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  1. 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
  2. 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/
  3. 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/
  4. 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/
  5. 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/
  6. 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.
  7. Guidance Coronavirus (COVID-19): latest information and advice Information for the public on the outbreak of coronavirus, including the current situation in the UK and information about the virus and its symptoms. Published 24 January 2020 Last updated 3 March 2020 — see all updates From: Department of Health and Social Care and Public Health England Contents Number of cases Risk level Returning travellers Information about the virus Recent government action Diagnosis and analysis Further information Go to NHS.UK/coronavirus for information about the virus and how to protect yourself. Number of cases As of 3 March, a total of 13,911 people have been tested in the UK, of which 13,860 were confirmed negative. 51 were confirmed as positive. The Department of Health and Social Care will be publishing updated data on this page every day at 2pm until further notice. This data is accurate as of 9am on the day of publication. If more cases are confirmed in the UK, it will be announced by the Chief Medical Officer of the affected country. Risk level Based on the World Health Organization’s declaration that this is a public health emergency of international concern, the UK Chief Medical Officers have raised the risk to the UK from low to moderate. Returning travellers Stay indoors and avoid contact with other people immediately if you’ve travelled to the UK from: Hubei province in China in the last 14 days, even if you do not have symptoms Iran, lockdown areas in northern Italy or special care zones in South Korea since 19 February, even if you do not have symptoms other parts of mainland China or South Korea, Hong Kong, Japan, Macau, Malaysia, Singapore, Taiwan or Thailand in the last 14 days and have a cough, high temperature or shortness of breath (even if your symptoms are mild) other parts of northern Italy (anywhere north of Pisa, Florence and Rimini), Cambodia, Laos, Myanmar or Vietnam since 19 February and have a cough, high temperature or shortness of breath (even if your symptoms are mild) Use the 111 online coronavirus service to find out what to do next. Do not go to a GP surgery, pharmacy or hospital. In Scotland call your GP or NHS 24 on 111 out of hours. In Wales call 111 (if available in your area) or 0845 46 47. In Northern Ireland call 111. Lockdown areas in northern Italy: in Lombardy: Codogno, Castiglione d’Adda, Casalpusterlengo, Fombio, Maleo, Somaglia, Bertonico, Terranova dei Passerini, Castelgerundo and San Fiorano in Veneto: Vo’ Euganeo Special care zones in South Korea: Daegu Cheongdo See maps of the specified areas. This guidance is based on the recommendations of the UK Chief Medical officers. These areas have been identified because of the volume of air travel from affected areas, understanding of other travel routes and number of reported cases. This list will be kept under review. For areas with direct flights to the UK we are carrying out enhanced monitoring. Passengers will be told how to report any symptoms they develop during the flight, at the time of arrival, or after leaving the airport. Read more about what you should do if you’re asked to self-isolate. Information about the virus A coronavirus is a type of virus. As a group, coronaviruses are common across the world. Typical symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties. Generally, coronavirus can cause more severe symptoms in people with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease. Novel coronavirus (COVID-19) is a new strain of coronavirus first identified in Wuhan City, China. The NHS website has more information about how coronavirus is spread and answers common questions about the virus. Recent government action The government published its coronavirus action plan on 3 March. On 10 February, the Secretary of State for Health and Social Care, Matt Hancock, announced strengthened legal powers to protect public health. The Health Protection (Coronavirus) Regulations 2020 have been put in place to reduce the risk of further human-to-human transmission in this country by keeping individuals in isolation where public health professionals believe there is a reasonable risk an individual may have the virus. Diagnosis and analysis The UK is one of the first countries outside China to have a prototype specific laboratory test for this new disease. Healthcare professionals who are contacted by a patient with symptoms following travel to an affected area have been advised to submit samples to Public Health England (PHE) for testing. Individuals should be treated in isolation After the experience of severe acute respiratory syndrome (SARS) in 2003, PHE developed a series of diagnostic tests to detect any member of the family of coronaviruses. These have been used for several years, and were able to detect the first UK case of Middle East respiratory syndrome (MERS) in 2012. With the first reported publication of the genome sequence of a 2019 novel coronavirus, PHE was able to rapidly develop further specific tests for this virus, working with WHO and global network of laboratories. When a clinician suspects novel coronavirus (COVID-19), they take samples from the nose, throat and deeper respiratory samples, package and send them safely to PHE Colindale. PHE can provide a laboratory result from this specific virus on the same working day. PHE also has the capability to sequence the viral genome and compare this to published sequences from China, if a case occurs. This will provide valuable information on any mutations in the virus over time and allow an improved understanding of how it spreads. Further information Coronavirus (COVID-19): UK government response Foreign and Commonwealth Office travel advice Published 24 January 2020 Last updated 3 March 2020 + show all updates https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public
  8. Overview-Coronavirus (COVID-19) Contents Overview Advice for travellers Common questions COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus. What's the risk of coronavirus in the UK? The UK Chief Medical Officers have raised the risk to the public from low to moderate. Health professionals are working to contact anyone who has been in close contact with people who have coronavirus. What's the risk of coronavirus for travellers? There are some countries and areas where there's a higher chance of coming into contact with someone with coronavirus. See our coronavirus advice for travellers. Symptoms of coronavirus The symptoms of coronavirus are: a cough a high temperature shortness of breath But these symptoms do not necessarily mean you have the illness. The symptoms are similar to other illnesses that are much more common, such as cold and flu. How coronavirus is spread Because it's a new illness, we do not know exactly how coronavirus spreads from person to person. Similar viruses are spread in cough droplets. It's very unlikely it can be spread through things like packages or food. Do I need to avoid public places? Most people can continue to go to work, school and other public places. You only need to stay away from public places (self-isolate) if advised to by the 111 online coronavirus service or a medical professional. How to avoid catching or spreading coronavirus Do wash your hands with soap and water often – do this for at least 20 seconds always wash your hands when you get home or into work use hand sanitiser gel if soap and water are not available cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze put used tissues in the bin immediately and wash your hands afterwards try to avoid close contact with people who are unwell Don't do not touch your eyes, nose or mouth if your hands are not clean Check if you need medical help NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do. Use this service if: you think you might have coronavirus in the last 14 days you've been to a country or area with a high risk of coronavirus – see our coronavirus advice for travellers you've been in close contact with someone with coronavirus Use the 111 coronavirus service Information: Do not go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone. Getting help in Scotland, Wales or Northern Ireland Scotland: call your GP surgery or call 111 if your surgery is not open Wales: call 111 Northern Ireland: call 111 How to self-isolate if you're asked to If there's a chance you could have coronavirus, you may be asked to stay away from other people (self-isolate). This means you should: stay at home not go to work, school or public places not use public transport or taxis ask friends, family members or delivery services to do errands for you try to avoid visitors to your home – it's OK for friends, family or delivery drivers to drop off food You may need to do this for up to 14 days to help reduce the possible spread of infection. Read more coronavirus self-isolation advice. Treatment for coronavirus There is currently no specific treatment for coronavirus. Antibiotics do not help, as they do not work against viruses. Treatment aims to relieve the symptoms while your body fights the illness. You'll need to stay in isolation away from other people until you've recovered. More information GOV.UK: coronavirus action plan GOV.UK: information on coronavirus and the situation in the UK NHS England: coronavirus information for health professionals https://www.nhs.uk/conditions/coronavirus-covid-19/
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