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Can Dexamethasone Improve COVID-19 Survival For Critically Ill Patients?

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British researchers have found an inexpensive and readily available steroid that prevented more than a third of the sickest COVID-19 patients from dying. Researchers conducted a new study, including a large group of coronavirus-infected patients who required mechanical ventilation to breathe. A ten-day course of the drug dexamethasone reduced mortality by 35%, according to researchers from the University of Oxford. In patients with less severe symptoms but still required supplemental oxygen, the steroid treatment reduced death rates by 20%. Dexamethasone could become the first drug treatment with lifesaving effects for COVID-19 patients. The only other medication remdesivir the antiviral drug has proven effective in an extensive clinical trial, but its benefit was limited to shortened recovery time.

Administering the medication to patients in the early stages of the infection could be dangerous for those who are experiencing milder symptoms. According to Dr. Steven J. O’Day, director of regional research at Providence St. John’s Health Center in Santa Monica, people who are tempted to misuse the drug will cause much sicker patients.

The drug dexamethasone is a corticosteroid that emulates the effect of cortisol, which is a hormone produced by the adrenal glands. Dexamethasone can effectively bring down inflammation and is prescribed to treat allergic diseases, skin diseases, rheumatoid arthritis, and autoimmune diseases.

Oxford University’s Dr. Peter Horby, an infectious-diseases expert and one of the clinical trial’s chief investigators, stated the corticosteroid “is the first drug to be shown to improve survival in COVID-19,” He further explained that the survival benefit is prevalent in patients who are ill enough to require oxygen treatment. Dexamethasone could become the standard care in these patients, and the drug is inexpensive and can be used immediately to save lives worldwide, he added. 

According to experts, the reported benefits of dexamethasone or any other steroid are exclusive to coronavirus patients with severe symptoms. Corticosteroids inhibit the production of T cells, a type of white blood cell that the immune system uses to fight a coronavirus infection. With fewer T cells at work, O’Day advised that the treatment could backfire by making a person more vulnerable to infection.

 Approximately 40% of COVID-19 patients who rely on mechanical ventilators will die of the disease, and this drug could provide a new alternative for physicians who are treating critically ill patients. Physicians are currently reviewing the data from the study before implementing any new forms of treatment for patients.

Critical care specialist at UC San Diego’s School of Medicine, Dr. Mark Hepokoski, stated in the study’s initial results stand up to review by independent scientists it could offer him comfort knowing there is a treatment to provide their sickest patients. 

COVID-19 resembles two forms of severe illnesses that are commonly treated in intensive care units. Septic shock is one of them, which is a diagnosis that steroid medications can be used for treatment. The second is acute respiratory distress syndrome, a condition for which steroids are often avoided.

The effectiveness of dexamethasone and precise results will make it a “game-changer” if the study’s findings prove accurate. The new results surfaced from a clinical trial in the United Kingdom known as  Randomized Evaluation of COVID-19 Therapy, or RECOVERY. The RECOVERY trial consisted of 2,104 patients who received dexamethasone and 4,321 who acquired care routinely provided in hospitals throughout the United Kingdom.

The British study results suggest a 10-day regimen of dexamethasone would prevent 1 in 8 mechanically ventilated patients from dying. Patients that require supplemental oxygen alone, about 1 in 25 patients, could be saved by the treatment.

The drug’s use does include some risks, such as making extremely ill patients more susceptible to fungal and bacterial infections that can be fatal. It can make patients’ blood sugar challenging to regulate for heavily sedated patients and on a respirator. This can cause an increased risk of profound muscle weakness.

Since dexamethasone is often used in critically ill patients, the new findings indicate prompt critical care specialists to use it sooner than as a last resort, according to Hepokoski. This could prevent the need for mechanical ventilation for patients, he added. Multiple healthcare experts have stated that dexamethasone could be a useful drug with its wide availability, low price tag, and the ability to scale quickly. 

Discovering effective treatments for patients such as dexamethasone can transform the impact of COVID-19 on patients affected worldwide.

Sources:

  1. https://www.latimes.com/world-nation/story/2020-06-16/widely-available-steroid-can-improve-chances-covid-19-survival
  2. https://wordofhealth.com/2020/05/20/woh-series-part-2-current-treatments-for-covid-19/
  3. https://www.saintjohnscancer.org/about-jwci/people/steven-oday/
  4. https://www.healthline.com/health/corticosteroids-what-are-they
  5. https://www.ndm.ox.ac.uk/principal-investigators/researcher/peter-horby
  6. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/t-cell
  7. https://profiles.ucsd.edu/mark.hepokoski
  8. https://medlineplus.gov/ency/article/000668.htm
  9. https://www.nhlbi.nih.gov/health-topics/acute-respiratory-distress-syndrome
  10. https://clinicaltrials.gov/ct2/show/NCT04381936

Covid-19

Coronavirus: Sanitize or Disinfect?

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During the COVID-19 pandemic, it is imperative that you wash your hands frequently or sanitizing them when soap and water are not available and cleaning commonly-touched-surfaces to keep yourself protected.

While sanitizers and disinfectants are commonly referred to as interchangeably, both products are different and should be used in separate circumstances.  

According to the CDC, cleaning, sanitizing, and disinfecting all have different definitions:

  • Cleaning eliminates germs, dirt, and other impurities from surfaces, but does not necessarily kill them.
  • Sanitizing decreases the number of germs on surfaces or objects by killing them or removing them—to a safe level, according to public health standards or requirements.
  • Disinfecting kills germs on objects or surfaces.

Diane Calello, MD, executive and medical director of New Jersey Poison Center and associate professor of emergency medicine at Rutgers New Jersey Medical School, states sanitizing does not kill everything. 

The Environmental Protection Agency (EPA) defines sanitizers as chemical products that can kill 99.9% of germs on hard surfaces. Again, disinfectants are more potent, killing 99.999% of germs on hard, non-porous surfaces or objects.

The difference comes down to that sanitizing solutions aren’t as potent as disinfecting solutions. Some products can be both sanitizers and disinfectants. Dr. Calello says concentrated bleach can be a disinfectant, but if it’s very diluted, it might be a sanitizer meaning it kills fewer bacteria and viruses.

Sanitize or Disinfect?

There are specific procedures for cleaning groceries, surfaces in your home like doorknobs, and your hands, and it’s crucial to get them right. When it comes to groceries, you don’t need to wipe them down with disinfectant wipes (or any other disinfectants) or a sanitizer. You can clean them using water, but no soap when you bring them to your home.

For highly-touched areas of your home like doorknobs, toilet handles, and even sinks, you want to save disinfectants for these areas. However, for countertops where surfaces are exposed to food preparation, its best to sanitize those so any chemical residue isn’t as powerful and potentially harmful.

As for your own hands, you should not use disinfecting wipes as it can be hazardous for your skin, according to Dr. Calello. She further adds that at the poison center, she works for has seen people’s adverse effects using disinfectants on their own bodies. She said there was a man who acquired powerful, industrial-use disinfectant wipes and developed a blistering rash.

Donald Ford, MD, family medicine doctor at Cleveland Clinic, states that you can wipe off surfaces but wash your hands. Due to the “good” bacteria that live on your skin, when you apply something that kills all the bacteria on your hands, you’re killing off some helpful and natural bacteria. 

Dr. Calello says there is a reason why we do not apply something that does not kill every organism like a hand sanitizer, which should contain 60% alcohol. However, it’s essential to remember that hand sanitizer is adequate if you’re out in public, but washing hands with soap and water for at least 20 seconds is preferred.

Since the COVID-19 pandemic, there has been an increase in people purchasing disinfectants and sanitizing products and knowing when to sanitize and disinfect surfaces or objects can help in practicing proper sanitation. 

Sources: 

  1. https://www.health.com/condition/infectious-diseases/coronavirus/sanitize-vs-disinfect
  2. https://www.cdc.gov/flu/school/cleaning.htm
  3. https://www.epa.gov/sites/production/files/documents/ece_curriculumfinal.pdf
  4. https://www.njpies.org/administrative-staff/
  5. https://rutgershealth.org/provider/diane-calello
  6. https://www.health.com/condition/infectious-diseases/coronavirus/how-to-use-cleaning-chemicals-safely

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Covid-19

How to Properly Disinfect Every Type of Face Mask

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Face masks help limit the spread of COVID-19 by catching respiratory droplets that are released when people sneeze, cough, or talk. According to Dr. Steve Pergam, MPH, medical director of infection prevention at Seattle Cancer Care Alliance, this is how the virus spreads person to person through these droplets.

When a person nearby inhales the droplets or the droplets land inside their mouth or nose, they could contract an infection with the virus. They could also likely contract the virus by touching a contaminated mask then touches their mouth or nose.  

Cleaning and sanitizing your mask is essential to limit the possibility of contracting the virus from contaminated surfaces, including face masks. 

This article will show how to safely disinfect common types of masks for reuse and handle medical-grade masks that cannot be easily cleaned outside of a medical setting.

Cloth Face Coverings

Debra Goff, PharmD, FIDSA, FCCP, an infectious diseases specialist and pharmacy professor at The Ohio State University Wexner Medical Center, states that bandanas, cloth masks, neck gaiters, and scarves are masks that can be cleaned and reused.

If you plan to machine-wash your mask, first, wash your hands. Then remove the mask and do not touch your eyes, nose, or mouth, Goff advises.

Place the mask directly into the washing machine then wash your hands immediately.

Goff recommends using your regular laundry detergent in addition to bleach and the warmest water recommended for that fabric type. Once the mask is washed, dry on high heat until it’s completely dry.

For hand-washing your mask, she suggests following the same method washing your hands before removing your face mask.

To disinfect your mask properly, soak it in a bleach solution containing four teaspoons of household bleach per each quart of water for 5 minutes.

Then soak the mask, and rinse thoroughly with water, and let the mask air-dry.

Goff states it’s best to clean cloth face masks after each use.

Medical-Grade Masks 

Kaiming Ye, Ph.D., professor and department chair of biomedical engineering and director of the Center of Biomanufacturing for Regenerative Medicine at Binghamton University, State University of New York, states that some masks, like N95 and surgical masks, are intended for single-use only.

This means the masks should be thrown away in the trash after wearing them for the average person.

Ye says these masks can be reused in professional settings, however, if properly sanitized. He says N95 masks can be disinfected by UVC germicidal irradiation or vapor phase hydrogen peroxide. 

However, there have been no tests performed on surgical mask disinfection or reuse as the demand is low, Ye notes. Goff suggests inspecting the mask when you take it off when you can’t replace your mask between each use.

If the face mask is dirty, torn, or saturated with moisture, she says you should discard it. Suppose it appears to be clean and intact. In that case, she recommends storing it in a clean paper bag or another breathable container between uses.

Ideally, however, they shouldn’t be reused.

Face Shields 

Since face shields open on the side, they don’t protect you from sneezes or coughs behind you. Face shields, however, protect your eyes.

Goff says face shields are often worn with a face mask for added protection. When it comes to cleaning face shields, first wipe down the inside using a clean cloth saturated with a neutral detergent solution or cleaner wipe.

Then wipe down the outside using a disinfectant wipe or clean cloth saturated with a disinfectant solution. Followed by wiping the outside of the face shield with clean water or alcohol to remove the residue.

Allow the face shield to air-dry, and finally, wash your hands when you’re done. Face masks are an essential way to prevent and limit the spread of COVID-19.

Make sure your face masks are cleaned or discarded after use by following these guidelines on how to keep every type of face mask sanitized.  Keep in mind that medical masks are not designed for reuse. Face shields may be used in addition to a face mask for more protection, and should also be cleaned between uses.

Sources: 

  1. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
  2. https://www.cdc.gov/media/releases/2020/p0714-americans-to-wear-masks.html
  3. https://www.seattlecca.org/providers/steven-a-pergam
  4. https://pharmacy.osu.edu/directory/debra-goff
  5. https://www.binghamton.edu/biomedical-engineering/people/profile.html?id=kye

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Covid-19

Abbott’s Latest COVID-19 Test Costs $5

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Abbott Labs has received emergency approval from the FDA for its rapid antigen test that detects COVID-19 in fifteen minutes. According to Brett Giroir, the United States Assistant Secretary for Health and the Department of Health and Human Services stated the test is a “game-changer.” 

The FDA’s emergency use authorization for Abbott’s BinaxNOW COVID-19 Ag Card is approximately the size of a credit card. BinaxNOW will cost $5 and include a free mobile app that will let people who test negative display a temporary, date-stamped health pass renewed each time a new test is taken. 

The antigen test involves a nasal swab that uses the same type of technology as a flu test. Abbott announced it expects 50 million BinaxNOW tests a month produced by October.

Joseph Petrosino, a professor of virology at Baylor College of Medicine, expressed his enthusiasm for Abbott’s new COVID-19 test. He stated the test’s massive scale would allow millions of people to have access to quick and reliable COVID-19 testing. He added this would help get infectious people off the streets and into quarantine, limiting the virus’s spread.

The BinaxNOW COVID-19 Ag Card is the fourth antigen test to receive an emergency use authorization from the Food and Drug Administration. 

The antigen test looks for pieces of the virus that are not as reliable as the traditional Polymerase chain reaction test, which looks for the virus’s genetic material. However, they are faster, less expensive, and less invasive. PCR tests have been beset by supply chain problems and back-ups at labs, which have delayed results and cause confusion among patients, doctors, and public health officials. 

 Sources: 

  1. https://www.abbott.com/BinaxNOW-Test-NAVICA-App.html
  2. https://www.cnn.com/2020/08/27/investing/abbott-labs-rapid-covid-test/index.html
  3. https://www.bcm.edu/people-search/joseph-petrosino-28634

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