Welcome to the last edition of the medical news. Every 2 weeks we have been bringing you key healthcare topics that have recently been under the microscope.
This week’s topics:
As it approaches almost 4 months since the first reports of COVID-19 cases in China, Europe is now the centre of the pandemic.
On Wednesday afternoon, the number of global cases passed 200,000 with the true number likely higher due to the limitations of current testing capacity. Measures to curb the spread and deaths from COVID-19 have begun to pick up speed this week.
The number of cases is rising rapidly in Europe and the new restrictions reflect this. The EU has banned travel into the passport-free Schengen zone for at least 30 days by non-EU nationals, with many countries within the zone tightening their internal borders.
At least 10 countries in the EU are closing their borders this week. Italy began its lockdown on 9th March with Spain and France following suit on the 14th and 17th respectively.
The lockdowns in Spain and France will last for at least 15 days with the one across Italy likely to last 24 days or longer.
These drastic measures are in response to the sharp rise in cases and deaths over the past few weeks. It is hoped that there will be a dramatic reduction in transmission as a result and prevent health services being overwhelmed even further.
Other countries such as the USA and the UK are starting to introduce measures such as social distancing and stricter rules on who needs to self-isolate, with many other countries taking similar measures.
The COVID-19 pandemic is a truly global health crisis and it will take cooperation on a global scale to reduce the impact.
What can we learn from this?
The strict lockdown measures in places such as China and Italy have undoubtedly helped reduce the number of cases. However, lockdown cannot last forever; social activities and daily life must begin to resume at some point.
The world is now watching China to see how the situation changes as they lift some of the most stringent measures. The lockdown reduced transmission levels greatly, but it is uncertain whether the virus will ‘bounce back’ once these are lifted.
This potential ‘second wave’ is a concern of researchers at Imperial College London, who has been advising the UK government.
They are concerned that every time these measures are lifted, a resurgence in cases will be seen. They have suggested that measures such as social distancing will need to remain in place until a vaccine is available.
These increasingly strict measures around the world illustrate the real and perceived threat of this virus. Modeling for the UK suggests that with no action at all, half a million people or more could die from COVID-19. Without mass restrictions, there could still be as many as 260,000 deaths with the NHS completely overwhelmed by demand.
Question to think about: What are the challenges of implementing strict lockdown measures, and how might a measure like this affect the number of cases of COVID-19, considering also when the restrictions are lifted?
PrEP; pre-exposure prophylaxis, is a drug that prevents HIV from being passed on. It will be routinely made available on the NHS from April to those deemed at high risk of catching HIV.
HIV negative people at high risk of getting HIV, for example, if they have a HIV positive partner, take PrEP. This is an antiretroviral that works by stopping the replication of HIV in the body. After a 3-year study involving more than 20,000 people, NHS England will provide the drug to patients for free.
The evidence shows that PrEP almost eradicates the risk of catching HIV when taken. New diagnoses of HIV reached a two-decade low in 2018, of 4484 new cases in the UK.
This is due to preventative measures including increased HIV testing, condom use and use of PrEP.
PrEP can either be taken regularly; one pill per day at the same time every day or can be used ‘on-demand’ which is known as event-based dosing.
For event-based dosing, adhering to the correct number of pills can be more difficult. To do this, the person needs to take a double dose 2-24 hours (but ideally 24) before the anticipated risk i.e. HIV exposure.
Then another dose needs to be taken 24 hours after the double dose then daily doses until at least 48 hours after the last exposure.
What can we learn from this?
The government has the ambition to reduce HIV transmission in the UK to zero within the next decade. Most recent estimates suggest that there are almost 110,000 people living with HIV in the UK, with 7% of those unaware that they are HIV positive.
HIV likely made the jump from chimpanzees to humans around 1920 but was only discovered in the 1980s by doctors in America. They saw mostly homosexual men dying from an immunodeficiency – later known as AIDS. Acquired Immune Deficiency Syndrome (AIDS) caused by the Human Immunodeficiency Virus (HIV).
It soon became a global public health crisis, and as of 2018, 35 million people have died from AIDS since the epidemic began. The WHO states that the AIDS epidemic is not over and has a target to end AIDS by 2030.
With early diagnosis and effective treatment, now most people who have HIV do not go on to develop AIDS. HIV is a sexually transmitted disease, but for people with HIV who have been taking medication and have an undetectable level of the virus for 6 or more months, they cannot pass it on through sexual intercourse.
This concept is undetectable = untransmittable.
Question to think about: Why might somebody at risk of catching HIV be reluctant to take PrEP?
In America, a phase 1 trial is beginning for a vaccine against COVID-19.
45 healthy volunteers will receive the injection twice, approximately 28 days. Usually, a vaccine would be tested first in animals to ensure it triggers an immune response however this step has been skipped as it uses pre-existing technology.
The vaccine currently being tested is not made from the virus that causes Covid-19. It includes a short segment of genetic code copied from the virus, made in a laboratory. The hope is that this will prime the body’s immune system should the person be infected with COVID-19.
Vaccines usually take 10-15 years to develop, but efforts to develop a vaccine to COVID-19, which poses a threat globally, are being fast-tracked. It is suggested that a vaccine could be available to the public in 18 months, if all goes well.
The scientific community around the world is fast-tracking research and there is a huge amount of collaboration occurring to try to develop therapeutics or a vaccine to this widely progressing virus.
Alongside the possibility of a vaccine, many drugs used to treat other conditions are being trialed for COVID-19.
As well as this vaccine entering phase 1 testing, many drugs are undergoing clinical trials. Drugs used against Ebola and HIV are amongst those that represent the most hope for a treatment for COVID-19. More than 100 drugs are listed in China’s clinical trials registry.
What can we learn from this?
The prospect of developing a vaccine in such a short amount of time shows the incredible efforts of the scientific community.
Roughly 35 companies and institutions are developing vaccines with 4 candidates already being tested in animals and this one entering the early stages of trials in humans.
This represents hope for ending the pandemic, as only a vaccine can prevent people from getting the virus.
Once a vaccine is through all of the required testing and ready to be available to the public, the next challenge of ensuring it is available to everyone globally sets in.
There will be a huge demand for such a vaccine, with most producers of vaccinations having nowhere near the production capacity needed.
The UK has a hierarchy of who should receive a vaccine in an event such as a flu pandemic; healthcare and social workers and those at high medical risk, including pregnant women and children, should get the vaccine first.
However, in a pandemic like this one, all countries will be competing with each other to get as many doses of the vaccine as possible, not just debating which groups in the population should have priority.
Question to think about: How will a vaccine help to end the COVID-19 pandemic?
Words by: Safiya Zaloum
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NHS Hot Topic – Brexit
NHS Hot Topic – Vaccines
NHS Hot Topic – Coronavirus
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