Japan supercomputer shows humidity affects aerosol spread of coronavirus

By Rocky Swift

TOKYO (Reuters) – A Japanese supercomputer showed that humidity can have a large effect on the dispersion of virus particles, pointing to heightened coronavirus contagion risks in dry, indoor conditions during the winter months.

The finding suggests that the use of humidifiers may help limit infections during times when window ventilation is not possible, according to a study released on Tuesday by research giant Riken and Kobe University.

The researchers used the Fugaku supercomputer to model the emission and flow of virus-like particles from infected people in a variety of indoor environments.

Air humidity of lower than 30% resulted in more than double the amount of aerosolised particles compared to levels of 60% or higher, the simulations showed.

The study also indicated that clear face shields are not as effective as masks in preventing the spread of aerosols. Other findings showed that diners are more at risk from people to their side compared to across the table, and the number of singers in choruses should be limited and spaced out.

There has been a growing consensus among health experts that the COVID-19 virus can be spread through the air. The U.S. Centers for Disease Control and Prevention (CDC) revised its guidance this month to say the pathogen can linger in the air for hours.

The Riken research team led by Makoto Tsubokura has previously used the Fugaku supercomputer to model contagion conditions in trains, work spaces, and class rooms.

Notably, the simulations showed that opening windows on commuter trains can increase the ventilation by two to three times, lowering the concentration of ambient microbes.

“People’s blind fear or unfounded confidence against the infection of COVID-19 is simply because it is invisible,” Tsubokura said.

(Reporting by Rocky Swift; Editing by Michael Perry)

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Cancer takes heavy toll on women’s work, finances, study shows

Young women with cancer are at a high risk for employment and financial consequences, a new study finds.

“Our study addresses the burden of employment disruption and financial hardship among young women with cancer — a group who may be at particular risk for poor financial outcomes after cancer given their age and gender,” said researcher Clare Meernik, a fellow at the University of North Carolina at Chapel Hill’s Lineberger Comprehensive Cancer Center.

She and her colleagues surveyed more than 1,300 women in North Carolina and California a median of seven years after diagnosis. Their cancer was diagnosed when they were 15 to 39 years of age and working.

Following their diagnosis, 32% of the women had to stop working or cut back on their hours. Twenty-seven percent said they had to borrow money, go into debt or file for bankruptcy because of cancer treatment.

Women with disrupted employment were more likely — by 17 percentage points — to have these problems than women who were able to keep working.

Half of the women said they were stressed about their big medical bills, and women with disrupted employment were more likely to suffer psychological distress by 8 percentage points than women who were able to keep working.

The findings were published online Oct. 12 in the journal Cancer.

“Our findings highlight the need for effective interventions to promote job maintenance and transition back to the workforce after cancer treatment, as well as increased workplace accommodations and benefits, to improve cancer outcomes for young women,” Meernik said in a journal news release.

More information

To learn more about work and financial effects of cancer, visit the American Cancer Society.

Copyright 2020 HealthDay. All rights reserved.

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Confidential data shows many Illinois coronavirus outbreaks have been undisclosed: report

Outbreaks of coronavirus in schools, workplaces and other facilities are driving the surge of new COVID-19 cases in Illinois, some of which have not been publicly identified, according to a new study. 

The study from journalists at the Brown Institute for Media Innovation and the Midwest Center for Investigative Reporting published in USA Today indicates that individual clusters of coronavirus infections are primarily responsible for the latest wave of new COVID-19 cases vexing public health officials in the state, with several outbreaks occurring at correctional facilities and a major military base.

The second-largest outbreak identified by the study, which until now has not been reported to news organizations, is occurring at the Great Lakes Naval Base in Lake County, Ill., where 228 new cases of COVID-19 have been identified over the past month according to confidential data recorded by Illinois officials and obtained by the study.

The number of cases in Cook County Jail is also surging, with 1,074 cases reported as of Sept. 30 and continuing despite the Department of Corrections’ decision to halt visits to the prison earlier this year. A spokesperson said the outbreak “continues to be deliberate and aggressive” when contacted for comment on the study.

Many of the outbreaks identified by the study, including the one at Great Lakes Naval Base, have not previously been identified in public statements by the Illinois Department of Health, which told the journalists in a statement that it was bound by state and federal law to shield the identities of infected persons.

“Another consideration is the fact that people may not have become infected at the business location,” the Health Department told the study’s authors.

Other outbreaks in several meatpacking plants across the state have also been recorded, according to the study, while an outbreak at one combination elementary and middle school, the Sparta Lincoln School in Randolph, Ill., infected more than a dozen faculty, students and family members forcing the school to temporarily shutter and reopen with new anti-coronavirus procedures.

State health officials announced 2,538 new COVID-19 cases on Sunday. Illinois has reported more new cases in the past seven days than much of the country, though it lags behind larger states such as Texas and Florida.

The state has now identified more than 322,000 total infections of COVID-19, and is currently seeing as many new cases per day as it saw in during the peak of its first wave of coronavirus infections earlier this year.

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Confidential coronavirus data shows undisclosed outbreaks in Illinois

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Confidential statewide coronavirus outbreak data shows workplace, school and prison outbreaks are driving the increases — and that many of these outbreaks have never been made public. (Photo: wellesenterprises / Getty Images)

Like many Midwestern states, Illinois has struggled with rising coronavirus cases and death counts recently, surpassing 300,000 confirmed cases this month and recording its highest daily death count since late June on Friday. 

Public health officials issued a “warning list” for 28 Illinois counties at risk for coronavirus surges and blamed, in part, businesses who were “blatantly disregarding mitigation measures, people not social distancing, gathering in large groups and not using face coverings.”

Now, confidential statewide coronavirus outbreak data, obtained by the Documenting COVID-19 project at the Brown Institute for Media Innovation as part of a collaboration with the Midwest Center for Investigative Reporting, shows workplace, school and prison outbreaks are driving the increases — and that many of these outbreaks have never been made public.

The Illinois Department of Public Health, citing a state communicable diseases code, does not release details about where many outbreaks have occurred, limiting its disclosures to long-term care and assisted living facilities. Separately, the Illinois Department of Corrections and some county health departments regularly release numbers of infected inmates and prison staff. 

But the internal statewide data we obtained — prepared by the state health department and covering four different dates between July and September — gives detailed information and case counts for nearly 2,600 separate outbreaks across Illinois. 

“Even though they are close to it, sometimes the infected don’t know that there’s an outbreak where they work. It’s a problem,” said Dr. Michael D. Cailas, an associate professor of occupational and environmental health sciences at the University of Illinois School of Public Health, who reviewed the confidential state data for this story. Cailas, who has mapped Chicagoland long-term care outbreaks, added that many of the workplace outbreaks in Illinois are simply “not known” to the public.

In response to questions, the Illinois Department of Public Health said that it is bound by state and federal laws designed to protect the identity of those infected. “Another consideration is the fact that people may not have become infected at the business location,” said department spokesman Melaney Arnold. As part of its contract tracing efforts, the health department is compiling data on the types of facilities and locations where outbreaks are occurring and is “working to make this information available.”

The data shows:

The single biggest source of coronavirus infections in Illinois are federal, state and county prisons and jails. The Cook County Jail has 1,074 positive cases, the largest count of any single outbreak.

But significant outbreaks at other Illinois prisons, including Stateville Correctional Center in Crest Hill, near Chicago; East Moline Correctional Center in Rock Island; and Robinson Correctional in Crawford, brings the prison total as of Sept. 30 to nearly 3,400 cases across 27 different facilities. That’s nearly double the almost 1,800 prison figure for Illinois reported by the Marshall

Phase 2b/3 Trial Shows Efficacy of Filgotinib for the Induction and Maintenance of Remission in Moderately and Severely Active Ulcerative Colitis

— Filgotinib 200mg Achieved Endoscopic, Histologic and Six-Month Corticosteroid-Free Remission at Week 58 with a Consistent Safety Profile —

— Study Enrolled Biologic-Naïve and Biologic-Experienced Patients, a High Proportion of Whom Were Highly Refractory —

Gilead Sciences, Inc. (Nasdaq: GILD) and Galapagos NV (Euronext & Nasdaq: GLPG) today presented late-breaking data demonstrating sustained efficacy and safety with filgotinib, an investigational, oral, once-daily, JAK1 preferential inhibitor, for the treatment of moderately to severely active ulcerative colitis (UC). The data from the randomized, double-blind, placebo-controlled, Phase 2b/3 SELECTION trial showed that a significantly higher proportion of patients treated with filgotinib 200 mg, versus placebo, achieved clinical remission at Week 10 and maintained remission through Week 58. In addition, significantly more patients achieved six-month corticosteroid-free remission. The full results were presented today at the 2020 United European Gastroenterology Week (UEGW) Virtual Meeting (Abstracts #LB19 and #LB20).

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20201012005470/en/

UC is a longer-term condition characterized by inflammation of the mucosal lining of the colon and rectum. An increasingly prevalent disease, UC has a significant impact on the quality of life of more than 2 million people around the world. Despite current treatments, many patients experience fecal urgency, incontinence, recurring bloody diarrhea and the need to empty their bowels frequently, often accompanied by abdominal pain, poor sleep and fatigue.

“There remains a tremendous need for treatments that can achieve meaningful and sustained clinical outcomes in ulcerative colitis,” said Laurent Peyrin-Biroulet, MD, PhD, Gastroenterology Department at Lorraine University in France, and presenting investigator of the SELECTION maintenance study. “These study results showed that filgotinib reduced bleeding and stool frequency while also achieving remission across a range of measures, including endoscopy and histology, in an oral formulation.”

The SELECTION study included biologic-naïve patients, for whom prior conventional therapy had failed, as well as biologic-experienced patients – a high proportion of whom had been non-responders to at least two different lines of prior biologics. In total, 43 percent of patients in the biologic-experienced cohort had failed treatment with both a TNF inhibitor and vedolizumab. The study allowed the enrollment of patients who were taking steroids, and/or immunomodulators, including methotrexate, mercaptopurine (6-MP) or azathioprine, as they would in real-world clinical practice.

Efficacy Data of Filgotinib in Induction and Maintenance

Overall, 1,348 biologic-naïve or biologic-experienced adult patients with moderately to severely active UC were randomized and treated in the SELECTION study. Among biologic-naïve patients treated with filgotinib 200 mg, a significantly higher proportion of patients achieved clinical remission at Week 10 compared with placebo (26.1% vs. 15.3%, p=0.0157). Additionally, a significantly higher proportion of biologic-naïve patients treated with filgotinib 200 mg versus placebo achieved Mayo Clinic Score (MCS) remission (24.5% vs. 12.4%, p=0.0053), endoscopic remission (12.2% vs. 3.6%, p=0.0047) and histologic remission (35.1% vs. 16.1%, p<0.0001). A significantly higher proportion of biologic-experienced patients treated with filgotinib 200mg achieved clinical remission at Week 10 compared with placebo (11.5% vs. 4.2%, p=0.0103).

Patients treated with filgotinib who achieved clinical response or

Remdesivir study shows promise for COVID-19, but no magic bullet

Oct. 12 (UPI) — The results of the ACTT-1 trial, which looked at the effectiveness of remdesivir as a treatment for COVID-19, have finally been published. So far the only drug that has been shown to reduce deaths from the disease has been dexamethasone, a steroid that suppresses the immune system through its anti-inflammatory effects. Steroids have a secondary effect on the disease — they don’t target the virus itself. Remdesivir, on the other hand, goes straight to the cause of the disease by inhibiting the virus.

The drug, which was developed by Gilead Sciences, was approved for use by the U.S. Food and Drug Administration under an “emergency use authorization” on May 1. It was recently used to treat President Donald Trump.

Gilead Sciences has claimed that the drug has significant benefits for patients — but robust data has been lacking until now. This makes the long-awaited results of the ACTT-1 trial important. Having read the study, most physicians treating patients with COVID-19 will be asking themselves the same question: “Should I be using remdesivir for my patients?”

Who should get it?

The trial follows a gold-standard design of being double blind, randomized and controlled, and like most trials published in top medical journals, at first glance the outcomes are fairly impressive. They found that patients receiving the drug improved and recovered more quickly, were less likely to progress to severe disease, were discharged from hospital sooner, and had a lower death rate of 11.4% compared with 15.2% in patients receiving “usual” treatment.

Based on these positive findings, it would be tempting to conclude that all patients who have the disease should receive the drug, but since it costs around $2,340 to treat one patient, and is likely to be in short supply in the United Kingdom for the foreseeable future, the question warrants a more considered analysis.

The use of any drug also has potentially negative consequences. Remdesivir has not been around long enough to have a track record for safety, and the reports of side effects in COVID-19 patients continue to grow.

When we unpick the data and look at analyses of smaller groups (subgroup analyses), the only patients for whom benefit was conclusively demonstrated were those who were less severely ill and receiving only supplemental oxygen rather than being on a ventilator. It is worth remembering that ACTT-1 is a relatively small trial and sicker patients may well benefit, but it has yet to be proven. Another interesting subgroup analysis showed that patients receiving dexamethasone showed added benefit with the addition of remdesivir, which is good news.

No magic bullet

So when I go into my hospital this week and am confronted on the wards with patients who are ill with COVID-19, ACTT-1 tells me that, provided I can find remdesivir on the pharmacy shelf, I should be confident to use it in any patients who are receiving oxygen alone, in the hope that they will recover sooner and, more importantly, avoid progression to needing ventilation

New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients

New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients

PR Newswire

WASHINGTON, Oct. 8, 2020

WASHINGTON, Oct. 8, 2020 /PRNewswire/ — Today, the Berkeley Research Group (BRG) published an analysis of historical trends in 340B contract pharmacy arrangements. The findings conclude that the growth in the number of these arrangements is fueling explosive growth in the program at large and driving the 340B program farther and farther away from its original intended goal of providing discounted medicines to safety-net entities treating uninsured and vulnerable patients. 

New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients
New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients

Congress created the 340B program to help safety-net providers, including certain qualifying hospitals and federally-funded clinics, access discounts on prescription medicines for low-income or uninsured patients. In 2010, a Health Resources and Services Administration (HRSA) policy opened the door to allow all 340B entities to contract with an unlimited number of for-profit retail pharmacies (e.g., CVS, Walgreens) to dispense 340B medicines. While this policy may have been intended to improve patient access to needed medications, it had the misguided effect of creating an opening that allowed for-profit vendors, pharmacies and pharmacy benefit managers to exploit the program and make a profit on 340B sales – sales intended to benefit low-income and vulnerable patients.

“It is clear that contract pharmacies have leveraged market power to drive unprecedented program growth and siphon money out of the program and away from vulnerable patients,” said Stephen J. Ubl, president and chief executive officer of the Pharmaceutical Research and Manufacturers of America (PhRMA). “I urge lawmakers to consider the results of this analysis and pursue policies that ensure the 340B program benefits vulnerable patients rather than just line the pockets of for-profit corporations.”

Key findings from the analysis show that many retail pharmacies and other third parties have taken advantage of and financially benefited from the 340B program’s contract pharmacy arrangements:

  • 340B covered entities and their contract pharmacies generated an estimated $13 billion in gross profits on 340B purchased medicines in 2018, which represents more than 25% of pharmacies’ and providers’ total profits from dispensing or administering brand medicines.

  • Following HRSA’s expansion of the contract pharmacy program in March 2010, contract pharmacy participation grew a staggering 4,228% between April 2010 and April 2020.

  • While over 27,000 distinct pharmacies participate in the 340B program today, over half of the 340B profits retained by contract pharmacies are concentrated in just four pharmacy chains – Walgreens, Walmart, CVS Health and Cigna’s Accredo specialty pharmacy.

Analysis after analysis shows there is explosive growth in the program, but there is little to no clear evidence that this growth has benefited low-income and vulnerable patients. Even the New England Journal of Medicine found no evidence that expansion of the 340B program has resulted in improved care or lower mortality among low-income patients.

These new findings build upon a mounting body of evidence from the Government Accountability Office

UN chief: Pandemic shows need for universal health coverage

The United Nations chief says the coronavirus pandemic has highlighted the “utterly inadequate health systems” around the world and he argues that universal health coverage is essential for nations to deal with future health crises

He said the failure to respond adequately to the outbreak has claimed more than 1 million lives, infected over 30 million people in 190 countries, wiped out 500 million jobs and is costing the global economy $375 billion a month. Indicators of human advancement and well-being are going in reverse for the first time since the U.N. started measuring them in 1990, he added.

Guterres said in a video message and policy briefing that COVID-19 has shown the need for universal health coverage, strong public health systems, and emergency preparedness for communities and people everywhere.

“At least half the world’s people do not have access to the health services they need,” he said. “Some 100 million people are driven into poverty each year by catastrophic health care costs.”

The secretary-general noted all countries agreed in 2015 on U.N. goals for 2030 that include working toward universal health coverage, “but we cannot wait 10 years.”

“We need universal health coverage, including mental health coverage, now,” Guterres said.

According to the new policy paper, “health is a fundamental human right, and universal health coverage is a critical tool for achieving health for all.”

“Universal health coverage is defined as a situation where all individuals and communities receive the health services they need without undue financial hardship,” it says.

“The report is not linked to the electoral calendar here in the United States,” Dujarric said. “It is targeted at every country, and I think we see the world over the issues that arise when people don’t have access to health care.”

The policy paper also calls for urgent efforts to control further transmission of the coronavirus, including universal provisions for testing, isolating, contact tracing and care, and the protection of other health services during the pandemic.

“COVID-19 is indirectly killing people with heart disease and cancer, as well as those it infects,” Guterres said. “And access to mental health services and sexual and reproductive health programs cannot be compromised.”

He also called for a huge expansion of access to new rapid diagnostic methods and treatments, and ensuring that future coronavirus vaccines “are a global public good with equitable access for everyone, everywhere.”

The lessons learned from the pandemic “call for universal health coverage

COVID-19 ICU Patients Have High Risk of Clots, Research Shows | Health News

By Alan Mozes
HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 6, 2020 (HealthDay News) — Hospitalized COVID-19 patients face an increased risk of developing dangerous blood clots, a new review indicates.

The odds of a clot are highest for the most critically ill patients. Analysis of 66 studies found that 23% of COVID-19 patients in an intensive care unit (ICU) developed a blood clot in the leg, known as a deep vein thrombosis (DVT).

Overall prevalence of a DVT was 14% among ICU and non-ICU COVID-19 patients, and 8% among those with mild-to-moderate disease risk who were not admitted to the ICU.

The “numbers are surprisingly high when compared with other hospitalized patients,” said study author Dr. Cihan Ay.

Of great concern are blood clots in the legs that can break away and travel to the lungs. This is a life-threatening condition known as pulmonary embolism (PE).

Nearly 4% of patients not admitted to the ICU developed a pulmonary embolism. And “we found a very high PE risk of 14% in patients treated at an intensive care unit,” said Ay, an associate professor in hematology and hemostaseology at the Medical University of Vienna in Austria.

According to the American Heart Association, DVT and PE are each a form of venous thromboembolism, or VTE, as both refer to a blood clot that originates in a vein.

VTE is estimated to affect between 300,000 and 600,000 Americans every year, the AHA notes. It is most frequently triggered by surgery, cancer, hospitalization or long-term immobilization.

To examine VTE risk related to COVID-19, Ay and his colleagues analyzed the findings of 66 studies, involving roughly 28,000 COVID-19 patients.

On average, the COVID-19 patients were about 63 years old, and six in 10 were men. About one-fifth had been admitted to an ICU.

None of the studies looked at clotting risk among COVID-19 patients who had not received hospital treatment. So the findings do not speak to DVT or PE risk among such patients, said Ay, although “it seems that the risk of clots is low in patients with a mild clinical course of COVID-19.”

Early in the pandemic, it became clear that blood clot risk seemed elevated in patients with COVID-19 compared to other diseases. To prevent clotting, “physicians worldwide intensified dosing of blood thinners for COVID-19 patients,” Ay said.

This created another potential problem, however, since blood thinners increase the risk of bleeding.

The study authors hope their review will offer clinicians more insight into clotting risk profiles, offering guidance as to which patients truly need preventive clot treatment, Ay said.

As to why COVID-19 might drive up clotting risk in the first place, Ay said experts can only speculate based on available data.

“First, the clinical course in such patients is often severe, which by itself increases the thrombosis [clotting] risk,” he said. “Second, researchers found that COVID-19 interacts with the blood clotting system and the blood vessels, which might explain the increased risk in those patients.”

Dr. Gregg Fonarow is director of the

White House outbreak shows limits of COVID-19 testing strategy

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Days after President Trump tested positive, White House press secretary Kayleigh McEnany has also tested positive for COVID-19.

USA TODAY

White House Press Secretary Kayleigh McEnany said she tested negative for COVID-19 “every day since Thursday” – until she tested positive Monday. 

McEnany’s disclosure shows the limits of daily testing in halting the spread of the coronavirus that causes COVID-19. A person might have such small traces of the virus after exposure a case isn’t identified until days later, even using the most accurate and sensitive tests.

It’s “what we call a window period: that’s the period after you get infected and before you test positive,” said Dr. Richard Scanlan, chair of the College of American Pathologists Council on Accreditation.

The widening outbreak of people connected to President Donald Trump brings new scrutiny to the White House’s strategy, which relies on testing everyone who comes in close contact with the president. But experts say a coronavirus test is a just snapshot at any given moment.

Some public health experts criticize the White House for putting so much weight on frequent testing. Test specificity ranges across the board – some need only small amounts of virus particles to produce a positive result, while others require tens of thousands of particles.

people positive around trump (Photo: Javier Zarracina)

The most sensitive type of test is polymerase chain reaction, or PCR, which amplifies a small amount of DNA sample from a nasal swab. PCR tests are usually conducted at labs and can take days to process, but some portable machines can deliver results in less than one hour.

PCR tests can usually detect a virus four days after a person is infected, Scanlan said. 

Antigen tests, which detect proteins of the coronavirus, are less expensive and deliver results more quickly than most types of PCR tests.

The U.S. Department of Health and Human Services has purchased thousands of antigen testing machines and sent them to nursing homes. HHS also purchased 150 million rapid antigen strip tests called BinaxNOW test, made by Abbott Laboratories. 

But antigen tests are less sensitive than PCR tests and often don’t detect an infection until about seven days after a person has been infected, Scanlan said.

A person who becomes sick typically develops symptoms four or five day after exposure. But symptoms can can range from two to 14 days after infection, and many people never get sick. 

“So the PCR test starts picking up the virus about a day before you develop symptoms, whereas the antigen test might be a couple of days after you develop symptoms,” Scanlan said.

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COVID-19 widespread testing is crucial to fighting the pandemic, but is there enough testing? The answer is in the positivity rates.

USA TODAY

More: Rapid, cheap home tests: Companies attempt to make coronavirus tests widely available

More: ‘Totally unacceptable’: Testing delays force labs to prioritize COVID-19 tests for some, not others

More: Inaccurate results from rapid COVID-19 tests raise concerns about widespread screening

The White House has