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Treat Covid-19 Early to Save Patients’ Lives, SARS Veteran Urges - Bloomberg
Hong Kong’s top pandemic doctor sees a way out of intensive care for thousands of Covid-19 patients: keeping them from entering in the first place.
Hong Kong’s top pandemic doctor sees a way out of intensive care for thousands of Covid-19 patients: keeping them from entering in the first place. After sobering experiences 17 years ago with the outbreak of severe acute respiratory syndrome, Yuen Kwok-Yung is advocating early, aggressive hospitalization and treatment to minimize ravaging disease and death. Hong Kong’s 2% Covid-19 fatality rate as of Friday, well below the global average, lends weight to the approach. Most therapies for SARS-CoV-2 are authorized for use in severely ill patients, in some cases backed by research that’s still in question. Yuen, the Henry Fok professor in infectious diseases at the University of Hong Kong for 15 years, is admitting patients with minimal disease so they can be isolated, monitored and treated if needed. “In places like the U.K. and U.S., usually if you have mild symptoms, you are not admitted to a hospital at all -- you just wait at home until you feel very bad or you have shortness of breath,” he explained over Zoom from his office. “But we basically admit any patients, even without much symptoms, into the hospital for isolation.” The strategy reduces transmission in the community, and enables patients to enter a clinical trial and receive experimental treatment soon after developing a fever or showing other signs of worsening illness, Yuen said. That’s critical because the amount of SARS-CoV-2 virus or “viral load” in patients peaks at around the time symptoms appear -- similar to influenza. Yuen, who graduated from the University of Hong Kong in 1981 and has the rare distinction of being a microbiologist, surgeon and physician, has been at the forefront of the city’s response to infectious outbreaks for decades. In 1998, he and colleagues described the first dozen patients afflicted with the H5N1 strain of avian influenza. Five years later, they reported SARS in a patient visiting Hong Kong from Guangzhou, China. Yuen recalls the trial and error involved in saving patients from SARS, also caused by a coronavirus. Soon after, he identified “ a time bomb” of environmental and social conditions that he predicted would inevitably result in more deadly coronavirus outbreaks. That prediction came true in December, when the first cases of a mysterious pneumonia came to light in Wuhan, in China’s Hubei province. Hong Kong responded to the novel coronavirus by preparing tests and advising citizens to wear masks. Meantime, Yuen’s lab was conducting research that led to the first reported cluster among family members in which human-to-human transmission of the new coronavirus occurred. In February, he joined the WHO-China Joint Mission to investigate the country’s early response and his lab has since reported a number of important findings, including the first confirmed SARS-CoV-2 reinfection. Bitter Lesson “All this is an extension of our experience in the year 2003,” Yuen said. “We have nothing to brag about because we learned bitterly from 2003 SARS.” The appearance of an unknown virus to which no one has immunity created a desperate need for effective treatments. Hong Kong doctors are using several experimental infusions including convalescent plasma -- a mix of factors extracted from recovered patients’ blood -- and interferon, an immune-system protein. They’re also using the antivirals ribavirin and Kaletra, although preliminary results released Thursday from a World Health Organization-led trial involving 11,266 patients in 30 countries found they don’t decrease patients deaths. Yuen said he wasn’t surprised by the results of the WHO’s study because the drugs weren’t administered soon after patients became ill. “No antiviral will work if given late,” he said. The drugs were also administered singly, rather in combinations that could add to their impact, he said. ‘Modestly Active’ “We know that one drug is not good because all of these are very modestly active,” Yuen said. “We need early cocktail therapy to get good results.” Giving a combination of ribavirin, Kaletra and interferon to patients in the first week of illness reduced the time to clear the virus by six days and shortened hospitalization by a week, when compared with giving Kaletra alone, Yuen and colleagues showed in a study in May. The trial, published in The Lancet medical journal, recruited 127 patients from Feb. 10 to March 20 -- more than half of the Covid-19 cases reported in Hong Kong during that period. Patients began treatment about five days after developing symptoms. “With the memory of the 2003 SARS pandemic, most patients with Covid-19 in Hong Kong accepted antiviral treatment, which explained our high recruitment rate,” Yuen and his team wrote. Sixteen years earlier, Yuen and many from the same group showed that a cocktail of ribavirin and Kaletra prevented serious illness and death in SARS patients. Saudi Arabia researchers said earlier this month that Kaletra given with interferon improved survival in patients hospitalized with Middle East respiratory syndrome, also caused by a coronavirus. The effect was greatest when treatment was started within a week of symptom onset, the authors said, noting “an important time-to-treatment effect on mortality.” Interferon Response Evidence is mounting for early use of interferon in some patients. Blockbuster studies published by the journal Science last month showed about 14% of critical Covid-19 patients have insufficient levels of the substance, which orchestrates defenses against viral pathogens. Read More: Covid Doctors Find a Turning Point in Life-Threatening Cases If the body mounts a good interferon response when the viral load is low, it can limit subsequent viral replication and prevent dangerous inflammation, Yuen said. A late or delayed interferon response to a high viral load, though, may trigger severe damage to the lungs. “This is really disastrous,” he said. That’s made injections of interferon the “backbone” of early treatments. Some doctors outside Hong Kong agree with Yuen’s approach. Using antivirals early may suppress viral load and prevent the serious hyper-inflammatory response some patients develop in their second week of illness, said Richard Russell, a respiratory physician and senior clinical researcher in the Nuffield Department of Medicine at the University of Oxford, who is also conducting studies on Covid-19 patients. Yuen’s strategy has pointed to how multiple existing antivirals may be repurposed and partnered with immune-modulating drugs as a bridge until protective vaccines become available, said Steven Opal, clinical professor of medicine at Brown University in Providence, Rhode Island. Dexamethasone, a cheap, generic anti-inflammatory, was found in June to reduce deaths by almost a third among Covid-19 patients receiving mechanical ventilation. The University of Oxford study confirmed what Yuen had observed with SARS patients in 2003: that the medication could quell the immune overreaction, sometimes called a cytokine storm, in deteriorating patients showing signs of inflammation. Dexamethasone and Gilead Science Inc.’s remdesivir help patients with more advanced disease, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “The one thing we really need to do is get a bunch more interventions for early infection to prevent people from going on to needing hospitalization,” he said in an interview with the American Lung Association this month. Antibodies that are specifically designed to fight the coronavirus may also help, Fauci said. U.S. President Donald Trump credited Regeneron Pharmaceuticals Inc.’s antibody treatment with his recovery from infection. Leprosy Drug Yuen’s team is also investigating the potential of clofazimine, an inexpensive, 50-year-old antimicrobial that’s on the WHO’s list of essential medicines for leprosy. Studies in hamsters indicated it could fight SARS-CoV-2 and prevent infection. Hong Kong took rapid and decisive action in response to Covid-19 because of the legacy of SARS, Yuen said. He hopes others will learn from the current crisis about the need to prepare for and mitigate the risks of future pandemics. “It’s the 2003 experience that allowed us to walk another mile early,” Yuen said. “I hope that everybody in the world will learn this time that emerging infectious disease is something that would happen more and more frequently.”
Goldman Says Short Dollar as Odds Firm for Biden Win, Vaccine - Bloomberg
The dollar may tumble to its lows of 2018 on the rising likelihood of Joe Biden winning the U.S. election and progress on a coronavirus vaccine, according to Goldman Sachs Group Inc.
The dollar may tumble to its lows of 2018 on the rising likelihood of Joe Biden winning the U.S. election and progress on a coronavirus vaccine, according to Goldman Sachs Group Inc. “The risks are skewed toward dollar weakness, and we see relatively low odds of the most dollar-positive outcome -- a win by Mr. Trump combined with a meaningful vaccine delay,” strategists including Zach Pandl wrote in a note Friday. “A ‘blue wave’ U.S. election and favorable news on the vaccine timeline could return the trade-weighted dollar and DXY index to their 2018 lows.” The ICE U.S. Dollar Index has fallen over 3% so far this year to just over the 93 level as investors reacted to unprecedented pandemic-related monetary stimulus from the Federal Reserve and rock-bottom interest rates. The gauge traded below 89 in 2018, a level which would imply a further slide of more than 4%. Goldman joins the likes of UBS Asset Management and Invesco Ltd. in predicting a weaker dollar as Biden extends his lead over President Donald Trump with less than three weeks to election day. It recommends investors short the dollar against a volatility-weighted basket consisting of the Mexican peso, South African rand and Indian rupee. The strategists also suggest buying the euro, Canadian and Australian dollars against the greenback. “The wide margin in current polls reduces the risk of a delayed election result, and the prospect for near-term vaccine breakthroughs may provide a backstop for risky assets,” they wrote.
China's Insistence That Taiwan Isn't a Country Starts Backfiring - Bloomberg
The more China tells the world that Taiwan isn’t a country, the more Beijing’s adversaries are starting to treat it like one.
The more China tells the world that Taiwan isn’t a country, the more Beijing’s adversaries are starting to treat it like one. Ahead of Taiwan’s National Day on Saturday, Beijing’s embassy in New Delhi was reported to have issued a letter telling India’s media not to refer to it as a country or to Tsai Ing-wen as its president. Indians responded by helping the hashtag #TaiwanNationalDay go viral while banners with the Taiwanese flag were hung outside the Chinese embassy. “Hats off to friends from around the world this year, #India in particular, for celebrating #TaiwanNationalDay,” Taiwanese Foreign Minister Joseph Wu wrote in a Twitter post on Saturday. Instead of marking Taiwan’s independence, a red line that Beijing has warned could trigger an invasion, the day commemorates a 1911 uprising in the central Chinese city of Wuhan against China’s last imperial dynasty. That led to the creation of the Republic of China, which leader Chiang Kai-shek then brought to Taiwan seven decades ago when he fled Beijing as the Communist Party took power. For many in Taiwan today, the Republic of China seems like historical relics with diminishing relevance for the democracy of 24 million people. Taiwan has long abandoned Chiang’s goal of reconquering what he knew as the mainland, and polls show that more and more Taiwanese don’t want any unification with China. But celebrating the Republic of China is strategically useful for Tsai’s government. It allows her to sidestep the question of formal independence, avoiding a potentially devastating conflict with China while providing cover to create a distinct political and cultural identity for Taiwan -- ultimately undermining President Xi Jinping’s goal of subsuming it under Communist Party rule. “Taiwan has become more and more adept at finding space behind the ‘red lines,’” said Jonathan Sullivan, director of China Programs at the University of Nottingham Asia Research Institute. “Beyond a formal ‘declaration of independence,’ it is hard to think of a line that is not malleable or has actually worked.” Here’s What Could Happen If China Invaded Taiwan Military tensions have risen in recent months, with Chinese fighter jets moving ever closer to Taiwan as the Communist Party ramps up rhetoric, warning Tsai against moves that push it further away from China. It has been particularly angered by the Trump administration, which has stepped up weapons sales to Tsai’s government and sent over the most senior American officials to Taiwan in decades to discuss the pandemic and economic ties. In Tsai’s address at a national day event on Saturday, she called for talks with Beijing while vowing to defend the island. “We are willing to facilitate meaningful dialogue,” she said, adding that “showing weakness and making concessions will not bring peace.” Hu Xijin, editor of the Communist Party-run Global Times, said the remarks were Tsai’s “softest tone” in years and “obviously less arrogant than her past remarks.” He attributed the shift to China’s increased threats of war, which his newspaper has helped disseminate. “The Chinese mainland must maintain strong military pressure, which can be triggered at any time, over the island of Taiwan, to ensure that certain forces on the island restrain themselves,” Hu wrote. China has long used the threat of force to intimidate Taiwan. It fired missiles into waters near the main island of Taiwan in the late 1990s simply because then-leader Lee Teng-hui was allowed to speak at Cornell University. It also expressed fury at his proposal for Taiwan and China to have “special state-to-state” relations. But things have changed as Taiwan drifted ever further from the Chinese identity that Chiang’s Kuomintang party imposed on it via the Republic of China. Now Tsai and officials from her ruling Democratic Progressive Party regularly call Taiwan a country on social media. “We don’t have a need to declare ourselves an independent state,” Tsai told the BBC shortly after she was re-elected by a landslide in January. “We are an independent country already, and we call ourselves the Republic of China, Taiwan.” For many Taiwanese, the Republic of China was akin to a foreign occupation when the Kuomintang party arrived after Japan’s surrender in World War II. A violent uprising against the KMT prompted officials to massacre Japanese-trained civil servants, lawyers and doctors who could’ve administered an independent Taiwanese state. Taiwan endured decades of martial law under one-party rule before democratic reforms brought competitive elections, and in 2000, it elected the first non-KMT leader. During Tsai’s inauguration speech in 2016, she hailed the fact that the Taiwanese people had taken control of the Republic of China: “My dear fellow Taiwanese,” she said. “We did it.” Within 30 years Taiwan has gone from a one-party dictatorship to an open democratic system. The R.O.C. was re-born here. The Taiwanese people made it better, more beautiful, stronger. I am proud to serve as VP and contribute to this ongoing transformation.#TaiwanNationalDaypic.twitter.com/667ulaPHQI — 賴清德Lai Ching-te (@ChingteLai) October 9, 2020 Tsai’s government has sought to assert more of a Taiwanese national identity, including by redesigning passports this year to highlight the word “Taiwan” while minimizing “Republic of China.” At the same time, people who support a Taiwanese identity also take pride in Republic of China emblems such as the flag, according to Margaret Lewis, a law professor at Seton Hall University. “The symbols from the past have taken on new and complex meaning in the present,” she said. This broader shift doesn’t bode well for Xi’s plan to one day unite China and Taiwan, preferably through coercion rather than war. That has some observers particularly worried. “No trend is going in the PRC’s preferred direction, except perhaps the military balance,” said Sullivan from the University of Nottingham, referring to Communist Party rule in Beijing. “That’s what makes me nervous.”
Minnesota Congressmen Flew Delta After Flying With Trump - Bloomberg
Minneapolis (AP) -- Three Minnesota congressmen are facing backlash over taking a commercial flight home from Washington, D.C., on Friday night just two days after they shared Air Force One with President Donald Trump.
Representative Pete Stauber Minneapolis (AP) -- Three Minnesota congressmen are facing backlash over taking a commercial flight home from Washington, D.C., on Friday night just two days after they shared Air Force One with President Donald Trump. U.S. Reps. Pete Stauber, Tom Emmer and Jim Hagedorn all were on the same Delta Airlines flight despite the airline’s restrictions on passengers recently exposed to COVID-19. Trump announced early Friday morning he had tested positive for the virus. Delta’s policy says customers who know they were exposed to the virus in the past 14 days cannot travel on the company's aircraft. The airline defines exposure as face-to-face contact with someone carrying the virus, or sustained contact for more than 15 minutes less than 6 feet apart. Ken Martin, chairman of the state Democratic party, said the three Republican congressmen put the health and safety of other passengers at serious risk. Hagedorn pushed back in a post on his campaign Facebook page Saturday morning, saying the three men had tested negative and had not been exposed to someone carrying the virus longer than 15 minutes and closer than 6 feet. He said the men also informed the airline and the flight’s captain of their situation, and the airline “made the decision to fly based upon the facts.” Delta spokeswoman Gina Laughlin told the Minneapolis Star Tribune that the flight was less than 40% full and that no one left the plane before it took off to protest the men’s presence. Another Delta spokesman, Anthony Black, told The Associated Press on Saturday that he did not know what other passengers on the flight were told about the situation. Black confirmed the airplane was held for about an hour until the airline's operations center in Atlanta cleared it to fly. He said Delta was reviewing the matter to see if proper procedures were followed. A top Minnesota Republican who greeted Trump at Minneapolis-St. Paul International Airport on Wednesday said he tested negative for the coronavirus. House Minority Leader Kurt Daudt said in a statement that he got tested Friday morning and obtained the results Saturday afternoon.
Fauci Sees Early Treatments as 'Bridge' to Vaccine: Virus Update - msnNOW
Australia is targeting the creation of a “travel bubble” with New Zealand by the end of the year as the pace of coronavirus infections in the two countries eases, with Melbourne easing some restrictions ahead of schedule.
Pedestrian pass in front of a JPMorgan Chase & Co. bank branch in the Midwood neighborhood in the Brooklyn borough of New York, on Sept. 24. We're tracking the latest on the coronavirus outbreak and the global response. Sign up here for our daily newsletter on what you need to know. Australia is targeting the creation of a “travel bubble” with New Zealand by the end of the year as the pace of coronavirus infections in the two countries eases, with Melbourne easing some restrictions ahead of schedule. Antibodies that stop the coronavirus from spreading in the body are among promising strategies for averting severe illness from Covid-19 before vaccines arrive, according to Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. New York, which earlier contained the nation’s worst Covid-19 outbreak, reported more than 1,000 new cases for the first time since early June. New U.S. infections crept above the pace of recent days. Thousands of maskless protesters gathered in London, clashing with police as they demonstrated against the government’s expanded anti-coronavirus restrictions. As Europe’s second wave persisted, Germany posted its highest daily number of new cases since April. Key Developments: Subscribe to a daily update on the virus from Bloomberg’s Prognosis team here. Click CVID on the terminal for global data on coronavirus cases and deaths. Virus Hotspots Covid-19 cases per 100,000 people over the past 14 days Source: European Centre for Disease Prevention and Control Australia and New Zealand Target Travel Corrider by Year-End (10:57 a.m. HK) New South Wales, most populous state, reported no new infections over the past 24 hours, the first time since June 10 that there were no new cases. New Zealand reported two new virus cases on Sunday. “Ultimately whether New Zealand opens up to Australia will be a matter for New Zealand,” Simon Birmingham, Australia’s tourism minister, said in an interview on television broadcaster Nine Network. The situation in Victoria’s state capital of Melbourne is slowly improving, with 16 new virus cases and two deaths reported in the past 24 hours. The city’s rolling 14-day average for infections stands at 22, below the 30-50 range required for easing of some social restrictions on Monday. Victoria Premier Daniel Andrews said some curbs will be relaxed earlier than the current schedule given the progress. Early Covid Treatments Could Be ‘Bridge’ to Vaccine, Fauci Says (7:28 a.m. HK) Antibody-based medications, other blood products from recovered patients and antivirals are being investigated as early treatments, Fauci said. The aim is to prevent patients from developing the serious lung damage for which Gilead Sciences Inc.’s remdesivir and the anti-inflammatory drug dexamethasone are administered. “We are focusing very heavily now on treatment of early infection and, or prevention of infection,” Fauci told the Journal of the American Medical Association in an interview Friday. “And that’s the bridge to the vaccine.” Johnson Trails in Opinion Poll as Virus Policies Anger Britons (5:50 p.m. NY) Boris Johnson’s Conservative Party trails the main opposition Labour Party in an opinion poll for the first time in months, with half of those surveyed saying they disapprove of how government has handled the coronavirus crisis. Police move in to disperse protesters in Trafalgar Square in London on Sept. 26. Photographer: Justin Tallis/AFP via Getty Images According to an Opinium survey for the Observer, a left-leaning newspaper, Keir Starmer’s Labour rose 3 points to 42% with Johnson’s party dropping by the same amount to 39%. At the end of March, soon after the government imposed a lockdown on the economy and four months after winning the election in a landslide, the Conservatives had 54% support. While the survey comes years before the country is obliged to hold a general election, it’s a reminder that Johnson’s administration has become bogged down in a series of missteps. Thousands of protesters, some with placards such as “This is tyranny,” took to the streets of central London on Saturday, angered by the government’s expansion of coronavirus restrictions. This is not acceptable. I urge all protestors to leave now. Large gatherings are banned for a reason - you are putting the safety of our city at risk. https://t.co/bdwigYFtF1 — Mayor of London (gov.uk/coronavirus) (@MayorofLondon) September 26, 2020 Hawaii Care Home Operator Ousted After Veterans’ Deaths (5:35 p.m. NY) A state-owned health care organization in Hawaii will take over a veterans care home where 26 residents have reportedly died of Covid-19. Hawaii’s Health Systems Corp will become the operator of the Yukio Okutsu Veterans State Home in Hilo on the Big Island, taking over from Avalon Health Care, based in Salt Lake City, Utah, the Associated Press and local media reported. The veterans home deaths comprise a large proportion of the state’s total coronavirus fatalities. Hawaii has had over 12,000 cases. A federal team from the U.S. Department of Veterans Affairs, along with the Hawaii Emergency Management Agency, revealed failures to take proper precautions to prevent the spread of the virus, Hawaii News Now reported this week. Most of the 89 residents living at the home before the outbreak have contracted the virus, along with dozens of employees. California Cases Exceed Average (2:05 p.m. NY) California added 4,197 new cases, bringing the total to 798,237. An additional 134 deaths were reported, with the fatality count at 15,532. The one-day increase in cases and deaths exceed the 14-day average. The state said Friday it’s seeing early signs of rising virus case counts and emergency-room visits after several weeks of improvement, with forecasts showing that hospitalizations may jump 89% in a month. California has 2,717 ICU beds available -- about 900 more than its low two months ago. Italy Vows No National Lockdown (12:45 p.m. NY) Italian Prime Minister Giuseppe Conte said there won’t be a new national lockdown as the country is “in a completely different situation” compared with the beginning of the year. Saying that the government has strengthened the health system, he added that there may be more stringent measures in specific clusters or areas “but in a limited, circumscribed way.” A healthcare worker collects a swab sample from a passenger at the Covid-19 rapid test facility at Fiumicino Airport in Rome, Sept. 25. Photographer: Alessia Pierdomenico/Bloomberg France Cases Fall Again From Record (1:10 p.m. NY) France reported a drop in the number of new cases for the second day to 14,412, retreating from a record 16,096 set on Thursday. The seven-day average rose to 12,179. Another 39 fatalities were reported, for a total of 31,700. Dutch Deaths Rise by Most Since June (11:35 a.m. NY) Deaths caused by Covid 19 rose by 38 on Friday in the Netherlands, the highest jump since May 15, national press agency ANP reported on Saturday. The infection rate has also been increasing recently, with capital Amsterdam as one of the biggest contributors. Dutch prime minister Mark Rutte said on Friday the new surge is “worrisome” and extra regional measures in cities Amsterdam, Rotterdam and The Hague are likely needed. Soccer stadiums risk a ban on supporters again if visitors don’t adhere to the rules, Tamara van Ark, minister for Sport and Medical Care, said on Saturday. Denmark Plans Widespread Random Testing (11:30 a.m. NY) Denmark plans to randomly test as many as 1 million residents -- almost a fifth of the population -- for Covid 19 antibodies to get a handle on the virus’ spread. Statens Serum Institut, the agency that tracks infectious diseases, will contact Danes over 15 years old to answer questions about symptoms and risk factors, and send home tests to those who respond. The agency says it has 500,000 tests available, and if demand exceeds that, it’ll distribute more on a first come, first serve basis. New York Cases Pass 1,000 for First Time Since June (10:34 a.m. NY) New York state reported more than 1,000 new cases for the first time since early June. Governor Andrew Cuomo reported 1,005 cases as the New York City battles outbreaks in Brooklyn and Queens. The 0.2% increase was, however, in line with the daily average increase over the last seven days. Another four deaths were reported. Passengers sit apart from one another on the deck of a NY Waterway ferry on Sept. 25. Photographer: Cindy Ord/Getty Images New York, hit early in the pandemic, was reporting more than 10,000 cases a day during its peak and in mid-April almost 800 daily deaths. More than 25,000 residents have died from the virus. Cuomo has said to expect higher cases during the reopening process, and has urged residents to wear masks and remain socially distant. Testing has also increased significantly since June. — With assistance by Reed Stevenson, Andras Gergely, Stephan Kahl, Dorota Bartyzel, Sara Marley, Jason Gale, and Brett Miller