Researchers at the University of Tennessee Health Science Center working with colleagues at the University of New Mexico have identified three drugs, already approved for other uses in humans, as possible therapeutics for COVID-19, the illness caused by the SARS-CoV-2 virus.

Aging is a process that affects not only living beings. Many materials, like plastics and glasses, also age — ie they change slowly over time as their particles try to pack better — and there are already computer models to describe this. Biological materials, such as living tissue, can show similar behaviour to glasses except that the particles are actual cells or bacteria which have their own propulsion. Researchers at the University of Göttingen have now used computer simulations to explore the aging behaviour of these “living” glassy systems. There was a surprise in that the activity of the particles can actually drive aging, which has potential consequences for a number of applications. Their research was published in Physical Review Letters.

A recent research study conducted by City, University of London’s Professor Christoph Bruecker and his team has revealed how micro-structured finlets on owl feathers enable silent flight and may show the way forward in reducing aircraft noise in future.

The jab works equally well in people of all ages and ethnicities, further data suggests.

Two NHS bosses – Baroness Harding and medical director Stephen Powis – are told to stay at home.

Twenty years ago treatment for HIV was a rare luxury in South Africa. Exorbitant costs and President Thabo Mbeki’s government’s fierce opposition to providing antiretroviral treatment (ART) kept it out of the public sector.

They were terrible days. Many lives were lost.

The environment has changed remarkably since then. The turning point came in 2004 when, after four years of struggle, led by the Treatment Action Campaign, the government begrudgingly agreed to start providing ART.

Antiretroviral coverage of people with HIV in South Africa has increased from 0% in 2000 to 71% in 2019. The South African antiretroviral programme is now the largest in the world, with more than five million people on treatment, and increasing. HIV-linked deaths decreased from 150 000 in 2000 – peaking at around 300 000 in 2006 – to 72 000 in 2019.

But deaths have not decreased as much as was hoped. HIV remains a leading cause of death in South Africa. Many people still present to health facilities with advanced HIV disease. And Aids remains a major contributor to hospitalisations and deaths in Africa.

Globally, 690 000 people died from HIV in 2019.

Doctors Without Borders (MSF) supports hospitals in South Africa, Guinea, the Democratic Republic of Congo (DRC), Malawi and the Central African Republic that continue to treat large numbers of people with AIDS. Because people present with very advanced HIV disease, up to one in three dies during their hospital stay.

One of the main challenges remains that diagnostics and drugs aren’t readily available for people suffering from advanced HIV. This group of people is very vulnerable to deadly opportunistic infections such as tuberculosis (TB), meningitis and severe bacterial infections.

This all goes to show the world is very far from the end of Aids.

Gaps

In the last ten years the focus has been on diagnosing people with HIV and starting them on treatment. Efforts around the test-and-treat approach have been mobilised around the UNAIDS 90-90-90 targets: 90% of people with HIV to know their status; 90% of those whose status is known to be on antiretroviral therapy; and 90% of those on antiretrovirals to have an undetectable viral load.

This is necessary but it is not enough to address HIV-related mortality. Life-long treatment requires life-long support. Some people will interrupt treatment; some will struggle to take their tablets every day, risking developing drug resistance and treatment failure.

Today, most people with advanced HIV either are failing or have interrupted treatment. In two MSF-supported studies in the DRC and Kenya, only 20%-35% of inpatients with advanced HIV were ART-naïve (had never accessed treatment) and over half of those on ART had treatment failure.

The reality of treatment interruption and treatment failure requires a new approach.

This is why MSF piloted Welcome Back Services in Khayelitsha, Cape Town. The services focus on the needs of patients returning to care and those failing treatment. Stigmatisation and blaming patients for interrupting or failing treatment is common. This leads to delays in seeking care, and patients presenting as false-naïve – patients retesting for HIV and hiding the fact that they were previously on treatment.

This in turn leads to patients presenting in more advanced stages of the disease or on inadequate treatment.

This is one of the reasons why HIV still claims too many lives. Patients who present very late often have severe immune suppression, multiple concurrent life-threatening illnesses and significant organ damage due to HIV itself. Treatment is complicated by the need for many different medicines, with a higher risk of drug interactions and severe side effects. Even with intensive care, unavailable in most settings, many patients die.

TB is the leading cause of death among people with HIV in resource-limited settings. It is estimated that TB is responsible for around 50% of deaths. Two other leading causes are cryptococcal meningitis, which is responsible for one in five HIV deaths, and severe bacterial infections.

Together, these infectious diseases cause more than two thirds of HIV-related deaths. All three are preventable and treatable – if detected early enough.

No time to lose

There are immediate steps that can be taken.

There are more options than ever to prevent TB disease. New evidence shows that shorter regimens of rifapentine and isoniazid, weekly for three months or daily for one month, are equally effective at treating latent TB and decreasing deaths compared to the older regimen of isoniazid for six to 36 months. And a recent trial demonstrated that a four-month treatment with a new regimen was as efficacious as the current six-month regimen to treat active TB disease.

When left untreated, the odds of surviving cryptococcal meningitis are zero. But cryptococcal meningitis can be prevented and there have been advances in treatment. Daily fluconazole is recommended in some countries for prevention of a first episode, and everywhere as secondary prophylaxis to prevent recurrent disease. Treatment with flucytosine and amphotericin B reduces mortality by 40%. Yet these medicines are still missing in many – if not most – health structures in Africa.

Steps can be taken to prevent death from advanced HIV. These include earlier detection at the primary care level – before patients develop disease so severe that they seek hospital admission. The longer the delay to diagnosis and treatment, the lower the chances of survival.

This is where CD4 tests and rapid tests for TB and cryptococcal meningitis are life-saving.

What is needed urgently to save lives is accelerated access to a package of care for the prevention, diagnosis and treatment of advanced HIV at the primary care and hospital level, along with strategies with clear targets to decrease Aids mortality.

Gilles van Cutsem, Honorary Research Associate, Centre for Infectious Disease Epidemiology and Research, University of Cape Town

This article is republished from The Conversation under a Creative Commons license. Read the original article.

^{Image credit: Getty Images}

Gilles van Cutsem

• People worldwide have been experiencing high levels of distress during the Covid-19 pandemic
• A New Zealand survey shows that, despite eliminating the virus, people’s mental health took a knock
• Researchers are encouraging governments to prioritise mental wellbeing during this time

The 2020 Covid-19 pandemic has been causing an enormous amount of mental distress all over the world.   

While many countries struggled to cope with high numbers of seriously ill patients, New Zealand’s speedy reaction contained and ultimately eliminated the virus. These measures, however, came at a cost, not just to the country’s economy, but also to its people’s mental wellbeing, according to recent survey results.

About halfway through their toughest lockdown, a demographically representative public survey revealed higher than normal levels of stress, anxiety, and depression, especially among younger people.

“New Zealand’s lockdown successfully eliminated Covid-19 from the community, but our results show this achievement brought a significant psychological toll,” study co-author and psychologist Susanna Every-Palmer from the University of Otago, Canada, said in a news release.

The survey results, which included 2 010 responses from adult New Zealanders between 15 and 18 April, corresponding to days 19 to 22 of the lockdown, were published in PLOS One. 

Younger people more severely affected

According to the results, the level of mental distress was much higher in younger adults, with almost half of those aged between 18 and 24 experiencing moderate to severe psychological distress, compared to less than one in 10 adults aged 65 years and older.

“Substantially increased rates of distress were seen among those who reported having lost their jobs or experienced a reduction in work as a result of the pandemic, those who had potential vulnerabilities to Covid-19, or identified their health status as poor, and those who had a past diagnosis of a mental illness,” said Every-Palmer.

However, it’s worth noting that the study couldn’t distinguish whether it was the lockdown itself that was causing the mental health effects or the broader threat of the pandemic.

Older people felt safer in NZ than elsewhere

Despite older people being at greater risk of severe Covid-19 and mortality, and having less social connection via online platforms, their mental health appeared to be less affected by the situation.

“This is not to say older people were unscathed,” the authors explained, but Every-Palmer explained that “older people may also have felt they were safer in New Zealand than elsewhere”.

Overall, younger age groups appeared particularly vulnerable, which could be attributable to the lockdown’s implementation coinciding with different daily disruptions and economic impacts for different age groups.

Increase in domestic violence, sexual assault

Sadly, with the lockdown came consequences like people being confined to their homes, and a subsequent rise in domestic violence in many instances. This was consistent with local media reports, the authors noted.

Almost one in 10 participants directly experienced some form of family harm, the authors wrote. More cases of physical assault, sexual assault, harassment, and intimidation in the home were being reported – between three and four times higher than normal, according to the survey.

These results also correspond with similar increases in domestic abuse around the world during lockdown, including South Africa, News24 reported during level 3 lockdown.

The silver lining

Despite the negative toll on the economy, wellbeing, and safety of women, the majority of survey respondents (62%) said they could see the “silver lining” of remaining in isolation, whether it be for themselves or for society.

“People reported taking the opportunity to pause, reflect, consider priorities, recreate healthy habits, and they appreciated the environmental benefits brought by reduced travel,” said Every-Palmer.

In fact, a change in events such as working from home, spending more time with family, and living in a quieter environment reportedly gave some respondents the opportunity to pause, reflect and consider their priorities, the results indicate.

Respondents also showed a more positive attitude towards the end of the research period, which could mean that lockdown simply takes some time to get used to. 

Governments need to take action

However, Every-Palmer pointed out that the consequences of the pandemic will be pervasive and prolonged, and urged governments to step in and prioritise their people’s mental wellbeing. 

“Our findings emphasise the need to put resources into supporting mental well-being both during and after lockdowns.

“Governments should make providing mental health support a similar priority to other health measures, such as contact tracing, provision of personal protective equipment, and procurement of ventilators,” she said.

Every-Palmer added that supporting the population’s psychological well-being includes ensuring people have access to accurate information, basic necessities and specialist mental health services, among other things.

“Free access to high-quality e-therapies and telehealth support also becomes increasingly important if people are afraid or are not allowed to leave their homes.”

READ | OPINION | World Mental Health Day: Under-investment in mental health has never been more acutely felt

READ | Lockdown, pandemic effects: Soweto study re-emphasises need for better access to mental healthcare

READ | SA involved in massive global study on effects of Covid-19 pandemic – and you can play your part

^{Image: Getty/Dimitri Otis}

Compiled by Zakiyah Ebrahim

• Face masks don’t restrict breathing during exercise, researchers say
• This means that they’re harmless and should therefore be worn when exercising
• An exception, however, is in cases where people suffer from severe cardiopulmonary disease

Since a face mask is supposed to cover the mouth and nose in order to limit the spread of the new coronavirus, wearing one while exercising is uncomfortable for most people.

However, contrary to previous findings that wearing a mask during exercising impairs oxygen intake – as well as the World Health Organization’s official advice, stating that “people should NOT wear masks while exercising, as masks may reduce the ability to breathe comfortably” – a new study suggests that this isn’t the case.

According to the researchers who looked at the effects of face masks on the cardiorespiratory system (the heart, blood vessels, and lungs) during physical activity, most people should be able to breathe perfectly well with a mask on while exercising, despite it not feeling comfortable.

“There might be a perceived greater effort with activity, but the effects of wearing a mask on the work of breathing, on gases like oxygen and CO2 in blood or other physiological parameters, are small, often too small to be detected,” study author and exercise physiologist, Susan Hopkins from the University of California San Diego (UCSD), said in a news release by the university.

The findings were published in the Annals of the American Thoracic Society.

Exercising with face mask harmless

For their study, Hopkins and colleagues reviewed existing scientific literature on the effects of different face masks, including surgical masks, N95 respirators, and cloth face masks, on cardiorespiratory response during physical activity.

Based on their analysis, they said that current evidence suggests while face masks worn by healthy people during exercise result in minimal resistance to airflow, they do not seem to significantly impact lung function and oxygen intake, and are therefore harmless.

They did acknowledge that dyspnea (breathing discomfort) may potentially increase when exercising with a face mask, especially when one is not used to doing so.

“Wearing a face mask can be uncomfortable,” says Hopkins.

“There can be tiny increases in breathing resistance. You may re-inhale warmer, slightly enriched CO2 air. And if you’re exercising, the mask can cause your face to become hot and sweaty.

“But these are sensory perceptions. They do not impact cardiopulmonary function in healthy people.”

Exceptions for certain people

The authors also gave the assurance that their findings apply to both young and old adults, irrespective of gender. However, there is an exception in patients with severe cardiopulmonary disease who have an increased risk of experiencing exertional dyspnea, they cautioned.

“In such cases, these individuals might feel too uncomfortable to exercise, and that should be discussed with their doctor,” Hopkins said.

“However, the fact that these individuals are at great risk should they contract Covid-19 must also be considered.”

The researchers also disclosed that the literature investigating this issue is evolving and that further studies are still needed to support these findings.

READ | Valve masks don’t slow the spread of the Covid-19 virus – and here’s the science to back it up

READ | The importance of staying active while staying in

READ | Here are the best and worst materials for face masks

^{Image: Getty/LeoPatrizi}

Compiled by Zakiyah Ebrahim