility, ask the facility about its plans for keeping their residents safe from flu (a similar situation) and whether they have thought about what they will do if SARS-CoV-2 is spreading widely. It will be important to check that your parents and grandparents have prepared a Will and have considered an Enduring Power of Attorney in case they are unable to make care-based decisions for themselves. These aren’t fun to organise or think about, but they’re important whether we see a COVID-19 pandemic or not, so just use this as a reminder to get it done. Pandemic is a word, how we react to it is down to us We all want to have some control over our lives but when a virus comes knocking as this one is, we feel the loss of that control. The lists above are something we can actually do. We’re working on this in our household now, bit by bit. The lists have helped us all focus on how that “thing going on in that faraway country” will impact us when it comes to our neighborhood. This process has already made things a little more familiar and a little less unknown and scary. We’ve done some things that will help. We know there are still risks but we’ve talked about them, calmly, as a family. Of course, this doesn’t remove the many unknowns, but we’re sure we’ll gradually reduce those as science gets us more answers. Hopefully, these answers will bring good news; lower death rates, effective antiviral drugs, and new vaccines. We do have some experience of a pandemic and it wasn’t panic-worthy. The pandemic of H1N1 “swine flu” in 2009 had some unhappy consequences, but it was by no means a zombie apocalypse. China has bought us time to prepare. Let’s not waste any more of it. Instead, let’s get our planning hats on and all work the problem together. This is one of those rare times when we’re unarguably all in this together. SARS-CoV-2 doesn’t care about our beliefs, our sex or gender, our colour or our clothes – it just wants to make a home in our human cells. It’s perfectly okay to be anxious about this. But work the problem. References https://virologydownunder.com/not-so-novel-numbers-around-covid-19-and-sars-cov-2/ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Interim pre-pandemic planning guidance: community strategy for pandemic influenza mitigation in the United States: early, targeted, layered use of nonpharmaceutical interventions. Published Date: February 2007 https://stacks.cdc.gov/view/cdc/11425 Australian Health Management Plan for Pandemic Influenza (AHMPPI) August 2019 https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-ahmppi.htm Clean hands protect against infection https://www.who.int/gpsc/clean_hands_protection/en/ https://virologydownunder.com/so-you-think-youve-about-to-be-in-a-pandemic/
  12. Saving the lives of stroke victims by streamlining workflow After a stroke, every minute of delay can be fatal. Viz.ai monitors CT images for signs of large vessel occlusion in under 30 minutes, and alerts the medical team immediately. By Brian Blum MARCH 3, 2020 CT scans of the human brain. Photo by Shutterstock The biggest cause of death or debilitation from stroke is time to treatment. It’s not a matter of training but of workflow automation. CT scans need to be analyzed immediately, then sent to the right expert. If a particular facility doesn’t have the necessary equipment, where’s the closest hospital that does? If only a specific surgeon can do the job, how can he or she be located? Every minute of delay can potentially be fatal. After six hours, it’s often too late to save a patient. This problem requires intelligence of the artificial kind. Which is what Israeli tech company Viz.ai provides. Viz.ai’s software monitors CT-generated images for signs of “large vessel occlusion” (LVO) strokes that may otherwise have been missed or taken too long to spot. While LVOs account for only some 10% of strokes, they are the most devastating and result in more than 50% of the healthcare spend on stroke patients, Viz.ai cofounder David Golan tells ISRAEL21c. “Patients either die or they live in assisted living facilities, sometimes for decades,” he says. Viz.ai offers a technological solution for spotting large vessel occlusions and coordinating treatment quickly for stroke patients. Photo: courtesy Stroke care went through what Golan calls “a transformative change” in the last decade. Until then, the main emergency treatment available was a drug, tPA (tissue plasminogen activator), “which goes into the brain and tries to melt or bust the clot in the blood vessel,” Golan explains. tPA is the gold standard for ischemic strokes – those involving small blood vessels – ideally administered within three hours after a stroke. For massive strokes like LVOs, tPA doesn’t work as well. A new approach, mechanical thrombectomy, is now the treatment of choice for LVOs. “It involves making a small incision in the groin, then a catheter is threaded all the way to the brain to engage the clots and remove them,” Golan explains. “It’s like science fiction. It’s revolutionary in how it helps. Patients will arrive at the hospital half paralyzed. They can’t speak. Forty-five minutes later, they sit up in bed. Sometimes they ask to go home the same day.” There’s one crucial caveat: “Very few hospitals can provide this procedure,” Golan says. “They need dedicated equipment and staff as well as an angio-suite.” In the United States, only 1,000 surgeons can perform the procedure and fewer than 120 hospitals are properly outfitted, Golan says. (In Israel, only 12 surgeons can do it.) So, in addition to diagnosing an LVO stoke quickly, the medical team also needs to know the closest hospital that can perform a mechanical thrombectomy. “You have to sync between two hospitals, a brain surgeon, anesthesiologists. Sometimes there can be 20 or 30 people involved,” Golan notes. Without AI, all this happens “in a completely serial fashion, where one person calls the other and then the next,” Golan explains. “We said to ourselves, this is fixable.” Dramatically hastens communication and decisions Viz.ai cofounder and CTO David Golan. Photo: courtesy Viz.ai’s software detects an LVO in under 30 minutes. Then, it “broadcasts that news to everyone who’s subscribed to get an alert on their phone,” Golan says. That might be a surgeon asleep in another city who, with a tap on his or her phone, can call up the patient’s scan. The app allows all involved staff to be in contact by voice and chat. “It dramatically shortens the time for the team to communicate and make decisions,” Golan says. “Everyone is brought into the loop immediately. Sometimes, the ER in another hospital will call and say, ‘You have a patient with a stroke’ when the first ER didn’t even realize the scan had been completed.” Golan saw a case where a senior neurologist was on a plane, got an alert on his phone via the airline’s Wi-Fi and orchestrated treatment for a patient from 10,000 feet in the air. Viz.ai’s software is now installed in 300 US hospitals – and not just those with the facilities to conduct a thrombectomy. “If you’re in an expensive, state-of-the-art hospital, you’ll probably be treated okay,” Golan says. “The problem is the rural hospitals without resources. We’re all about connecting the hospitals in the periphery with the main hospitals in real time.” In Israel, Viz.ai is testing its system at hospitals in the Galilee region – including Rambam Health Care Campus in Haifa. In the US, Golan mentions Mount Sinai in New York and the Erlanger Southeast Regional Stroke Center in Tennessee as customers. Setting up Viz.ai is relatively easy, Golan says – it can even be done remotely, although the company usually sends a representative to the hospital. Solving the time conundrum Viz.ai was founded by Golan and Dr. Chris Mansi, a surgeon who identified the problem in 2015 after operating on a woman who was hit by a car in London. Mansi performed emergency surgery to reduce pressure on her brain. The operation was a success, but the woman subsequently died. Mansi wanted to know why. He discovered that there had been a four-hour delay in identifying from her medical scans that the patient had a large blood clot and needed to be transferred to Mansi’s hospital. As Mansi probed further, he learned that fewer than 10% of LVO patients receive brain-saving treatment in time. He spoke about what led to the creation of Viz.ai in a 2018 TED Talk, below. Mansi moved to California to enroll in the Stanford MBA program with the aim of solving this time conundrum for LVO stroke patients. Golan was at Stanford working on his post-doc in machine learning and AI. “I was oriented towards an academic career, publishing papers,” Golan tells ISRAEL21c, when he had “a stroke-like experience” that left him unable to speak or move his limbs for a short time. “Even at Stanford Hospital, one of the best in the world, I could see there were workflow problems,” he says. After he was discharged, a friend suggested he consult with Mansi to read his scans. Mansi told Golan, “You’re are very lucky you’re not dead. Solving this inefficient workflow is what brought me to Stanford.” Golan replied, “Your idea can actually be built.” And he, Golan, was just the computer science engineer to do it. Mansi and Golan raised a seed round of $7.5 million from Google CEO Eric Schmidt’s Innovation Endeavors, followed by a $21 million Series A round in 2018 and a Series B of $50 million in October 2019. Viz.ai’s flagship product – Viz LVO – received FDA clearance in 2018. Golan returned to Israel where he runs the Tel Aviv branch of Viz.ai. “Nothing compares with the talent here,” Golan says. The company’s 85 staffers are split equally between the Israeli and American locations, with more hires planned in the coming year. Enough work to go around Israel has other companies that use artificial intelligence to make sense of radiological scans. Aidoc was named by TIME as one of its “50 Genius Companies of 2018” for technology that analyzes scans in real time, catching potentially serious issues even before a human radiologist reviews the results. Zebra Medical does much the same, focusing on detecting cardiovascular disease, fatty liver cells (an early sign of diabetes) and emphysema, and analyzing bone mineral density. The company has partnered with Dell Services to host the some 2 million scans a month it receives from hospitals. The competition doesn’t worry Golan. “There’s room for everyone,” he says. “I know the founders of these companies. They’re great guys. There’s enough work to go around.” Indeed, with a new stroke diagnosed every 40 seconds in the US alone, resulting in 140,000 deaths a year, that certainly seems to be the case. “There’s so much to be done, patients can only benefit from better care,” Golansays. For more information, click here https://www.israel21c.org/saving-the-lives-of-stroke-victims-by-streamlining-workflow/
  13. Israeli company develops rapid diagnostic kit for COVID-19 ‘This kit has undergone testing by several central laboratories and hospitals that have now verified its ability to diagnose COVID-19.’ By Abigail Klein Leichman MARCH 1, 2020, 3:33 PM BATM’s rapid diagnostic array. Photo: courtesy Israeli company BATM of Hod Hasharon announced that its biomedical division has developed a diagnostics kit to detect coronavirus from saliva samples in less than half an hour. CEO Dr. Zvi Marom tells ISRAEL21c that the test is compatible with the current hospital-based method for diagnosing COVID-19, reverse-transcription polymerase chain reaction (RT-PCR) – a type of gene sequencing that takes about eight hours. “This kit has undergone testing by several central laboratories and hospitals that have now verified its ability to diagnose COVID-19,” says Marom, referring to the disease caused by coronavirus infection. Marom, who has degrees in medicine and in industrial electronics, said BATM already has an advanced diagnostics kit that detects SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The COVID-19 aspect will be added to that kit. “BATM is working with academic and research institutions, mainly in Europe, to progress the kit to make it at a price point suitable for large-scale production,” says Marom. “The kit, which supports all the Centers for Disease Control and Prevention (CDC) recommendations, has already received interest from customers in several countries.” By next year, BATM expects that the test will be commercialized as part of its NATLab doctor’s office solution using artificial intelligence and individual disease cartridges to diagnose bacterial, viral or fungal infections within 90 minutes. For now, only meningitis can be diagnosed with NATLab, produced by BATM subsidiary Ador Diagnostics in Rome. “Once NATLab is ready, it will change the way infectious diseases are diagnosed because you don’t have to send people to hospitals and it doesn’t require special training,” says Marom. A Chinese company, WuXi Diagnostics, also announced the development of rapid diagnostic kits for COVID-19. Marom says several Chinese kits were studied in Israel and found to be too expensive for general use and too prone to false positives. “Nearly eight years ago we decided to try to find a new way to diagnose pathogens because we believe the current diagnostic methods are not good enough,” says Marom. “We are now gearing to build large quantities of our kit at a reasonable price.” https://www.israel21c.org/israeli-company-develops-rapid-diagnostic-kit-for-covid-19/
  14. Israeli MDs give free counseling to coronavirus patients Physicians from some of Israel’s largest hospitals have volunteered for the Innonation social project geared to helping isolated patients all over the world. By Abigail Klein Leichman MARCH 1, 2020 Illustrative photo by Mongkolchon Akesin via Shutterstock.com Thanks to a new social-action project, Chinese coronavirus patients were able to ask Israeli primary care physician Dr. Rachel Libenson Vansh how to maintain proper health and hygiene while confined at home. Using a Zoom video link over China’s Weibo social network, Libenson Vansh answered their questions in English with immediate translation into Chinese. This remarkable setup, which took place over a week ago, was the first in a series of interactive video broadcasts spearheaded by Israeli organization Innonation, which links talents, companies and organizations across borders through its hubs in Israel and China. One hundred Israeli physicians have volunteered to speak remotely with quarantined COVID-19 patients on topics of concern — such as family and children; dermatology (including sensitivity to protective masks); diet; psychology (as well as dealing with anxieties); pregnancy; and signs of serious illness that require immediate attention. Figures today show the COVID-19 virus has infected 86,584 people in more than 60 countries and caused 2,976 deaths. Many people who have been put into quarantine, or are self-isolated at home, are worried and fearful and have many questions about their situation and how to look after themselves. “The health systems in countries affected by the coronavirus are under tremendous pressure. They find it difficult to deal with the medical needs of people living under quarantine and with the general population that fears going to clinics and hospitals,” says Amit Gal-Or, who cofounded Innonation in 2016 with his father, Amir, and brother, Raz. “This Israeli volunteer initiative will provide them with the necessary knowhow to deal with the daily medical difficulties that currently are not being met.” The online project will target people in China, Japan, South Korea, Italy, the United States, Israel and any other countries where there are quarantines and fears about going out in public. Israeli physician Dr. Ishay Lev leads a remote medical instruction seminar aided by Chinese translator Mazal Liu. Photo courtesy of Innonation Doctors from major medical centers The doctors who volunteered for the Innonation video project are from some of Israel’s major medical centers, including Sheba, Tel Aviv, Rambam, Wolfson and Soroka. In cooperation with companies that agreed to supply practical technology and medical databases, Innonation has started operating broadcast stations at all the participating hospitals. “The technology bridges the medical gap in these countries, while the recruitment of Israeli medical institutions and the impressive volunteering of the best doctors in Israel help realize this project and meet the tremendous demand for the necessary medical knowledge,” says Gal-Or. Speaking to ISRAEL21c last Thursday, Amit Gal-Or said three sessions were completed with Chinese patients and another three are planned this week with patients recruited via social media in other countries. “The way it works is that first we do a live session where people apply to join and send their questions. That is capped to about 100 people so we can have a real give and take,” says Gal-Or. “Then we edit the videos and release them for publishing all over the world. It’s a mix of the personal and the necessary scale to help large numbers of people.” Donation of medical supplies to China Amit Gal-Or, one of the founders of Innonation. Photo: courtesy The video project follows on Innonation’s previous initiative of recruiting donors for medical equipment sorely needed in China. Board members and partners of Innonation and the Israeli Chamber of Commerce in China (IsCham) have so far donated some 500,000 pieces of protective gear including masks, gowns and gloves. Gal-Or, 23, has lived and been educated in China for 12 years. He is currently in Tel Aviv, where Innonation has an office in addition to branches in Chinese regions including Beijing, Hangzhou and Hong Kong. The Gal-Or family has been active in technology, telecommunications and real estate deals in the Chinese market for about 20 years. “We are experts at connecting, and this issue of the coronavirus hit us very personally,” he says. “We wanted to figure out ways to contribute aside from the donations of supplies. The Jewish tradition is about sharing knowledge. And the quality of expertise and technology in Israel’s medical field is very high quality. So we felt that the way to really contribute is through knowledge sharing.” Innonation reached out to managers of several medical centers with which it has ties. “It was incredible to see how quickly doctors wanted to volunteer and managers wanted to support this project,” says Gal-Or. Innonation has also established a company to facilitate the building of new hospitals and the transfer of Israeli medical technology. This global initiative is run by teams in China and Israel with the goal of improving medical systems and facilitating joint R&D projects internationally. But the video project is Gal-Or’s focus for the time being. He acknowledged that Innonation doesn’t profit from this activity aside from the positive publicity it engenders. “This is about connecting people in crisis with doctors and hospitals. We will continue until we see the virus disappear.” https://www.israel21c.org/israeli-mds-give-free-counseling-to-coronavirus-patients-worldwide/
  15. What is the Coronavirus? The coronavirus belongs to a large family of viruses identified as the cause of certain animal diseases and can cause disease in humans, too. The name 'coronavirus' refers to their resemblance to a crown (corona in Latin) when viewed in an electron microscope. The severity of human illness depends on the particular virus strand of this family and ranges between mild ailment, such as a cold, up to a serious disease that can negatively affect the lungs and lead to multiple organ failure, such as the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). What is the novel coronavirus? The novel coronavirus had not been previously identified as a cause of disease in humans. In December 2019, it was identified as the pathogen causing a cluster of pneumonia cases in Wuhan, Hubei province, central mainland China, and later on, it was found to spread to all provinces of mainland China as well as internationally. In terms of its genetic makeup, the SARS virus, which was the cause of severe morbidity in 2003/4, is the most similar to the novel virus in China among all other coronaviruses that cause human morbidity. On 11.2.20, the World Health Organization decided on an official name for the virus - SARS-CoV-2, and the disease it causes - COVID-19. How is the novel coronavirus transmitted to humans? The vast majority of the index patients worked or visited Wuhan's live animal and seafood market. This is why it was thought that there was animal-to-person spread. The animal causing the infection has not been identified with certainty. Person-to-person spread of the virus has been identified; infection probably occurs upon exposure to respiratory secretions when sneezing or coughing. How contagious the infection is remains unclear, but it appears to be like the flu. People can most likely infect others before symptoms appear - this is known to occur in other viral infections. What are the symptoms? The symptoms of the infection caused by the novel coronavirus are similar to those of influenza: fever, cough, shortness of breath, and respiratory distress. In a medical evaluation, it is not possible to distinguish between a coronavirus infection and other respiratory diseases. The infection might lead to acute pneumonia, Severe Acute Respiratory Syndrome (SARS), renal failure and can be fatal. The percentage of severe cases is not yet known. How severe is the 2019 corona illness? The clinical knowledge concerning the new disease is not yet complete. The data coming out of mainland China indicate that the illness is mild in most cases. Up to 20% of the confirmed patients develop complications and the mortality rate is approximately 2% of the patients. It is most probable that not all those infected in China had a medical evaluation, and that some have not been diagnosed. It is not clear what the risk factors of a severe illness are. Currently, available information suggests that older adults and people with a weak immune system or chronic medical condition, such as diabetes or a cardiovascular disease, may be at risk for more severe illness. How is the Coronavirus treated? There is currently no specific treatment for the novel coronavirus infection. People infected with the coronavirus receive supportive care; medical care is given according to the patient's medical condition. As yet, there is no vaccine, but countries are working on a virus, such as Israel.
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