News, June 16th

Breakthrough in COVID-19 cure:  Dexamethasone lowers death risk among severe cases, show trials

Low doses of the steroid dexamethasone can reduce deaths by one-third in severely affected COVID-19 patients, according to researchers who assessed the performance of the inexpensive drug in more than 2,100 people.

The analysis is part of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial which was established to test a range of potential therapies for COVID-19, including low-dose dexamethasone — a steroid treatment.

The RECOVERY trial included over 11,500 patients, enrolled from more than 175 hospitals in the UK, noted a statement published by the University of Oxford on Tuesday.

In the trial, a total of 2,104 patients were randomised to receive dexamethasone six milligrammes once per day — either by mouth or by intravenous injection — for ten days, and were compared with 4,321 patients randomised to usual care alone.

Among the patients who received usual care alone, mortality was highest in those who required ventilation (41 per cent), intermediate in those patients who required oxygen only (25 per cent), and lowest among those who did not require any respiratory intervention (13%), the scientists said.

They found that dexamethasone reduced deaths by one-third in ventilated patients, and by one fifth in other patients receiving oxygen only.

However, the researchers said there was no benefit from dexamethasone among the patients who did not require respiratory support.

Based on these results, the scientists believe that the drug could prevent nearly one death in the treatment of around eight ventilated patients, or around 25 patients requiring oxygen alone.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” said Peter Horby, one of the chief investigators of the trial from the University of Oxford in the UK.

“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” Horby said.

The drug, according to the scientists, is inexpensive, on the shelf, and can be used immediately to save lives worldwide.

“These preliminary results from the RECOVERY trial are very clear –dexamethasone reduces the risk of death among patients with severe respiratory complications,” said Martin Landray, another chief investigator of the trial from the University of Oxford.

“COVID-19 is a global disease it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide,” Landray added.

DDG Wolff calls for values-based multilateralism to boost the WTO

The liberal international order was constructed based on four pillars — the multilateral trading system (International Trade Organization, and General Agreement on Tariffs and Trade), the United Nations, the IMF and the World Bank.  These institutions were part of an effort to underwrite the hope for perpetual peace.  In this context, the WTO and the GATT are not simply contracts, but are a purposed construct for achieving a much more basic human aspiration, peace.

The vision to use trade to promote peace and stability was reflected in the opening words of the 1948 Havana Charter for the International Trade Organization(8) to create conditions of stability and well-being which are necessary for peaceful and friendly relations among nations,…

The signatories of the ITO Charter understood that trade does not guaranty peace.  After all, Germany and the United Kingdom had extensive trade before the outbreak of the First World War.  However, the architects of the liberal international order believed that trade can help maintain peace.  For this reason, in the aftermath of the Second World War, the European Coal and Steel Community and the European Common Market were formed, within a global framework of the multilateral trading system.

Far too often the simplest lessons of history are forgotten or obscured by the passage of time.  When the GATT was transformed into the WTO in 1995 – a peaceful and optimistic time after the end of the Cold War and the dissolution of the Soviet Union, there was no longer any reference to peace and stability when establishing the new Organization by 128 Members.  Since then, the WTO membership has expanded to 164, covering over 98% of world trade, and universality has become the Organization’s objective.

The nexus of the multilateral trading system and positive peace may have become obscure to many of the original Members of the WTO, but it is a concept very much alive for some recent Members, such as Afghanistan and Liberia, which joined in 2016 and have fresh experience with the trauma of war.   And, as noted, the subject is extremely current for many of the 23 countries seeking to join now, which are characterized as fragile and conflict-affected.

France sends police reinforcements to Dijon to quell unrest

The French government sent police reinforcements and a top official to the Dijon region Tuesday to quell four nights of unusually violent clashes between rival groups that have left at least 10 injured and cars burned and rattled the community.

The reasons for the unrest are under investigation, but local officials say it appears linked to the drug trade and tensions between members of France’s Chechen community and other groups.

Similar clashes erupted in the Mediterranean city of Nice in recent days, which the mayor attributed to tensions over drug territory between local Chechen residents and their rivals. Four people were reported injured there.

The unrest in Dijon’s Gresilles neighborhood apparently began last week after a teenager from France’s Chechen community was attacked by local residents, according to junior Interior Minister Laurent Nunez. That led to multiple days of reprisals, he told reporters in Dijon.

After tensions continued through the weekend, the interior minister ordered police reinforcements to the area and announced Monday that the government would take over management of the situation.

Images from BFM television showed two cars and several garbage cans on fire Monday, black smoke rising over a leafy neighborhood of low-rise apartment buildings. Young people wearing hoods and masks carried metal bars or bats as they roamed the area, and a makeshift gasoline bomb in a plastic bottle lay on the pavement.

A police helicopter circled overhead, and a dozen police vans lined a nearby street as firefighters sought to douse the scattered blazes. People looking out from nearby balconies covered their mouths from the smoke.

The local administration says at least 10 people have been injured so far. Nunez said some participants brandished firearms, which are relatively rare in such situations in France.

Unidentified local residents told BFM they felt abandoned by police over the weekend and so had to take matters in their own hands.

After the government sent reinforcements, Nunez visited the area to show government support for the population and insisted that “no one should carry out justice themselves.”

“At a time when we … talk of violent police, racist police, the (officers) proved they are the guarantors of our republican order,” he said. He said the national reinforcements would remain in the area “as much time as necessary.”

Graffiti on a nearby shopfront read “Long Live Putin,” in reference to Russian President Vladimir Putin, whose military fought Chechen militants in two wars in the 1990s and early 2000s. France offered asylum to many Chechens at the time, and there are now Chechen communities scattered around France.

The unrest comes amid tensions between French police and the government. Amid protests around France over racial injustice and police brutality, the government said last week it would ban police from using chokeholds to subdue people. But the government backed down Monday after police themselves protested. France is experimenting with expanding the use of stun guns as a potential alternative.

Latin America and the Caribbean countries need to spend more and better on health to be better able to face a major health emergency like COVID-19 effectively

Health spending in Latin America & the Caribbean (LAC) was about USD 1,000 per person in 2017, only ¼ of what was spent in OECD countries (adjusted for purchasing power). At the same time, health systems’ capacity is also considerably lower, including the ability to provide access to services of good quality to the most vulnerable groups. In addition, much is left to be done to improve efficiency, effectiveness and targeting of health spending. While the LAC region is struggling to respond to the major challenges of the COVID-19 pandemic, a serious reflection is needed not only on how to secure more funding but also on how to spend resources better, according to a new joint OECD – World Bank report, the first Health at a Glance publication entirely dedicated to the LAC region.

Health at a Glance: Latin America & the Caribbean 2020 says that total health expenditure across LAC countries is 6.6% of GDP, lower than the 8.8% in OECD countries. Spending varied from 1.1% in Venezuela to up to 11.7% in Cuba and 9.2% in Uruguay in 2017.

Government spending and compulsory health insurance represent an average of 54.3% of total health spending in LAC, significantly lower than the 73.6% in the OECD. This shows that health systems in the LAC region are heavily dependent on out-of-pocket expenditures or supplemental private insurance from households. Honduras, Haiti, and Guatemala have the highest proportions of private spending, while Cuba and Costa Rica have the lowest.

Health systems in LAC have fewer resources and less capacity than OECD countries to confront the COVID-19 pandemic. The LAC region has an average of two doctors per 1,000 population, and most countries stand well below the OECD average of 3.5, with only Cuba, Argentina and Uruguay having more. The average number of hospital beds in LAC is 2.1 per 1,000 population, that is less than half of the OECD average of 4.7. Barbados, Cuba, and Argentina have more hospital beds than the OECD average, whereas the stock is below one hospital bed per 1,000 population in Guatemala, Honduras, Haiti, Venezuela, and Nicaragua. Moreover, according to data gathered just before the COVID-19 pandemic started, there were just 9.1 Intensive Care Unit (ICU) average beds per 100,000 population in 13 LAC countries, which is much lower than the 12 ICU average beds per 100,000 population found in OECD countries. Brazil, Uruguay, and Argentina are above the LAC average, while the lowest ratios are observed in Costa Rica and El Salvador.

Health at a Glance: LAC 2020 highlights that poor allocation of health spending is slowing down, if not halting, progress towards universal health coverage in LAC. For example, weak health information systems are a major impediment. Across 22 LAC countries, an average of 10% of all deaths are never reported in public mortality databases. This means a reliable picture of population health is often missing. According to the Global Corruption Barometer, 42% of respondents across 12 LAC countries considered that there were corruption problems in the health sector. Most LAC countries have parallel health sub-systems with multiple and overlapping mechanisms of governance, financing, and service provision, making it hard to steer resources to where they are most needed in an efficient way.

The report also highlights how quality of care in LAC is often poor. Twelve out of the 33 LAC countries fall short of attaining the minimum immunization levels recommended by the WHO to prevent the spread of diphtheria, tetanus and pertussis (90% of the target population) and 21 out of 33 fail to meet this target for measles (95% of the target population). This indicates the difficulties that countries are likely to have in making a future COVID-19 vaccine available for the whole population. Among six LAC countries with available data, women with early diagnosis for breast cancer had a 78% probability of surviving at least five years, while in adults with colon cancer it was 52% and for rectal cancer it was 46%, which are all much lower than the 85%, 62% and 61% survival rates observed in OECD countries.

Finally, the publication identifies key critical risk factors for poor health in LAC. Eight percent of children under the age of 5 and 28% of adolescents are overweight. This figure increases to over 53% among adult men and to more than 61% among adult women. Obesity increases the risk of chronic disease and can also lead to complications and death in patients infected by COVID-19. Moreover, nearly one in four men and close to one in ten women aged 15 and above smoke daily. Smoking rates among children aged between 13 and 15 years old are 15% for boys and 12% for girls. Although average alcohol consumption in LAC is lower than in the OECD, it has increased by 3% between 2010 and 2016. Almost 35% and 22% of road traffic accidents among men and women, respectively, can be attributed to alcohol consumption.

Major Covid-19 drug breakthrough with steroid dexamethasone

The steroid dexamethasone was shown on Tuesday to be the first drug to significantly reduce the risk of death among severe Covid-19 cases, in trial results hailed as a “major breakthrough” in the fight against the disease.

Researchers led by a team from the University of Oxford administered the widely available drug to more than 2,000 severely ill Covid-19 patients.

Among those who could only breathe with the help of a ventilator, dexamethasone reduced deaths by one third, and by one-fifth in other patients receiving oxygen only, according to preliminary results.

Normally used to treat a range of allergic reactions as well as rheumatoid arthritis and asthma, dexamethasone is an anti-inflammatory.

Daily doses of the steroid could prevent one-in-eight ventilated patient deaths and save one out of every 25 patients requiring oxygen alone, the team said.

The trial, carried out by the RECOVERY research group that is searching for effective Covid-19 treatments, included a control group of 4,000 patients who did not receive the drug.

New Zealand no longer free of coronavirus as two women test positive

It took just eight days for New Zealand to lose its COVID-free status when two women who had been given permission to leave quarantine early after arriving from abroad tested positive for the coronavirus, authorities said on Tuesday (June 16).

Prime Minister Jacinda Ardern said the government would review what happened, but that it was clear checks were not adequate in this case.

“Vigorous testing is now taking place across those who were in the quarantine facility at the same time, and those who may have had any, even the remotest chance of contact (with the women),” Ardern said in a Facebook Live post.

New Zealand had trumpeted its achievement last week of becoming one of the first countries in the world to eliminate COVID-19 and return to pre-pandemic normality, lifting all social and economic restrictions except border controls.

The country requires all people arriving from abroad to quarantine for 14 days to avoid reintroducing the disease. The two women aged in their 30s and 40s had travelled from Britain to visit a dying parent in

Wellington on June 7, the director general of health said in a news conference.

Both had gone into quarantine in Auckland after landing but had been given special permission to leave on compassionate grounds, even though one had symptoms which she attributed to a pre-existing condition.

They tested positive after they returned to quarantine.

The new cases ended a 24-day streak of no new infections in the country.

Health Minister David Clark said he was suspending all exemptions to the quarantine rules until he had confidence in the system.

“Compassionate exemptions should be rare and rigorous and it appears that this case did not include the checks that we expected to be happening. That’s not acceptable.”

One family member of the women has been isolated in Wellington. Staff at the hotel they women lived in would be tested. Co-passengers on their flight, staff at Auckland airport and anyone else whom the women met would be contacted.

The cases take the total number recorded in the country to 1,506. Deaths from the disease remain at 22, among the lowest in the developed world.

Virtual Internships Provide Inside Look at Court

For more than a decade, an annual summer intern program hosted by the Northern District of Alabama has given law students a vivid close-up view of the criminal and civil process.

This year, the highly hands-on program was jeopardized by wide shutdowns related to the coronavirus (COVID-19). But with imagination and persistence, more than 50 students will still get a memorable learning experience—most or all of it online.

“At any point in time, you can have your reality shifted,” said Chief Judge L. Scott Coogler. “The students are still really getting an experience. They are seeing how the law continues to operate, and how to act and continue as lawyers.”

Operating by computer hookup, this year’s program includes regular meetings with lawyers and criminal law experts, as well as in-depth opportunities to draft federal court orders and opinions, learn the ropes of working in chambers, and even perform acts of community service from afar.

As in other years, the vast majority of interns recently finished their first year of law school, a time when opportunities remain somewhat limited for aspiring lawyers, and most hail from the University of Alabama Law School. This year, additional students applied when their law firm internships were canceled by the pandemic. All told, more than 50 interns are taking part in two groups over the summer.

“I am very happy,” said Jesse Westerhouse, an intern. “We are getting to do some writing and research. It is a phenomenal experience.”

During a recent online meeting, Coogler provided guidance to his law clerks on the handling of various cases. He periodically paused to explain points of law to his new class of interns, their faces lined up in gallery style on a video screen.

“Who knows what a mutual company is?” Coogler asked. When no one answered, he explained that it is an insurance company in which policy owners also are part owners of the company. The practical significance is that more jurors need to be summoned in cases involving mutual companies, since their policy holders cannot be empaneled.

The program is popular at the University of Alabama, which like Coogler’s courthouse is in Tuscaloosa. One reason is that Coogler selects his law clerks from among former interns.

Published by jim

Curator of things...

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