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China’s new SARS-like virus has spread to Thailand

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The new strain of coronavirus, in the same family as the deadly severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), originated in Wuhan, the largest city in central China, and has spread to Thailand via a Chinese tourist.
It has cast a shadow over Lunar New Year celebrations and put the rest of Asia on alert. Virologists around the world are now studying its genome sequence shared by Chinese researchers, but many questions still remain.
Researchers have yet to rule out the possibility that the virus could be transmitted from person to person, and on Wednesday, the US Centers for Disease Control and Prevention issued a Watch Level 1 Alert — the lowest of a three-tier travel health notices that warns visitors of Wuhan to “be aware and practice usual precautions.”

First case detected outside China

On Monday, Thai authorities confirmed that a Chinese woman arriving from Wuhan, has been quarantined with the new virus, the first time it has been detected outside China.
According to the World Health Organization, the 61-year-old woman said she had not been to the seafood market linked to the outbreak. But she did report “a history of visiting a local fresh market in Wuhan on a regular basis prior to the onset of illness” on January 5, the WHO said in a statement.
The first, and the majority, of the infected cases in Wuhan have been traced to the Nanhua Wholesale Seafood Market, which has been shut down for disinfection since January 1. Wuhan health authorities said on Wednesday that some “environmental samples” taken from the market tested positive for the virus.
Apart from fish, the market also sold other live animals, including birds, rabbits and snakes — sparking concerns that the virus might have been transmitted to humans from animals, just like SARS and MERS.
The seafood market at the center of China's pneunomia outbreak has been closed down.
Leo Poon, a virologist at the University of Hong Kong who was among the first to decode the SARS coronavirus, said the Thai case suggests two possibilities: the woman was either infected by an animal in another market, or by another person.
The first possibility would mean that the source of the new virus is more widespread than authorities previously believed, and the second would indicate its ability to transmit between humans — which could turn a local outbreak into a global pandemic.
“I think the first possibility is more likely,” Poon said. “This also reiterates the issue of food safety — the risk of selling exotic animals in markets should be assessed now and new policy should be established as soon as possible.”
China — and the world — has paid a heavy price for the consumption of wild animals. The SARS epidemic from November 2002 to July 2003 killed 774 people after spreading to 37 countries. The coronavirus was traced to the civet cat, a wild animal considered a delicacy in parts of southern China, where the epidemic began.
But Professor Poon and other experts in Hong Kong said the possibility of human-to-human transmission cannot be excluded.

Can it be transmitted between humans?

The question of transmission between humans is particularly crucial as China’s busy Lunar New Year travel season has recently begun. Hundreds of millions of Chinese are expected to be crammed into trains, buses and planes for family reunions. Millions of Chinese are also expected to travel overseas around Lunar New Year, which falls on January 25.
Chinese health authorities and the WHO had long maintained that there is no “obvious evidence” of human-to-human transmission, and that no health care workers have been infected by the new coronavirus. But early on Friday, while maintaining the lack of clear evidence of such a transmission, Wuhan health authorities said in an announcement that “the possibility of human to human transmission cannot be excluded.”
It reported a case where a couple were infected by the new coronavirus. The husband, who caught the illness first, worked at the Nanhua Wholesale Seafood Market, but the wife said she had no direct exposure to the market. A few other infected patients also denied they had any exposure to the market.
Migrant workers wait outside the Guangzhou train station before returning home because of the worry over SARS during the deadly epidemic in 2003. Migrant workers wait outside the Guangzhou train station before returning home because of the worry over SARS during the deadly epidemic in 2003.
To gain more understanding of the outbreak, a group of Hong Kong experts traveled to Wuhan this week to meet with Chinese authorities and visit the hospital where those infected were quarantined.
Chuang Shuk-kwan, head of the Communicable Disease department at Hong Kong’s Centre for Health Protection, said that it is possible that the husband had transmitted the disease to his wife a few days after he was infected, and therefore human-to-human transmission cannot be ruled out.
But the risk of sustained transmission between humans is low, given that no medical workers have been infected, Chuang said at a press conference on Wednesday.

Not as lethal as SARS

For now, the new coronavirus appears to not be as lethal or contagious as SARS or MERS. Its symptoms are mainly fever and coughing, with a number of patients having difficulty breathing.
A mysterious virus is making China (and the rest of Asia) nervous. It's not SARS, so what is it?A mysterious virus is making China (and the rest of Asia) nervous. It's not SARS, so what is it?
As of Thursday, six patients remain in critical condition. Among them, some have renal and liver failures, and two are relying on life support, said Raymond Lai Wai-man, the chief infection control officer of the Hong Kong Hospital Authority, who is among the group that visited Wuhan.
Compared with 2003, when Chinese officials initially covered up the extent of the SARS outbreak, authorities in the country have been more open and timely in sharing information this time around.
Apart from inviting experts from Hong Kong and Taiwan to visit Wuhan, Chinese researchers have also shared the genome sequence of the new coronavirus with the WHO.
“Additional investigation is needed to ascertain the presence of human-to-human transmission, modes of transmission, common source of exposure and the presence of asymptomatic or mildly symptomatic cases that are undetected,” the WHO said in the statement. “It is critical to review all available information to fully understand the potential transmissibility among humans.”

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Cough and cold medication shortage to end next year, pharmacists association says – The Daily Press

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Children’s Tylenol returning slowly to retail outlets in town

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Parents with sick kids might be able to take a break from crushing adult Tylenol and mixing it with apple sauce if they hurry quickly to a local pharmacy.

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Children’s Tylenol (acetaminophen) in liquid form began arriving at retail outlets in late November, but in such limited quantities that pharmacists are keeping them behind the counter and limiting them to one bottle per customer.

A Shopper’s Drug Mart pharmacist The Daily Press spoke with on Tuesday wouldn’t say how much they’d received but advised to hurry while quantities last. A Rexall pharmacist is only selling children’s Tylenol to parents with sick kids, not to those just preparing for a rainy day.

Adam Chappell, owner and pharmacist at Parma Right in The 101 Mall, told The Daily Press he was expecting nine retail-sized bottles of children’s Tylenol last Wednesday, which he also planned to keep behind the counter and limit to one bottle per customer.

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He predicts that more will become available, but that there will be extended shortages in the short term. Pharmacies are being allocated small amounts by the manufacturers, to spread out supply.

The shortage makes it difficult for parents to control fevers in their children, leading to more doctor visits, he said.

“We had more public health measures in place with COVID, so we had 1½ to two years where we really didn’t see much influenza or common cold,” said Chappell, whose independent pharmacy opened in November.

“So now we’re seeing everything all at once because we’re now socializing more. It’s that time of year, so we’re starting to see more influenza, cough and colds and COVID is still circulating. I think it’s a combination of higher use and some lingering logistical issues.”

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Shelves sit half empty in the adult cough and cold section at the Shopper’s Drug Mart at 227 Algonquin Blvd. E. on Tuesday. The shortage is expected to end between January and March of 2023, said Jen Belcher with the Pharmacists Association of Ontario. The timing would coincide with the end of the cold and flu season.NICOLE STOFFMAN/The Daily Press
Shelves sit half empty in the adult cough and cold section at the Shopper’s Drug Mart at 227 Algonquin Blvd. E. on Tuesday. The shortage is expected to end between January and March of 2023, said Jen Belcher with the Pharmacists Association of Ontario. The timing would coincide with the end of the cold and flu season.NICOLE STOFFMAN/The Daily Press jpg, TD

A children’s drug shortage began in the spring and worsened in the summer when an early onset of flu and respiratory syncytial virus was made worse by COVID-19, which presents as a cold. Parents began stocking up.

When local manufacturers could not keep up with demand, Health Canada arranged to import supply from the United States and Australia, whose first shipment in early November went straight to hospitals, in part because the labels were not bilingual, Postmedia reported.

Health Canada has authorized 500,000 bottles of imported children’s acetaminophen for retail to arrive in December, and domestic supply is starting to recover, Jen Belcher with the Ontario Pharmacists Association told The Daily Press in a telephone interview.

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“The demand really hasn’t abated, and manufacturing really hasn’t been able to keep up from a straight capacity standpoint, rather than a supply interruption with a lack of ingredients,” she said, when asked to respond to a claim by the German pharmacist’s association.

That organization asserts pandemic lockdowns in China are blocking exports of the raw ingredients used for medications, Postmedia reported Nov. 16.

If lockdowns in China continue, however, she conceded it could interrupt the ingredient supply in the long-term.  There is also a global reliance on India for the raw ingredients used in over-the-counter medication.

Canadian manufacturers can tap various international suppliers if approved by Health Canada, Belcher said.

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Children’s Advil (ibuprofen), an anti-inflammatory, continues to be in short supply in pharmacies, but available in hospital. Neither Belcher nor Chappell has heard reports of Health Canada planning to import it for retail outlets.

Adult Tylenol and Advil remain plentiful.

Chappell recommends that parents speak to their pharmacist to determine a dosage of adult pills based on the child’s weight and symptoms. They can be crushed and added to yogurt, apple sauce or chocolate syrup.

If parents can wait a few days for the package to arrive, they can order a supply for their child from a compounding pharmacist, who is qualified to make custom medications including liquid formulations. There are several compounding pharmacists in Sudbury, but none in Timmins.

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Adults in Timmins who have come down with a cold or flu lately may also have been surprised to see empty shelves in the adult cough and cold section of their local pharmacy.

“When it comes to cough and cold medication for both adults and children, we’re not seeing an imported supply of those. Those are short and have been for quite some time due to this high level of demand, small amounts have been trickling through the supply chain but it hasn’t been enough to keep up with demand,” said Belcher.

She expects the adult cough and cold medication shortage to end sometime between January and March, 2023, just in time for the end of flu season.

A quick check of the adult cough and cold section of four downtown pharmacies on Tuesday showed partially empty shelves, but there was still a variety of medication to choose from.

Belcher said pharmacists have lots of experience finding alternatives for patients, if necessary.

“While the over-the-counter medications in short supply are the most visible representation of the challenges to our supply chain, pharmacy teams have been managing very high levels of drug shortages, some critical, where there are really few or no alternative options,” she said, adding that up to 20 per cent of the team’s day is spent managing shortages.

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Study explores the risk of new-onset diabetes mellitus following SARS-CoV-2 infections – News-Medical.Net

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In a recent study posted to the medRxiv* preprint server, researchers evaluated individuals who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and were diagnosed with diabetes mellitus within six months of the onset of coronavirus disease 2019 (COVID-19) to understand the temporal relationship between SARS-CoV-2 infections and diabetes mellitus.

Study: Are fewer cases of diabetes mellitus diagnosed in the months after SARS-CoV-2 infection? Image Credit: Africa Studio/Shutterstock

Background

Recent research indicates a potential increase in the new-onset diabetes mellitus diagnoses after SARS-CoV-2 infections. While the causative mechanisms are not clearly understood, various hypotheses suggest the roles of stress-induced hyperglycemia during SARS-CoV-2 infections, changes in the innate immune system, virus-induced damage or changes to the beta cells or vasculature of the pancreas, as well as the side effects of the treatment in the increased incidence of diabetes mellitus diagnoses.

Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic have decreased physical activity and increased obesity. The stress induced by the pandemic has also increased endogenous cortisol levels, a known risk factor for diabetes mellitus. Examining the temporal relationship between SARS-CoV-2 infections and new-onset cases of diabetes mellitus will help develop effective screening and therapeutic strategies.

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About the study

In the present study, the team conducted a nationwide analysis using electronic health records aggregated in the National COVID Cohort Collaborative (N3C) database in the United States (U.S.). They analyzed all individuals with SARS-CoV-2 infections and type 2 diabetes mellitus between March 2020 and February 2022. Data from the health records for the six months preceding and following the SARS-CoV-2 infections were included to avoid selection and ascertainment bias.

SARS-CoV-2 infections were confirmed based on the International Classification of Diseases, Tenth Revision (ICD-10) code, or laboratory test results. New-onset diabetes mellitus cases were defined as those that did not have an ICD code for diabetes mellitus in their electronic health records before September 2019. The incidence of diabetes mellitus was then analyzed concerning SARS-CoV-2 infections.

Results

The results reported a sharp increase in new-onset diabetes mellitus diagnoses in the 30 days following SARS-CoV-2 infections, with the incidence of new diagnoses decreasing in the post-acute stage up to approximately a year after the infection. Surprisingly, the number of new-onset diabetes mellitus cases in the months following SARS-CoV-2 infections is lower than in the months preceding the infection.

The authors believe that the increase in healthcare interactions brought about due to the COVID-19 pandemic might explain the notable increase in diabetes mellitus diagnoses in the time surrounding SARS-CoV-2 infections. New patients might have been tested for hemoglobin A1C or glucose levels during their first interaction with the healthcare system, the results of which might have then been used to diagnose diabetes mellitus.

Additionally, SARS-CoV-2 infection-induced physiological stress could have triggered diabetes mellitus in high-risk individuals who might have developed the disease later in life without COVID-19.

According to the authors, the overall risk of developing diabetes mellitus has increased, irrespective of SARS-CoV-2 infections, due to the drastic decrease in physical activity, weight gain, and the stress induced by the COVID-19 pandemic. Furthermore, a longer follow-up period might report an increased incidence in new-onset diabetes mellitus cases, with the SARS-CoV-2 infection precipitating disease development in individuals who might not have otherwise developed diabetes.

Conclusions

To summarize, the researchers conducted a cross-sectional, nationwide analysis of individuals in the U.S. to understand the temporal relationship between diagnoses of new-onset diabetes mellitus and SARS-CoV-2 infections. The results reported a spike in diabetes mellitus diagnoses in the one month following SARS-CoV-2 infections, followed by a marked decrease in the number of diagnoses for up to a year after the infection.

The authors believe that the sudden increase in diabetes diagnoses could be due to increased healthcare interactions brought about by the COVID-19 pandemic. The new-onset diabetes mellitus cases could also be a reaction to the physiological stress induced by SARS-CoV-2 infections.

Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic might be responsible for the high incidence of diabetes mellitus, irrespective of SARS-CoV-2 infections. However, extensive research is required to understand the epidemiology and mechanisms connecting SARS-CoV-2 infections with new-onset diabetes mellitus.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

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Toronto-based infectious disease expert seeing more older patients with flu in hospital

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An infectious diseases physician in Toronto is reporting an increase in the number of older patients he is seeing with seasonal influenza.

Dr. Isaac Bogoch at Toronto General Hospital noted this year’s flu season started early and escalated quickly.

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According to the Public Health Agency of Canada, children under five are still making up the largest age bracket of flu patients in hospital. However, rates among seniors (aged 65 and up) are on the rise.

Bogoch expects the number of flu cases to keep increasing. The season usually peaks in January.

To track the number of flu cases in Durham Region this season, click here.

 

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