U.S. president Donald Trump considers them a COVID-19 “game changer,” his top infectious diseases advisor says the evidence is flimsy, while ethicists worry pouring millions of the tablets into hospitals is a long shot that could make people sicker.
Two old anti-malaria medications are being pushed as potential treatments in the scramble to find something, anything, to neutralize the virus causing COVID-19.
Already, U.S. media are reporting a run on the drugs since Trump said they hold “tremendous promise.” In Nigeria, two people have overdosed after self-medicating with the pills, and Lagos State health authorities are urging against massive consumption of the tablets chloroquine and hydroxychloroquine.
There are concerns people could start hoarding the pills, the way many did with the anti-viral Tamiflu during the bird flu fright in 2005, and self-medicate in the hope of staving off the virus.
“You should not take medication without the scientific evidence,” Dr. Theresa Tam, Canada’s chief public health officer, said Monday. “These drugs are not without side effects. In fact, they have quite significant side effects.
“People have to be really, really careful about this. Don’t do it.”
One million doses of hydroxychloroquine are being donated to Canadian hospitals by Quebec-based JAMP Pharma Group. The company says its offer is twofold: to make the drugs available for people hospitalized with COVID-19, and to avoid a shortage of the pills for people who already need them to survive. Hydroxychloroquine, a less toxic version of chloroquine, is a common generic drug that’s used to treat lupus and rheumatoid arthritis, and lupus organizations are already reporting people are having problems filling prescriptions because of Trump’s exuberance. Those living with lupus are immune-compromised, putting them at greater risk of COVID-19.
Both drugs have shown activity against the virus that causes COVID-19 in vitro, meaning in tissue cultures. But some papers suggest the drugs can increase viral replication. “That is to say it can hurt you potentially,” said Dr. Anand Kumar, a critical care doctor at Winnipeg Health Sciences Centre, who is also trained in infectious diseases.
“There is the odd study that says these compounds could help, but there are just as many that fail to show any benefit and others that go the other way and suggest potential harm, Kumar said.
“Absolutely, it should be studied in a randomized trial, I have no problem with that. But the idea that people should start taking chloroquine because it’s a game-changer, I think is just nuts, frankly.”
The drug is already being given to hospitalized COVID-19 patients on an “uncontrolled basis” in multiple countries, including the U.S., according to the U.S. Centers for Disease Control and Prevention. It’s one of several drugs under investigation in a mega trial sponsored by the World Health Organization — Solidarity — that’s looking at whether existing drugs can be repurposed to fight COVID-19.
But there’s no agreement on optimal dosing, and while the antimalarials are generally well tolerated in the healthy, it may not be true for the frail and the sick.
“It would be much better if the government could come up with a policy that said, for dying or severely compromised patients we will try some agents and we’ll do it in an organized manner so that we can figure out if anything helps and we don’t cause a slew of unexpected side effects,” said Dr. Arthur Caplan, head of the division of bioethics at NYU Langone Medical School. Caplan says the data from China is hyper-weak and “pouring zillions of pills into the world’s population achieves nothing but risking side-effects, at present.”
Outside of randomized controlled trials, several of which are underway in Canada, including to test whether hydroxychloroquine could prevent infections in frontline health-care workers, Kumar said the pills might be used as “salvage” therapy, when doctors have nothing left. “But frankly, the probability of it being useful in that situation is extremely low, slim to zero.”
In every single pandemic, everybody has hundreds of solutions they think might work
One theory is that the drug may dampen down an over-exuberant cytokine storm. Normally when exposed to a virus, the body stimulates the immune cells to produce chemicals to throw off the invader. But the cells can become so hyper-stimulated they start attacking the self, your own tissue.
Other contenders include Gilead Sciences’ Remdesivir, which Trump also mentioned last week. The drug has been given to hundreds of infected people in the U.S., Europe and Japan on an emergency access basis. Demand has flooded the company’s emergency treatment access system, which was never set up to handle a pandemic. The company has temporarily halted access while it pivots to a new system.
“If it works well, and that’s a big if, that could be a game-changer,” Kumar said. However a similar drug was used years ago in SARS and failed, because toxicity was too great.
“In every single pandemic, everybody has hundreds of solutions they think might work,” Tam said. “We can’t rule out the fact they don’t work, but let’s prioritize the top ones that world scientists think are important and do proper trials.”
‘Tremendous’ response from blood donors has supply keeping pace with demand – Red Deer Advocate
OTTAWA — Canadians have been coming forward in large numbers to donate blood after Canadian Blood Services warned of a possible shortage as a result of the COVID-19 pandemic.
Blood donor clinics have extended their hours and put in place strict safety protocols for anyone giving blood.
“The response has been tremendous,” Dr. Isra Levy, the agency’s vice-president of medical affairs and innovation, said Friday.
“From our point of view, the numbers are very, very satisfying in the sense that we’re able to match demand with supply. We really need to keep up that altruism that has motivated donors to come in.”
Canadian Blood Services operates a national blood inventory that allows products to be regularly shifted around the country to meet hospital and patient needs.
About 400,000 of Canada’s 37 million residents give blood on a regular basis.
Levy warned nearly two weeks ago that Canada was facing a critical blood shortage. Donations had dropped about 20 per cent because of concerns about the novel coronavirus.
Because of a suspension of elective surgeries, the demand for blood is also down about 15 per cent, Levy said Friday.
While things are going well now, he added, the concern is whether Canadians will continue to keep donating over the long run.
“We’re going to have this challenge for many weeks to come and the implication is we’re going to need our donors to really continue to show up,” Levy said.
“They need to think about things not about as an urgent and immediate need for blood, but as an ongoing, pressing concern that we have about a potential for a sudden drop in inventory.”
Calgary’s blood donor clinic had to reduce appointments last week because of long lineups and wait times.
Donors waited behind a red line outside the clinic while checking in. Inside, chairs were placed strategically in the waiting room and every other bed was used. Health workers wiped down every donor station thoroughly between patients.
Some donors recently took to social media to discuss the importance of giving.
“First real trip out of the house in a while to Canadian Blood Services. As a former recipient, I understand first hand the importance of donors,” wrote Katie Mitchell on Instagram.
“They have put great steps in place to have donors maintain social distancing requirements. So happy I wasn’t rejected.”
“My dad needs transfusions every three weeks so in addition to worrying about COVID-19, he’s concerned about blood supply shortages,” wrote Sara Jane O’Neill on Twitter.
“Please donate if you can.”
Levy said some donors in Ottawa have told him that they feel they’re able to make a difference when everything else in the world is out of their control.
“It’s a sense of contribution in an uncertain time,” he said.
“The people who are showing up at our donor collection centres, anecdotally, express a sense of satisfaction that they’re able to do something for the community beyond staying at home and finding ways to fill their time.”
This report by The Canadian Press was first published March 27, 2020
— By Bill Graveland in Calgary. Follow @BillGraveland on Twitter
The Canadian Press
8 new cases of COVID-19 in Manitoba, bringing total to 72 – CBC.ca
There are eight new cases of COVID-19 in Manitoba, bringing the province’s total to 72.
Health officials made the announcement at a news conference at the Manitoba Legislative Building Sunday morning.
Officials are looking into the new cases to determine where those people got the coronavirus and whether they could have passed it to anyone else.
One of the patients is in an intensive care unit, and another has been admitted to hospital, chief provincial public health officer Dr. Brent Roussin said.
He said two Manitobans have recovered from the virus so far.
The total number of deaths from the virus reported in Manitoba remains at one: a Winnipeg woman in her 60s, who died Friday after she was admitted to an intensive care unit in critical condition the previous week.
More than 7,000 tests for COVID-19 have been done in the province so far.
Roussin reiterated that the measures the province has taken under the Public Health Act will come into effect on Monday, including limiting public gatherings to 10 people and requiring retail businesses like grocery stores to make sure people are one to two metres apart.
These new measures bolster what was previously only a recommendation.
On Saturday, Manitoba saw its biggest jump in COVID-19 cases since the virus was first detected here, as health officials announced 25 new patients had been identified.
Thunder Bay's third COVID-19 case is spouse of first – Tbnewswatch.com
THUNDER BAY – Thunder Bay’s third confirmed case of COVID-19 is the spouse of the city’s first case, which was announced Friday. At that time, the health unit considered the spouse a probable case. The couple returned from a week-long trip to Florida earlier this month.
The Thunder Bay District Health Unit announced the new case Sunday, noting the couple had followed guidance to self-isolate for 14 days upon returning to Canada. Medical Officer of Health Janet DeMille reiterated that, based on an investigation of the couple’s contacts since returning to the city and their period of infectiousness, there was little risk they had spread the virus.
“We look at how they travelled, who was with them, and the timelines of the travel,” DeMille said Sunday. “We’re still investigating the first case and following up.”
The health unit currently assumes a patient’s period of infectiousness can begin up to 48 hours before the onset of symptoms. That guideline was updated from a benchmark of 24 hours prior to symptoms earlier this week as health authorities learn more about the virus. DeMille said the couple’s return flight into Thunder Bay was not within that period.
The couple remain at home in self-isolation.
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