Which OTC Cold Medications Are Safe for the Heart?

Little has changed in the $8 billion world of useless and confusing over-the-counter (OTC) cold, flu, and sinus medications since the Skeptical Cardiologist first tackled “What Cold Medications Are Safe For My Heart” in 2015.

I still advise avoiding combination OTC cold meds and utilizing specific medications for specific symptoms.

The original post covers most of the usual suspects in this mostly useless arena. I updated it in 2016 with comments on a few additional OTC components. That post on Alka-Seltzer, phenylephrine, and doxylamine is included below.

Alka-Seltzer Plops Into the OTC Cold Market

I had always viewed Alka-Seltzer as an effervescent tablet for acid reflux, but the brand (now owned by Bayer) has moved aggressively into the bewildering morass of OTC cold meds. Indeed, when Alka-Seltzer began in 1931, it was a combination of aspirin and sodium bicarbonate (baking soda) marketed for upset stomachs. Popular commercials from the 1960s featured the catchy jingle (still stuck in my head) “Plop, plop, fizz, fizz. Oh what a relief it is” often sung by Speedy, an odd anthropomorphic creature with an Alka-Seltzer thorax and cap. (The jingle was written by Tom Dawes of The Cyrkle [“Red Rubber Ball”], not by the father of Julianna Margulies.)

Recently, I received a request from an out-of-town guest who was suffering from a cough and upper respiratory infection to purchase Alka-Seltzer Plus in the form of a tablet that dissolves in hot water.

At his request, Alka-Seltzer Plus Day Multi-Symptom Cold and Flu was purchased at the local Walgreens.

The ingredients are typical for many of the Alka-Seltzer products:

• Dextromethorphan (promoted for cough but ineffective and with considerable side effects, see my initial post)
• Acetaminophen (Tylenol, for pain and fever)
• Phenylephrine (decongestant)

Phenylephrine: Ineffective Substitute for Pseudoephedrine

I didn’t cover phenylephrine previously. It has taken the place of pseudoephedrine in on-the-shelf OTC cold medications.

Like pseudoephedrine, phenylephrine is a sympathomimetic drug, meaning it stimulates receptors of the sympathetic nervous system. Unlike pseudoephedrine, phenylephrine is useless as a decongestant when taken in the dosages available over the counter.

A study published in 2015 confirmed what previous studies had suggested: Phenylephrine in dosages of 10 to 40 mg daily was no more effective than placebo in reducing symptoms of nasal congestion.

An accompanying editorial called on manufacturers to remove this useless drug from their products.

Alas, all of the Alka-Seltzer preparations that claim to treat congestion utilize phenylephrine as the decongestant.

The transition to useless phenylephrine took place when pseudoephedrine was taken off the shelves and put behind the counter to reduce its usage in making methamphetamine.

Therefore, Alka-Seltzer Plus Cold and Flu contains two useless ingredients plus acetaminophen (Tylenol).

You can buy a large bottle of cheap generic acetaminophen and take exactly the right dose you need for relieving fever or body aches without paying for two useless accompanying drugs that have the potential for giving you unwanted side effects.

Sleep Aids in OTC Cold Meds

I covered the most common drug found in OTC cold meds promoted for nighttime use, diphenhydramine (Benadryl), in my previous post.

Nighttime Alka-Seltzer products contain a similar sedating antihistamine called doxylamine succinate.

Doxylamine is the active ingredient in the brand-name sleep aid Unisom and the “ZzzQuil” products from the NyQuil brand that are promoted for inducing sleep. It is available in cheap, generic form.

According to DrugBank, “It is also the most powerful over-the-counter sedative available in the U.S., and more sedating than many prescription hypnotics. In a study, it was found to be superior to even the barbiturate, phenobarbital for use as a sedative.”

Note that the effective dosage recommended in separate sleep aids is 25 mg, not the 12.5 mg found in Alka-Seltzer OTC cold meds. Thus, if you want an effective dosage of doxylamine to help you sleep, you must double the recommended dosage of Alka-seltzer’s nighttime product, which then gives you too much acetaminophen and dextromethorphan.

Doubling these drugs raises the potential for side effects. Common dextromethorphan side effects include nausea/vomiting, dizziness, diarrhea, and nervousness. Too much acetaminophen can damage the liver.

In addition, both dextromethorphan and acetaminophen interact with multiple other medications. Dextromethorphan is known to interact with many medications.

Acetaminophen can interfere with warfarin and increase the risk of dangerous bleeding.

My advice for 2020 is unchanged from 2015. As I summarized previously:

“I think you are much better off avoiding these brand name mixtures of different active ingredients.

Instead, you should take what you need for a specific symptom in the appropriate dosage and time interval.

Thus, if you have pain, take the minimal dose of Tylenol that relieves it and repeat when it comes back.

If you have a cough, recognize that the OTC ingredients are no better than placebo and are being abused as recreational drugs. Most coughs go away shortly; but if one is particularly troublesome and persistent, get a cough suppressing drug from your physician.

If you have a really runny nose with a lot of sneezing, it is probably OK to take pseudoephedrine even if you are a heart patient or have high blood pressure. Take it as I described above. Start with 30 mg of the little red pseudoephedrine pills. Wait an hour to see how you feel. Take a second if it has not been effective. Repeat at 4 to 6 hour intervals as needed. Take your blood pressure at least once after starting it.

Don’t buy the multi-symptom multiple ingredient combinations, which are simply a marketing tool to get you to spend more money on something from which you won’t benefit.”

Consumer Reports seems to agree with me in a 2017 post on this topic (which doesn’t credit me).

Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical director of echocardiography at St. Luke’s Hospital in St. Louis. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this post first appeared.

https://www.medpagetoday.com/blogs/skeptical-cardiologist/84478

Congress calls Juul, four other e-cig companies to testify about youth vaping

Five leading e-cigarette companies will be dragged before Congress early next month, according to a Wednesday afternoon announcement from Rep. Diana DeGette (D-Colo.).

It’ll be the first chance for lawmakers on both sides of the aisle to question or scold many of these companies for their alleged role in fueling the growing youth vaping epidemic. Five companies, Juul, Logic, NJOY, Fontem, which makes the product “blu,” and Reynolds American, which makes “VUSE,” will testify on Feb. 5.

It’s the latest in a spate of bad news for the beleaguered industry, which has been staring down the possibility of the government banning flavored e-cigarettes altogether. Many of these companies are also the subject of multiple congressional investigations into marketing and business practices that targeted young people, according to lawmakers.

“While consumers remain in the dark of the possible health consequences, these companies are making billions of dollars as they lure a new generation of young people into a lifetime of nicotine addiction,” DeGette, the chair of the oversight panel conducting the hearing, wrote in a press release.

It’s a time-honored tradition for unpopular industries to be called before Congress for high-profile tongue lashings. In years prior, drug makers, drug wholesalers, bankers, and airlines have felt Congress’ wrath. Most famously, seven tobacco executives irreparably damaged their industry’s reputation when they testified before the Energy and Commerce Committee in 1994.

Juul will share the stage with its competitors, but it is likely to take more heat on the dais than the other four participants.

Despite spending more than $4 million lobbying Congress in 2019, Juul has been criticized by everyone from former FDA Commissioner Scott Gottlieb to presidential hopeful Sen. Elizabeth Warren (D-Mass.) for its role in fueling the youth vaping epidemic.

The company has already been hauled before Congress this year. Juul’s co-founder and chief product officer, James Monsees, and chief administrative officer, Ashley Gould, faced a grilling before the House Oversight Committee back in July.

The hearing is also the latest sign of Congress’ desire to seriously shake up the booming vaping market. Congress held roughly half a dozen hearings on the topic last year and recently raised the minimum age for vaping to 21.

Congress calls Juul, four other vape companies to testify about youth vaping

WHO postpones decision on declaring China outbreak global health emergency

The World Health Organization on Wednesday delayed a decision on whether to declare the ongoing outbreak of a novel virus that originated in China a global health emergency, with agency officials saying they needed more information to reach a consensus.

Following a meeting of a WHO emergency committee, Tedros Adhanom Ghebreyesus, the WHO’s director-general, said he had asked the committee to continue the discussion Thursday.

“This is an evolving and complex situation,” said Tedros, as he is known. He said declaring the outbreak a public health emergency of international concern, or PHEIC, was a decision “I’m only prepared to make with appropriate consideration of all the evidence.”

The delay came as new cases were reported and the situation in China was rapidly changing.

Authorities said they planned to implement a travel lockdown in Wuhan, the city of 11 million people where the outbreak is believed to have started. Starting at 10 a.m. local time Thursday, public transit service is going to be suspended, and flights and trains from the city are going to be canceled.

Designating an outbreak a PHEIC grants the WHO director-general additional powers to issue recommendations for how countries should respond. While countries can ignore those directives, such an announcement can coalesce global attention on an outbreak.

Dr. Didier Houssin, the chair of the WHO emergency committee, said members were divided over whether to recommend Tedros declare a PHEIC. Ultimately, he said, “the committee felt it was a little too unprecise to very clearly state that it was time to suggest to the [director-general] that it was a PHEIC.”

Hundreds of cases of the virus, which has been determined to belong to a family called coronaviruses, have been confirmed in Wuhan. Infections have also started to crop up around China. Health authorities have identified cases in people traveling from Wuhan to countries including Thailand, Japan, South Korea, and, as of Tuesday, the United States.

With millions of people expected to travel around the Lunar New Year holidays, which kick off this week, health authorities fear spread of the virus could accelerate. Countries, including the United States, are screening passengers arriving from Wuhan for symptoms of the infection, including cough, fever, and shortness of breath, and informing travelers about the signs of the virus to encourage them to seek out medical care if they become sick.

There have been 17 confirmed deaths related to the virus, which is known provisionally as 2019-nCoV. At least some of the patients who died had existing health complications when they contracted the virus.

North Korea has closed its border to foreign travelers, according to tour operators. Restricting travel and trade with a country dealing with an outbreak, however, is viewed as unlikely to stop disease spread and as likely to discourage countries from being transparent about outbreaks. The PHEIC designation would have enabled Tedros to urge countries not to close borders or limit trade.

Coronaviruses, which include SARS and MERS, typically spread to humans from an animal source. Many of the early cases of the novel coronavirus were linked to a seafood market in Wuhan that also sold game. But health authorities have confirmed that some infections have come through human-to-human transmission. They are still trying to determine whether spread among people is limited or whether it might be spreading in a sustained manner, meaning it easily passes from one person to the next and then onward. They are also trying to learn if people with the virus can spread it only when they are symptomatic or before symptoms arise as well.

The seafood market in Wuhan was closed Jan. 1, the day after Chinese health officials reported to the WHO a strange spike in pneumonia cases in the city. That allowed scientists to discover the novel virus.

The emergence of a global coronavirus outbreak from China is reminiscent of the SARS outbreak of 2002 to 2003, which went on to kill nearly 800 people. The PHEIC designation (pronounced “fake”) was created following an update to the International Health Regulations after that outbreak.

The first PHEIC was declared for the 2009 H1N1 flu pandemic, and others have included the 2014-2016 West African Ebola outbreak and the Zika outbreak in 2016. The WHO set up an emergency committee to assess whether MERS should be declared a PHEIC, but it concluded after meeting several times that the disease did not constitute a global health emergency.

There are currently two active PHEICs: the ongoing Ebola outbreak in the Democratic Republic of the Congo and the continued transmission of polio.

WHO postpones decision on whether to declare China outbreak a global public health emergency

With phase 2 in the bag, Akcea to test triglyceride-buster in cardio conditions

One month after Akcea’s partner Novartis opted out of its triglyceride-targeting program, the treatment beat placebo handily at lowering blood triglyceride levels in patients who have, or are at risk of, heart disease. The phase 2 data tee it up for trials in specific cardiovascular ailments, including familial chylomicronemia syndrome (FCS).

The study tested various dose levels and frequencies of the antisense drug, known as AKCEA-APOCIII-LRx, against placebo in 114 patients. Patients received injections of the treatment or placebo once a week, every two weeks, or every month, for at least six months.

More than 90% of patients taking the highest dose saw their triglyceride levels drop to healthy levels, compared to just 5% of patients on placebo, the company announced on Wednesday. The treatment also made a “significant” dent in apolipoprotein C-III (ApoC-III), a protein made in the liver that plays a role in triglyceride metabolism, and two kinds of “bad” cholesterol called very low-density lipoprotein cholesterol and remnant cholesterol.

Its safety profile looked good, with side effects similar across treatment and placebo groups. These were mostly injection site reactions, the company said in a statement. Most patients (85%) finished treatment and patients in both groups quit the study at similar rates.

“Based on the positive results from this study, we plan to rapidly pursue development of AKCEA-APOCIII-LRx for familial chylomicronemia syndrome or FCS,” said Akcea Chief Medical Officer Louis O’Dea, M.D., in the statement.

FCS, a rare, genetic disorder that stops the body from breaking down fats, is the target of another Akcea program, volanesorsen, approved in the European Union as Waylivra. Although an FDA advisory committee voted 12-8 in favor of its approval, the agency rejected the drug. The company told BioSpace last summer it was working on a path forward for the treatment in the U.S. and Canada.

Akcea plans to bring AKCEA-APOCIII-LRx beyond FCS, though it hasn’t specified which cardiovascular diseases this might include.

“Because we were able to achieve substantial triglyceride lowering with this investigational medicine, we are also considering developing it for other rare and common diseases associated with elevated triglycerides. We are very grateful to the patients, families and physicians who participated in this study and are excited about the potential to bring this much-needed therapy to patients,” O’Dea added.

https://www.fiercebiotech.com/biotech/phase-2-bag-akcea-to-test-triglyceride-buster-fcs

SGLT2 windfall? Heart failure gold rush likely to benefit diabetes players

When the FDA approved Eli Lilly and Boehringer Ingelheim’s Jardiance as a heart-helping addition for heart failure patients, it kicked off an arms race in the SGLT2 class. That war for supremacy isn’t without reason: The heart failure market is set for a gold rush in the coming years, and it could spell blockbuster sales for drugmakers that stake a claim.

Powered by a booming slate of SGLT2 cardiovascular approvals, the U.S. heart failure market is set to grow by sevenfold in the coming decade from $3.7 billion in 2018 to $22.1 billion in 2028, according to GlobalData.

What will spur that boom? The rising prevalence of heart failure co-morbidities like diabetes, for one, but also a rapidly aging population and a rising need for treatments following a heart attack.

According to GlobalData, a booming market will not only benefit meds like AstraZeneca’s Farxiga, Eli Lilly and Boehringer Ingelheim’s Jardiance, and Johnson & Johnson’s Invokana––both of which sport heart-helping labels––but also a range of generic medicines, including statins, currently used as standard of care for heart failure patients.

“The exciting growth seen in the HF market will be largely due to SGLT inhibitors,” GlobalData analyst Heather Farrell said in a release. “Their trial results in reducing mortality and risk of hospitalization are unmatched, so far, and the familiarity of the drugs as anti-diabetics will hopefully improve the uptake and optimize dosing strategies.”

When the FDA gave the SGLT2 class its first entry into heart failure after Jardiance’s approval in 2015, it kick-started a heated competition in the space that is still going today.

The most recent trendsetter in the group, Farxiga, is awaiting an FDA priority review for its application to treat heart failure patients with or without Type 2 diabetes––a first-in-class approval that would likely change the direction of the field as a whole.

Farxiga is currently approved to reduce the risk of hospitalizations in heart failure patients with a reduced ejection fraction (HFrEF) and Type 2 diabetes, as well as solo and combo approvals in diabetes proper.

The heart failure nod, granted in October, was based on outcomes trial data showing Farxiga cut the rate of hospitalizations by 36% among HFrEF patients and by 24% among those without one. Farxiga already sports those benefits on its label in Europe, where it’s known as Forxiga.

Farxiga previously trailed SGLT2 rivals like Johnson & Johnson’s Invokana and Eli Lilly and Boehringer Ingelheim’s Jardiance in marketing cardiovascular benefits but will take a major step ahead of both if it nabs this newest FDA green light.

The priority review comes on top of a fast-track designation Farxiga scored in September on the heels of trial data showing it cut CV risks by 26% when added to standard-of-care therapy for heart failure patients with or without Type 2 diabetes as part of its Dapa-HF outcomes trial.

GlobalData’s report not only singled out SGLT2 meds as possible market drivers in the coming years but also novel treatments like Bayer and Merck & Co.’s sGC enzyme simulator vericiguat. The med hit its primary endpoint in a phase 3 trial in November despite missing the mark in the two phase 2 studies that preceded it.

Novo Nordisk’s Ozempic, a diabetes fighter in the GLP-1 class, also recently scored an FDA approval to reduce the risk of CV events in heart failure patients with diabetes and an established heart disease. The agency based its decision on Novo’s CV outcomes study, dubbed Sustain 6, that showed patients treated with Ozempic posted a 26% relative risk reduction over placebo in preventing CV events, including death, non-fatal heart attacks and non-fatal strokes.

Ozempic, initially approved in December 2017 as a treatment for diabetes, launched in early 2018 and has since raced out to blockbuster status. In the first nine months of 2019, Ozempic posted DKK 6.87 billion ($1 billion) in global sales.

Novo’s other next-gen GLP-1, oral med Rybelsus, is under study as a CV preventative in patients with Type 2 diabetes as part of Novo’s Soul CVOT study launched in June.

https://www.fiercepharma.com/pharma/sglt2-windfall-heart-failure-gold-rush-likely-to-benefit-diabetes-players-analyst

FDA Publishes Initial Rejection Letter of Sarepta’s Vyondys 53 for Duchenne

In August 2019, the U.S. Food and Drug Administration (FDA) issued a Complete Response Letter (CRL) to Sarepta Therapeutics over its golodirsen for Duchenne muscular dystrophy (DMD) with a confirmed mutation amenable to exon 53 skipping. In December, the FDA approved the drug, now named Vyondys 53.

After receiving the CRL, Sarepta’s chief executive officer, Doug Ingram, told investors and DMD families that the FDA’s rejection was related to concerns about the risk of infection and possible kidney toxicity. When asked to release the actual CRL, he declined, saying that “might not look like we’re being as respectful as we’d like to be.” Then he assured the audience that he hadn’t misrepresented the FDA’s CRL.

Only now, the FDA, in a surprise move, posted the CRL on the agency’s website. The CRL was written by Ellis Unger, director of the FDA’s CDER’s Office of Drug Evaluation I. The CRL not only brings up the potential toxicities of the drug but raises questions about the drug’s efficacy.

For example, the CRL notes, “The 6-minute walk data from Study 4053-101 are not discussed herein, but they show progressive loss of physical function in essentially all boys. Moreover, there is no correlation between maintenance of physical performance and the magnitude of truncated dystrophin production, further suggesting that if there is indeed a clinical effect of golodirsen, the effect size is small.”

The letter then goes on to discuss the infections and renal toxicity, saying, “Both are potentially life-threatening, and the latter (renal toxicity) is difficult or impossible to monitor.”

The publication of the letter not only raises the question of why the agency decided to approve it several months later, but why the company has failed to run a confirmatory trial over the company’s Exondys 5, for DMD, which was approved after considerable drama and controversy in 2016. Exondys 51 is approved for DMD patients with a confirmed mutation amenable to exon 51 skipping.

DMD is a muscle wasting disease caused by mutations in the dystrophin gene. It is a progressive disease that usually causes death in early adulthood, with serious complications that include heart or respiratory-related problems. It mostly affects boys, about 1 in every 3,500 or 5,000 male children.

After the CRL, Sarepta made a formal dispute resolution request to the FDA. Sarepta indicated that the agency’s Review Division quickly evaluated and resolved the issue and granted the appeal. Sarepta re-submitted its NDA to the Review Division, which approved the drug.

The agency is requiring Sarepta to conduct a confirmatory trial for Vyondys 53, which Sarepta says it will wrap by 2024. This echoes the company’s plans to run a confirmatory trial as required by the FDA for Exondys 51, but which four years later has not been performed.

Exondys 51 costs about $300,000 per year, based on the patient’s weight, but can run up to $1 million annually. Vyondys 53 has a similar pricing structure.

In the CRL, Unger also ties in safety concerns to Exondys 51. At the time of that approval in 2016, the concerns over infections was theoretical. Unger wrote, “Three years later, with 469 patients exposed to commercial eteplirsen, we have incontrovertible evidence of a significant likelihood of serious infections, including sepsis, septic shock, and possibly death. Thus, the risk of serious and life-threatening infections is no longer theoretical.”

And he goes on to make the connection between risk of infection and Vyondys 53 because the “the infection risk is a function of the patient population and the delivery system—not the drug.”

He also said that based on the animal research data, the risk of renal toxicity was worse in Vyondys 53 than it was for Exondys 51. And there’s still no particular way to monitor patients for early signs of renal toxicity.

Meanwhile, the FDA is still waiting for Sarepta to launch its confirmatory trial for Exondys 51, which was required as part of the drug’s 2016 approval.

Unger wrote, “Given that you have established a standard paradigm and design for these types of studies, given that you have relationships with a number of DMD referral centers, and given that some 469 patients have received commercial eteplirsen, it is necessary to ask why you have not initiated your required confirmatory study with due diligence.”

https://www.biospace.com/article/fda-comes-clean-on-sarepta-s-golodirsen-for-duchenne-muscular-dystrophy/

China Coronavirus Update: What it is, How Dangerous it is, What is Being Done

It originally started as mysterious cases of pneumonia reported in China. It has now been identified as a new strain of coronavirus, which as of today, has infected more than 440 people and killed nine in China. On Jan. 21, 2020, the first case was reported in the U.S. The unnamed patient is being treated at Providence Regional Medical Center in Everett, Washington. He recently returned from Wuhan, China, the source of the infections.

The U.S. National Institutes of Health (NIH) is taking the risk of these infections seriously, and beginning work on a vaccine. But the first phase of clinical trials of the vaccine wouldn’t take place for several months and it would be more than a year before a vaccine might be available.

However, biotech company Moderna is working with the federal agencies on a vaccine. The company’s chief executive officer Stephane Bancel told CNBC they might be able to develop one in less than two months.

In the company’s SEC filing, it wrote, “Moderna’s mRNA vaccine technology could serve as a rapid and flexible platform that may be useful in responding to newly emerging viral threats, such as the novel coronavirus. While we have not previously tested this rapid response capability, Moderna confirms that we are working with NIH/NIAID/VRC on a potential vaccine response to the current public health emergency.”

The virus was first reported in December 2019. Most of the cases have been in China, although there have been reports of infections in Thailand, South Korean, Japan, and now the U.S.

The virus is a coronavirus, the same family of viruses that causes colds, but also more severe infections such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

At the moment, the risk appears to be relatively low, although the concern is similar to those seen with SARS, MERS and even very different types of viruses, such as Ebola. One reason is that they all appear to have originated in animals and then spread to humans. The term for this is zoonotic. And the new coronavirus appears to be communicable between humans.

“Human-to-human spread has been confirmed [but] how easily or sustainably this virus is spreading remains unknown,” said Nancy Messonnier, director of the U.S. Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases in a press conference. “Right now we are testing for this virus at CDC, but in the coming weeks we anticipate sharing these tests with domestic and international partners.”

The World Health Organization (WHO) is holding an emergency meeting today to decide if the outbreak should be classified as an international public health emergency. Although there are more than 440 reported cases, epidemiologists believe there are likely thousands of cases that have gone unreported or undiagnosed.

SARS was believed to have originated in bats then spread to civet cats before infecting humans. MERS is believed to have originated in camels. HIV, Ebola and H5N1 influenza all came out of wildlife before humans interacted with infected animals. In SARS, for example, almost 40% of the first cases were in food preparers and people who handled, killed or sold wild animals.

The new coronavirus infection appears connected to a seafood market in Wuhan City in China, which has more a population of more than 11 million. A CNN report found that the South China Seafood City market in Wuhan not only sold seafood, but also raccoon dogs and deer.

“When you bring animals together in these unnatural situations, you have the risk of human diseases emerging,” Kevin Olivan, a disease ecologist and conservationist at the EcoHealth Alliance, told National Geographic. “If the animals are housed in bad conditions under a lot of stress, it might create a better opportunity for them to shed virus and to be sick.”

At this point, not enough is known about the new coronavirus to determine how great the risk actually is. At the moment, public health experts don’t believe the risk is as high or as dangerous as the measles or the flu. But there’s clearly concern, and with the ease of international travel and the possibility of the virus mutating further to become either more deadly or more communicable, public health officials are on high alert.

Pascal Soriot, the chief executive officer of AstraZeneca, told CNBC at the World Economic Forum in Davos, Switzerland that the company “plans for this kind of event,” but like its competitor Merck, was holding off until the WHO provided guidance on how to respond. “It really looks like at this point it’s very contained,” he said.

“This is one of those inflection moments in outbreak history where we have enough information to be very concerned, but not enough information to say this is going to be an international crisis,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

https://www.biospace.com/article/nih-working-on-vaccine-against-new-chinese-coronavirus/