Amazon employee in Seattle tests positive for coronavirus

Amazon (NASDAQ:AMZN) confirms that an employee working in Seattle has tested positive for the coronavirus.

The employee worked downtown in the company’s Amazon Brazil office, which is separate from the main headquarters.

The state of Washington has seen the most COVID-19 cases in the U.S., many tied to a nursing facility in the Seattle suburbs.

https://seekingalpha.com/news/3548411-amazon-employee-in-seattle-tests-positive-for-coronavirus

Coronavirus updates: Working From Home, Italy, death rates

Companies ranging from Google and Twitter to Indeed and JPMorgan have asked many of their employees to work from home to help prevent the spread of coronavirus.

Italy (79 deaths, 2,502 cases) is now the worst-affected country from the coronavirus outside Asia, overtaking Iran now in terms of the number of fatalities and infections from the virus.

WHO added that the coronavirus death rate is 3.4% globally, higher than previously thought (and compared to the 1% infected by seasonal flu), but it doesn’t spread as efficiently as influenza .

https://seekingalpha.com/news/3548430-coronavirus-updates-wfh-italy-death-rates

Drug Already Used In Japan May Treat COVID-19

A group of scientists in Germany have identified a drug called camostat mesylate, that they believe may work to combat COVID-19, the disease caused by the SARS-CoV-2 coronavirus.

The new study published last week in Cell, shows that SARS-CoV-2 binds to human cells in a similar way to the original SARS coronavirus (SARS-CoV) that caused a worldwide outbreak in 2003, with this binding depending on viral proteins called ‘spike’ proteins.
“Spike is so named because that’s what it looks like: a spike on the surface of the virus particle,” said Angela L. Rasmussen, PhD, a virologist in the faculty of the Center for Infection and Immunity at the Columbia Mailman School of Public Health. “In order for a virus to infect a cell, it has to attach itself to a protein on the surface of that cell which we call the receptor. For SARS-CoV-2, this is a protein called ACE2. Spike binds ACE2 and allows SARS-CoV-2 to enter and infect cells,” she added.

As well as this initial process, the spike protein has to be primed by an enzyme called a protease in order for the virus to complete entry into the cell. The study showed that similar to SARS-CoV, SARS-CoV-2 uses a protease called TMPRSS2 to complete this process.
The scientists then looked at whether there were any compounds available that could stop the entry of coronavirus into the cell by stopping the TMPRSS2 protease from working. From previous work on SARS-CoV, they found one potential candidate called camostat mesylate and showed that the drug stopped SARS-CoV-2 from infecting lung cells in a dish.

“We found that SARS-CoV-2, like SARS-CoV, uses the host proteins ACE2 and TMPRSS2 to enter cells. Both viruses should therefore infect similar cells in patients and may cause disease via similar mechanisms,” said Markus Hoffmann, PhD, researcher in the Infection Biology Unit of the German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany and first author of the paper.
Developing new drugs for infectious diseases or even diseases such as cancer or neurological conditions can take years, even decades. But camostat mesylate has already been tested in people, albeit not for the treatment of COVID-19.
“We knew from our previous work that camostat mesylate was active against other coronaviruses, including SARS-CoV. Therefore, we tested whether it is also active against SARS-CoV-2,” said Stefan Pöhlmann, PhD, Professor in the same institute in Göttingen. “Our study shows that camostat mesylate blocks infection of cells with SARS-CoV-2-like particles and with authentic, patient-derived SARS-CoV-2. Moreover, camostat mesylate inhibited infection of important target cells – human lung epithelial cells,” he added.
The compound is approved in Japan for the treatment of a number of non-infectious conditions in people, such as chronic pancreatitis and postoperative reflux esophagitis and has also had some tests in mice infected with SARS-CoV. However, it has never been tested in humans with COVID-19.
“It does require trials in humans to determine if it’s effective, and I suspect it would also require pre-clinical animal work with SARS-CoV-2 specifically before human trials could start. If it has been shown to be safe for clinical use in other countries, it may be fast-tracked for FDA approval or the FDA may authorize emergency off-label use,” said Rasmussen, indicating that the FDA will have to examine safety data and pre-clinical data before determining which, if any course of action to take with investigating the drug further.
One concern is that TMPRSS2 might not be the only protease that controls spike priming and hence blocking it may be ineffective in people as other proteases may act as backups, still allowing the virus entry into cells. There are also questions to be asked about how the drug would actually alter the ability of the virus to cause disease in people.
“Pathogenesis can’t be studied in cultured cells, so these questions will need to be addressed using animal models and human clinical samples,” said Rasmussen.
Given the similarities between SARS-CoV and the current virus SARS-CoV-2, the researchers also looked at whether people who recovered from SARS had any immunity to the new virus strain. They took serum containing antibodies taken from 3 recovering SARS-CoV patients back around the time of the original outbreak in 2003 and showed that this blocked entry of SARS-CoV-2 into cells.
“Antibodies from patients who had recovered from SARS blocked the SARS-CoV-2 from infecting cells in culture. This suggests that antibodies against SARS might be useful as a treatment for SARS-CoV-2,” said Rasmussen.
SARS in 2003 was a smaller outbreak compared to the current situation with only 8,098 cases formally recorded and over 7,000 people surviving. It is not known how many of these people are still alive today, but it is possible that they will have some immunity to COVID-19. On a wider scale, studying these people may provide incredibly useful clues about successfully treating COVID-19. So, what are the next steps for the researchers?
“We are currently analyzing whether camostat mesylate-related inhibitors show improved antiviral activity. So far we have not been contacted by others regarding off-label use of camostat mesylate. However, we are contacting physicians to discuss this option,” said Pöhlmann.
There are currently no FDA-approved treatments for COVID-19, but last week, the National Institutes of Health announced that the antiviral drug remdesivir had begun testing in a human clinical trial in the U.S. Remdesivir, marketed by Gilead Sciences has previously shown promise in preventing MERS coronavirus disease in tests on monkeys and is already being used in human trials in Wuhan. The first patient in the U.S. is an American who was evacuated from the Diamond Princess cruise ship, which became a floating incubator for the virus, resulting in over 700 infections and six deaths reported so far.
https://www.forbes.com/sites/victoriaforster/2020/03/03/there-is-a-drug-already-used-in-japan-which-may-treat-covid-19-says-new-study/#5c1a0c614127

NY insurers ordered to to waive costs associated with coronavirus testing

New York Gov. Andrew Cuomo (D) announced Monday evening that he would direct state health insurers to waive fees related to coronavirus testing in the state amid fears of an outbreak in the U.S.
In a series of tweets, Cuomo wrote that cost should not be a barrier for New Yorkers receiving screenings for the novel form of coronavirus behind an outbreak that began in China and has since killed more than 3,000 people worldwide, infecting tens of thousands more.
“I am announcing a new directive requiring NY health insurers to waive cost sharing associated with testing for #coronavirus, including emergency room, urgent care and office visits,” Cuomo tweeted. “We can’t let cost be a barrier to access to COVID-19 testing for any New Yorker.”
“New Yorkers receiving Medicaid coverage will not have to pay a co-pay for any testing related to #coronavirus. Currently all COVID-19 tests being conducted at the State’s Wadsworth Lab are fully covered,” he added.
Cuomo’s announcement comes a day after the first confirmed case of the coronavirus was reported in New York. Several dozen cases are confirmed in a handful of states, while several people have died in Washington state.
https://thehill.com/policy/healthcare/485622-new-york-insurers-ordered-to-to-waive-costs-associated-with-coronavirus

Will COVID-19 Expose Physician Shortfall, EMTALA Shortcomings?

The COVID-19 coronavirus is in the U.S., and what it will do here has yet to fully be seen. I suspect it will not have a high lethality among otherwise healthy individuals. But I’m no virologist and time will tell.
I do have a couple of observations.
First, we are already working with a shortage of physicians. We don’t have enough primary care physicians or specialists. Until Medicare (which funds residency training) agrees to increase the number of physicians trained after medical school, we will continue to have a shortage. Sadly, we have a fair number of young physicians who invested money and time in medical school but who can’t find residency slots. We refer to them as “graduate physicians,” and we should find ways to use them as we use nurse practitioners (NPs) and physician assistants (PAs). They have more didactic and clinical education on graduation than new NP and PA graduates have.
This matters not only because we already have too few physicians, but because an epidemic could leave us short of more physicians, who become afflicted with the disease. Reports out of the People’s Republic of China suggest that it has been hard on physicians, who are not only getting infected and sometimes dying but also completely exhausted from their work. (Additionally rendering them more susceptible to infection.)
Another issue we have is that it can take months for a physician to work in a hospital (to be “credentialed”). Having done some credentialing lately for a new job, I can attest. A physician has mounds of paperwork to fill out and has to send copies of every kind of certification and verification imaginable, even if they’re already on file from a previous period of employment. Said physician may have to get a new state license, which is often as daunting (or more so) than what hospitals require.
Further, he or she must send driver’s licenses, passports, reports of previous lawsuits (already available online), references, sometimes fingerprints, and even explanations of more than 1 month without consistent work in medicine. While that may seem like a good idea to some, it can make it very difficult to move physicians to new locations in a pinch. Or in an epidemic.
We need a better way to do this in times of crisis, and I suggest that there should be a central emergency credentialing system maintained by each state, which could be agreed upon and shared. Thus, if (for example) all the physicians in a small hospital in Alabama were stricken ill, physicians from Pennsylvania could be allowed to come and work, and this could be accomplished with a click and a file transfer.
States are already working on interstate licensing; that’s great. We also need inter-hospital credentialing, so that physicians who have the time off, or who are semi-retired (or fully retired) can get into the fray.
As an aside, we should develop a better, more uniform way to use those graduate physicians I mentioned above who would be more than willing to fill in and learn, and get paid, in times of crisis.
Second, hospitals during flu season are already at capacity. If we have an outbreak from the novel coronavirus, patients from primary care offices, clinics, and urgent care facilities, as well as self-triaged concerned citizens, will show up in hospital emergency departments in large numbers, potentially serving as hubs for spread of infection.
The answer to every question in an office or clinic, on a phone-triage line or telemedicine site simply can’t be “just go to the emergency room,” because the ER will be beyond capacity, as will the inpatient side of the hospital. Furthermore, what might be a simple head cold could well become worse if exposed to the sicker patients in the ER waiting room and treatment areas.
This might require some modification of the Emergency Medical Treatment and Labor Act (EMTALA), the “anti-dumping” law that mandates that everyone be seen regardless of ability to pay. Not in order to extract money but in order to sometimes say “you aren’t dangerously ill, we don’t have time or space to see you, go home and avoid crowds, and come back if you’re worse.”
Finally, we need to support America’s small and medium hospitals outside urban areas. They could serve as a relief in times of great national distress. Rest assured, in a pandemic, the big hospital teaching centers will be full and more than full. Strategically, America needs the option of vibrant, well-staffed smaller hospitals in suburban and rural communities. Not only for epidemics but for natural disasters, terrorism, or open warfare. (No, I’m not paranoid. Peace and safety are rarities in history.)
I pray the COVID-19 coronavirus dies a rapid death. But if it doesn’t, we have work to do. We just don’t have the staff or capacity we’ll need in case it continues its inaugural journey around the world.
Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test and Life in Emergistan.
https://www.medpagetoday.com/blogs/kevinmd/85210

G7 to make no direct calls for fiscal, monetary support in coronavirus statement

Group of Seven nations will voice their determination to fight the economic hit of the coronavirus but stop short of directly calling for new government spending or coordinated central bank interest rate cuts, two G7 officials said on Tuesday.

As the widening epidemic stokes fears of a global recession, finance ministers and central bank governors of the G7 major economies will issue a statement after their conference call scheduled at 1200 GMT on Tuesday.
In the statement, G7 countries will pledge to work together to mitigate the damage to their economies from the fast-spreading epidemic, one of the G7 officials told Reuters on condition of anonymity due to the sensitivity of the matter.
Another G7 source said G7 members would voice their determination for joint coordinated action, if needed, to limit the impact of the coronavirus on the global economy. Both sources said they would stop short of directly calling for concrete fiscal and monetary measures right now.
“We are still very much at the beginning of the outbreak. And it is not yet possible to predict how the epidemic will develop. So the impression is that it’s still too early for such a step,” said the second G7 source.
The news disappointed some investors who had hoped for more explicit measures of support by the major industrial powers.
Japan’s Nikkei <.N225> lost steam and closed 1.2% lower, though global stocks extended a tentative recovery from their coronavirus slump on Tuesday on hopes for united policy action.
Stephen Innes, chief market strategist at AxiCorp, said such a message from the G7 was not what markets had been hoping for.
“At this stage, I don’t think the G-7 are willing to show their stimulus hand and are holding back the fiscal cannons for a later date once they can better quantify the supply-side shock from Covid19,” Innes said in a note, referring to the disease caused by the virus.
The virus, which has spread to 60 countries, has killed more than 3,000 people and upended global supply chains.
Australia’s central bank cut interest rates to record lows on Tuesday, joining China in offering stimulus to fight the economic fallout from the coronavirus.
LIMITS OF POLICY
Analysts, however, have doubts about how effective rate cuts might be.
While central bank and fiscal policy can boost demand by lowering the cost of borrowing and putting money in people’s wallets, they cannot repair disrupted global supply chains or convince people to fly if local governments or companies bar such activities.
With rates in Japan and Europe already in negative territory, those doubts are even more amplified, suggesting the Bank of Japan and the European Central Bank (ECB) could seek alternatives to simply cutting rates.
The ECB is working on measures to provide liquidity to businesses hit by the economic fallout of the outbreak, three sources familiar with the discussion told Reuters.
“A lower price of money does not fix the fear that people have of catching the virus,” said Joe Capurso, foreign exchange analyst at Commonwealth Bank of Australia in Sydney.
“That is what’s causing the economic disruption and lower interest rates aren’t going to fix the fear.”

https://www.marketscreener.com/NIKKEI-225-4987/news/Exclusive-G7-to-make-no-direct-calls-for-fiscal-monetary-support-in-coronavirus-statement-sources-30097692/

Any U.S. citizen can be tested for virus at doctor’s orders under new guidance

Vice President Mike Pence said on Tuesday that U.S. public health authorities had issued new guidance to make clear that a doctor’s order was all that would be needed for any American to be tested for the novel coronavirus.
“We’re issuing new guidance, effective immediately, from the CDC that will make it clear that any clinician on health authority can administer the test,” Pence told reporters at the White House, referring to the U.S. Centers for Disease Control and Prevention.
https://www.reuters.com/article/us-health-coronavirus-usa-testing/any-u-s-citizen-can-be-tested-for-coronavirus-at-doctors-orders-under-new-guidance-pence-idUSKBN20Q35U