Health24.com | Coronavirus: After SA tops 1 000 cases, minister again warns on ‘vulnerable’ groups

Health Minister Zweli Mkhize on Friday said that his department has made “clinical observations that are of concern”, as total confirmed coronavirus cases in South Africa passed the 1 000-mark.

The minister confirmed that total positive cases were at 1 170, and that 28 537 tests had been conducted.

He also said there has only been one Covid-19-related death so far – a 48-year-old woman. 

The minister also outlined key observations so far, saying that the infection of people with accompanying diseases was increasing.

“This is well illustrated by the Covid-19 patient that has passed away in the Western Cape.

“We therefore urge our citizens to be vigilant, protect themselves and not unnecessarily expose themselves by making contact with a lot of people.

“It is important to remain in your home, create a distance between yourself and anyone, including family members that are unwell,” he said.

READ | Coronavirus in SA: All the confirmed cases

Know your status

The minister stressed that people should know their HIV status, get tested and immediately start treatment should they test positive.

He emphasised this point after pointing out that HIV-positive people with a low CD4 count fell into the vulnerable category.

Other underlying medical diseases that make people vulnerable are:

  • Chronic lung diseases, including TB, asthma and COPD
  • Auto immune diseases of any kind
  • Chronic kidney diseases
  • Cancer
  • Diabetes

There was also a warning for smokers and dependent alcohol consumers, who were also considered a vulnerable population group.

“We encourage smokers to quit smoking and for those who drink alcohol, to do so moderately,” the minister said

Elderly vulnerable

He also said that the elderly population in our society was vulnerable.

To illustrate this, he said, in KwaZulu-Natal, one of the confirmed cases is an 81-year-old female who is now in ICU and on a ventilator.

“She initially presented with pneumonia and was admitted and treated as such. Because of the severity of the pneumonia, she was tested for Covid-19 and was confirmed.

“This elderly woman lives in an old age home. As a result, all other elderly people from this old age home are regarded as being vulnerable and are being tested.

“Those who will test positive will then be put in isolation.”

Internal transmissions increasing

The minister also warned about an increase in the rate of internal transmissions, as patients without a history of international travel have been detected in many provinces.

“The Free State province is such an example. The majority of 61 patients infected arose from the church conference which had five international visitors who subsequently tested positive for Covid-19.

“Amongst these were various local church leaders who have since tested positive for Covid-19, thus making their own church members direct contacts.

“These church members have had to be screened and tested. The church leaders and members who were tested have since been put in quarantine.

“It must be noted that these confirmed cases in the Free State province are concentrated in Mangaung and this requires dedicated focus of interventions.

“All the above factors have emphasised the need to rapidly expand testing, early detection and early treatment. We are intensifying the offensive,” Minister Mkhize said.

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Health24.com | Coronavirus morning update: SA’s first death, plenty of lockdown arrests, and Italy’s unwanted record

WHAT’S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 1 170, as the country recorded its first death related to the virus.

So far, 28 537 tests have been conducted.

There have been 31 recoveries, according to latest data provided by the Health Ministry.

Other key numbers:

Total number of patients in hospitals (both public and private): 55

Total number of patients in ICU : 4

Total number of patients in ventilation: 3

READ MORE |All the confirmed cases of coronavirus in SA

Latest news:

One person has died and four others are in ICU, battling with the coronavirus, Health Minister Zweli Mkhize said late on Friday.

It was earlier on Friday announced that two people had died, but one person’s coronavirus test returned negative.

There are a total of 1 170 confirmed cases as of Friday night.

Mkhize said four patients with Covid-19 were in ICU, three on ventilators.

READ MORE | Coronavirus in SA: 1 dead, 4 others critical

Fifty-five people were arrested for contravening regulations on the first day of the national lockdown.

The 21-day lockdown came into effect at midnight, restricting movement to fight the spread of Covid-19.

Police Minister Bheki Cele said the police’s phones were “abuzz” with complaints of people breaking the law.

He was speaking at an inter-ministerial address on Friday.

Working with these “good citizens”, Cele said 55 people were arrested on Friday.

Five people were arrested in the Free State; 20 in Gauteng – six in Alexandra; seven were arrested in KwaZulu-Natal; 10 in Limpopo; and two in the Western Cape.

READ MORE | 55 people arrested on first day of national lockdown – Cele

German nationals stuck in South Africa because of the lockdown on travelling will be repatriated on Tuesday, after the German government intervened.

Speaking at an inter-ministerial media briefing on Friday, Transport Minister Fikile Mbalula said the evacuation would take place on Tuesday.

Earlier on Friday, News24 reported that a group of 60 German tourists had been placed in quarantine after one tested positive for Covid-19.

READ MORE | German tourists stuck in SA to be repatriated after their govt intervenes

The Department of Transport is reconsidering some of the new regulations that came into effect on Friday, after some incidents during the first day of the national lockdown.

Speaking at a media briefing on Friday, Transport Minister Fikile Mbalula said the taxi industry had raised concerns regarding regulations that state taxis could not exceed 50% of their legal capacity.

He added more concerns were raised about the limitation of cargo movements to only essential cargo, and all cargo would now be allowed passage.

The department was also in the “process of issuing new directions covering transitional arrangements relating to driver’s and learner’s licensing issues”, Mbalula said.

READ MORE | Transport Dept reconsidering lockdown regulations on taxis, cargo, licensing

WHAT’S HAPPENING IN THE REST OF THE WORLD

Cases update:

For the latest global data, follow this interactive map from Johns Hopkins University & Medicine.

Positive cases worldwide are now more than 485 000, while deaths are more than 26 800.

Seven countries, China, Italy, Spain and Germany, the United States and all have more than 50 000 cases.

Italy has almost 9 000 deaths, nearly triple that of China where the virus first broke out.

READ MORE | All the confirmed cases worldwide

Latest news:

Italy recorded a shocking spike in coronavirus deaths on Friday with 969 new victims, the worst daily record for any country since the pandemic began.

The infection rate however continued its downward trend, with the civil protection agency reporting nearly 86 500 confirmed cases in Italy – a 7.4% increase, down from around 8% in previous days.

READ MORE | Coronavirus: Italy sets disturbing record after nearly 1 000 die in a single day

British Prime Minister Boris Johnson announced on Friday that he is self-isolating after testing positive for the Covid-19 virus.

“Over the last 24 hours I have developed mild symptoms and tested positive for coronavirus,” he said on Twitter.

“I am now self-isolating, but I will continue to lead the government’s response via video-conference as we fight this virus.”

“Be in no doubt that I can continue thanks to the wizardry of modern technology to communicate with all my top team to lead the national fightback against coronavirus,” he added in the video message.

READ MORE | British PM Johnson tests positive for Covid-19

France is extending by two weeks until at least 15 April its stay-at-home order for all people to curtail the coronavirus outbreak, Prime Minister Edouard Philippe said on Friday.

President Emmanuel Macron had ordered people in France to stay at home from 17 March for two weeks for all but essential tasks. But the scale of the epidemic in the country had made it inevitable that the lockdown would be extended.

“In agreement with the president, today I’m announcing the renewal of the confinement period for two more weeks,” Philippe said at the Elysee presidential palace.

“Obviously this period will be extended again if conditions require it,” he added. The additional two weeks from 1 April means it would now expire on 15 April.

READ MORE | France extends virus lockdown

HEALTH TIPS(as recommended by the NICD and WHO)

• Avoid contact with people who have respiratory infections 

• Maintain social distancing – stay at least one metre away from somebody who is coughing or sneezing

• Practise frequent hand-washing, especially after direct contact with ill people or their environment

• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus

• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.

READ MORE: Coronavirus 101 

Image credit: Getty Images

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A new way to study HIV’s impact on the brain

Though many negative repercussions of human immunodeficiency virus infection can be mitigated with the use of antiretroviral therapy (ART), one area where medical advances haven’t made as much progress is in the reduction of cognitive impacts. Half of HIV patients have HIV-associated neurocognitive disorders (HAND), which can manifest in a variety of ways, from forgetfulness and confusion to behavior changes and motor deficiencies.

To better understand the mechanisms underlying HAND, researchers from Penn’s School of Dental Medicine and Perelman School of Medicine and from the Children’s Hospital of Philadelphia (CHOP) brought together their complementary expertise to create a laboratory model system using three of the types of brain cells thought to be involved. Led by doctoral student Sean Ryan, who was co-mentored by Kelly Jordan-Sciutto of Penn Dental Medicine and Stewart Anderson of CHOP and Penn Medicine, the model recapitulates important features of how HIV infection and ART affect the brain.

“Frankly the models we generally use in the HIV field have a lot of weaknesses,” says Jordan-Sciutto, co-corresponding author on the paper, which appears in the journal Stem Cell Reports. “The power of this system is it allows us to look at the interaction between different cell types of human origin in a way that is more relevant to patients than other models.”

In addition to studying HIV, members of the team plan to use the same model to shed light on the neurological mechanisms that underlie other conditions, such as schizophrenia, Alzheimer’s, and even normal aging.

“We’re collaborating with a variety of colleagues to use this system to study Alzheimer’s disease as well as schizophrenia,” says Anderson, co-corresponding author on the paper. “We have the components in a dish that we know are interacting in these diseases, and this gives us a new mix-and-match way to understand how certain cells are contributing to neuronal damage.”

Indeed, the impetus to create the model grew not out of HIV research but work that Ryan was pursuing in Anderson’s lab on schizophrenia.

“We had been looking at the role of microglia, the resident immune cells of the central nervous system,” says Ryan, first author on the work. “We wanted to see if we could see the mechanistic changes that occur with microglia in schizophrenia.”

To do so, Ryan and Anderson were interested in using human-induced pluripotent stem cells — adult cells that are reprogrammed to resemble embryonic stem cells — which can be coaxed into differentiating into a variety of different cell types.

But schizophrenia is a complicated disease with a variety of contributing genetic and environmental factors and a broad spectrum of presentations. Rather than looking at something complex, they sought to apply their new system to a disease that likewise causes neurological damage but does so in a more dramatic way and in which microglia are also implicated: HIV/AIDS infection.

They reached out to Jordan-Sciutto, who has deep experience investigating the mechanisms of HAND and was eager for the opportunity to develop a model superior to those currently available. Together, the scientists identified the three cell types they were most interested in studying: neurons, astrocytes, and microglia.

Neurons aren’t directly infected by HIV but are known to be damaged during infection. Meanwhile astrocytes are believed to interact with neurons, causing damage by sending pro-inflammatory factors into the spaces between cells, called synapses. And microglia, which are responsible for maintaining a healthy environment in the absence of disease, are seen to expand and contribute to inflammation during HIV infection.

After nailing the technical challenge of creating this tractable model in which each cell type is generated independently and then mixed together, the team used it to probe how HIV infection and ART impact the cells, both alone and in combination.

“A lot of people are taking PreEP [pre-exposure prophylaxis] if they’re in a situation where their risk of contracting HIV is heightened,” says Ryan. “Just as we want to understand the cognitive impacts of HIV, we also want to see whether these drugs alone are impacting the brain health of otherwise healthy people.”

The researchers looked at RNA expression in their cultures to get a sense of what proteins and signaling pathways were becoming activated in each scenario. During infection, they saw inflammatory pathways that had previously been implicated in HIV in earlier research. When they introduced the antiretroviral drug EFZ, which is not in common use in the United States but remains a frontline therapy in many other areas of the world, with an infection, the activity of most of these pathways was reduced.

“But this scenario involved its own unique response,” says Ryan. Certain pathways associated with inflammation and damage remained despite the introduction of EFZ.

“EFZ treatment of the tri-cultures that included HIV-infected microglia reduces inflammation by around 70%,” Ryan says. Interestingly, EFZ by itself also triggered inflammation, though to a lesser extent than infection.

“It seems a combination of infection and ART is creating its own unique response that is different from the sum of its parts,” Ryan says. “Knowing what pathways are still active due to ART could help us appropriately target additional therapies so patients don’t develop HAND.”

Many features of infection seen in the three-cell culture mirror what is known from HIV infection and ART treatment in people, giving the researchers confidence in the reliability of their model.

“Just looking at the microglia,” says Anderson, “we see in our system that they are taking on both of their normal roles in keeping key signaling systems balanced during their normal state and activating and causing damage when they’re fighting infection. We’re able to model normality and abnormality in a way we haven’t been able to before.”

For Jordan-Sciutto, the new system “is really going to change the way my lab operates going into the future.” She’s hopeful many other HIV scientists will take it up to further their studies as she also explores more aspects of HIV’s impact on the brain, such as how it navigates through the blood-brain barrier that normally protects the central nervous system from inflammation and infection.

The study authors give credit to the collaborative environment at Penn for this cross-disciplinary project. “Tentacles of this project extend from CHOP to the dental school to the vet school to the medical school,” says Anderson. “Penn is a very special place where people seem to be more likely to share their technologies around and let other people work with and develop them. This project is a great example of that.”

Kelly L. Jordan-Sciutto is vice chair and professor in the Department of Basic and Translational Sciences in Penn’s School of Dental Medicine, associate dean of graduate education, and director of biomedical graduate studies at the Perelman School of Medicine.

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Double-walled nanotubes have electro-optical advantages

One nanotube could be great for electronics applications, but there’s new evidence that two could be tops.

Rice University engineers already knew that size matters when using single-walled carbon nanotubes for their electrical properties. But until now, nobody had studied how electrons act when confronted with the Russian doll-like structure of multiwalled tubes.

The Rice lab of materials theorist Boris Yakobson has now calculated the impact of curvature of semiconducting double-wall carbon nanotubes on their flexoelectric voltage, a measure of electrical imbalance between the nanotube’s inner and outer walls.

This affects how suitable nested nanotube pairs may be for nanoelectronics applications, especially photovoltaics.

The theoretical research by Yakobson’s Brown School of Engineering group appears in the American Chemical Society journal Nano Letters.

In an 2002 study, Yakobson and his Rice colleagues had revealed how charge transfer, the difference between positive and negative poles that allows voltage to exist between one and the other, scales linearly to the curvature of the nanotube wall. The width of the tube dictates curvature, and the lab found that the thinner the nanotube (and thus larger the curvature), the greater the potential voltage.

When carbon atoms form flat graphene, the charge density of the atoms on either side of the plane are identical, Yakobson said. Curving the graphene sheet into a tube breaks that symmetry, changing the balance.

That creates a flexoelectric local dipole in the direction of, and proportional to, the curvature, according to the researchers, who noted that the flexoelectricity of 2D carbon “is a remarkable but also fairly subtle effect.”

But more than one wall greatly complicates the balance, altering the distribution of electrons. In double-walled nanotubes, the curvature of the inner and outer tubes differ, giving each a distinct band gap. Additionally, the models showed the flexoelectric voltage of the outer wall shifts the band gap of the inner wall, creating a staggered band alignment in the nested system.

“The novelty is that the inserted tube, the ‘baby’ (inside) matryoshka has all of its quantum energy levels shifted because of the voltage created by exterior nanotube,” Yakobson said. The interplay of different curvatures, he said, causes a straddling-to-staggered band gap transition that takes place at an estimated critical diameter of about 2.4 nanometers.

“This is a huge advantage for solar cells, essentially a prerequisite for separating positive and negative charges to create a current,” Yakobson said. “When light is absorbed, an electron always jumps from the top of an occupied valence band (leaving a ‘plus’ hole behind) to the lowest state of empty conductance band.

“But in a staggered configuration they happen to be in different tubes, or layers,” he said. “The ‘plus’ and ‘minus’ get separated between the tubes and can flow away by generating current in a circuit.”

The team’s calculations also showed that modifying the nanotubes’ surfaces with either positive or negative atoms could create “substantial voltages of either sign” up to three volts. “Although functionalization could strongly perturb the electronic properties of nanotubes, it may be a very powerful way of inducing voltage for certain applications,” the researchers wrote.

The team suggested its findings may apply to other types of nanotubes, including boron nitride and molybdenum disulfide, on their own or as hybrids with carbon nanotubes.

Story Source:

Materials provided by Rice University. Note: Content may be edited for style and length.

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Quantum copycat: Researchers find a new way in which bosons behave like fermions

Bosons and fermions, the two classes into which all particles — from the sub-atomic to atoms themselves — can be sorted, behave very differently under most circumstances. While identical bosons like to congregate, identical fermions tend to be antisocial. However, in one dimension — imagine particles that can only move on a line — bosons can become as stand-offish as fermions, so that no two occupy the same position. Now, new research shows that the same thing — bosons acting like fermions — can happen with their velocities. The finding adds to our fundamental understanding of quantum systems and could inform the eventual development of quantum devices.

“All particles in nature come in one of two types, depending on their ‘spin,’ a quantum property with no real analogue in classical physics,” said David Weiss, Distinguished Professor of Physics at Penn State and one of the leaders of the research team. “Bosons, whose spins are whole integers, can share the same quantum state, while fermions, whose spins are half integers, cannot. When the particles are cold or dense enough, bosons behave completely differently from fermions. Bosons form ‘Bose-Einstein condensates,’ congregating in the same quantum state. Fermions, on the other hand, fill available states one by one to form what is called a ‘Fermi sea.'”

Researchers at Penn State have now experimentally demonstrated that, when bosons expand in one dimension — the line of atoms is allowed spread out to become longer — they can form a Fermi sea. A paper describing the research appears March 27, 2020 in the journal Science.

“Identical fermions are antisocial, you can’t have more than one in the same place so when they are very cold they don’t interact,” said Marcos Rigol, professor of physics at Penn State and the other leader of the research team. “Bosons can be in the same place, but this becomes energetically too costly when their interactions are very strong. As a result, when constrained to move in one-dimension, their spatial distribution can look like that of non-interacting fermions. Back in 2004, David’s research group experimentally demonstrated this phenomenon, which was theoretically predicted in the 1960s.”

Even though the spatial properties of strongly interacting bosons and non-interacting fermions are the same in one dimension, bosons can still have the same velocities as each other, while fermions cannot. This is due to the fundamental nature of the particles.

“In 2005, Marcos, then a graduate student, predicted that when strongly interacting bosons expand in one dimension, their velocity distribution will form a Fermi sea,” said Weiss. “I was very excited to collaborate with him in demonstrating this striking phenomenon.”

The research team creates an array of ultracold one-dimensional gases made up of bosonic atoms (‘Bose gases’) using an optical lattice, which uses laser light to trap the atoms. In the light trap, the system is at equilibrium and the strongly interacting Bose gases have spatial distributions like fermions, but still have the velocity distributions of bosons. When the researchers shut off some of the trapping light, the atoms expand in one dimension. During this expansion, the velocity distribution of the bosons smoothly transforms into a one that is identical to fermions. The researchers can follow this transformation as it happens.

“The dynamics of ultracold gases in optical lattices are the source of many novel fascinating phenomena that only recently have started to be explored,” said Rigol. “For example, Dave’s group showed in 2006 that something as universal as temperature is not well defined after Bose gases undergo dynamics in one dimension. My collaborators and I related this finding to a beautiful underlying mathematical property of the theoretical models describing his experiments, known as ‘integrability.’ Integrability plays a central role in our newly observed dynamical fermionization phenomenon.”

Because the system is “integrable,” the researchers can understand it in great detail and by studying the dynamical behavior of these one-dimensional gases, the Penn State team hopes to address broad issues in physics.

“In the last half century many universal properties of equilibrium quantum systems have been elucidated,” said Weiss. “It has been harder to identify universal behavior in dynamical systems. By fully understanding the dynamics of one-dimensional gases, and then by gradually making the gases less integrable, we hope to identify universal principles in dynamical quantum systems.”

Dynamical, interacting quantum systems are an important part of fundamental physics. They are also increasing technologically relevant, as many actual and proposed quantum devices are based on them, including quantum simulators and quantum computers.

“We now have experimental access to things that if you would have asked any theorist working in the field ten years ago ‘will we see this in our lifetime?’ they would have said ‘no way,'” said Rigol.

In addition to Rigol and Weiss, the research team at Penn State includes Joshua M. Wilson, Neel Malvania, Yuan Le, and Yicheng Zhang. The research was funded by the U.S. National Science Foundation and the U.S. Army Research Office. Computations were performed at the Penn State Institute for Computational and Data Sciences.

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In Earth’s largest extinction, land animal die-offs began long before marine extinction

The mass extinction at the end of the Permian Peri od 252 million years ago — one of the great turnovers of life on Earth — appears to have played out differently and at different times on land and in the sea, according to newly redated fossils beds from South Africa and Australia.

New ages for fossilized vertebrates that lived just after the demise of the fauna that dominated the late Permian show that the ecosystem changes began hundreds of thousands of years earlier on land than in the sea, eventually resulting in the demise of up to 70% of terrestrial vertebrate species. The later marine extinction, in which nearly 95% of ocean species disappeared, may have occurred over the time span of tens of thousands of years.

Though most scientists believe that a series of volcanic eruptions, occurring in large pulses over a period of a million years in what is now Siberia, were the primary cause of the end-Permian extinction, the lag between the land extinction in the Southern Hemisphere and the marine extinction in the Northern Hemisphere suggests different immediate causes.

“Most people thought that the terrestrial collapse started at the same time as the marine collapse, and that it happened at the same time in the Southern Hemisphere and in the Northern Hemisphere,” said paleobotanist Cindy Looy, University of California, Berkeley, associate professor of integrative biology. “The fact that the big changes were not synchronous in the Northern and Southern hemispheres has a big effect on hypotheses for what caused the extinction. An extinction in the ocean does not, per se, have to have the same cause or mechanism as an extinction that happened on land.”

Members of Looy’s lab have conducted experiments on living plants to determine whether a collapse of Earth’s protective ozone layer may have irradiated and wiped out plant species. Other global changes — a warming climate, a rise in carbon dioxide in the atmosphere and an increase in ocean acidification — also occurred around the end of the Permian period and the beginning of the Triassic and likely contributed.

On land, the end-Permian extinction of vertebrates is best documented in Gondwana, the southern half of the supercontinent known as Pangea that eventually separated into the continents we know today as Antarctica, Africa, South America and Australia. There, in the South African Karoo Basin, populations of large herbivores, or plant eaters, shifted from the Daptocephalus assemblage to the Lystrosaurus assemblage. These groups are now extinct.

In the ocean, the extinction is best documented in the Northern Hemisphere, in particular by Chinese fossils. The end-Permian extinction is perhaps best associated with the demise of trilobites.

To improve on previous dates for the land extinction, an international team of scientists, including Looy, conducted uranium-lead dating of zircon crystals in a well-preserved volcanic ash deposit from the Karoo Basin. Looy, who is also a curator of paleobotany at the campus’s Museum of Paleontology and curator of gymnosperms at the University and Jepson Herbaria, confirmed that sediments from several meters above the dated layer were devoid of Glossopteris pollen, evidence that these seed ferns, which used to dominate late Permian Gondwanan floras, became extinct around that time.

At 252.24 million years old, the zircons — microscopic silicate crystals that form in rising magma inside volcanoes and are spewed into the atmosphere during eruptions — are 300,000 years older than dates obtained for the confirmed Permian-Triassic (P-T) boundary in China. This means that the sediment layer assumed to contain the P-T boundary in South Africa was actually at least 300,000 years too old.

Dates for an ash deposit in Australia, just above the layers that document the initial plant extinction, similarly came in almost 400,000 years older than thought. That work was published in January by Christopher Fielding and colleagues at the University of Nebraska in Lincoln.

“The Karoo Basin is the poster child for the end-Permian vertebrate turnover, but until recently, it was not well-dated,” Looy said. “Our new zircon date shows that the base of the Lystrosaurus zone predates the marine extinction with several hundred thousand years, similar to the pattern in Australia. This means that both the floral and faunal turnover in Gondwana is out of sync with the Northern Hemisphere marine biotic crisis.

“For some years now, we have known that — in contrast to the marine mass extinction — the pulses of disturbance of life on land continued deep into the Triassic Period. But that the start of the terrestrial turnover happened so long before the marine extinction was a surprise.”

In their paper, Looy and an international team of colleagues concluded “that greater consideration should be given to a more gradual, complex, and nuanced transition of terrestrial ecosystems during the Changhsingian (the last part of the Permian) and, possibly, the early Triassic.”

Looy and colleagues published their findings March 19 in the open access journal Nature Communications. Her co-authors are Robert Gastaldo of Colby College in Maine; Sandra Kamo of the University of Toronto in Ontario; Johann Neveling of the Council for Geosciences in Pretoria, South Africa; John Geissman of the University of Texas in Dallas and Anna Martini of Amherst College in Massachusetts. The research was funded by the National Science Foundation.

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Health24.com | Could stroke drug help coronavirus patients avoid ventilators?

For people very sick with the new coronavirus, access to a mechanical ventilator can mean life or death. Trouble is, they’re in short supply in the United States and around the world.

Now, research suggests that a widely used clot-busting stroke drug might help coronavirus patients who can’t access a ventilator or who fail to improve even when they do gain access.

Blood-clotting disorder

The research focuses on a drug called tissue plasminogen activator (tPA), which is normally used to quickly dissolve blood clots that cause strokes or heart attacks.

New data from China and Italy suggest that people with Covid-19, the disease caused by the coronavirus, have a significant blood-clotting disorder.

Patients in respiratory failure develop blood clots in the lungs and tiny blockages in the lung’s blood vessels. These tiny clots keep blood from reaching air spaces in the lungs, and that’s where blood normally receives oxygen from the lungs.

“This is a way to repurpose a drug for which there is already widespread clinical utility,” said senior researcher Dr Michael Yaffe, a professor of biology and biological engineering at Massachusetts of Institute of Technology.

Dr Hunter Moore, a transplant fellow at the University of Colorado Denver, is a study co-author.

“Everyone is looking for ways to mitigate the threat of this disease, and there’s a lot of investment and interest in new drugs,” Moore said. “But if this disease gets out of control, those drugs won’t have had safety evaluations. TPA has.”

While well-studied in stroke and heart attack, the use of tPA for acute respiratory distress syndrome has mostly been investigated in animals. A small human trial was conducted in 2001 on people with severe respiratory distress who weren’t expected to survive.

Potential therapeutic value

Moore said tPA reduced the death rate in those patients from 100% to 70%.

The researchers noted that further studies haven’t been done because people typically improve well with the support of ventilators. But as Covid-19 overwhelms the health care system, there may not be enough ventilators for patients who need them.

“TPA may potentially hold therapeutic value in treating severely ill Covid-19 patients with acute respiratory distress syndrome that is unresponsive to typical ventilation strategies,” said Dr Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

He said the science supporting its use is sound.

“Tiny clots block small blood vessels in the lungs, preventing adequate oxygenation and ventilation,” said Glatter, who wasn’t part of the study. “The drug also prevents clots from blocking blood vessels in the kidney and heart, leading to kidney and heart failure. TPA dissolves the clots, opening up small blood vessels, improving the ability of the lungs and other critical organs to function normally.”

A ‘compassionate trial’

While bleeding is a potential risk of tPA, Glatter noted that this didn’t happen in the one study that was done.

Yaffe said researchers are planning a “compassionate use” trial of the drug on Covid-19 patients, possibly beginning within a week, to see if tPA helps these patients. They will be assessing both intravenous tPA and inhaled tPA.

A compassionate use trial allows patients with a serious or life-threatening illness to receive an investigational therapy.

Patients selected for the trial will either be on ventilators or appear to need ventilation. They will be high-risk patients who have potentially deadly acute respiratory distress syndrome.

The researchers hope to test tPA in 12 people, but will evaluate its effectiveness and safety after four patients.

Extraordinary measures

The dose of tPA they’ll use is lower than that typically prescribed for stroke or heart attack patients. It will also be delivered over a longer time period.

Yaffe said tPA’s manufacturer, Genentech, is providing the study medication for free. If the trial is successful, the drug maker has told researchers it is prepared to ramp up production.

Given the increasing rate of Covid-19 infections, the researchers hope the trial might begin as soon as next week.

“Extraordinary times call for extraordinary measures. If an observational trial of this treatment in the first series of patients is effective and safe, the approach could be readily broadened. This would have multiple patient-related and public health benefits,” the researchers said in their study.

*Published online in the Journal of Trauma and Acute Care Surgery.

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Image credit: Getty Images

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