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Monday, March 9, 2020

NIH’s Fauci on coronavirus: ‘The risk group is very, very clear’

As clinicians gear up to fight the novel coronavirus spreading throughout the U.S., top officials say they should focus special attention on seniors.
“It’s so clear that the overwhelming weight of serious disease and mortality is on those who are elderly and those with a serious comorbidity: heart disease, chronic lung disease, diabetes, obesity, respiratory difficulties,” said Anthony Fauci, M.D., director of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases.
“There will be outliers, as we’ve seen with influenza, [a person] who is young and healthy who winds up getting COVID-19, [gets] seriously ill and dies,” Fauci said in a taped interview with Howard Bauchner, M.D., editor of the Journal of the American Medical Association. “But if you look at the weight of the data the risk group is very, very clear.”

It was just one of the observations he shared about COVID-19 which has been grabbing headlines, but for which there is limited information when it comes to treatment.
Here’s what else Fauci had to say about COVID-19:
On testing capacity in the U.S.:
“There were clearly some missteps … The goal over the next week to do is to rev it up so you could have at least a million-plus tests available for deployment within the next week to two. Hopefully, that eventuates into a reality, not just a goal. Then after that, when you get online, some of the very good companies that know what they’re doing [are] making a diagnostic test. Then I think the flow of those tests will be really smooth. Unfortunately, today we’re not there yet.”
On the quality of the COVID-19 tests:
“They’re good. They’re standard [polymerase chain reaction] tests, and, if you do a PCR test right, it’s highly specific. Obviously, there are confirmation tests you want to do if you get just one because there can be contaminations with PCR. But they’re very sensitive down to a few copies much like some of the tests we have for HIV where we can get down to a few copies. If it’s positive, you absolutely can make a [clinical] decision. If it’s negative, you may be early on in the infection and the viral load may be so low, you don’t get it. That’s more of a concentration issue.”
RELATED: Congress releases $8.3B coronavirus funding package. Here’s what’s in it
On the actual case fatality rate:
“There’s the number of cases that have come to the attention of healthcare providers. As of [Friday] morning, that’s like 98,000. Then on the other side, you have the number of documented deaths. That’s now like 3,700, 3,800. When you do that pure simple math, the deaths are the numerator, the cases are the denominator, that’s where you get the report from WHO that it’s somewhere between a 2% and 3% case fatality rate. However, when people do modeling … you have various assumptions that there are this many asymptomatic cases that never get counted. When you do that, you get a range of case fatality rates that always less than the actual numerical one because it always factors in relative proportions of asymptomatic ones that we don’t count.”
On where studies are focusing for potential therapies:
“There are a couple of randomized controlled trials: A couple in China and one that we’re doing here in the United States … because we have a continuing number of increasing people who are infected to test the drug such as remdesivir (using a standard of care versus standard of care with remdesivir). Hopefully in the next few months, if we have enough … The Chinese are already a couple hundred into their clinical trial, that when the DSMV looks at the data, we’ll know whether it works or not. If it does, that would be wonderful and we’ll start distributing the drug. If it doesn’t, we’ll have to go toward other avenues.”
On the lack of disease among children:
“What I still don’t totally understand is the lack of detectable infections in children, as well as the lack of serious disease. In one of the reports, there wasn’t a single identified case in someone younger than 15 which seems almost unbelievable. They have to be getting infected. Why they’re not developing clinical disease is really interesting. This is something we really need to study because it certainly will tell us something about what a correlative immune protection is.”
On how we protect the elderly:
“Even if you’re not in the area with ongoing community spread, you’d do mitigation for everyone. Whether they’re elderly, immunocompromised or young, common sense should prevail.
The way we protect them in general is: Don’t take any unnecessary risks with them. If you have someone in their 70s, 80s or beyond, and even if they’re relatively healthy, do you really want to get on a plane and fly to wherever unless you have to? You have to treat the elderly and those with underlying conditions to protect them because they are vulnerable.”
Check out what else he had to say below.
https://youtu.be/7HGC-mRNTPo
 

It’s tough for clinical trial participants to learn results

Most clinical trial participants are not told the results of their study—even though most people want to know, and researchers want to tell them.
The reason: Communication is a big barrier, a new study says. Simply put, researchers and subjects may not speak the same language.
Teaching researchers to make their findings understandable to the lay person could make trial participants feel like respected research partners—and increase the number who are looking to join in, according to a study from Medical University of South Carolina (MUSC) researchers.
The emphasis in translational research is to communicate results into meaningful messages for members of the community.
“So part of translation is not only translating from bench to bedside but also translating your findings back to the participants who made it work,” said senior author Teresa Kelechi, associate dean for research in the MUSC College of Nursing. “At the end of the day, it’s because of them that we’re doing science.”
For the study, Kelechi and lead author Cathy Melvin, a professor of public health, led focus groups for past trial participants.
Of 48 participants interviewed, nearly 70% said they never received results of their trial, although 75% would have liked to. About 95% of researchers surveyed considered it important to share results with participants.
Nevertheless, the researchers said they had little training or communication on how to release the information to participants. Funding for such communication might also be a factor, since grant money for studies is usually for recruiting participants and conducting the study, with little left over for reaching the participants.
“For me, this was an eye-opening experience,” Kelechi said in a university news release. “I’ve been doing research for 20 years but was unaware how much the feels unequipped to report their findings to study participants. They want to give back, but that is not a skill set that they have, but it is one they want to develop.”
Trial participants also expressed a willingness to share findings with friends, health care providers and others with the same condition. Most said emailing the results would be their preference, though older adults preferred mailed letters, postcards or calls.
Kelechi and Melvin are optimistic that the communication gap can be bridged.
“We have two groups of people who want the same thing, which is to share information with each other,” Melvin said. “So, given the good will on both sides, I’m very optimistic and feel that there is a real opportunity for us to make a difference in this area.”
The article was published March 2 in the Journal of Clinical and Translational Science.
https://medicalxpress.com/news/2020-03-tough-clinical-trial-results.html

How coronavirus binds to cells in the lungs


A close look at how the coronavirus binds to cells in the lungs
A team of researchers from the Westlake Institute for Advanced Study in Hangzhou, Westlake University and Tsinghua University has produced a high-resolution image of SARS-CoV-2 during the initial phase of infection of a human cell. In their paper published in the journal Science, the group describes how they captured the image and what it showed.
The current coronavirus epidemic is technically known as the spread of the COVID-19 disease—it is caused by the SARS-CoV-2 virus. As it spreads, scientists around the world are working to better understand it toward developing a vaccine. To that end, the team in China took a picture of a single virus during the initial stages of .
The study built on recent work done by a combined team from the University of Texas at Austin and the National Institutes of Health. They found that a protein on the virus, known as its spike protein, was better able to bind to the ACE2 protein in humans than the virus responsible for the SARS outbreak in 2003.
As a way to learn more about how the virus binds, the researchers used cryo- to capture images of the ACE2 protein prior to infection and during initial stages of infection by a SARS-CoV-2 .
The ACE2 protein is an enzyme that plays a role in converting a hormone called angiotensin to an active state, allowing it to help constrict blood vessels and thus control blood pressure. It is found in the heart, intestines, kidneys, and most importantly for this new work, in the lungs. Prior work has shown that this protein is initially targeted by several viruses such as SARS. The reason it plays such a big a role in viral infections is because it also helps to transport amino acids across cell membranes.
To create the new images, the researchers produced a solution with a high concentration of the ACE2 protein and another with a high concentration of the and live viruses. They then froze the samples very quickly to keep them in place and fired electrons at them. The process resulted in the creation of multiple 2-D images, which they combined to form 3-D images.

Explore further
Revealed: Protein ‘spike’ lets the 2019-nCoV coronavirus pierce, invade human cells

More information: Renhong Yan et al. Structural basis for the recognition of the SARS-CoV-2 by full-length human ACE2, Science (2020). DOI: 10.1126/science.abb2762Daniel Wrapp et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation, Science (2020). DOI: 10.1126/science.abb2507 https://medicalxpress.com/news/2020-03-coronavirus-cells-lungs.html

Second HIV patient reportedly ‘cured’

It was 12 years ago that a German patient was seemingly cured of HIV. Now doctors in the United Kingdom believe they’ve finally duplicated that success, this time in a 40-year-old Englishman.
Adam Castillejo was known until recently only as the “London patient.” Now, after surviving years of grueling treatments, he says he sees himself as an “ambassador of hope” for others.
Although his doctors publicly describe his case as a long-term remission, experts in interviews have called it a cure for the AIDS-causing virus, according to a report in The New York Times.
“This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist at the University Medical Center Utrecht in the Netherlands. “It’s reachable,” she told the Times. Wensing is also co-leader of IciStem, a group of scientists studying to treat HIV.
Like Timothy Ray Brown, his predecessor, Castillejo was getting treatment for a (Castillejo had Hodgkin’s lymphoma; Brown had leukemia). Both underwent bone-marrow transplants designed to beat the cancer, not the HIV.
In both cases, the critical transplant was from a donor with a mutation in the CCR5 protein. The Times explained that HIV uses the protein to enter certain immune cells but cannot latch on to the mutated version. In other words, the donor was HIV-resistant.
Castillejo’s was in May 2016. He has been off anti-HIV drugs since September 2017. He and Brown are the only patients known to have stayed HIV-free for more than a year after quitting the drugs.
To be cured of both cancer and HIV was “surreal,” Castillejo told the newspaper. “I never thought that there would be a cure during my lifetime.”
Details of the new case, to be published March 10 in Nature, were scheduled for presentation at this week’s Conference on Retroviruses and Opportunistic Infections, in Seattle.
Brown, whose case was described in 2007, is now 52 and living in Palm Springs, Calif. He was far sicker after his procedures than Castillejo, and nearly died.
One of the U.K. doctors, Dr. Ravindra Gupta of University College London, called the new case a game-changer. “Everybody believed after the Berlin patient that you needed to nearly die basically to cure HIV, but now maybe you don’t,” Gupta told the Times.
Transplants are dangerous and may not be a realistic treatment right now. But experts say the new “” may pave the way for related but more practical immune cell-modifying approaches.
There are no guarantees that Castillejo’s remission will persist, but Gupta said the indications are good since there are so many similarities with Brown’s recovery.
Brown, meanwhile, said he is rooting for Castillejo. “If something has happened once in , it can happen again,” Brown said. “I’ve been waiting for company for a long .”
https://medicalxpress.com/news/2020-03-hiv-patient-reportedly.html

Glaukos +6% on move to SmallCap 600

Glaukos (NYSE:GKOS) is up 6% postmarket after news that it’s joining the S&P SmallCap 600 index.
The company will replace AK Steel Holding (NYSE:AKS), which is set to be acquired soon by SmalCap 600 constituent Cleveland-Cliffs.
The move is effective prior to the open of trading this Friday.

First EMS worker in NYC tests positive for coronavirus

The first EMS worker in the city has tested positive for the coronavirus, the union said Monday.
The man got the potentially deadly bug from his girlfriend, an airline flight attendant who is now quarantined overseas, a source added.
“Today we received confirmation that a member of the FDNY Emergency Medical Services, assigned to the Borough of Brooklyn, has tested positive for the Coronavirus, also identified as COVID-19. This is the first confirmed case by one of New York City’s medical first responders,” said Oren Barzilay, president of FDNY EMS Local 2507.
“This was inevitable, given that our members are continually exposed to diseases and illness,” the union leader said.
Barzilay said the infected person and several of his EMS co-workers are under mandatory quarantine.
“We are confident that the FDNY, together with the Department of Health, will be diligent in tracking down people outside of the Department that have been in contact with this member,” he said.
Emergency-medical technicians respond to thousands of emergencies every day to aid people in need of medical attention.
“This news is highly illustrative of the exceptionally dangerous role that members of the FDNY Emergency Medical Service play each and every day. Despite the ongoing risks associated with this virus for our members, their families and their friends, we are all absolutely dedicated to protecting New Yorkers with the emergency medical services they need during these uncertain times,” Barzilay said.
Earlier Monday, Gov. Andrew Cuomo revealed that Rick Cotton, the executive director of the Port Authority of New York and New Jersey, has the coronavirus. As head of the PA, Cotton oversees the region’s three airports as well as the PATH train service between the two states.
https://nypost.com/2020/03/09/first-ems-worker-in-nyc-tests-positive-for-coronavirus/

Aon buys Willis for $30 billion in world’s largest insurance deal

Aon Plc said on Monday it would buy Willis Towers Watson Plc for nearly $30 billion, in an all-stock deal which will make it the world’s biggest insurance broker and give it more pricing power, but also attract regulatory scrutiny.

The acquisition, the insurance sector’s largest ever, unifies the second and third largest brokers globally into a company worth almost $80 billion, overtaking market leader Marsh & McLennan Companies Inc. It comes at a time when insurers are facing rising claims and new threats from the global outbreak of coronavirus and climate change.
Aon had scrapped plans last year to pursue a merger with Willis, a day after media reports forced it to reveal it was in the early stages of considering an all-stock offer for the Irish-domiciled company. The merger agreement came right after a 12-month restriction under Irish rules for revisiting the deal expired.
The timing also coincides with a violent market correction, as Wall Street’s main stock indexes plummeted and the Dow Jones Industrials crashed 2,000 points on Monday, driven by 20% slump in oil prices and the rapid spread of coronavirus.
This also weighed on Aon, whose shares dropped 16% on Monday, much more than the 8% drop in Willis shares.
When asked about the timing of the deal, Aon Chief Executive Officer Greg Case told Reuters: “This is the time we move,” noting that he spoke to 250 senior colleagues on Monday who were “energized” by the deal.
“In a world of volatility, clients have needs around protecting assets,” Case said.
Willis shareholders will receive 1.08 Aon shares for each of their shares. The offer represents a premium of 16% to Willis’ closing price on Friday.
Aon shareholders will own about 63% and Willis investors about 37% of the combined company. The deal is expected to add to Aon’s adjusted earnings per share in the first full year, with full savings of $800 million achieved in the third year.
Aon will keep headquarters in London and be led by Aon CEO Case and Aon CFO Christa Davies. Willis CEO John Haley will become executive chairman.
Aon and Willis put together insurance contracts for clients that involve a number of insurance providers, for anything from airlines to large sporting events.
Brokers also play a key deal-making role in the 330-year-old Lloyd’s of London [SOLYD.UL] commercial insurance market, which carries out much of its business face-to-face and insures specialist risks like oil rigs and soccer stars’ legs.
Aon and Willis also provide investment and employee benefits advice, and broker deals for reinsurers, who share part of insurers’ exposure to potential large losses like hurricanes, in return for part of the premium.
The combined entity will work across risk, retirement and health businesses. The deal will also allow the “new” Aon to offer clients services in areas like cyber, intellectual property and climate risk, executives said.
SECOND TIME LUCKY?
The deal follows Marsh’s purchase last April of British rival Jardine Lloyd Thompson for $5.7 billion.
“The insurers and re-insurers are unlikely to be happy about the deal given the scale of the two players coming together,” said analyst Ben Cohen at Investec.
The deal terms state Aon must pay $1 billion to Willis if the deal falls through.
Aon’s Davies said she was confident of getting all the necessary approvals for the deal.
“We have had great counsel on the topic of anti-trust, feel really good about it,” Case said.
Credit Suisse advised Aon, while Willis was advised by Goldman Sachs.

https://www.marketscreener.com/WILLIS-TOWERS-WATSON-PUBL-25623167/news/Aon-buys-Willis-for-30-billion-in-world-s-largest-insurance-deal-30131689/?countview=0