martes, 31 de marzo de 2020

Diagnostics race to keep up with Covid-19, why the elderly are at more risk for infection, & rise in pediatric cancer cases

Morning Rounds
Shraddha Chakradhar

Covid-19: Diagnostic tests are moving fast, but the coronavirus may be moving faster 

Ever since the FDA cleared manufacturers of a range of testing devices to begin testing for Covid-19 cases, facilities across the U.S. have prepared to ramp up their diagnostic capabilities. Northwell Health in New York, one of the earliest such centers to pivot to Covid-19 testing, can now run up to 2,000 tests a day. But will the availability of more tests be enough to keep up with the rapidly spreading virus? STAT's Matthew Herper has more here.

Here's what else is happening: 
  • AI has become an early line of defense against the pandemic as scientists deploy the technology to screen and triage patients in hospitals, and identify which ones are likely to develop severe symptoms. Read more about how the technology is being used against Covid-19 here
  • In recent weeks, as small studies have shown that hydroxychloroquine could be used against Covid-19, orders for the antimalaria drug have jumped and caused shortages. But without full-blown clinical trial data, doctors should avoid prescribing the drug, writes STAT's Ed Silverman.  
  • CRISPR pioneer Jennifer Doudna has opened a 2,500-square-foot scientific lab to run Covid-19 tests. The facility plans to process 1,000 patient samples in a 24-hour period, but can ramp that up to 3,000 if needed.   
  • The U.S. federal government ought to deploy the U.S. Public Health Commission Corps, argue Andrew Meshnick, Brian Miller, and Boris Lushniak in a new First Opinion for STAT. The Corps — with more than 6,300 medical workers — is the only national uniformed service meant to support public health and could help fight Covid-19, they write. 
  • This summer's scheduled Olympic Games in Tokyo will now be held from July 23-Aug. 8, 2021. The Paralympic Games will be held from Aug. 24-Sept. 5 next year. 




What explains Covid-19's lethality for the elderly?

Researchers in England just shared new estimates of the risk that Covid-19 poses to elderly patients: The infection kills more than 13% of those ages 80 and older, compared to only about 0.3% of those in their 40s. The findings, which are based on data from more than 71,000 patients infected with Covid-19 in Wuhan and around 700 patients who were repatriated from China, also reveal that the mortality rate among 60-year-olds is about 4%, a rate that doubles to nearly 9% among those in their 70s. Immunologists are also trying to understand why elderly patients are particularly vulnerable to Covid-19. Biological aging and the presence of chronic conditions may only partially explain what's happening, STAT's Sharon Begley reports, but changes in the body's natural defense system and how T cells and B cells  are deployed to fight invaders may paint a clearer picture. Read more here. 



As coronavirus spreads, doctors in the ED warn 'the worst of it has not hit us yet'

The effects of Covid-19 are perhaps being felt most by emergency department physicians, who are on the front lines of the fight against the illness. STAT's Helen Branswell spoke to three ED physicians, and they describe distressing conditions, from reusing protective equipment to the daily risk of exposure. Here's what they said: 
  • Craig Spencer, an ER physician at New York-Presbyterian/Columbia University Medical Center, on the current situation in hospitals: "I didn’t see a single patient with chest pain. Not a single person with abdominal pain. I’m worried about where those patients are. ... And who’s going to be thinking about the non-Covid mortality, the impact of Covid on non-Covid patients?"
  • Megan Ranney, an emergency physician at Lifespan Health Systems in Providence, R.I., on equipment shortages: "Almost all of our personal protective equipment is meant to be disposable. Instead, we are wearing procedural masks, surgical masks as long as we can. ... This does not feel normal. It feels scary."
  • Lakshman Swamy, an intensive care doctor at Boston University Medical Center and the VA Boston, on the daily risk involved: "Every time I go to the ICU I basically hug my family and take a picture of my kids ... in my mind, if I have an exposure, I don’t know if I’ll come home." 





Inside STAT: Volunteer network tries to help health care workers who have 'helped us'


MEMBERS OF MN COVIDSITTERS APPEAL TO MEDICAL STUDENTS TO JOIN THEIR INITIATIVE DURING THEIR DAILY ZOOM CHECK-IN MEETING. (COURTESY MN COVIDSITTERS)
It started off as an idea from a few medical students in Minnesota: provide child care, pet-sitters, or general help to the many medical professionals who were struggling to keep up with the demands of their personal lives in the wake of Covid-19. MN Covidsitters has since grown into a volunteer network of more than 350 volunteers who provide support to more than 200 physicians, nurses, and other medical staff. Other similar support organizations have similarly cropped up elsewhere in the U.S., and efforts are underway to create an app that would automate the process of matching volunteers with medics who are looking for help. STAT's Shafaq Zia has more here


Priority review of high-risk medical devices is associated with more recalls

Medical devices such as pacemakers and breast implants, called Class III devices, carry the highest risk and therefore require the most FDA oversight when it comes to approval. A new study reveals that such devices that are granted an expedited FDA review end up being recalled more frequently than high-risk devices that go through a regular review process. Scientists looked at FDA data between January 2005 and December 2015 and found that more than 60% of class III devices that underwent priority review during this time were recalled for safety issues, compared to around 30% of such devices that were subject to a standard review process. Devices under priority review were also recalled about six months sooner than those under standard review. And even though priority review is supposed to be faster than standard reviews, the new study found that the expedited process actually took seven months longer than the standard one. 



Scientists project 11 million pediatric cancer deaths without more investment in health access

There will be nearly 14 million new cases of childhood cancer globally in the next 30 years if no new investments are made to improve treatment access, according to a new analysis. Scientists modeled possible scenarios if no improvements are made to expand who can access pediatric cancer treatments or to ensure that those who need it can access health services. They found that 11 million children — the vast majority of whom will be from middle- and low-income backgrounds — will die from their cancer. The scientists also found that by scaling up access to primary care, ensuring proper referral to specialists, and shoring up supportive services to ensure people stick with treatment, more than half of the projected deaths could be avoided. And spending $20 billion per year over the next 30 years to ensure access could result in a return of $3 per $1 spent by allowing many millions of children to enter the workforce and give back to the economy, the authors report. 



What to read around the web today

  • The world pushes back against e-cigarettes and Juul. The New York Times
  • Five states now face legal challenges over abortion bans amid coronavirus pandemic. CBS News
  • U.S. and J&J commit $1b to coronavirus vaccine codeveloped by Beth Israel. The Boston Globe
  • What happens when a city's hospital closes 'without warning' during a pandemic? The Guardian
  • Her genetic test revealed a microscopic problem — and a jumbo price tag. Kaiser Health News

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