Repurposed Antiviral Drugs for Covid-19 — Interim WHO Solidarity Trial Results (NEJM) World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs — remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a — in patients hospitalized with coronavirus disease 2019 (Covid-19). These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.
…The benefit with the fourth (remdesivir) may be its ability to change the course of hospitalization in some patients, but the results of the Solidarity trial tell us not to expect substantially reduced mortality. The next set of questions regarding remdesivir can be answered only in placebo-controlled trials with complex data. Should remdesivir be reserved for the treatment of patients with selected risk factors? What is a more effective timing for the use of remdesivir, and should it be used in combination with other agents? How is the course of hospitalization affected by the type and level of care delivered in particular settings? Detailed examination of these questions within the Solidarity trial would have undermined the very simplicity that made it possible. How to answer these more complicated and nuanced questions quickly remains a challenge for the scientific community. It will not be simple to achieve clarity on when and how — or even whether — to use remdesivir.’
2.Unique Pattern of COVID-19 Infection in the State of Hawaii (International Journal of Infectious Diseases) The State of Hawaii is one of the most remote of the Pacific islands with approximately 1.4 million persons. The racial and ethnic diversity is enormous. For example, the white Caucasians make up ∼25%, Asians including Japanese, Chinese and other Asians ∼30%, Hawaiians 20%. Pacific Islanders, mostly from Micronesia and Samoa, comprise ∼4%. We discovered that COVID-19 population rates in this group were up to 10 times the rate in all the others together and made up almost 30% of cases.
No significant differences were observed in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo.
(J. Harris: Good interactive appraisal of where you stand in the vaccination line.THIS WILL GIVE YOU
AN APPROXIMATION OF WHEN YOU MIGHT GET A VACCINATION.)
‘There Absolutely Will be a Black Market’: How the Rich and Privileged Can Skip the Line for Covid-19 Vaccines (STAT News) Athletes, politicians, and other wealthy or well-connected people have managed to get special treatment throughout the pandemic, including preferential access to testing and unapproved therapies. Early access to coronavirus vaccines is likely to be no different, medical experts and ethicists told STAT. It could happen in any number of ways, they said: fudging the definition of “essential workers” or “high-risk” conditions, lobbying by influential industries, physicians caving to pressure to keep their patients happy, and even through outright bribery or theft.
MAFIA LOCKDOWN PROTESTS Anti-lockdown protests have emerged in Italy as business owners fear the new restrictions may hurt their businesses. Organized crime has long profited from failing businesses, particularly during emergencies, by investing in or taking over operations from owners who do not have funding available to remain in business on their own. But COVID-19 restrictions, including increased law enforcement presence, are reportedly hindering the mafia’s ability to conduct their illicit operations. In response, the mafia has orchestrated violence at anti-lockdown protests in Naples last week. Several known mafia members thought to be directing violence were identified at the protests, where police and several journalists were assaulted. Regional Governor Vincenzo de Luca described the acts as “guerilla warfare.” The operating restrictions on bars and restaurants, including nightclubs and other nightlife, are estimated to have decreased the Camorra mafia’s drug revenue by as much as 60 percent. These incidents further illustrate the complex downstream effects of COVID-19 and associated risk mitigation measures.
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