Comparison of anxiety and depressive of head and neck cancer patients before and during the 2019 coronavirus pandemic

 

Jiani Liu and colleagues from  Sun Yat-sen University, Zhuhai, China,  studied the effect of the COVID-19 pandemic on the anxiety and depressive symptoms of cancer patients before and during the 2019 coronavirus pandemic.

A total of 526 head and neck cancer patients were included in the final analysis; 27% of cases experienced anxiety and depression before the pandemic and 50 % during the COVID-19 pandemic. (P=0.018).

The present study demonstrates the significant impact of COVID-19 on the psychological states of cancer patients. This findings indicating the need for appropriate changes in treatment decisions, enhanced psychotherapy, and interventions to reduce the incidence of anxiety, depression, and even suicide during the pandemic.

Getting infected with both COVID-19 and influenza viruses

 Co-infection of COVID-19 with other respiratory pathogens which may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge new concern. Eleven prevalence studies with total of 3,070 patients with COVID-19, and 79 patients with concurrent COVID-19 and influenza were evaluated by Dadashi et al from Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran . The overlap of COVID-19 and influenza, as two epidemics at the same time can occur in the cold months of the year. The prevalence of influenza infection was 0.8% in patients with confirmed COVID-19. The frequency of influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and 0.4% in the America. 

This information highlights the importance of getting properly vaccinated for both COVID-19 and influenza and practicing safe prevention (wearing masks and maintaining distance) as advised by the local health authorities. Neck breathers including laryngectomee should practice extra vigilance to avoid respiratory infections.

Discordant in Detection of COVID-19 in the Nasopharynx Versus Trachea for Patients With Tracheostomies

 Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS-CoV-2 testing. Smith and colleagues from the University of Michigan retrospectively compared the detection of SARS-CoV-2 in hospitalized patients with COVID-19 and tracheostomies.

The authors employed SARS-CoV-2 RNA nucleic acid amplification test (NAAT) in 45 newly  tracheotomized patients in nasopharyngeal (NP) and tracheal (TR) samples taken within a 48-hour period.

Thirty-two (71.1%) of the 45 patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive.

The authors concluded that patients with tracheostomies may have a higher false-negative rate if only one site is assessed for SARS-CoV-2. They recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist.

Hospitalization and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic

 

People with total laryngectomy (PTL) have an altered anatomy for breathing and speaking. The presence of a neck stoma poses an additional virus entry point aside from the nose, mouth and conjunctiva. This could increase the susceptibility to COVID-19 for PTL.

Govender and colleagues from the University College Hospital in London performed a national audit to provide data on shielding, hospital admissions and mortality for patients with total laryngectomy in the UK over the pandemic. Eight of the 24 PTL that were hospitalized with COVID -19 died within 28 days. Although the overall mortality in PTL over the first lockdown did not appear to be higher than the “best case” estimates from previous years one in three PTL who acquired COVID-19 and were admitted to hospital, died within 28 days of testing positive. These findings are relevant to the current care and management of PTL over the pandemic.

This study highlights gaps in the collection of baseline information on hospital admissions, length of stay and mortality for people with laryngectomy in the UK, restricting comparisons between the current data and historical data.

The need for further research on whether neck-breathers should be tested via both nasopharyngeal and tracheal aspirates is important not just currently, but also in case of any future respiratory epidemics.

Safety of celebrating the spring holidays with family and Friends for head and neck cancer patients.

The upcoming spring holidays (Easter, Passover and Ramadan) creates challenges for those who are looking forward to celebrating them in person with friends and family. The availability of vaccination against the virus made it easier to resume the tradition of in person celebration although the risk of acquiring the infection can be high in some situations.

Vigilance and mitigating the risk of acquiring COVID-19 infection are especially important for Individuals with cancer including of the head and neck, who are at greater risk of suffering from a serious and life threatening COVD -19 infection.

Celebrating the holidays in close settings can be risky because of the difficulty of maintain social distance, and adequate ventilation. Mask wearing is impractical while eating and drinking.

The Center of Disease Control’s Interim Public Health Recommendations for Fully Vaccinated provide useful guidelines that can help plan a safe Seder and avoid risky scenarios that would allow the COVID-19 virus to spread. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

For the purposes of the CDC’s recommendations people are considered fully vaccinated for COVID-19 more than 2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or  more than 2 weeks after they have received a single-dose vaccine (Johnson and Johnson/Janssen ).

Interpretation of the CDC recommendations to the spring holidays scenario for fully vaccinated people are:

•             It is permissible for fully vaccinated people to celebrate indoor with other fully vaccinated people or unvaccinated people from a single household who are at low risk for severe COVID-19 disease without wearing masks or physical distancing.

•             Wearing masks, practicing physical distancing, and adhering to other prevention measures is required when celebrating with unvaccinated people who are at increased risk for severe COVID-19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease

•             Wearing masks, maintaining physical distance, and practicing other prevention measures are required when celebrating with unvaccinated people from multiple households

•             Avoiding medium - and large-sized Seder

•             Unvaccinated individuals from different households should refrain from celebrating in person.

Since the COVID-19  vaccine is not currently available to children, extra caution should be practiced when they are present. Outdoor gathering with masks or opening the windows to improve the ventilation, and distancing would be safest.

Although the available vaccines are helpful in curbing the spread of COVID-19 their efficacy against the variants of the virus in unknown. These variants seem to spread more easily and quickly than other variants, which may lead to more cases of COVID-19. It is there prudent to continue to maintain vigilance in the upcoming holiday.

 

Potential devastating impact of COVID-19 pandemic on the diagnosis and treatment of head and neck cancer

New data from the United Kingdom reveals potential devastating impact of COVID-19 pandemic on head and neck cancer patients. At the peak of the first lock down, there was a 59% drop in urgent referrals for people with a suspicion of head and neck cancer.

The devastating impact on projected five-year survival for people with head and neck cancer sees the pre-COVID projected 5 year survival of 47% will potentially drop to 43% of head and neck cancer patients.

This could lead to an additional 451 deaths in people with head and neck cancer in the United Kingdom.

The data from DATA-CAN (The Health Data Research Hub for Cancer) provided a valuable insight into the effects of the COVID-19 pandemic on all cancer patients and cancer services. The research found:

• A decline in urgent referrals for cancer (70% decrease) during the initial lock down
• A decline in chemotherapy attendances (40% decrease) during the initial lock down
• For certain cancers, these declines had only partially recovered.

The researchers have now looked in detail at the impact on head and neck cancers and found that, at its worst, there was a drop of nearly 60% in urgent referrals for a suspicion of head and neck cancer during the first lockdown. This meant that 6 out 10 people who had symptoms potentially indicating head and neck cancer were not being referred to a specialist to investigate further.

Estimates suggest that this could have a devastating impact on five-year survival for people with head and neck cancer. Pre-COVID, around 47% of people with head and neck cancer would be projected to survive for five years or more. This figure could now drop to 43% which could potentially lead to an additional 451 deaths in people with head and neck cancer as a result of the pandemic.

Watch a video that presents the data and how to mitigate it.

Laryngectomees’ challenges coping with COVID – 19 Pandemic as vaccines are available.

 

Laryngectomees are more susceptible to some respiratory infections because the air they inhale is not filtered by passing through their nose. Consequently, they are at an increased risk of inhaling respiratory pathogens (viruses, bacteria, and fungi) directly into their lungs.

Laryngectomees are also at high risk for poor outcomes when contracting COVID-19 because of their propensity to suffer from collapse of the lower lobs of their lungs (atelectasis). This is due to loss of upper airway resistance and impaired mucociliary functions, and mucosal irritation from cold, or dry inspired air. Further comorbidities such as advanced age, chronic disease (pulmonary, peripheral vascular, cardiac, cerebrovascular), diabetes, and past smoking, increase this risk.

Therefore, laryngectomees have to be vigilant and protect themselves from becoming infected with COVID-19. This can be done by wearing eat and mosuture exchanger (HME) with greater filtering properties ( i.e., Provox Micron TM); using 2 surgical masks (preferably N95), one over the stoma and the other over the mouth and nose; staying at least 6 feet away from others; washing hands often with soap and water for at least 20 seconds; and not touching their stoma, HME, eyes, nose, and mouth with unwashed hands.

Laryngectomees can protect themselves by receiving vaccination against COVID-19. All COVID-19 vaccines currently available in the United States have been shown to be highly effective at preventing COVID-19. Based on clinical trials, experts believe that getting a COVID-19 vaccine may also help keep one from getting seriously ill even when one get infected with COVID-19. Becoming vaccinated may also protect people around the vaccinated person, particularly those at increased risk for severe illness from COVID-19. This also contributes to the curbing of the national and world pandemic.

Among the benefits of being vaccinated is the emotional relief of gaining protection from the virus, and the ability of feel safer in face to face social interactions and when seeking medical and dental care.

Clinical trials demonstrated that the known and potential benefits of these vaccine outweigh the their side effects, and the known and potential harms of becoming infected with COVID-19. The Center for Disease Control’s (CDC) has reported that severe allergic reactions to COVID-19 vaccines are very rare and happened at a rate of 11.1 cases per million vaccinations. 

Vaccination is not expected to relax the CDC recommendations for continued use of masks and social distancing. This is because vaccines are not 100% effective, their protective effect is not maximized for at least six weeks, and vaccines may keep a person from getting sick but not from transmitting the virus. Masks and HMEs reduce the spread of any mutated strain of the coronavirus, while vaccines may not be as effective in preventing the transmission of newer, more contagious strains.

It is advisable to contact one’s physicians for guidance about vaccination or if one gets ill with the Corona virus. There are currently treatments available that can be administered early in the course of the infection to mitigate the illness and prevent complications. It would be prudent to following the guidance and instruction issued by the CDC and the local government health authorities.

Asymptomatic transmission of COVID-19, with or without vaccination

 

One of the problems with this COVID-19 pandemic, from a public health standpoint, is that asymptomatic or presymptomatic persons can transmit the virus to others without knowing that they are infected themselves. Estimates of asymptomatic transmission are 17-20%.

Protection procedure include  isolation (keeping infected persons away from others); and quarantine ( keeping persons who might have been exposed to the virus away from others).

Asymptomatic infections complicate these protective measures since it is impossible to tell who is infected. Current practice is essentially to assume that anyone might be infected and capable of transmission, and therefore masks and social distancing are necessary. Despite trials showing 95% efficacy of the two mRNA vaccines (compared to 70%, possibly higher, for the Johnson and Johnson vaccine), vaccination is not expected to relax the recommendations for continued masks and social distancing. The reasons are:

• Vaccines are not 100% effective;
• Vaccines protective effect is not maximized for at least six weeks;
• Vaccines may keep a person from getting sick but not from transmitting the virus.

Masks (if clean and properly worn) reduce the spread of any mutated strain of the coronavirus, while vaccines may not be as effective in preventing the transmission of newer, more contagious (but not more virulent) strains. There have been several mutated strains appearing in the UK, Brazil, South Africa, California, and other countries and states. As a rule they do not cause a more severe case of the disease but they may be more infective than existing strains.

Based on Dr. Glen Reeves article.

COVID-19 vaccines adverse reactions in the USA

 

     The Vaccine Adverse Event Reporting System (VAERS) receives reports on adverse reactions to vaccines. These reports can be filed by patients, health care providers, or even family members. As of 17 January 55 Americans have died soon after receiving an mRNA vaccination. The FDA and CDC investigate all these reports. Of course, most deaths are due to underlying illnesses; the system does not require proof that the vaccine caused the event in order to accept the report. The CDC has reported that severe allergic reactions to COVID-19 vaccines were happening at a rate of 11.1 per million vaccinations; for a rough comparison flu vaccinations have a rate of 1.3 deaths per million. Norway has changed its COVID-19 vaccination guide to direct officials not to give "very frail" people the vaccines.

based on Dr Glen Reeves article.

 

Cancer Care During the COVID- 19 Pandemic

 

Dr Brook's Letter to the Editor  published  in the New York Times has an important message to all cancer survivors:

The prolonged COVID -19 pandemic has led to an increase in the number of patients who present with late-stage, previously undiagnosed cancers, and recurrence of a previously diagnosed malignancy.

This is probably due to the reluctance of people to seek medical care because of fear of contracting COVID -19 at medical facilities; the closing or reduction in clinical services; the requirement to obtain COVID -19 testing before some medical procedures; and the use of telemedicine without physical examination instead of an actual office visit.

It is important that people not defer their medical care during the pandemic. It is especially important that those who previously received a cancer diagnosis continue their treatment and follow-up. Those who experience new or unusual signs and symptoms that may indicate aggravation of their condition or a new ailment should seek medical care without delay.

Postponing care or ignoring symptoms may lead to complications and deterioration, making future care more difficult and leading to increased morbidity and mortality.

Increased risk of serious illnesses including advanced stage cancer due to COVID -19 pandemic

 

The prolonged COVID-19 world wide pandemic led to an increase in medical problems due to other etiologies. Medical providers are facing growing number of patients with previously undiagnosed late stage cancers, and recurrence of a previously diagnosed malignancies.  This led to an increase in the number of radical surgeries including laryngectomies and increase in the death rate among patients with many types of cancer.   

This is likely due to several factors that include the reluctance of individuals to seek medical care because of fear of contracting COVID-19 at medical facilities; the closure or reduction of clinical services, the suspension of cancer screening, the deferral of routine diagnostic work, the requirement to obtain COVID-19 testing prior to some medical procedures, and the utilization of telemedine without physical examination instead of an actual office visit.

It is therefore important that individuals do not defer their medical, dental, and mental care during the COVID-19 pandemic. It is especially important that those who were previously diagnosed with an ailment including cancer continue their treatment and follow up. Those who experience new or unusual signs and symptoms that may indicate an aggravation of their condition or a new ailment should seek medical care without delay. Postponing care or ignoring symptoms may lead to complications and deterioration making future care more difficult and may lead to increase morbity and mortality.

  

Three studies from Italy and Scotland reported seven laryngectomees who  developed COVID -19 infection. Two acquired the infection while in the hospital after undergoing laryngectomy. The infection was serious in three of them and they required intubation and intensive care admission. All the patients survived.

The authors concluded that individuals who have undergone laryngectomy for head and neck squamous cell carcinoma are high risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways.

The "Laryngectomee Guide for COVID-19 Pandemic" is available in English, Spanish, Portuguese, Italian, Turkish, Bosnian, and Japanese.

The "Laryngectomee Guide for COVID-19 pandemic” is available in English, Spanish, Portuguese, Italian, Turkish, Bosnian,  Malaysian, and Japanese.

The corona (COVID-19) pandemic presents many medical, social and psychological challenges for laryngectomees and their medical providers. The Laryngectomee Guide for COVID -19 provides information for laryngectomee and neck breathers how to cope with the COVID -19 pandemic. It contains information how to prevent the infection and deal with depression, social isolation, fibrosis, lymphedema, mucous problems, and voice prosthesis leak. It provides suggestions how to deal with esophageal dilation, hospitalization, and keep fit and eat well.

The Guide in English is available as eBook (free) at  https://bit.ly/2AY41RO , and paperback at: https://amzn.to/3i5XncR   through Amazon.com and https://bit.ly/3glrlJf through Lulu publishing. 

The Guide in Spanish is available as eBook (free) at https://bit.ly/3bFgPeb and paperback at https://bit.ly/32djqIW 

 

The Guide in Portuguese is available as as eBook (free) at  https://bit.ly/3eFcYPN  and paperback at https://bit.ly/3pklpVJ 

The Guide is available from Associação Portuguesa de Terapeutas da Fala (APTF)(Portuguese Speech Therapists Association)

The Guide in Italian is available as eBook (free) at https://bit.ly/2RfdrgE and paperback at 

 https://bit.ly/2DSWq92

The Guide in Romanian is available as eBook (free) at https://bit.ly/3nfGSgO and paperback at https://bit.ly/3a7kWAS   

The Guide in Bosnian is available as eBook (free) at https://bit.ly/2TzfKfG and paperback at https://bit.ly/3p2Mf4e and  https://publish.sweek.com/books/244071/ 

The Guide in Turkish is available as eBook (free) at https://bit.ly/2RHYIeg and paperback at 

 https://bit.ly/3cmgu0k 

The Guide in Malaysian is included in The Laryngectomee Guide Malaysian Edition.  It is available as Paperback http://bit.ly/3n4fK3m , eBook http://bit.ly/2X29Rcu  

The Guide in Japanese is available as eBook (free) https://bit.ly/3j94Don  , and paperback at: https://bit.ly/3jd85yf

    

The eBook is also available from the Japanese Laryngectomee Association.

Guide in English

Guide in Spanish

Guide in Portuguese

Guide in Italian 

Guide in Turkish 

Guide in Romanian

Guide in Bosnian

Guide in Japanese

The Head and Neck Alliance offers links for Laryngectomee Guide and Laryngectomee Guide for COVID-19 pandemic.

Click this link to obtain The Laryngectomee Guide in 20 languages/dialects: English, French, Russian, Italian, Chinese (traditional and simplified), Korean, Indonesian,Turkish, Arabic, Bulgarian, Romanian, Portuguese, Persian (Farsi), Tagalog, Bosnian, and Spanish (Central American, Andine, Spain, and South American version) and Laryngectomee Guide for COVID-19 Pandemic.

All eBooks are Free.

How to avoid and cope with quarantine fatigue

Months into the COVID-19 pandemic, the effects of the disease and public safety precautions have been devastating — mental health and addiction issues have risen, jobs have been lost and, tragically, tens of thousands have lost their lives. Some have simply become weary of the monotony and loneliness of staying at home. These lonely and isolation can be more severe in laryngectomees and head and neck cancer survivors who have communication difficulties.

All of this has led to what experts are calling “COVID-19 quarantine fatigue,” a modern-day version of what is known as “caution fatigue.” This is a phenomenon when one’s body and mind tire of the persistent sense of danger and the constant stress it is causing, leading to becoming complacent or unable to make good decisions.

With quarantine fatigue, one might grow weary of — or actively ignore — the precautions that can slow the spread of COVID-19. The sense of urgency in managing the global health emergency may fade,  leading to impatient or tiredness of complying with the health and safety guidelines.

One may begin to feel hopeless, as if no amount of measures can keep one safe from exposure. This can result in decreasing the home sanitizing and forgetting to wear a face covering when going out. Some may expand the number of people they spend time with in person or forego all precautionary measures.

There is an understandable eagerness to ‘go back to normal.’ Since the virus is invisible,  it may seem that it does not really exist, even though there is evidence it is still spreading. There is a genuine desire to and interact and connect with others and deny or ignore the health risks associated with the virus.

It is important to resist quarantine fatigue and remember that we are all in this together and it takes cooperation from everyone in the community to decrease the spread of COVID-19. Yielding to isolation fatigue can cause an increase in COVID-19 cases as well as repeated lockdowns and further shuttering of businesses and schools. A rise in infection rates, can overwhelm the health care system, and increased deaths in those who are vulnerable.

Resisting quarantine fatigue is especially important in older adults, people who have severe underlying medical conditions and immunocompromised individuals who are at higher risk for developing serious complications from COVID-19 illness.

Enclosed are recommendations how to avoid quarantine fatigue and continue being diligent in the collective efforts to keep our community healthy and reduce the number of COVID-19 infections:

• Staying informed with trusted and reliable resources, such as the Centers for Disease Control and Prevention (CDC) website.
• Avoiding constant exposure to news, though it may be beneficial to check local news at occasional intervals to learn pertinent details about COVID-19 in your community.
• Taking care of oneself — eating a nutritionally balanced diet, exercising, getting appropriate amounts of sleep, practicing self-care, and taking care of one’s medical needs.
• Staying connected with loved ones, friend and support groups.
• Maintaining precautions to avoid catching or spreading the disease.

Hydroxychloroquine and Coronavirus Disease 2019: A Systematic Review

Hydroxychloroquine (HCQ) emerged early in the course of the coronavirus disease 2019 (COVID-19) pandemic as a possible drug with potential therapeutic and prophylactic benefits. It was quickly adopted in China, Europe, and the USA. A systematically review of the existing clinical evidence of HCQ use for the prevention and treatment of COVID-19 was performed by  Rakedzon and colleagues from Rambam health Center, Haifa, Israel

The researcher all clinical studies describing HCQ administration to treat or prevent COVID-19 in PubMed before June 20, 2020. This included randomized controlled trials (RCTs), non-randomized comparative cohorts, and case series studies that had all undergone peer review.

A total of 623 studies were screened; 17 studies evaluating HCQ treatment were included. A total of 13 were observational studies, and 4 were RCTs. In terms of effect on mortality rates, observational studies provided conflicting results. As a whole, RCTs, including one large British RCT that has not yet been published, showed no significant effect of HCQ on mortality rates, clinical cure, and virologic response. The use of HCQ as a post-exposure prophylactic agent was found to be ineffective in one RCT. The authors concluded that there is no evidence supporting HCQ for prophylaxis or treatment of COVID-19. Many observational trials were methodologically flawed. Scientific efforts have been disappointingly fragmented, and well-conducted trials have only recently been completed, more than 7 months and 600,000 deaths into the pandemic.

List of Open Clinical Trials for Patients with COVID-19 in the USA VA and Department of Defense facilities.

There is an urgent need to find effective treatment or a vaccine for COVID-19. Worldwide there are over 1,800 trials addressing COVID-19-related health care. There are 10 trials developed by the US Department of Veterans Affairs (VA), US Department of Defense, and the National Institute of Allergy and Infectious Diseases have provided important data on effective treatment options. The clinical trials listed below are all open as of May 31, 2020.

Adaptive COVID-19 Treatment Trial (ACTT)

This study is an adaptive, randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of novel therapeutic agents in hospitalized adults diagnosed with COVID-19. The study will compare different investigational therapeutic agents to a control arm. ID: NCT04280705

Study to Evaluate the Safety and Antiviral Activity of Remdesivir (GS-5734) in Participants with Severe Coronavirus Disease (COVID-19)

The primary objective of this study is to evaluate the efficacy of 2 remdesivir (RDV) regimens with respect to clinical status assessed by a 7-point ordinal scale on Day 11 (NCT04292730) or Day 14 (NCT04292899).

Expanded Access Remdesivir (RDV; GS-5734)

The treatment of communicable Novel Coronavirus of 2019 with Remdesivir (RDV; GS-5734) also known as severe acute respiratory syndrome coronavirus 2.

A Study to Evaluate the Safety and Efficacy of Tocilizumab in Patients With Severe COVID-19 Pneumonia (COVACTA)

This study will evaluate the efficacy, safety, pharmacodynamics, and pharmacokinetics of tocilizumab  compared with a matching placebo in combination with standard of care in hospitalized patients with severe COVID-19 pneumonia.

Administration of Intravenous Vitamin C in Novel Coronavirus Infection (COVID-19) and Decreased Oxygenation (AVoCaDO)

The study evaluates if Vit C is safe and tolerable in COVID-19 subjects given early or late in the disease course and may reduce the risk of respiratory failure requiring mechanical ventilation and development of ARDS along with reductions in supplemental oxygen demand and inflammatory markers.

Treatment Of CORONAVIRUS DISEASE 2019 (COVID-19) With Anti-Sars-CoV-2 Convalescent Plasma (ASCoV2CP)

This is an expanded access open-label, single-arm, multi-site protocol to provide convalescent plasma as a treatment for patients diagnosed with severe, or life-threatening COVID-19.

A Study to Evaluate the Safety and Efficacy of MSTT1041A (Astegolimab) or UTTR1147A in Patients With Severe COVID-19 Pneumonia (COVASTIL)

This is a Phase II, randomized, double-blind, placebo-controlled, multicenter study to assess the efficacy and safety of MSTT1041A (astegolimab) or UTTR1147A in combination with standard of care (SOC) compared with matching placebo in combination with SOC in patients hospitalized with severe coronavirus disease 2019 pneumonia.

Adaptive COVID-19 Treatment Trial 2 (ACTT-II)

ACTT-II will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have 3 home visits.  

Click to get more information 

Dr. Brook's interview about becoming a laryngectomee, and coping with COVID-19

Dr. Itzhak Brook is a physician and laryngectomee.

In the interview made for the International Association of Laryngectomees 69th Annual Meeting - Voice Institute 60th meeting on June 13, 2020, he describes how he dealt with throat cancer, and became a laryngectomee. He also discusses how laryngectomees can protect themselves from COVID-19 virus and deal with the challenges of caring for their airways during this period.

Dr. Itzhak Brook is a physician and laryngectomee.

In the interview made for the International Association of Laryngectomees 69th Annual Meeting - Voice Institute 60th meeting on June 13, 2020, he describes how he dealt with throat cancer, and became a laryngectomee. He also discusses how laryngectomees can protect themselves from COVID-19 virus and deal with the challenges of caring for their airways during this period.

Treatments for COVID-19 What helps, what doesn't, and what's in the pipeline for COVID-19

Most who become ill with COVID-19 will be able to recover at home. No specific treatments for COVID-19 exist right now. But some of the same things you do to feel better if you have the flu — getting enough rest, staying well hydrated, and taking medications to relieve fever and aches and pains — also help with COVID-19.

Scientists are working hard to develop effective treatments. Therapies that are under investigation include drugs that have been used to treat malaria and autoimmune diseases; antiviral drugs that were developed for other viruses, and antibodies from people who have recovered from COVID-19.

Enclosed is an update about the current treatments and potential ones for COVID-19 prepared by Harvard Medical School.

Signs and symptoms of COVID-19 infection

COVID-19 affects different people in different ways. Infected people have had a wide range of symptoms reported – from mild symptoms to severe illness.

Symptoms may appear 2-14 days after exposure to the virus. The CDC recommends that people with these symptoms may have COVID-19:

•          Fever or chills
•        Cough
•       Shortness of breath or difficulty breathing
•        Fatigue
•        Muscle or body aches
•        Headache
•        New loss of taste or smell
•       Sore throat
•        Congestion or runny nose
•        Nausea or vomiting
•       Diarrhea

Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately

•     Trouble breathing
•        Persistent pain or pressure in the chest
•        New confusion
•        Inability to wake or stay awake
•        Bluish lips or face

Call your medical provider for any other symptoms that are severe or concerning to you.

It is helpful to have a plan in place in case one becomes sick. Identifying a caregiver and staying in touch with family, friends, neighbors, and healthcare professionals during the pandemic through email or phone, especially if some lives alone is important. If one is aware of an exposure or are experiencing symptoms such as a sore throat, dry cough, fever, and/or shortness of breath, seek medical help as soon as possible. Trying to contact one’s care team over the phone before coming into a medical center can facilitate their care.

COVID-19 May Be a Blood Vessel Disease. Learn more about this

Many of the infection’s bizarre symptoms have one thing in common. This article is by Dana G Smith.  

Months into the pandemic, there is now a growing body of evidence to support the theory that the novel corona virus can infect blood vessels, which could explain not only the high prevalence of blood clots, strokes, and heart attacks, but also provide an answer for the diverse set of head-to-toe symptoms that have emerged.

In a paper published in April in the scientific journal The Lancet, Mehra and a team of scientists discovered that the SARS-CoV-2 virus can infect the endothelial cells that line the inside of blood vessels. Endothelial cells protect the cardiovascular system, and they release proteins that influence everything from blood clotting to the immune response. In the paper, the scientists showed damage to endothelial cells in the lungs, heart, kidneys, liver, and intestines in people with COVID-19.

Click to read the whole article. 

COVID-19 virus and blood cells