The surge in buying in stocks that investors
perceive may benefit from the coronavirus outbreak continues this
morning. The outbreak, mainly in China, has spread to Hong Kong.
The dean of the University of Hong Kong’s medical estimates that as many as 44,000 people in Wuhan could be infected.
The island’s economy, already in recession, is
taking a further blow as residents avoid restaurants, malls and crowded
places. Tourist spending is plummeting as well. Hong Kong Disneyland
Resort closed Sunday and will not reopen until it clarifies a plan with
health authorities. The city’s official Lunar New Year celebrations have
also been canceled.
It seemed like it was only a matter of time.
Even before the first U.S. case of a novel coronavirus that’s broken out in China
was confirmed Tuesday, American health officials and hospitals were
braced to respond. Hospitals and clinics were adapting their screening
protocols to ask about travel to Wuhan, the city where the spread has
been centered. State health departments were relaying messages to local
providers, alerting them to be on the lookout for the infection’s
symptoms. Labs were set to collect patient samples and ship them off for
diagnostic testing.
Even though this is a new virus, health officials said this was the
type of situation they anticipated. They’ve prepared before for other
emerging infectious diseases, including Zika and Ebola, as well as other
coronaviruses like SARS and MERS. For this current outbreak, federal
health officials have already issued recommendations for surveillance, testing, and care of patients, and hospitals have been following those guidelines.
“It’s not that we shouldn’t be concerned, but we should keep things
in context,” said Dr. Howard Zucker, New York state’s health
commissioner. “The most important thing is that we’ve been here before,
we’ve seen these challenges before. We’ve been able to identify them and
work through them and we will do the same here as a collaborative
effort on this task.”
There are some particular obstacles with the coronavirus, which is provisionally being called 2019-nCoV but has yet to get a permanent name.
For one, it presents as a respiratory infection, leading to fever,
cough, and shortness of breath — meaning it can look like the flu.
“It’s flu season, so everyone has respiratory symptoms,” said Dr.
Theresa Madaline, hospital epidemiologist at Montefiore Health System in
New York.
That leads to the second challenge: While labs around the country can
test for influenza, the only way at the moment to confirm an infection
of the novel coronavirus in the U.S. is to ship samples off to the
Centers for Disease Control and Prevention in Atlanta. CDC officials
have said they are currently testing samples of other patients in the
U.S. to determine if they have the virus, which in China has sickened
more than 570 and killed at least 17.
The CDC is also working on developing a diagnostic test that it can
deploy to states, but with a new virus like this, “it can take three to
six weeks,” said Scott Becker, the executive director of the Association
of Public Health Laboratories. “My hope is that it’s on the lower end
of that. We know they’re throwing all kinds of assets at it at CDC.”
Kelly Wroblewski, APHL’s director of infectious disease, said it’s
important to expand the number of sites that can diagnose the virus
should it start spreading widely among people here. If that were to
happen, testing demand could overwhelm any one location, which would
delay confirming who has the virus.
She said current recommendations include sending a nasal swab and
samples of phlegm from the lungs and blood serum to the CDC to test for
the coronavirus and distinguish it from other viruses.
Earlier this week, the CDC held a call with state health officials,
who asked the same types of questions that experts around the world have
been scrambling to figure out, said Dr. Marcus Plescia, the chief
medical officer of the Association of State and Territorial Health
Officials. Those unknowns include the animal source from which the virus
jumped to humans, whether people are infectious if they are not yet
showing symptoms, and how easily the virus spreads among people.
“What states are doing right now is gearing up surveillance, and
trying to understand what the constellation of symptoms is and where
cases are coming from,” Plescia said.
Federal health officials have started screening passengers
arriving from Wuhan at five U.S. airports, looking for people who have
fevers. Several hospitals around the John F. Kennedy Airport in New York
are prepared to help with any cases that may emerge from screenings,
Zucker said. The city’s public health department has also said it is
ready to safely transport any patients. While experts say that these
airport screenings are unlikely to catch anyone who is actively showing
symptoms of disease — especially since the disease has an incubation
period of at least a few days — these checks could remind passengers to
seek medical care if they do start to show symptoms.
At clinics and hospitals, the first step is identifying patients who
need additional screening for the virus. According to the CDC’s
guidelines, providers should ask patients with fever and a cough or
shortness of breath if they’ve traveled to Wuhan recently or been in
contact with anyone who might have the coronavirus.
But it’s a bit of a balancing act, experts said. Clinicians need to
be informed so they can spot a rare pathogen, but at the end of the day,
the likelihood in the U.S. for now is that a respiratory infection is
going to be a case of cold or flu.
“It’s better to be somewhat overprepared than underprepared,” said
Dr. Eric Toner, a public health preparedness scientist at Johns Hopkins
University’s Center for Health Security. “You don’t want to go overboard
by treating every patient as though they have Ebola. It’s prudent to
use some caution, but the extremely high levels of care that needed to
be implemented for Ebola — like special ways of incinerating every
material that touched a patient and how you handled waste — aren’t yet
warranted here.”
Some hospitals have started to incorporate coronavirus-specific
questions into their electronic health records system, but others have
found it’s much simpler to have the person who first sees the patient
conduct a quick survey of their symptoms and travel history.
“Getting the changes in place through health systems IT is
challenging,” said Dr. John Lynch, an infectious disease specialist at
Harborview Medical Center, part of the University of Washington’s
medical system in Seattle. “A lot of the [electronic health records] are
not really nimble, and we end up just going back to the basic system of
having the staff and nurses ask this question.”
Hospitals also have choreographed routines to guide patients safely
through their facilities, to reduce the chance the virus spreads there.
That includes taking them to a private room, where a more detailed
screening can take place. (At this point, human-to-human transmission
has only been confirmed in China, not in any of the other countries that
travelers have carried the virus to, including Japan, South Korea, and
Thailand, according to the World Health Organization.)
If there were a suspected case at Harborview, Lynch said, “We’d get a
surgical mask on them and then get them out of waiting rooms into some
other space — that’s really the most important step.”
At the University of California, San Francisco, clinicians can take
patients to a room that was built just for people possibly infected with
an emerging pathogen — an addition inspired by the 2014-2016 West
African Ebola outbreak.
“The room is isolated to reduce the chance of transmission,” said Dr.
Charles Chiu, an infectious disease physician at UCSF. Chiu noted that
more than a dozen health workers in China had been infected with the
novel coronavirus. “It’s worrisome,” he said.
One primary concern is the safety of immunocompromised patients,
including those who have been through chemotherapy or have received
organ transplants. These patients are “very susceptible” to developing
pneumonia from coronaviruses, Chiu said. “I think this is going to be a
test for our public health surveillance systems and infrastructure,” he
said.
In Washington state, where the first U.S. case of the virus was
confirmed, health officials framed the response as an example of how it
should be done.
The patient, a man in his 30s who traveled back to his home north of
Seattle from China on Jan. 15, fell ill on Jan. 16. He sought out
medical care on Jan. 19, and his clinicians realized this could be a
case of the coronavirus. They isolated the man, took samples from him
and shipped them off to the CDC, and told him to stay at home so he
wouldn’t risk spreading the virus. State and county officials were
alerted, and by the time the CDC confirmed the infection on Jan. 21,
they were ready to transport him safely to a hospital, where he could be
treated in isolation by a team that took the proper precautions to
avoid contracting the virus.
Health officials have since identified 16 people the man had contact
with when he had the virus, and have begun reaching out to them.
“We think this has been a very rapid response,” Washington Gov. Jay Inslee said Tuesday.
Dr. Reddy’s Laboratories Ltd. said it swung to a net loss in its third quarter due to an impairment of a birth-control product.
Net loss amounted to 5.70 billion Indian rupees ($79.9 million) for
the quarter ended December, compared with a net profit of INR4.85
billion a year earlier, the India-based pharmaceutical company 500124, +4.89%RDY, -0.83% said Monday.
A FactSet poll had estimated a net profit of INR4.86 billion for the third quarter.
Dr. Reddy’s said it took an impairment loss of INR11.14 billion in
the birth-control product due to significant adverse market conditions.
Revenue rose 14% to INR43.84 billion in the third quarter from INR38.50 billion a year earlier. https://www.marketwatch.com/story/dr-reddys-laboratories-swings-to-net-loss-in-third-quarter-2020-01-27?siteid=rss&rss=1
Gilead Sciences is considering repositioning NUC inhibitor remdesivir
as a treatment for the coronavirus now sweeping across parts of China.
The antiviral last made headlines when Gilead tested it, with little
success, as a treatment for Ebola virus.
As happened during the Ebola outbreak, the surge in cases of
infection with a potentially fatal strain of the coronavirus in parts of
China has led to a flurry of statements from biotechs with assets they
claim could help keep the virus under control. Gilead became the latest
drug developer to throw its hat into ring when it issued statements
about its plans to Bloomberg Law and Reuters.
“Gilead is in active discussions with researchers and clinicians in
the United States and China regarding the ongoing Wuhan coronavirus
outbreak and the potential use of remdesivir as an investigational
treatment,” the big biotech said.
Based on previous outbreaks, few, if any, of the programs now being
talked up will lead to drugs that make a difference, either
therapeutically or commercially. However, Gilead is in a slightly
different position than some of the other companies with an interest in
the virus.
Whereas Moderna is applying its untested “rapid response capability”
to the development of a new mRNA vaccine and other companies are at
similarly early stages, Gilead has a drug that has already been tested
in humans. That positions Gilead to respond more quickly to the
outbreak, although it also leaves scope to doubt whether it has a drug
capable of tackling coronavirus.
Gilead pushed remdesivir forward quickly in collaboration with the
Centers for Disease Control and Prevention and the U.S. Army Medical
Research Institute for Infectious Diseases in response to the West
African Ebola virus epidemic that began in 2013. The R&D program
culminated in a randomized controlled clinical trial that tested
remdesivir and three other drugs in patients with Ebola.
The trial found two of the drugs were more effective than remdesivir,
putting an end to efforts to establish the NUC inhibitor as a treatment
option in Ebola. Despite the setback, remdesivir could emerge as a
potential treatment for coronavirus.
Interest in the use of remdesivir against coronavirus is underpinned
by data including the findings of early-stage tests published in 2018.
The tests generated preliminary evidence that remdesivir inhibits murine
hepatitis virus and Middle East respiratory syndrome coronavirus
without spurring the rise of dangerous drug-resistant strains.
“These studies define the target of GS-5734 activity and demonstrate
that resistance is difficult to select, only partial and impairs fitness
and virulence of MHV and SARS-CoV, supporting further development of
GS-5734 as a potential effective pan-[coronavirus] antiviral,” the
authors of the 2018 paper (PDF) wrote. https://www.fiercebiotech.com/biotech/gilead-mulls-repositioning-failed-ebola-drug-china-virus
The death toll from a coronavirus outbreak in China rose to 81 on
Monday, as the government extended the Lunar New Year holiday and more
big businesses shut down or told staff to work from home in an effort to
curb the spread.
Chinese Premier Li Keqiang visited the central city of Wuhan, the
epicenter of the outbreak, as the government sought to signal it was
responding seriously.
Asian shares tumbled, with Japan’s Nikkei average sliding 2.0%, its
biggest one-day fall in five months, as investors grew increasingly
anxious. Demand spiked for safe-haven assets such as the Japanese yen
and Treasury notes.
The total number of confirmed cases in China rose about 30% to 2,744,
with about half in Hubei province, the capital of which is Wuhan. But
some experts suspect the number of infected people is much higher.
As worry grew around the world, Chinese-ruled Hong Kong, which has
had eight confirmed cases, banned entry to people who had visited Hubei
in the past 14 days. The ban did not cover Hong Kong residents.
The nearby gambling hub of Macau, which has had at least one case of
the flu-like virus, imposed a similar ban on those arriving from Hubei,
unless they can prove they are virus-free.
The city of Haikou on Hainan island in southern China said tourists from Hubei would be quarantined for 14 days.
“Hubei people are getting discriminated against,” a Wuhan resident complained on the Weibo social media platform.
The number of deaths from the virus in Hubei climbed to 76 from 56, health officials said, with five deaths elsewhere in China.
While a small number of cases linked to people who traveled from
Wuhan have been confirmed in more than 10 countries, including Thailand,
France, Japan and the United States, no deaths have been reported
elsewhere.
Li is the most senior leader to visit Wuhan since the outbreak began.
Clad in a blue protective suit and mask, he inspected efforts to
contain the epidemic and spoke to patients and medical staff, the
government said.
Wuhan, a city of 11 million people, is in virtual lockdown and severe
limits on movement are in place in several other Chinese cities. Much
of Hubei province, home to nearly 60 million people, is under some kind
of travel restriction.
The government is extending the week-long Lunar New Year holiday by
three days to Feb. 2, in a bid to slow the spread of the virus. The
Lunar New Year is usually a time for travel by millions, but many have
had to cancel plans.
INCUBATION
Investors are worried about the impact on travel, tourism and broader economic activity.
During the 2002-2003 outbreak of Severe Acute Respiratory Syndrome
(SARS), a coronavirus that originated in China and killed nearly 800
people globally, air passenger demand in Asia plunged 45%. The travel
industry is more reliant on Chinese travelers now than it was then.
The newly identified coronavirusvirus is believed to have originated
late last year in a Wuhan market illegally selling wildlife.
Much is not known about it, including how easily it spreads and just
how dangerous it is. It can cause pneumonia, which has been deadly in
some cases.
National Health Commission Minister Ma Xiaowei said on Sunday the
incubation period could range from one to 14 days, and the virus was
infectious during incubation, unlike SARS.
The World Health Organization (WHO) estimated an incubation period of
two to 10 days. It is also not clear if an infected person can pass it
on before they show symptoms.
Wendy Barclay, a professor and virologist at Imperial College London,
said many of the respiratory viruses that spread among humans do
transmit even in the absence of symptoms, and it would not be surprising
if the new coronavirus also did.
“If this does prove to be the case then controlling the spread does
become more of a challenge, and measures like airport screening are
unlikely to stem the virus effectively,” she said.
‘OVERWHELMED’
Australia confirmed its fifth case on Monday involving a woman on the
last flight out of Wuhan to Sydney before China’s travel ban.
Health Minister Greg Hunt told the Australian Broadcasting
Corporation (ABC) authorities aimed to get about 100 Australian children
and young people out of Wuhan. Countries including the United States
are working to evacuate their citizens.
One father of two, Nathan Wang, told the ABC his wife was stuck in
Wuhan with the children. “We absolutely want the children to come back,
because hospitals in Wuhan are overwhelmed,” he said.
Images on social media showed hospital corridors packed with people seeking treatment.
Airports around the world have stepped up screening of passengers
from China, although some health experts have questioned its
effectiveness.
Last week the WHO stopped short of calling the outbreak a global
health emergency, but some health experts question whether China can
contain the epidemic.
WHO Director-General Tedros Adhanom Ghebreyesus is due to travel to Beijing to meet officials and health experts.
Some of China’s biggest companies have been affected, with hotpot
restaurant chain Haidilao International Holding shutting branches
nationwide from Sunday until Friday.
Gaming giant Tencent Holdings Ltd advised staff to work from home
until Feb. 7, and e-commerce firm Alibaba removed vendors’ offers of
overpriced face masks from its online Taobao marketplace as prices
surged. https://www.reuters.com/article/us-china-health/china-extends-holiday-businesses-shut-as-virus-toll-rises-to-81-idUSKBN1ZQ01Q
