Public health officials across Canada and around the world are working flat out to test as many people as possible for the novel coronavirus.
Srinivas Murthy is working to figure out how to help them if the result is positive.
“What medicines work?” he asks. “We don’t know.”
Murthy, a professor of critical care at the University of British Columbia, is one of hundreds of Canadian scientists spending long hours in their labs and by their computers trying to help governments and clinicians figure out how to deal with the COVID-19 pandemic.
Earlier this month, the federal government awarded almost $27 million in grants to coronavirus-related research. The money is funding 47 projects across the country.
There are studies into faster diagnostic tests, how the disease is transmitted and the structure of the virus itself. Other scientists are considering why some people ignore public health warnings and how the public perceives risk.
Some are asking how to keep health workers safe. Some are looking at the effects on children or Indigenous people or on food security. Lessons from past public-health crises are also being studied.
“It’s basic research. It’s public health research. It’s community-based research,” said Yoav Keynan of the National Collaborating Centre for Infectious Diseases at the University of Manitoba.
“Many are redirecting their efforts to the virus. There are many things that need to be worked on.”
Murthy is trying to find out how hospitals can treat patients who have the COVID-19 virus. Each virus is different, he said, and what works on one won’t work on another.
“This is a new virus,” he said. “We don’t know what specific medication works.”
That means trying familiar drugs that have been effective on other viruses. Using what’s known about this coronavirus, Murthy estimates the chances of old drugs working on it and starts with the most likely candidate.
“We build on what we’ve already got,” he said.
Right now, he’s working with an antiviral agent that was originally developed in the fight against AIDS. Clinical trials with COVID-19 patients who have agreed to participate are the next step.
“We know it’s safe,” said Murthy. “We don’t know if it’s effective.”
When you include public health and medical personnel involved, the scientific fight against the coronavirus now involves thousands of people, Keynan said.
“There are many gaps in understanding the transmission of the virus — how long the virus stays on surfaces or the proportion of individuals that contract the virus but remain asymptomatic and serve as a reservoir for spreading the virus.”
The good news is that public-health research has come a long way since the SARS virus swept through 26 countries in 2003.
“We have better communication, better knowledge-sharing and better lab capacity,” said Keynan.
“Sharing of information globally and within Canada has improved dramatically over the last 17 years. And we’re going to need all of it.”
Canadian scientists are at the forefront of worldwide efforts to bend the curve of COVID-19 infections down, said Keynan.
“Canadian researchers are global leaders in infectious diseases and virology and we have better capacity than we had in 2003 to be meaningful contributors. We are making contributions.”
But no single lab or nation is going to come up with all the answers on its own, Keynan said.
“This is not a Canadian effort. This is a global effort.”
This report by The Canadian Press was first published March 22, 2020
— Follow Bob Weber on Twitter at @row1960
Insolvency trustee warns of more personal bankruptcies during COVID-19 crisis – NTV News
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An insolvency trustee is advising households to take a close, hard look at their budgets during the COVID-19 crisis. Nancy Snedden of BDO Canada warns personal bankruptcies will increase. NTV’s Ben Cleary reports.
Winnipeg lupus patients on edge amid shortage of drug at centre of COVID-19 trials – CBC.ca
An unproven claim a drug used to treat lupus can combat COVID-19 is causing an increase in prescriptions of the drug, creating shortages and putting Winnipeggers who rely on it on edge.
Elena Anciro was diagnosed with lupus eighteen years ago and relies on taking hydroxychloroquine daily in order to function without being in intense pain, and to reduce the flare-ups that make it hard to get out of bed.
“People have called this medication ‘lupus life insurance,'” Anciro said. “It is vital.”
While the drug was created in the 1950’s to treat malaria, it is commonly prescribed to control inflammation and pain for those with lupus and rheumatoid arthritis.
However, it came to the forefront in the fight against COVID-19 thanks to a famous tweet by U.S President Donald Trump.
The tweet sent earlier this month heralded it as a possible way to treat COVID-19.
HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains – Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents)…..
It sent people scrambling to get their hands on the drug, causing a spike in prescriptions in Manitoba and a dire warning from the province’s health regulators — it was being over-prescribed and now they are facing “serious shortages.”
“Due to the recent yet-to-be-proven claims of effectiveness of hydroxychloroquine sulfate against COVID-19 and the growth in prescribing for it, we are now faced with a very serious shortage (and some brands, outages) of the product,” read a March 26 notice co-authored by the College of Physicians and Surgeons, Nurses and Pharmacists.
“This presents very serious challenges for long-term continuity of care for patients suffering from rheumatoid arthritis and lupus.”
Manitoba reports spike in prescriptions of hydroxychloroquine
According to the notice there has been a “significant increase” in Manitoba over the past two weeks in the number of prescriptions written and dispensed for hydroxychloroquine and Kaletra — an antiretroviral used to treat HIV.
As part of mandatory reporting requirements, a drug shortage report was given to Health Canada on March 19 by the drugs’ manufacturer, Apotex Inc. It cited the shortage was due to “demand increase” for the drug.
Anciro is just one of the 15,000 Canadians who have lupus, an autoimmune disease that cause severe inflammation of the joints among other symptoms. A further 300,000 Canadians have rheumatoid arthritis, many of whom also rely on the drug to function in their lives.
“When Trump announced that and this all happened, to have to not only worry about getting this sick from this highly contagious virus, [but also] having to worry about the pills that allow me to be well, is very stressful,” said Anciro.
Stephanie Corbett is another Winnipegger who takes hydroxychloroquine daily to treat lupus. The mother of five was diagnosed with lupus nine years ago and says without the drug, she’d likely end up in the hospital.
So far, both have been able to fill their prescription without any issues. Both say it would take weeks for the drug to leave their system, but when it does, it’ll be devastating.
“It will be life-threatening for people like me,” said Corbett.
“I’ll end up in the hospital. The rashes will start. The pain will get worse. You know, every symptom will start rearing.”
Clinical trial at U of M
While a clinical trial is currently underway at the University of Manitoba to see if hydroxychloroquine can be repurposed to reduce the severity of COVID-19, there are currently no approved treatments or vaccines for the virus.
Virologist Jason Kindrachuk says the key message for Manitobans is they need to wait and see the outcomes of these trials before jumping to conclusions.
“The data is simply not there. I’m not arguing for or against it. I’m just saying that right now we don’t have data to support that it is actually truly beneficial for patients,” said Kindrachuk, an associate professor at the University of Manitoba and Canada research chair in emerging viruses.
He says the scientific community needs to do a better job of communicating to the public the proven benefits of a drug.
“Our biggest concern is that we don’t want to give people false hope if we truly don’t know whether or not there’s a benefit, because, again, we can have a position where people are demanding hydroxychloroquine,” Kindrachuk said
CBC reported last week that medical regulators across the country were seeing overprescription of drugs such as hydroxychloroquine and azithromycin, another drug being studied as part of the fight against COVID-19.
Regulators reported an increase in orders for the drugs from doctors who list it as “for office use.” These requests are typically from doctors who want to keep a supply on hand for future use, raising concerns that stockpiling was occurring.
The Manitoba College of Physicians and Surgeons cautioned its members against stockpiling, warning that it may be reviewing prescriptions of these drugs and “prescribers must be able to demonstrate good medical care.”
“These drugs have an intended use and prescribing these drugs as a precautionary measure leads to drug shortages and is compromising care for other patients,” the College wrote on Thursday.
A warning was only given to nurses from their regulator, warning them not to prescribe Hydroxychloroquine or azithromycin to treat COVID-19.
“Nurses have an obligation to ensure that their practice and any treatment they prescribe is evidence-informed,” wrote the College of Nurses.
Both Corbett and Anciro say they understand Manitobans are gravitating to the drug because they are scared.
“But as of right now, there is nothing saying that the public should to be taking it,” said Corbett.
“So leave the drug for the people with the diseases that are taking it and that need it to survive.”
FDA OK's Addition To Stockpile Of Malaria Drugs For COVID-19 – KCCU
Over the weekend, the Food and Drug Administration granted two malaria drugs “emergency use authorization” for the treatment of COVID-19. The move makes it easier to add the medicines to the strategic stockpile, which can be drawn upon in the current public health emergency.
The drugs — chloroquine and hydroxychloroquine — have been identified as potential COVID-19 treatments based on lab tests and small, limited studies in humans.
But gold standard clinical trials in the United States only just got underway. Preliminary results from those studies aren’t expected for weeks or months.
One thing is for sure, the FDA decision doesn’t reflect an official determination that the drugs work against the coronavirus.
“This is not FDA approval of hydroxychloroquine or chloroquine for the treatment of COVID-19,” says epidemiologist Rajesh Gandhi, who is leading Massachusetts General Hospital’s COVID-19 treatment task force. “There’s an epidemic of misinformation out there, and we need to combat that.”
The emergency use authorization only applies to the supply of these two drugs in the Strategic National Stockpile, the government’s storehouses of emergency medical supplies located in warehouses throughout the country.
Hospitals would need to request access to the drugs through their states, and the medicines would only be distributed to patients who have been hospitalized and tested positive for COVID-19, but for whom a “clinical trial is not available, or participation is not feasible,” according to the FDA.
“It’s nice to know that they have it in the event we’re running low or going to run out,” says Onisis Stefas, chief pharmacy officer at Northwell Health in New York, where doctors are already using the drug for patients who can’t be enrolled in clinical trials. “It’s good to have this as backup.”
The emergency use authorization won’t affect patients seeking this drug from their local pharmacies, where shortages have been reported.
Sandoz, the generic and biosimilar arm of drugmaker Novartis, donated 30 million doses of hydroxychloroquine to the stockpile. Bayer Pharmaceuticals donated 1 million doses of chloroquine. The Department of Health and Human Services announced on Sunday that it accepted these doses “for possible use in treating patients hospitalized with COVID-19 or for use in clinical trials.”
President Trump began promoting both drugs at his daily coronavirus press briefings earlier this month, prompting a spike in hydroxychloroquine prescriptions and concern about shortages and accidental poisonings.
If the drugs were helpful, doctors would be pleased to have a treatment option.
“We were told patients with COVID-19 who received this drug cleared the virus better than patients that did not receive the drug,” says Francois Nosten, who directs the Shoklo Malaria Research Unit in Thailand, and has been working with chloroquine and hydroxychloroquine for decades. “But it’s not sufficient information to be sure that this drug can be used or should be used in treating patients more widely.”
Preliminary findings often don’t pan out.
“The whole history of infectious disease is littered with drugs we all thought were going to be promising but turned out … not to be,” Mass General’s Gandhi says, adding that some of these medicines even turned out to be harmful.
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