Hydrochloroquine and azithromycin will be the focus of a clinical trial enrolling 2,000 participants. (UW Medicine Photo)
One of the treatments touted by President Donald Trump for COVID-19, a combination of the antimalarial drug hydroxychloroquine and the antiviral drug azithromycin, is the subject of a nationwide study with UW Medicine playing a role.
The Phase 2b clinical trial, sponsored by the National Institute of Allergy and Infectious Disease at the National Institutes of Health, will involve 2,000 outpatients who have tested positive for COVID-19 and are in the early stages of treatment.
We know from a number of different other kinds of infections that if antiviral treatment is going to be effective, it tends to be most effective if its given very early on, Ann Collier, a professor at the University of Washingtons School of Medicine, said in a video about the study.
The two drugs have been the subject of other studies including a complementary 630-patient trial in which UW Medicine is also involved. That smaller trial is designed to focus on the effect of the drugs on viral shedding, while the larger trial will focus on clinical outcomes.
Hydroxychloroquine and azithromycin are attractive drug candidates for treating COVID-19 because theyve already undergone extensive testing for other medical applications, such as treating malaria and autoimmune diseases such as lupus.
However, the interest shown by Trump in hydroxychloroquine and a similar drug, chloroquine, has led to shortages for patients who need those drugs for other types of treatment. Moreover, the studies conducted to date have raised questions about the drugs efficacy.
There have been a number of publications looking at outcomes in hospitalized patients given this treatment, Collier said. But none of them have been [conducted using] the rigorous study design that is usually used to determine whether treatments are effective.
In addition to UW, 30 other sites across the country associated with the AIDS Clinical Trials Group will be enrolling patients for the randomized, controlled study. Half the participants will receive the drug combination for seven days, while the other half will receive placebos. Therell be six months of follow-up afterward.
Hydroxychloroquine carries a risk of causing heart problems but Collier said the drug dosage has been adjusted to address the Food and Drug Administrations concerns, and patients will be closely checked for signs of toxicity.
In a news release, NIAID Director Anthony Fauci said the study should provide definitive answers about the drug combinations effects.
Although there is anecdotal evidence that hydroxychloroquine and azithromycin may benefit people with COVID-19, we need solid data from a large randomized, controlled clinical trial to determine whether this experimental treatment is safe and can improve clinical outcomes, Fauci said.
The trial is open to outpatients aged 18 or older who have tested positive for COVID-19 and are experiencing symptoms, but have no need for hospitalization. The first dose of study treatment is to be administered within 96 hours of the positive test. Those interested in participating in the trial should email actg.communications@fstrf.org or actu@uw.edu, or call or text 206-773-7129.
But if the vice president is also incapacitated, there is no way to use Sections 3 or 4. When Congress drafted the Twenty-Fifth Amendment in 1965, members acknowledged this gap but consciously decided not to fill it. The amendment was already extraordinarily wordy, and the risk of double incapacity seemed minimal. Fifty-five years later, though, that risk is easier to imagine.
So what would happen if Trump and Pence were so sick that neither could function? Article II of the Constitution lets Congress provide for the Case of Inability, both of the President and Vice President, declaring what Officer shall then act as President, and such Officer shall act accordingly, until the Disability be removed. In other words, Congress can pass line-of-succession statutes. And it has, most recently in 1947. That law still stands, and it puts the speaker of the House next in line, followed by the president pro tempore of the Senate, followed by members of the Cabinet.
Ronald J. Krotoszynski, Jr.: States are using the pandemic to roll back Americans rights
However, Article II provides no procedures for determining inability. Imagine that Speaker Nancy Pelosi, believing that Trump and Pence are too ill to function, cites Article II and declares herself acting president. If Trump or Pence replied that no inability existed, control of the White House would be thrown into doubt. Courts could settle the matter in due time, but just a few hours of uncertainty could be perilous.
But even if Trump and Pence were undeniably incapacitated, the country could still face a meltdown. As a matter of both policy and law, it is highly problematic that the speaker and president pro tempore are in the line of succession.
The biggest policy problem is that these congressional leaders are often members of the party opposed to the president. A line of succession statute would ideally provide continuity, because a sudden transfer of presidential power from one party to the other would be jarring. The new acting president would struggle for legitimacy (imagine power suddenly shifting from Trump to Pelosior, if that doesnt trouble you, from President Barack Obama to Speaker Paul Ryan). Avoiding such a transfer would produce perverse incentives for White House staff and other members of the presidents political party to cover up or sugarcoat the presidents and vice presidents medical conditions.
During Watergate, after Vice President Spiro Agnew resigned and before Gerald Ford was confirmed to replace him, no one held the office for eight weeks. Democratic Speaker Carl Albert promised that if something happened to President Richard Nixon and Albert became acting president, he would appoint a Republican vice president, then resign. From the standpoint of todays poisonous politics, such nonpartisan sacrifice seems inconceivable.
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WASHINGTON, D.C. -- A majority of U.S. adults believe that preventing the spread of the coronavirus is more important than protecting people's medical privacy. Amid the growing use of digital medical data to track COVID-19 infections, 61% of Americans prioritize these preventative efforts, even if that means people have to reveal sensitive medical information.
As more cities and states loosen stay-at-home restrictions and businesses reopen during the COVID-19 crisis, some experts and officials are pushing for expanded contact tracing. Contact tracing -- identifying and informing people who may have come into contact with an infected person -- involves releasing personal information to local authorities and, in some countries, to the broader public when new cases are confirmed, using medical and cellphone location data.
Majorities of all age groups; of city, suburban and rural residents; and of working and nonworking people prioritize taking steps to contain the spread of COVID-19 over protecting medical privacy.
Majority of Americans Think Preventing the Spread of the Coronavirus Is More Important Than Protecting Medical Privacy
If you had to choose, which of the following do you think is more important? Protecting people's medical privacy, even if it makes it harder to limit the spread of the coronavirus, or preventing the spread of the coronavirus, even if that means people have to reveal sensitive medical information?
These results are from an April 27-May 10 web survey, collected using a probability-based sample of 8,564 U.S. adults from the Gallup Panel. More than seven in 10 older adults -- those aged 65 and older -- believe preventing the spread of the coronavirus is more important than protecting medical privacy. Older adults, who are at higher risk for developing more serious complications from COVID-19 illness, are more likely to prioritize efforts to prevent COVID's spread (72%) than adults 18-44 (58%) and 45-64 (56%).
Residents of cities are highly likely to say that preventing the spread of the coronavirus is more important than protecting people's medical privacy (69%). However, a majority of residents from suburbs (62%) and small towns/rural areas (55%) also think doing so is more important.
A majority of employed adults (57%) say that preventing the spread of the coronavirus is more important, even if that means people have to reveal sensitive medical information. However, employed adults are more likely than those not working to prioritize protecting people's medical privacy. This is notable because some employers are ramping up contact tracing and strictly enforcing social distancing in the workplace, sometimes using apps to track how close employees get to each other.
Republicans are the most likely of all party groups to think that protecting people's medical privacy is paramount -- 57% say protecting people's medical privacy is the more important goal, versus 42% of independents and 23% of Democrats. More than three-quarters of Democrats (77%) think that preventing the spread of the coronavirus is more important.
These findings reflect an ongoing partisan divide in most attitudes about the coronavirus situation in the U.S. However, Republicans are far from unified on the privacy question because 43% believe it is more important to prevent the spread of the virus, even if that means jeopardizing medical privacy.
As more businesses reopen and Americans return to the workplace, shop in retail stores and visit other places closed because of the COVID-19 crisis, there will likely be increasing calls for health surveillance, including rigorous contact tracing, to prevent additional outbreaks. Such efforts will require new tools and practices that could weaken safeguards for digital medical data and privacy laws. The options range from mobile contact tracing apps and so-called "immunity passports" that certify someone has recovered from COVID-19 to digital tools to enforce quarantines and public disclosure of personally identifiable information about those who have tested positive.
Artificial intelligence (AI) plays a central role in many contact tracing and predictive applications. According to a 2019 study by Northeastern University and Gallup, Democrats and Republicans had similarly high levels of concern about their personal privacy related to AI. Seventy-two percent of Republicans and 67% of Democrats reported worrying very often or often that their personal information is at risk when using products or services that employ AI.
The COVID-19 crisis has caused public health concerns to outweigh these privacy worries for a majority of Americans, particularly Democrats. As public officials and employers weigh the costs and benefits of exposing sensitive information and restricting privacy to curb new cases, a majority of Americans are willing to accept these negative consequences for patient confidentiality. However, as with many policy choices related to the COVID-19 recovery, there is little consensus by party. While nearly eight in 10 Democrats prioritize these efforts to stop the virus' spread, a majority of Republicans think that protecting people's medical privacy is more important.
Learn more about how the Gallup Panel works.
We, the leaders of global health, human rights and development institutions, come together to urgently draw the attention of political leaders to the heightened vulnerability of prisoners and other people deprived of liberty to the COVID-19 pandemic, and urge them to take all appropriate public health measures in respect of this vulnerable population that is part of our communities.
Acknowledging that the risk of introducing COVID-19 into prisons or other places of detention varies from country to country, we emphasize the need to minimize the occurrence of the disease in these settings and to guarantee that adequate preventive measures are in place to ensure a gender-responsive approach and preventing large outbreaks of COVID-19. We equally emphasize the need to establish an up-to-date coordination system that brings together health and justice sectors, keeps prison staff well-informed and guarantees that all human rights in these settings are respected.
In the light of overcrowding in many places of detention, which undermines hygiene, health, safety and human dignity, a health response to COVID-19 in closed settings alone is insufficient. Overcrowding constitutes an insurmountable obstacle for preventing, preparing for or responding to COVID-19.
We urge political leaders to consider limiting the deprivation of liberty, including pretrial detention, to a measure of last resort, particularly in the case of overcrowding, and to enhance efforts to resort to non-custodial measures. These efforts should encompass release mechanisms for people at particular risk of COVID-19, such as older people and people with pre-existing health conditions, as well as other people who could be released without compromising public safety, such as those sentenced for minor, non-violent offences, with specific consideration given to women and children.
A swift and firm response aimed at ensuring healthy and safe custody, and reducingovercrowding, is essential to mitigate the risk of COVID-19 entering and spreading in prisons and other places of deprivation of liberty. Increasing cleanliness and hygiene in places of deprivation of liberty is paramount in order to prevent the entry of, or to limit the spread of, the virus.
Compulsory detention and rehabilitation centres, where people suspected of using drugs or engaging in sex work are detained, without due process, in the name of treatment or rehabilitation should be closed. There is no evidence that such centres are effective in the treatment of drug dependence or rehabilitation of people and the detention of people in such facilities raises human rights issues and threatens the health of detainees, increasing the risks of COVID-19 outbreaks.
All states are required to ensure not only the security, but also the health, safety and human dignity, of people deprived of their liberty and of people working in places of detention at all times. This obligation applies irrespective of any state of emergency.
Decent living and working conditions as well as access to necessary health services free of charge form intrinsic elements of this obligation. There must be no discrimination on the basis of the legal or any other status of people deprived of their liberty. Health care in prisons, including preventive, supportive and curative care, should be of the highest quality possible, at least equivalent to that provided in the community. Priority responses to COVID-19 currently implemented in the community, such as hand hygiene and physical distancing, are often severely restricted or not possible in closed settings.
Prison populations have an overrepresentation of people with substance use disorders, HIV, tuberculosis (TB) and hepatitis B and C compared to the general population. The rate of infection of diseases in such a confined population is also higher than among the general population. Beyond the normal infectivity of the COVID-19 pandemic, people with substance use disorders, HIV, hepatitis and TB may be at increased risk of complications from COVID-19.
To ensure that the benefits of treatments started before or during imprisonment are not lost, provisions must be made, in close collaboration with public health authorities, to allow people to continue their treatments without interruption at all stages of detention and upon release. Countries should embrace a health systems approach, where prisons are not separated from the continuity-of-care pathway but integrated with community health services.
Enhancing prevention and control measures in closed settings as well as increasing access to quality health services, including uninterrupted access to the prevention and treatment of HIV, TB, hepatitis and opioid dependence, are therefore required. Authorities must ensure uninterrupted access and flow of quality health commodities to prisons and other places of detention. Staff, health-care professionals and service providers working in closed settings should be recognized as a crucial workforce for responding to the COVID-19 pandemic and receive appropriate personal protective equipment and support as necessary.
In their responses to COVID-19 in closed settings, states must respect the human rights of people deprived of their liberty. Restrictions that may be imposed must be necessary, evidence-informed, proportionate (i.e. the least restrictive option) and non-arbitrary. The disruptive impact of such measures should be actively mitigated, such as through enhanced access to telephones or digital communications if visits are limited. Certain fundamental rights of people deprived of their liberty and corresponding safeguards, including the right to legal representation, as well as the access of external inspection bodies to places of deprivation of liberty, must continue to be fully respected.
We urge political leaders to ensure that COVID-19 preparedness and responses in closed settings are identified and implemented in line with fundamental human rights, are guided by World Health Organization (WHO) guidance and recommendations and never amount to torture and other cruel, inhuman or degrading treatment or punishment. In prisons, any intervention should comply with the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules).
People deprived of their liberty exhibiting symptoms of COVID-19 or who have tested positive should be monitored and treated in line with the most recent WHO guidelines and recommendations. Prisons and other places of detention must be part of national COVID-19 plans with dedicated participation of affected populations. All cases of COVID-19 in closed settings should be notified to responsible public health authorities, who will then report to national and international authorities.
In line with our mandates, we remain available to provide support in the rapid deployment of the recommendations outlined above.
Ghada Fathi Waly,Executive Director, UNODC
Tedros Adhanom Ghebreyesus,Director-General, WHO
Winnie Byanyima,Director-General, Executive Director, UNAIDS
Michelle Bachelet,United Nations High Commissioner for Human Rights
We thank UNDP for their contributions to this statement.
WHOs latest World Health Statistics reveal that low-income countries reported the biggest gains in life expectancy, which rose by 11 years between 2000 and 2016.
Other achievements during this period include a dramatic scale-up in access to services to prevent and treat HIV, malaria and tuberculosis. Child mortality was also halved thanks to better maternal and child healthcare.
However, WHO chief Tedros Adhanom Ghebreyesus warned that the COVID-19 pandemic could further thwart progress.
The new statistics shine a light on one of the key drivers of this pandemic: inequality, he said during the agencys latest update on the crisis.
Tedros reported that more than one billion people worldwide spend at least 10 per cent of their household budgets on healthcare, while more than 55 percent of countries have fewer than 40 nursing and midwifery personnel, per 10,000 people.
The COVID-19 pandemic is causing a significant loss of life, disrupting livelihoods, and threatening to undo much of the progress we have made, he said.
While the coronavirus is an unprecedented shock to the world; through national unity and global solidarity, we can save both lives and livelihoods and ensure that other health services for neglected diseases, child vaccination, HIV, TB and malaria continue to both function and improve.
WHO also highlighted the challenge of preventing COVID-19 deaths in long-term care facilities: an unfortunate phenomenon that has occurred across the world, according to the agencys Executive Director.
Dr. Michael Ryan said residents are vulnerable to the respiratory disease because they tend to be older, and many have underlying health conditions.
He added that there already is a long list of countries where more than half of all COVID-19 cases were found in these settings.
I think this is something thats going to have be dealt with as countries now emerge from the high incidence phase, he said.
Not only is it a tragedy that this disease is occurring and killing so many people in those facilities. Ifthat disease remains in those facilities, it will come back out into communities through the workers who work there and families who visit.
Dr. Ryan also explained that long-term care facilities are not like hospitals as settings vary around the world.
Some can have many, many residents who are served by a relatively small number of staff. Furthermore, these workers may or may not have been fully trained in areas such as healthcare provision or infection prevention and control.
Dr. Ryan called for continued vigilance against COVID-19 but also action to protect older citizens in long-term care facilities, citing the example of hospitals twinning with these institutions to support infection prevention and control, diagnostics and rapid testing.
HORNELL, N.Y. (WETM) The Steuben County Public Health Department has reported that a 90 year old female who lived in a nursing home in the Hornell area has died from COVID-19.
Steuben County has now reported 40 deaths due to COVID-19, about 30 in nursing homes in the Hornell and Bath area. This is the countys first reported COVID-19 death since May 1.
Steuben County had previously reported deaths at Hornell Gardens, Elderwood at Hornell, and the Taylor Health Center.
We were hopeful that we could reach phase one of reopening without any more COVID-19 deaths, said Public Health Director, Darlene Smith. Let this serve as a reminder to all of us that although we have reached a decline in cases, we are not in the clear yet. All of our actions going forward will determine how many more lives are impacted by this horrible disease.
All residents should continue to stay home and monitor themselves for COVID-19 symptoms of fever, cough, shortness of breath, chills or repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell and contact their healthcare provider for instructions if feeling ill.
Steuben County is set to begin phase one of the Governors reopening plan on May 15. To date the county has reported 248 cases, 151 recoveries, 40 deaths, and nearly 3,400 tests.
COVID-19 stay-at-home orders could exacerbate challenges faced by mothers in academia.
As daily life grinds to a halt worldwide in response to the coronavirus disease 2019 (COVID-19) pandemic, professionals are adjusting to a new reality of remote working. For many researchers, the release from teaching and administrative activities means more time for independent work. In contrast, parents of young children for whom school has been cancelled are facing uniquely challenging responsibilities. Although academic fathers are not immune to the impacts of confinement, it is traditionally women who carry the heaviest load (1, 2).
These women risk suffering yet another motherhood penalty. Instead of writing papers, they are likely to devote time to homeschooling children and doing household chores. For those who have not yet leaked from the pipeline (3) and are struggling to keep their careers on track, these months of heavier duties may increase the distance between them and their male and childless peers.
Gender inequality in science is an urgent issue, and motherhood plays a major role in it (4). Recent years have witnessed the emergence of many initiatives that ignited changes toward addressing this problem [e.g., (58)]. We cannot allow this pandemic to reverse advances and further deepen the gender gap in science.
Policies and actions to mitigate the motherhood penalty can benefit all scientists. Deadlines for grant proposals, reports, and renewal requests must be postponed. Funding agencies should consider creating granting programs designed around the reality of academics with families. By instituting more flexible policies, we can make science fairer for everyone affected by the pandemic.
ONTARIO A food processing plant in Weiser voluntarily shut down on Sunday afternoon after receiving a phone call from an employee who had tested positive for the novel coronavirus COVID-19, according to a company official.
We brought in a separate sanitation crew and cleaned the plant, said Douglas Wold, human resources manager, for Fry Foods, Inc. during a phone interview today. I ended up getting ahold of the health department on Monday.
Since then, a cluster of COVID-19 cases has been discovered among employees. Eight have tested positive, but Wold says those cases have all been condensed to a party that took place with out-of-state guests, throughout the week prior to the first case being reported.
Those individuals are also close contacts outside of the workplace, reads a news release from Southwest District Health, which states it has been working closely with Fry Foods.
They were symptomatic first, so they brought it from out of the state, Wold says.
He clarified that the party was actual to a series of visits that lasted almost a whole week with a lot of coming and going.
At least 80 of the plants employees have been tested, he said, adding that he created a bubble chart to track cases. Those tests have all been by courtesy, he said, adding that there were no symptoms.
Right now, we dont have any confirmed in-plant transfer cases, it was all at this party, Wold says, adding fingers crossed.
Contact investigations are underway with those who have tested positive, and epidemiologists will notify people who may have been potentially exposed.
Individuals who do not receive a call from the health district have not been named as a close contact and do not have cause for elevated concern, reads the health authoritys news release.As with any cluster of illness in the community, SWDH will continue to work closely to monitor and respond to any changes.
As far as the length of time the plant will stay closed, Wold said it was premature to decide now, but that they were prepared to stay closed for fourteen days if it was the best decision for the community and the employees.
Fortunately, none of the food that was processed during the time-frame of the party has left the plant, he says.
We have contacted the people we supply out of courtesy, he said. But were taking precautions.
This has included putting food into storage that was packaged during that time. Wold says company officials are hopeful that if it sits in storage long enough and there was any virus exposure, that it would die.
Nothing went out, it went into a subzero freezer, he said.
According to federal and state health authorities, there is no evidence that COVID-19 is transmitted through food or food packaging. For this reason, the U.S. Food and Drug Administration does not anticipate that food products would need to be recalled or be withdrawn from the market if they were produced in a facility during a time period a worker was potentially shedding the virus.
Wold says the health department did not tell operators to shut down the plant, but that owners of the company opted to do so out of an abundance of caution.
As of today, 20% of the plants employees have been tested by courtesy Wold says, adding that those tested havent had any symptoms.
The company has been and continues to be very responsive and is taking appropriate precautions to ensure the health and safety of the staff, according to Southwest District Health.
Nikole Zogg, the health authoritys director, reminds citizens that it is still important to take precautions to protect both yourself and others around you.
Please avoid social gatherings with those not in your immediate household, continue to practice physical distancing, stay home when you are sick, wash your hands or use hand sanitizer often, and wear cloth face coverings when leaving your home, she says.
Citizens with COVID-19-like symptoms, such as respiratory illness with fever, cough or difficulty breathing should call their medical provider prior to going.
Southwest District Health serves a six-county region, which includes Washington and Payette counties. The cluster at the food plant, brings Washington Countys total cases to 10. There have been 14 cases in Payette, with two deaths reported.
(NEXSTAR) An experiment using a fluorescent substance and black lights shows just how quickly a virus like COVID-19 might spread in a restaurant or cruise ship setting.
The study was performed by experts on contact infection and Japans NHK, the countrys national public broadcaster.
During the experiment, one of the ten participants played the infected person. The fluorescent paint was applied to that persons palms to replicate what might happen after a sneeze was covered with the hands.
All ten then enjoyed a buffet-style meal for 30 minutes before a black light was used to track the spread of the virus. Traces of the fluorescent paint had spread to numerous dishes, the faces of three people and the hands of all participants.
John Nicholls, a clinical professor in pathology at the University of Hong Kong, told CNN the video demonstrates the coronavirus efficiency at spreading on surfaces and to people. I think it really highlights the need of what people have been saying about hand hygiene to stop the spread of disease, Nicholls said.
Nicholls also noted, however, that the amount of fluorescent substance on the infected subject wasnt necessarily an accurate representation of the amount of germs on someones hand after a sneeze.
In a second experiment, all of the subjects washed their hands before and during eating, and workers disinfected commonly touched surfaces, according to CNN. When researchers turned on the black light, none of the virus had spread to the other diners.
