Key discovery in psoriatic arthritis points way for developing targeted treatments

The strongest evidence yet of a single cause for psoriatic arthritis has been discovered by researchers. The disease may be activated by the same trigger in different patients which, if identified, could move towards creating therapies that would prevent psoriatic arthritis, and potentially providing a cure.
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Does the Mediterranean diet protect against rheumatoid arthritis?

Previous research has demonstrated a variety of health benefits associated with the Mediterranean diet, which is rich in olive oil, cereals, fruit and vegetables, fish, and a moderate amount of dairy, meat, and wine. Now results suggest that the diet may also help prevent rheumatoid arthritis in individuals who smoke or used to smoke.
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Risk of new lockdowns rises with fear of second COVID-19 wave

LONDON/BRUSSELS (Reuters) – Fears of a second wave of COVID-19 infections shut six major food markets in Beijing on Friday, while India, which opened up this week, recorded a record daily increase and half a dozen U.S. states said their hospital beds were filling up fast.

FILE PHOTO: People wearing face masks queue to enter a reopened Primark store as Madrid eases lockdown restrictions following the coronavirus disease (COVID-19) outbreak, in Madrid, Spain, June 11, 2020. REUTERS/Susana Vera/

Health officials worldwide have expressed concerns in recent days that some countries grappling with the devastating economic impact of lockdowns may lift restrictions too swiftly, and that the coronavirus could spread during mass anti-racism protests.

“We must be ready to roll back relaxation of measures if needed,” the European Union’s health commissioner Stella Kyriakides said after urging its 27 members to plough ahead with testing the population as they reopen schools and businesses.

In China, where the new coronavirus originated, two new cases of COVID-19, the disease it causes, were recorded in the capital. Authorities closed part or all of six big wholesale food markets which the two men had recently visited but it was not known how they had become infected.

India opened most public transport, offices and malls this week after nearly 70 days even though health officials said it was weeks away from flattening the rising infection curve.

The official death toll, at 8,498, is relatively small, but the health ministry said registered cases rose by 10,956 on Friday, a record, with many in Delhi, Mumbai and Chennai.

Syed Ahmed Bukhari, the head of Delhi’s Jama Masjid, one of India’s biggest mosques, ordered a halt to congregations until the end of the month.

“What is the point of visiting mosques at a time when the virus is spreading so fast?” he said.

FIRST WAVE NOT OVERCOME

In Turkey, the top medical association said the easing of restrictions on June 1 had come too soon, although the daily death toll as fallen in recent weeks to about 20.

“There is talk of when the second wave will hit, but we have not yet been able to overcome the first wave,” Cavit Isik Yavuz, part of the coronavirus research team at the Turkish Medics Association said.

While new infections are slowing in most of Europe, health experts see a moderate to high risk that post-lockdown rises may warrant new restrictions.

The European Centre for Disease Prevention and Control (ECDC) predicted a moderate acceleration across Europe in coming weeks, which could place healthcare systems under stress if not checked rapidly. Government control measures could check and reverse upward trends within two to three weeks, it said.

Andrea Ammon, director of the ECDC, stressed the importance of maintaining physical distancing, hand hygiene and what she called “respiratory etiquette”.

Officials have expressed concern the virus could spread among the tens of thousands who have crowded together in Europe’s big cities to demonstrate against racism after the death in U.S. police custody of George Floyd.

“Mass events could be a major route of transmission,” said Martin Seychell, a health official at the EU Commission.

SOLIDARITY CALL

World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus said late on Thursday that the threat of a resurgence remained very real.

“We must also remember that, although the situation is improving here in Europe, globally it’s getting worse … We will continue to need global solidarity to defeat this pandemic fully,” he said.

Of 5,347 new deaths recorded worldwide, 3,681 were in the Americas, the WHO said on Thursday.

In about half a dozen U.S. states including Texas and Arizona, the number of coronavirus patients filling hospital beds is rising, fanning concerns that the reopening of the U.S. economy may unleash a second wave of infections. Alabama, Florida, North Carolina, South Carolina, Oregon and Nebraska all had a record number of new cases on Thursday.

“I want the reopening to be successful,” Harris County Judge Lina Hidalgo, the top executive for the county that encompasses Houston, Texas, told reporters. “But I’m growing increasingly concerned that we may be approaching the precipice of a disaster.”

More hospitalisations inevitably mean more deaths ahead, said Spencer Fox, research associate at the University of Texas at Austin.

“We are starting to see very worrying signs about the course the pandemic is taking in cities and states in the U.S. and around the world,” he said. “When you start seeing those signs, you need to act fairly quickly.”

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Wall Street’s main indexes opened sharply higher on Friday, a day after the biggest one-day dive in about three months on fears of a resurgence in infections. Global stocks .MIWD00000PUS were up 1.3% after four days of consecutive losses.

The United States has now recorded more than 113,000 coronavirus deaths, by far the most in the world. That figure could be over 200,000 by September, Ashish Jha, the head of Harvard’s Global Health Institute, told CNN.

additional reporting by Reuters bureax around the world, writing by Philippa Fletcher; Editing by Kevin Liffey and Toby Chopra

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Virus has multiple pathways into cells, Moderna vaccine clears safety hurdle in mouse study

(Reuters) – The following is a brief roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

FILE PHOTO: A worker checks the temperature of a client at a local store opened for pick up, as phase one of reopening after lockdown begins, during the outbreak of the coronavirus disease (COVID-19), at 5th Avenue in New York City, New York, U.S., June 12, 2020. REUTERS/Eduardo Munoz/File Photo

Coronavirus has more than one gateway into cells

Two teams of European researchers, working independently, have identified a new entryway through which the coronavirus gets into cells and infects them, suggesting another approach to stopping it. One key route – via a protein on cell surfaces called ACE2 – is well known. The newly identified gateway is a cell-surface protein called neuropilin-1, or NRP1. A “spike” on the surface of the coronavirus binds to NRP1, allowing the virus to break into the cell, similar to how a virus spike attaches itself to ACE2. Other viruses also employ NRP1 as an entry into cells, including the one that causes mononucleosis. In laboratory experiments with human cells, one of the teams found that an antibody that binds to NRP1 can block the coronavirus spike from attaching and prevent infection. Neither of the studies has been through the peer-review process. One was posted on the preprint server bioRxiv on Wednesday and the other late last week. The research groups say their findings suggest that NRP1 could be another target for drugs and vaccines against the new virus. (bit.ly/2C1nKk4; bit.ly/2UE2pDJ)

Mouse study suggests Moderna vaccine will be safe in humans

A study of Moderna Inc’s COVID-19 vaccine in mice lends some assurance that it will not increase the risk of more severe disease in humans, and that one dose may provide protection against the novel coronavirus, according to preliminary data released on Friday. Prior studies testing vaccines in similar viruses have suggested that rather than being protective, they might accidentally cause more severe disease, especially in individuals who do not produce an adequately strong immune response. Scientists see this risk as a key hurdle that must be cleared before vaccines can be safely tested in thousands of healthy people. While the data released by the U.S. National Institutes of Allergy and Infectious Disease and Moderna were encouraging, mouse data is no guarantee of what will happen in humans. Further testing also suggested that the vaccine induces potent neutralizing antibody responses – the type of response needed to block the virus from infecting cells – and that it appeared to protect against infection in the lungs and nose without evidence of toxic effects. The study, which has not yet been peer reviewed, was posted on the bioRxiv website. Moderna said on Thursday it plans to begin final-stage trials enrolling 30,000 people in July. (; reut.rs/37pvckt;bit.ly/30Br3sr)

Hydroxychloroquine affect on immune system not helpful against virus

Researchers studying how hydroxychloroquine modifies the body’s immune response have found it is unlikely to be helpful in fighting the coronavirus, in the latest evidence against use of the decades-old malaria drug promoted by U.S. President Donald Trump. The medicine, which is also used treat inflammatory conditions like lupus and rheumatoid arthritis, was shown to prevent the new coronavirus from replicating in test tube experiments. While it does reduce severe inflammation, the researchers say, it simultaneously suppresses the immune responses needed to fight off the virus and does not allow the body to develop so-called trained immunity, which facilities the defense against infections. “The fact that hydroxychloroquine averts trained immunity argues against the usefulness of this drug in clearing SARS-CoV-2 infection,” the researchers wrote in a not-yet-peer-reviewed paper posted on Tuesday on the preprint server medRxiv. (bit.ly/30CRQoe)

COVID-19 is a neurological disease too

Add problems with the brain and nervous system to the list of complications in patients with COVID-19, say doctors, providing further evidence that it is far more than a respiratory illness. For a report on Thursday in the Journal of Neurology, researchers pooled data from 41 previously published studies of the neurological effects of the coronavirus. The most common nonspecific neurological symptoms were fatigue (seen in 33.2% of patients), loss of appetite (30.0%), shortness of breath (26.9%), and general malaise (26.7%). The most common specific neurological symptoms – which occurred less often – included disorders of smell and taste, Guillain-Barré syndrome and inflammation of the brain, spinal cord, and meninges. These tallies did not include strokes that result from blood clotting disorders caused by the coronavirus. In a report published on Sunday in Annals of Neurology, a separate team of doctors called COVID-19 “a global threat to the nervous system” and said, “the number of recognized neurologic manifestations of SARS-CoV-2 infection is rapidly accumulating.” (bit.ly/2YnRuz6; bit.ly/3hgFCYp)

Mask-wearing significantly reduces infection risk

Of all the lifestyle changes imposed to prevent the spread of the new coronavirus, mask-wearing may be the most important, a new study suggests. Researchers say infection trends shifted dramatically when mask-wearing rules were implemented on April 6 in northern Italy and April 17 in New York City – two epicenters of the pandemic. “This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9,” they calculated in a study published on Thursday in PNAS: The Proceedings of the National Academy of Sciences of the USA. When mask-wearing went into effect in New York, the daily new infection rate fell by about 3% per day, researchers said. In the rest of the country, daily new infections continued to increase. Direct contact precautions – social distancing, quarantine and isolation, and hand sanitizing – were all in place before mask-wearing rules went into effect in Italy and New York City. But they only help minimize virus transmission by direct contact, while face covering helps prevent airborne transmission, the researchers say. “The unique function of face covering to block atomization and inhalation of virus-bearing aerosols accounts for the significantly reduced infections,” they said. That would indicate “that airborne transmission of COVID-19 represents the dominant route for infection,” they conclude. (bit.ly/3fvbabp)

(GRAPHIC: The lifeline pipeline, COVID-19 treatments, vaccines in development – here)

Reporting by Nancy Lapid and Julie Steenhuysen; Editing by Bill Berkrot

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Federal Help Falters As Nursing Homes Run Short Of Protective Equipment

Around the country, nursing homes trying to protect their residents from the coronavirus eagerly await boxes of masks, eyewear and gowns promised by the federal government. But all too often the packages deliver disappointment — if they arrive at all.

Some contain flimsy surgical masks or cloth face coverings that are explicitly not intended for medical use. Others are missing items or have far less than the full week’s worth of protective equipment the government promised to send. Instead of proper medical gowns, many packages hold large blue plastic ponchos.

“It’s like putting a trash bag on,” said Pamela Black, the administrator of Enterprise Estates Nursing Center in Enterprise, Kansas. “There’s no real place for your hands to come out.”

As nursing homes remain the pandemic’s epicenter, the federal government is failing to ensure they have all the personal protective equipment, or PPE, needed to prevent the spread of the virus, according to interviews with administrators and federal data.

Despite President Donald Trump’s pledge April 30 to “deploy every resource and power that we have” to protect older Americans, a fifth of the nation’s nursing homes — 3,213 out of more than 15,000 — reported during the last two weeks of May that they had less than a week’s supply of masks, gowns, gloves, eye protectors or hand sanitizer, according to federal records. Of those, 946 reported they had at least one confirmed COVID infection since the pandemic began.

“The federal government’s failure to nationalize the supply chain and take control of it contributed to the deaths in nursing homes,” said Scott LaRue, president and CEO of ArchCare, the health care system of the Roman Catholic Archdiocese of New York, which operates five nursing homes.

Widespread equipment shortages continue in some places as the virus rages lethally through nursing homes and other long-term care facilities. More than 217,000 short-term patients and long-term residents in nursing homes have contracted COVID-19, and 43,000 have died.

Some homes still have not received the first of two batches of supplies the Federal Emergency Management Agency said it would ship in May. Instead, some got only cloth masks that the Department of Health and Human Services commissioned through a contract with HanesBrands, the apparel company known for its underwear. An HHS webpage says the masks are not intended for caring for contagious patients but can be given to workers for their commutes or to residents when they leave their rooms.

As homes keep scrounging for supplies in a chaotic market with jacked-up prices and continued scarcity, 653 skilled nursing facilities informed the government they had completely run out of one or more types of protective supplies at some point in the last two weeks of May, according to records released last week by the Centers for Medicare & Medicaid Services, or CMS.

“The federal government has got to step up,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group based in Washington, D.C. “We’re now — what? — three months into this pandemic, and these facilities still don’t have enough PPE to protect themselves and their residents?”

A ‘Relentless Commitment’

In April, Trump pledged his administration “will never waver in its relentless commitment to America’s seniors.” But FEMA’s shipments of masks, gloves, gowns and eye protection have had a more modest goal: “to serve as a bridge between other PPE shipments.”

In written comments, FEMA defended the quality of the poncho gowns but said that because of complaints, the contractor was creating a “short instructional video about proper use of the gowns” to share with homes. FEMA officials said that, as of June 4, the agency had shipped packages to 11,287 nursing homes, starting at “the soonest possible date in the COVID-19 global supply chain climate.”

Yet 67 of the Good Samaritan Society’s 147 nursing homes have not received a FEMA shipment, including homes that are fighting the biggest outbreaks in Sioux Falls, South Dakota; Greeley, Colorado; and Omaha, Nebraska, according to Nate Schema, the Evangelical Lutheran society’s vice president of operations. “We have not received a shipment in our six or seven hot spots,” he said.

The supplies that did arrive tended to be in one size only, he said, and “the quality wasn’t quite up to the same level we’ve been receiving” through the society’s affiliation with Sanford Health, a large hospital and physician system.

The society has enough equipment, but small nursing home groups and independent homes are still struggling, particularly with obtaining N95 masks, which filter out tiny particles of the virus and are considered the best way to protect both nursing home employees and residents from transmitting it.

The CMS records show 711 nursing homes reported having run out of N95 masks, and 1,963 said they had less than a week’s worth. But FEMA is not shipping any N95 masks, and nursing homes are having trouble obtaining them from other sources. Instead, it is sending surgical masks, but more than 1,000 homes have less than a week’s supply of those.

Messiah Lifeways at Messiah Village in Mechanicsburg, Pennsylvania, received a FEMA shipment this week that had face shields and gloves, but only three days’ worth of surgical masks and “very low low-grade quality” gowns that lacked sleeves, said Katie Andreano, a Messiah communications specialist.

Only two of ArchCare’s five nursing homes have received any FEMA shipments even though it is based in New York City, the site of the nation’s biggest outbreak. The equipment for those two homes lasted less than a week. LaRue tried to procure equipment from abroad, but all of the potential suppliers turned out to be fraudulent. He said ArchCare has had to rely on sporadic supplies from the state and city emergency management offices.

“As we sit here today, I’m still not able to get more than a few days’ supply of N95 masks, and I still struggle to a certain extent with gowns,” LaRue said. “That doesn’t make you sleep at night, because you’re not sure when the next delivery comes.”

‘It’s Not Going To Work’

In addition to the supplies, the administration has dedicated $5 billion to nursing homes out of $175 billion in provider relief funds appropriated by Congress. Hospitals are getting much more. Administrators said money doesn’t solve the broken private supply chains, where the availability of PPE is spotty and the equipment is vastly overpriced.

“Too often, the only signs of FEMA’s much-hyped promise of PPE are scattershot delivery with varying amounts of ragtag supplies,” said Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit nursing homes and other service agencies for older people.

The cloth masks from HHS have been particularly perplexing to nursing home administrators, given the caveats that accompanied them. The instructions for the masks said they could be washed up to 15 times, according to Sondra Norder, president and CEO of St. Paul Elder Services in Kaukauna, Wisconsin.

“I don’t know how we would possibly track how many times each mask has been washed,” she said. The instructions also said the masks should not be washed with disinfectants, bleach or chemicals, which is how Norder said nursing homes clean their laundry.

Norder said she laundered about 100 masks and they shrank. “The ones that have been washed are tiny, and I certainly wouldn’t want to put something on someone’s face that hasn’t been laundered,” she said. “All my colleagues [at other nursing homes] received the same thing and were also baffled by it, wondering, ‘How are we going to use these?’”

KHN senior correspondent Christina Jewett contributed to this report.

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Aging Health Industry Public Health

COVID-19 HHS Nursing Homes

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Only French victims of faulty breast implant may claim damages, EU court says

BRUSSELS (Reuters) – German victims of defective breast implants made by French company Poly Implant Prothese (PIP) cannot claim damages from its insurer as its policy covered only French victims, Europe’s top court said on Thursday, dealing a blow to thousands of women worldwide.

The PIP scandal, in which the company filled its implants with unauthorized industrial silicone instead of medical silicone, occurred in 2010 and affected about 300,000 women in some 65 countries. The company shut down in 2010.

A German victim had sought compensation from PIP’s insurer Allianz IARD in a German court for her faulty breast implants, saying that a clause in the company’s policy which restricted coverage to French victims was against EU laws.

The Luxembourg-based Court of Justice of the European Union disagreed.

“The general prohibition of discrimination on grounds of nationality cannot be the basis for challenging a clause, contained in a contract concluded between a manufacturer of medical devices and an insurance company, that places a territorial limit on civil liability insurance coverage,” judges said.

The PIP Implant World Victims Association called for changes to EU rules for medical devices and more protection for cross-border consumers.

“The regulation favours international exchanges of products, which is a good thing, but consumer protection stops at the border,” said Olivier Aumaitre, a lawyer for the association.

“More than 10 years after the revelation of the scandal, the European authorities have still not deemed it necessary to remedy this major deficiency.”

PIP founder Jean-Claude Mas was jailed for four years and fined 75,000 euros ($85,365) in 2013 after a police investigation revealed a sophisticated fraud.

The case is C-581/18 TÜV Rheinland LGA Products et Allianz IARD (DE).

($1 = 0.88 euros)

Reporting by Foo Yun Chee, additional reporting by Myriam Rivet in Paris; Editing by Angus MacSwan

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