Hospitalised COVID-19 patients can have ongoing symptoms for months -study

FILE PHOTO: People walk past an illustration of a virus outside a regional science centre, as the city and surrounding areas face local restrictions in an effort to avoid a local lockdown being forced upon the region, amid the coronavirus disease (COVID-19) outbreak, in Oldham, Britain August 3, 2020. REUTERS/Phil Noble

LONDON (Reuters) – More than half of COVID-19 patients discharged from hospital still experienced symptoms of breathlessness, fatigue, anxiety and depression for two to three months after their initial infection, according to the findings of a small UK study.

The research, led by scientists at Britain’s Oxford University, looked at the long-term impact of COVID-19 in 58 patients hospitalised with the pandemic disease.

It found that some patients have abnormalities in multiple organs after being infected with the novel coronavirus and that persistent inflammation caused problems for some for months.

The study has not been peer-reviewed by other scientists but was published before review on the MedRxiv website.

“These findings underscore the need to further explore the physiological processes associated with COVID-19 and to develop a holistic, integrated model of clinical care for our patients after they have been discharged from hospital,” said Betty Raman, a doctor at Oxford’s Radcliffe Department of Medicine who co-led the research.

An initial report by Britain’s National Institute for Health Research (NIHR) published last week showed that ongoing illness after infection with COVID-19, sometimes called “long COVID”, can involve a wide range of symptoms affecting all parts of the body and mind.

The Oxford study’s results showed that two to three months after the onset of the COVID-19, 64% of patients suffered persistent breathlessness and 55% reported significant fatigue.

MRI scans showed abnormalities in the lungs of 60% of the COVID-19 patients, in the kidneys of 29%, in the hearts of 26% and the livers of 10%.

“The abnormalities detected … strongly correlated with serum markers of inflammation,” Raman said. “This suggests a potential link between chronic inflammation and ongoing organ damage among survivors.”

Reporting by Kate Kelland in London. Additional reporting by Ann Maria Shibu in Bengaluru; Editing by Alison Williams and Steve Orlofsky

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Pfizer Says May Begin Supplying COVID-19 Vaccine After US Elections

FILE PHOTO. The Pfizer logo at its offices in Manhattan, New York, USA. August 1, 2016. REUTERS / Andrew Kelly

Oct 16 (Reuters) – Pfizer Inc said on Friday it will request authorization for emergency use in the United States of its COVID-19 vaccine candidate around the third week of November, an announcement that makes it highly unlikely that the immunization is available before the US elections.

The American pharmaceutical company develops the vaccine together with the German firm BioNTech SE.

Pfizer said it could determine whether the vaccine is effective as early as this month, based on its 40,000-person clinical trial, but that it also requires safety data that won’t be available until November at the earliest.

The news from Pfizer, published in a letter from its CEO on its website, boosted the US stock market and the company’s stock.

“Let me be clear, assuming the data is positive, Pfizer will apply for emergency use authorization in the United States shortly after the safety goal is reached in the third week of November,” said CEO Albert Bourla.

US President Donald Trump said a vaccine would be available before the Nov. 3 election, but health officials and companies have only said key data could be released this month.

The possibility of further delays was raised after clinical trials of two rival vaccines were suspended in the United States and other countries this fall.

Health authorities have sought to ease concerns about fears that few Americans will want to get vaccinated in the first stage. Earlier this month, the Food and Drug Administration (FDA) formalized a requirement for drug companies to provide at least two months of safety data for half of the volunteers in the trials.

Pfizer’s comments at this time raise the possibility that the United States will approve a vaccine for the coronavirus this year, a crucial step in controlling the pandemic that has killed more than 1 million people and devastated the global economy.

Reports by Manas Mishra, Manojna Maddipatla in Bengaluru, and Michael Erman in New Jersey. Edited in Spanish by Marion Giraldo

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Doctors probe whether COVID-19 is causing diabetes

(Reuters) – Mario Buelna, a healthy 28-year-old father, caught a fever and started having trouble breathing in June. He soon tested positive for COVID-19.

The Simis family, Atticus, Sarah, Arthur and Ophelia, pose for a photo in Gardnerville, Nevada, September 24, 2020. Simis family/Handout via REUTERS

Weeks later, after what had seemed like a recovery, he felt weak and started vomiting. At 3 a.m. on Aug. 1, he passed out on the floor of his home in Mesa, Arizona.

Paramedics rushed him to a nearby hospital, where doctors put him in intensive care after saving him from a coma. They told him he could have died. Their diagnosis – type 1 diabetes – stunned and frightened him. He had no history of the disease.

“COVID triggered it,” Buelna said the doctors told him.

Buelna’s ordeal and similar cases reflect a new worry about the dangerous relationship between diabetes and COVID-19 that’s being urgently studied by doctors and scientists around the world. Many experts are convinced that COVID-19 can trigger the onset of diabetes – even in some adults and children who do not have the traditional risk factors.

It’s already been well-documented that people with diabetes face much higher risks of severe illness or death if they contract COVID-19. In July, U.S. health officials found that nearly 40% of people who have died with COVID-19 had diabetes. Now, cases like Buelna’s suggest the connection between the diseases runs both ways.

“COVID could be causing diabetes from scratch,” said Dr. Francesco Rubino, a diabetes researcher and chair of metabolic and bariatric surgery at King’s College London.

Rubino is leading an international team that is collecting patient cases globally to unravel one of the biggest mysteries of the pandemic. Initially, he said, more than 300 doctors have applied to share cases for review, a number he expects to grow as infections flare up again.

“These cases are coming from every corner of the world and every continent,” Rubino told Reuters.

In addition to the global registry, the U.S. National Institutes of Health is financing research into how the coronavirus may cause high blood sugars and diabetes.

In these situations, symptoms can escalate quickly and become life threatening. These cases may take months to surface after exposure to COVID-19, so the full extent of the problem and the long-term ramifications may not be known until well into next year. More intensive research is needed to definitively prove, beyond the mounting anecdotal evidence, that COVID-19 is triggering diabetes on a wide scale.

“We have more questions than answers right now,” said Dr. Robert Eckel, president of medicine and science at the American Diabetes Association. “We could be dealing with an entirely new form of diabetes.”

‘ABSOLUTELY TERRIFYING’ DIAGNOSIS

Type 1 diabetes occurs when the body’s immune system mistakenly destroys insulin-producing cells in the pancreas, preventing the regulation of blood sugar levels. About 1.6 million Americans have the disease.

Type 2 diabetes is more prevalent, afflicting about 30 million Americans. Those patients still produce insulin, but over time their cells become insulin-resistant, allowing blood sugar to rise.

Type 1 diabetes cases have previously been associated with other viral infections, including influenza and previous coronaviruses. It is known that infections can stress the body and increase blood sugar levels. But this tends to happen in people predisposed to the disease. Only some of them eventually develop diabetes, and scientists still don’t fully understand why.

This year, doctors also are seeing some people without the risk factors for type 2 diabetes – such as being older or overweight – experience a diabetic emergency after exposure to COVID-19.

In type 1 diabetes, initial symptoms can include extreme thirst, fatigue, frequent urination and weight loss. Arthur Simis had no idea those were signs for the disease.

This summer, he and his wife, Sarah, noticed their 12-year-old son, Atticus, appeared thin and slept a lot. They figured he was stressed out from being trapped at home in the pandemic, or going through a growth spurt.

On July 9, as his symptoms persisted, Arthur Simis took his son to an urgent care center near their home in Gardnerville, Nevada. The medical staff detected dangerously high blood sugar levels and ketones in his urine, both indicators that Atticus was in diabetic ketoacidosis, or DKA.

The doctor told Simis that his son needed hospital care immediately to avoid slipping into a coma from his newly diagnosed type 1. An ambulance took them 50 miles to the nearest hospital in Reno.

His father spent three nights sleeping at his side in the pediatric ICU. He sobbed on the phone to his wife, because only one parent was allowed inside, a measure to control coronavirus infections.

“How could he have diabetes?” Simis recalls asking the doctors. “It was absolutely terrifying.”

Simis believes his son had been infected by the coronavirus because the father and his wife experienced symptoms in the spring. The couple went to urgent care but never got tested for the coronavirus because of stricter testing criteria at the time. Atticus tested negative for an active coronavirus infection in the ICU, medical records show. But he was never tested for antibodies that could show whether he was exposed weeks earlier.

Doctors say that’s not unusual in a fast-moving pandemic, as they focus on individual emergencies rather than big-picture research questions. But the lack of testing in many of these cases, they say, may complicate efforts to detect whether and how the coronavirus might be causing diabetes.

CHILDREN IN INTENSIVE CARE

The initial reports of COVID-related diabetes include more children with cases like that of Atticus.

In a study published in August, researchers at Imperial College in London and several hospitals there found that cases of type 1 diabetes among children nearly doubled to 30 during late March to early June – as the pandemic raged – compared to the same period in previous years. Five of the children tested positive for a prior coronavirus infection, but the study’s authors said many of the children were not tested.

In the United States, Children’s Hospital Los Angeles said the percentage of newly diagnosed type 2 patients who arrived in diabetic ketoacidosis, a potentially fatal buildup of acid in the blood, has nearly doubled for March through August compared to the same period in 2018 and 2019.

Dr. Lily Chao, director of the type 2 diabetes clinic there, said the hospital is still investigating whether this increase is driven by exposure to COVID-19.

Brandi Edwards, a registered nurse and diabetes educator at Alabama’s Huntsville Hospital, said calls about pediatric cases began to surge in May. Doctors summon her when a child arrives in the emergency room or ICU so she can counsel the family on insulin injections, glucose readings and how daily life will change going forward.

“We’ve seen more type 1 cases this year than I ever remember,” Edwards said. “There were three kids in the pediatric ICU at the same time. That is so rare.”

EVICTION NOTICE

After surviving a diabetic emergency, life for a newly diagnosed patient can be overwhelming. Medication and other supplies to manage diabetes can cost hundreds of dollars every month, and long waits to see an endocrinologist are common in many areas.

Buelna, the patient in Arizona, is still waiting for his Medicaid plan to approve a continuous glucose monitor more than two months after his diagnosis. The disease knocked him out of work for weeks and wrecked his family’s finances. His wife, Erika, is eight months pregnant and they have a 3-year-old daughter, Katalina. The family got an eviction notice on Aug. 2, while Mario was in the ICU, and they rely on a food bank for some meals.

Buelna said he fell into a depression in the hospital, cut off from family visits, and credits his sister with lifting his spirits in phone calls.

“I want to get better so I can see my kids grow up,” he said. “I’m not ready to go yet.”

Reporting by Chad Terhune; Editing by Brian Thevenot

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Coronavirus: Remdesivir Does Not Shorten Healing Times, WHO Says

In Cairo, Egypt. Remdesivir, the experimental antiviral from the US laboratory Gilead, has little or no effect on the length of hospital stay of patients with COVID-19 or on their chances of survival, according to the results of a study. clinical study conducted by the World Health Organization (WHO). / Photo taken on June 25, 2020 / REUTERS / Amr Abdallah Dalsh

GENEVA (Reuters) – Remdesivir, the experimental antiviral from US laboratory Gilead, has little or no effect on the length of hospital stay of patients with COVID-19 or on their chances of survival, according to the results of a clinical study conducted by the World Health Organization (WHO).

The treatment, one of the first to be used to fight the disease caused by the new coronavirus, was notably one of those administered recently to US President Donald Trump.

Through its study called “Solidarity”, the WHO evaluated the effects of potential treatments including remdesivir, hydroxychloroquine, the lopinavir-ritonavir combination (an approved treatment against HIV) and interferon, on 11,266 adult patients at across more than 30 countries.

The results of the study, announced Thursday by the WHO, have yet to be analyzed. They have been uploaded to the medRxiv pre-release server.

Earlier this month, data from a US study on Gilead’s remdesivir showed that the treatment could shorten patients’ recovery time by five days.

Responding to a request for comment from Reuters, Gilead said the WHO data “appears inconsistent” with that obtained from studies validating the clinical benefits of remdesivir.

“We are concerned that the data from this open global study has not undergone the rigorous review necessary to allow for constructive scientific discussion,” added the US laboratory.

The US drug administration (FDA) authorized the emergency use of remdesivir in the United States on May 1. Since then, the use of the experimental antiviral has been authorized in several other countries.

Deena Beasley and Stephanie Ulmer-Nebehay; French version Jean Terzian

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COVID-19 again? Reinfection cases raise concerns over immunity

LONDON (Reuters) – The case of a man in the United States infected twice with COVID-19 shows there is much yet to learn about immune responses and also raises questions over vaccination, scientists said on Tuesday.

FILE PHOTO: Protective face masks with flags design are seen on display in a shop in Paris, as the coronavirus disease (COVID-19) outbreak continues in France, October 13, 2020. REUTERS/Charles Platiau

The 25-year-old from Reno, Nevada, tested positive in April after showing mild symptoms, then got sick again in late May with a more serious bout, according to a case report in the Lancet Infectious Diseases medical journal.

The report was published just hours after U.S. President Donald Trump, who was infected with COVID-19 and hospitalised earlier this month, said he believes he now has immunity and felt “so powerful”.

Scientists said that while known incidences of reinfection appear rare – and the Nevada man has now recovered – cases like his were worrying. Other isolated cases of reinfection have been reported around the world, including in Asia and Europe.

In the Netherlands, the National Institute for Public Health confirmed on Tuesday that an 89-year-old Dutch woman, also sick with a rare form of bone marrow cancer, had recently died after contracting COVID-19 for a second time.

Dutch media said this was the first known case worldwide of a death after SARS-CoV-2 coronavirus reinfection.

‘IMPLICATIONS FOR VACCINATION’

“It is becoming increasingly clear that reinfections are possible, but we can’t yet know how common this will be,” said Simon Clarke, a microbiology expert at Britain’s Reading University.

“If people can be reinfected easily, it could also have implications for vaccination programmes as well as our understanding of when and how the pandemic will end.”

The Nevada patient’s doctors, who first reported the case in a non peer-reviewed paper in August, said sophisticated testing showed that the virus strains associated with each bout of infection were genetically different.

“These findings reinforce the point that we still do not know enough about the immune response to this infection,” said Paul Hunter, a professor in medicine at Britain’s University of East Anglia.

Brendan Wren, a professor of vaccinology at the London School of Hygiene & Tropical Medicine, said the Nevada case was the fifth confirmed example of reinfection worldwide.

“The demonstration that it is possible to be reinfected by SARS-CoV-2 may suggest that a COVID-19 vaccine may not be totally protective,” he said. “However, given the (more than) 40 million cases worldwide, these small examples of reinfection are tiny and should not deter efforts to develop vaccines.”

World Health Organization spokesman Tarik Jasarevic concurred that the U.S. case underlined what was unknown about immunity. “And this also really is an argument against what some have been advocating, and that’s building naturally what is called herd immunity. Because we don’t know,” he told a briefing.

Reporting by Kate Kelland; Additional reporting by Anthony Deutsch in Amsterdam, Stephanie Nebehay in Geneva; Editing by Andrew Cawthorne

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Quebec imposes new curbs, Ontario warns of ‘more complex’ second wave as COVID-19 cases spike

MONTREAL/TORONTO (Reuters) – Quebec on Monday ordered new restrictions on bars and restaurants in coronavirus hot spots, while Ontario’s premier warned of a “more complex” second wave, as Canada’s two most-populous provinces saw big increases in COVID-19 cases.

Quebec, the Canadian province hit hardest by the novel coronavirus, will curb social gatherings in homes and limit bar and restaurant service to takeout for 28 days in Montreal and two other regions, Premier Francois Legault said. It reported 750 new coronavirus cases on Monday.

“It’s time to take action,” Legault told reporters in Montreal. “The situation is at the limit.”

The restrictions, which start on Thursday in the three regions, will not close businesses or schools.

But Legault introduced restrictions like allowing only people living at the same address to be there at the same time. Libraries, movie theaters and museums will close and protesters will have to wear masks during demonstrations, he said.

Earlier on Monday, Ontario, Canada’s most-populous province, reported a new daily high of 700 cases, with a bit more than a day’s worth of samples still pending at labs. The number of patients in hospital was also rising steadily, reaching 128, data showed.

“We know that this wave will be more complicated, more complex, it will be worse than the first wave we faced earlier this year,” Ontario Premier Doug Ford told reporters in Toronto.

The Ontario Hospital Association called on the province to bring back restrictions in some regions on indoor dining and bars, places of worship, weddings, gyms and other non-essential businesses.

Canada garnered praise earlier this month after it reported zero coronavirus deaths for the first time since March. But health officials are now warning that some local authorities could be overwhelmed unless the wave of infections is curbed.

In Alberta, where cases have also been rising, the provincial government postponed dozens of surgeries and imposed visiting restrictions at a Calgary hospital because of an outbreak. Twenty-six patients and 27 staff have confirmed infections and more than 100 staffers are in isolation. Four patients have died.

Overall, cases in Canada rose by 1,454 to 153,125, while six more deaths took the total to 9,268, according to data released on Sunday.

Reporting by Allison Lampert in Montreal and Mahad Arale in Toronto; Additional reporting by Allison Martell and and Rod Nickel in Winnipeg; Editing by Denny Thomas and Peter Cooney

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U.S. CDC takes down coronavirus airborne transmission guidance

(Reuters) – The U.S. Centers for Disease Control and Prevention (CDC) on Monday took down its guidance warning on possible airborne transmission of the novel coronavirus, saying that the draft recommendation was posted in error.

The now-withdrawn guidance, posted on the agency’s website on Friday, recommended that people use air purifiers to reduce airborne germs indoors to avoid the disease from spreading.

“CDC is currently updating its recommendations regarding airborne transmission of SARS-CoV-2. Once this process has been completed, the update language will be posted,” the agency said.

The CDC did not immediately respond to Reuters request for comment on when the guidance will be updated.

The health agency had said that COVID-19 could spread through airborne particles that can remain suspended in the air and travel beyond six feet.

Presently, the agency’s guidance says the virus mainly spreads from person-to-person through respiratory droplets, which can land in the mouth or nose of people nearby. (bit.ly/2EknVZc)

Earlier this month, U.S. President Donald Trump took exception to comments from the CDC director, who said masks might be even more effective than a vaccine for the novel coronavirus that could be broadly rolled out in mid-2021.

That followed a New York Times report that guidance about novel coronavirus testing posted last month on the CDC’s website was not written by the agency’s scientists and was posted over their objections.

The World Health Organization has not changed its policy on aerosol transmission of the coronavirus, it said on Monday.

The agency still believes the disease is primarily spread through droplets, but that in enclosed crowded spaces with inadequate ventilation, aerosol transmission can occur, said Mike Ryan, executive director of the WHO’s emergencies program.

Reporting by Manas Mishra in Bengaluru, Stephanie Nebehay in Geneva and Kate Kelland in London; Editing by Ramakrishnan M. and Shinjini Ganguli

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U.S. CDC says coronavirus could spread through air

Sept 21 (Reuters) – The U.S. Centers for Disease Control and Prevention has warned that COVID-19 could spread through airborne particles that can remain suspended in the air and travel beyond six feet.

The agency previously said the virus mainly spreads from person to person through respiratory droplets when a sick person coughs, sneezes or talks.

The updated guidance, posted on the agency’s website on Friday, also recommended that people use air purifiers to reduce airborne germs indoors to avoid the disease from spreading. (bit.ly/2EknVZc)

Airborne viruses are among the most contagious, and the CDC warned that poorly-ventilated places increase the risk of spreading.

Studies have shown that the new coronavirus could spread through aerosols in the air, and the World Health Organization has said it is monitoring “emerging evidence” of possible airborne transmission.

Reporting by Manas Mishra in Bengaluru; Editing by Ramakrishnan M.

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Moderna sees 20 million doses of COVID-19 vaccine candidate by year end

FILE PHOTO: A sign marks the headquarters of Moderna Therapeutics, which is developing a vaccine against the coronavirus disease (COVID-19), in Cambridge, Massachusetts, U.S., May 18, 2020. REUTERS/Brian Snyder/File Photo

(Reuters) – Moderna Inc said on Friday it was on track to produce 20 million doses of its experimental coronavirus vaccine by the end of the year, while maintaining its goal of readying 500 million to 1 billion doses in 2021.

Vaccines and treatments are seen as essential in controlling the COVID-19 pandemic that has shown no signs of slowing and killed over 944,000 people worldwide.

A handful of vaccines, including those from Pfizer Inc and AstraZeneca, are also being tested in large studies.

Moderna had enrolled 25,296 participants out of a planned 30,000 in its late-stage study as of Wednesday. (bit.ly/35PkSnc)

The company is working with Switzerland’s Lonza Group AG and Spain’s Laboratorios Farmacéuticos Rovi to make the vaccine outside the United States.

Moderna has a vaccine supply deal in place with the U.S. for 100 million doses, and has finished advanced talks with the European Union for the vaccine.

The Centers for Disease Control and Prevention anticipates that 35 million to 45 million doses of vaccines from the first two companies to receive authorization will be available in the United States by the end of this year.

Moderna plans to seek emergency authorization for its vaccine’s use in high-risk groups if it proves to be at least 70% effective, its chief executive officer told Reuters earlier this week.

Reporting by Manas Mishra in Bengaluru; Editing by Shounak Dasgupta

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Economic activity in Argentina hits a record low in April amid the pandemic

BUENOS AIRES (Reuters) – Argentina’s economic activity plummeted by 26.4 percent in April, the worst monthly decline since records began, as the country grapples with the fallout from the new coronavirus pandemic and lockdown measures, the official statistics agency said on Monday.

The monthly drop, which came after the South American country imposed a general lockdown in mid-March, is worse than a 21 percent drop expected by analysts polled by Reuters, which highlights the extent of the damage the pandemic has inflicted on the local industry.

The Argentine government faces a difficult balancing act between fighting a recent jump in COVID-19 cases and reopening the economy. It extended the quarantine in and around the capital, Buenos Aires, but has relaxed rules in other parts of the country.

The drop followed a drop of 11.5 percent in March, and outpaced declines during crises in 2002 and 2009. It is the worst since the statistics agency began keeping records in 1993.

With already plunging into two years of recession and defaulting on external debt, Argentina is heading for an annual economic downturn in 2020, according to estimates by organizations, including the International Monetary Fund, that it will reach around 10 percent.

Wajdi Alfi prepared for the Arabic newsletter

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