COPD World News - Week of December 27, 2020

FDA committee recommends authorizing use of second COVID-19 vaccine in US

Silver Spring, Maryland - An FDA advisory committee voted Thursday to recommend that a second COVID-19 vaccine be authorized for emergency use in the United States. The Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted 20-0 with one abstention in favor of authorizing the vaccine’s use in adults aged 18 years or older, setting the stage for the FDA to issue a second emergency use authorization (EUA) for a vaccine in as many weeks, which it is widely expected to do. The messenger RNA (mRNA)-based vaccine developed by Moderna Inc. and the NIH was shown to be safe and highly efficacious in an ongoing phase 3 trial, according to results released by Moderna last month that were confirmed in an FDA document published this week. Last week, the VRBPAC endorsed another mRNA-based vaccine developed by Pfizer and BioNTech, which was followed a day later by the FDA issuing an EUA for the vaccine for patients aged 16 years or older. Priority groups, including health care workers, began receiving that vaccine on Monday amid a record surge in cases in the U.S. According to tracking by Johns Hopkins University, more than 17 million people in the U.S. have been diagnosed with COVID-19 since the start of the pandemic, and nearly 309,000 people have died. The availability of two highly effective vaccines “is going to finally turn the tide on this pandemic, and quickly,” said Monica Gandhi MD, MPH, professor of medicine and associate chief of the division of HIV, infectious diseases and global medicine at the University of California, San Francisco. “The efficacy of the vaccines is higher than we could have imagined a year ago and — with two options — distribution and administration should occur quickly,” Gandhi told Healio. “If 70% population level immunity is needed to still viral spread, I think this is achievable in the United States by the summer of 2021.” In a VRBPAC briefing document published online this week, the FDA confirmed that the Moderna vaccine was 94.1% efficacious in preventing symptomatic COVID-19, based on 196 cases among the study population as of Nov. 21 — 185 in the placebo group and 11 in the vaccine arm. All 30 documented cases of severe COVID-19 among the study population occurred in the placebo arm. “It’s wonderful that this vaccine has such great efficacy and a great safety profile,” Krutika Kuppalli, MD, assistant professor of medicine in the division of infectious diseases at the Medical University of South Carolina, told Healio. “Hopefully we will be able to get more people to have confidence in the vaccine and take it up.” Gandhi noted that Moderna’s phase 3 trial enrolled over a third of participants from communities of color and over 25% were over age 65 years, in whom the vaccine was 86.4% efficacious. In contrast to the Pfizer and BioNTech vaccine, which needs to be stored at nearly –100°F, the Moderna vaccine is stable for 30 days in a regular medical or home refrigerator, which will make it more accessible, Kuppalli said. “It doesn't need that ultra-cold storage, so we'll be able to make the rollout of the vaccine a bit more feasible for people who live in more rural areas of the United States and other parts of the world where this vaccine will be rolled out,” she said. In response to claims that it was having production issues, Pfizer said Thursday that it had successfully shipped all 2.9 million doses of vaccine requested by the U.S. government to the locations where it was asked to ship them. “We have millions more doses sitting in our warehouse but, as of now, we have not received any shipment instructions for additional doses,” the company said in a statement. Pfizer said it will ship up to 50 million doses of the vaccine globally by the end of this year and up to 1.3 billion doses in 2021. Some locations in the U.S. discovered this week that vials of vaccine delivered by Pfizer contain more doses than expected. The FDA said it OK to use every full obtainable dose from each vial, but that less-than-full doses should not be pooled together from different vials. Moderna has said that it will have approximately 20 million doses of its vaccine ready to ship in the U.S. by the end of 2020 and up to 1 billion doses available globally in 2021. Both vaccines are given in two doses — Pfizer’s 21 days apart, and Moderna’s 28 days apart. “This is really a great moment for science in terms of what we have been able to do so quickly in the setting of this horrible pandemic,” said Kuppalli. Like many health care workers, Kuppalli received the first dose of the Pfizer vaccine earlier this week. Residents of long-term care facilities are also being prioritized in the first wave of vaccinations. “I had very mixed feelings in terms of being excited to be in the first round of vaccinations but [also] definitely feeling a little bit sad and feeling a little bit guilty because there are so many people out there who need this life saving therapeutic,” Kuppalli said. “I really want to make sure that we are able to get it to everyone who needs it. I’m very happy that we're moving forward with this process to try and continue to scale up our vaccine production and vaccine rollout for everybody who needs it and not just here, but really, we need to do this all over the world.”

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COPD World News - Week of December 20, 2020

Covid vaccine boost for millions as hospitals near braking point

Oxford, UK - The coronavirus vaccine developed by Oxford University and Astra Zeneca is expected to win approval next week as the head of the drugs giant said it “should be” effective against the highly transmissible new strain of the virus. Senior government officials expect the drugs watchdog to give the green light before Thursday, speeding up the provision of the jab to the 15m people who could end up in hospital if they caught the virus. Astra Zeneca’s chief executive, Pascal Soriot, today reveals that new data will show the vaccine is as effective as the Pfizer and Moderna jabs that have already been approved, protecting 95% of patients, and is “100% effective” in preventing severe illness requiring hospital treatment. Approval for the drug cannot come soon enough officials said.

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COPD World News - Week of December 13, 2020

Germany to impose stricter lock-down to battle COVID-19

Berlin, Germany - Germany will close most stores from December 16th until at least Jan. 10, cutting short the busy Christmas shopping season, as it tightens coronavirus restrictions and tries to rein in the spread of the disease, Chancellor Angela Merkel said. “I would have wished for lighter measures. But due to Christmas shopping the number of social contacts has risen considerably,” Merkel told journalists following a meeting with leaders of the country’s 16 federal states. “There is an urgent need to take action,” she said. Only essential shops such as supermarkets and pharmacies, as well as banks, are to remain open from December 16th. Hair salons, beauty salons and tattoo parlours will also have to shut. The government will support affected companies with a total of around 11 billion euros ($13.3 billion) a month. Businesses that are forced to close may receive up to 90% of fixed costs, or up 500,000 euros a month, Finance Minister Olaf Scholz said. Schools will be closed in principle, and employers are asked to close operations or have employees work from home. The sale of fireworks will be banned ahead of New Year’s Eve. Germany has been in partial lock-down for six weeks, with bars and restaurants closed, while stores and schools have remained open. Some regions have already imposed tougher measures as infections grew. “‘Lock-down light’ has had an impact, but it was not sufficient,” Bavaria’s prime minister Markus Soeder said. “The situation is out of control.” Private gatherings will remain limited to no more than five people from two households. For the Christmas holidays, the rule will be eased slightly so that families can celebrate together. Merkel and Soeder said it was too soon to say whether the economy could re-open after Jan. 10. New daily infections and deaths have reached records in recent days, and more politicians have been sounding the alarm. Germany, Europe’s largest economy, was more successful than many European countries in keeping the pandemic under control in the first wave in March and April. But it has been struggling to turn the tide in the second wave. The number of confirmed coronavirus cases in Germany increased by 20,200 to 1,320,716, data from the Robert Koch Institute (RKI) for infectious diseases showed on Sunday. The reported death toll rose by 321 to 21,787, the tally showed.

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COPD World News - Week of December 6, 2020

Vaccines have become political

Ottawa, ON - It was inevitable that the federal government's handling of COVID-19 vaccines would become political. Politics has shaped public perceptions of the pandemic's severity since it began. But now the vaccines themselves are becoming politically polarized, with divisions emerging between those who want them and those who don't. Since the spring, polls have shown consistently that one of the major factors associated with how Canadians view the pandemic is how they vote. Supporters of the Liberals and New Democrats have been more likely to report concerns about the public health risks of COVID-19, while Conservative voters have been more likely to eschew precautions and oppose restrictions. Polling conducted by a number of firms in November — as cases across the country continued to rise — still showed signs of this split between left and right in Canada. The latest survey by Léger for the Association of Canadian Studies suggests that only 12 per cent of Liberal voters want to ease pandemic restrictions as soon as possible — even if another wave is possible early in the new year — while 31 per cent of Conservative voters say they want governments to ease up. The poll also found that 52 per cent of Conservative voters are very or somewhat afraid of contracting COVID-19, compared to 66 per cent of New Democratic voters and 74 per cent of Liberal supporters. A recent poll by the Angus Reid Institute (ARI) found that between 87 and 89 per cent of Canadians who voted for the Liberals, NDP or Bloc Québécois in last year's election report regularly wearing masks indoors; 71 per cent of Canadians who voted for the Conservatives reported doing the same. And Liberal, NDP and Bloc voters were about twice as likely as Conservative supporters to list COVID-19 as one of their top three issues of concern. When asked how governments should prioritize their responses to the pandemic, Conservatives were about twice as likely as Liberals to tell a recent survey for Abacus Data that there has been "too little emphasis on limiting the impact on jobs, income and the economy" — and more than three times as likely to say there has been "too much emphasis on limiting the health risk." We've seen proof of these political attitudes in how Canadians voted in October's provincial elections in Saskatchewan and British Columbia. The New Democrats (the main left-of-centre party in both provinces) did significantly better among voters who cast ballots by mail — and avoided crowds by doing so — than among those who voted in person. Right-of-centre parties in both provinces did much better in the in-person voting. Since attention has turned to vaccines, the Conservatives in Ottawa have focused their attacks on the federal government's plan to acquire and distribute the vaccines in this country. Conservative Leader Erin O'Toole has claimed that Canada will be "near the back of the line," though vaccines are expected to start arriving in early 2021. But this week's Léger poll suggests a minority of Canadians share O'Toole's concern. While the poll suggests 37 per cent of Canadians are worried Canada might not get the vaccine at the same time as the United States and the United Kingdom — where the vaccines are produced — 48 per cent said they are "not that concerned" and feel "a few months won't make much of a difference." A recent Léger poll suggests Conservative voters are more likely than other Canadians to be concerned about a delay in obtaining vaccines — and less likely to want to get vaccinated as soon as possible. 

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COPD World News - Week of November 29, 2020

Ontario woman receives $12K ambulance bill from Nova Scotia

Toronto, ON - Ontario resident Madelyn MacNeill is healthy and so didn't expect she'd be rushed to hospital for emergency surgery while visiting her parents in Nova Scotia during the summer. Nor did she expect the almost $13,000 bill for ground and air ambulance transportation that arrived weeks after she returned to Ontario. It's a cautionary tale for anyone travelling between provinces, especially during these COVID-19 times. "When I opened up the bill and saw it was $12,800 my jaw dropped. I was in quite a bit of shock," the 27-year-old said. "I can't afford to pay that amount of money all upfront. It boggles my mind."  In June, MacNeill, who lives in Toronto, was working from home and hadn't seen her family for a while. She figured she'd drive home to Nova Scotia, self-isolate and continue to work, then enjoy some family time. However, on the last day of isolation, she experienced problems and days later an ambulance was required to take her to the New Glasgow hospital. Ontario resident Madelyn MacNeill (far right) did get to enjoy some time with family this summer, but left with a hefty ambulance bill. Once there, it was determined she needed emergency surgery in Halifax, about 150 kilometres away. She was told there were no ground ambulances available so she was transported by air and underwent surgery right away. "At no time was I told I would be footing the bill for the air ambulance or any sort of cost associated with the inter-hospital transfer," she said. She did expect a bill for the ground ambulance. MacNeill said she has Ontario provincial health coverage and insurance through her work and never imagined she would need travel health insurance while in another part of Canada. "Every time I travel out of the country, I always purchase traveller's insurance but I honestly never thought that I would need travel insurance for inter-provincial travel. I always thought in Canada we had universal health care," she said. Ontario resident Madelyn MacNeill was billed $12,000 in August for an air ambulance transport from Aberdeen Hospital in New Glasgow, N.S., to the Halifax Infirmary. (Submitted) Even ambulance travel within a province can be pricey and cause financial hardship, a situation highlighted by CBC's Marketplace back in 2015. Today those fees for ground ambulance for provincial residents vary from a low of $45 in Ontario to a high $325 in Saskatchewan. Some provinces, such as Alberta, provide free ground ambulance service for seniors. Manitoba, which in 2015 had the highest ground ambulance fees in the country, has lowered its fee to no more than $250.   All provinces charge non-residents more for ambulance services. Not all provinces post their fees online and despite numerous requests, some did not provide CBC with the information. Of those that did, Nova Scotia had the highest fee of $732.95 for ground ambulance for people from other provinces. The fee for residents of the province is $146.55. Air ambulance fees are even costlier for out-of-province residents. Of those provinces which post fees or provided information, P.E.I. and Nova Scotia do not charge residents, but people from other provinces who require the service are billed $12,000. Both provinces, along with Newfoundland and Labrador, say they bill on a "cost recovery" basis. Health care consultant Mary Jane Hampton said ambulances are not part of the Canada Health Act, the federal legislation that sets out what is universally covered.  "It's a complicated business but when the Canada Health Act was written, the only things that were covered in that legislation that would be insured were things that happened inside a hospital and services that are performed by a doctor," Hampton said. She notes ambulances in Nova Scotia used to be based at funeral homes and were used for basic transportation in a medical emergency. Today, they are staffed by highly qualified paramedics.  "I'm not suggesting that it's an easy issue to fix, but from a public point of view and from a patient point of view, it would make a great deal of sense to me for us to figure out how to get the [ambulance] user fees off the table and come up with a different funding model altogether," Hampton said, She urged people to contact their member of Parliament about rewriting legislation to make ambulances an essential service.

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COPD World News - Week of November 22, 2020

Potential new target to combat inflammatory diseases

Melbourne, AU - An international team of researchers have uncovered a drug-like compound that blocks a crucial inflammatory pathway, potentially paving the way for a new treatment for a host of diseases—including COVID-19. WEHI's Associate Professor Seth Masters and his research team discovered the compound could prevent up-regulation of CD14, a key inflammatory protein. The discovery was recently published in EBioMedicine. Inflammation is our body's natural reaction to infection, said Associate Professor Masters. "In the beginning, it helps you fight the infection—but too much inflammation is linked to a range of chronic and acute diseases," he said. In a viral disease such as COVID-19, some patients experience excessive inflammation—called a cytokine storm—which can lead to hospitalization or death. Blocking the CD14 pathway can reduce the severity of many diseases, and potentially save lives. The team focused their research on a protein called CD14, that is found on certain inflammatory immune cells called macrophages. "CD14's job is to detect infection, helping to drive inflammation to clear a pathogen. But we know that the amount of CD14 increases on macrophages as inflammation progresses, potentially getting out of control, which could lead to worse outcomes for infections or other diseases," Associate Professor Masters said. "Our team used CRISPR technology to search for genes that help CD14 levels to rise. We found many really interesting genes that were critical—and when we turned these genes off, they could prevent CD14-driven inflammation from overwhelming the body. Excitingly, a drug-like inhibitor blocks the protein produced by one of these genes. We found this compound could block the rise in CD14 and consequent inflammation in the laboratory, which is incredibly promising," Associate Professor Masters said the discovery of a potential anti-inflammatory compound opened the doors for new anti-inflammatory therapies. "If this compound could be developed into a safe and effective drug, it could potentially assist in the treatment of many inflammatory diseases. However, once available, the drug would only be beneficial for curbing severe inflammation. Inflammation is a critical process for fighting many infectious, so we only need to use an anti-inflammatory drug for the most severe and life-threatening forms of inflammation," Associate Professor Masters said. The next step in this research would be to see if this drug candidate worked against particular diseases in pre-clinical trials. There is great hope this research will one day be translated into an effective treatment for inflammatory illnesses." The research was supported by a Viertel Senior Medical Research Foundation Fellowship (SLM), the European Union's Horizon 2020 research and innovation program, and the Australian and Victorian governments. GSK funded aspects of the research.

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COPD World News - Week of November 15, 2020

Are Albertans working while sick?

Calgary, AB – According to a news report from Edmonton City News the exponential rise of COVID-19 cases in Alberta has the province’s top doctor increasingly worried, especially as those that are sick, are still working, shopping, and meeting while symptomatic. “A further eight per cent visited retail or service businesses and eight per cent attended a social gathering,” said Chief Medical Officer of Health, Dr. Deena Hinshaw. That data is coming from Edmonton but the numbers not far off in Calgary. So why are people working and going out while sick, and will the enforcement of fines stop the behaviour? “I think the question we have to ask ourselves is what pressures they are under to continue doing what they’re doing.” Stefan Baral is a public health and family physician studying the inequities of the pandemic. He said enforcing COVID-19 could unfairly impact lower-income or marginalized communities. “I think it’s not because they want to break the rules, it’s because they’re feeling pressures in different ways about their own basic needs and often of their families.” Baral said, for example, those without stable living, can’t self-isolate in their own room, or those who need to work to support their families may not get paid sick leave and must work. “A lot of the infections that are happening in people’s homes are related to unmet needs,” added Baral. “I think some of it may be related to education, I think a lot of it is related to desperation.” The Canada Recovery Sickness Benefit offers up to $500 per week to those who don’t receive paid sick leave, but union officials said that amount is not enough to pay the bills, it may not come soon enough, and the application process may present barriers. Defiance in the pandemic has been documented including a mostly maskless gathering Wednesday in Winnipeg which exceeded the limit of five people. However, Baral said, for the most part, there’s a social imbalance in truly staying safe from the virus. “This response is really more of a nuisance for folks already on the margins, who live in multi-generational homes. The response feels best designed for those who are the richest.” Baral said before we take the enforcement approach, officials should address gaps with resources and supports.

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COPD World News - Week of November 8, 2020

Study looks at long-term benefits of pulmonary rehabilitation in COPD patients

Azusa, CA – A recent study published in the Journal CHEST looked at the effects of pulmonary research in chronic obstructive pulmonary disease. The study focused on whether pulmonary rehabilitation (PR) improves exercise capacity in patients in the short-term. In patients with COPD, the researchers explored the long-term benefits on symptoms of dyspnea, anxiety, depression and quality of life two years after completion of eight weeks of PR. One hundred sixty-five COPD patients completed an eight-week, community-based, comprehensive PR program, comprising two-hour sessions twice weekly. Sessions included aerobic exercise and an educational program. Patients were encouraged to perform daily walking exercise up to 30 minutes at home. The researchers evaluated a number of outcome measures at baseline, 8 weeks and 2 years including: dyspnea measured by the modified Medical Research Council (mMRC) questionnaire, quality of life assessed by Saint George’s Respiratory Questionnaire (SGRQ), and anxiety measured by the Anxiety Inventory for Respiratory Disease (AIR) and using the Depression Anxiety Stress Scale (DASS). In addition, they measured exercise capacity using the Incremental Shuttle Walk Test (ISWT) at baseline and 8 weeks. Mean age of patients in the study (SD) was 72 (8.6) years; 55% were men. At 8 weeks, improvements in mMRC, SGRQ, ISWT, DASS and AIR were all statistically significant (p<0.001). During the 2-year follow-up, changes observed at 8 weeks were maintained for anxiety symptoms, and for symptoms, impact and total SGRQ scores. In multivariate analysis, initial elevated levels of dyspnea, depression, anxiety and decreased exercise capacity predicted greater quality of life improvement at 2 years (all p<0.001). They concluded that over a 2-year period, an effective 8-week PR program provides sustained improvement in anxiety and quality of life. Short-term improvements in dyspnea, depression and stress symptoms at 8 weeks were not maintained at 2 years.

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COPD World News - Week of November 1, 2020

Australia records zero Covid-19 cases for first time in five months

Victoria, AU - Zero cases were reported in the 24 hours between 20:00 on Friday and 20:00 on Saturday - the first time this has happened since 9 June. The state of Victoria - epicentre of Australia's second wave - recorded zero cases for the second day in a row after a 112-day lockdown. Health officials say more restrictions may be eased in the coming days. "Thank you to all of our amazing health & public health workers & above all else the Australian people," Health Minister Greg Hunt said on his Twitter account. Australia has recorded some 27,500 infections and 900 deaths to Covid-19 since the pandemic started - far fewer than many nations.The nation of 25 million adopted an approach of using lockdowns and proactive testing and tracing to contain the virus, and Victoria - where 90% of Covid deaths occurred - imposed some of the severest stay-at-home and curfew rules in the world. Victoria and its largest city Melbourne began to reopen earlier this week after recording no new community-transmitted cases since June. People were able to freely leave their homes, retail stores, restaurants, cafes and bars could reopen and groups of up to 10 could start gathering. Victorian Premier Daniel Andrews praised the state's six million residents for following such strict rules and said they were well placed for a "Covid-normal Christmas".

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COPD World News - Week of October 25, 2020

EU removes Canadians from list of approved travelers because of COVID-19

Brussels, Belgium - European Union officials are moving to halt Canadians from travelling to the bloc of European countries amid the coronavirus pandemic. In July, the EU set up a list of countries whose citizens would be allowed access for non-essential travel. Canada had been on the approved list from Day 1, along with 14 other countries. The United States has been on the list of banned countries from the start. In August, the EU removed Algeria, Montenegro, Morocco and Serbia from the list because of rising COVID-19 case numbers in those countries. Officials meet every two weeks to decide if any changes should be made to the list, and no changes had been recommended since then. On Wednesday, officials met for their regularly scheduled meeting. According to Reuters, Bloomberg and other reports, they decided to remove three countries — Canada, Tunisia and Georgia — while adding Singapore to the approved travel list. An EU official speaking on condition of anonymity confirmed to CBC News that the bloc has decided to change the makeup of the list, the finalized version of which is expected to be made public within days. According to CBC's coronavirus tracker, there are more than 203,000 confirmed cases of the disease across Canada, with 2,251 new cases on Tuesday. After the changes, the list consists of nine countries: Australia, China, Japan, New Zealand, Rwanda, Singapore, South Korea, Thailand and Uruguay.  The decision doesn't ban travel immediately, nor is it necessarily strictly enforced in every EU country. Some countries, such as France, have not placed any restrictions on visitors from countries on the list. Germany has pared the list down while Italy requires a period of self-isolation and demands travelers take a private vehicle to their destinations even if they are on the list. The Canada Border Services Agency doesn't provide a detailed breakdown of how many Canadians have been travelling to various EU countries, but Statistics Canada does note that in July, the month with the most up to date data, 9,045 people came to Canada from Europe, including 2,044 from France, 691 from the Netherlands and 857 from Germany.

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COPD World News - Week of October 18, 2020

Blood type may be linked to risk for COVID-19 infection, likelihood of severe outcomes

Odense, Sweden - People with blood type O may be less likely to develop COVID-19 infection, and they may have a lower risk for severe outcomes if they contract the virus, according to results of two studies published in Blood Advances. Previous studies have shown several factors — including age, sex and comorbidities, such as cardiovascular disease — are associated with COVID-19 infection. However, severe cases are not limited to these risk groups. Other studies have suggested a potential role of ABO blood groups in risk for infection. “ABO blood groups are increasingly recognized to influence susceptibility to certain viruses, including SARS-CoV-1 and norovirus,” Torben Barington, MD, professor of medicine at Odense University Hospital and University of Southern Denmark, and colleagues wrote. “A, B and AB individuals are also at increased risk for thrombosis and cardiovascular diseases, which are important comorbidities among hospitalized COVID-19 patients, possibly mediated by glycosylation of proteins involved in hemostasis.” Infection risk In a retrospective cohort study, Barington and colleagues analyzed data of over 840,000 individuals in Denmark who underwent testing by polymerase chain reaction for SARS-CoV-2 between Feb. 27 and July 30. Most of those tested (56%) had available ABO and RhD blood group information. Researchers used ABO and RhD data of 2,204,742 individuals not tested for SARS-CoV-2 as a reference. This corresponded to approximately 38% of the entire Danish population. ABO and RhD blood groups and test results for SARS-CoV-2 served as the primary outcome. Hospitalization and death due to COVID-19 served as secondary outcomes. Of the 473,654 tested individuals who had a known blood group, 7,422 were positive for SARS-CoV-2 and 466,232 were negative. The positive and negative groups had similar proportions of men (32.9% vs. 32%) and similar median ages (52 years vs. 50 years). Results showed a small but statistically significant difference in blood group distribution between those with SARS-CoV-2 and those in the reference population (P < .001). Among patients with SARS-CoV-2, considerably fewer (38.4%) had blood type O than other tested blood types (P < .001). When excluding blood type O, researchers observed no significant differences among patients with blood types A, B and AB. They also observed no difference in the RhD group between positive cases and the reference population. The investigators reported RRs for contracting SARS-CoV-2 of 0.87 (95% CI, 0.83-0.91) for blood type O, 1.09 (95% CI, 1.04-1.14) for blood type A, 1.06 (95% CI, 0.99-1.14) for blood type B and 1.15 (95% CI, 1.03-1.27) for blood type AB. “It is very important to consider the proper control group because blood type prevalence may vary considerably in different ethnic groups and different countries,” Barington said in a press release. “We have the advantage of a strong control group because Denmark is a small, ethnically homogeneous country with a public health system and a central registry for lab data. So, our control is population-based, giving our findings a strong foundation.”

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COPD World News - Week of October 11, 2020

Continual lockdowns are not the answer to bringing Covid under control

Opinion: Edinburgh, Scotland - In April, cafes and restaurants opened in Vietnam full of bustle and life. In July, 10,000 baseball fans attended a match in a stadium in Taiwan. In August, thousands packed together for a music concert at the Wuhan Maya Beach Water Park in China. And this month, rugby internationals are going ahead in New Zealand with stadiums at full capacity. Daily life within these places has largely returned to normal. Compared to other countries, they have faced minimal economic damage. In fact, Taiwan never even had a lockdown, while lockdown measures in Vietnam, New Zealand and China were early, short and sharp. Out of a population of 1.4bn people, China has only suffered 4,634 Covid-19 deaths; Vietnam, Taiwan and New Zealand together have had 67. How are these countries keeping Covid-19 under control, their health services running, and their economies and societies afloat asks Prof Devi Sridhar of the University of Edinburgh. That’s the question we should all be asking. Instead, seven months into this crisis, the UK remains stuck in endless cycles of lockdown measures, its media still fixated on paralysing debates about how serious the virus really is and what the optimal strategy for addressing it should be. The UK initially made the mistake of treating coronavirus like flu. It was late to lock down, initially allowing the virus to spread through the population like a common cold. Once the severity of the virus became clear and the government enforced a lockdown, it squandered time and instead waited to see what would happen. Over the course of the past few months, the case numbers have gone up and down. During the summer, the UK appeared to have crushed the curve and brought its R number under control. But rather than replacing harsh lockdown measures with a functioning testing and tracing strategy, switching from quarantining the population to only quarantining those who had been exposed to the virus, the UK lifted restrictions without an effective fallback. Meanwhile, the government actively encouraged people to go abroad on holidays, meaning the virus was continually reimported to the country, setting off new chains of infection when those people returned. For the government, the purpose of lockdown seemed to be simply that: lock the country down and hope the problem would go away. But lockdown itself doesn’t fundamentally change the virus or its trajectory. It just buys us time. And as time went on, fatigue and anger set in. People started to equate suppressing the virus with staying at home and shutting businesses. The alarm bells began to ring: could the cost of these measures be higher than the toll of the virus itself? Should the lives of millions be constrained just to prevent the deaths of thousands? It’s no surprise that those offering easy, compelling solutions – “You can have your life back by Christmas”; “It’s either the economy or health”; “This virus is practically harmless to those under 55” – have found a willing audience in a frustrated and fatigued society. Many of these arguments can be grouped together under terms such as “herd immunity”, “focused protection” or “shielding the vulnerable”. If the virus is seemingly only a risk to the elderly or those with preexisting conditions, they argue, why not shield the vulnerable and let everyone else get on with normal life? Unfortunately, there are no such easy solutions. This plan may sound good on the surface, but it encounters deep problems in practice. It wouldn’t just be vulnerable people who had to shield, but their household members and those with whom they’re in regular contact. And how do you distinguish the vulnerable from the healthy? This isn’t just about age – Covid is proven to have worse outcomes in people who are overweight, of particular ethnicities, or have preexisting conditions they may not even be aware of. We’re only just beginning to understand the effects of the virus on people with even mild cases. Covid-19 doesn’t just attack the lungs; it also affects the kidneys, liver and blood vessels, and may attack the brain. It can cause long-term problems for young and previously healthy people, such that “long Covid” is now recognised as a condition by the NHS. Another problem is that immunity to coronaviruses wanes quickly and reinfection is possible. “Herd immunity” is illusory – we have no idea whether immunity from Covid is long-lasting, so it’s unlikely we’d reach a position where people who were shielding could safely emerge. After decades, we don’t have herd immunity to cholera, yellow fever, polio, measles, TB, malaria or plague. Public health measures were used to control their spread until vaccines or elimination strategies were developed. In fact, malaria was endemic in parts of the United States until the newly created Centers for Disease Control enacted a massive federal public health campaign to eliminate the disease in the early 1950s. We only reached herd immunity to measles with a vaccine. Similar stories can be told for many of the pathogens that have plagued humanity. So, what are the strategies to deal with coronavirus before an effective vaccine arrives? The answer cannot just be locking down continually, given the large economic and social costs this involves. A recent Lancet peer-reviewed paper, which I co-authored, examined international lessons from easing lockdown and identified three key elements that are essential for bringing the virus under control. Most important is a robust system for testing, tracing and isolating, where test results are returned within 24 hours, at least 80% of people’s contacts are reached and there is high adherence to a rule of 14 days’ isolation for those exposed to the virus. Strong public health guidance on avoiding the virus at any age is needed, encouraging people to get outside as much as possible, to avoid indoor, crowded and poorly ventilated spaces, and to use face coverings and distancing wherever possible. And we need strict border measures to prevent the virus from being reimported, instead of our current system that is lax and poorly monitored. This pandemic is still in its first or second chapter. Waiting for the virus to magically disappear, allowing it to run its course through society, or imposing continual lockdown measures without a clear strategy beyond waiting for a vaccine are all suboptimal choices that will damage our health, our economy and our society. At what stage will Britain look towards east Asia and the Pacific and say, “We want what they have”? At what point will we learn from their playbook: suppressing the virus, opening up the economy and regaining a semblance of normality in our daily lives? • Prof Devi Sridhar is chair of global public health at the University of Edinburgh

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COPD World News - Week of October 4, 2020

Mysterious post-COVID syndrome found in kids is now also affecting adults

Atlanta, GA - Months after the discovery of a "multisystem inflammatory syndrome" tied to COVID-19 in children, health officials are warning that a similar condition can strike adults as well. The Centers for Disease Control and Prevention (CDC) recently released a report describing a "multisystem inflammatory syndrome in adults" or (MIS-A). Like the syndrome in children, MIS-A is a severe illness that targets multiple organs and causes increased inflammation in the body, the report said. And with both syndromes, many patients either test positive for SARS-CoV-2, the virus that causes COVID-19, or have antibodies against it, indicating a recent infection. Currently, MIS-A appears rare, like its counterpart in children. The new CDC report identifies around two dozen cases of MIS-A. Still, the new report, published in the CDC journal Morbidity and Mortality Weekly Report, urges doctors to consider a diagnosis of MIS-A in adults with compatible signs and symptoms. "Ultimately, the recognition of MIS-A reinforces the need for prevention efforts to limit spread of SARS-CoV-2," the authors concluded. Reports of a mysterious inflammatory syndrome in children first appeared in the spring, and doctors dubbed the condition MIS-C, or "multisystem inflammatory syndrome in children." Children with this rare syndrome, which affects multiple organs and often requires hospitalization, can experience fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, and fatigue, according to the CDC. So far, the CDC has received reports of 935 cases of MIS-C in the United States, including 19 deaths. The official definition of MIS-C includes an age limit of 20 years old, and cases have been seen in children, teens and young adults. Over the summer, there were reports of a similar syndrome popping up in adults. The new CDC report describes 27 cases of MIS-A from the United States and the United Kingdom. Sixteen of these cases are described in detail, nine of which were officially reported to the CDC, and seven of which were described in published case reports. Among the 16 cases, patients ranged in age from 21 to 50 years old. Just one case was reported in the UK, with the rest reported in the US, including cases in Maine, Florida, Louisiana, Georgia, New York, Massachusetts, and Texas. Some adult symptoms were similar to those seen in children, including fever, gastrointestinal symptoms, and rash. Some patients reported chest pain or heart palpitations, and all had elevated levels of markers of inflammation. All of the patients had either a positive COVID-19 test or positive antibody test. Ten patients required treatment in the intensive care unit, and two patients died, the report said. The findings "indicate that adult patients of all ages with current or previous SARS-CoV-2 infection can develop a hyperinflammatory syndrome resembling MIS-C," the authors wrote. The authors note that hospitalized patients with COVID-19 in general can experience inflammation and effects on organs beyond the lungs. However, in most cases, those effects are accompanied by serious respiratory problems. However, with MIS-A, patients haven't shown serious respiratory symptoms. Of the 16 patients, half did not have any respiratory symptoms, and half had only mild ones. Concerningly, of 22 patients in the study with information on race/ethnicity available, all but one patient belonged to a minority group. "Long-standing health and social inequities have resulted in increased risk for infection and severe outcomes from COVID-19 in communities of color," the authors said. A similar trend has been seen in children with MIS-C—more than 70 percent of reported US cases have occurred in children who are Hispanic or Black, according to the CDC. The underlying causes of MIS-C and MIS-A are not known. But 30 percent of adults in the current report and 45 percent of a sample of 440 children with MIS-C tested negative for SARS-CoV-2, but positive for antibodies against the virus, "suggesting MIS-A and MIS-C might represent postinfectious processes," the authors wrote. Further research is needed to understand the exact causes of this condition and its long-term effects, they concluded.

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COPD World News - Week of September 27, 2020

Belief in Conspiracy Theories Is a Barrier to Controlling Spread of COVID-19

Philadelphia, PA - Belief in conspiracy theories about the coronavirus pandemic is not only persistent but also is associated with reluctance to accept a COVID-19 vaccine when one becomes available and to engage in behaviors such as mask-wearing that can prevent its spread, according to researchers at the Annenberg Public Policy Center. In a new study, based on a two-wave national panel survey conducted in late March and mid-July, the researchers find that belief in conspiracy theories about the source and seriousness of the pandemic persisted across the four-month period. These beliefs in March were associated with increasing reluctance to adopt preventive behaviors in July, including actions such as mask-wearing and accepting a vaccine when one is available. “Belief in pandemic conspiracy theories appears to be an obstacle to minimizing the spread of COVID-19,” said Dan Romer, research director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, who co-authored the study with APPC director Kathleen Hall Jamieson. “To control the pandemic, we need high rates of mask-wearing, physical distancing, and hand-washing now – and of vaccination when a safe and effective vaccine is available.” The study was published in the journal Social Science & Medicine. Researchers assessed belief in three COVID-19 conspiracy theories in March and July among 840 U.S. adults on a survey panel and found that high proportions believed in them at both times: More than 1 in 4 people (28%) in March reported believing that the Chinese government created the coronavirus as a bioweapon, a proportion that increased to 37% in July; Nearly 1 in 4 (24%) believed in March that some in the U.S. Centers for Disease Control and Prevention, or CDC, are exaggerating the danger posed by the virus in order to damage Donald Trump’s presidency, which increased to 32% in July; Nearly 1 in 7 (15%) believed that the pharma industry created the virus to increase sales of drugs and vaccines, which edged up to 17% in July. Heavy use of conservative media or social media was associated with a greater likelihood that people would report believing in these theories. This study extends prior APPC studies which found that people who rely on social media were more likely to be misinformed about vaccines and that people who used conservative or social media at the outset of the COVID-19 pandemic were more likely to believe conspiracy theories about it and to be misinformed about how to prevent the virus. “Conspiracy theories are difficult to displace because they provide explanations for events that are not fully understood, such as the current pandemic, play on people’s distrust of government and other powerful actors, and involve accusations that cannot be easily fact-checked,” Jamieson said. In the study, the authors argue that counteracting the effects of conspiracy beliefs will require “continued messaging by public health authorities on mainstream media and in particular on politically conservative outlets that have supported COVID-related conspiracy theories.” The researchers found that belief in conspiracy theories was inversely related to the perceived threat of the pandemic; taking of preventive actions, including wearing a face mask; and the intention to be vaccinated when there is a COVID-19 vaccine. Assessing people’s COVID-19 vaccination plans, researchers found a widening gap over time between people who most strongly believed the COVID-19 conspiracies and those who did not believe them. In March, those who did not believe the conspiracies were 2.2 times more likely to intend to be vaccinated than those who most strongly believed in the conspiracies – a ratio that had widened to 3.5 times in July: In March, 37% of people who most strongly believed in these three conspiracy theories reported that they intended to be vaccinated, compared with 81% of the people who did not believe in them. By July, the vaccination intention rates were 22% for those who most strongly believed in these conspiracies and 76% for those who did not believe in them. Believers in the coronavirus conspiracies were also more likely to have doubts about the safety of the measles, mumps, and rubella vaccine (MMR), a concern that appeared to play a role in their heightened hesitancy to accept a vaccine for COVID-19. The first wave of the survey was conducted before the CDC advised people in early April to wear nonsurgical masks as a preventive measure when they go out in public. In July, among those who were most likely to believe in the COVID-19 conspiracies, 62% reported wearing a mask every day that they went outside of the home and had exposure to others – compared with 95% of those who did not believe in the conspiracies. In other words, those who did not believe in the conspiracies were 1.5 times more likely to wear a mask every day outside of the home when they were in contact with others than the people who most strongly believed in the conspiracies. Members of historically disadvantaged racial and ethnic groups were more likely to believe the conspiracies, a finding which is rendered even more troubling because communities of color are disproportionately suffering the effects of COVID-19. However, older adults were less likely to believe the conspiracies, which is good news because they are more likely to suffer from the disease.

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COPD World News - Week of September 20, 2020

Sanofi and GSK sign agreements with the Government of Canada to supply up to 72 million doses of adjuvanted COVID-19 vaccine

London and Paris - Sanofi and GSK have today signed agreements with the Government of Canada for the supply of up to 72 million doses of an adjuvanted COVID-19 vaccine, beginning in 2021. Thomas Triomphe, Executive Vice President and Global Head of Sanofi Pasteur, said: " Today’s announcement showcases our unwavering commitment to develop a COVID-19 vaccine that is available to everyone when it comes to market.  To address a global health crisis of this magnitude, it takes partnerships and we are grateful to Canada for their collaboration, and to GSK for partnering with us to develop a safe and effective vaccine." Roger Connor, President of GSK Vaccines said: "GSK is proud to be working in partnership with Sanofi to make this vaccine available as soon as possible in Canada. Both companies have significant R&D and manufacturing capability world-wide and are already working hard to scale up production. This announcement from the Government of Canada supports our ongoing efforts." Both companies have vaccine manufacturing sites in Canada that are contributing to overall global COVID-19 vaccine development, and these plus their global industrial networks will play a pivotal role in the production of the COVID-19 vaccine doses for Canada – as agreed today. The Companies initiated a Phase 1/ 2 study on 3rd September and anticipate first results in early December 2020, to support the initiation of a Phase 3 study before the end of the year.  If these data are sufficient for licensure application, it is planned to request regulatory approval in the first half of 2021. In parallel, Sanofi and GSK are scaling up manufacturing of the antigen and adjuvant with the target of producing up to one billion doses in total per year globally.

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New Guidelines Issued on Medical Cannabis for Chronic Pain

Toronto, ON - Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting. Citing limited clinician knowledge about medical cannabis treatment and the opioid crisis, one task force member said the recommendations are timely. "We as a task force believe it's extremely important to bring [medical cannabis] to patients," Alan Bell, MD, of the University of Toronto, told MedPage Today. "Our main focus was to provide directions to clinicians." Medical cannabis has been suggested to treat chronic pain, the task force noted, but too many providers still do not utilize it because there has not been accepted guidelines about dosing and administration. Others prescribe medical cannabis without knowing how patients can properly dose. "There's a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen," Bell said. Led by Arun Bhaskar, MD, of Imperial College Healthcare NHS Trust Pain Management Centre in London, the 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain used a modified Delphi process. Among their recommendations: Treat the majority of patients along the "routine" scale. This means starting patients with 5 mg of cannabidiol (CBD) twice daily. Tetrahydrocannabinol (THC) should only be introduced if patients do not respond to at least 40 mg of CBD daily, starting with 2.5-mg daily THC doses. THC doses should be capped at 40 mg daily. Frail and elderly patients, and those with severe co-morbidity or polypharmacy should be treated via a conservative route. This means starting the THC dosses at 1 mg daily and titrating up the THC more slowly. Patients suffering from severe pain and those who have significant prior cannabis consumption can follow the rapid protocol. This mean starting with a CBD-THC balanced dose of between 2.5-5 mg per each compound once or twice daily. "Tailoring medical cannabis treatment to the individual is a critical component of successful treatment," according to the group's poster presentation at PAINWeek. The task force recommends starting with CBD in most cases because they have seen many patients benefit solely from CBD. Unlike THC, CBD does not have psychoactive properties. The task force encourages providers to consider medical cannabis for patients dealing with neuropathic, inflammatory, nociplastic, and mixed pain. The task force did not set a maximum treatment age; many of its clinicians reported seeing best results among geriatric patients, Bell said. They did not set a minimum CBD treatment age, with many treating pediatric patients with high doses of CBD for epilepsy. The task force did not set a minimum treatment age for THC because they could not come to an agreement, Bell said. That does not mean they endorse treating minors with THC; the brain's neuroplasticity until age 25 eliminates that possibility, Bell said. They suggested the best administration method is oral because of "ease of dosing and safety," according to the poster. They recommended pregnant and breastfeeding women, and people with psychotic disorders, not be administered medical cannabis. They also cautioned against mixing medical cannabis with anticoagulants, immunotherapy, or the epilepsy medication clobazam (Onfi, Sympazan, Frisium). The task force needed 75% agreement to adopt any resolutions and Bell said they agreed to most of their recommendations on the first vote. "There's way too much of opioids being used for chronic pain despite a lack of evidence and the harms associated with opioids," Bell said. "We feel this is a major barrier that we are trying to overcome...that may exist because of the knowledge gap" regarding medical cannabis. The task force featured clinicians from North America, Brazil, Europe, Australia, and Africa, according to the poster. It also included clinicians "with many, many years" of clinical experience working with medical cannabis, Bell said, from practices ranging from primary care to oncology to pediatrics and more. They began the consensus process by completing clinical practice surveys, then reviewed questions and attended two virtual meetings.

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COPD World News - Week of September 13, 2020

Link Between Influenza and Acute Heart Issues Confirmed by CDC Study

Atlanta, GA – A recent study confirms yet another reason to get the flu shot early. The goal of this study was to determine whether acute cardiovascular events were an important contributor to the morbidity and mortality associated with influenza. It looked at the spectrum of acute cardiovascular events among adults hospitalized in the U.S. with laboratory-confirmed influenza from 2010 to 2018. And, the risk factors for acute heart failure and acute ischemic heart disease in adults with influenza. The researchers reported that influenza epidemics result in 140,000 to 810,000 hospitalizations and 12,000 to 61,000 deaths each year in the U.S. Like other types of viral infections, influenza can affect the heart and circulatory system. A healthy heart may be able to handle breathing difficulties, increased blood pressure, increased heartbeat, and inflammation symptomatic of an infection, but the same might not hold true for a weakened heart. Among more than 80,000 adults hospitalized with laboratory-confirmed influenza, nearly 12% suffered an acute cardiovascular event, most commonly acute heart failure and acute ischemic heart disease, according to a cross-sectional study from CDC researchers. Note that clinicians should be advised to encourage influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza. Therefore, influenza may exacerbate cardiovascular conditions, such as heart failure, or may contribute to acute cardiovascular events, including myocarditis, pericarditis, and cardiac tamponade. However, few population-based studies have examined the frequency of acute heart events linked to influenza. In a recent cross-sectional study, cardiovascular events were found to be common contributors to the morbidity and mortality of influenza among hospitalized patients. Of adults hospitalized with the flu, 11.7% suffered an acute cardiovascular event -- most commonly acute heart failure (6.2%) and/or acute ischemic heart disease (5.7%) -- according to data from the U.S. Influenza Hospitalization Surveillance Network. Of these patients, 31.2% were admitted to the intensive care unit, 14.0% required mechanical ventilatory support, and 7.3% died in the hospital, reported Shikha Garg, MD, of the CDC's National Center for Immunization and Respiratory Diseases in Atlanta, and colleagues in the Annals of Internal Medicine. The study was based on the large surveillance network, which covers 9% of the U.S. population across various states, and included 80,261 patients hospitalized with the flu in 2010-2018 who had adequate medical records. Median age was 69. The researchers used primary and secondary discharge codes to identify acute cardiovascular events. Patients with these events were hospitalized for a median of 5 days. Predictors significantly associated with a higher risk of acute heart failure and acute ischemic heart disease in adults hospitalized with influenza included older age, tobacco use, and underlying cardiovascular disease, diabetes, and renal disease. Acute cardiovascular events were detected in 20.6% of patients with chronic cardiovascular disease, 19.3% of those with chronic renal disease, and 14.8% of those with diabetes. Of the included patients, 47.2% received the flu shot for the current season, 39.2% did not receive the shot, and 13.6% had unknown vaccination status. Patients vaccinated against influenza at least 2 weeks before hospitalization had a significantly lower risk for acute heart failure (adjusted risk ratio [aRR] 0.86, 95% CI 0.80-0.92) and acute ischemic heart disease (aRR 0.80, 95% CI 0.74-0.87) compared with unvaccinated patients. Additionally, patients receiving early antiviral treatment had a lower risk of acute cardiovascular events compared with those receiving late treatment. "Although this analysis was not designed to assess the effectiveness of influenza vaccination or antiviral medications, evidence suggests that these interventions may have benefits in attenuating disease severity," Garg and colleagues noted. Study limitations included the possible under-detection of flu cases, given that influenza testing was based on practitioner orders. Additionally, the reliance on ICD codes to identify cardiovascular events could have introduced misclassification bias, the researchers acknowledged.

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COPD World News - Week of September 6, 2020

GSK and Sanofi team up on COVID-19 vaccine

Paris, London - Sanofi and GSK announced that they have started the Phase 1/2 clinical trial for their adjuvanted COVID-19 vaccine. The vaccine candidate, developed in partnership by Sanofi and GSK, uses the same recombinant protein-based technology as one of Sanofi’s seasonal influenza vaccines with GSK’s established pandemic adjuvant technology. The Phase 1/2 clinical trial is a randomized, double blind and placebo-controlled trial designed to evaluate the safety, reactogenicity (tolerability) and immunogenicity (immune response) of the COVID-19 vaccine candidate. A total of 440 healthy adults are being enrolled in the trial across 11 investigational sites in the United States. The companies anticipate first results early December 2020 which will support the initiation of a Phase 3 trial in December 2020. If data are sufficient for licensure application, the plan is to request regulatory approval in the first half of 2021. Sanofi is leading the clinical development and registration of the COVID-19 vaccine. Preclinical data showed an acceptable reactogenicity profile and data based on two injections of the adjuvanted recombinant vaccine showed high levels of neutralizing antibodies that are comparable to levels in humans who recovered from the COVID-19 infection. Pre-clinical results will be published later this year. In parallel, Sanofi and GSK are scaling up manufacturing of the antigen and adjuvant with the target of producing up to one billion doses in 2021. “Sanofi and GSK bring proven science and technology to the fight against the global COVID-19 pandemic, with the shared objective of delivering a safe and effective vaccine,” said Thomas Triomphe, Executive Vice President and Global Head of Sanofi Pasteur. “The initiation of our clinical study is an important step and brings us closer to a potential vaccine which could help defeat COVID-19. Our dedicated teams and partner continue to work around the clock as we aim to deliver the first results in early December. Positive data will enable a prompt start of the pivotal phase 3 trial by the end of this year.” Roger Connor, President of GSK Vaccines added, “Moving this vaccine candidate into clinical development is an important moment in the progress towards addressing the global pandemic we are all facing. This builds on the confidence shown by governments already in the potential of this protein-based adjuvanted vaccine candidate, which utilizes established technology from both companies, and can be produced at scale by two of the leading vaccine manufacturers globally. We now look forward to the data from the study, and if positive, beginning Phase 3 by the end of the year.” The development of the adjuvanted COVID-19 vaccine candidate is being supported through funding and a collaboration with the Biomedical Advanced Research and Development Authority, part of the office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services.

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COPD World News - Week of August 30, 2020

Influenza vaccine ordered early to avoid dual outbreak of flu and COVID-19

Charlottesville, PEI – The CBC reported that the Chief Public Health Officer of PEI, Dr. Heather Morrison, says influenza vaccine is coming to the province earlier than usual this year in the hopes of avoiding the flu causing even more problems during the COVID-19 pandemic. "We put in more orders for influenza vaccine. It's expected in, actually a little bit earlier, so it'll be in by the end of September," Morrison said. "We're very fortune the funding has been allotted for high-dose influenza for those 65 years of age and older." The vaccine will be also available in mist form this year, she said. "We anticipate and hope we can distribute a good amount of influenza vaccine," she said. Morrison said she wants to avoid a situation where an influenza and COVID-19 outbreak are happening all at once. She said the symptoms with the flu and COVID-19 are similar, and minimizing the impacts of the flu can help avoid confusion. Many P.E.I. students will be heading back to school next week for the first time since they shut down about six months ago due to COVID-19, and many people are wondering what will happen if a positive case is detected at an Island school. Morrison said tracing would begin with close contacts of the student. "Close contacts are those that had face-to-face contact for quite a few minutes," she said, adding that is why cohorts are important in returning to school. "We would be identifying who is a close contact and then doing testing of those individuals. And close contacts who are tested, even if they test negative, would still have to self-isolate for a period of 14 days." There have been no school-age kids who have tested positive for COVID-19 on P.E.I., Morrison said. "Really across the country really only, just over eight per cent of the cases have been in that zero to 19 year range." Children sometimes don't have as severe symptoms as adults and can have mild or no symptoms at all. "The younger children less than 10 years of age don't seem to transmit the virus in quite the same way as those 10 years of age and up," she said, adding children over 10 seem to pass the virus the same way as adults.

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Kids can carry coronavirus in respiratory tract for weeks, study suggests

Seoul, SK - Children can carry coronavirus in their noses and throats for weeks even if they don't show any symptoms, which might explain how the virus can spread silently, researchers in South Korea reported Friday. "In this case series study, inapparent infections in children may have been associated with silent COVID-19 transmission in the community," the researchers wrote in a new study. "Interestingly, this study aligns with adult data in which up to 40% of adults may remain asymptomatic in the face of infection," Dr. Roberta DeBiasi and Dr. Meghan Delaney, both of Children's National Hospital in Washington, DC, wrote in an accompanying editorial. Neither was involved in the research. "In this study, the authors estimate that 85 infected children (93%) would have been missed using a testing strategy focused on testing of symptomatic patients alone," they wrote. The study comes out at a time when the US Centers for Disease Control and Prevention has been criticized for changing its guidelines on asymptomatic testing, which the American Academy of Pediatrics called "a dangerous step backward" in a statement on Friday. In the CDC's updated guidelines, some people without symptoms may not need to be tested, even if they've been in close contact with someone known to have the virus. This newly released research adds more evidence as to why casting a wide net when it comes to contact tracing is a key strategy to mitigate viral spread. "We know that children often show few or no symptoms of COVID-19. We also know they are not immune to this virus, and they can become very sick. Testing exposed individuals who may not yet show symptoms of COVID-19 is crucial to contact tracing, which helps identify and support other people who are at risk of infection," AAP President Dr. Sally Goza said in the statement. The study, published in the journal JAMA Pediatrics on Friday, included data on 91 asymptomatic, pre-symptomatic and symptomatic children diagnosed with Covid-19 between February 18 and March 31 at 22 centers throughout South Korea. Among those patients, 20 of them -- or 22% -- did not show any obvious symptoms and remained asymptomatic throughout the study. Another 18 children -- or 20% -- were presymptomatic, meaning they didn't look or feel sick at the time but eventually got symptoms later. In total, more than half of the children -- 71 kids or 78% -- did show symptoms, which included fever, cough, diarrhea, abdominal pain and loss of smell or taste, among other symptoms. The duration of the symptoms appeared to vary, ranging from one to 36 days. "This suggests that even mild and moderately affected children remain symptomatic for long periods of time," DeBiasi and Delaney wrote in the editorial. The data showed that only 8.5% of those patients with symptoms were diagnosed with Covid-19 at the time their symptoms began. Most -- 66.2% -- of the patients with symptoms had symptoms that were not recognized before they were diagnosed, and 25.4% developed symptoms after they were diagnosed. "This highlights the concept that infected children may be more likely to go unnoticed either with or without symptoms and continue on with their usual activities, which may contribute to viral circulation within their community," DeBiasi and Delaney wrote.The study found genetic material from the virus was detectable in the children for a mean of 17.6 days overall. Even in the children who had no symptoms, the virus was detectable for 14 days on average. It's also possible that the virus remained in the children even longer, the study said, because the date of initial infection wasn't identified. However, this doesn't necessarily mean the children were spreading virus, experts say. The presence of the virus genetic material in swabs "need not equate with transmission, particularly in people who do not have important symptoms such as cough and sneeze," Calum Semple, professor in child health and outbreak medicine at the University of Liverpool who was not involved in the study, said in a written statement on Friday. In addition, "sensitive molecular detection methods may detect viable, infective virus but also nonviable or fragments of RNA with no capability for transmission," DeBiasi and Delaney wrote. More research also is needed to determine whether similar findings would emerge among a larger group of children from other parts of the world. Still, the new study provides information that can be used by pubic health officials when considering the spread of the virus in schools, according to DeBiasi and Delaney. "A surveillance strategy that tests only symptomatic children will fail to identify children who are silently shedding virus while moving about their community and schools," they wrote. "In regions where use of face masks is not widely accepted or used by the general public, asymptomatic carriers may serve as an important reservoir that may facilitate silent spread through a community." The Friday statement from AAP's Goza reinforced the need for systematic, wide-ranging tracking. "Without data and transparency, science and medical professionals are hampered -- and families are harmed -- as we lack information that helps us understand how easily this virus can be transmitted to others and how to stop it," she said.

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COPD World News - Week of August 23, 2020

ED visits for acute respiratory illnesses rise before thunderstorms

Seattle, WA - In a large-scale study, ED visits for thunderstorm-related acute respiratory illnesses were increased in older U.S. adults, including those with asthma and COPD, according to findings published in JAMA Internal Medicine. “Thunderstorm-related atmospheric changes are expected to increase in severity with rising global temperatures,” Eric Zou, PhD, assistant professor of economics at the University of Oregon, and colleagues wrote. “Although large-scale evidence is limited, vulnerable populations such as older adults or those with common chronic respiratory diseases like asthma or chronic obstructive pulmonary disease are expected to be susceptible to negative health effects from these changes.” Researchers analyzed atmospheric and lightning data from the U.S. National Oceanic and Atmospheric Administration from all 3,127 counties in the U.S. from January 1999 to December 2012. To identify ED visits with acute respiratory diagnoses, the researchers compared these data with insurance claims and comorbidity data from 46,581,214 Medicare beneficiaries aged older than 65 years (mean age, 77 years; 58.6% women). Overall, 12,334,021 (26.5%) had COPD, 4,891,027 (10.5%) had a chronic diagnosis of asthma, and 3,074,360 (6.6%) had asthma and COPD. Zou and colleagues identified 22,118,934 respiratory ED visits and 822,095 county days with major thunderstorms, which were defined as the presence of lightning, precipitation and above-median wind speed. According to the researchers, assuming an average population of 37.7 million Americans aged 65 years or older, approximately 52,000 additional ED visits for respiratory illnesses were estimated to occur in the 3 or more days surrounding the day of a thunderstorm from 1999 to 2012. The researchers reported no association between thunderstorms and ED visits for sepsis or pulmonary embolism. “Our findings suggest antecedent rises in particulate matter concentration and temperature may be the dominant mechanism of thunderstorm-associated acute respiratory disease in older Americans, which may contribute to strain on the health care system as storm activity increases with rising global temperatures,” the researchers wrote.

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COPD World News - Week of August 16, 2020

Number of children contracting SARS-CoV-2 steadily increasing, CDC says

Atlanta, GA - When the coronavirus started to spread in China and nearby countries, scientists observed that the elderly, those who have weakened immune systems, and those with underlying health conditions were most vulnerable to succumbing to coronavirus disease (COVID-19). It seemed as if the virus spares children and adolescents. However, as the pandemic progressed, the number of children contracting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has steadily increased. The U.S. Centers for Disease Control and Prevention (CDC) released new guidance revealing that the number and infection rate of COVID-19 cases among children have steadily increased between March and July, which may worsen as schools start to re-open.In the United States and across the globe, where more than 21.82 million people have already contracted the virus, fewer cases of COVID-19 have been reported in children between 0 and 17 years of age compared to adults. The number and rate of infection in children have increased over the past months. The CDC said that this is maybe due to the lack of testing in children and focusing on adults and those who are at high-risk. The CDC also reported that while there is an increase in infections in children, the hospitalization rate among this age group is significantly lower compared with adults, hinting that children are at low risk of developing severe COVID-19 infection. Recent data shows that the rate of hospitalization among children is 8 per 100,000, while the rate for adults is about 164.5 per 100.000. Further, children have lower rates of mechanical ventilation and deaths compared with adults but warned that 1 in 3 children hospitalized due to COVID-19 in the U.S. was admitted to the intensive care unit, which is the same rate in adults. CDC added that children with certain underlying health conditions and infants who are less than 1-year old might at a heightened risk of severe illness. Of the children who developed severe COVID-19, most have underlying health conditions. Just like adults, children who develop severe COVID-19 may have respiratory failure, shock, myocarditis, acute renal failure, coagulopathy, and multi-organ system failure. They are also at a high risk of developing multisystem inflammatory syndrome in children (MIS-C). The health agency noted that it is still unclear whether children are as vulnerable to SARS-CoV-2 infection compared with adults. There is still no evidence on whether children and adolescents can transmit the virus as effectively as adults. “Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults and that children can spread the virus effectively in households and camp settings,” the CDC explained. School closures have helped mitigate the spread of the virus in the United States, especially among children. This may explain the low incidence of COVID-19 in children compared with adults. With the schools starting to re-open in the United States, it is unclear if “Comparing trends in pediatric infections before and after the return to in-person school and other activities may provide additional understanding about infections in children. Increasing testing in children can help mitigate the spread of the virus. The CDC advises parents to ask their health care providers about testing. “As children return to school and other in-person activities, pediatric healthcare providers should be prepared to answer questions from families about testing and when it is safe to return to school or be with people outside the household,” the CDC added. Still, the CDC reiterates the importance of educating children and their parents on everyday infection prevention measures, including the importance of washing the hands, social distancing, and wearing of masks in public. The CDC released updated isolation guidance and warned that people recovering from COVID-19 should not assume they automatically have three months of immunity from reinfection. The report comes after a string of reports claimed that those who recovered from the infection would be naturally resistant to the second bout of infection.

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COPD World News - Week of August 9, 2020

Survey shows that 32% of Canadians may hold off on getting eventual COVID-19 vaccine

Hamilton, ON - For months, governments around the world have imposed lockdowns and travel bans, shuttered schools, and blocked visitors from hospitals and long-term care homes, all in the name of slowing transmission of the new coronavirus. But most members of the medical community agree widespread uptake of an eventual vaccine is what's needed for the COVID-19 pandemic to finally fizzle out. "We're not going to return to normal the minute a vaccine is approved," said researcher Matthew Miller, an associate professor at McMaster University's department of biochemistry and biomedical sciences. "We're only going to return to normal when the vast majority of the population is immune to the virus." Survey results released from the non-profit Angus Reid Institute and reported by CBC found half of Canadians say they have no reservations and are ready to get a COVID-19 vaccination as soon as it's available. But 32 per cent — roughly a third of respondents — say they'd likely wait a while. Another 14 per cent don't want to get a vaccine at all. The findings were based on a survey conducted between July 23 and 24 among a representative randomized sample of 1,519 Canadian adults who are members of Angus Reid Forum, an online panel. Ève Dubé, a medical anthropologist and researcher on public health and vaccination at the Quebec National Institute of Public Health, said for the small portion of people who are routinely anti-vaccine, it can be "really hard to change their minds." Potential COVID-19 vaccine has re-energized anti-vaccination groups, health experts warn Then there's typically a larger group of people who are somewhat hesitant to get vaccinated. In the case of a potential COVID-19 vaccine, their concerns are often based on safety, given the unprecedented speed of the research — which is crunching what typically takes a decade into less than two years. Among the third of survey respondents who want to hold off on getting a vaccine, 76 per cent said they're worried about side effects. "Those people are not strongly opposed," Dubé said. "But they have questions and fears." Medical community shouldn't 'blame and shame' skeptics. Hamilton, Ont., resident Amanda Perino counts herself among them. Typically, the mother of two considers herself "pro-vaccine," with both her children getting all the standard shots for measles and other illnesses. But in the case of an eventual option for COVID-19, she's warier. An Angus Reid survey has revealed that only about half of Canadians would take a COVID-19 vaccine no questions asked when one becomes available, but health officials and other experts say patience is key to winning over skeptics. 2:01 "I just have reservations on long-term effects," Perino said. "We don't even know what the long-term effects of COVID are, either. I just don't know if we know enough about the virus itself to have a vaccine that's safe." Researcher Maya Goldenberg, an associate professor in the department of philosophy at the University of Guelph who's written extensively on vaccine hesitancy, said the medical community needs to handle these kinds of "legitimate" concerns with care. Doing so will require patience, not irritation or dismissal, on the part of healthcare providers, she said. "There will be concerns about whether it's been tested properly, and if the rush means we're going to be cutting corners on safety," Goldenberg said. "The number one thing to do is not blame and shame people when they have questions. This is true for vaccines for children, for flu — anything."

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COPD World News - Week of August 2, 2020

Blood test detects positive COVID-19 result in 20 minutes

Melbourne, Australia - World-first research by Monash University in Australia has been able to detect positive COVID- 19 cases using blood samples in about 20 minutes, and identify whether someone has contracted the virus. In a discovery that could advance the worldwide effort to limit the community spread of COVID-19 through robust contact tracing, researchers were able to identify recent COVID-19 cases using 25 microlitres of plasma from blood samples. The research team, led by BioPRIA and Monash University's Chemical Engineering Department, including researchers from the ARC Center of Excellence in Convergent BioNano Science and Technology (CBNS), developed a simple agglutination assay—an analysis to determine the presence and amount of a substance in blood—to detect the presence of antibodies raised in response to the SARS-CoV-2 infection. Positive COVID-19 cases caused an agglutination or a clustering of red blood cells, which was easily identifiable to the naked eye. Researchers were able to retrieve positive or negative readings in about 20 minutes. While the current swab / PCR tests are used to identify people who are currently positive with COVID-19, the agglutination assay can determine whether someone had been recently infected once the infection is resolved—and could potentially be used to detect antibodies raised in response to vaccination to aid clinical trials. Using a simple lab setup, this discovery could see medical practitioners across the world testing up to 200 blood samples an hour. At some hospitals with high-grade diagnostic machines, more than 700 blood samples could be tested hourly—about 16,800 each day. Study findings could help high-risk countries with population screening, case identification, contact tracing, confirming vaccine efficacy during clinical trials, and vaccine distribution. This world-first research was published today (Friday 17 July 2020) in the prestigious journal ACS Sensors. A patent for the innovation has been filed and researchers are seeking commercial and government support to upscale production. Dr. Simon Corrie, Professor Gil Garnier and Professor Mark Banaszak Holl (BioPRIA and Chemical Engineering, Monash University), and Associate Professor Timothy Scott (BioPRIA, Chemical Engineering and Materials Science and Engineering, Monash University) led the study, with initial funding provided by the Chemical Engineering Department and the Monash Center to Impact Anti-microbial Resistance. Dr. Corrie, Senior Lecturer in Chemical Engineering at Monash University and Chief Investigator in the CBNS, said the findings were exciting for governments and health care teams across the world in the race to stop the spread of COVID-19. He said this practice has the potential to become upscaled immediately for serological testing. "Detection of antibodies in patient plasma or serum involves pipetting a mixture of reagent red blood cells (RRBCs) and antibody-containing serum/plasma onto a gel card containing separation media, incubating the card for 5-15 minutes, and using a centrifuge to separate agglutinated cells from free cells," Dr. Corrie said. "This simple assay, based on commonly used blood typing infrastructure and already manufactured at scale, can be rolled out rapidly across Australia and beyond. This test can be used in any lab that has blood typing infrastructure, which is extremely common across the world." Researchers collaborated with clinicians at Monash Health to collect blood samples from people recently infected with COVID-19, as well as samples from healthy individuals sourced before the pandemic emerged. Tests on 10 clinical blood samples involved incubating patient plasma or serum with red blood cells previously coated with short peptides representing pieces of the SARS-CoV-2 virus. If the patient sample contained antibodies against SARS-CoV-2, these antibodies would bind to peptides and result in aggregation of the red blood cells. Researchers then used gel cards to separate aggregated cells from free cells, in order to see a line of aggregated cells indicating a positive response. In negative samples, no aggregates in the gel cards were observed. "We found that by producing bioconjugates of anti-D-IgG and peptides from SARS-CoV-2 spike protein, and immobilizing these to RRBCs, selective agglutination in gel cards was observed in the plasma collected from patients recently infected with SARS-CoV-2 in comparison to healthy plasma and negative controls," Professor Gil Garnier, Director of BioPRIA, said. "Importantly, negative control reactions involving either SARS-CoV-2-negative samples, or RRBCs and SARS-CoV-2-positive samples without bioconjugates, all revealed no agglutination behavior." Professor Banaszak Holl, Head of Chemical Engineering at Monash University, commended the work of talented Ph.D. students in BioPRIA and Chemical Engineering who paused their projects to help deliver this game changing COVID-19 test. "This simple, rapid, and easily scalable approach has immediate application in SARS-CoV-2 serological testing, and is a useful platform for assay development beyond the COVID-19 pandemic. We are indebted to the work of our Ph.D. students in bringing this to life," Professor Banaszak Holl said. "Funding is required in order to perform full clinical evaluation across many samples and sites. With commercial support, we can begin to manufacture and roll out this assay to the communities that need it. This can take as little as six months depending on the support we receive."

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COPD World News - Week of July 26, 2020

The U.S. hits 4 million cases Of coronavirus

Washington, DC - Last week the United States exceeded 4 million reported Covid-19 cases, according to the Johns Hopkins coronavirus tracker. One million of these were reported in the last two weeks and outbreaks continue to result in record case numbers in several states. Over 1,000 Americans died yesterday from the disease, leaving many people asking “What can be done now?” to try and stem the pandemic. “Slowing the spread is not a mystery,” said Rebecca Katz, Professor and Director of the Center for Global Health Science and Security at Georgetown University. “We know it is a combination of individuals taking appropriate precautions (masks, physical distance, hand hygiene, avoiding crowded locations) and having sufficient capacity to test, trace and isolate,” she added. “It’s not an easy decision, but many of these states need to move to more aggressive efforts to limit person-to-person contact,” said Steven A. Pergam, MD, MPH Associate Professor, Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center. “The virus thrives on humans being close together and to date what has been most effective at controlling spread is policies targeting gatherings in public places. More restrictive “shelter at home” orders are likely the most effective, but major local efforts to limit even small gatherings is the key. This, coupled with masking of those who cannot physically distance, limits opportunities for the virus to spread and can help slow community transmission,” he added. “They need a full on enforced lock down ASAP to get things under control,” said David Fisman, Professor of Epidemiology at University of Toronto in Canada and a practicing internist.”The difficulty is that lock down won't stop transmissions that have already happened so would expect ongoing increases in hospitalizations for 2-3 weeks even after lock down as that's the amount of time it takes for those transmissions to become cases, and those cases to get sick enough for hospitalization and intensive care,” he added. “That’s tough and a tie between state-wide masking mandates and efforts to ensure adequate testing is available,” said Saskia Popescu, an infectious disease epidemiologist and Professor at the University of Arizona College of Public Health. “This includes drive through options, free testing sites, and ultimately the capacity to rapidly perform the tests and relay the results. A delay in testing means that people are forced to isolate longer assuming they have the virus, but it also delays reporting and contact tracing. This needs to be followed by ensuring hospitals and public health departments have the resources they need to avoid being over-stressed and healthcare workers have the critical resources needed to treat patients safely. Lastly, we need more public communication campaigns about risk awareness and the importuning of masking/social distancing,” she added. “Based on international experience, for example in Hong Kong, the following measures would likely make most difference (short of a full stay-at-home order): Close bars, restaurants and gyms. Switch to working from home as much as possible. Stop indoor gatherings between different households,” said Adam Kucharski, Associate Professor at the London School of Hygiene & Tropical Medicine in the U.K. Many states are experiencing significant outbreaks – do you think that these are likely to spread to all/most U.S. states or can individual states potentially curb the spread? “People move across state borders. If we have outbreaks in one part of the country, we must be prepared for transmission to other parts of the country. This is why continued vigilance is critical,” said Katz. “It seems likely that travel between states is going to lead to recurrent clusters in states that have controlled transmission. For example, what is going on in Florida may eventually affect New York or other cities throughout the country. This is particularly true if outbreaks cannot be controlled. I just imagine how many people from all over the U.S. will visit Disney World over the next few weeks,” said Pergam. “In states with disease under control can do cautious opening with adherence to the Japanese C's (avoid close, closed, crowded) and mask mandates. This has worked elsewhere and there's no reason it shouldn't in the U.S. Need to test widely as this is a sneaky disease, and you don't want to be recognizing spread only with super-spreader events,” said Fisman. “It’s very likely at this point and the politicization of the pandemic hasn’t helped. Other states and prepare their health and public health systems, but also ensure they can scale up testing and response mechanisms,” said Popescu. “Contact tracing alone is unlikely to be enough to stop large outbreaks, but scaled up testing - particularly in high risk groups like healthcare works, care home staff, key workers in shops - could help identify infections and prevent chains of transmission, working in tandem with wider social distancing measures,” said Kucharski. Some people have suggested that mitigation strategies proposed several months ago such as contact tracing and accessible testing are no longer adequate to contain outbreaks in badly affected states. What are your thoughts on this?“You need to have the combination of strategies. People need to do their part. You also don't give up on testing, tracing and isolation. But when you have widespread community transmission, you may also need to put more restrictive policies in place,” said Katz. “Testing and contact tracing remain critical pillars of prevention, but in some of these large urban centers, the public health infrastructure are overwhelmed and won’t keep up with the sheer number of cases. This is exacerbated by major cutbacks in county and state public health programs. However, cities like New York city show it can be done even in the midst of a large pandemic – it takes investment,” said Pergam. “Mitigation in these situations really shifts to structures and policies which assure more physical distancing in the community – keeping people at home. Universal masking can help decrease exposure risk, and targeted prevention specifically targeting high-risk setting like nursing homes and prisons, can save lives. Finally, all good public health policy involves communication and community education about prevention,” Pergam added. “Those efforts definitely become strained the bigger the outbreak and the fewer their resources, which means we need to be able to flex and scale up their capacities. That shouldn’t be seen as an indicator for giving up though,” said Popescu. “Contact tracing is meaningless when you have a massive number of'll simply overstretch and wear down and already overextended public health workforce,” said Fisman. “It may be a helpful intervention when cases are knocked down to low levels and you're preventing resurgences,” he added.

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COPD World News - Week of July 19, 2020

Misericordia hospital adopts 'aggressive' protocols in bid to control COVID-19 outbreak

Edmonton, AB -  A growing outbreak of COVID-19 has forced the Misericordia Community Hospital to close its doors to most new patients and institute a series of "aggressive" pandemic protocols in bid to slow the spread of the virus.  As of Monday morning, 18 patients and 14 staff at the west-Edmonton hospital have tested positive for coronavirus, Alberta Health Services and Covenant Health said in a joint statement.  Eight new cases, including seven patients and one staff member, were identified over the weekend. As of Friday, 11 patients and 13 staff had tested positive for COVID-19. Two patients have died. The first death was confirmed on June 25. AHS officials became aware of the second patient death on July 4, Dr. David Zygun, Edmonton zone medical director with AHS, said Monday. The second death was a man in his 70s. The outbreak at the Misericordia began on June 20, Zygun said. Health Minister Tyler Shandro said the province is monitoring the situation closely.  "This is an evolving situation, and it has been evolving over the last 48 hours or so," Shandro said. "Testing is going on to be able to do the tracing and contain the outbreak. AHS is working with Covenant [Health], and our public health officials are working with them as well, to make sure the infection prevention and control measures are in place at the Misericordia to make sure that the patients and the staff are protected. "Obviously, I'm very concerned and have been, as this situation has been evolving over the last couple of days." Dr. David Zygun, Edmonton zone medical director with AHS, warned Monday that the outbreak at the Misericordia is "an evolving situation." (David Bajer/CBC) Patients who have tested positive are being cared for together on three units, including the hospital's designated COVID-19 unit. In all, eight units are now included in the outbreak restrictions as a necessary precaution. "AHS and Covenant Health officials have implemented aggressive outbreak protocols and are undertaking widespread testing and contact tracing of any potentially exposed patients and staff," Dr. Marcia Johnson, deputy chief medical officer of health said in the statement. "Health officials are working around the clock to prevent further spread of this virus, protect the health and well-being of patients, staff and physicians, and bring a timely and safe resolution to this outbreak." Hospital closed to new admissions To reduce the risk of further transmission, AHS said the hospital is now closed to new admissions and transfers for surgical and medical patients. The emergency department remains open. But paramedics will take patients to other Edmonton hospitals, except in emergencies where the hospital is the nearest acute care site, AHS said. Surgical capacity will be restricted to day surgery. Overnight surgeries will be postponed or completed at another site in the Edmonton area. 

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COPD World News - Week of July 12, 2020

Aerosols are a bigger coronavirus threat than WHO guidelines suggest

Geneva, Switzerland - When someone coughs, talks or even breathes, they send tiny respiratory droplets into the surrounding air. The smallest of these droplets can float for hours, and there is strong evidence that they can carry live coronavirus if the person is infected. The risk from these aerosols isn’t currently incorporated into the World Health Organization’s formal guidance for nations, though. The WHO suggests that the coronavirus is primarily transmitted by coughing or sneezing large droplets into someone’s face, not a longer-term threat that can be floating in the air. After pressure from scientists, that may soon change. This week, more than 200 scientists published an open letter to the WHO warning about airborne transmission of COVID-19 via aerosols and urging the organization to recognize the risks. The WHO has since acknowledged growing evidence of airborne spread of the disease, but it has not yet changed its advice to protect people from contracting COVID-19 from aerosols. As professors who study fluid dynamics and aerosols, we believe it is important for people to understand the risks and what they can do to protect themselves. Aerosols are particles that are suspended in the air. When humans breathe, talk, sing, cough or sneeze, the emitted respiratory droplets mix in the surrounding air and form an aerosol. Because larger droplets quickly fall to the ground, respiratory aerosols are often described as being made up of smaller droplets that are less than 5 microns, or about one tenth the width of a human hair. In general, droplets form as a sheet of liquid breaks apart. You’ve probably experienced this phenomenon by blowing soap bubbles. Sometimes the bubble doesn’t fully form, but instead breaks apart into many droplets. Similarly, in humans, small sheets and strands of liquid – mucus – often stretch across portions of the airway. This most often occurs in locations where the airway opens and closes again and again. That happens deep within the lungs as the bronchioles and alveolar sacs expand and contract during breathing, within the larynx as the vocal folds vibrate during speech, or at the mouth, as the tongue and lips move while talking. The airflow produced by breathing, speaking and coughing breaks apart these sheets of mucus, just like blowing the soap bubble. The size of the droplets varies based on how and where they are produced within the airway. While coughing generates the largest quantity of droplets, research has shown that just two to three minutes of talking can produce as many droplets as one cough. Droplets that are smaller than 5 microns can remain suspended in the air for many minutes to hours because the effect of air drag relative to gravity is large. In addition, the water content of virus-carrying droplets evaporates while they are airborne, decreasing their size. Even if most of the fluid evaporates from a virus-laden droplet, the droplet does not disappear; it just becomes smaller, and the smaller the droplet, the longer it will stay suspended in the air. Because smaller diameter droplets are more efficient at penetrating deep into the pulmonary system, they also pose a much greater infection risk. The WHO guidelines suggested that the virus RNA found in small droplets wasn’t viable in most circumstances. However, early research on the SARS-CoV-2 virus has shown that it is viable as an aerosol for up to 3 hours.

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COPD World News - Week of July 5, 2020

Misericordia hospital adopts 'aggressive' protocols in bid to control COVID-19 outbreak

Edmonton, AB -  A growing outbreak of COVID-19 has forced the Misericordia Community Hospital to close its doors to most new patients and institute a series of "aggressive" pandemic protocols in bid to slow the spread of the virus.  As of Monday morning, 18 patients and 14 staff at the west-Edmonton hospital have tested positive for coronavirus, Alberta Health Services and Covenant Health said in a joint statement.  Eight new cases, including seven patients and one staff member, were identified over the weekend. As of Friday, 11 patients and 13 staff had tested positive for COVID-19. Two patients have died. The first death was confirmed on June 25. AHS officials became aware of the second patient death on July 4, Dr. David Zygun, Edmonton zone medical director with AHS, said Monday. The second death was a man in his 70s. The outbreak at the Misericordia began on June 20, Zygun said. Health Minister Tyler Shandro said the province is monitoring the situation closely.  "This is an evolving situation, and it has been evolving over the last 48 hours or so," Shandro said. "Testing is going on to be able to do the tracing and contain the outbreak. AHS is working with Covenant [Health], and our public health officials are working with them as well, to make sure the infection prevention and control measures are in place at the Misericordia to make sure that the patients and the staff are protected. "Obviously, I'm very concerned and have been, as this situation has been evolving over the last couple of days." Dr. David Zygun, Edmonton zone medical director with AHS, warned Monday that the outbreak at the Misericordia is "an evolving situation." (David Bajer/CBC) Patients who have tested positive are being cared for together on three units, including the hospital's designated COVID-19 unit. In all, eight units are now included in the outbreak restrictions as a necessary precaution. "AHS and Covenant Health officials have implemented aggressive outbreak protocols and are undertaking widespread testing and contact tracing of any potentially exposed patients and staff," Dr. Marcia Johnson, deputy chief medical officer of health said in the statement. "Health officials are working around the clock to prevent further spread of this virus, protect the health and well-being of patients, staff and physicians, and bring a timely and safe resolution to this outbreak." Hospital closed to new admissions To reduce the risk of further transmission, AHS said the hospital is now closed to new admissions and transfers for surgical and medical patients. The emergency department remains open. But paramedics will take patients to other Edmonton hospitals, except in emergencies where the hospital is the nearest acute care site, AHS said. Surgical capacity will be restricted to day surgery. Overnight surgeries will be postponed or completed at another site in the Edmonton area. 

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