|
|
| |
 |
|
|
Presented by
|  |
|
|
With help from Myah Ward
STRONG MEDICINE — For weeks doctors and nurses around the country had no real handbook for how to treat the Covid patients that started showing up in their emergency rooms. They had some insight from clinicians in Italy and China and experience treating patients with respiratory ailments, but early treatments included a lot of frantic guesswork.
Now, five months after the first Covid patient walked into a clinic in Everett, Wash., there’s still no FDA-approved therapy or treatment for the virus. In fact, there are two fewer drugs with even a preliminary nod from the agency: The FDA pulled its emergency use authorizations today of chloroquine and hydroxychloroquine, the antimalarial drug touted by President Donald Trump as a Covid treatment.
There are still far more questions than answers when it comes to managing Covid patients. But doctors have made some progress. About 560,000 Covid patients are known to have recovered, according to Johns Hopkins University, though the figure is almost certainly higher because not all states track recoveries and not every infected person goes to the hospital. Here’s a look at what we’ve learned about treating Covid, and what doctors have yet to figure out.
What we got wrong — In the early days of the pandemic, doctors were more willing to try off-label drugs without the usual vetting process, said Daniel Culver, a pulmonary and critical care physician at the Cleveland Clinic who leads a committee that evaluates Covid clinical trial research. That’s partly behind the rise and now fall of hydroxychloroquine. Clinical trials are still ongoing, but the drug’s effectiveness at treating Covid remains questionable.
What we are learning — Evidence is mounting that the antiviral drug remdesivir is effective at helping severely infected Covid patients with low oxygen levels. It’s now the only drug with emergency use authorization from the FDA.
There are hundreds of trials underway for dozens of Covid treatments. Some therapies, like using convalescent plasma from recovered patients to treat the critically ill, are being studied but so far there’s no definitive evidence on whether they are effective.
What we learned not to do — Doctors now believe it’s no longer a good idea to intubate — meaning put on a ventilator — all patients with low oxygen, said Amy Compton-Phillips, chief clinical officer for Providence Health System, which has 51 hospitals including the one that treated the first U.S. Covid patient.
Early on, Compton-Phillips said, her system relied on the advice of doctors in Italy and China to quickly put patients on a ventilator because it was thought to better protect health care workers and because the disease progressed so rapidly. But over time, the health system, which created a registry to track care for Covid patients across its hospitals, realized many patients didn’t need the invasive procedure, which comes with its own risks, right away. Instead the hospital tried other procedures to help patients boost oxygen levels, like proning patients — putting them on their stomachs — to help them inflate their lungs. Over the time, the health system cut its intubations in half, and mortality rates also declined.
What we know now about treating complications — Doctors also began to realize that Covid was more than just a respiratory disease — it can affect all organs and in particular kidneys. Up to 15 percent of patients hospitalized with Covid develop acute kidney injury and many need dialysis.
Intensive-care doctors now pay more attention to how much fluid they are giving patients, being more careful not to flood their lungs and other organs. And they focus more on keeping Covid patients from developing blood clots, which have led to amputations, strokes and other complications.
And hospitals are working on preventing infections by reducing the use of invasive procedures like catheters and better isolating infected patients. “It’s a question of being systematic and careful rather than a eureka thing,” Culver said. “Everyone wants to focus on bells and whistles, but the blocking and tackling part is the most important.”
What we still don’t know — “We’re not even at the end of the beginning for learning about this virus,” Compton-Phillips said. Researchers are trying to figure out answers to the biggest questions including how to intervene early to keep the virus from becoming severe, what are the long-term complications of a Covid infection and why it has been more lethal in black and Hispanic populations.
Welcome to POLITICO Nightly: Coronavirus Special Edition. My nine-month-old son took his first steps this weekend! Reach out with tips: rrayasam@politico.com or on Twitter at @renurayasam.
|
|
| |
A message from PhRMA:
America’s biopharmaceutical companies are sharing their knowledge and resources more than ever before to speed up the development of new medicines to fight COVID-19. They’re working with doctors and hospitals on over 1,100 clinical trials. Because science is how we get back to normal. More. |
| |
|
|
A woman reacts as she gets her temperature checked outside the Apple store in Covent Garden in London. The British government relaxed coronavirus lockdown laws significantly today, allowing zoos, safari parks and non-essential shops to open to visitors. | Getty Images
|
|
|
|
INSPECTION FAILURE — Thousands of nursing homes across the country have not been checked to see if staff are following proper procedures to prevent coronavirus transmission, Rachel Roubein and Maggie Severns write. Only a little more than half of the nation’s nursing homes had received inspections, according to data released earlier this month, which prompted a mandate from Medicare and Medicaid chief Seema Verma that states complete the checks by July 31 or risk losing federal recovery funds.
A POLITICO survey of state officials suggests that the lack of oversight of nursing homes has many roots. Many states that were hit hard by the virus say they chose to provide protective gear to health workers rather than inspectors, delaying in-person checks for weeks if not months. Some states chose to assess facilities remotely, conducting interviews over the phone and analyzing documentation, a process many experts consider inadequate. “It is not possible or believable that the infection control surveys accurately portray the extent of infection control deficiencies in U.S. nursing facilities,” the report states.
The American way of dying — Hancock County, Ga., a predominantly African American jurisdiction where most deaths have occurred in nursing homes, has the most rapidly growing Covid death rate in the country. McKinley County, N.M., and Hancock County are among the many low-income areas in the U.S. with swiftly growing death rates.
|
|
|
|
|
| |
HAPPENING TOMORROW at 12 p.m. EDT/9 a.m. PDT: A VIRTUAL INTERVIEW WITH LOS ANGELES MAYOR ERIC GARCETTI: Los Angeles is grappling with a rising number of Covid-19 cases and a wave of protests for racial justice after the killing of George Floyd. California Playbook authors Carla Marinucci and Jeremy White will find out how Los Angeles Mayor Eric Garcetti is dealing with these twin crises during a virtual interview TOMORROW. REGISTER HERE.
|
| |
| |
|
|
|
DARK CLOUDS IN GOLDEN STATE — More than 200,000 Americans are likely to die from Covid by Oct. 1, up from a previous estimate of just under 170,000, according to newly updated projections from the University of Washington’s Institute for Health Metrics and Evaluation. The projected deaths in California have almost doubled: About 15,155 Californians are predicted to die, up from 8,812.
Despite rising case loads, Democratic Gov. Gavin Newsom offered his most vigorous defense yet today for reopening California’s economy, writes California Playbook co-author Jeremy White . “There’s a certain point where you have to recognize you can’t be in a permanent state where people are locked away for months and months and months on end,” Newsom said, warning of the broader public health impacts of seeing “lives and livelihoods completely destroyed.”
Whether California’s economy bounces back could rest on one sector in particular: child care. Steep revenue losses and costly new health and safety requirements are putting beleaguered child care programs out of existence in the high-cost state just as more parents return to the workplace, California consumer regulation reporter Katy Murphy writes. Even a relatively small percentage of closures could sideline workers and hamper the recovery, particularly in California's tourism, entertainment and dining sectors, where remote work is not possible.
Slots towns go bust — In January, 2020 was looking like it could be the sixth straight year of revenue growth for the U.S. gambling industry, especially after more states approved legal sports betting. In 2019, $10.2 billion was paid in gambling taxes to state and local governments.
The virus brought these dollars to a screeching halt, Myah Ward writes. The billions brought in by gambling to states and cities helps pay for education initiatives, health insurance programs, infrastructure and more.
Gambling destinations have been especially traumatized. Reno, Nev., saw 337,000 come through its airport, or 11,000 a day, in April 2019, Reno Mayor Hillary Schieve said. In April 2020, just 17,000 visited the “Biggest Little City in the World.”
In April last year, gambling revenue in the Reno area was more than $65 million, Schieve said. For April 2020, it was zero — with a nearly $80 million loss.
Rob Cashell, Jr., who owns three casinos in northern Nevada, and one outside of Carson City, spent almost $600,000 paying employees for six weeks before he furloughed them once he realized how long the shutdown would last. The state’s casinos shut down March 18, and were allowed to reopen June 4. In Reno, the family-owned Bonanza Casino had never before closed its doors during its 47-year existence, general manager Ryan Sheltra said.
It’s dire in Atlantic City as well, where casino operators are advocating for a reopening on July 4, historically the city’s most profitable weekend, said Jane Bokunewicz, a professor at New Jersey’s Stockton University and a former executive at Atlantic City’s Tropicana casino. The city where Donald Trump owned three casinos accounts for 20 percent of New Jersey’s tourism revenue.
In Biloxi, Miss., gambling accounts for upwards of 40 percent, or $20 million, of the city’s budget, Mayor Andrew Gilich said. He said it’s going to be hard to recover that money as the city scrambles to fill the hole.
Casinos nationwide have been reopening this month, following state and local guidelines. Cashell has seen signs of a promising rebound in Reno, but he worries his business couldn’t weather another shutdown.
“I've depleted all of our cash reserves, so I'm hopeful that between now and the end of the year we'll be able to rebuild those cash reserves and get back on our feet,” he said. “But if that shutdown were to come again between now and the end of the year at some point, I'm not sure what that would mean for us.”
‘Very powerful decision’ — LGBT rights advocates triumphed at the Supreme Court today, winning a sweeping decision from the justices that protects gay, lesbian and transgender employees from being disciplined, fired or turned down for a job based on their sexual orientation. Two of the court’s Republican appointees, Neil Gorsuch and John Roberts, joined the court’s Democratic appointees to deliver the surprising 6-3 victory to those arguing for anti-discrimination protections. When asked about the ruling, Trump offered a mild response. “I've read the decision,” the president said of the various opinions, which ran to 119 pages. “Some people were surprised, but they’ve ruled and we live with their decision. That’s what it’s all about. We live with the decision of the Supreme Court. Very powerful, very powerful decision, actually.”
|
|
|
|
|
|
GOOD ENOUGH TO BE A TRACING — Contact tracing is essential while we wait for a coronavirus vaccine. But it requires a lot of work — and a lot of people. “It’s all about notifying people as early as possible that they’ve potentially been infected, so that they can quarantine themselves or take other precautionary steps to stop the spread of the virus, says Steven Overly in the latest POLITICO Dispatch. Steven explains how smartphone apps could save the day, and why a lack of coordination between states could spell trouble.
|
|
|
|
|
| |
|
|
| |
|
|
|
BORROW, TAX OR BOTH — Total global government debt totaled $188 trillion by the end of 2018, and now Covid-19 is adding tens of billions to that number, through a combination of extra spending (more than $11 trillion) and lower tax revenues. There are two dominant economic schools of thought in democracies about how to deal with that, Ryan Heath writes: The first says keep spending while debt is essentially free (with interest rates at or near zero), and the second says pay it back by raising taxes on those who can afford it.
Left-wing Nobel Prize-winning economists Thomas Piketty and Joseph Stiglitz are advocating recommendations in a new report published today by a group of international NGOs, including Oxfam. The top goals are to close digital tax loopholes and increase corporate tax receipts. They argue that the biggest economic winners from the pandemic — digital companies that don’t depend on face-to-face interactions or physical goods for their revenue — are the same ones that find it easiest to minimize or evade tax. On a Zoom call about the report, Stiglitz called the revenue gap “100 times worse” than in 2009 after the financial crisis.
There’s a decent chance Big Tech will be hit. Big individual countries like U.K. and France have moved ahead with national digital taxes, while the Organization for Economic Cooperation and Development — a Paris-based economic advice club for rich governments — has been working toward a global deal to tax digital companies. French Finance Minister Bruno Le Maire told the French Senate last Thursday that only the U.S. is holding up a deal.
Raising corporate tax rates “is not enough,” Piketty argues: He says wealth taxes and “a global system with global registry to track income flows and asset ownership” are needed. “The case for a wealth tax has become stronger since the pandemic,” Piketty said on the Zoom call, and is popular among both Democratic and Republican voters, if not the parties themselves.
International Monetary Fund chief Kristalina Georgieva warned a roundtable of economists hosted by the GLOBSEC think tank today that “money cannot be free forever,” but while it is, governments should use it to protect economic growth. “We should be careful not to withdraw support too quickly,” Georgieva said, because that would kill off the fragile economic recovery. |
|
| |
Protect Yourself and Others From Coronavirus: Even if you don’t have symptoms, you could spread the coronavirus. Practice these physical distancing and hygiene tips to keep yourself and your loved ones safe: Stay 6 feet away from others in public; wash your hands often for 20+ seconds; disinfect frequently touched surfaces like cellphones and light switches; and wear a cloth face covering when out in public. Together, we can slow the spread. Visit coronavirus.gov to learn more.
|
| |
| |
|
|
|
|
|
85 percent
The proportion of the U.S. beef slaughter and packaging industry controlled by the four largest meatpackers — Tyson Foods, JBS, National Beef and Cargill — according to USDA data. These larger companies have garnered strong federal attention in trying to get back online after pandemic disruptions, but smaller firms have struggled to gain the same regulatory easing and financial aid.
|
|
|
|
|
WHEN VACCINES AREN’T NEEDED — Scientific advances have put us closer than we’ve ever been to the end of AIDS. Ethical concerns could still push it out of reach. Advances in prevention and treatment have lessened the urgency in finding a vaccine or cure for the disease, writes senior European health care reporter Sarah Wheaton, but they’ve also complicated the clinical trials needed to prove that a potential breakthrough is effective. “Our success is the thorn in the flesh,” said Linda-Gail Bekker, deputy director of the University of Cape Town’s Desmond Tutu HIV Center.
AIDS revolutionized drug research, as desperate patients raged at regulators for denying them access to experimental drugs that might not work, or could even be dangerous, but often represented the only chance of saving their lives. Activists in the 1980s and 1990s convinced governments and drugs regulators to let them take untested medicines even if it might undermine the strict process for clinical trials. The uncertainty of an unproven treatment was better than a death sentence. The widespread adoption of antiretroviral drugs — to manage or prevent the disease — have turned that logic on its head. People on treatment can essentially live a normal life with HIV — and be confident that they won’t pass the virus on to others, leaving scientists and drugmakers facing a different ethical dilemma: How do you justify testing a vaccine that might not work when we know a daily pill can prevent HIV?
|
|
| |
A message from PhRMA:
America’s biopharmaceutical companies are sharing their knowledge and resources more than ever before to speed up the development of new medicines to fight COVID-19. They’re working with doctors and hospitals on over 1,100 clinical trials. And there’s no slowing down. America’s biopharmaceutical companies will continue working day and night until they beat coronavirus. Because science is how we get back to normal. See how biopharmaceutical companies are working together to get people what they need during this pandemic. |
| |
|
|
|
|
| |
Follow us on Twitter
|
| |
FOLLOW US
|
| |
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.