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Thursday, April 15, 2021

Mask wearing to no longer be required in Israel as of Sunday

 Israel will lift the requirement to wear masks outdoors starting from Sunday, Health Minister Yuli Edelstein announced Thursday, adding that he instructed the ministry’s Director-General Chezy Levy to sign a directive for this purpose. The requirement will remain for indoor spaces.

The move had been under discussion for several weeks, but authorities decided to wait until the end of the national holidays of Remembrance Day and Independence Day fearing that mask-less celebrations might lead to a spike in the cases.

The vast majority of experts agree that the risk of contracting the coronavirus outdoors is very limited.
 “We know that wearing masks outdoors is not as effective as doing it indoors,” Dr. Eyal Leshem, the director of the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center, Tel Hashomer told The Jerusalem Post last week. “Moreover, we see that many people don’t actually wear masks anymore anyway. Therefore, at this point, with a low number of cases and a majority of the population vaccinated or recovered, it would make sense from epidemiological and public health perspectives to lift the requirement.”
Israel has currently only 3,000 active cases. At the peak of the pandemic, there were dozens of thousands.
“The masks are intended to protect us from the coronavirus,” Edelstein said. “After our health professionals came to the conclusion that they are no longer needed outdoors, I decided to allow it according to their recommendation.”
“The level of morbidity in Israel is very low thanks to our successful vaccination campaign, and thus we can ease up further restrictions for you, citizens of Israel,” he said. “I ask you to still carry a mask in order to enter closed buildings. Together we will keep the morbidity low.”

Also on Sunday, the education system will resume functioning in full after over a year. All children will go back studying in their classrooms with no more capsules.

Maldives to Offer Holidaymakers Vaccines on Arrival in Push to Revive Tourism

 

  • Maldives is to offer visitors vaccinations on arrival as part of three-pronged initiative aimed at reviving the country's hard hit tourism sector, said its tourism minister Abdulla Mausoom.
  • The tourism minister would not be pushed on a timeline for the visitor vaccination rollout, noting the local population would receive their first and second doses first.
  • To date, around 53% of the country's population has received their first dose. That includes 90% of its front-line tourism workers.
Maldives will soon offer visitors vaccinations on arrival as part of its three-pronged initiative aimed at reviving the country's hard hit travel sector, according to its tourism minister.

The "3V" strategy, which encourages tourists to "visit, vaccinate, and vacation," will provide a "more convenient" way to visit the country, Abdulla Mausoom told CNBC on Wednesday.

At present, visitors to Maldives must provide a negative polymerase chain reaction (PCR) test and proof of hotel booking to gain entry. Mausoom said the country's Health Protection Agency is set to make an announcement on restriction-free entry to vaccinated arrivals "very soon — maybe even this week."

Maldives, an archipelago state in South Asia renowned for its tropical beaches and pristine waters, is heavily dependent on its tourism industry. Around 67% of its gross domestic product (GDP) is derived directly and indirectly from the sector.

The tourism minister would not be pushed on a timeline for the visitor vaccination rollout. He noted that the government's priority is to ensure the entire resident population receives their first and second shots first.

However, once that process is complete, the country will be ready to vaccinate arrivals, he said.

To date, around 53% of the island nation's approximately 530,000 residents have received their first dose, according to Reuters' vaccination tracker. Some 90% of front-line tourism staff have received their first dose, said Mausoom.

Mausoom did not state whether arrivals would be expected to pay for their shots, but he said that supply would not be an issue.

He said the country has received vaccine donations from India, China, and the World Health Organization's Covax scheme, which aims to ensure that vaccines are fairly and equitably distributed. Maldives has also ordered additional supplies from Singapore, he said.

"I don't think supply's a problem in Maldives because our population is relatively small," said Mausoom. "The quota we get from the various organizations and friendly nations also will help."

Mausoom said the tourism drive was a necessary strategy to help the country reach its target of 1.5 million tourist arrivals and 10 million bed nights this year.

"When we reach this year's target, still we will have a shortfall of what the country needs," he said. "But still, that is much better than we anticipated in late 2020."

Already this year, Maldives has received 350,000 arrivals, as holidaymakers — primarily from nearby India — take advantage of the country's limited entry requirements.

Meantime, guests are booking longer stays, with many using the islands as a destination for so-called "workations" — or a working vacation. Mausoom said he is hopeful that will continue, with tourists staying to receive both their first and second doses.

"Workation — working from Maldives is now becoming very trendy," he said. "You see very rich executives, company executives, come here and they are based here."

https://www.necn.com/news/business/money-report/maldives-to-offer-holidaymakers-vaccines-on-arrival-in-a-push-to-revive-tourism/2447114/

AXA partners Microsoft on ‘all-in-one’ digital health platform

 European insurance giant AXA has stepped up an alliance with Microsoft to develop an international digital health platform on the back of successful pilots in Germany and Italy last year. 

The aim is to develop an “all-in-one” digital platform featuring a self-assessment tool, a personalised medical concierge service for appointment booking, and teleconsultations, along with home care service like medicine delivery.

It will also include a directory of healthcare professionals and a digital document vault to store records, with the entire suite operating within Microsoft’s Cloud for Healthcare platform. It will also draw on the tech giant’s artificial intelligence and secure data-sharing expertise, as well as contacts with other digital health players.

The self-assessment, teleconsultation and medical concierge tools are already available to AXA customers in Germany and Italy, with a roll-out in the UK, Spain, Belgium, and Switzerland due before the end of the year and other countries around the word to follow thereafter.

AXA said in a statement that the platform “simplifies healthcare journeys and empowers customers with access to a fully integrated ecosystem” that will be tailored to local health systems.

It also claims that it will “break down health service silos to improve research, treatments and prevent diseases”.

Ultimately, the goal is to develop an open platform that can be integrated with other third-party services and can be used by healthcare providers and patients, regardless of whether they are AXA customers.

The two partners said that with health expenditure outpacing GDP growth over the next 15 years in almost all of the 37 countries in the Organisation for Economic Co-operation and Development (OECD) – even before the COVID-19 crisis – digital health provides an opportunity to reduce costs while delivering more personalised care.

Last year, an AXA PPP-backed report concluded that a large-scale shift to online consultations alone in the UK reduce patient no shows, save businesses up to £1.5 billion in lost employee work time, and free up considerable healthcare capacity.

“In many countries, the fragmentation, complexity and costs of health systems are a barrier to access to care,” said AXA chief executive Thomas Buberl, adding that this was thrown into sharp contrast in 2020 by the pandemic, albeit offset by a boom in telemedicine.

“Our ambition, together with [Microsoft], is to help offer simpler and first-class healthcare for every patient, as well as for health professionals,” he added.

https://pharmaphorum.com/news/axa-partners-microsoft-on-all-in-one-digital-health-platform/

White House won't buy more Pfizer, Moderna COVID-19 vaccine shots after J&J pause

 The White House announced it will not buy more shots of Pfizer or Moderna’s COVID-19 vaccines after a federal recommendation to pause the use of Johnson & Johnson’s vaccine.

White House COVID-19 Response Coordinator Jeffrey Zients said Wednesday during a media briefing that there are already enough shots of the two vaccine candidates either in production or distribution. The statements come a day after the Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) recommended states pause the use of J&J’s vaccine to explore extremely rare cases of blood clots.

“There is plenty of Pfizer and Moderna doses on order and being delivered,” Zients said. “We are doing everything we can to accelerate those doses.”

He said that President Joe Biden already ordered 100 million additional doses from Pfizer and Moderna back in February. That brings the total doses on order to 300 million from both companies.


Pfizer’s CEO Albert Bourla, Ph.D., tweeted Tuesday that the drugmaker has ramped up production of its vaccine and can deliver 10% more doses by the end of May than previously agreed. It still plans to get the full 300 million by the middle of July, two weeks earlier than planned.

Zients added that there will not be any changes to the allocations of doses.

“There is plenty of supply in the system,” he said. “Over the last three weeks we made available more than 25 million doses of Pfizer and Moderna. This week we are shipping out 28 million doses through state and federal channels.”

He said there should be enough that anyone scheduled for a J&J vaccine can still get one of the other approved vaccines.

CDC Director Rochelle Walensky, M.D., said during the briefing that the recommended pause was made out of an abundance of caution, and the blood clot events that have been reported are extremely rare.

She added that the CDC wanted to alert “healthcare providers to be on the lookout for these rare events and make sure we treat these appropriately.”

https://www.fiercehealthcare.com/payer/white-won-t-buy-more-pfizer-moderna-covid-19-vaccine-shots-after-j-j-pause

Cross-specialty care program helps RWJBarnabas Health treat lingering COVID-19 symptoms

 Now more than a year into the global pandemic, it’s become clear that not all of the patients recovering from acute COVID-19 infection are following the same journey.

growing body of academic literature is describing the long-term impacts of COVID-19 on patients’ health, whether that be a lingering cough and fatigue or a broader range of issues including brain fog and joint pain.

“We are all continuing to learn about COVID-19, PASC (long COVID) and their treatments,” Vanessa Trespalacios, M.D., an internal medicine physician at New Jersey-based RWJBarnabas Health Medical Group, told Fierce Healthcare. “COVID-19 and its sequelae can affect any and all organ systems, therefore a comprehensive, multidisciplinary approach is necessary. This disease causes a ripple effect that extends beyond the individual and consideration must be given to the varying degrees of impact on the individual’s home and work life.”

To this end, RWJBarnabas Health launched an integrated, multidisciplinary program focused on treating persistent COVID-19 symptoms at its flagship Saint Barnabas Medical Center (SBMC) in October.

“Earlier [last] year when the pandemic descended upon the New Jersey area, [SBMC] was hit pretty significantly,” Stephen Zieniewicz, president and CEO of SBMC, said in a video on the center’s website. “We had over 1,500 patients that were inpatients here, and that affected not only the patients but their family members. We right away recognized that … many of them would require follow-up and a variety of different specialty services. We reached out to physician leadership here at SBMD as well as with our medical group to design a program that recently launched in order to support these post-COVID patients and their needs.”

The Post-COVID CARE (Comprehensive Assessment, Recovery and Evaluation) program incorporates 17 different specialties supported by the health system, ranging from infectious diseases to neurology to behavioral health. It’s recommended for patients who are still experiencing lingering symptoms four weeks after a COVID-19 diagnosis and does not require a referral to participate.

Those enrolled in the program are guided by the process by a designated nurse navigator, who connects them to the appropriate specialist, schedules their care and corresponds with the patient and their primary care physician.

“Unlike other diseases, Post-Acute Sequelae of COVID-19 (PASC) impacts each patient differently resulting in a very individualized treatment plan,” Trespalacios, who serves as director of the program, said. “On average, each patient may have three to four specialty referrals in addition to diagnostic testing. The nurse navigator is critical to facilitating patient appointments in order to minimize treatment delays.”


Trespalacios said adopting this personalized, adaptive approach has helped the organization better tackle the wide range of issues that follow a COVID-19 infection. Among the 120 patients treated through the program to date, outcomes have varied from an improvement in symptoms or daily function to “a complete resolution of symptoms,” she said.

Also of note, she said the medical center has been logging relevant data points over time to flesh out its COVID-19 care pathways and inform future efforts.  

While RWJBarnabas Health initially took a “measured” approach to ensure it had the capacity to treat those who were enrolled, in late 2020 it decided to move forward with a pediatric version of the program that hosts the same full range of specialty services, which officially launched in February.

The system said in a statement that it has also rolled out multidisciplinary programs and clinics focused on post-COVID-19 recovery at a handful of other facilities, including the Robert Wood Johnson University Hospital in New Brunswick, Newark Beth Israel Medical Center and Community Medical Center and Monmouth Medical Center’s Southern Campus. It also is planning another clinic at Jersey City Medical Center.

RWJBarnabas’ programs are among the growing number of post-COVID-19 care initiatives hospitals and health systems have been developing over the past several months.

Mount Sinai Health System, for instance, launched a center as far back as May that aimed to support recovering COVID-19 patients and collect early data at a time when much of the U.S. health system was still working in the dark. Similar to RWJBarnabas, the Mount Sinai Center for Post-COVID Care’s approach focuses on delivering support from a broad range of medical specialties.  

Cleveland Clinic, Penn Medicine, UCSF Health, Cedars-Sinai and UAB Medicine are among other major names with dedicated programs or clinics in place.

Survivor Corps, a nonprofit organization founded to support COVID-19 patients and support data-driven research efforts, hosts an interactive map of post-COVID-19 care centers located in the U.S.

https://www.fiercehealthcare.com/hospitals/cross-specialty-care-program-helps-rwjbarnabas-health-treat-lingering-covid-19-symptoms

Teladoc Health Stock Faces 'Durable Growth Opportunity'

 Teladoc Health Inc 

TDOC 2.44% benefited from increased adoption of telehealth during the 2020 pandemic, according to Needham, and should be able to sustain this elevated growth “on the strength of its expansive platform.”

The Teladoc Health Analyst: Ryan MacDonald initiated coverage of Teladoc Health with a Buy rating and a price target of $235.

The Teladoc Health Thesis: While Teladoc Health’s stock trades at a premium valuation to its digital health peers, this premium multiple seems justified, MacDonald said in the initiation note.

While estimating the global telehealth market at approximately $84.5 billion, the analyst noted that the company “maintains a pole position in this market that we believe is in the early innings.”

“Despite boasting a market-leading position that includes approximately 73mm members and 14mm visits enabled, we believe that Teladoc has a long runway for growth with its existing base via increased member penetration and PMPM expansion driven by multi-product sales,” he wrote.

https://www.benzinga.com/analyst-ratings/analyst-color/21/04/20642268/teladoc-health-stock-faces-durable-growth-opportunity-heres-why

International team creates first chimeric human-monkey embryos

 team of scientists from the U.S., China, and Spain reported Thursday they have created the first embryos that were part human and part monkey and kept them alive for up to 20 days in laboratory dishes.

The ethically controversial creation of chimeras — containing cells from multiple species — is part of a drive to make experimental models to help scientists better understand early development, devise new treatments for human disease, and possibly find methods to grow organs for transplant inside other animals, such as pigs or sheep. Such chimeras can be used in experiments that can’t be done with human embryos, for example, but combining human cells with those of primates ushers in new and urgent ethical concerns.

To be clear, the work, published in the journal Cell, is in very early stages. The team did not create living, breathing part-human animals. They created very early embryos and never implanted them into the uterus of any animal. Concerns about human-animal chimeras center on what Stanford bioethicist and legal scholar Hank Greely calls “brains, balls, and beauty” — worries that an animal could look at all human, be born with a human brain, or be able to reproduce.

This experiment carried none of those risks, but makes it clear that the time to start discussing the ethics of human-animal chimeras is now. “It’s a first-in-kind experiment,” Nita Farahany, a professor of law and philosophy at the Duke University School of Law who co-authored a perspective piece on the ethics of the research, told STAT. “Whenever you cross a major technological or biological hurdle like this one, it’s a good moment to stop and reflect.”

The report provides the scientific details of work that began several years ago in Spain and China and made waves after it was leaked to the El País newspaper in 2019. (The Covid-19 pandemic delayed the completion and publication of the work, the researchers said.)

In the experiment, researchers injected 25 of a specific kind of human pluripotent stem cell (called “pinnacle stem cells” because they can turn into any kind of cell, including extraembryonic cells such as placenta) into each of 132 6-day-old macaque monkey embryos. The researchers stained the human cells with an exceptionally bright red fluorescent protein called tdTomato so they would be detectable within the monkey embryo as it developed.

The scientists took advantage of a new technique that allowed them to grow monkey embryos outside the womb for up to 20 days, a stage where the embryos were still largely undeveloped, but had formed layers and cavities. Survival of the embryos declined during the experiment; after 10 days, 103 embryos were still developing, and by day 19, just three of the chimeric embryos remained alive. (After 20 days, monkey embryos grown outside the womb, even those that are not chimeric, simply collapse.)

Still, the researchers found a high number of human cells in the chimeric embryos that survived. On average, 3% to 4% of the cells in the embryos were human, and in one embryo, up to 7% were. “When we observed human cells were alive in monkey embryos, that was amazing,” Tao Tan, a principal investigator at the State Key Laboratory of Primate Biomedical Research and Kunming University of Science and Technology in Yunnan, China, and one of the paper’s lead authors, told STAT.

Work published earlier this year by a research group in France showed that human cells did not survive well in monkey embryos. The key to the success in the new paper may be the particular stem cells that were used, as well as the way they were cultured.

The work, other scientists said, is the most successful to date in keeping a relatively large number of human cells alive and healthy in a nonhuman embryo. “This paper is a dramatic demonstration of the ability of human pluripotent stem cells to be incorporated into the embryos of the cynomolgus monkey,” said Magdalena Zernicka-Goetz, a developmental biologist at Caltech whose lab first developed, in mice, the technique of growing embryos in lab dishes. Such work gained increasing attention with the announcement last month that Jacob Hanna, a developmental biologist at the Weizmann Institute of Science in Israel, had kept mouse embryos alive and seemingly healthy for an extended period in an artificial womb.

The results published Thursday showed a far higher rate of survival for human cells in a nonhuman embryo than in previous experiments with sheep-human or pig-human chimeras, where sometimes just one in 100,000 cells were human.

It was those disappointing results that pushed the researchers to turn to monkeys, which are much more closely related to humans and have a similar developmental timeline, said the project’s leader, Salk Institute developmental biologist Juan Carlos Izpisua Belmonte. “Human cells do not robustly contribute to chimera formation in species evolutionarily distant to humans,” he said.

In monkeys, it was a different story. “We found the human and monkey cells cooperate with each other in building the embryo,” said Jun Wu, a research team member who is now an assistant professor at UT Southwestern Medical Center in Dallas, but was a staff scientist at the Salk when he worked on the project. Wu’s research has shown that when human cells are placed in culture with mouse cells, “we see the mouse cell actively kill the human cell, but when we place human and monkey cells together, there is no competition.”

Experiments such as this one cannot be funded with federal research dollars, though they break no U.S. laws. The work was conducted in China, not because it was illegal in the United States, the researchers said, but because the monkey embryos, which are difficult to procure and expensive, were available there. The experiment used a total of 150 embryos, which were obtained without harming the monkeys, “just like in the IVF procedure,” Tan said.

But such experiments, which combine human cells with those of animals, are nevertheless controversial. This work, and other work by Izpisua Belmonte, has moved so rapidly, bioethicists have had trouble keeping up.

“The complicated thing is that we need better models of human disease, but the better those models are, the closer they bring us to the ethical issues we were trying to avoid by not doing experiments in humans,” Farahany said. “Remarkable steps forward require urgent public engagement.”

In addition to considerations about research that may blur the line between humans and animals, the work on monkeys raises issues about both animal welfare and human consent. While many “de-identified” human cells can be used in research without consent for specific experiments, that may not be the best approach for highly controversial experiments such as this one, she said.

Izpisua Belmonte and the other researchers agreed that ethical debate and guidelines for such work is critical. They said they discussed the work with ethicists before proceeding and received extensive review and approval from all scientific institutions involved. The paper’s discussion section starts not with scientific findings as is usual in a research paper, but with a statement about ethical considerations.

The researchers say animal-human chimeras could prove a powerful tool in biomedicine and that the new research is important for helping understand what roadblocks stand in the way of merging human cells into animal embryos. Their hope is to understand the principles in monkey-human chimeras, which seem easier to create, and then try to apply that knowledge to the more technically challenging but ethically more acceptable pig-human chimeras.

The researchers, and other scientists STAT contacted for comment, said one of the most exciting things about the new paper was the discovery of “crosstalk” between human and monkey cells in the developing embryo, something that did not occur so readily in human-pig chimeras. “Human cells in pig tissue is akin to communications between two distant languages, such as Chinese and French, whereas human cells in macaques is like communications between two closely related languages, like Spanish and French,” said Izpisua Belmonte. “We do think understanding interspecific cross-talk could be the key for generating more successful chimeras.”

One major goal, they say, is to find a way to grow human organs in pigs or other animals to ease the shortage for transplants. Currently, more than 100,000 Americans are awaiting organs for transplant. But some scientists question whether that goal is achievable given how hard the research has proven so far.

“How realistic is it to think that someday this line of research could actually be able to produce organs for transplants into human patients?” asked Paul Knoepfler, a stem cell scientist and professor at the UC Davis School of Medicine. “If that is extremely unlikely given technical challenges, even setting aside ethical considerations, how much further should this research be pushed just to advance our knowledge of human development?”

Knoepfler said the research posed a host of other questions as well. “Is there a point at which a chimera is “too human”? For instance, what if a monkey-human chimera ended up being more human than monkey, should special rules apply?” he asked. “What if there are many human cells in the developing brain of a chimera?”

The issue of the brain merits special consideration, in part because many consider the brain the organ that makes humans unique. Because of these considerations, the National Academy of Sciences convened a group to weigh in on the ethics and governance of the emerging field of neural organoids, transplants, and chimeras. The report, released earlier this month, stated that many ethical issues in the field could be addressed by existing mechanisms, but that it was critical to continually reassess concerns as the science developed.

The Cell paper is interesting, said the report committee’s co-chair, Joshua Sanes, a neuroscientist and professor of molecular and cell biology at Harvard, but it is not pertinent to a discussion about neural chimeras because the less-than-3-week-old embryos had not reached the point of having a nervous system. Still, he said the new work reinforced the committee’s urging that ethical conversations “get ahead of the curve.”

“It’s pretty clear the entire field is moving ahead with great rapidity,” Sanes said. “It’s not clear how fast it will go, or in which direction, but we do need to revisit these issues regularly.”

Work is already afoot to loosen internationally recognized ethical limits that prohibit scientists from growing any human embryo outside the body for longer than 14 days. The rule had been in place for decades, and was developed in a time when it was technologically impossible to keep embryos alive outside the body for more than a few days. But that’s changed dramatically in recent years, and with increased interest in powerful gene editing tools such as CRISPR to genetically modify embryos to cure disease, motivation is strong to push biological limits further — and to have clear guidelines about what may be going too far.

Said Knoepfler: “Leaving it up to every researcher and institutional ethics review board to entirely come up with their own rules on human embryo research seems to me like a recipe for big trouble.”

https://www.statnews.com/2021/04/15/international-team-creates-first-chimeric-human-monkey-embryos/