Covid vaccine boost for millions in UK as hospitals near braking point

Oxford, UK - The coronavirus vaccine developed by Oxford University and Astra Zeneca is expected to win approval this week as the head of the drugs giant said it “should be” effective against the highly transmissible new strain of the virus. Senior government officials expect the drugs watchdog to give the green light before Thursday, speeding up the provision of the jab to the 15m people who could end up in hospital if they caught the virus. Astra Zeneca’s chief executive, Pascal Soriot, today reveals that new data will show the vaccine is as effective as the Pfizer and Moderna jabs that have already been approved, protecting 95% of patients, and is “100% effective” in preventing severe illness requiring hospital treatment. Approval for the drug cannot come soon enough. 

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Hep C World News - Week of December 20, 2020

FDA committee recommends authorizing use of second COVID-19 vaccine in US

Silver Spring, Maryland - An FDA advisory committee voted Thursday to recommend that a second COVID-19 vaccine be authorized for emergency use in the United States. The Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted 20-0 with one abstention in favor of authorizing the vaccine’s use in adults aged 18 years or older, setting the stage for the FDA to issue a second emergency use authorization (EUA) for a vaccine in as many weeks, which it is widely expected to do. The messenger RNA (mRNA)-based vaccine developed by Moderna Inc. and the NIH was shown to be safe and highly efficacious in an ongoing phase 3 trial, according to results released by Moderna last month that were confirmed in an FDA document published this week. Last week, the VRBPAC endorsed another mRNA-based vaccine developed by Pfizer and BioNTech, which was followed a day later by the FDA issuing an EUA for the vaccine for patients aged 16 years or older. Priority groups, including health care workers, began receiving that vaccine on Monday amid a record surge in cases in the U.S. According to tracking by Johns Hopkins University, more than 17 million people in the U.S. have been diagnosed with COVID-19 since the start of the pandemic, and nearly 309,000 people have died. The availability of two highly effective vaccines “is going to finally turn the tide on this pandemic, and quickly,” said Monica Gandhi MD, MPH, professor of medicine and associate chief of the division of HIV, infectious diseases and global medicine at the University of California, San Francisco. “The efficacy of the vaccines is higher than we could have imagined a year ago and — with two options — distribution and administration should occur quickly,” Gandhi told Healio. “If 70% population level immunity is needed to still viral spread, I think this is achievable in the United States by the summer of 2021.” In a VRBPAC briefing document published online this week, the FDA confirmed that the Moderna vaccine was 94.1% efficacious in preventing symptomatic COVID-19, based on 196 cases among the study population as of Nov. 21 — 185 in the placebo group and 11 in the vaccine arm. All 30 documented cases of severe COVID-19 among the study population occurred in the placebo arm. “It’s wonderful that this vaccine has such great efficacy and a great safety profile,” Krutika Kuppalli, MD, assistant professor of medicine in the division of infectious diseases at the Medical University of South Carolina, told Healio. “Hopefully we will be able to get more people to have confidence in the vaccine and take it up.” Gandhi noted that Moderna’s phase 3 trial enrolled over a third of participants from communities of color and over 25% were over age 65 years, in whom the vaccine was 86.4% efficacious. In contrast to the Pfizer and BioNTech vaccine, which needs to be stored at nearly –100°F, the Moderna vaccine is stable for 30 days in a regular medical or home refrigerator, which will make it more accessible, Kuppalli said. “It doesn't need that ultra-cold storage, so we'll be able to make the rollout of the vaccine a bit more feasible for people who live in more rural areas of the United States and other parts of the world where this vaccine will be rolled out,” she said. In response to claims that it was having production issues, Pfizer said Thursday that it had successfully shipped all 2.9 million doses of vaccine requested by the U.S. government to the locations where it was asked to ship them. “We have millions more doses sitting in our warehouse but, as of now, we have not received any shipment instructions for additional doses,” the company said in a statement. Pfizer said it will ship up to 50 million doses of the vaccine globally by the end of this year and up to 1.3 billion doses in 2021. Some locations in the U.S. discovered this week that vials of vaccine delivered by Pfizer contain more doses than expected. The FDA said it OK to use every full obtainable dose from each vial, but that less-than-full doses should not be pooled together from different vials. Moderna has said that it will have approximately 20 million doses of its vaccine ready to ship in the U.S. by the end of 2020 and up to 1 billion doses available globally in 2021. Both vaccines are given in two doses — Pfizer’s 21 days apart, and Moderna’s 28 days apart. “This is really a great moment for science in terms of what we have been able to do so quickly in the setting of this horrible pandemic,” said Kuppalli. Like many health care workers, Kuppalli received the first dose of the Pfizer vaccine earlier this week. Residents of long-term care facilities are also being prioritized in the first wave of vaccinations. “I had very mixed feelings in terms of being excited to be in the first round of vaccinations but [also] definitely feeling a little bit sad and feeling a little bit guilty because there are so many people out there who need this life saving therapeutic,” Kuppalli said. “I really want to make sure that we are able to get it to everyone who needs it. I’m very happy that we're moving forward with this process to try and continue to scale up our vaccine production and vaccine rollout for everybody who needs it and not just here, but really, we need to do this all over the world.”
 

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Hep C World News - Week of December 13, 2020
 

Germany to impose stricter lockdown to battle COVID-19

Berlin, Germany - Germany will close most stores from December 16th until at least Jan. 10, cutting short the busy Christmas shopping season, as it tightens coronavirus restrictions and tries to rein in the spread of the disease, Chancellor Angela Merkel said. “I would have wished for lighter measures. But due to Christmas shopping the number of social contacts has risen considerably,” Merkel told journalists following a meeting with leaders of the country’s 16 federal states. “There is an urgent need to take action,” she said. Only essential shops such as supermarkets and pharmacies, as well as banks, are to remain open from December 16th. Hair salons, beauty salons and tattoo parlours will also have to shut. The government will support affected companies with a total of around 11 billion euros ($13.3 billion) a month. Businesses that are forced to close may receive up to 90% of fixed costs, or up 500,000 euros a month, Finance Minister Olaf Scholz said. Schools will be closed in principle, and employers are asked to close operations or have employees work from home. The sale of fireworks will be banned ahead of New Year’s Eve. Germany has been in partial lockdown for six weeks, with bars and restaurants closed, while stores and schools have remained open. Some regions have already imposed tougher measures as infections grew. “‘Lockdown light’ has had an impact, but it was not sufficient,” Bavaria’s prime minister Markus Soeder said. “The situation is out of control.” Private gatherings will remain limited to no more than five people from two households. For the Christmas holidays, the rule will be eased slightly so that families can celebrate together. Merkel and Soeder said it was too soon to say whether the economy could re-open after Jan. 10. New daily infections and deaths have reached records in recent days, and more politicians have been sounding the alarm. Germany, Europe’s largest economy, was more successful than many European countries in keeping the pandemic under control in the first wave in March and April. But it has been struggling to turn the tide in the second wave. The number of confirmed coronavirus cases in Germany increased by 20,200 to 1,320,716, data from the Robert Koch Institute (RKI) for infectious diseases showed on Sunday. The reported death toll rose by 321 to 21,787, the tally showed.
 

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Hep C World News - Week of December 6, 2020

Constant flow of vaccines anticipated

Ottawa, ON - Once vaccines are approved for use in Canada, the top military general leading the rollout is anticipating a “constant flow” of doses into the country. “What we expect to see in January is constant flow of vaccines that come in, Pfizer and others as well, as they become available. So, they will be distributed, and then the next wave comes in… next delivery comes in for the second dose, in a prescribed timeframe,” said Maj.-Gen. Dany Fortin who is the vice president of logistics and operations within the Public Health Agency of Canada. In an interview on CTV’s Question Period, Fortin said that his plans are centred around the expectation of receiving doses “early in the new year.” “All I can tell you at this time is that we expect to receive them in January, and we expect to receive them as soon as possible in that timeframe, and in successive amounts… multiple deliveries,” Fortin said. “We're planning on January onwards. It would not be prudent military planning on my part, on our part, to take us close to that date. So we're really planning on being ready by mid-December,” he said. That preparedness includes a “dry-run” for the distribution of the Pfizer vaccine on Monday, where essentially a test distribution factoring in all the delicacies of the doses are taken into account, and ensuring health care workers are comfortable with the administration process, without using any actual vials. Because the Pfizer vaccine—expected to be the first one approved by Health Canada—requires ultra-cold storage around minus 80 degrees Celsius, it is going to be delivered directly by the pharmaceutical giant, first to at least 14 provincial “points of delivery” and then on to the places where it will be administered, as identified by the provinces. “There are very peculiar requirements and we're paying close attention to those requirements to avoid wastage,” said Fortin. This has included ordering, distributing, and installing ultra-cold freezers and plans to procure dry ice to help keep the doses stable. “There are a number of steps, as you can imagine with the minus 80 vaccines, where they have to be thawed, they have to be decanted, they have to be mixed, and then there's a certain period of time when in cold storage, they can only last so many days,” he said. While each of the vaccines will have “unique characteristics,” the Pfizer doses are shaping up to prove the most logistically challenging. “We'll learn more as we go about those different vaccines in terms of handling them,” Fortin said.
 

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Hep C World News - Week of November 29, 2020

Opioid overdoses a looming challenge as winter arrives

Toronto, ON - There are calls for Toronto to expand and improve services within its already strained shelter system to avert a deadly uptick in opioid overdoses, a situation that appears to be threatening the city this winter. Toronto recorded 132 suspected opioid overdose deaths between April 1 and Sept. 30, nearly double the rate of deaths recorded in the prior two years. Of those deaths, 18 took place within city-operated shelters, which has prompted calls for improvements to prevent more people from dying as the shelter system is expected to buckle in the coming months. "It's scary," said Roxie Danielson, a downtown Toronto street nurse. "A lot more folks are dying." Danielson said the pandemic has worsened the city's opioid crisis on multiple fronts. Harm reduction services and safe consumption sites have cut down their hours and capacity, she explained, while more people are experiencing homelessness and isolation because of economic disruption and other restrictions. Those who have turned to shelters have received inadequate support, Danielson said, adding that people are too often "using alone in the washroom" rather than in a supervised environment with health-care workers present. "It would be nice to get more health care and harm reduction services embedded within the shelter system," Danielson told CBC Toronto.  Supervised consumption sites are regulated by the provincial government. The city operates a safe consumption site at The Works, but similar services are not available in shelters. Toronto has temporarily expanded its shelter system during the pandemic, adding nearly 2,300 additional beds. Many of them are in hotels and motels, which may be contributing to the rising overdose deaths. In a statement, the city said those spaces "can be more isolating than traditional congregate settings. This can exacerbate addiction issues and lead to an increase in overdoses." Shelters users 'don't just need a safe place to sleep' The Toronto Board of Health on Monday adopted a number of new measures to combat the opioid crisis, including a call for "urgently expanding" the overdose prevention and harm reduction programs available in shelters. The Board of Health Chair, Coun. Joe Cressy, said the number of opioid deaths in Toronto could "skyrocket" this winter without improvements to health services and additional funding.  He said an enhanced shelter system must be part of any strategy to prevent deadly overdoses. "People in our shelter system don't just need a safe place to sleep," Cressy said. "They need wraparound health-care supports, and that's urgent now."
 

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Hep C World News - Week of November 22, 2020

Report shows increase in overdose deaths and most users dying alone

Toronto, ON - Overdose deaths in Ontario surged in the months after the coronavirus pandemic was declared, with most of them involving people who were found alone at the time of their death. A new report published by Vice News predicts at least 2,200 people in Ontario could die of opioid overdoses by the end of the year, in part due to the public health restrictions meant to curb the spread of COVID-19. This would be a 50 percent increase in opioid deaths in the province from 2019, which had 1,512 opioid-related deaths, and would make 2020 the worst year on record for overdose deaths for the province. “It’s just devastating considering that deaths have been increasing year over year from fatal overdoses. And such a leap during a pandemic that is already so traumatic and difficult for so many people is just adding to that challenge,” Dr. Tara Gomes, an epidemiologist with Ontario Drug Policy Research Network, told VICE News. Her group is one of the authors of the 22-page report alongside Public Health Ontario and the Ontario coroner.  The spike in overdose deaths in Ontario in the wake of the pandemic mirrors similar trends across Canada and the U.S., with dozens of provinces and states reporting surges in overdose deaths since March.  The overdose death rates in British Columbia and Alberta, for example, are far outpacing the number of COVID-19 deaths.  “This increase in drug-related deaths is being driven by a combination of numerous factors, including an increasingly toxic unregulated (“street”) drug supply, barriers to access to harm reduction services and treatment, and physical distancing requirements leading to more people using drugs alone,” states the report.  The report, which provides a snapshot of 2020 opioid overdose trends in the province based on statistics from January until the end of June, notes that three out of four opioid-related deaths (around 75 percent) occurred among people who were using drugs alone or in hotels and motels during the pandemic, meaning no one was there to intervene in the event of an overdose or reverse it with the antidote naloxone.  Dr. Dirk Huyer, Ontario’s chief coroner, told VICE News there has also been a notable increase in the number of stimulants found to be contributing factors in these overdose deaths. While cocaine was found to be ingested by nearly half of the people who died, it’s difficult to determine which substance was the direct cause of death when the person died alone, he said.  “It's a terrible challenge, because if you are using alone, then you're at risk of dying, of course,” Huyer said. “Not only does it lose the opportunity to provide the answer, we also then have difficulties to fully understand the prevention opportunities… What it all means still needs to be unpacked.” One of the largest increases in opioid-related deaths in Ontario have occurred among younger people from 25 to 44 years old, the report states. There were 289 deaths among people in this age bracket before the pandemic compared to 389 deaths during the pandemic.  The report also highlights communities that are seeing an overlap of rising overdose death rates with disproportionate COVID-19 infection and death rates. “We observed a shift towards opioid-related deaths occurring more frequently within communities with higher concentrations of people who are recent immigrants and/or racialized,” the report states.  “This parallels recent trends in COVID-19 infection and death rates that are increasingly being concentrated in ethnically diverse neighbourhoods in Ontario, and suggests that pandemic responses are disproportionately leading to negative impacts on both COVID-19 and opioid-related outcomes among racialized communities.” Gillian Kolla, a postdoctoral fellow at the Canadian Institute for Substance Use Research at the University of Victoria who has reviewed the report, told VICE News that another striking finding is that neighbourhoods with the lowest socioeconomic statuses are among those that have the highest overdose rates.  “For years within public health, we've been calling for a focus on the social determinants of health, and the ways in which racism within our society, the ways in which our history and current experience of colonialism, and the ways in which the dismantling of our social programs have led to increasing rates of poverty and increasing homelessness,” Kolla said.
 

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Hep C World News - Week of November 15, 2020

A guide to help decriminalize people who use drugs

Toronto, ON - As the COVID-19 pandemic and the overdose crisis sweep across Canada, all policymakers have an obligation to adopt evidence-based measures that uphold the health and safety of people who use drugs. This includes municipal and provincial governments, who can take immediate steps to minimize the harms of current drug laws by decriminalizing drug possession for personal use (i.e. “simple drug possession”) in their own jurisdictions.This report outlines how they can do this through a request to the federal Minister of Health, who has a broad power to issue exemptions from the federal law criminalizing simple drug possession. This approach is not novel and employs an existing provision in the Controlled Drugs and Substances Act (CDSA) that already allows supervised consumption services to operate without risk of criminal prosecution. On background, between January 2016 and March 2020, more than 16,300 people in Canada were reported to have fatally overdosed. Since the onset of the COVID-19 pandemic, record numbers of overdose deaths have been reported in multiple cities and provinces. In September 2020, British Columbia experienced a 112% increase from the number of overdose deaths in the previous September, and more people have died from overdose in the first eight months of 2020 than in all of 2019. Alberta has experienced record high overdose deaths in 2020 with the majority of municipalities reporting 140% increases in emergency medical services (EMS) responses to opioid-related events from the first to second quarter of 2020. In Toronto, EMS responded to 132 suspected opioid-related overdose deaths between April 1 and September 30, 2020, an increase from 59 during the same period in the previous year. This reflects a 40% increase in overdose deaths across Ontario.
 

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Hep C World News - Week of November 8, 2020

Coronavirus vaccine from Pfizer, BioNTech prevents COVID-19, early results show

New York, NY - The coronavirus vaccine developed by Pfizer and BioNTech was strongly effective in preventing COVID-19 among volunteers given the shot, early study results announced by the companies Monday show, giving a pandemic-wracked world a glimpse of life after quarantines, travel restrictions, masks and school closures. The results, from a large Phase 3 trial that began in late July, cap off a dizzying eight months of research, into which scientists at Pfizer and German drug developer BioNTech compressed what's normally a years-long process of developing, testing and manufacturing a vaccine. Their effort is the first to reach this point, pacing dozens of programs in the U.S., China, Russia, the U.K., Germany and India that were quickly launched in hopes of proving a counterpunch powerful enough to limit the spread of the virus called SARS-CoV-2. Pfizer and BioNTech's announcement came after an interim analysis, in which the companies found that the vaccine was more than 90% effective at preventing COVID-19 compared to a placebo. The analysis included 94 cases, implying that some 86 infections were in the placebo group, compared to eight on the vaccine. Those numbers were sufficient to declare success, as they easily beat pre-specified thresholds for vaccine efficacy. The two companies expect to soon submit the results to the Food and Drug Administration for an emergency authorization, assuming positive safety data that they anticipate having in hand next week. No serious safety concerns have been reported to date, Pfizer and BioNTech said.

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Hep C World News - Week of November 1, 2020

Remdesivir Fails to Prevent Covid-19 Deaths in Huge Trial

New York, NY - Critics said the study, sponsored by the W.H.O., was too Remdesivir, the only antiviral drug authorized for treatment of Covid-19 in the United States, fails to prevent deaths among patients, according to a study of more than 11,000 people in 30 countries sponsored by the World Health Organization. The drug was granted emergency authorization by the Food and Drug Administration on May 1 after a trial by the National Institutes of Health found that remdesivir modestly reduced the time to recovery in hospitalized patients. President Trump received the antiviral after he began showing symptoms earlier this month. “This puts the issue to rest — there is certainly no mortality benefit,” said Dr. Ilan Schwartz, an infectious disease physician at the University of Alberta in Canada. But other scientists said the design of the W.H.O.’s sprawling clinical trial, which collected data from hundreds of hospitals, meant the conclusions were not definitive. poorly conducted to be definitive. Conducted in dozens of countries with various health care systems and inconsistent treatment protocols, the data are difficult to analyze and compare, said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco. The findings, which were posted online on Thursday, have not yet been peer-reviewed or published in a scientific journal. Remdesivir, which was originally developed as a treatment for Ebola and hepatitis C, interferes with the reproduction of viruses by jamming itself into new viral genes. The N.I.H. study also did not find that remdesivir prevented deaths in patients with Covid-19. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, acknowledged in the spring that remdesivir was not a “knockout” drug. A final analysis, published in The New England Journal of Medicine on Oct. 8, suggested “a trend toward reduced mortality” in certain patients receiving remdesivir, according to the drug’s maker, Gilead.
 

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Hep C World News - Week of October 25, 2020

Federal health minister appeals to Alberta to reconsider closing opioid treatment program

Ottawa, ON - B.C. endorses opioid injections for treating addiction as Alberta ends program and Ontario ponders Canada's health minister is calling on the Alberta government to reconsider the closure of its injectable opioid agonist treatment program, which Premier Jason Kenney says will end in the spring when the province stops funding it. The service provides patients with severe opioid use disorder, a recognized condition, with injections of pharmaceutical-grade heroin, known as diacetylmorphine, or hydromorphone. "We are disappointed by this decision from the Alberta government, and we urge them to reconsider," a spokesperson for Patty Hajdu said. The health minister's call comes one week after a group of patients benefiting from Alberta's injectable opioid agonist treatment (iOAT) pilot program filed a lawsuit seeking an injunction to stop Alberta's provincial government from ending it. If the three Alberta clinics that offer the treatment close, few people east of British Columbia would have access to the program, which is a cornerstone of the federal government's latest strategy to combat the opioid crisis. Loss of funding for intensive opioid therapy program will have fatal consequences, critics warn "Many people are struggling with substance use, and in too many communities, the COVID-19 pandemic is compounding this ongoing public health crisis," the minister's statement said. Three weeks after Alberta announced it would stop funding a safe injection site in Lethbridge, an unsanctioned, supervised consumption site was set up in a tent. The city of 100,000 has the highest per-capita rate of opioid overdose deaths in Alberta, and the original site that was shut down was one of Canada's busiest. 3:23 From January 2016 to March of this year 16,364 Canadians died from opioid overdoses according to figures from the federal government. The numbers have shown an increasing trajectory, with 3,799 deaths last year, and over 1,000 in the first three months of 2020. The federal government began opening the door to community-based iOAT treatments in 2018 and has provided funding for pilot projects. The move followed decades of research — first in Europe, then in British Columbia. Multiple studies suggested that providing daily access to pharmaceutical grade injectable opioids allowed long-term chronic users to stabilize their lives, find homes and stop engaging in criminal activity many relied on to support their addictions. Most stuck with the program long term, and some were able to stop using injection drugs altogether. Alberta's previous NDP government launched the pilot program in late 2017. Kenney is giving the 60 patients currently enrolled one year to transition to other programs that do not involve injecting opioids. He has called the federal government's approach "facilitating addiction." "Handing out free narcotics to addicts is not compassion," the premier said in response to questions from CBC News in September. Patients file lawsuit to keep Alberta program operating Patients enrolled in the program have have filed 11 affidavits in a lawsuit that is attempting to put a human face on the treatment. People who had focused their entire lives on the pursuit of drugs described awakening to a new world free of the stress and danger on the streets.
 

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Hep C World News - Week of October 18, 2020

Continual lockdowns are not the answer to bringing Covid under control

Opinion: Edinburgh, Scotland - In April, cafes and restaurants opened in Vietnam full of bustle and life. In July, 10,000 baseball fans attended a match in a stadium in Taiwan. In August, thousands packed together for a music concert at the Wuhan Maya Beach Water Park in China. And this month, rugby internationals are going ahead in New Zealand with stadiums at full capacity. Daily life within these places has largely returned to normal. Compared to other countries, they have faced minimal economic damage. In fact, Taiwan never even had a lockdown, while lockdown measures in Vietnam, New Zealand and China were early, short and sharp. Out of a population of 1.4bn people, China has only suffered 4,634 Covid-19 deaths; Vietnam, Taiwan and New Zealand together have had 67. How are these countries keeping Covid-19 under control, their health services running, and their economies and societies afloat asks Prof Devi Sridhar of the University of Edinburgh. That’s the question we should all be asking. Instead, seven months into this crisis, the UK remains stuck in endless cycles of lockdown measures, its media still fixated on paralysing debates about how serious the virus really is and what the optimal strategy for addressing it should be. The UK initially made the mistake of treating coronavirus like flu. It was late to lock down, initially allowing the virus to spread through the population like a common cold. Once the severity of the virus became clear and the government enforced a lockdown, it squandered time and instead waited to see what would happen. Over the course of the past few months, the case numbers have gone up and down. During the summer, the UK appeared to have crushed the curve and brought its R number under control. But rather than replacing harsh lockdown measures with a functioning testing and tracing strategy, switching from quarantining the population to only quarantining those who had been exposed to the virus, the UK lifted restrictions without an effective fallback. Meanwhile, the government actively encouraged people to go abroad on holidays, meaning the virus was continually reimported to the country, setting off new chains of infection when those people returned. For the government, the purpose of lockdown seemed to be simply that: lock the country down and hope the problem would go away. But lockdown itself doesn’t fundamentally change the virus or its trajectory. It just buys us time. And as time went on, fatigue and anger set in. People started to equate suppressing the virus with staying at home and shutting businesses. The alarm bells began to ring: could the cost of these measures be higher than the toll of the virus itself? Should the lives of millions be constrained just to prevent the deaths of thousands? It’s no surprise that those offering easy, compelling solutions – “You can have your life back by Christmas”; “It’s either the economy or health”; “This virus is practically harmless to those under 55” – have found a willing audience in a frustrated and fatigued society. Many of these arguments can be grouped together under terms such as “herd immunity”, “focused protection” or “shielding the vulnerable”. If the virus is seemingly only a risk to the elderly or those with preexisting conditions, they argue, why not shield the vulnerable and let everyone else get on with normal life? Unfortunately, there are no such easy solutions. This plan may sound good on the surface, but it encounters deep problems in practice. It wouldn’t just be vulnerable people who had to shield, but their household members and those with whom they’re in regular contact. And how do you distinguish the vulnerable from the healthy? This isn’t just about age – Covid is proven to have worse outcomes in people who are overweight, of particular ethnicities, or have preexisting conditions they may not even be aware of. We’re only just beginning to understand the effects of the virus on people with even mild cases. Covid-19 doesn’t just attack the lungs; it also affects the kidneys, liver and blood vessels, and may attack the brain. It can cause long-term problems for young and previously healthy people, such that “long Covid” is now recognised as a condition by the NHS. Another problem is that immunity to coronaviruses wanes quickly and reinfection is possible. “Herd immunity” is illusory – we have no idea whether immunity from Covid is long-lasting, so it’s unlikely we’d reach a position where people who were shielding could safely emerge. After decades, we don’t have herd immunity to cholera, yellow fever, polio, measles, TB, malaria or plague. Public health measures were used to control their spread until vaccines or elimination strategies were developed. In fact, malaria was endemic in parts of the United States until the newly created Centers for Disease Control enacted a massive federal public health campaign to eliminate the disease in the early 1950s. We only reached herd immunity to measles with a vaccine. Similar stories can be told for many of the pathogens that have plagued humanity. So, what are the strategies to deal with coronavirus before an effective vaccine arrives? The answer cannot just be locking down continually, given the large economic and social costs this involves. A recent Lancet peer-reviewed paper, which I co-authored, examined international lessons from easing lockdown and identified three key elements that are essential for bringing the virus under control. Most important is a robust system for testing, tracing and isolating, where test results are returned within 24 hours, at least 80% of people’s contacts are reached and there is high adherence to a rule of 14 days’ isolation for those exposed to the virus. Strong public health guidance on avoiding the virus at any age is needed, encouraging people to get outside as much as possible, to avoid indoor, crowded and poorly ventilated spaces, and to use face coverings and distancing wherever possible. And we need strict border measures to prevent the virus from being reimported, instead of our current system that is lax and poorly monitored. This pandemic is still in its first or second chapter. Waiting for the virus to magically disappear, allowing it to run its course through society, or imposing continual lockdown measures without a clear strategy beyond waiting for a vaccine are all suboptimal choices that will damage our health, our economy and our society. At what stage will Britain look towards east Asia and the Pacific and say, “We want what they have”? At what point will we learn from their playbook: suppressing the virus, opening up the economy and regaining a semblance of normality in our daily lives?• Prof Devi Sridhar is chair of global public health at the University of Edinburgh

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Hep C World News - Week of October 11, 2020

Trump takes Regeneron's antibodies, Gilead's remdesivir, dexamethasone in first days of COVID-19 hospital stay

Washington, DC - President Donald J. Trump's medical team is navigating an uncertain COVID treatment course for the nation's now-hospitalized leader. With Trump's symptoms "up and down," his physicians are throwing the kitchen sink at the virus, including a steroid therapy typically reserved for the most dire cases. Trump's personal doctor told reporters the president had been treated with Gilead Sciences' investigational antiviral remdesivir as well as dexamethasone, a common generic steroid that has shown clinical promise in cutting severe COVID-19 patients' death rates.  Both treatments followed an 8-gram dose of Regeneron's investigational antibody cocktail, dubbed REGN-COV2, administered after the president's Thursday diagnosis, along with aspirin and famotidine, better known as branded Pepcid. The president was also taking zinc and vitamin D, two typical immune-boosting supplements, according to a Friday memo from his physician, Dr. Sean Conley.Trump spent the weekend in treatment at Walter Reed Medical Center in Bethesda, Maryland, after being airlifted there by helicopter late Friday afternoon. The president reportedly experienced two drops in oxygen saturation levels below 94% before being hospitalized, Conley told reporters. Despite what Conley called "frequent ups and downs" in his condition, Trump said he was "feeling much better" in a Saturday video posted on Twitter, and then made an eyebrow-raising drive-by to wave to supporters outside Walter Reed.   The broad treatment course the president is receiving has little clinical data backing up its efficacy but may indicate Trump's condition, SVB Leerink Geoffrey Porges said in a note to clients.  For one, Regeneron's cocktail showed limited use in patients with a low viral load, indicating Trump may have been diagnosed as seronegative for antibodies with a high viral load at time of treatment. Adding remdesivir and dexamethasone on top of that—a treatment course with "zero information," Porges wrote—could indicate Trump's condition was "worst than first suggested" and could be at high risk of deteriorating in the coming days. "As every sentient human being now recognizes, being 74 yrs old and overweight are significant independent risk factors for serious complications of COVID," Porges wrote. "Having a poor immune response (which must have been observed) is another important one." Regeneron's antibodies are among the few potential therapies for COVID-19 that have shown promise in clinical trials. Regeneron recently posted early results from an adaptive phase 1/2/3 study showing the therapy lowered virus levels and relieved symptoms more quickly than standard of care in patients infected with COVID-19 but not sick enough to be hospitalized.
 

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Hep C World News - Week of September 27, 2020

Experts question merits of social circles amid rising case counts, return to school

Toronto, ON - For months, Canadians have been bubbling up with other friends and family to socialize safely during the pandemic. But with COVID-19 case counts rising in many communities, kids back in schools and more people returning to work, many public health experts agree that what worked as a safe approach in the early days of the lockdown now comes with more risk. "I honestly think with the return to school right now, most people's bubbles have burst," says epidemiologist Ashleigh Tuite. "You're talking about large numbers of connections." In Ontario, "social circles" allow you to see up to 10 people without the usual pandemic precautions in place as long as all of those family members, friends or neighbors make a pact to socialize only with each other, while in Alberta, the cap for your "cohort" is your household plus up to 15 other people. In B.C., the guidelines for a "bubble" are a little looser. Officials say the members of your immediate household can be "carefully expanded" to include outsiders, with the goal of limiting the number as much as possible — since these are people you're allowed to kiss, hug, chat with and dine with, without masks or distancing. It's a concept being adopted in several countries around the world. And while it works well in principle, experts warn it may be harder to maintain at this point in the pandemic. "As a theory, the bubble makes a lot of sense," said Dr. Dominik Mertz, an associate professor in the division of infectious diseases at Hamilton's McMaster University. "But there's a lot of confusion from people over what it is." He also added it can be tough to do safely, particularly if the bubble involves multiple households "who all have different risks." Parts of Canada are seeing 'exponential' growth in COVID-19 cases with Ontario headed toward a thousand new cases per day, says infectious disease specialist Dr. Michael Gardam. For many people, losing their bubble could mean a long, lonely winter, made worse by mental health struggles or living alone. "We know there are benefits to having that human contact," said Dr. Nitin Mohan, a physician epidemiologist and assistant professor at Western University in London, Ont.  But when dropping temperatures push people indoors, where transmission risk is higher, and families start making plans to gather over the upcoming stretch of holidays, it could make adhering to the bubble principles even tougher.  Mertz says Canadians should already be planning for upcoming gatherings like Thanksgiving. If outside-the-bubble family members want to celebrate together, find ways to do it safely, he says, by meeting outdoors and staying apart as much as possible. Otherwise, you're blending several household bubbles together and upping the risk for everyone. And if you do throw caution to the wind for a turkey feast, there's another approach: Isolate yourself as much as possible for two weeks after the gathering.  "That would give us downtime, so in case someone got infected, you are not spreading it from that gathering into each individual bubble," Mertz said.

For more information: https://tinyurl.com/yy95zngx

Hep C World News - Week of September 20, 2020

London's pioneering safer drug supply program gets huge boost from feds

Ottawa, ON - A London program that began as a discreet supply of safe drugs to three women has earned government sanction and millions of dollars as the COVID-19 pandemic worsens Canada’s opioid crisis. Federal Health Minister Patty Hajdu announced Friday funding for four safer supply projects in Ontario, with the bulk, $6.5 million, for the London InterCommunity Health Centre’s safer supply program. The funding will improve London’s program, and the announcement itself shows the change in public acceptance of that program, LIHC executive director Scott Courtice said. The Dundas Street centre will hire more staff, including another nurse practitioner, registered nurses and social service and outreach workers, to offer greater social and medical supports for clients, he said. At the moment, the program’s one full-time and one part-time doctor and two nurse practitioners focus on prescribing safe drugs and the clients’ most serious health concerns, he said. “The prescribing is harm reduction, trying to keep people alive so they’re not reliant on a toxic supply,” Courtice said. “But we want to go further than that. We want to help people improve their overall health and well-being. The wraparound supports move us from harm reduction to stabilizing people, ideally in housing, and then working on the whole range of health and social issues that are at the root of the addiction in the first place.” One of the first in Canada, London’s safer supply program began with no fanfare or public attention under the director of Dr. Andrea Sereda about four years ago. She began supplying hydromorphone tablets to three women, rather than see them get potentially toxic drugs on the street. The program had been quietly running for three years and grown to 100 people before the initiative was first described in The London Free Press last year. The idea raised eyebrows even in the medical community, but Sereda and other supporters point to a reduction in overdoses and an overall improvement in people’s health as reasons to prescribe safe opioids. The program has since expanded to other communities, and Prime Minister Justin Trudeau two weeks ago said his government is “moving aggressively” on ensuring safe supply programs to battle the opioid crisis. “Where we started, it felt like we were innovative and on our own,” Courtice said. “Now it feels with Health Canada that we’ve got a stamp of approval and we’re on the right track. It is amazing how quickly people have recognized how sensible and pragmatic this solution is.” Some of the federal funding — spread out over four years — will go to research examining the health and social outcomes of the safer supply program, and the potential cost savings by keeping people out of the expensive-to-run hospital and criminal justice systems. “It is new work and we need to learn as we grow, and show what we’re doing is actually working,” Courtice said. The number of opioid deaths is rising across Canada, as the pandemic has played havoc with the quality and quantity of street drugs, while forcing reductions in medical and social services and further isolation of people addicted. In the London region, there were half as many overdose deaths recorded for the first four months of the year as in all of last year. Public Health Ontario reported 30 opioid overdose deaths in the area from January to April, up from 23 in the same period last year. There were 60 opioid-related deaths in the London-area in all of 2019, down from 62 reported the year before, the worst year for overdose deaths in the area. LIHC received the bulk of the $9.5 million in federal grants announced Friday, with the rest going to safer supply programs in Ottawa and Toronto. “It is devastating to see that the COVID-19 outbreak has worsened the situation for Canadians struggling with substance use disorders, including those living in Ontario,” Hajdu said in a news release.

For more information: https://tinyurl.com/y5msaecd

Hep C World News - Week of September 13, 2020

COVID-19 in advanced cirrhosis greatly raises risk of death

Chapel Hill, NC - People with chronic liver disease admitted to hospital with COVID-19 are dying at a much higher rate than the rest of the population, figures collated by liver specialists in Europe, Asia and North America show. Advanced cirrhosis greatly increased the risk of death, the study found. People with severe cirrhosis were almost 30 times more likely to die after a COVID-19 diagnosis than people with chronic liver disease without cirrhosis, the figures show. The overall death rate in people with chronic liver disease was 39% among reported cases. Two international registries were established in March 2020 to track the outcomes of people with chronic liver disease and cirrhosis after diagnosis with COVID-19. Investigators from 14 specialist liver clinics in the United States, Spain and the United Kingdom have now reported on the first 152 cases submitted to the registries, in a publication in the Journal of Hepatology. Large case series published to date have not shown a high prevalence of chronic liver disease in people hospitalised with COVID-19, suggesting that people with chronic liver conditions are not at higher risk of developing severe symptoms because of SARS-CoV-2 infection. However, no study has looked specifically at the clinical outcomes of people known to have chronic liver disease.
 

For more information: https://tinyurl.com/ydfbwc76

Hep C World News - Week of September 6, 2020

Why many people may not disclose substance use to healthcare providers

Vancouver, BC - According to a report published by Catie, a team of researchers from the BC Centre for Excellence in HIV/AIDS, the BC Centre on Substance Use, the First Nations Research and Knowledge Exchange and universities in Vancouver, studies have found that in Canada some people who use substances “experience high rates of co-occurring mental illness, infectious disease, and chronic medical conditions that are further exacerbated by high rates of poverty and homelessness.” The Vancouver team reviewed the scientific literature on issues related to the care and treatment of people who use drugs. The researchers found that although substance users experience many health issues, getting help is not easy. Researchers in Vancouver report that people who use substances can face “substantial barriers to receiving quality and equitable healthcare services. People who use drugs often delay or avoid care due to experienced and/or anticipated stigma and discrimination within the healthcare system, which can lead to insufficient care for drug use and co-occurring health problems.” Furthermore, the Vancouver researchers also stated that “people who use drugs may strategically choose not to disclose drug use or the full extent of their drug use to healthcare providers over concerns of being denied care, as well as potential legal, child welfare, housing, and employment consequences associated with criminalization of drug use.” The researchers undertook a study to better understand factors associated with non-disclosure of substance use to healthcare providers. To do so, they surveyed 261 people who used substances and found that 52% of people surveyed did not disclose their substance use to care providers. As well, indigenous people were less likely to disclose than non-Indigenous people and people with HIV were less likely to disclose their substance use. They found that people who disclosed their substance use had lower self-rated quality of care. The research team stated that its findings underscored the need for “culturally safe and non-stigmatizing care to address pervasive stereotyping in the healthcare system and improved screening for substance use disorder in outpatient healthcare services.”
 

For more information: https://tinyurl.com/y3396dex

Hep C World News - Week of August 30, 2020

Decriminalization of drugs 'not a silver bullet' for overdose crisis, prime minister says

Vancouver, BC - Prime Minister Justin Trudeau would not back decriminalization of drugs as a public-health response to the country's escalating opioid crisis, insisting that the approach, while raised as an option by advocates and medical officials across the country, is not a "silver bullet'' solution. Trudeau is facing renewed pressure to decriminalize the possession of hard drugs, as officials in several provinces, including British Columbia, Ontario and Alberta, say they are grappling with an increasing number of deaths related to the toxic drug supply amid the COVID-19 pandemic.  The prime minister was firm on his stance on the policy in an interview with CBC Vancouver on Wednesday, saying the government is prioritizing other options such as greater access to a safe supply of opioids. "I think in any crisis like this, there is not one silver bullet," the prime minister told The Early Edition on Wednesday. "We're prioritizing the things that are going to make the biggest difference immediately," he said, citing Ottawa's plans for "ensuring" a safer supply of drugs. "The opioid crisis is much more of a health issue rather than a justice issue." Many illegal drugs have been found to contain the opioid fentanyl — a substance up to 100 times more toxic than morphine. According to the B.C. Ministry of Mental Health and Addictions, it is one of the reasons why today's illegal drug supply is "so unpredictable and highly toxic" and a major part of the overdose crisis facing the country. More than half a dozen officials and groups — including the Canadian Association of Chiefs of Police, B.C. Premier John Horgan, Canada's Chief Public Health Officer Dr. Theresa Tam and many of her provincial counterparts like B.C. Provincial Health Officer Dr. Bonnie Henry — have called on the federal government to decriminalize the possession of small amounts of hard drugs in order to reduce the number of opioid-related deaths. Provincial Health Officer Dr. Bonnie Henry, seen at a news conference on June 26, has for years called for the decriminalization of small amounts of drugs for personal use. B.C. Mental Health and Addictions Minister Judy Darcy said later Wednesday that while she hadn't heard Trudeau's comments directly, the provincial government will "continue to engage" with the federal government on the issue. "The position of our government has been from the beginning that addiction is not a moral issue. Addiction is not a character failure. Addiction is a health issue and it should be treated that way," Darcy said. "It should not be treated as a criminal issue. And so we will continue to press forward on that issue." Darcy added the province is working with federal officials on increasing access to safe supply. When asked what the province can do on its own to decriminalize, Darcy said pilot programs are underway in Vancouver, Abbotsford and Vernon and "showing really good results." In Abbotsford, Darcy said, police are teaming up with peer support workers. Instead of "criminalizing" people who have small amounts of drugs for personal use, she said, the teams connect them with health care, mental health and addiction supports. "We believe that's the way to go," Darcy said. Recent data has shown a spike in the number of people dying of illicit drug overdoses since the COVID-19 pandemic began. In June, B.C. reported an increase of 130 per cent in the number of deaths compared to June of last year. The number of people dying with "extreme" concentrations of fentanyl in their bodies has also risen. The B.C. government expanded access to a safe supply of prescription drugs in the spring. Officials have said border closures have disrupted the usual flow of drugs into B.C., leading the supply to be replaced by unstable and unpredictable substances produced locally by those who might be inexperienced.  The pandemic also restricted access to Supervised consumption sites, leaving users isolated at home with these potentially toxic drugs. Last week, the federal government announced it would be spending more than $580,000 on a new project to offer a safe supply of opioids in Toronto.  "We are moving forward aggressively on ensuring a safer supply to be able to prevent people from having to get this terrible, terrible fentanyl, carfentanil into their systems. This is a significant step," Trudeau said Wednesday. "And that is what we've moved forward on without having to take the step to decriminalization." Last week, Ottawa also announced steps toward promised changes to federal drug policy, including funding to look at improving supervised consumption sites. Federal prosecutors are now also being instructed to criminally prosecute only the most serious drug possession offences that raise public safety concerns and to find alternatives outside the criminal justice system for the rest, including simple possession cases. Fight against overdose crisis must do more than target prescription opioids, study says Asked how much political pushback from the Opposition was influencing his hesitation on decriminalization, the prime minister replied, "very little." "Increasingly, Canadians are looking at a range of newer actions that they're encouraging us to look at. And we're going to continue to work to make sure that the decisions we take are grounded in science and are the right ones for Canadians."

For more information: https://tinyurl.com/y4f79mnw

Hep C World News - Week of August 23, 2020

COVID-19 is ‘a crisis within a crisis’ for homeless people

Phoenix, AZ - Nearly 200 tents stand inches apart on the scorching gravel lots, many covered in blankets for an extra layer of relief from the desert sun. Outside, their occupants sit on hot ground or in folding chairs, nearby palm trees providing no shade. Despite 12-foot-square sections painted in the gravel, there is little social distancing for Phoenix’s homeless population. Created by local officials in late April as a temporary solution for some of the estimated 3,700 unsheltered homeless, the fenced-in lots on the edge of downtown promised round-the-clock security, social distancing and access to water and toilets. But residents complain that hygiene supplies have become scarce, and measures meant to contain the spread of COVID-19 are not enforced. “We have been, like, ignored,” said 61-year-old Elisheyah. “There’s no safety, nothing to guarantee you can be safe out here.” Homeless people are one of the most vulnerable populations in the COVID-19 pandemic, yet they’re largely invisible victims of the crisis. Very little is known about how they are faring in part because the U.S. Department of Housing and Urban Development — the main federal agency overseeing homeless programs — has not required its national network of providers to gather information on infections or deaths. That’s despite the fact that unlike other high-risk, congregate-living groups, such as nursing home residents or prisoners, homeless people interact more with the public. At the start of the pandemic, researchers warned that at least 1,700 of the country’s estimated 568,000 homeless people could eventually die of COVID-19. The administration’s homelessness czar told Congress in July there had been just 130 homeless deaths, noting that was “significantly lower than had been originally projected.” However, the Howard Center for Investigative Journalism tracked at least 153 homeless deaths in the same time period in just six areas with large homeless populations — San Francisco, Los Angeles, New York City, Washington, D.C., Seattle and Phoenix — and found at least 206 deaths nationwide by early August. “This country for a long time has written off the lives of people experiencing homelessness,” said Dr. Margot Kushel, a nationally recognized homelessness expert and medical professor at the University of California, San Francisco. “And now it is literally the thing that is really going to make it very difficult to control this pandemic.” Kushel called the pandemic “a crisis within a crisis,” noting that most homeless people are usually in poorer health and, with widespread closures, had lost access to services providing food, water and shelter.

For more information: https://tinyurl.com/y376q7bk

Hep C World News - Week of August 16, 2020

People with Hepatitis C Who Inject Drugs — Underserved, Not Undeserving

Sydney, Australia – An opinion piece recently published in the New England Journal of Medicine looked at the development of highly curative direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection and how it has transformed clinical management of HCV and provided the impetus for the World Health Organization’s ambitious HCV-related targets for 2030. These targets include marked improvements in prevention (including expanded harm reduction for people who inject drugs), upscaling of HCV screening and linkages between screening and other health services to enable treatment for 80% of people with chronic hepatitis C, and a 65% reduction in HCV-related deaths and a 90% reduction in new infections from 2015 levels. Of 71 million people with chronic hepatitis C globally, an estimated 6.1 million are people who inject drugs, and injection drug use is responsible for most new infections in many countries. To reduce the burden of HCV, public health and clinical responses should focus on key populations: people with advanced liver disease (to reduce HCV-related mortality) and those at high risk for transmitting HCV (to reduce the incidence of HCV infection). Although these populations overlap, the latter is younger, is more highly marginalized, and tends to lack access to care. A comparison of HCV responses in Australia, Canada, and the United States is informative. Starting in 2013, the licensing of expensive DAA regimens resulted in clinical prioritization of people with more advanced liver disease. In Australia and Canada, DAAs were initially available under pharmaceutical companies’ compassionate-use programs for people with cirrhosis. Government subsidization of DAAs in Canada in 2014 (through provincial programs) focused on people with advanced fibrosis, although the population eligible for subsidized therapy has since been broadened. Access to government-subsidized DAAs in Australia starting in 2016 (through a single-payer federal program) was unrestricted, although early data showed higher uptake among older patients and those with cirrhosis. In the United States, a more complex set of payers and restrictions was involved, but the initial goal was similar: to reduce deaths from complications of liver disease. The reversal in previously increasing trends in HCV-related liver transplantation, hepatocellular carcinoma, and liver-related mortality in all three countries demonstrates the population-level effects of DAAs. The countries diverge, however, when it comes to political leadership, development of national HCV strategies, and public health responses to HCV. The Australian government developed a model under which it received unrestricted access to DAAs over a 5-year contract period with an annual expenditure cap — the so-called Netflix model. The price of DAAs was estimated at U.S.$7,352 to U.S.$10,736 per course, considerably lower than in the United States. There were no access restrictions based on stage of liver disease or ongoing drug or alcohol use, and all physicians could prescribe DAAs. Roughly 85,000 people with HCV (of an estimated 188,000) were treated by the end of 2019, with more than 6000 physicians prescribing DAAs. Uptake of these medications has been higher among marginalized populations, including people who inject drugs, people with recent incarceration, and HIV-infected men who have sex with men, than among other people with HCV. High uptake of DAAs among people who inject drugs has more than halved the prevalence of active HCV infection (from 51% in 2015 to 18% in 2019) in this population and has resulted in reductions in new infections among younger at-risk populations. Several initiatives included in Australia’s national HCV-strategy framework — its fifth since 2000 — have enabled this success, including government funding for community-based organizations; education and no-cost HCV screening for affected communities; integrated HCV-treatment programs in drug-dependency clinics, community clinics for people who inject drugs, and prisons; and enhanced HCV-prevention approaches, particularly needle- and syringe-delivery programs and opioid agonist treatment. Broad use of harm reduction has been pivotal for primary prevention and for helping connect people with screening and treatment services — and therefore for reaping the population-level benefits of using HCV treatment as prevention.

For more information: https://www.nejm.org/doi/full/10.1056/NEJMp2002126?query=TOC

Hep C World News - Week of August 9, 2020

A coronavirus vaccine won’t change the world right away

New York, NY - Soaring hopes for a shot may spark resistance to simple strategies that can tamp down transmission. In the public imagination, the arrival of a coronavirus vaccine looms large: It’s the neat Hollywood ending to the grim and agonizing uncertainty of everyday life in a pandemic. But public health experts are discussing among themselves a new worry: that hopes for a vaccine may be soaring too high. The confident depiction by politicians and companies that a vaccine is imminent and inevitable may give people unrealistic beliefs about how soon the world can return to normal — and even spark resistance to simple strategies that can tamp down transmission and save lives in the short term. Two coronavirus vaccines entered the final stages of human testing last week, a scientific speed record that prompted top government health officials to utter words such as “historic” and “astounding.” Pharmaceutical executives predicted to Congress in July that vaccines might be available as soon as October, or before the end of the year.  As the plotline advances, so do expectations: If people can just muddle through a few more months, the vaccine will land, the pandemic will end and everyone can throw their masks away. But best-case scenarios have failed to materialize throughout the pandemic, and experts — who believe wholeheartedly in the power of vaccines — foresee a long path ahead. “It seems, to me, unlikely that a vaccine is an off-switch or a reset button where we will go back to pre-pandemic times,” said Yonatan Grad, an assistant professor of infectious diseases and immunology at the Harvard T.H. Chan School of Public Health. Or, as Columbia University virologist Angela Rasmussen puts it, “It’s not like we’re going to land in Oz.” The declaration that a vaccine has been shown safe and effective will be a beginning, not the end. Deploying the vaccine to people in the United States and around the world will test and strain distribution networks, the supply chain, public trust and global cooperation. It will take months or, more likely, years to reach enough people to make the world safe. For those who do get a vaccine as soon as shots become available, protection won’t be immediate — it takes weeks for the immune system to call up full platoons of disease-fighting antibodies. And many vaccine technologies will require a second shot weeks after the first to raise immune defenses. Immunity could be short-lived or partial, requiring repeated boosters that strain the vaccine supply or require people to keep social distancing and wearing masks even after they’ve received their shots. And if a vaccine works less well for some groups of people, if swaths of the population are reluctant to get a vaccine or if there isn’t enough to go around, some people will still get sick even after scientists declare victory on a vaccine — which could help foster a false impression it doesn’t work. A proven vaccine will profoundly change the relationship the world has with the novel coronavirus and is how many experts believe the pandemic will end. In popular conception, a vaccine is regarded as a silver bullet. But the truth — especially with the earliest vaccines — is likely to be far more nuanced. Public health experts fear that could lead to disappointment and erode the already delicate trust essential to making the effort to vanquish the virus succeed.
 

For more information: https://tinyurl.com/y6b5zccg

Hep C World News - Week of August 2, 2020

Deaths and years of potential life lost from excessive alcohol use
 

Atlanta, GA – A recent study showed that excessive alcohol use was responsible for approximately 93,000 deaths and 2.7 million YPLL annually in the United States during 2011–2015. This means that an average of 255 Americans die from excessive drinking every day, shortening their lives by an average of 29 years. The majority of these alcohol-attributable deaths involved males, and approximately four in five deaths involved adults aged ≥35 years. The number of alcohol-attributable deaths among adults aged ≥65 years was nearly double that among adults aged 20–34 years. Approximately one half of alcohol-attributable deaths were caused by chronic conditions, but acute alcohol-attributable deaths, all of which were caused by binge drinking, accounted for the majority of the YPLL from excessive drinking. Little progress has been made in preventing deaths caused by excessive drinking; the average annual estimates of alcohol-attributable deaths and YPLL in this report are slightly higher than estimates for 2006–2010, and the age-adjusted alcohol-attributable death rates are similar, suggesting that excessive drinking remains a leading preventable cause of death and disability. From 2006–2010 (5) to 2011–2015, average annual deaths caused by alcohol dependence increased 14.2%, from 3,728 to 4,258, and deaths caused by alcoholic liver disease increased 23.6%, from 14,695 to 18,164. These findings are consistent with reported increasing trends in alcohol-induced deaths (e.g., deaths from conditions wholly attributable to alcohol) among adults aged ≥25 years, including alcoholic liver disease, as well as with increases in per capita alcohol consumption during the past 2 decades. Age-adjusted alcohol-attributable death rates varied approximately twofold across states, but deaths caused by excessive drinking were common across the country. The differences in alcohol-attributable death and YPLL rates in states might be partially explained by varying patterns of excessive alcohol use, particularly binge drinking, which is affected by state-level alcohol pricing and availability strategies and differential access to medical care. The findings in this report are subject to at least five limitations. First, the prevalence of alcohol consumption ascertained through the Behavioral Risk Factor Surveillance System is based on self-reported data, which substantially underestimates alcohol consumption. Second, these estimates are conservative, because former drinkers, some of whom might have died from alcohol-related conditions, are not included in the estimates of alcohol-attributable deaths and YPLL for partially alcohol-attributable causes of death. Third, direct alcohol-attributable fraction estimates for some chronic and acute conditions rely on data older than that of 2011–2015 and might not accurately represent the proportion of excessive drinkers among persons who died of some conditions (e.g., drug overdoses) during that period. This emphasizes the importance of more timely information on alcohol involvement and various health conditions. Fourth, several conditions partially related to alcohol (e.g., tuberculosis, human immunodeficiency virus, and acquired immunodeficiency syndrome) are not included because published risk estimates were not available. Finally, the alcohol-attributable deaths and YPLL are based on alcohol-related conditions that were listed as the underlying (i.e., primary) cause of death, and not as a multiple cause of death, yielding conservative estimates. The implementation of effective population-based strategies for preventing excessive drinking, such as those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL. These strategies can complement other population-based prevention strategies that focus on health risk behaviors associated with excessive alcohol use, such as safer prescribing practices to reduce opioid misuse and overdoses and alcohol-impaired driving interventions.
 

For more information: https://tinyurl.com/yyoy5kgd

Hep C World News - Week of July 26, 2020

DAAs lower risk for death among patients with HCV, regardless of cirrhosis

Washington, DC - Treatment with direct-acting antivirals was associated with decreased mortality among a sample of more than 50,000 Medicare beneficiaries with hepatitis C virus, regardless of the presence of cirrhosis, according to data published in JAMA Network Open. Yamini Kalidindi, MHA, an associate at the Moran Company, and colleagues noted that HCV is the most common bloodborne illness in the United States, and that evidence of the cost-effectiveness of DAA treatment is lacking. “Previous simulations used extended lives as a key outcome to indicate that the benefits associated with DAA treatment can exceed the costs of these drugs,” they wrote. “However, real-world evidence is limited on the association between DAA treatment and reduced mortality, information that is crucial to assessing the value of costly DAA drugs.” To examine the association of DAA treatment with mortality among Medicare beneficiaries with HCV, Kalidindi and colleagues performed a cohort study using the claims data of 51,478 Medicare beneficiaries who sought HCV care for the first time between Jan. 1, 2014, and Dec. 31, 2016, after at least a 1-year “washout period.” They obtained death dates, demographic data and indicators of health risks from the Master Beneficiary Summary Files. Overall, the study showed that DAA treatment was statistically significantly associated with a decrease in mortality among patients with and without cirrhosis. According to the study, 8,240 patients (16%) had cirrhosis and 43,238 patients (84%) did not. In the cirrhosis arm, the adjusted HR of dying between patients treated with DAAs and those not treated with DAAs was 0.51 (95% CI, 0.46-0.57). The study showed that the association of DAA treatment with mortality did not differ by sex or dual-eligibility status in the cirrhosis group. The study showed that, among patients without cirrhosis, the adjusted HR of dying between those receiving DAA treatment and those without DAA treatment was 0.54 (95% CI, 0.50-0.58). Similar to the first group, these data did not differ by sex. However, the researchers found that the survival advantage associated with DAAs for nondual-eligible beneficiaries was statistically significantly higher than that for dual-eligible beneficiaries among patients without cirrhosis (HR = 0.47; 95% CI, 0.41-0.55 vs. HR = 0.57; 95% CI,0.52-0.62). “These findings suggest that increasing access to direct-acting antiviral drugs for all patients with hepatitis C virus infection, regardless of disease progression, could improve population health,” the authors concluded.

For more information: https://tinyurl.com/y3q3ktkb

Hep C World News - Week of July 19, 2020

Blood test detects positive COVID-19 result in 20 minutes

Melbourne, Australia - World-first research by Monash University in Australia has been able to detect positive COVID- 19 cases using blood samples in about 20 minutes, and identify whether someone has contracted the virus. In a discovery that could advance the worldwide effort to limit the community spread of COVID-19 through robust contact tracing, researchers were able to identify recent COVID-19 cases using 25 microlitres of plasma from blood samples. The research team, led by BioPRIA and Monash University's Chemical Engineering Department, including researchers from the ARC Center of Excellence in Convergent BioNano Science and Technology (CBNS), developed a simple agglutination assay—an analysis to determine the presence and amount of a substance in blood—to detect the presence of antibodies raised in response to the SARS-CoV-2 infection. Positive COVID-19 cases caused an agglutination or a clustering of red blood cells, which was easily identifiable to the naked eye. Researchers were able to retrieve positive or negative readings in about 20 minutes. While the current swab / PCR tests are used to identify people who are currently positive with COVID-19, the agglutination assay can determine whether someone had been recently infected once the infection is resolved—and could potentially be used to detect antibodies raised in response to vaccination to aid clinical trials. Using a simple lab setup, this discovery could see medical practitioners across the world testing up to 200 blood samples an hour. At some hospitals with high-grade diagnostic machines, more than 700 blood samples could be tested hourly—about 16,800 each day. Study findings could help high-risk countries with population screening, case identification, contact tracing, confirming vaccine efficacy during clinical trials, and vaccine distribution. This world-first research was published today (Friday 17 July 2020) in the prestigious journal ACS Sensors. A patent for the innovation has been filed and researchers are seeking commercial and government support to upscale production. Dr. Simon Corrie, Professor Gil Garnier and Professor Mark Banaszak Holl (BioPRIA and Chemical Engineering, Monash University), and Associate Professor Timothy Scott (BioPRIA, Chemical Engineering and Materials Science and Engineering, Monash University) led the study, with initial funding provided by the Chemical Engineering Department and the Monash Center to Impact Anti-microbial Resistance. Dr. Corrie, Senior Lecturer in Chemical Engineering at Monash University and Chief Investigator in the CBNS, said the findings were exciting for governments and health care teams across the world in the race to stop the spread of COVID-19. He said this practice has the potential to become upscaled immediately for serological testing. "Detection of antibodies in patient plasma or serum involves pipetting a mixture of reagent red blood cells (RRBCs) and antibody-containing serum/plasma onto a gel card containing separation media, incubating the card for 5-15 minutes, and using a centrifuge to separate agglutinated cells from free cells," Dr. Corrie said. "This simple assay, based on commonly used blood typing infrastructure and already manufactured at scale, can be rolled out rapidly across Australia and beyond. This test can be used in any lab that has blood typing infrastructure, which is extremely common across the world." Researchers collaborated with clinicians at Monash Health to collect blood samples from people recently infected with COVID-19, as well as samples from healthy individuals sourced before the pandemic emerged. Tests on 10 clinical blood samples involved incubating patient plasma or serum with red blood cells previously coated with short peptides representing pieces of the SARS-CoV-2 virus. If the patient sample contained antibodies against SARS-CoV-2, these antibodies would bind to peptides and result in aggregation of the red blood cells. Researchers then used gel cards to separate aggregated cells from free cells, in order to see a line of aggregated cells indicating a positive response. In negative samples, no aggregates in the gel cards were observed. "We found that by producing bioconjugates of anti-D-IgG and peptides from SARS-CoV-2 spike protein, and immobilizing these to RRBCs, selective agglutination in gel cards was observed in the plasma collected from patients recently infected with SARS-CoV-2 in comparison to healthy plasma and negative controls," Professor Gil Garnier, Director of BioPRIA, said. "Importantly, negative control reactions involving either SARS-CoV-2-negative samples, or RRBCs and SARS-CoV-2-positive samples without bioconjugates, all revealed no agglutination behavior." Professor Banaszak Holl, Head of Chemical Engineering at Monash University, commended the work of talented Ph.D. students in BioPRIA and Chemical Engineering who paused their projects to help deliver this game changing COVID-19 test. "This simple, rapid, and easily scalable approach has immediate application in SARS-CoV-2 serological testing, and is a useful platform for assay development beyond the COVID-19 pandemic. We are indebted to the work of our Ph.D. students in bringing this to life," Professor Banaszak Holl said. "Funding is required in order to perform full clinical evaluation across many samples and sites. With commercial support, we can begin to manufacture and roll out this assay to the communities that need it. This can take as little as six months depending on the support we receive."
 

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Hep C World News - Week of July 12, 2020

Older Hep C patients may remain at risk for HCC even after viral clearance

New York, NY - Chronic hepatitis C patients ages 75-84 remained at high risk of liver cancer even after direct-acting antivirals (DAAs) cleared the virus, according to an observational study in Japan. "In this era in which therapy with DAAs has replaced interferon-based therapies, HCV cure rates between 90% and 100% have been reported, regardless of age or liver fibrosis status," Dr. Elichi Ogawa of Kyushu University Hospital in Fukuoka told Reuters Health by email. "As a result, the number of patients requiring a liver transplant has fallen sharply, as have deaths associated with HCV." "However, whether or not DAA treatment and HCV cure decreases the risk for the development of hepatocellular cancer (HCC) such that HCC surveillance is no longer necessary remained unclear," he said. "Our study focused on patients 75-84, an age that has been under-represented in clinical trials, in an attempt to clarify this problem." "Our findings showed that regular monitoring of patients in this age group is necessary," he said, "even after HCV elimination and improvement of hepatic fibrosis markers." As reported in the Journal of Infectious Diseases, the multicenter cohort study included 2,405 chronic hepatitis C patients without a history of liver cancer in whom HCV elimination was achieved by DAAs. Five hundred (20.8%) were ages 75-84 and 1,101 (45.8%) were 60-74 at the time of DAA initiation. In the 75-84 group, 34.8% were men, 27.2% had a diagnosis of cirrhosis, and 71.6% were treatment-naïve. At baseline, two-thirds had a fibrosis biomarker (FIB-4) index of 3.25 or greater. They also had a higher FIB-4 index and lower serum albumin level than those ages 60-74, and were more likely to have undergone HCV treatment. Overall, 64 patients (2.7%) developed HCC during the median 3.5 years of follow-up. The researchers analyzed the incidence of HCC according to the transition of the FIB-4 index from baseline to week 12 after the end of treatment. Among patients ages 75-84 with high FIB-4 at baseline (at least 3.25), there was no significant difference in the annual incidence of HCC between those with a week-12 FIB-4 index of at least 3.25 (2.75%/year) or <3.25 (2.16%/year). By contrast, annual incidence did differ significantly among those ages 60-74, at 3.61% and 1.51%/year, respectively (adjusted hazard ratio, 2.20). After adjustment, a higher risk of developing HCC was conferred by, among other factors: age 60-74 (HR 4.95); age 75-84 (HR 6.93); being male (HR 2.29); and having cirrhosis (HR 2.41). Further, in 495 propensity-matched pairs, the cumulative HCC incidence in the 75-84 group without cirrhosis was significantly higher compared to the 60-74/non-cirrhosis group. The authors conclude, "Older patients aged 75-84 remained at high risk for the development of HCC, even after HCV elimination and the improvement of FIB-4 index to <3.25." Dr. Nadeem Anwar, Director of Hepatology at the University of Cincinnati Medical Center said the finding "seems to be compatible with what is seen in clinical experience." "The incidence of HCC is dependent on various risk factors, like age, gender, family history of HCC and absence or presence of cirrhosis. Twenty percent of HCC is seen in non-cirrhotic patients. Hence, despite the treatment of hepatitis C, the risk for cancer remains, especially in the older populations." "Liver biopsy is still considered the gold standard for determination of the degree of fibrosis," he noted. "Among the currently available non-invasive tools for measuring fibrosis, FIB-4 fares quite well, but still there is room for error. Since it uses transaminases (AST and ALT) as markers of fibrosis," he said, "any fluctuation in these enzymes would affect the FIB-4 score and may under- or over-report the degree of fibrosis. Hence, any study where it is used to distinguish cirrhotic from non-cirrhotic patients could be prone to introducing error."

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Hep C World News - Week of July 5, 2020

Scientists urge WHO to address airborne spread of coronavirus

Geneva, Switzerland - More than 200 scientists from over 30 countries are urging the World Health Organization to take more seriously the possibility of the airborne spread of the novel coronavirus as case numbers rise around the world and surge in the United States. In a forthcoming paper titled “It is Time to Address Airborne Transmission of Covid-19,” 239 signatories attempt to raise awareness about what they say is growing evidence that the virus can spread indoors through aerosols that linger in the air and can be infectious even in smaller quantities than previously thought. Until recently, most public health guidelines have focused on social distancing measures, regular hand-washing and precautions to avoid droplets. But the signatories to the paper say the potential of the virus to spread via airborne transmission has not been fully appreciated even by public health institutions such as the WHO. The paper, which was shared with The Washington Post ahead of publication this week in the journal Clinical Infectious Diseases, comes as the WHO faces criticism over its coronavirus response, calls for reform and a U.S. threat to cut funding and withdraw completely. The fact that scientists resorted to a paper to pressure the WHO is unusual, analysts said, and is likely to renew questions about the WHO’s messaging. “WHO’s credibility is being undermined through a steady drip-drip of confusing messages, including asymptomatic spread, the use of masks, and now airborne transmission,” said Lawrence Gostin, a professor of global health law at Georgetown University who provides technical assistance to the organization. He praised the WHO for hosting regular briefings and acknowledged that the organization is in a tough spot because it “has to make recommendations for the entire world and it feels it needs irrefutable scientific proof before coming to a conclusion.” But he warned that “the public, and even scientists, will lose full confidence in WHO without clearer technical guidance.” A spokesperson for the organization said it is aware of media reports about the issue and will have technical experts review the matter. The agency has repeatedly defended its handling of the pandemic.

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Hep C World News - Week of June 28, 2020

NIH Blood Test Developed for Liver Cancer Screening

Bethesda, Maryland - Researchers say they have developed a new test that can help identify people who are likely to develop hepatocellular carcinoma (HCC), the most common form of liver cancer. The approach uses a simple blood test to check for the patient’s previous exposure to certain viruses. Scientists at the National Cancer Institute (NCI) led the study describing the novel approach. The research also involved researchers from the National Institute of Diabetes and Digestive and Kidney Diseases and several academic centers. The findings “A Viral Exposure Signature Defines Early Onset of Hepatocellular Carcinoma” are published in Cell. “Hepatocellular carcinoma (HCC) is an aggressive malignancy with its global incidence and mortality rate continuing to rise, although early detection and surveillance are suboptimal. We performed serological profiling of the viral infection history in 899 individuals from an NCI-UMD case-control study using a synthetic human virome, VirScan. We developed a viral exposure signature and validated the results in a longitudinal cohort with 173 at-risk patients who had long-term follow-up for HCC development,” write the investigators. “Our viral exposure signature significantly associated with HCC status among at-risk individuals in the validation cohort (area under the curve: 0.91 [95% CI 0.87–0.96] at baseline and 0.98 [95% CI 0.97–1] at diagnosis). The signature identified cancer patients prior to a clinical diagnosis and was superior to alpha-fetoprotein. In summary, we established a viral exposure signature that can predict HCC among at-risk patients prior to a clinical diagnosis, which may be useful in HCC surveillance.” “Together with existing screening tests, the new test could play an important role in screening people who are at risk for developing HCC. It could help doctors find and treat HCC early. The method is relatively simple and inexpensive, and it only requires a small blood sample,” said the study’s leader, Xin Wei Wang, PhD, co-leader of the NCI Center for Cancer Research (CCR) Liver Cancer Program. Certain factors increase a person’s chances of developing HCC, such as infection with hepatitis B or hepatitis C virus or cirrhosis of the liver. People who have risk factors are recommended to get screened for HCC every six months with an ultrasound with or without a blood test for alpha-fetoprotein. But not everyone with risk factors for HCC will develop the disease. Although screening can lead to earlier detection, most patients are diagnosed when the cancer is advanced and often incurable. However, HCC that is caught early has a much better chance of being cured.

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Hep C World News - Week of June 21, 2020

Too soon to call dexamethasone a COVID-19 breakthrough

London, UK - Not long after researchers in England said the low-cost steroid dexamethasone reduced deaths among hospitalized COVID-19 patients, health experts around the world started raising alarm bells about the study—and the extreme enthusiasm it generated. Researchers funded by the U.K. government said dexamethasone lowered the risk of death in COVID-19 patients on ventilators or oxygen by 35% and 20%, respectively. But they only released a summary of the data, rather than the full study. That irked some high-profile doctors, particularly in the wake of hydroxychloroquine's dramatic rise and fall. “It will be great news if dexamethasone, a cheap steroid, really does cut deaths by one-third in ventilated patients with COVID-19, but after all the retractions and walk-backs, it is unacceptable to tout study results by press release without releasing the paper,” said Atul Gawande, M.D., author and former CEO of healthcare venture Haven, on Twitter. In England, the top-line results were enough to convince the National Health Service (NHS) to approve dexamethasone for use in all COVID-19 patients requiring ventilation. And the World Health Organization vowed to update its clinical guidance on treating the coronavirus to incorporate the new data on the steroid. But those endorsements of dexamethasone came on the heels of perhaps the most extraordinary of the COVID-19 walk-backs: the FDA’s retraction of its emergency use authorization for hydroxychloroquine in COVID-19. The agency pulled its approval of the malaria drug, which had been loudly endorsed by President Donald Trump, after controlled studies revealed it provided no benefit to patients. The hydroxychloroquine debacle was clearly on the mind of Hilary Jones, a well-known physician and TV commentator in Britain. He urged viewers in an on-air interview Wednesday not to “go rushing to the shop asking for dexamethasone,” which, like hydroxychloroquine, is a decades-old drug that’s inexpensive. However, “it’s not a preventative,” he said. What’s more, Jones pointed out, “the death rate even with dexamethasone is still 28%. So, it’s still massively high; this is still a very nasty virus.” The clinical trial, he added, will need to “show real benefit over risk.” One well-known problem with steroids is that they can suppress the immune system, which could complicate the recovery process for any virus. That concern was voiced to Reuters by Thomas McGinn, M.D., deputy physician-in-chief at Northwell Health. He said he wouldn’t recommend the use of dexamethasone to treat COVID-19 without seeing the full results of the U.K. study published in a peer-reviewed journal—a sentiment echoed by physicians at the University of Washington and Massachusetts General Hospital. The U.K. trial of dexamethasone, called Recovery, enrolled more than 11,500 patients at 175 NHS hospitals. The researchers are “working to publish the full details” of the study as soon as possible, according to a statement.

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Hep C World News - Week of June 14, 2020

Seasonality will likely only have ‘minor' impact on COVID-19 epidemiology

Ottawa, ON - Seasonality will likely have only a minor role in the epidemiology of COVID-19 compared with public health interventions such as school closures and social distancing, which have been shown to have a major impact, according to a prospective cohort study in the Canadian Medical Association Journal. “It is unclear whether seasonal changes, school closures or other public health interventions will result in a slowdown of the current COVID-19 pandemic,” Peter Jüni, MD, FESC, director of the Applied Health Research Centre at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and professor in the department of medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto, and colleagues wrote. “We aimed to determine whether epidemic growth is globally associated with climate or public health interventions intended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).” Jüni and colleagues performed a prospective cohort study of all 144 geopolitical areas throughout the world with at least 10 cases and local transmission as of March 20, 2020, excluding China, South Korea, Iran and Italy. According to the study, researchers used weighted random-effects regression to examine the relationship between epidemic growth and latitude, temperature, humidity, school closures, limits on mass gatherings and the implementation of social distancing during an exposure period lasting from March 7 through March 13. In total, the study included 375,609 cases. There were few or no correlations between epidemic growth of COVID-19 and geographic latitude or temperature during the exposure period. Weak negative associations with relative humidity (ratios of rate ratios [RRR] per 10%, 0.91; 95% CI, 0.85-0.96) and absolute humidity (RRR per 5 g/m3, 0.92; 95% CI, 0.85-0.99) were noted. Strong associations was observed for restrictions of mass gatherings (RRR, 0.65; 95% CI, 0.53-0.79), school closures (RRR, 0.63; 95% CI, 0.52-0.78) and social distancing (RRR, 0.62; 95% CI, 0.45-0.85). In a multivariable model, the researchers observed a strong association with the number of implemented public health interventions (P for trend = .001), whereas the correlation with absolute humidity was no longer significant. “Taken together, these findings suggest that seasonality is likely to play only a minor role in the epidemiology of COVID-19, while public health interventions (school closures, restricting mass gatherings, social distancing) appear to have a major impact,” the authors concluded. “The important effect of public health interventions needs to be weighed carefully against potential economic and psychosocial harms when deciding when and how to lift restrictions.”
 

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Hep C World News - Week of June 7, 2020

In the Anti-Vaxxer Era, Will Countries Make a Coronavirus Vaccine Mandatory?

Calgary, AB - In 2019, the World Health Organization listed vaccine hesitancy as one of the ten gravest threats to global health. Now, public health agencies are trying to figure out what to do next. After months of isolating from friends and family, it seems like most people are desperately hoping for a COVID-19 vaccine that’ll put an end to the pandemic. But in an era of misinformation and lockdown protests, often touted by anti-vaxxers, there’s an open question on how much uptake there will be for the vaccine, should one arrive. And that leads to a second question: should governments consider making a COVID-19 vaccine mandatory? “Making vaccines mandatory is the last tool in the toolkit of public health,” said Lynora Saxinger, a professor with the University of Alberta department of medical microbiology and immunology. Vaccination rates for most diseases are quite high, which suggests public health agencies won’t have to force people to take a COVID-19 vaccine, Saxinger said. For example, according to the World Health Organization (WHO), as of 2018, an estimated 84 percent of the global population was immunized for Hepatitis B; about 86 percent of children received a measles vaccine before their second birthday; and 84 percent of infants were immunized for polio. (Rates tend to be higher in North America and Europe than elsewhere largely due to unequal access.) But there's been a lot of misinformation spreading about the coronavirus, Saxinger said, so she’s worried it could sway Canadians away from vaccines. Both Saxinger and another expert told VICE they’re particularly worried about people who don’t identify as anti-vaxxers, but express hesitancy when considering vaccinations, because they’re likely more susceptible to misinformation. Last week, Alberta Premier Jason Kenney said he has no intention of making a COVID-19 vaccine mandatory. However, if a safe and effective vaccine is found, the government will “strongly encourage people to use it as we do in flu season" Kenney said. Laval University medical anthropologist, Ève Dubé, said she’s noticed a lot of people express “a perception that the government will force people to get vaccinated.” “These are rumours...it’s really unlikely,” she said. According to Dubé, it might not be feasible to mandate inoculation. When a vaccine is finally found, mass production will take a while, which means there won’t be enough doses at the start to make it mandatory, Dubé said. Past government practice across the country also makes it difficult to enforce inoculation, she said. Alberta’s public health act allows the province to make vaccines mandatory, but that’s never been pursued. Provinces like Ontario, New Brunswick, and Manitoba have implemented some mandatory vaccines, but Quebec, for example, hasn’t, Dubé said. That would make it a lot easier for Ontario than Quebec to impose a mandatory COVID-19 vaccine. Yet studies have shown that just as many people in Quebec get immunized as in Ontario, Dubé said, so making vaccines mandatory likely isn’t necessary. Plus, less than one percent of Canadians identify as anti-vaxxers. The anti-vaxxer movement is stronger in the U.S. where groups are well-funded, heavily organized, and enjoy more influence, she said. “Trust is key with governments and public health,” Dubé added. According to most estimates, the world is still at least a year away from a COVID-19 vaccine.

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Hep C World News - Week of May 31, 2020

COVID-19 in advanced cirrhosis greatly raises risk of death

Chapel Hill, NC - People with chronic liver disease admitted to hospital with COVID-19 are dying at a much higher rate than the rest of the population, figures collated by liver specialists in Europe, Asia and North America show. Advanced cirrhosis greatly increased the risk of death, the study found. People with severe cirrhosis were almost 30 times more likely to die after a COVID-19 diagnosis than people with chronic liver disease without cirrhosis, the figures show. The overall death rate in people with chronic liver disease was 39% among reported cases. Two international registries were established in March 2020 to track the outcomes of people with chronic liver disease and cirrhosis after diagnosis with COVID-19. Investigators from 14 specialist liver clinics in the United States, Spain and the United Kingdom have now reported on the first 152 cases submitted to the registries, in a publication in the Journal of Hepatology. Large case series published to date have not shown a high prevalence of chronic liver disease in people hospitalised with COVID-19, suggesting that people with chronic liver conditions are not at higher risk of developing severe symptoms because of SARS-CoV-2 infection. However, no study has looked specifically at the clinical outcomes of people known to have chronic liver disease.
 

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Hep C World News - Week of May 24, 2020

Covid Patients Testing Positive After Recovery Aren’t Infectious, Study Shows

Seoul, SK - Researchers are finding evidence that patients who test positive for the coronavirus after recovering aren’t capable of transmitting the infection, and could have the antibodies that prevent them from falling sick again. Scientists from the Korean Centers for Disease Control and Prevention studied 285 Covid-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved, as indicated by a previous negative test result. The so-called re-positive patients weren’t found to have spread any lingering infection, and virus samples collected from them couldn’t be grown in culture, indicating the patients were shedding non-infectious or dead virus particles. The findings are a positive sign for regions looking to open up as more patients recover from the pandemic that has sickened at least 4.8 million people. The emerging evidence from South Korea suggests those who have recovered from Covid-19 present no risk of spreading the coronavirus when physical distancing measures are relaxed. The results mean health authorities in South Korea will no longer consider people infectious after recovering from the illness. Research last month showed that so-called PCR tests for the coronavirus’s nucleic acid can’t distinguish between dead and viable virus particles, potentially giving the wrong impression that someone who tests positive for the virus remains infectious. The research may also aid in the debate over antibody tests, which look for markers in the blood that indicate exposure to the novel coronavirus. Experts believe antibodies probably convey some level of protection against the virus, but they don’t have any solid proof yet. Nor do they know how long any immunity may last. A recent study in Singapore showed that recovered patients from severe acute respiratory syndrome, or SARS, are found to have “significant levels of neutralizing antibodies” nine to 17 years after initial infection, according to researchers including Danielle E. Anderson of Duke-NUS Medical School. Other scientists have found higher levels of IgM, an antibody that appears in response to exposure to an antigen, in children, according to an article published on medRxiv. That suggests younger populations have the potential to produce a more potent defense against Covid-19. The study has not been certified by peer review. As a result of the findings in the South Korea study, authorities said that under revised protocols, people should no longer be required to test negative for the virus before returning to work or school after they have recovered from their illness and completed their period of isolation. “Under the new protocols, no additional tests are required for cases that have been discharged from isolation,” the Korean CDC said in a report. The agency said it will now refer to “re-positive” cases as “PCR re-detected after discharge from isolation.” Some coronavirus patients have tested positive again for the virus up to 82 days after becoming infected. Almost all of the cases for which blood tests were taken had antibodies against the virus.
 

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Hep C World News - Week of May 17, 2020

Moderna delivers first human data for a coronavirus vaccine

Cambridge, MA - Since early this year, Moderna has been at the forefront of an urgent worldwide push to develop a vaccine for the coronavirus in just months, rather than the many years vaccines typically take to test. On Monday, the biotech became the first company to report data from a study of human volunteers. The results — an early look at a 45-volunteer Phase 1 trial sponsored by the National Institutes of Health — aren't nearly enough to prove whether the vaccine is safe or can prevent infection with SARS-CoV-2.  Much more data from larger and longer studies will be needed to more definitively prove whether mRNA-1273 can protect against infection by the new coronavirus. Instead, this first look is meant to show which doses appear promising enough to move into wider testing, that the vaccine doesn't cause any serious health programs and that it can spur the body to produce antibodies capable of neutralizing the virus. While only summary data are available, Moderna looks to have accomplished those early goals. In the trial, three small groups of healthy people between 18 and 55 years old received one or two shots of mRNA-1273 at three dose levels: 25, 100 or 250 micrograms. The company reported that the immune responses observed were higher with each dose — a sought-after pattern that suggests benefits are positively correlated with dose level. Two weeks after getting their second shot, at day 43, 15 people on the low dose had levels of binding antibodies comparable to what is seen in blood samples of patients who have recovered from COVID-19. In the 10 people given the medium dose, the levels of those antibodies "significantly exceeded" the numbers seen in recovered patients. Samples aren't available yet for the remaining study volunteers, including those who got the highest dose. Thus far, data on neutralizing antibodies — the proteins used by the immune system to fight off infections — are only available for the first four volunteers to get the low or medium doses. After 43 days, all eight of them produced antibodies that were capable of neutralizing live SARS-CoV-2 in a serological test known as a PRNT assay. Supporting that finding were data from a preclinical test in mice infected with the virus, which showed inoculation with mRNA-1273 prevented viral reproduction in the animals' lungs, Moderna said.  "The totality of the data released today, the interim Phase 1 data and the preclinical mouse challenge model, give us confidence that mRNA-1273 has a high probability to provide protection from COVID-19 disease in humans," said CEO Sté​phane Bancel on a Monday conference call. One volunteer in the low and medium dose groups had a side effect deemed severe, redness around the site of injection. There were more worrisome findings at the high dose: three cases of severe "systemic symptoms" after the second shot. "I believe these flu-like symptoms are really an indirect measure of a strong immune response," said Tal Zaks, Moderna's chief medical officer, on the conference call. All observed side effects "have been transient and self-resolving," he added.  Based on the findings, Moderna will drop its high dose and test a 50 microgram and 100 microgram dose in the planned Phase 2 trial, which the Food and Drug Administration recently cleared to start. That study, in turn, will help Moderna find the final dose to test in a Phase 3 trial that could begin in July. The dose that Moderna selects will be important to watch, as the lower the dose, the easier it will be for Moderna to produce and distribute widely. Earlier this month, Moderna said a deal with drug manufacturer Lonza would help it make up to 1 billion doses a year, but that figure assumed a 50-microgram dose of mRNA-1273 would be successful. "We are investing to scale up manufacturing so we can maximize the number of doses we can produce to help protect as many people as we can from SARS-CoV-2," Bancel said in the statement. Just three days ago, the Trump administration formed "Operation Warp Speed" as part of major government push to make a coronavirus vaccine available by the end of the year. Moderna's experimental vaccine represents perhaps the best hope to fulfill that extremely aggressive timeline. Moderna has been able to move faster than most drugmakers because it uses a technology that can design and produce vaccines more quickly than with traditional techniques. Its technology, which uses messenger RNA, or mRNA, molecules to teach the body to make certain proteins, is unproven, however, having yet to result in an approved vaccine for any disease. Even if Moderna succeeds in its accelerated development of mRNA-1273, then, the vaccine would likely arrive with still unanswered questions about its safety and effectiveness across wide groups of people. Other companies are testing mRNA vaccines as well. BioNTech and partner Pfizer, CureVac AG and Translate Bio, via a deal with Sanofi, are in the mix as well. BioNTech's candidate entered human testing in the U.S. this month, and in Germany last month. Moderna stock soared Monday, hitting an all-time high after rising by more than 25%. The jump also pulled shares in both BioNTech and Translate Bio higher. 

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Hep C World News - Week of May 10, 2020

No evidence to date to suggest COVID-19 antibodies protect against re-infection

Geneva - There is currently no evidence to suggest that people who recover from COVID-19 and have antibodies are protected against reinfection with the illness, according to a scientific brief from WHO. As a result, although some governments have suggested that the presence of antibodies to SARS-CoV-2 may be an “immunity passport” that allows individuals to travel or return to work under the belief that they are protected from reinfection, there is no evidence to support that. The development of immunity to a pathogen through natural infection is “a multistep process” that generally occurs over the period of 1 to 2 weeks, according to the brief. The combined adaptive response may clear the virus from the body and could prevent progression to severe illness or reinfection by the same virus, if the response is strong enough. The presence of antibodies in the blood is commonly used to track this process, the brief notes. WHO officials say that as of April 24, no study has assessed whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans and that tests that detect antibodies to SARS-CoV-2 in people need further study to establish accuracy and reliability. These tests also need to differentiate between past infections from SARS-CoV-2 and those caused by the known set of six human coronaviruses two of which cause Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome and four of which cause the common cold. According to WHO, at this point in the pandemic, there is not enough evidence regarding the effectiveness of antibody-mediated immunity to ensure the reliability of an “immunity passport” or “risk-free certificate” yet. WHO officials also noted that people who believe that they are immune to a second infection because they have received a positive test result may ignore public health advice, which could increase the risk for ongoing transmission of COVID-19. Experts from the Infectious Diseases Society of American echoed these concerns during a press briefing last week. “The hope for antibodies has been that the detection of them in the blood represents protection for reinfection,” Mary K. Hayden, MD, FIDSA, IDSA spokesperson and professor of internal medicine and pathology at Rush University Medical Center, said during the briefing. “That's really the million-dollar question.” Hayden explained that even if antibody immunity is proven, the degree of protection is unknown and could wane over time. Because of this, it should generally be assumed that people with antibodies could be at risk for reinfection and should not change their behavior in any way regarding social distancing and other actions.

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Hep C World News - Week of May 3, 2020

CADTH reports on effectiveness of hydroxychloroquine as COVID-19 therapy
 

Ottawa, ON - There is currently no evidence regarding the efficacy of chloroquine or hydroxychloroquine for the prevention of COVID-19. The evidence has major limitations, and is associated with inconsistent and uncertain findings. Chloroquine and hydroxychloroquine have been identified as potential treatments for COVID-19, with some clinical trials combining chloroquine or hydroxychloroquine with the antibacterial azithromycin. With respect to treating COVID-19, the current evidence related to the clinical efficacy of chloroquine or hydroxychloroquine, used with or without azithromycin, has major limitations, and is associated with inconsistent and uncertain findings. As such, at this time, no conclusions can be made regarding the use of these therapies for the treatment of COVID-19. However, several trials are currently underway, including some in Canada, and it may be expected that more definitive answers will be provided in the future.
 

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Hep C World News - Week of April 26, 2020
 

Blood-pressure drugs are in the crosshairs of COVID-19 research

Baltimore, Mayland - Scientists are baffled by how the coronavirus attacks the body - killing many patients while barely affecting others. But some are tantalized by a clue: A disproportionate number of patients hospitalized by COVID-19, the disease caused by the virus, have high blood pressure. Theories about why the condition makes them more vulnerable – and what patients should do about it – have sparked a fierce debate among scientists over the impact of widely prescribed blood-pressure drugs. Researchers agree that the life-saving drugs affect the same pathways that the novel coronavirus takes to enter the lungs and heart. They differ on whether those drugs open the door to the virus or protect against it. Resolving that question has taken on new urgency after an April 8 report by the U.S. Centers for Disease Control and Prevention showed that 72% of hospitalized COVID-19 patients 65 or older had hypertension. The drugs are known as ACE inhibitors and ARBs, broad categories that include Vasotec, Valsartan, Irbesartan, as well as their generic versions. In a recent interview with a medical journal, Anthony Fauci - the U.S. government’s top infectious disease expert - cited a report showing similarly high rates of hypertension among COVID-19 patients who died in Italy and suggested the medicines, rather than the underlying condition, may act as an accelerant for the virus. Efforts to understand how the virus uses the pathway to the heart and lungs, and the role of the medicines, are complicated by a lack of rigorous studies. “There are millions of Americans that take an ACE inhibitor or AR daily,” said Dr Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore. “This is one of the most important clinical questions.” An estimated 100 million U.S. residents suffer from high blood pressure, which increases the risk of heart disease, stroke and kidney failure. About four-fifths of them need to take prescription drugs to control it, according to the CDC. ACE inhibitors and ARBs are widely prescribed to patients with congestive heart failure, diabetes or kidney disease. The drugs account for billions of dollars in prescription sales worldwide. The absence of clear answers on how the drugs impact COVID-19 patients has sparked rampant speculation in correspondence and editorials posted on medical journal websites and those where scientists share unreviewed, pre-publication study drafts. Many patients are agonizing over whether their medicines will help or hurt them.
 

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Hep C World News - Week of April 19, 2020

New data on Gilead’s remdesivir show no benefit for coronavirus patients
 

Geneva, Switzerland - The antiviral medicine remdesivir from Gilead Sciences failed to speed the improvement of patients with Covid-19 or prevent them from dying, according to results from a long-awaited clinical trial conducted in China. Gilead, however, said the data suggest a “potential benefit.” A summary of the study results was inadvertently posted to the website of the World Health Organization and seen by STAT on Thursday, but then removed. “A draft document was provided by the authors to WHO and inadvertently posted on the website and taken down as soon as the mistake was noticed. The manuscript is undergoing peer review and we are waiting for a final version before WHO comments,” said WHO spokesperson Tarik Jasarevic. The data (for details, see screenshot below) will be closely scrutinized but are also likely imperfect. The study was terminated prematurely, which could have affected the results. The context that would be provided by a full manuscript is missing, and the data have not been reviewed as normally occurs before publication. Many studies are being run to test remdesivir, and this one will not be the final word. Results are expected soon from a Gilead-run study in severe Covid-19 patients, although that study may be difficult to interpret because the drug is not compared to patients receiving only standard treatment. Encouraging data from patients in that study at the University of Chicago were described by researchers at a virtual town hall and obtained by STAT last week. However, unlike those data, these new results are from a randomized controlled trial, the medical gold standard. Gilead is also running a study with a control group in more moderate Covid-19 patients, and the National Institute of Allergy and Infectious Diseases is running a study that compares remdesivir to placebo. There are even more studies of the drug ongoing. According to the summary of the China study, remdesivir was “not associated with a difference in time to clinical improvement” compared to a standard of care control. After one month, it appeared 13.9% of the remdesivir patients had died compared to 12.8% of patients in the control arm. The difference was not statistically significant. “In this study of hospitalized adult patients with severe COVID-19 that was terminated prematurely, remdesivir was not associated with clinical or virological benefits,” the summary states. The study was terminated prematurely because it was difficult to enroll patients in China, where the number of Covid-19 cases was decreasing. An outside researcher said that the results mean that any benefit from remdesivir is likely to be small.
 

For more information: https://tinyurl.com/y8o4undn

Hep C World News - Week of April 12, 2020

Small study finds that hyped malaria pill doesn’t help clear coronavirus
 

Shanghai, China - According to a study reported by Bloomberg News, hydroxychloroquine, the 65-year-old malaria drug that President Donald Trump has praised, appeared not to help patients get rid of the pathogen. The pill didn’t help patients clear the virus better than standard care and was much more likely to cause side effects, according to a study of 150 hospitalized patients by doctors at 16 centers in China. The research, which hasn’t been peer-reviewed, was released Tuesday. The drug did help alleviate some clinical symptoms of Covid-19, however, and the patients who took it showed a greater drop in C-reactive protein, a measure of inflammation. “When testing new treatments, we are looking for signals that show that they might be effective before proceeding to larger studies,” said Allen Cheng, an infectious diseases physician and a professor of epidemiology at Melbourne’s Monash University. “This study doesn’t show any signal, so it is probably unlikely that it will be of clinical benefit.” There were more side effects in the group of 75 people who took hydroxychloroquine, but they were mostly mild, the most common being diarrhea. The researchers, led by Wei Tang of Ruijin Hospital in Shanghai, wrote that the medicine’s anti-inflammatory effects probably helped alleviate patients’ symptoms. More studies of hydroxychloroquine are underway after the medicine made headlines in recent weeks and was endorsed by Trump. “The results of those studies will be of interest,” Cheng said.
 

For more information: https://tinyurl.com/ybeedeut

Hep C World News - Week of April 5, 2020

Hepatitis patients using Low-Dose Aspirin had lower risk of liver cancer

Stockholm, Sweden - The goal of this study was to determine if low-dose aspirin use was associated with lower risks of incident hepatocellular carcinoma (HCC) and liver-related deaths among Swedish adults chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Researchers here, led by Tracey G. Simon, asked if low-dose aspirin use was associated with lower risks of incident HCC and liver-related deaths among Swedish adults chronically infected with HBV or HCV infections? Evidence from the literature has suggested that aspirin may prevent progression of liver disease and HCC via different potential mechanisms, including prevention of platelet degranulation, modulation of bioactive lipids, and inhibition of the proinflammatory cyclooxygenase-2 (COX-2) enzyme. However, prior observational studies lacked detailed data regarding key determinants of hepatic outcomes, including underlying viral hepatitis, cirrhosis, and use of antiviral medications. A Swedish population study showed that adults with chronic viral hepatitis B or C who took low-dose aspirin long term were less likely to develop liver cancer or to die from liver-related causes, without a significantly higher risk of gastrointestinal bleeding. Note that the authors called for future research to clarify the appropriate timing of aspirin initiation, minimum necessary duration, and durability of response in diverse cohorts beyond the largely Caucasian Swedish population and in people with non-viral causes of liver disease. In the New England Journal of Medicine, Jonas F. Ludvigsson, MD, PhD, of the Karolinska Institutet in Stockholm, and colleagues showed that Swedish adults with chronic viral hepatitis who took low-dose aspirin long term were less likely to develop liver cancer or to die from liver-related causes, without a significantly higher risk of gastrointestinal bleeding. Ludvigsson and team identified 50,275 adults from the Swedish Register for Surveillance of Communicable Diseases who were diagnosed with HBV or HCV from 2005 to 2015. These individuals did not have a history of aspirin use. Those who were starting to take low-dose aspirin of 75 or 160 mg (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses of aspirin -- 2,998 had HBV and 11,207 had HCV. More than half of the aspirin users (56%) had coronary artery disease, and 87% had at least one cardiovascular risk factor (diabetes, dyslipidemia, obesity, or hypertension). A majority of aspirin users (84%) filled prescriptions for 290 or more consecutive cumulative defined daily doses after the initial prescription. Over a median follow-up period of 7.9 years, the researchers recorded 1,612 incident cases of HCC and 5,017 liver-related deaths. The estimated cumulative incidence of HCC was 4.0% among aspirin users versus 8.3% among non-users (difference -4.3 percentage points, 95% CI -5.0 to -3.6, adjusted hazard ratio [HR] 0.69, 95% CI 0.62-0.76). Additionally, individuals who took aspirin for a longer time derived a greater benefit. Compared with short-term use (3 months to 1 year), the risk of liver cancer was 10% lower for 1-3 years of use, 34% lower for 3-5 years of use, and 43% lower for 5 or more years of use. The 10-year liver-related mortality rate was 11.0% (95% CI 10.8-11.2%) among aspirin users and 17.9% (95% CI 17.8-18.0%) among non-users (risk difference -6.9 percentage points, 95% CI -8.1 to -5.7, adjusted HR 0.73, 95% CI 0.67-0.81). Ludvigsson and team observed benefits of aspirin usage regardless of sex, hepatitis severity, or type of hepatitis. The risk of gastrointestinal bleeding -- a concern when taking aspirin long term -- was not significantly higher among aspirin users versus non-users (10-year risk 7.8% and 6.9%, respectively, difference of 0.9 percentage points, 95% CI -0.6 to 2.4). Study limitations included the fact that the Swedish study population was mainly white, and that the researchers did not have information on aspirin adherence. In addition, they lacked information regarding smoking, HBV DNA levels, HCV eradication, specific fibrosis stages, HCC screening, aflatoxin exposure, and coffee consumption.
 

For more information: https://tinyurl.com/sjh75zx
 

Hep C World News - Week of March 29, 2020

COVID-19 drug trials begin in Canadian hospitals

Toronto, ON – The Toronto Star recently reported that more than a dozen Canadian hospitals will start enrolling patients as part of an unprecedented global collaboration to test four potential treatments for Covid-19 the disease caused by the pandemic coronavirus that currently has no vaccine or cure. Dubbed SOLIDARITY, the multinational trial is being co-ordinated by the World Health Organization and aims to enrol thousands of patients from around the world. In the absence of a vaccine — something that is at least a year or more away — the goal is to quickly identify treatments that could mitigate the toll of COVID-19, which has already killed more than 20,000 people worldwide. If successful, doctors will finally have some evidence-based research for deciding which drugs to use, or exclude, when treating patients with severe cases of COVID-19 — and the world will have a new playbook for conducting urgent clinical research in the middle of an international health emergency. “This is a global, co-ordinated megatrial,” said Dr. Srinivas Murthy, an infectious disease and critical care specialist and associate professor with the University of British Columbia, who sits on the global steering committee for SOLIDARITY. “With just a handful of patients, you can’t really prove anything ever. So we need lots and lots of patients from around the world to prove if (any of these drugs) are useful. “This is completely unprecedented and if this gets pulled off, this is a new model for global collaboration.” The Canadian arm of the global trial, dubbed CATCO (Canadian Treatments for COVID-19), is being funded by the Canadian Institutes of Health Research, which provided nearly $1 million as a part of the federal government’s $275-million commitment towards supporting medical research for COVID-19. Murthy said at least 15 Canadian sites have signed on so far, including Sunnybrook Health Sciences Centre, the Canadian sponsor of the trial, and three other GTA hospitals. Other participating countries include Argentina, Bahrain, France, Iran, Norway, South Africa, Switzerland, Thailand and Spain. Three countries that are notably absent from the collaboration, however, are China, Italy and the United States — the nations hardest hit by COVID-19 so far, collectively reporting more than 245,000 cases. The decision over which drugs to include was the source of heated debate, according to Murthy, who has been consulting the WHO on COVID-19 since January. Eventually, the steering committee settled on four drug treatments that are already licensed for other diseases but show preliminary potential for treating COVID-19 (see sidebar). None of these are expected to be a “miracle cure,” Murthy cautioned, but may prove beneficial towards improving outcomes for certain patients or allow doctors to rule out drugs that clearly don’t work. In selecting these drugs, experts considered not only what was available and effective, but what could be quickly scaled up to reach populations around the world, Murthy said. Typically, the exercise of setting a research agenda is something that can take years; for SOLIDARITY, it all came together within weeks. “The fact that we expedited it so quickly is probably a good thing,” he said. “But at the same time, when you expedite things, things can sometimes get lost, overlooked, or over-addressed. So did we make the right decisions? It’s unclear. But I think time will tell.” The foundational work that allowed SOLIDARITY to assemble so rapidly was laid in the aftermath of the 2014 Ebola outbreak in West Africa, when the WHO came under fierce criticism for its slow and ineffective response. From that stemmed the creation of the WHO’s “R&D Blueprint,” a global strategy for ensuring that the world would be better prepared for future outbreaks. The Blueprint created a plan for fast-tracking drugs and vaccines for a serious and sudden outbreak. It also identified a list of priority pathogens, including Ebola, SARS, MERS and “Disease X” — a placeholder name for a yet-unknown pathogen that experts knew would eventually emerge and explode into a pandemic. In other words, something like COVID-19. In the absence of any treatments, desperate clinicians have started trying unproven drugs for COVID-19 and publishing small studies — reports that are often compelling but lack statistical significance and need to be replicated in much bigger studies before conclusions can be drawn. Currently, more than 500 clinical trials are already registered with the WHO. This is impressive “but also concerning,” Murthy wrote in an editorial published Thursday with the Canadian Medical Association Journal. “There’s been hundreds of small and likely not useful clinical trials testing a random number of different agents,” he told the Star. “When in fact what we need to do is co-ordinate all of these efforts at a global scale — and actually learn things that are useful.”

For more information: https://tinyurl.com/stwv92r

Hep C World News - Week of March 22, 2020

FDA approves new drug to treat HCC

Princeton, NJ - Bristol Myers Squibb Company (NYSE: BMY) recently announced that Opdivo (nivolumab) 1 mg/kg plus Yervoy (ipilimumab) 3 mg/kg (injections for intravenous use) was approved by the U.S. Food and Drug Administration (FDA) to treat hepatocellular carcinoma (HCC) in patients who have been previously treated with sorafenib.Approval for this indication has been granted under accelerated approval based on overall response rate and duration of response seen in the Opdivo + Yervoy cohort of the Phase 1/2 CheckMate -040 trial. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.  “HCC is an aggressive disease in need of different treatment approaches,” said Anthony B. El-Khoueiry, M.D., lead investigator and associate professor of clinical medicine and phase I program director at the Keck School of Medicine, University of Southern California (USC) and the USC Norris Comprehensive Cancer Center. “The overall response rate observed in the Opdivo + Yervoy cohort of the CheckMate -040 trial underscores the potential of this dual immunotherapy as a possible treatment option for patients.” In the CheckMate -040 cohort of HCC patients previously treated with sorafenib, after a minimum follow up of 28 months,1 33% (16/49; 95% CI: 20-48) of patients responded to treatment with Opdivo + Yervoy; 8% (4/49) had a complete response (CR) and 24% (12/49) had a partial response (PR).1 Duration of responses (DOR) ranged from 4.6 to 30.5+ months, with 88% lasting at least six months, 56% at least 12 months and 31% at least 24 months.1 Overall response rate (ORR) and DOR were assessed by Blinded Independent Central Review (BICR) using Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1).1 ORR assessed by BICR using modified RECIST was 35% (17/49; 95% CI: 22-50), with a CR reported in 12% (6/49) of patients and a PR reported in 22% (11/49) of patients. Opdivo is associated with the following Warnings and Precautions including immune-mediated: pneumonitis, colitis, hepatitis, endocrinopathies, nephritis and renal dysfunction, skin adverse reactions, encephalitis, other adverse reactions; infusion-related reactions; embryo-fetal toxicity; and increased mortality in patients with multiple myeloma when Opdivo is added to a thalidomide analogue and dexamethasone, which is not recommended outside of controlled clinical trials. Please see the Important Safety Information section below, including Boxed WARNING for Yervoy (ipilimumab) regarding immune-mediated adverse reactions, as well as select safety information from CheckMate -040. “The incidence of liver cancer is rising in the United States, and HCC is the most common and aggressive form of the disease,” said Andrea Wilson, president and founder, Blue Faery: The Adrienne Wilson Liver Cancer Association.
 

For more information: https://tinyurl.com/rf8glqd

Hep C World News - Week of March 15, 2020
 

New guidelines call for all US adults aged 18-79 to be screened for Hep C

Atlanta, GA - The opioid crisis and an increase in illicit drug use have fueled a resurgence of hepatitis C, a viral infection of the liver. Most adults in the United States should be screened for hepatitis C, according to guidelines published Monday, as the opioid crisis and more prevalent use of illicit injected drugs have driven a nearly fourfold increase in new cases over the last decade. Despite substantial advances in treatment over the past five years, infections are on the rise. Roughly 44,700 new hepatitis C infections were reported in the United States in 2017, according to federal data. A major challenge for health officials is that a significant number of people have the virus but do not know they are infected, said the U.S. Preventive Services Task Force, a national panel of health experts. The expanded guidelines, which were published in The Journal of the American Medical Association, call for the screening of all adults between the ages of 18 and 79. Previously, U.S. health guidelines had recommended testing for adults born between 1945 and 1965. Hepatitis C leads to chronic liver disease in most people who contract it, and some eventually develop cirrhosis and liver cancer. It is spread primarily through the sharing of needles among people who use illicit drugs. The most rapid increase in cases of acute hepatitis C between 2010 and 2017 was reported among young adults between the ages of 20 and 39 who injected drugs, according to the study. Rates increased especially among Native Americans and Alaska Natives, and non-Hispanic white people. The risk of sexual transmission of the disease is low, but it increases for people who have multiple partners, who have a sexually transmitted disease or who are infected with H.I.V., according to the Centers for Disease Control and Prevention. “Some people may not be aware of their risk or they may not want to disclose it to you, so the way to capture the most people is to screen everyone,” said Dr. Douglas K. Owens, chair of the U.S. Preventive Services Task Force and a professor of medicine at Stanford University. “It also helps reduce the stigma.” Members of the task force are appointed by the federal Department of Health and Human Services, but it operates independently from the department. The task force makes recommendations, based on evidence, about clinical preventive services. About 2.4 million Americans are living with hepatitis C. A major challenge for health officials is that hepatitis C complications develop over a period of years, and many people who have contracted it have no symptoms and do not know they are infected.
 

For more information: https://tinyurl.com/ubknddg

Hep C World News - Week of March 8, 2020

Closely watched opioid trial in New York postponed due to coronavirus

Long Island, NY - A highly anticipated trial pitting New York state against McKesson Corp (MCK.N), Johnson & Johnson (JNJ.N), CVS Health Corp (CVS.N) and others for allegedly fueling the opioid epidemic has been postponed due to the coronavirus outbreak, according to the court. The postponement of the March 20 jury trial was a precautionary measure due to the number of people traveling to attend, according to a spokesman for New York Attorney General Letitia James.  A new trial was not set but a hearing will be held April 14 to decide next steps in the case, which is in state court in Suffolk County on New York’s Long Island. The case is the first against a wide range of companies — drug makers, distributors and pharmacy chains — and was brought by the state of New York and the suburban New York City counties of Suffolk and Nassau. Analysts have been watching to see if the companies would settle before the trial, which could provide a framework for a deal to resolve thousands of lawsuits against the companies. The last opioid trial that was scheduled to start in October led to a last-minute $260 million settlement between two Ohio counties and three major drug distributors and Teva Pharmaceutical Industries Ltd (TEVA.TA). The October trial also helped push drug distributors McKesson, Cardinal Health Inc (CAH.N) and AmerisourceBergen Corp (ABC.N) and drugmakers Teva and J&J to propose settling all of the cases against them for $48 billion, although they have struggled to secure support for the deal. More than 3,000 lawsuits, which have mostly been brought by state and local governments, are pending against drug companies over the opioid crisis. Many of them are consolidated before a federal judge in Cleveland. In the only major opioid trial, J&J was ordered to pay $465 million to Oklahoma last year to help alleviate the epidemic. More than 400,000 overdose deaths have been attributed to opioids in the United States since 1997, and the lawsuits generally accuse the companies of downplaying the risks of the drugs or failing to stop suspicious orders.

For more information: https://tinyurl.com/smqh56m

Hep C World News - Week of March 1, 2020

Supervised consumption services review committee releases findings

Calgary, AB - UCP-appointed panel assessed impact of sites on crime rates, social order, property values and business The Alberta government released the findings of a highly anticipated review of the social and economic impacts of supervised consumption sites for drug users on Thursday. The UCP-appointed Supervised Consumption Services Review Committee was tasked last summer with looking into the effects of the sites on crime rates, social order, property values and businesses. The panel did not consider the impact such facilities have on harm reduction, establishing new sites, provincial funding or housing in its review.  Associate minister of Mental Health and Addictions Jason Luan and Justice Minister Doug Schweitzer addressed the press ahead of the committee's remarks at Calgary's McDougall Centre. "I'm deeply troubled with some of the findings of the report," Luan said. "What we heard was a wake-up call. From increases in social disorder, to discarded needles ... what we see is a system of chaos." Luan said that in the wake of the report's findings, the government's priorities would include dealing with issues of needle debris, delivering quality control measures, and working closely across ministries to implement a "fair, firm and compassionate" approach toward addiction issues. Rod Knecht, the committee's chair, said that the committee engaged 19,000 Albertans through public town halls, email submissions, and meetings with key stakeholders to compile its final report, which was submitted at the end of December 2019. Committee vice-chair Geri Bemister-Williams said the "vast majority" of Albertans that they heard from care about their communities, neighbourhoods and neighbours, and "spoke passionately" about the changes in their neighbourhoods since the consumption sites opened. Some businesses and stakeholders, Bemister-Williams said, told the committee that they had no input in the consultation process for the development of the safe consumption sites. Committee calls overdose reversal success rate into question The committee members also said that it found supervised consumption sites have cited "inaccurate" rates of reversing overdoses.  A report published by the Alberta Community Council on HIV last year found that Alberta's supervised consumption sites have had a 100-per-cent success rate. But Bemister-Williams suggested that the committee found that the way overdose reversals are tracked and reported by safe consumption sites are not consistent. She suggested that some recorded overdoses were minor events and involved the administration of oxygen rather than Naloxone. "In many cases, 'adverse events' — even if non-life threatening or minor — are reported as overdoses, and the term 'reversal' is used when the response was a simple administration of oxygen," Bemister-Williams said.  "This leaves the public with an inference that without these sites, thousands of people would fatally overdose or no longer be alive." When pressed for details and asked whether the actions were life-saving, Bemister-Williams did not answer and said she was not there "to make assumptions." CBC News referenced the report directly to clarify these statements, but Bemister-Williams quoted it directly; it also does not specify whether or not the oxygen that was provided in these instances was life-saving. When asked at the press conference if this meant the previously cited 100 per cent success rate in reversing overdoses had been exaggerated, Bemister-Williams would only say that the committee found it was inaccurate. Bemister-Williams told the press that the report's findings included a dramatic increase in opioid-related deaths in the areas surrounding the safe consumption sites. "Although there have been no fatalities at any of the sites, opioid-related deaths increased within the immediate vicinity of the sites after they opened," Bemister-Williams said. In a reference to the city of Lethbridge, she cited a 400 per cent increase in fatalities around some sites. According to the data in the report, the fatalities have jumped from one person to five people. However, the title of the data table used within the report that reflects an increase of deaths surrounding the sites appears to include deaths by alcohol poisoning as well was drugs. A breakdown of these figures was not provided within the report. Bemister-Williams said, had "increased substantially" near most of the sites, and told the media that citizens reported undertaking measures to feel safer "on their own" like building fences and installing lights.  Every community reported an increase in needle debris on public and private property, Bemister-Williams said, as well as feces and garbage. "Despite efforts to address needle debris … many community members still felt this was woefully inadequate. Of note, several schools near the sites have implemented needle pickup committees," she said. "We heard from families that they were avoiding public parks altogether." In conclusion, Bemister-Williams said the committee "recommends the government consider the accounts of Albertans who took the time to share their views." Committee members Bemister-Williams and Knecht — along with ministers Luan and Schweitzer — did not take further questions after the press conference.
 

For more information: https://tinyurl.com/v6jtx72

Hep C World News - Week of February 23, 2020

Injection drug users miss opportunities for HIV or HCV testing

Atlanta, GA – A report published in Helio states that researchers here estimated that around 90% of people who inject drugs missed opportunities for HIV or hepatitis C virus testing during a recent 8-year period — especially rural males seeking care for skin infections or endocarditis. The researchers used data from more than 840,000 health care encounters. “We were interested in assessing HIV and hepatitis C infection testing rates for patients with substance use disorders, and in understanding opportunities for increasing testing rates at clinical visits,” said Lara Bull-Otterson, PhD, MPH, an epidemiologist in the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Currently there is not a specific billing code to indicate that a person injects drugs. Such a code would be helpful to identify people who inject drugs (PWID) who might require HIV and hepatitis C testing and other important health care services, such as substance use treatment or overdose prevention interventions.” Bull-Otterson and colleagues used a nationwide health insurance database to assess the prevalence of testing for HIV and HCV infection among patients with claims filed between 2010 and 2017 who had at least one diagnosis, procedure or medication dispensed that was indicative of injection drug use. The researchers then estimated the percentage of PWID tested for HIV or HCV and assessed demographic and clinical factors associated with testing. Overall, they found that approximately 90% of 844,242 PWID missed opportunities for testing — 71,938 (8.5%) were tested for HIV and 65,188 (7.7%) for HCV. According to the study, missed opportunities were independently associated with being male and having a rural residence. Bull-Otterson said that testing rates for HIV and HCV in PWID are probably low because clinicians have “competing priorities” for care while treating patients for conditions related to their substance use disorder, such as overdose, endocarditis or a soft tissue infection. She said algorithms can be developed that use diagnoses, procedures, tests and medications in a patient’s electronic health record as indicators of injection drug use and these algorithms can be used to generate EHR prompts for health providers to perform HIV testing and could be effective in increasing HCV testing.
 

For more information: https://tinyurl.com/s56gex9

Hep C World News - Week of February 16, 2020

Study shows benefits of treating opioid addiction, HCV at same time

Baltimore, Maryland - Data from a recent study showed the benefits of initiating opioid agonist therapy and hepatitis C treatment at the same time in patients with opioid use disorder and ongoing injection drug use. Benefits included a high rate of SVR and lower rates of drug use, HIV risk-taking behaviors and overdose. In the ANCHOR study, Elana Rosenthal, MD, assistant professor at the University of Maryland School of Medicine Institute of Human Virology, and colleagues treated 100 patients with chronic HCV, opioid use disorder (OUD) and ongoing injection drug use with sofosbuvir/velpatasvir for 12weeks and offered them buprenorphine initiation. The prospective, open-label, observational trial was conducted at a harm reduction drop-in center in Washington, D.C. “We wanted to do a study of patients with active injection drug use of opioids to assess if patients with ongoing drug use could achieve cure rates comparable to non-using populations, but we also wanted to acknowledge that, in these patients, HCV was a symptom of the patient’s underlying opioid use disorder,” Rosenthal told Healio. “We felt an imperative to provide evidence-based treatment for OUD in the same way that we would treat someone’s elevated cholesterol if they came in with a heart attack.” Rosenthal said patients were “eager” to receive HCV treatment, “and when they were turned away, it further reinforced a distrust in the healthcare system that already exists for many people who use drugs.” “Our hope was that, rather than demanding abstinence prior to treatment, we could  utilize HCV treatment as an opportunity to create a therapeutic relationship with a marginalized population, leverage this relationship to reduce harm associated with drug use and potentially engage them in treatment of opioid use disorder, in addition to HCV treatment,” she said. The primary endpoint was, and secondary endpoints were uptake of and retention in OAT, change in risk behavior and determinants of SVR. Results showed that 82% patients achieved SVR, which was not associated with baseline OAT status, on-treatment drug-use or imperfect daily adherence but was significantly associated with completing two or more bottles of sofosbuvir/velpatasvir and being on OAT at week 24, Rosenthal and colleagues reported. During the study, 53 of 67 patients not on baseline OAT initiated OAT. At week 24, 68% patients were on OAT, which was associated with fewer opiate-positive urine drug screens, lower HIV risk-taking behavior scores and lower rates of opioid overdose, according to the researchers. “People who use drugs can and should be treated for HCV,” Rosenthal said. “Concerns about ongoing drug use and adherence impacting HCV cure are not supported in the literature and should not be used to justify excluding this population from treatment. Further, utilizing HCV treatment as an opportunity to engage people who inject drugs in treatment for opioid use disorder not only improves HCV outcomes, but can reduce harms associated with drug use as well.”

For more information: https://tinyurl.com/yxxe4hse

Hep C World News - Week of February 9, 2020

Study looks at opioid discontinuation after surgery among chronic opioid users

Toronto, ON - Many patients use opioids chronically before surgery; it is unclear if surgery alters the likelihood of ongoing opioid consumption in these patients. The researchers performed a population-based matched cohort study of adults in Ontario, Canada undergoing one of 16 non-orthopaedic surgical procedures and who were chronically using opioids, defined as (1) an opioid prescription that overlapped the index date and (2) either a total of 120 or more cumulative calendar days of filled opioid prescriptions, or 10 or more prescriptions filled in the prior year. Each surgical patient was matched based on age, sex, Charlson comorbidity index, and daily preoperative opioid dose to three non-surgical patients who were also chronic opioid users. The primary outcome was time to opioid discontinuation. The cohort included 4755 surgical and 14 265 matched non-surgical patients. After adjustment for sociodemographic characteristics and comorbidities, surgery was associated with an increased likelihood of opioid discontinuation (adjusted hazard ratio: 1.34, 95% confidence interval [CI]: 1.27, 1.42). Among surgical patients, factors associated with a reduced odds of discontinuation included a mean preoperative opioid dose above 90 morphine milligram equivalents (adjusted odds ratio [aOR]: 0.39; 95% CI: 0.32, 0.49) or filling a prescription for oxycodone (aOR: 0.73; 95% CI: 0.56, 0.98). Receipt of an in-patient Acute Pain Service consultation (aOR: 1.34; 95% CI: 1.06, 1.69) or residing in the highest neighborhood income quintile (aOR: 1.35; 95% CI: 1.04, 1.79) were associated with a greater odds of opioid discontinuation. The researchers concluded that for chronic opioid users, surgery was associated with an increased likelihood of discontinuation of opioids in the following year compared with non-surgical chronic opioid users. The study was led by Naheed K. Jivraj of the UofT and ICES

For more information: https://bjanaesthesia.org/article/S0007-0912(19)30964-X/fulltext

Hep C World News - Week of February 2, 2020

Drug deaths summit to take place in Glasgow
 

Glascow, Scotland - A UK-wide summit on tackling problem drug use will be held in Glasgow next month, it has been announced. Drug recovery experts, senior police officers and government ministers from all four UK nations will attend the event. The number of drug-related deaths in Scotland is at record levels, higher than that reported for any other EU country. Both the UK and Scottish governments have committed to addressing the issue.  The Scottish government wants drug policy powers handed to Holyrood so it can alter policy to treat the issue as a public health, and not judicial, matter. And the UK government said prevention and recovery are as important as enforcing drugs laws. Kit Malthouse, the UK minister for crime and policing, will chair the summit on February 27th. He said: "People are dying from drugs every day across the UK and this summit will bring us together to tackle the issue of drug misuse. "We must have firm enforcement action and do all we can on prevention, recovery and treatment, too."Image copyright Getty Images Image caption Those trying to halt the drugs crisis say poverty must be tackled  Scottish government calls for a change in law to enable establishment of a safer drug consumption facilities have so far been rejected by the UK government. Current drug laws, which are reserved to Westminster, prevent possession of Class A drugs within such a facility. But the Scottish Conservatives' public health spokeswoman, Annie Wells MSP, has said she is willing to consider the decriminalisation of drugs. The number of drug-related deaths in Scotland soared to 1,187 in 2018, the highest rate since records began in 1996. Public health minister Joe FitzPatrick, who called for an emergency meeting with his UK counterparts in July last year, revealed the summit announcement was made without any consultation with the Scottish government. He said: "What Scotland faces in terms of drug deaths is nothing short of a public health emergency and we will engage constructively with any attempts to save lives. "Regardless of how the UK government have chosen to go about this, what really matters is reducing harm and saving lives. "That's why listening to, and engaging with, people with lived experience of drug use and those on the front line must be central to any summit."
 

For more information: https://www.bbc.com/news/uk-scotland-scotland-politics-51240315

Hep C World News - Week of January 26, 2020

Study finds specific opioid triples risk of deadly heart infection in injection drug users

London, ON - One specific formulation of an opioid pill is linked to a three-fold increase in a potentially deadly heart infection among injection drug users, a new London study says. One specific formulation of an opioid pillis linked to a three-fold increase in a potentially deadly heart infection among injection drug users, a new London study says. In a report published Wednesday in the medical journal The Lancet Infectious Diseases, London researchers take a closer look at the link between endocarditis — a bacterial infection of the heart valves or lining of the heart — and the controlled-release version of hydromorphone, a prescription opioid commonly abused by injection drug users in London. “It’s quite a radical idea that the medication may be part of the problem,” said Dr. Michael Silverman, lead author and associate scientist at the Lawson Health Research Institute, the medical research arm of London’s hospitals. “Generally, we thought, ‘It doesn’t matter what they inject, it’s always bad to inject (drugs).’ It’s true, injecting puts you at risk, but . . . we’re seeing more (endocarditis) than we would expect, not just in London but across North America.” hydromorphone and endocarditis in injection drug users, was completed at Lawson, Western University and the Institute for Clinical Evaluative Sciences (ICES), a non-profit organization that compiles and processes provincial health data. The researchers examined a data set of 60,529 admissions related to injection drug use at Ontario hospitals between April 2006 and September 2015. Of those admissions, 733 patients had endocarditis. The team found areas with high hydromorphone prescription rates had more than double the cases of endocarditis compared to regions with lower prescription rates. The researchers also looked at individual prescription records and found injection drug users who were prescribed controlled-release hydromorphone were three times more likely to develop endocarditis than ones prescribed other opioids. While some people who were prescribed immediate-release hydromorphone were hospitalized for endocarditis, the rate was significantly less than injection drug users using the controlled-release pills. “Added to the existing data, these findings make a compelling argument for the role of controlled-release hydromorphone in the growing risk of infective endocarditis among persons who inject drugs,” Dr. Matthew Weir, adjunct scientist at ICES and associate scientist at Lawson, said in a statement. Drug users crush the hydromorphone pills, exposing the contents to bacteria that live on human skin, blend them with water in a cooker — a small disposable metal vessel used to mix or heat drugs — and inject the solution. Since hydromorphone pills can sell for up to $60 on the street, users will often keep any leftover drug-water solution in the cooker and save it for later. Previous studies by the London researchers found the controlled-release version of hydromorphone doesn’t dissolve completely, leaving micro shards that can scratch blood vessels and make them vulnerable to infection.

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Hep C World News - Week of January 19, 2020

Vancouver tests new drug-dispensing machine
 

Vancouver, BC - Health advocates say a safe supply of opioids is critical to help prevent people from overdosing on tainted street drugs. Now, a pilot project in Vancouver's Downtown Eastside provides some high-risk users with access to an automated machine that dispenses opioids prescribed by a doctor. The machine, called MySafe, is stocked with hydromorphone tablets that are released on a pre-determined schedule to high-risk opioid users. A user must scan their palm on the machine to identify themselves. The machine recognizes each individual by verifying the vein pattern in their hand and then dispenses their prescription. Made of steel and bolted to the floor, MySafe resembles an ATM or vending machine. It logs every package that is released and sends that information to a web feed that only program administrators can access. Thousands of Canadians have lost their lives to the opioid crisis. In British Columbia, close to 5,000 people have died from overdoses since the province declared a public health emergency in 2016. A toxic drug supply, often contaminated by a powerful opioid called fentanyl, is responsible for at least 80 per cent of overdose deaths in B.C. in the past three years, according to the province's coroners service. Fight for safe supply of drugs is 'this generation's Insite,' advocates say "I think the only ethical response in this situation is to at least give people an alternative of a safe pharmaceutical drug that they will not overdose on," said MySafe founder and infectious disease doctor Mark Tyndall. Tyndall says unlike methadone treatment, which is considered an abstinence-based program and helps addicts only with cravings and withdrawal symptoms, prescribed hydromorphone still gives users a high without the risk of death. Participants are opioid users who have a history of overdosing. They must undergo a medical evaluation before being prescribed hydromorphone and agree to regular follow ups with a health professional. During the pre-screening, a prospective participant must have fentanyl detected in their urine to be eligible. MySafe is located next to an overdose prevention site and participants can use the drugs there in the presence of health-care and front-line workers. The machine can supply enough pills for 48 users, holding five days worth of drugs for each participant, all of whom have their own specific prescriptions. Participants can use the machine up to four times a day, but they must wait a few hours between each use. The machine can be programmed to make the window between doses as long or as short as administrators want.
 

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Hep C World News - Week of January 12, 2020

UAE on track to eradicate hepatitis C within next decade

Abu Dhabi, UAE - New 'micro-elimination' method being rolled out to target small groups one by one. The UAE is on course to eliminate hepatitis C within a decade with the help of a new strategy to wipe out the virus in “baby steps”. The process of ‘micro-elimination’, which targets specific communities or at-risk groups one by one for screening and treatment, would help detect cases and treat patients who might not even know they had the condition, experts said. The approach was trialled in Ras Al Khaimah and is set to be adopted by the Ministry of Health, Samir Alawadi, a consultant gastroenterologist and President of Emirates Gastroenterology and Hepatology Society, said. The tactic means specific groups in a community will be identified and targeted by health workers, rather than the population as a whole. For example, those at greater risk, such as those who undergo blood transfusions, could be prioritised with interventions. Agreements between authorities, hospitals and insurance providers in the UAE can then see expensive treatment provided for the virus, which primarily affects the liver and can cause fatal cirrhosis and liver cancer if left untreated, for all residents. The UAE has previously said it intends to eliminate the disease by 2030, in line with World Health Organisation goals to drastically reduce prevalence. “Along with micro-elimination strategies and the new approved treatments available within the UAE, I think this target can be met within the next 10 years,” Dr Alawadi said. “While prevalence rates in the UAE are low, collaboration between governments, primary care providers, other healthcare specialists, policy makers and pharma companies is key to achieving the WHO elimination targets. “Efforts so far have proven to be successful, however, further simplifying the approach by creating a strategic plan to break down national elimination goals into smaller achievable goals for individual populations, and working collaboratively, will really support to maintain momentum of elimination efforts.” There are an estimated 170 million carriers of Hepatitis C around the world and the Middle East and North Africa regions have the highest regional infection rates. The virus causes approximately 399,000 fatalities each year worldwide, according to WHO. The prevalence in the UAE ranges from 0.24 to 1.64 per cent of the population. But medics have said up to 70 per cent of patients remain undiagnosed. “There’s been a revolution in the treatment of hepatitis B and C, which are major killers,” Stefan Wiktor, Professor in the Department of Global Health at the University of Washington, Seattle, who attended a conference about micro-elimination in Dubai this year, said. “Around 1.4 million people die from chronic viral hepatitis B and C every year but now there’s an effective treatment for both.” While overall infection rates in the UAE are low, he said among some small sub-groups of the population, hepatitis C rates could be far higher. For example, among people who inject drugs, it could be as high as 50 per cent, he said. “The challenge that many countries have had is the fact that it’s all a bit overwhelming,” Professor Wiktor said. “The sheer number of people that need to be tested and treated seems daunting so, the concept of micro-elimination is an idea of carrying out the task in baby steps. “You could pick a city or region and really develop a plan and try to tackle the issue in a smaller area to show that it’s possible and to learn lessons that could then be applied on a national level.  “Basically, this is an idea that simplifies national elimination by identifying a more feasible, more practicable population or group in which you could try to achieve elimination more rapidly.”

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Hep C World News - Week of January 5, 2020

Surge in alcohol-related ER visits by women
 

Ottawa, ON - There has been a significant rise in alcohol-related emergency department visits among women and young adults in Ontario, according to a new study published on Monday in the Canadian Medical Association Journal. The findings were consistent with provincial and national data that show a rise in binge drinking and average weekly alcohol consumption. It’s the latest in a growing number of studies around the world that has found an increase in alcohol-related deaths and ER visits over the last 20 years or so, and highlighted the costly burden on the health-care system. Dr. Daniel Myran, the lead author of the study, said researchers had expected to see increases. “But the extent of the increases that we saw were quite surprising,” said Myran, a family doctor and resident with University of Ottawa’s School of Epidemiology and Public Health.  “I find these increases alarming, and I think that policy-makers should find these increases alarming.” The study by researchers in Ottawa looked at data over a 14-year period involving more than 15 million people in Ontario between the ages of 10 and 105, and examined trends over time based on sex, age and socioeconomic status. The authors of the study said the findings suggested a potential need for the medical community to screen for unhealthy drinking and for services targeting demographics at higher risk. The findings also serve as a possible warning that younger Ontario residents may be falling into harmful drinking patterns, with potential long-term health care consequences in the future. According to the Canadian Substance Use Costs and Harms, the economic impact in Ontario in 2014 from alcohol abuse was $5.34 billion, or $390.66 per person. This included health-care costs, lost productivity, and legal costs. Canada-wide, the cost surged to $14.64 billion for the same period, the website said. The latest study looked at data involving 767,346 emergency visits “entirely caused by alcohol” in Ontario between 2003 and 2016 and found that visits by those between the ages of 25 and 29 rose 175 per cent. Within that age group, trips to the ER by women jumped 240 per cent and rose 145 per cent for men. While men still made up the bulk of alcohol-related hospital visits, the rate of visits among women increased by more than 86 per cent, compared to a 53 per cent rise among men.
 

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