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Morning Rounds Shraddha Chakradhar

Coronavirus hijacks cells in unique ways that suggest how to treat it


RNA (in green) from the SARS-CoV-2 virus is shown taking over the cells it infects. (ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI)

The way SARS-CoV-2, the coronavirus behind Covid-19, takes over human cells could explain not only why the infection is particularly devastating for certain groups, but also how the virus could potentially be treated. Other viruses, including influenza and SARS, rely on a one-two punch to fight back against the body's two immune defense arms — one for an immediate attack against invading pathogens and another that relies on cells that serve as reinforcements. Recent studies suggest that SARS-CoV-2, however, seems to disable the short-term attack against viruses, while turning up the mechanism that calls on reinforcements. The result: no real brakes on the virus' attack, and instead a continuous storm of inflammatory molecules in patients' lungs. STAT's Sharon Begley has more here

Here's more on the latest with the coronavirus: 

  • Top WHO official Mike Ryan said yesterday that any cut the U.S. makes to its funding to the global health agency will have a "major implication for delivering essential health services to the most vulnerable people in the world." President Trump has criticized the WHO's handling of the pandemic and has told the director-general the U.S. would withhold funding — which is "on the order of $100 million a year," according to Ryan — unless the WHO pledges "substantive improvements" in the next month.
  • Former CMS Administrator Andy Slavitt, former HHS Secretary Kathleen Sebelius, and 19 other big names in the health care industry released what they call the #OpenSafely plan for U.S. states to reopen the economy without jeopardizing the progress made against Covid-19. The plan includes opening up communities that have seen two weeks of declining cases, but also calls for ensuring adequate testing capabilities and sufficient PPE for first responders and health care workers. 
  • Christi Grimm, the principal deputy inspector general for HHS who documented shortages of medical supplies and Covid-19 tests earlier this year, will testify before the House Oversight and Reform Committee next week. After Grimm issued her report, she was criticized by President Trump, who then also nominated a permanent inspector general to replace her. 

Monkey studies suggest Covid-19 infection produces protective antibodies

Two studies in monkeys find that coronavirus infection produces antibodies that seem to protect against future illness. In one study, researchers infected nine adult rhesus macaques with SARS-CoV-2. The animals got sick, but recovered after 28 days. When the researchers exposed the monkeys to the coronavirus a week later, none got sick, even though there were trace amounts of virus in some of the animals' lungs. In the other study, 25 monkeys were vaccinated using prototypes of a Covid-19 vaccine from the scientists leading the study and Johnson & Johnson, while 10 remained unvaccinated. The vaccinated monkeys developed antibodies, and when all the monkeys in the study were exposed to SARS-CoV-2, the vaccinated monkeys didn't have high levels of virus in their lungs, while all the unvaccinated monkeys did. The findings will need to be replicated in humans, but study lead Dan Barouch told the Boston Globe he's hopeful since humans and rhesus monkeys share 93% of their genetic makeup. 

Analysis reveals how people around the world respond to depression treatment

A new review of mental health surveys from 16 countries around the world offers a glimpse into how those with depression respond to treatment. More than 80,000 who took the WHO's World Mental Health survey between 2002-2016 were included in the analysis. Of the more than 2,700 people who had a history of being treated for their major depressive disorder, 68% thought it was helpful. This figure increased the more professionals people sought help from, although it leveled off after people reported seeking out nine different providers. Those who found treatment beneficial often were older when they sought out treatment; were highly educated; didn't wait long after first experiencing symptoms to seek out treatment; and were prescribed medication by a mental health specialist. 

Inside STAT: Why calling health care workers ‘heroes’ could be harmful

Health care workers on the frontlines of Covid-19 are being called heroes for treating volumes of very sick patients in a dynamic environment, while putting their personal safety at risk. But in new STAT First Opinion, a frontline physician-public health organizer, a chaplain, and a storytelling coach argue that the "hero" label is harmful and distracts from the realities of what medical professionals are facing. "The hero image burns so bright that it eclipses any light shining on the failures of the system that could turn heroes into involuntary martyrs," they write, failures such as a lack of proper protective equipment. Health care workers could also be dissuaded from sharing their experiences: "[T]he more space the hero label takes up," the authors write, "the harder it will be for them to authentically express themselves." Read more here.

Pharmacists' prescriptions are a viable way to help expand access to contraception, study finds

As some states work to expand access to birth control, a new study suggests that pharmacists writing prescriptions for these medications could be a way to achieve that. Researchers surveyed 410 women in four of the 12 U.S. jurisdictions that have passed laws since 2016 to allow pharmacists to prescribe hormonal contraceptives — a third got prescriptions from pharmacists while the others were prescribed birth control by clinicians. Pharmacists were much more likely to prescribe contraceptives for six months or longer compared to clinicians as well as less likely to write a prescription for shorter than a month's supply. Women who received prescriptions from pharmacists also tended to be young, uninsured, and unlikely to have a bachelor's degree, which are all risk factors for unintended pregnancies. 

Nurses report dire lack of appropriate protection for treating Covid-19 patients

A survey of more than 23,000 nurses affiliated with National Nurses United, the largest U.S. organization of RNs, finds that 87% report having to reuse PPE, including single-use respirators or masks, when treating a Covid-19 patient. A majority of nurses reported having some skin or clothing exposed when caring for a suspected or confirmed Covid-19 patient, and about a quarter said that they had been exposed to Covid-19 patients without proper PPE and continued working within 14 days of this exposure. Another 28% reported having to reuse "decontaminated" respirators with Covid-19 patients, even though decontamination can degrade their quality and efficacy. And despite these potential risks, only 16% of respondents report having been tested for Covid-19. 

What to read around the web today

  • Lockdown delays cost at least 36,000 lives, data show. The New York Times
  • US has three months to rebuild medical supplies stockpile, Obama administration scientists warn. The Guardian
  • A secret coup and a ‘poison pill’ have frozen shares of a biotech in the race for a Covid-19 vaccine. STAT Plus
  • ‘How could the CDC make that mistake?’. The Atlantic
  • ‘We’re expendable’: Russian doctors face hostility, mistrust. Associated Press

Thanks for reading! More tomorrow,

Shraddha

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Thursday, May 21, 2020

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