Category Archives: Genetic Medicine

As of Friday afternoon, Thomass county was up to 110 confirmed cases. Winter is coming, as he put it. But Thomas maintains hope that a blanket DNR policy will not be necessary. Assess, make decisions, reassess, make another decision. Repeat is how he described the coronavirus-treatment playbook to me. We can do this as long as we have PPE and vents.

Kerry Kennedy Meltzer: Im treating too many young people for the coronavirus

Although explicit, widespread rationing by health-care providers is unprecedented in the modern history of the United States, it is constantly happening around the world. Our doctors face moral dilemmas and impossible choices every day, said Doctors Without Borders Avril Benoit. Even while COVID-19 is requiring reallocation of resources, we still have women who need emergency C-sections and children with malnutrition. We are converting trauma and burn clinics to care for the disease. You do the best you can with what you have. And many of our locations will not be able to do more than isolate people and provide palliative care.

Patients, too, make rationing decisions. Every time we weigh whether or not to go to the doctor or to take medication, were balancing costs and benefits. Many peoplean estimated third of U.S. adultsalso make decisions about what they want should they become very ill. In the form of advance directives, they give instructions about when medical professionals should extend their lives with so-called extraordinary measures, and when they shouldnt.

The directives can be elaborate or spare, but generally land on a spectrum between prioritizing comfort and prolonging life, should the two become mutually exclusive. The most common designations are full code and DNR, but directives can also get very specific. The options are not binary, care or none. A person who voluntarily designates as DNR wouldnt be abandonedhe or she would still get IV fluids, oxygen, and medication, especially for pain.

Read: How the coronavirus became an American catastrophe

After determining advance directives, you should share them with family members or friends who might be communicating with medical professionals on your behalf. Have nuanced conversations with people close to you about what you do or dont want in various dire scenarios. This eases the burden on them.

It eases the burden on medical providers as well. Too often, Lindsey said, a person is found unconscious by paramedics, then shocked back to life and brought to the hospital, or put on a ventilator, and only hours later a family member shows up with an advance directive that indicates that this was not what the patient wanted. This was a tragic and challenging scenario pre-COVID, particularly if an individuals directives werent followed during that period of resuscitation, he said. But in the midst of this pandemic, the delay puts all the providers in the chain of care at unnecessary risk of exposure. And it takes a ventilator out of use for someone who might have wanted it.

As straightforward as it is to establish an advance directive and talk through what kind of care you want with your family, many of us avoid doing precisely that. Who wants to talk about the possibility of getting sick and dying? Thomas does. Im still a relatively young person, and my wife and I have that discussion relatively often, he told me. It should be had frequently, but especially now.

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The Curve Is Not Flat Enough - The Atlantic

At least eight strains of the coronavirus are making their way around the globe, creating a trail of death and disease that scientists are tracking by their genetic footprints.

While much is unknown, hidden in the virus'unique microscopic fragments are clues to the origins of its original strain, how it behaves as it mutates and which strains are turning into conflagrations while others are dying out thanks to quarantine measures.

KATHRYN GEORGE/STUFF

Scientists are tracking eight strains of the coronavirus by their genetic footprints.

Huddled in once bustling and now almost empty labs, researchers who oversaw dozens of projects are instead focused on one goal: tracking the current strains of the SARS-CoV-2 virus that cause the illness Covid-19.

Labs around the world are turning their sequencing machines, most about the size of a desktop printer, to the task of rapidly sequencing the genomes of virus samples taken from people sick with Covid-19. The information is uploaded to a website called NextStrain.org that shows how the virus is migrating and splitting into similar but new subtypes.

READ MORE:* Three months into the pandemic, here is what we know about the coronavirus* Coronavirus isn't alive and that's why it's so hard to kill* Coronavirus vaccine hunters: meet the scientists racing to find a cure* Key terms of the coronavirus outbreak, explained: From asymptomatic to zoonotic

While researchers caution they're only seeing the tip of the iceberg, the tiny differences between the virus strains suggest shelter-in-place orders are working in some areas and that no one strain of the virus is more deadly than another. They also say it does not appear the strains will grow more lethal as they evolve.

"The virus mutates so slowly that the virus strains are fundamentally very similar to each other," said Charles Chiu, a professor of medicine and infectious disease at the University of California, San Francisco School of Medicine.

The SARS-CoV-2 virus first began causing illness in China sometime between mid-November and mid-December. Its genome is made up of about 30,000 base pairs. Humans, by comparison, have more than 3 billion. So far even in the virus's most divergent strains scientists have found only 11 base pair changes.

That makes it easy to spot new lineages as they evolve, said Chiu.

"The outbreaks are trackable. We have the ability to do genomic sequencing almost in real-time to see what strains or lineages are circulating," he said.

So far, most cases on the USWest Coast are linked to a strain first identified in Washington state. It may have come from a man who had been in Wuhan, China, the virus' epicentre, and returned home on January 15. It is only three mutations away from the original Wuhan strain, according to work done early in the outbreak by Trevor Bedford, a computational biologist at Fred Hutch, a medical research centrein Seattle.

On the East Coast there are several strains, including the one from Washington and others that appear to have made their way from China to Europe and then to New York and beyond, Chiu said.

BEWARE PRETTY PHYLOGENETIC TREES

This isn't the first time scientists have scrambled to do genetic analysis of a virus in the midst of an epidemic. They did it with Ebola, Zika and West Nile, but nobody outside the scientific community paid much attention.

"This is the first time phylogenetic trees have been all over Twitter," said Kristian Andersen, a professor at Scripps Research, a nonprofit biomedical science research facility in La Jolla, California, speaking of the diagrams that show the evolutionary relationships between different strains of an organism.

The maps are available on NextStrain, an online resource for scientists that uses data from academic, independent and government laboratories all over the world to visually track the genomics of the SARS-CoV-2 virus. It currently represents genetic sequences of strains from 36 countries on six continents.

While the maps are fun, they can also be "little dangerous" said Andersen. The trees showing the evolution of the virus are complex and it's difficult even for experts to draw conclusions from them.

"Remember, we're seeing a very small glimpse into the much larger pandemic. We have half a million described cases right now but maybe 1000 genomes sequenced. So there are a lot of lineages we're missing," he said.

MANU FERNANDEZ/AP

Health workers applaud in support of the medical staff that are working on the Covid-19 virus outbreak in Spain.

DIFFERENT SYMPTOMS, SAME STRAINS

Covid-19 hits people differently, with some feeling only slightly under the weather for a day, others flat on their backs sick for two weeks and about 15 per centhospitalised. Currently, an estimated 1 per centof those infected die. The rate varies greatly by country and experts say it is likely tied to testing rates rather than actual mortality.

Chiu says it appears unlikely the differences are related to people being infected with different strains of the virus.

"The current virus strains are still fundamentally very similar to each other," he said.

The Covid-19 virus does not mutate very fast. It does so eight to 10 times more slowly than the influenza virus, said Anderson, making its evolution rate similar to other coronaviruses such as Ebola, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

It's also not expected to spontaneously evolve into a form more deadly than it already is to humans. The SARS-CoV-2 is so good at transmitting itself between human hosts, said Andersen, it is under no evolutionary pressure to evolve.

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The Covid-19 virus does not mutate very fast. It does so eight to 10 times more slowly than the influenza virus.

SHELTER IN PLACE WORKING IN CALIFORNIA

Chiu's analysis shows California's strict shelter in place efforts appear to be working.

Over half of the 50 SARS-CoV-2 virus genomes his San Francisco-based lab sequenced in the past two weeks are associated with travel from outside the state. Another 30 per centare associated with health care workers and families of people who have the virus.

"Only 20 per centare coming from within the community. It's not circulating widely," he said.

That's fantastic news, he said, indicating the virus has not been able to gain a serious foothold because of social distancing.

It's like a wildfire, Chiu said. A few sparks might fly off the fire and land in the grass and start new fires. But if the main fire is doused and its embers stomped out, you can kill off an entire strain. In California, Chiu sees a lot of sparks hitting the ground, most coming from Washington, but they're quickly being put out.

An example was a small cluster of cases in Solano County, northeast of San Francisco. Chiu's team did a genetic analysis of the virus that infected patients there and found it was most closely related to a strain from China.

At the same time, his lab was sequencing a small cluster of cases in the city of Santa Clara in Silicon Valley. They discovered the patients there had the same strain as those in Solano County. Chiu believes someone in that cluster had contact with a traveller who recently returned from Asia.

"This is probably an example of a spark that began in Santa Clara, may have gone to Solano County but then was halted," he said.

The virus, he said, can be stopped.

CHINA IS AN UNKNOWN

So far researchers don't have a lot of information about the genomics of the virus inside China beyond the fact that it first appeared in the city of Wuhan sometime between mid-November and mid-December.

The virus's initial sequence was published on January 10 by professor Yong-Zhen Zhang at the Shanghai Public Health Clinical Center. But Chiu says scientists don't know if there was just one strain circulating in China or more.

"It may be that they haven't sequenced many cases or it may be for political reasons they haven't been made available," said Chiu. "It's difficult to interpret the data because we're missing all these early strains."

Researchers in the United Kingdom who sequenced the genomes of viruses found in travellers from Guangdong in south China found those patients' strains spanned the gamut of strains circulating worldwide.

"That could mean several of the strains we're seeing outside of China first evolved there from the original strain, or that there are multiple lines of infection. It's very hard to know," said Chiu.

THE VIRUS DID NOT COME FROM A LAB

While there remain many questions about the trajectory of the Covid-19 disease outbreak, one thing is broadly accepted in the scientific community: The virus was not created in a lab but naturally evolved in an animal host.

SARS-CoV-2's genomic molecular structure - think the backbone of the virus - is closest to a coronavirus found in bats. Parts of its structure also resemble a virus found in scaly anteaters, according to a paper published earlier this month in the journal Nature Medicine.

Someone manufacturing a virus targeting people would have started with one that attacked humans, wrote National Institutes of Health Director Francis Collins in an editorial that accompanied the paper.

Andersen was lead author on the paper. He said it could have been a one-time occurrence.

"It's possible it was a single event, from a single animal to a single human," and spread from there.

- USA Today

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Eight strains of the coronavirus are circling the globe. They're giving scientists clues - Stuff.co.nz

Iceland has done a first-class job of rolling out a large-scale COVID-19 testing strategy across its population. Although it's is only a small nation, their approach is already providing somefascinatinginsights into the COVID-19 and the current pandemic.

Iceland health authorities, together with private biopharmaceutical company deCode Genetics, have so far administered 12,615 tests across the country, accounting for almost 3.5 percent of the total population. For context, the US has tested around 540,252 people, around 0.16 of the population.

Unlike most other countries, Iceland has been offering free screening among the general population even if they dont have any symptoms. This testing has identified up to 802 confirmed COVID-19 infections, at least 253 of which were obtained by a foreign traveler.

You can see all of the testing results on the health ministrys COVID-19 live data page.

What can we learn from this data? Well, first things first: these are preliminary results, for the time being, so we can't take them as gospel. Equally, every country has a unique infrastructure, culture, and social structure, so each countrys outbreak may not necessarily behave like Icelands.

The most interesting revelation is that Icelands data suggests around half of people who tested positive for COVID-19 in the country did not display any symptoms.

Early results from deCode Genetics indicate that a low proportion of the general population has contracted the virus and that about half of those who tested positive are non-symptomatic. The other half displays very moderate cold-like symptoms, Thorolfur Gunason, Icelands chief epidemiologist, told Buzzfeed News.

The work has also allowed researchers to understand how the novel coronavirus SARS-CoV-2 has mutated within the country. In one unique situation, it even appears that one Icelandic person was infected with two different variants of SARS-CoV-2 with subtlydifferent genetic material.

We have found 40 island-specific virus mutations. We found someone who had a mixture of viruses," explains Kri Stefnsson, director of deCode Genetics speaking to Danish newspaper Information. "They had viruses from before and after the mutation, and the only infections traceable to that person are the mutated virus.

While this number of mutations is slightly higher than other estimates, its nothing to worry about. According to Nathan Grubaugh, an epidemiologist at the Yale School of Public Health, mutations are a natural part of the virus lifecycle and we shouldnt worry when a virus mutates during disease outbreaks. By and large, preliminary data suggests SARS-CoV-2 has a relatively stable genome.

Iceland's small population means it's in aunique situation to carry out this kind of testing strategy, but every country would be doing this in an ideal world.The World Health Organization (WHO) has maintained that all countries need to start widespread testing for COVID-19, even among people who don't have symptoms. If we don't have the data, they say, the pandemic cannot be fought effectively.

You cannot fight a fire blindfolded and we cannot stop this pandemic if we don't know who is infected. We have a simple message for all countries; test, test, test,"Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said on March 16.

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Iceland's Prolific COVID-19 Testing Is Telling Us A Lot About The Outbreak - IFLScience

Alex Azar had sounded confident at the end of January. At a news conference in the hulking H.H.S. headquarters in Washington, he said he had the governments response to the new coronavirus under control, pointing out high-ranking jobs he had held in the department during the 2003 SARS outbreak and other infectious threats.

I know this playbook well, he told reporters.

A Yale-trained lawyer who once served as the top attorney at the health department, Mr. Azar had spent a decade as a top executive at Eli Lilly, one of the worlds largest drug companies. But he caught Mr. Trumps attention in part because of other credentials: After law school, Mr. Azar was a clerk for some of the nations most conservative judges, including Justice Antonin Scalia of the Supreme Court. And for two years, he worked as Ken Starrs deputy on the Clinton Whitewater investigation.

As Mr. Trumps second health secretary, confirmed at the beginning of 2018, Mr. Azar has been quick to compliment the president and focus on the issues he cares about: lowering drug prices and fighting opioid addiction. On Feb. 6 even as the W.H.O. announced that there were more than 28,000 coronavirus cases around the globe Mr. Azar was in the second row in the White Houses East Room, demonstrating his loyalty to the president as Mr. Trump claimed vindication from his impeachment acquittal the day before and lashed out at evil lawmakers and the F.B.I.s top scum.

As public attention on the virus threat intensified in January and February, Mr. Azar grew increasingly frustrated about the harsh spotlight on his department and the leaders of agencies who reported to him, according to people familiar with the response to the virus inside the agencies.

Described as a prickly boss by some administration officials, Mr. Azar has had a longstanding feud with Seema Verma, the Medicare and Medicaid chief, who recently became a regular presence at Mr. Trumps televised briefings on the pandemic. Mr. Azar did not include Dr. Hahn on the virus task force he led, though some of the F.D.A. commissioners aides participated in H.H.S. meetings on the subject.

And tensions grew between the secretary and Dr. Redfield as the testing issue persisted. Mr. Azar and Dr. Redfield have been on the phone as often as a half-dozen times a day. But throughout February, as the C.D.C. test faltered, Mr. Azar became convinced that Dr. Redfields agency was providing him with inaccurate information about testing that the secretary repeated publicly, according to several administration officials.

In one instance, Mr. Azar appeared on Sunday morning news programs and said that more than 3,600 people had been tested for the virus. In fact, the real number was much smaller because many patients were tested multiple times, an error the C.D.C. had to correct in congressional testimony that week. One health department official said Mr. Azar was repeatedly assured that the C.D.C.s test would be widely available within a week or 10 days, only to be given the same promise a week later.

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The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19 - The New York Times

Transgenic cropshave been planted in different countries for over twenty years, starting from 1996. About 191.7 million hectares were planted in 2018 to transgenic crops with high market value, such asherbicide tolerant soybeans,maize,cotton, andcanola; insect resistant maize, cotton, potato, andrice; and virus resistant squash and papaya. Withgenetic engineering, more than one trait can be incorporated or stacked into a plant. Transgenic crops with combinedtraitsare also available commercially.

To date, commercial GM crops have delivered benefits in crop production, but there are also a number of products in the pipeline that will make more direct contributions to food quality, environmental benefits, pharmaceutical production, and non-food crops.

Examples of these products include triple stack trait biotech rice with better yield amidst abiotic stresses, biotech chestnut tree with resistance to chestnut blight, biotech citrus greening resistant citrus, potato enriched with beta carotene, biofortified sorghum, bacterial (Xanthomonas) wilt resistant banana, Bunchytop virus resistant banana, insect resistantwheat, among others.

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Next-generation GMO crops poised to make major contributions to sustainable farming and medicine - Genetic Literacy Project

At least five patients, including some doctors, have overcome the critical state of health in which they had fallen due to the coronavirus and been moved from the Intensive Care units to normal hospital wards, after undergoing an expensive treatment that is producing good results.

Of the patients who have responded adequately to treatment, there are four from Santiago: Dr. Daniel Rivera, president of the Board of Directors of the Unin Mdica Clinic, urologist Fausto Hernndez, ex-governor Jos Izquierdo and patient Juan Ramn. In Santo Domingo, the political leader of San Pedro de Macors, Senator Jos Hazim, while Dr. Felix Antonio Cruz Jiminin has presented significant improvement, although he is still in intensive care with mechanical respiration, admitted to the General Hospital of the Plaza de health.

The details were offered by the Minister of Public Health, Rafael Snchez Crdenas, on the eighth day of the virtual press conference to report the updates to the Covid-19.He said it is a non-over-the-counter medicine that is applied intravenously and is applied to critically ill patients with complicated pneumonia.

A drug used in the treatment of arthritis patients has been applied to these patients.It is tocilizumab, a biological medicine, which is supplied through the High-Cost Medicines Program of the Ministry of Public Health.

Tocilizumab (Actemra) is a biologic medication approved to treat rheumatoid arthritis (RA) in adults, polyarticular juvenile rheumatoid arthritis (JRA), and the systemic form of juvenile idiopathic arthritis (JIA) in children. It isused to suppress the immune system in autoimmune diseases.

Biological drugs are artificial and manufactured using genetic engineering techniques and are closely related to a protein that the body produces naturally.

Dr. Snchez Crdenas reported that there are nine doctors registered with the virus, of whom four were in the process of their work, and others were infected on a cruise or airplane trip, and about three nurses.

He recalled that the highest risk of death is in people over 60 years old and people with co-morbidities, so he called people to take more extreme care of older adults.

Cross-testsThe Minister of Public Health, Rafael Snchez Crdenas, announced that from yesterday the trial would begin with cross-tests at the Dr. Defill National Laboratory, in order to speed up the confirmation of Covid-19 cases.

THE PROCESSSnchez Crdenas revealed that starting today, Saturday, rapid tests of up to 15 minutes will be made, through blood collection obtained from the pulpejo, with patients who have tested positive for other types of tests, to confirm their effectiveness, and then put them into service.

The testsThe effectiveness of rapid tests can be as high as 95%, and the PCR tests, which are being applied in the laboratory, are a specific test with 95% effectiveness, said Crdenas.Those 15-minute rapid tests, of which there are already samples in the country, will be tested today with patients.

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Treatment gets five out of Intensive Care - Dominican Today