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Thursday, March 5, 2020

Before coronavirus, China bungled swine epidemic with secrecy

When the deadly virus was first discovered in China, authorities told the people in the know to keep quiet or else. Fearing reprisal from Beijing, local officials failed to order tests to confirm outbreaks and didn’t properly warn the public as the pathogen spread death around the country.
All this happened long before China’s coronavirus outbreak, which has claimed more than 3,000 lives worldwide in less than three months. For the past 19 months, secrecy has hobbled the nation’s response to African swine fever, an epidemic that has killed millions of pigs. A Reuters examination has found that swine fever’s swift spread was made possible by China’s systemic under-reporting of outbreaks. And even today, bureaucratic secrecy and perverse policy incentives continue undermining Chinese efforts to defeat one of the worst livestock epidemics in modern history.
Beijing’s secretive early handling of the coronavirus epidemic has troubling similarities to its missteps in containing African swine fever, but with the far higher stakes of a human infection. After the coronavirus was found in December 2019 in Wuhan, the capital of Hubei province, local and national officials were slow to sound the alarm and take actions disease experts say are needed to contain deadly outbreaks. Beijing continues to gag negative news and online postings about the disease, along with criticism of the government’s response.
With swine fever, Beijing set a tone of furtiveness across government and industry by denying or downplaying the severity of a disease that the meat industry estimates has shrunk China’s 440-million-hog herd by more than half. The epidemic has taken a quarter of the world’s hogs off the market, hurt livelihoods, caused meat prices to spike globally and pushed food inflation to an eight-year high.
Cover-ups across China – coupled with underfinancing of relief for devastated pig farmers and weak enforcement of restrictions on pork transport and slaughter – have enabled the spread of the livestock virus to the point where it now threatens pig farmers worldwide, according to veterinarians, industry analysts and hog producers. Since the China outbreak, African swine fever has broken out in 10 countries in Asia.
The vacuum of credible information has made it impossible for farmers, industry and government to tell how and why the disease spread so quickly, making preventive measures difficult, said Wayne Johnson, a Beijing-based veterinarian who runs Enable Ag-Tech Consulting.
“To get it under control, you have to know where it is,” Johnson said.
China’s Ministry of Agriculture and Rural Affairs said in a statement to Reuters that it has repeatedly communicated to all regions the importance of timely and accurate reporting of African swine fever outbreaks and had zero tolerance for hiding and delaying the reporting of cases.
Interviews with farmers, industry analysts and major suppliers to China’s pork sector indicate otherwise. More than a dozen Chinese farmers told Reuters they reported disease outbreaks to local authorities that never made it into Beijing’s official statistics. Those infections are going unreported to central authorities in part because counties lack the cash to follow a separate requirement from Beijing to compensate farmers for pigs killed to control the disease.
Local officials have also avoided reporting outbreaks out of fear of the political consequences. And they have routinely refused to test pigs for the virus when mass deaths are reported, according to interviews with farmers and executives at corporate producers.
A farmer surnamed Zhao, who raises a herd in Henan province, said local officials told him as much when they resisted recording the outbreak he reported on his farm, which wiped out his herd.
“‘We haven’t had a single case of African swine fever. If I report it, we have a case,’” Zhao recalled an official telling him. The local officials could not be reached for comment and a fax seeking comment went unanswered.
When the coronavirus hit, Chinese authorities reacted with a push to reassure the public that all was well. The first reported death from the virus, also known as SARS-CoV-2, came on Jan. 9 – a 61-year-old man in Wuhan. In the following days, Chinese authorities said that the virus was under control and not widely transmissible.
The assurances came despite a lack of reliable data and testing capacity in Wuhan. Testing kits for the disease were not distributed to some of Wuhan’s hospitals until about Jan. 20, an official at the Hubei Provincial Centre for Disease Control and Prevention (Hubei CDC) told Reuters. Before then, samples had to be sent to a laboratory in Beijing for testing, a process that took three to five days to get results, according to Wuhan health authorities.
During that gap, city hospitals reduced the number of people under medical observation from 739 to 82, according to data from Wuhan health authorities compiled by Reuters, and no new cases were reported inside China.
China’s top leadership has dramatically ramped up the public-health response since its early missteps. Beijing built new hospitals in days to treat the sick and launched an unprecedented blockade of the disease epicenter on Jan. 23, first quarantining Wuhan’s 11 million residents at home, then suspending transport in all major cities of Hubei province, home to about 60 million people.
Still, the initial attempts to tightly control information left many people unaware of the risks and unable to take precautions that might have prevented infection – and the suppressing of news and commentary continues today. Wuhan authorities reprimanded eight people they accused of spreading “illegal and false” information about the disease. One of them, 34-year-old doctor Li Wenliang, later died from coronavirus, triggering an angry backlash on social media.
Some critical posts were allowed during a brief and unusual period of online openness in late January. But Beijing’s censors – the Cyberspace Administration of China (CAC) – have since cracked down on posts about Li and other information that authorities deem negative, according to CAC censorship orders sent to online news outlets and seen by Reuters. One CAC notice ordered online outlets to guard against “harmful information.” Another ordered them not to “push any negative story.”
The CAC did not respond to a request for comment sent by fax.

UNREPORTED OUTBREAKS

Beijing had years to prepare for African swine fever. Veterinarians have frequently warned Chinese authorities of the risks since the disease started spreading through the Caucasus region in 2007.
Pigs infected by the virus initially suffer high fever, loss of appetite and diarrhea. Then their skin turns red as internal hemorrhaging starts and their organs swell, leading to death in as little as a week.
With no vaccine or cure available for the disease, experts recommend that infected pigs and others housed in the same barn are culled, with the carcasses either burned or buried to prevent further infection. Farms, equipment and vehicles that could be contaminated need to be thoroughly cleaned and disinfected.
The first case in China was discovered on Aug. 1, 2018, on a farm near Shenyang, in the northeastern province of Liaoning. Just two weeks later, the virus was found more than 1,000 kilometers to the south in pigs bought by the country’s top pork processor, WH Group(0288.HK), from another northeastern province, Heilongjiang. It took Beijing another two weeks to block pig exports from the whole region, and that and other transport restrictions were poorly enforced, said Johnson and other industry experts. WH Group declined to comment.
One factor behind the epidemic: Chinese consumers prefer fresh pork – straight from the slaughterhouse, rather than chilled. This means hundreds of thousands of live pigs are moved long distances every day to supply processors in major cities. That mass movement spread the disease relentlessly.
Over the first four months of the outbreak, Beijing reported swine-fever cases almost daily as the virus spread from the northeast down through central China, west into Sichuan, and to the huge province of Guangdong by year-end. Veterinarians believe the virus spread quickly because it can survive for weeks on dirty farm equipment or livestock trucks.
And yet gaps in counting and tracking the pig disease have been routine across China. Reuters found a striking absence of reported outbreaks in some of the nation’s most productive pork regions.
For instance, almost none of the reported outbreaks have come from the major hog-raising provinces of Hebei, Shandong and Henan. The three contiguous northern provinces were the source of some 20% of the 700 million pigs China slaughtered in 2017. Many came from backyard farms, which make up a large part of China’s industry and have proven fertile breeding grounds for the disease. Yet each of the three provinces has reported just a single case of African swine fever, despite widespread anecdotal reports of outbreaks there that industry sources believe killed millions of pigs.
Neither Shandong nor Henan authorities responded to requests for comment. Hebei’s department of agriculture said it had “strictly reported and verified the epidemic” and that the disease situation was currently “stable.”
Six Henan farmers told Reuters they reported outbreaks during late 2018 and the first half of 2019. In some cases, local authorities helped deal with dead pigs, they said, but never tested for the virus.
That’s what happened when Wang Shuxi, a farmer in Henan’s Gushi County, lost more than 400 pigs in March 2019. Wang said he had no doubt that his pigs had African swine fever, even though authorities never tested them – and he couldn’t test them himself, because Beijing did not permit the commercial sale of disease test kits at the time.
His pigs showed telltale symptoms of the disease.

“The whole body went red,” he said. He injected the animals with an anti-fever medication to no avail. “At the start, they didn’t eat, and even after injections, it kept returning,” he said. “If you can’t cure it, you know it’s swine fever.”
Provincial and county governments had strong incentives to avoid verifying and reporting outbreaks because of Beijing’s rules on compensating farmers, said Huang Yanzhong, specialist in health governance with the Council on Foreign Relations in New York.
Under an African swine fever contingency plan drawn up in 2015, Beijing ordered the culling of all pigs on farms where the disease is found and on every farm within a three-kilometer radius. The central government raised compensation from 800 yuan ($115) to 1,200 yuan for every pig culled in 2018. Beijing typically promised to provide between 40% and 80% of the money, depending on the province. Localities would fund the rest.
In April 2019, the national agriculture ministry said the central government had allocated 630 million yuan to cull 1.01 million pigs to contain the disease. But that money either wasn’t sufficient or regularly did not get paid out, farmers told Reuters. None of about a dozen farmers who told Reuters they tried to report outbreaks said they had received the promised 1,200 yuan for each pig.
Many got nothing. Wang, the Gushi County farmer, said that almost a year after his pigs died, he has received no recompense. Gushi County officials could not be reached for comment.
Many farmers, eager to salvage value from their herds, have resorted to sending their pigs to slaughter at the first sign of illness – thereby thrusting the virus into the human food supply. The swine fever virus does not threaten people. But its presence in meat – where it can survive for weeks – creates a cycle of infection because many backyard farmers feed pigs with restaurant scraps that include pork.
Garbage feeding caused 23 outbreaks in 2018, Huang Baoxu, deputy director of the China Animal Health and Epidemiology Center, told reporters at a briefing in November that year. His remarks were a rare instance where the central government revealed findings about the spread of the hog virus. The center declined to comment for this story.
Farmers visiting slaughterhouses dealing in sick pigs also likely picked up the virus on their trucks or equipment, spreading it back to their farms, Johnson said.
In the southern province of Guangxi, the disease raged through the spring of 2019 and early summer, several farmers told Reuters last year. Bobai County was hit hard.
A Bobai farmer surnamed Huang said she lost almost 500 pigs during April and May. She said she tried to report the diseased pigs to the local government but was ignored. The official she spoke to by phone never came to her farm. He told Huang that her pigs could not be saved – but that they didn’t have African swine fever. His advice, she said: “hurry and sell the pigs while they could be sold.”
Huang said she sold more than 30 pigs that she believed had the virus. They looked healthy when she sold them, she said. Others sold obviously sick pigs at very low prices. “Traders took all the pigs, including the sick ones – as long as they could walk to the trucks,” she said.
Huang buried her dead pigs daily for weeks on a relative’s land. Others simply dumped their dead pigs on the roadside or in the mountains, she said. The government provided no help.
Eventually, in late May, Bobai County reported one pig dead from the disease, official statistics show.
Authorities in Guangxi did not respond to a request for comment, and officials in Bobai county’s agriculture bureau could not be reached.
Beijing’s agriculture ministry said in a statement that it had issued an August 2019 order requiring punishments in situations where localities failed to report outbreaks. The ministry said it meted out unspecified discipline to more than 600 local personnel for what it called failures to manage the disease that were uncovered in its investigations of problem areas.
The practice of processing infected hogs has persisted despite new rules from Beijing in July that required slaughterhouses to test all batches of pigs for the virus. The agriculture ministry said in January that 5% of the more than 2,000 samples taken from slaughterhouses in November tested positive for the disease.
An Australian study in September found 48% of meat products confiscated from Asian travelers arriving at its ports and airports contained the virus.
“It showed there’s an awful lot of unrevealed infection not being reported to the authorities,” said Trevor Drew, director of the Australian Animal Health Laboratory.
Slideshow (8 Images)
One such information gap is at the top of the industry – China’s large corporate pig producers. They have also been hit hard by the disease, despite taking more extensive measures than backyard farms to disinfect trucks and require workers to change clothes and shower before and after shifts.
None of China’s top publicly traded producers have publicly announced any swine fever outbreak, but executives of major hog producers acknowledged in interviews with Reuters that their herds were hit by the disease.
Thai conglomerate C.P. Pokphand(0043.HK) , one of China’s leading pig producers, has had swine-fever outbreaks on farms in Liaoning, Shandong, Henan and Jiangsu provinces, Bai Shanlin, chief executive of China operations, told Reuters in a rare admission by a listed firm. Executives at three other listed companies, also among China’s top pig producers, acknowledged outbreaks at several farms but declined to be identified.
None of the outbreaks that these large companies have confirmed to Reuters were reported by Beijing, according to a Reuters review of the agriculture ministry’s data on outbreaks.
By August 2019, a year after the first case was found in China, pork prices had passed a record set back in 2016. And they were still climbing rapidly. With a crucial national celebration approaching in October – the 70th anniversary of the founding of the People’s Republic – China’s top leaders took note. Pork is a staple of Chinese cuisine, and rising meat production has been among the many signature achievements in the Communist Party’s decades-long drive to bring prosperity to China.
In a video conference that month with officials from all 34 provinces and regions, Vice Premier Hu Chunhua issued a warning: Sufficient pork was vital to people’s lives and the country’s stability. He called for the urgent recovery of the herd as a key “political task.”
A raft of new production policies and incentives emerged from Beijing. And as the provinces rallied to replenish the nation’s herd, reports of African swine fever grew even more rare. Disease outbreaks reported by the agriculture ministry have tailed off since August. In January, Agriculture Minister Han Changfu said the situation has stabilized.
The government’s statistics are rife with contradictions, however. The ministry has reported 163 outbreaks of African swine fever since August 2018 and said 1.19 million pigs have been culled, a fraction of 1% of China’s total herd. Separate ministry data tracking the herd monthly show that, by September 2019, the herd had shrunk by 41% from the prior year.
These official estimates of the decline are far too low, three major industry suppliers told Reuters.
“It’s at least 60%,” said Johan de Schepper, managing director of Dutch feed ingredients firm Agrifirm International. His assessment, based on sales to about 100 large pig producers, echoed those of others in the industry.
The virus is still killing pigs nationwide and the herd may still be shrinking, say farmers and industry suppliers. “Half of the herd was gone before this winter, and I think half of the rest will be gone by the end of the season,” said Johnson, the veterinarian, citing conversations with clients from across China.
The problem: Some areas were hit with a second wave of the disease.
Henan province is among them, farmers told Reuters. Last year, about 60% of Henan’s herd was wiped out, mainly in the densely farmed areas in the south and west of the province, analysts at Guotai Junan Securities wrote in an internal memo seen by Reuters. Recently, the memo noted, the virus has moved through east Henan, taking out another 20%.
The vicious disease ruined Zhao, the farmer in central China’s Henan province. The virus struck in October, causing high fever, internal bleeding, vomiting and diarrhea in his pigs. Just two survived. The other 196 died in a week.
When Zhao tried to report the outbreak to the county veterinary authority, he said, officials strongly encouraged him to keep quiet. A local official reminded him of the national mandate to cull all pigs within three kilometers of an infected farm. That could spell disaster for his neighbors if Zhao spoke up.
“If it’s found to be African swine fever, people nearby will have to stop raising pigs,” Zhao recalled a local official telling him. Zhao decided against filing a report to protect his neighbors, he told Reuters on a recent visit to his farm.
Further up the political hierarchy, the deputy governor of Henan province was quoted by the provincial agriculture bureau as saying in December that Henan had been free of the disease for 14 months, after a single reported case in September 2018. The provincial government did not respond to requests for comment.
The disinformation game continues. Zhao says that when county officials came by his farm in January, they recorded that he still had 180 pigs. In fact, he said, he had just the two hogs that survived the October outbreak.
“The country is being kept in the dark,” he said.
https://www.reuters.com/article/us-swinefever-china-epidemic-specialrepo/special-report-before-coronavirus-china-bungled-swine-epidemic-with-secrecy-idUSKBN20S189

Airlines face $100 billion-plus virus hit, discounts ‘wouldn’t do any good’

The coronavirus epidemic could rob passenger airlines of up to $113 billion in revenue this year, an industry body warned on Thursday, while the head of Southwest Airlines said a drastic drop-off in travel demand seemed fear-driven, similar to the feeling after Sept. 11, 2001.
“We could discount prices tomorrow and it wouldn’t do any good,” Southwest Airlines Co (LUV.N) Chief Executive Gary Kelly said at an aviation conference in Washington.
Earlier, Kelly told CNBC: “9/11 wasn’t an economically driven issue for travel, it was more fear, quite frankly, and I think that’s what’s manifested this time. I think there’s elements of both but it has a 9/11-type feel.
“Hopefully, we’ll get this behind us quickly.”
The Dow Jones U.S. Airlines Index [.DJUSAR] closed down 8.6%.
The estimated revenue hit to the sector was made by the International Air Transport Association (IATA), which said the impact could range between $63 billion and $113 billion this year, depending on the progression of the virus.
That was more than three times its forecast for a $29 billion impact made just two weeks ago.
The COVID-19 virus emerged in China late last year and has now spread to more than 80 countries, leading to travel and other restrictions. It has killed more than 3,300 people and infected tens of thousands more, raising fears of a pandemic that could plunge the global economy into recession.
Airlines across the globe are rushing to cut flights and costs, and warning of a hit to earnings.
“There are lots of airlines that have got relatively narrow profit margins and lots of debt, and a cash flow shock like this could certainly send some into a very difficult situation,” IATA Chief Economist Brian Pearce told a media event in Singapore.
British regional carrier Flybe became the first big casualty of the outbreak after the British government walked away from a rescue package agreed upon in January due to the scale of the hit to demand over the virus.
In a sign of the new difficulties for airlines, a Turkish Airlines jet (THYAO.IS) was flown back to Istanbul without any passengers on board on Thursday on orders from Singapore after a passenger who had arrived on the same plane on Tuesday tested positive for the virus.
South Korea, Italy and Iran have been particularly badly affected. Germany, Japan, France, Spain, the United States, Singapore and Hong Kong have all reported more than 100 cases.

IATA said its lower forecast was based on the virus being contained in current markets with over 100 cases as of March 2, while the higher estimate was based on a broader epidemic. Both scenarios assume there will be a recovery by late summer.
Meanwhile, Southwest warned that the epidemic could wipe up to $300 million from its first-quarter operating revenue and Norwegian Air (NWC.OL) became the latest airline to scrap its profit forecast for 2020.
Norwegian, a pioneer of low-cost transatlantic travel, has been struggling for years due to cutthroat competition and heavy debts built up during rapid expansion.
Its shares, which have lost nearly 60% of their value this year, ended 13% lower on Thursday.
Analysts say few airlines are likely to remain unscathed, as both business and tourist travel are being affected, with meetings and events being canceled and companies limiting travel to protect employees.
Data provider ForwardKeys said on Thursday new flight bookings to Europe from elsewhere in the world fell by 79% in the last week of February, as the virus took hold in popular tourist destinations such as Italy.
“The drop-off in bookings to Italy is even worse than we have observed in the past for some of the most disruptive events such as terror attacks,” ForwardKeys Vice President Insights Olivier Ponti said.
https://www.reuters.com/article/us-healthcare-coronavirus-airlines/airlines-face-100-billion-plus-virus-hit-discounts-wouldnt-do-any-good-idUSKBN20S11G

Insurer lobby urges coronavirus test coverage, but can’t mandate changes

  • The nation’s health insurance lobby, which represents some of the biggest payers but not giant UnitedHealth Group, said it will cover testing for the coronavirus when ordered by a physician. It also said it will work to limit financial and administrative barriers to accessing the test, including prior authorization and network concerns.
  • Experts noted the trade group can nudge but not mandate that insurers change their policies. America’s Health Insurance Plans represents dozens of entities, including Aetna, CVS, Anthem, nonprofit Blue Cross plans, UPMC and Geisinger among its members, according to AHIP’s website.
  • Cigna issued its own statement, vowing to waive cost-sharing and co-payments for diagnostic tests for its fully insured plan members. Groups that use administrative services only plans “will also have the option to include coronavirus testing as a preventive benefit,” the payer said.
The administration is working to quickly expand testing by making the kits more readily available to state and local laboratories across the country as the case count increases, particularly among patients who did not travel to China — the origin of the outbreak — and have no direct link to travelers.
Initially, the government limited the testing to only those exhibiting symptoms of the virus who had also traveled to China. The tests were only being performed in a handful of laboratories in certain states at first.
Testing kits are becoming more readily available, but as the access to tests increases, it has raised questions about whether the nation’s insurers will cover the test and what limitations may exist.
AHIP attempted to ease concerns and said its members will cover the test and aim to limit other barriers for patients, including copay and other cost concerns.
Still, health policy experts cautioned that AHIP’s statement doesn’t create a mandate for its member insurance companies.
“They can’t require member companies to do anything,” Sabrina Corlette, a research professor at Georgetown University, told Healthcare Dive.
There are some legal obligations for insurers to cover laboratory testing, which would include coronavirus testing, but it depends on the type of plan, she said.
For instance, the Affordable Care Act requires individual health plans bought on the exchanges and small employer plans to cover essential health benefits, which includes laboratory testing. But for large and self-funded employers, there is no federal obligation to covering lab services or this specific test. However, Corlette noted “as a practical matter, I think most employer plans do cover lab, so it’s probably covered for most people in employer-based plans.”
Still, patients with high deductible plans, or those who are uninsured or have short-term limited duration plans, may be exposed to “cost sharing that they just can’t afford even if the test itself is covered,” she said.
AHIP only said it will take action to ease “and/or waive patient cost sharing.”
However, Washington state’s insurance commissioner issued an emergency order requiring insurers there to waive copay and deductibles for any consumer that requires testing for the coronavirus.
It also bars any prior authorization requirement for treating or testing for the virus and allows for a one-time early medication refill.
“Consumers are rightly concerned about prevention, testing and possible treatment,” Insurance Commissioner Mike Kreidler said in a statement on Thursday. “My emergency order provides guidance to health insurers and should help reassure the public that we will take all necessary steps to protect them.”
As testing expands to include commercial labs, patients will need to be on guard about whether their physician uses a lab that’s out-of-network, Corlette said. “Generally speaking, the insurer is only obligated to cover lab tests on an in-network lab and consumers could face full charge or higher out-of-pocket charges if the specimen is sent to an out-of-network lab.” Both LabCorp and Quest Diagnostics said they plan to make tests available next week.​
The illness has upended plans as large conferences dotted across the U.S. are canceled to avoid drawing thousands to gather in one area. United Airlines is cutting back flights domestically, the first major U.S. air carrier to do so and the major health tech conference HIMSS canceled its event.
https://www.healthcaredive.com/news/insurer-lobby-urges-coronavirus-test-coverage-but-cant-mandate-changes/573595/

Top insurers commit to easing cost barriers to coronavirus testing

Top insurers committed Thursday to mitigate the costs associated with testing for and treatment of the novel coronavirus that has begun spreading in the U.S.
The board of industry group America’s Health Insurance Plans (AHIP)—which includes the heads of top insurers like Humana, Anthem, CVS and Cigna—said in a statement they are committed to providing coverage for tests ordered by a physician. They also said they are working to ease network, referral and prior authorization requirements that could hinder access.
The group said their organizations would also potentially waive out-of-pocket costs for the tests.
“Health insurance providers will devote our resources, insights, and abilities to collaborate with key partners to confront and resolve this challenge,” AHIP said in a statement. “Working together with federal, state and community leaders; clinicians; pharmacies; drug makers; medical equipment providers; and other essential partners, we are confident that we can collectively overcome this challenge and keep the American people safe and healthy.”

The group said it would be teaming up with state and federal policymakers to allow for greater flexibility to change benefits or offer preventive services and treatments. Cigna was the first health plan to announce they would waive copayments or other cost-sharing on Thursday.
“During this time of heightened concern, Cigna’s role is clear. We will do everything we can to help contain this virus, remove barriers to testing and treatment, especially for seniors and people who are chronically ill, and give peace of mind to those we serve,” said David M. Cordani, Cigna CEO, in a statement. “This is another example of how, every day, we strive to stand by our customers through their life and health journeys.”
AHIP also reiterated its plan for providing crucial data to providers and directing members toward tech options that could avoid the spread of the virus, such as telehealth.
Health plans will also continue to use their platforms to ensure members have access to the most recent—and accurate—information from the Centers for Disease Control and Prevention or other sources to spot the symptoms or navigate these conversations with their doctors.
Centers for Medicare & Medicaid Services Administrator Seema Verma said in a statement that she spoke with AHIP CEO Matt Eyles on the matter and commended the group and its board members for the announced plan.
“The Trump Administration is utilizing a whole-of-America approach, including working with our private partners, so that our entire healthcare system and our communities are activated and coordinated in our efforts to protect the American people,” Verma said.
https://www.fiercehealthcare.com/payer/ahip-commits-to-easing-cost-barriers-to-coronavirus-testing

Coronavirus in NY: 9 new cases confirmed, with 1st in Nassau County

An additional nine New Yorkers have tested positive for coronavirus, Gov. Andrew Cuomo said Thursday, ballooning the total number of cases to 22 statewide.
Eight of the new cases are in Westchester, connected to a single New Rochelle lawyer, identified by sources as 50-year-old Lawrence Garbuz, while the ninth is on Long Island, Cuomo said.
The afflicted attorney’s wife, son and daughter have also tested positive, as have a friend, his wife and three of their four kids, Cuomo has said.
A neighbor who drove Garbuz to the hospital has additionally been confirmed to have the potentially deadly disease.
Because he also has an underlying respiratory infection, Garbuz is currently hospitalized in Upper Manhattan, while the others are self-isolating in their homes.
Two students at Yeshiva University’s Washington Heights campus — where Garbuz’s son attends classes — are being evaluated, as are seven co-workers and an intern from Garbuz’s law office near Grand Central, authorities have previously said.
Additionally, approximately 1,000 people connected to that web have been asked to self-isolate, according to officials.
Cuomo nevertheless urged calm.
“Here the facts do not merit the level of anxiety that we are seeing,” he said in an afternoon press briefing. “I believe it’s being generated because … people don’t know the truth, they don’t know the facts.
“I’m a little bit perturbed about the daily angst,” he continued.
The announcement of the additional patients came hours after Mayor Bill de Blasio announced two new cases in the five boroughs: A man in his 40s, and a woman in her 80s, both of whom are hospitalized in intensive care.
The Long Island patient is a 42-year-old Nassau County man currently hospitalized in an undisclosed county hospital, according to Cuomo.
“That individual has underlying medical conditions, which is one of the populations that is at greater risk for this virus,” said Cuomo, noting that the man’s condition is “improving.”
His close relatives have been advised to self-isolate, while disease detectives are re-tracing his steps in an attempt to track down anyone he may have come in contact with.
Officials are also working to ascertain exactly how the man caught the disease.
“We don’t know yet, but it’s community spread,” said Dr. Howard Zucker, the commissioner of the state Department of Health, noting that the man had not recently traveled to any countries affected by the outbreak.
https://nypost.com/2020/03/05/coronavirus-in-ny-9-new-cases-confirmed-including-first-in-nassau-county/

Blood plasma from recovered patients could help treat the new coronavirus

When it comes to creating treatments for Covid-19, the disease caused by the novel coronavirus, the first line of defense may be a century-old technology: purified blood plasma.
Medical literature published during the Spanish flu pandemic of 1918 includes case reports describing how transfusions of blood products obtained from survivors may have contributed to a 50% reduction in death among severely ill patients. In 1934, a measles outbreak at a Pennsylvania boarding school was halted when serum harvested from the first infected student was used to treat 62 fellow students. Only three of the 62 students developed measles — all mild cases.
More recently, plasma-derived therapy was used to treat patients during outbreaks of Ebola and avian flu. And on Wednesday the Japanese drugmaker Takeda Pharmaceutical Co. said it was developing a new coronavirus drug derived from the blood plasma of people who have recovered from Covid-19. Its approach is based on the idea that antibodies developed by recovered patients might strengthen the immune system of new patients.
Here’s what you need to know about how this old technology might help slow the coronavirus outbreak.

How is blood plasma turned into an infection-fighting drug?

Patients who have recovered from a disease have permanent antibodies generated by the immune system floating in their blood plasma, the liquid component of blood. To turn that into a drug, the plasma is harvested, tested for safety, and purified to isolate those protective antibodies. When injected into a new patient, the “plasma-derived therapy” — also known as convalescent plasma — provides “passive immunity” until the patient’s immune system can generate its own antibodies.
Mike Ryan, the head of the WHO’s emergencies program, has said convalescent plasma is a “very important area to pursue” as a potential treatment for patients with Covid-19. “It must be given at the right time because it mops up the virus in the system and it just gives the new patient’s immune system a vital push at the time it needs it — but it has to be carefully time and it’s not always successful.”

Is this approach already being used in this outbreak?

In February, doctors in Shanghai set up a special clinical to administer convalescent plasma to select patients who were newly infected with coronavirus.
“In China, we’ve only heard anecdotal reports of encouraging results. Nothing has been published yet,” said Greg Poland, a physician and infectious disease expert at the Mayo Clinic in Rochester, Minn. “But this approach is definitely worth trying.”

How is what Takeda is doing different?

Takeda already makes a medicine called intravenous immunoglobin, or IVIG, for treating patients who have immune disorders. It consists of antibodies of all types purified from the blood plasma of healthy people. Giving antibodies in this purified form is easier, because it requires a much lower volume of treatment; it’s safer, because there is no chance of transmitting other viruses; and it’s more efficient.
With its new treatment, TAK-888, Takeda hopes to create an IVIG from the blood of people who have been infected with the coronavirus and who have recovered. That could create a treatment or prophylactic relatively quickly. It might not need to go through phase I studies to demonstrate basic safety, or larger phase III studies to demonstrate efficacy. That means the treatment could be available sooner.
The other advantage of this approach is that researchers don’t need to figure out which antibodies work best at fighting off the novel coronavirus. They basically import the entire disease-fighting army of antibodies from patients whose bodies have already won. The antibodies in TAK-888 will be more narrowly selected to target coronavirus than those in garden variety IVIG.

How much of this new drug can Takeda make?

“We are not looking at this as a therapy that everyone should go on,” Julie Kim, the president of Takeda’s blood plasma unit, told STAT. “This will be targeted to patients who have severe disease.”
Kim said the hope is that a single donor might provide enough IVIG for a single patient. But it’s also possible that IVIG derived from several people would be needed to treat each patient. Takeda won’t know until it has taken steps to learn how many antibodies are present in patients who have recovered, and what dose of TAK-888 appears necessary to be effective. Those measures, Takeda said, could be discovered without large-scale trials.
Kim said that she could not comment on precise timelines until Takeda has had discussions with regulators like the Food and Drug Administration.

Are there others working with antibody treatments?

Yes. Among them is Regeneron, which is working on a mix of manufactured antibodies to attack the coronavirus. Vir Biotechnology, another biotech firm, has said it will have a similar approach.
The IVIG approach Takeda is using is known as “polyclonal antibodies,” which means, simply, that there are a lot of different types of antibodies in the mix. But many biotech drugs are what are known as monoclonal antibodies, single antibodies that can be originally generated in mice and then manufactured in huge tanks of cells.
One reason to be optimistic is that Regeneron has pulled it off before, manufacturing a treatment composed of three different monoclonal antibodies that appears to have some effectiveness against the Ebola virus.
Geoffrey Porges, an analyst at the investment bank SVB Leerink, said in an interview he was “very impressed” with the speed at which Regeneron developed an Ebola treatment. He said that the novel coronavirus might be harder, because it is not clear what parts of the rapidly mutating virus antibodies should target. “But if anyone can figure this out, it’s Regeneron,” he said.

Don’t vaccines also work by creating antibodies?

Vaccines work by teaching the body to make its own antibodies to an infectious agent without a person ever becoming infected. This is why they are among the most powerful weapons in public health.
But Porges, who worked at Merck’s vaccine division in the 1990s, said he thinks that creating a vaccine might be harder than companies expect, because this new virus is just not well enough understood. “You kind of need to have some fundamental understanding of the immunology and the virus before you can develop a vaccine,” he said. “It’s not clear to me that we have that.”
Many companies, including the biotechnology firm Moderna and the large pharmaceutical companies Johnson & Johnson and Sanofi, are working hard to develop vaccines quickly.

So which of these approaches is better? 

That’s not the right question. Convalescent plasma, and then IVIG, could provide our first-line defense for people with Covid-19, especially those who are older and at much higher risk for complications. A monoclonal antibody drug could reach a greater number of patients. We also need antiviral drugs, such as remdesivir, being tested by Gilead Sciences. And a vaccine could do the most to slow or stop transmission.
“We need them all,” said Poland of the Mayo Clinic.
How blood plasma from recovered patients could help treat the new coronavirus

Cooper Companies FQ1 earning down 12%

Cooper Companies (NYSE:COO) fiscal Q1 results:
Revenue: $646.2M (+3%); CVI: $485.2M (+3%); CSI: $161.0M (+2%).
Net income: $90.5M (-12%); EPS: $1.82 (-12%); non-GAAP EPS: $2.69 (-7%).
2020 guidance: Revenue: $2,767M – 2,817M; CVI revenue: $2,070M – 2,100M; CSI revenue: $697M – 717M; non-GAAP EPS: $12.80 – 13.20. Consensus: non-GAAP EPS of $12.82 on revenue of $2.8B.
https://seekingalpha.com/news/3549239-cooper-companies-fq1-earning-down-12