Health & healthcare/ September 2019 –

Written by  //  January 27, 2020  //  Health & Health care  //  No comments

Brookings Topic Page on Marijuana
European Centre for Disease Prevention and Control

What is the coronavirus and how worried should we be?
What are the symptoms caused by the virus from Wuhan in China, how does it relate to Sars, and at what point should you go to the doctor?
It is a novel coronavirus – that is to say, a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city, which also sold live and newly slaughtered animals. New and troubling viruses usually originate in animal hosts. Ebola and flu are examples.
Severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. Although Mers is believed to be transmitted to humans from dromedaries, the original hosts for both coronaviruses were probably bats. There are suspicions now that the new coronavirus may have originated in bats or snakes, and possibly then was transmitted to humans via an intermediary species
The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died are known to have been already in poor health.

The death toll from a coronavirus outbreak in China rose to 81, as the government extended the Lunar New Year holiday and more big businesses shut down or told staff to work from home in an effort to curb the spread. Malaysia imposed a temporary ban on Chinese nationals arriving from the city of Wuhan and surrounding Hubei province to stem the spread of the coronavirus outbreak. Residents of China’s Hubei province will be also banned from entering Hong Kong from Monday as China tries to halt the rapid spread of the outbreak. Here are more facts on the virus, called 2019-nCoV, which can be transmitted among humans and belongs to the same coronavirus family as Severe Acute Respiratory Syndrome (SARS).
As Coronavirus Fears Intensify, Effectiveness of Quarantines Is Questioned
Amid news the coronavirus is spreading at an accelerating rate, concern is growing that China’s lockdown of cities may not only have come too late but could even make the situation worse.
A top Chinese health official warned on Sunday that the spread of the deadly new coronavirus, already extraordinarily rapid, could accelerate further, deepening global fears about an illness that has sickened more than 2,000 people worldwide and killed at least 80 people in China. Adding to the growing alarm, the official, Ma Xiaowei, the director of China’s National Health Commission, said that people carrying the virus but not showing symptoms could still infect others. The incubation period, he added, can vary from one to 14 days, with a typical duration of about 10 days. Such asymptomatic transmission would represent a major difference between the new respiratory disease and SARS, which killed 800 people in China and around the world nearly two decades ago. “The epidemic is now entering a more serious and complex period,” Mr. Ma said during a news conference in Beijing. “It looks like it will continue for some time, and the number of cases may increase.” In China, it was a weekend of grim new warnings about the little-understood virus and a rising tally of infections and deaths. The official number of confirmed infections across China jumped by half within a span of 24 hours, building to 1,975 on Sunday from around 1,300 on Saturday morning.

26 January
Fourth coronavirus case confirmed in U.S., 1,000 more cases expected in China
Health authorities in China are struggling to deal with a skyrocketing infection rate in the country of the new coronavirus, with the number of cases increasing 50 percent in just 24 hours.
Chinese leader Xi Jinping has warned of an “accelerating spread” of the coronavirus, adding to worries about the scope of a health crisis that has claimed at least 56 lives and triggered emergency health measures in cities across China.
More than 50 million people were ordered on lockdown in central China, with a travel ban covering 16 cities in the central Hubei province, where the virus was first encountered. Here’s what we know:
● The third and fourth confirmed infections in the United States were announced this weekend, both residents of Wuhan traveling through Southern California. Infections also have been confirmed in France, South Korea, Japan, Nepal, Thailand, Singapore, Vietnam, Taiwan and Australia. We’re mapping the spread here.

24 January
The Wuhan coronavirus has hit Xinjiang, where China has imprisoned at least 1 million Uighur Muslims. Its filthy detention camps will make inmates sitting ducks.
What we know so far about the coronavirus outbreak
Death toll stands at 26 and 1,000-bed hospital being built in Wuhan to deal with outbreak is due to open next week
The Chinese government has restricted the movement of about 33 million people with an unprecedented and indefinite lockdown after the virus originated in the city of Wuhan.
The World Health Organization’s emergency committee has concluded it’s “too early” to declare an international public health emergency, but says the situation is still to be considered an emergency in China. “It has not yet become a global health emergency. It may yet become one,” said the WHO director general, Dr Tedros Adhanom Ghebreyesus.
A first version of a vaccine could start trials in the summer, but it will be close to year before vaccines are available publicly from drugs companies, one expert said at he World Economic Forum in Davos.


11-13 January
CBC The Current “neuroscientist Dan Levitin gives us his tips on how to age well, and why he thinks old age is a stage of life where we can still grow.”
A neuroscientist lays out the keys to aging well -complete transcript
(PBS) Daniel Levitin — a neuroscientist and professor emeritus of psychology at McGill University– has written extensively about the brain. Also a musician, he has written bestselling books examining the effect of music on the brain, as well as about how to think “straight” in an age of information overload. In Levitin’s latest book, “Successful Aging” he explores the questions: what happens in the brain as we age and what are the keys to aging well?

24 June
A vaccine for Alzheimer’s is on the verge of becoming a reality
For decades, research into Alzheimer’s has made slow progress, but now a mother and daughter team think they have finally found a solution – a vaccine that could inoculate potential sufferers
(Wired UK) Half the deaths in the US in 1900 were from infectious disease. By 2010, mortality related to infectious disease had been all but wiped out, leaving the two biggest killers as cancer and heart disease. Over the last 15 years, UK mortality statistics have shown a steady decline in deaths from heart disease, strokes and most major cancers – for men and women.
Over the same period the death rate from dementia – of which Alzheimer’s is the most common cause – has doubled: in part because lifespans have increased, and the effects of the disease increase with age. In the UK, there are currently 850,000 people living with dementia, and 500,000 – perhaps as many as two-thirds – have Alzheimer’s. In the UK, the Alzheimer’s Society expects dementia sufferers to exceed a million by 2025, with an unknown quantity of carers and family members affected.
A total of five drugs are available to relieve symptoms, but they cannot slow or stop the progression of the disease.
In the last ten years, over 100 anti-Alzheimer’s drugs have been abandoned in development or during clinical trials.
… researchers aren’t sure if high levels of beta-amyloid and tau cause Alzheimer’s or are symptoms of the condition. Both damaged versions of the proteins can cause neighbouring beta-amyloid and tau molecules to misfold as well – spreading the damaging tangles to other cells, breaking nerve cell connections with other neurons and slowly starving neurons to death.
The risks generally increase with age, but an inheritable form of the disease – early-onset Alzheimer’s – can affect people as young as 30. …  Some medications can reduce memory loss and aid concentration, but these just boost the performance of unaffected neurons, doing nothing to stop the kill-off of brain cells.
Chang Yi’s vaccine – UB-311 – couples a synthetic imitation of a common disease with a specific sequence of amino acids that are present only in the damaged beta-amyloid protein, and absent in the healthy form. This provokes an antibody response, clearing the tangled proteins away without provoking potentially damaging inflammation.
In January 2019, the company announced the first results from a phase IIa clinical trial in 42 human patients. “We were able to generate some antibodies in all patients, which is unusual for vaccines,” Chang Yi explains with a huge grin. “We’re talking about almost a 100 per cent response rate. So far, we have seen an improvement in three out of three measurements of cognitive performance for patients with mild Alzheimer’s disease.”
Because phase II trials are so small, there’s no statistically valid evidence yet that UB-311 has an impact on cognition and memory, but the lack of serious side-effects is a big step forward.

1 January
AI system outperforms experts in spotting breast cancer
(The Guardian) An artificial intelligence program has been developed that is better at spotting breast cancer in mammograms than expert radiologists.
The AI outperformed the specialists by detecting cancers that the radiologists missed in the images, while ignoring features they falsely flagged as possible tumours.
If the program proves its worth in clinical trials, the software, developed by Google Health, could make breast screening more effective and ease the burden on health services such as the NHS where radiologists are in short supply.
“This is a great demonstration of how these technologies can enable and augment the human expert,” said Dominic King, the UK lead at Google Health. “The AI system is saying ‘I think there may be an issue here, do you want to check?’”


16 November
The most remote emergency room: Life and death in rural America
If anything defines the growing health gap between rural and urban America, it’s the rise of emergency telemedicine in the poorest, sickest, and most remote parts of the country, where the choice is increasingly to have a doctor on screen or no doctor at all.
(WaPo) As hospitals and physicians continue to disappear from rural America at record rates, here is the latest attempt to fill a widening void: a telemedicine center that provides remote emergency care for 179 hospitals across 30 states. Physicians for Avera eCare work out of high-tech cubicles instead of exam rooms. They wear scrubs to look the part of traditional doctors on camera, even though they never directly see or touch their patients. They respond to more than 15,000 emergencies each year by using remote-controlled cameras and computer screens at what has become rural America’s busiest emergency room, which is in fact a virtual ER located in a suburban industrial park.

2 October
Chronically Simple helping manage the chaos of living with chronic disease
The Chronic Disease Prevention Alliance of Canada puts the number of Canadian adults living with chronic disease at 60 per cent. According to Statistics Canada, 6.2 million Canadians over the age of 15 live with one or more disabilities. And nearly half of Canadians have cared for an aging, ill, or disabled family member or friend, according to the agency’s latest data. …
The result was the August 2018 launch of Chronically Simple, a cloud-based app that helps patients and caregivers manage the day-to-day logistics around living with chronic disease or disability, from medication and appointment tracking, to accounting and note taking, to lab results and medical records storage. … Among its many secure features, Chronically Simple offers appointment and scheduling functions, as well as medication and prescription tracking. It’s programmed to send reminders and connect appointment, doctor and prescription details. It also allows the patient to store their own medical records and keep copies of important test results. Users can store important incidentals like tax-deductible parking, travel, equipment, and prescription receipts by taking photos of the receipts. They can also enter appointment notes, manually or via talk-to-text, to be indexed for easy searching by the patient or healthcare provider.

23 September
Liberals, NDP promise increased health care spending
(Globe & Mail) Justin Trudeau promised a re-elected Liberal government would spend an additional $6-billion over four years on health care, describing the promise as a “down payment” to launch negotiations with provinces on pharmacare.
At an announcement in Hamilton, Mr. Trudeau said the increased funding would ensure that every Canadian can “easily” find a family doctor or primary-care team. He said the money would also lead to clear national standards for access to mental-health services, improve home care and implement a rare-disease drug strategy.
Mr. Trudeau gave very few details on the plans for a universal pharmacare system beyond interim measures that were announced in this year’s budget. He did not release a costing for the proposed plan, nor did he say when it would be implemented. Not to be outdone, Greens’ Elizabeth May commits to funding mental health, which she says is affected by the climate crisis
Federal leader outlines her health platform, which includes reducing wait times for assistance programs and putting more money into mental-health services in rural and remote areas.

19 September
Take down the barriers to telemedicine
By Patrick Déry, senior associate analyst at the Montreal Economic Institute.
Given that the technologies behind telemedicine exist and are proven, why do Canada’s health-care systems remain stuck in the past?
(Opinion Montreal Gazette) Because our governments, consciously or not, allow all sorts of obstacles to complicate the lives of patients.
For example, a doctor who provides care to people located in a certain province must hold a licence to practise in that province, even if he or she already holds a licence from another province. This outdated requirement prevents a better allocation of medical resources. If doctors are available to lend a hand in our part of the country, even just temporarily, why not welcome them with open arms?
In the case of telemedicine, the maintenance of this same requirement by the majority of provinces is completely ridiculous. More and more Canadian companies are offering their employees access to virtual consultations through their group insurance plans. A doctor who provides such a consultation could renew a prescription for an Alberta patient, then follow up with another from Manitoba suffering from a chronic illness, direct a Quebec patient to a consultation with a specialist, and give advice to a New Brunswick patient, all without leaving his or her office.
Why force this doctor to hold and renew a licence to practise in each of these places? The anatomy of Canadians does not vary a lot from province to province!
The provincial governments have also set out all sorts of conditions that restrict access to telemedicine within the public systems. It is often reserved for patients who live in remote regions or who suffer from particular conditions. Sometimes, the government even requires the patient or the doctor to go to an authorized health facility to receive or provide virtual care. This defeats at least some of the purpose of telemedicine!
The way we pay doctors doesn’t help, either. Fee-for-service payments, which represent around three-quarters of Canadian doctors’ incomes, do not encourage them to carry out actions for which there will be no payment. Unsurprisingly, the very large majority of our doctors are hesitant to write an email or pick up a phone to contact us, let alone have a smartphone consultation.
Finally, our health-care systems are still often far too centred on doctors. While their expertise is sometimes indispensable, there are many situations in which nurses and pharmacists can lend a hand. Allowing them to do more would liberate doctors, a scarce resource, to do other things.

18 September
Factbox: India becomes latest country to ban sale of e-cigarettes
(Reuters) – India became the latest country after Brazil and Thailand to ban the sale of e-cigarettes in what could potentially be the biggest move against vaping globally over growing health concerns.

6 September
Three more deaths and at least 450 illnesses linked to vaping nationwide
The Centers for Disease Control (CDC) said some type of chemical exposure is likely associated with the illnesses, but more information is needed to determine the exact cause. Many of those hospitalized reported recently vaping a THC product with chemicals from marijuana, while a smaller group reported using regular e-cigarettes.
The CDC did not identify any particular brand of e-cigarette, but expressed concern about any product sold on the street or tampered with by users.
“They’re really concerned about unknown substances people are buying on the street,” LaPook said. “They think it’s not an infection, it’s a probably some chemical irritation. When you think about it, these e-cigarette devices are really like chemistry sets. You put in this liquid, you lick it, you heat it up – there’s some kind of chemical reaction. You’re creating all these different chemicals. You’re not entirely sure what these chemicals are, but we are sure of one thing: You are sucking a lot of them.”

Ebola outbreak in the Democratic Republic of the Congo
(European Centre for Disease Prevention and Control) The 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) has been ongoing since August 2018. This is the largest-ever outbreak reported in the country and the world’s second largest in history. It has been declared a Public Health Emergency of International Concern on 17 July 2019.

4 September
Malaria breakthrough as scientists find ‘highly effective’ way to kill parasite
Drugs derived from Ivermectin, which makes human blood deadly to mosquitoes, could be available within two years

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