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# COVID-19: Expertise

Expert opinion on the implications of COVID-19 and discussion of research in the field.

## > Editor’s Pick: Improving Antenatal Asthma Management: A Complex Journey

27 OCTOBER 2020

Asthma is a highly prevalent comorbidity during pregnancy, which can worsen as gestation progresses and is associated with several adverse perinatal outcomes. The adverse outcomes associated with maternal asthma are preventable with appropriate asthma management in pregnancy. However, the prevalence of adverse outcomes has not changed significantly over the last 20 years, even though knowledge and treatments for managing the disease in pregnancy has improved significantly. This is of concern now in the current climate with the coronavirus disease (COVID-19) pandemic and its potential impact on pregnant individuals with asthma. This article will discuss the treatments available for the management of asthma in pregnancy, the barriers for the translation of current knowledge into obstetric practice, and the importance of asthma education and self-management skills.

## > Risk Factors for Severe Coronavirus Disease (COVID-19)

27 OCTOBER 2020

Background: During the recent coronavirus disease (COVID-19) pandemic there have been several studies implicating an association between obesity, COVID-19 severity, and mortality. This retrospective study aims to investigate the association between obesity, other risk factors, and COVID-19 mortality of patients admitted over a 6-week period to the respiratory units at the authors’ hospitals. Methods: This is a retrospective study of 71 patients who were admitted into a respiratory unit over a 6-week period where the data were analysed for correlation between various risk factors, COVID-19 severity, and mortality. The statistical analysis was performed using excel statistics and SPSS (IBM, Armonk, New York, USA) statistical software. The significance was considered at p<0.05. The multivariate analysis, Z-test, Cox regression, Pearson correlation, and Kaplan–Meier analysis were used. Results: The mean age of the patients was 65.8 years (range: 35.0–93.0 years) standard deviation (13.21) and the male to female ratio was 2.73 (52:19, respectively). The most frequent comorbidities were obesity (42/71; 59%), hypertension (36/71; 50%), diabetes (22/71; 31%), heart disease (13/71; 18%), respiratory disease (9/71; 13%), and cancer (8/71; 11%). The mean body weight was 83.7 kg (60.4–147.7 kg) and the mean BMI was 32.2 (22.0–53.0 kg/m2). Smoking was reported in 8 (11%) of the patients. There were 20 (83%) mortalities among patients >70 years old (p<0.0001), 20 (83%) deaths among male patients (p<0.0001), 14 (58%) deaths among patients with a BMI >25 kg/m2 (p=0.001), 17 (70%) deaths reported for patients with hypertension (p=0.008), 6 (25%) mortalities for patients with cardiovascular disease (p=0.001), 14 (30%) deaths among patients who were mechanically ventilated (p=0.00028), and 5 (20%) mortalities among patients with cancer (p=0.003). Conclusions: Obesity, cancer, mechanical ventilation, male sex, intensive care unit admission, cardiovascular disease, and hypertension are significant risk factors for mortality in patients with COVID-19

## > ERS Congress Interview: Prof Greet Van den Berghe

27 OCTOBER 2020

In intensive care medicine, what have been the most important learnings from the COVID-19 pandemic so far? If you are referring to the most important new insights about the disease pathophysiology and possible treatments, I think it is too early to know for sure. As I said earlier, we should not rush into conclusions. We should continue to focus on high-quality research so that we understand better before we introduce treatments that may not only be beneficial but could also carry risk of harm. While being cautious and advising not to overinterpret any of the available data, I think that the severe form of COVID-19 respiratory failure and acute respiratory distress syndrome, that we have seen in our ICU worldwide, is quite different from the typical bacterial sepsis-induced acute respiratory distress syndrome. There is reason to believe that severe COVID-19 may start as a local ‘endotheliitis’ in the lungs rather than as a particularly destructive form of ‘alveolitis’ and that the early activation of coagulation may be a key trigger upstream in the cascade of inflammation and organ failure. In my personal opinion, protecting the endothelium, by omitting early use of parenteral nutrition and preventing hyperglycaemia and by a cautious use of corticosteroids for selected patients, to name but a few strategies that may work, while putting a brake on the coagulation cascade very early on in the disease course could be quite important in preventing poor outcome. This has been the strategy that we have followed during the first COVID-19 wave in our centre, where the very low mortality rate may have been a consequence hereof. But again, high-quality research via RCT is the only way to investigate properly whether that statement is true or false.

## > ERS Congress Interview: Dr Nina Brooks

27 OCTOBER 2020

What impact is the COVID-19 pandemic having on pulmonary rehabilitation, and how do you think it will shape the future of the field? Pulmonary rehabilitation has had to pivot to be virtual to some degree or another. Virtual pulmonary rehabilitation is a challenge as it is difficult to assess physical function and prescribe specific exercises. However, there are many advantages as it minimises the barriers related to access. The virtual rehabilitation will be great long-term, especially for those who live far from pulmonary rehabilitation centres.

## > The Treatment of Severe Respiratory Disorders in Challenging Times

27 OCTOBER 2020

Prof Welte opened the symposium by describing the key roles of hypercoagulation and inflammation in the course of severe coronavirus disease (COVID-19). This was complemented by Dr Larbig’s talk that introduced CSL312, a new human monoclonal antibody targeting coagulation factor XIIa, which aims to target both hypercoagulation and inflammation. Prof Idzko followed with a discussion about the challenges of treating respiratory conditions such as alpha-1 antitrypsin deficiency (AATD) during the COVID-19 pandemic. Dr Sucena explained that many patients had been unable or unwilling to attend health centres to receive alpha-1 antitrypsin (AAT) therapy, putting them at risk of increased morbidity. In response, Prof Herth discussed the use of self-administered AAT to ensure that patients receive regular therapy. Prof Greulich described the difficulties in providing robust evidence for the positive impact of AAT therapy on mortality, and Prof Sandhaus introduced a recent observational study that overcomes some of these problems, with findings that suggest AAT therapy results in improved survival rates and a slower decline in quality of life (QoL). Finally, Profs Idzko, Singh, and Chalmers emphasised that better treatments are needed for other respiratory conditions, and introduced drugs that are currently under development to address this need; these include a new antibody intended to treat a broad range of the severe asthma population (CSL311; CSL Behring, King of Prussia, Pennsylvania, USA) and nebulised IgG to treat non-cystic fibrosis bronchiectasis (NCFB) (CSL787; CSL Behring). Overall, advances continue to be made in the treatment of severe respiratory conditions, despite the difficulties posed by the current COVID-19 pandemic.

## > Review of the Virtual European Respiratory Society (ERS) International Congress 2020

27 OCTOBER 2020

THE 30th anniversary of the European Respiratory Society (ERS) meeting was set to be a spectacle in Vienna, Austria, but no one could predict what the year had in stall for us. In response to the ongoing coronavirus disease (COVID-19) pandemic, the ERS made the decision to hold the 30th ERS International Congress virtually. Even with this unexpected turn of events, the society put together a platform that showcased research and facilitated discussion and interaction, which was attended by over 33,000 delegates. In the ‘Welcome to 30th Congress’ section of the platform, the ERS President Thierry Troosters welcomed attendees to the event. Amongst many of his encouraging words, Prof Troosters highlighted how many professionals in the respiratory field had dedicated their lives to fighting the COVID-19 pandemic on the frontlines or have been involved in researching pharmacological and nonpharmacological treatments for the many patients affected by the disease. He further noted that: “The pandemic also showed the pivotal role of links to other country and regional societies. We exchange knowledge and help each other with dissemination of science around the pandemic in many of the disease areas covered by the society.”

## > COVID-19 Delays Could Have a Profound Impact on Breast Cancer Outlook

26 OCTOBER 2020

SDELAYS in treatment, as a result of the coronavirus disease (COVID-19) pandemic, have been experienced by many people with cancer across the world. According to an analysis using Kantar Health’s CancerMPact® Patient Metrics database, the delays in breast cancer surgery earlier this year could result in an additional 3,000 deaths in the USA over the next 10 years. The Kantar Health, New York City, New York, USA, database provides data and insight to drug developers and investors and estimates that there will be over 335,000 new breast cancer cases in the USA in 2020, around 320,000 of which will be nonmetastatic. The routine treatment that is normally started shortly after diagnosis provides patients with a good chance of positive outcomes; however, a 2016 study showed that a 60-day delay in receiving breast cancer surgery can cause a 4% increase in the number of deaths after 5 years and 7% more deaths at 10 years.

## > Male Sex May Be the Defining Factor in Predicting Susceptibility to and Severity of SARS-CoV-2 Infection: A Case Series

26 OCTOBER 2020

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the virus that causes the coronavirus disease (COVID-19). This paper will describe a series of three confirmed cases of COVID-19 and use patterns observed in these cases to discuss the association of this infection with male sex through different mechanisms linked to the X chromosome. The patients’ symptoms and diagnostic testing are reviewed, while also focussing on the illness status of their immediate family members. It is known that the X chromosome is linked to SARS-CoV-2 viral infectivity through the androgen receptor gene which is located on the X chromosome, and that angiotensin-converting enzyme 2 has an unconfirmed pattern of X-linked inheritance of its allelic variants, some of which are known to afford stronger binding affinity to SARS-CoV-2. However, there are no studies that investigate these factors in combination with each other and how this combination predicts disease outcome in males versus females, providing a more concrete explanation for the observed pattern that suggests this disease leads to poorer disease outcomes in males. Investigation of these factor combinations will allow for greater understanding of the epidemiology of this virus and the development of more accurate guidelines for the prevention, diagnosis, management, and prognosis of SARS-CoV-2 infection.

## > Low Risk of Moderate or Severe COVID-19 in Congenital Heart Disease

23 OCTOBER 2020

RETROSPECTIVE data analysed by researchers at Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA has shown that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in patients with congenital heart disease was associated with a low risk of moderate or severe coronavirus disease (COVID-19).

## > COVID-19 and the Liver In Vitro

13 OCTOBER 2020

IN THIS YEAR’S European Association for the Study of the Liver (EASL) Digital International Liver Congress (ILC) 2020, the session ‘COVID-19 and the Liver’ covered the essential information hepatologists need to know about the novel virus. Opening the session, Prof Sandra Ciesek gave the audience a background on the facts and figures of coronavirus disease (COVID-19).

## > Multiple Sclerosis Medication Effectively Inhibits SARS-CoV-2 Replication In Vitro

09 OCTOBER 2020

REPLICATION of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to be inhibited by an antiviral medication approved in the treatment against multiple sclerosis in vitro.

## > The EMG GOLD Podcast: Pharma’s Month in Review

06 OCTOBER 2020

This month, we reflect on some of the standout events from September in the pharmaceutical industry, highlighting shifting public perceptions of the industry, exploring the FDA’s pushback against counterfeit medications, and providing an update on the latest COVID-19 vaccine developments.

## > COVID and The Cardiovascular System

01 OCTOBER 2020

Patients with COVID-19 and cardiovascular disease or hypertension are at greatest risk for severe infection and mortality, but the underlying mechanisms for this association are not completely clear. There are several possible explanations for this, as outlined in this article by Akbulut et al.

## > Impact of the COVID-19 Pandemic on Trauma and Orthopaedic Service in the Republic of Ireland

29 SEPTEMBER 2020

The novel coronavirus disease-2019 (COVID-19) has been identified as the cause of a rapidly spreading respiratory illness that is thought to have originated from Wuhan, China in early December 2019. Since then, the free movement of people has decreased, which has thus reduced the number of trauma-related casualties. The Irish governments initiated strict social distancing measures in response to the COVID-19 pandemic in late March 2020. It remains challenging to quantify the impact this had on reducing the spread of the virus. The viral outbreak has led to significant changes in the lifestyle of Irish citizens. The aim of this study was to examine the impact of the pandemic on activity, related to emergencies in trauma and orthopaedics departments.

## > Prone Position Puts Severe COVID-19 Patients on Ventilation at Risk of Permanent Nerve Damage

28 SEPTEMBER 2020

PRONING patients on ventilation is common practice to help breathing and reduce mortality and has been utilised for those with acute respiratory distress syndrome as a result of coronavirus disease (COVID-19). But according to a new study, patients seriously ill with COVID-19 could be at risk of developing permanent nerve damage from being placed in the prone position while on ventilation. Nerve damage rarely occurs when non-COVID-19 patients on ventilators are placed in the prone position; however, generalised weakness is a common occurrence due to being bedridden for long periods of time. This is a reason why the researchers believe the nerve injuries to be initially missed, as they were masquerading as common effects of being bedridden. However, during the rehabilitation process, the researchers identified a pattern of weakness in patients who had been severely ill with COVID-19 that was concerning, which often included severe weakness or even one-sided paralysis of important joints such as the wrist, ankle, or shoulder.

## > Can Inflammatory Biomarkers Be Used to Predict Severe COVID-19 Disease?

28 SEPTEMBER 2020

SEVERITY of coronavirus disease (COVID-19) varies massively in patients who become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from patients having very mild to life-threatening symptoms and needing mechanical ventilation. Researchers from KAIST, Daejeon, South Korea, have identified key markers that could help predict which patients are at increased risk of developing severe COVID-19, and thus allow attending physicians to produce a more personalised treatment plan for the patient.Acute respiratory distress syndrome accounts for 70% of the deaths in severe COVID-19 infections by causing extensive damage to the airway as a result of an exaggerated immune response to SARS-CoV-2. To identify those at risk, researchers from KAIST, using a public database, analysed RNA sequencing data extracted from individual airway cells of healthy controls and patients with mild and severe COVID-19.

## > The EMG Health Podcast: My PPE Doesn’t Fit Me?

25 SEPTEMBER 2020

This week, Jonathan chats to Professor Theresa Rohr-Kirchgraber and medical student, Laura Christopher, from the Indiana University School of Medicine, about the gender and sex disparities that exist in medical research. They examine clinical trial recruitment and delve into the data on how ill-fitting PPE affects HCPs.

## > What is the Mechanism for Blood Clotting in COVID-19?

11 SEPTEMBER 2020

THROMBOSIS is a significant contributor to morbidity and mortality in coronavirus disease-2019 (COVID-19), and researchers may have identified the mechanism for the impact it has on blood clotting. Activation of the complement system in the proinflammatory state of COVID-19 can contribute to clot formation and can be initiated by several different proteins. Complement is made up of >50 circulating proteins and has the ability to recognise and render harmless bacteria, viruses, and damaged cells in the bloodstream; excessive activation of the complement system, including in severe infections, can affect the body’s own cells and result in tissue damage. Researchers at Uppsala University and Uppsala University HospitalUppsala, Sweden, have studied the levels of mannose-binding lectin (MBL) in patients hospitalised with COVID-19.

## > Do COVID-19 Related Prostate Cancer Treatment Delays Impact Oncological Outcomes?

4 SEPTEMBER 2020

DELAYS in nonemergent surgery for prostate cancer (PC), as a result of the coronavirus 2019 (COVID-19) pandemic, have been shown to not adversely affect oncological outcomes according to results from a large European cohort. Currently, COVID-19 is transforming urological practice with most urological societies recommending the deferral of any surgical treatment for patients with PC. Because it is not clear whether a delay between diagnosis and surgical management may impose a disadvantageous effect on oncologic outcomes of these patients, researchers at Université Libre de Bruxelles, Brussels, Belgium, aimed to assess the impact of such surgical delay.

## > Chronic Kidney Disease Patients Receiving On-site Dialysis at Increased Risk of COVID-19

1 SEPTEMBER 2020

NURSING home residents receiving haemodialysis for chronic kidney disease may be at greater risk of COVID-19. Researchers at the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, identified residents at a nursing home, an already vulnerable population, who were found to have repeated and prolonged exposure to the virus.An outbreak of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in a nursing home with 170 residents in Maryland. Within the vulnerable population in nursing homes, COVID-19 can spread rapidly and long-term care facilities may see high numbers of confirmed cases and deaths. In the nursing home, 29 out of 32 patients receiving dialysis from an on-site haemodialysis centre were tested for exposure to SARS-CoV-2, of whom 15 tested positive (47%), compared to only 16% of the residents in the home not receiving dialysis. Mr Benjamin Bigelow, medical student and lead author, commented: “Based on our results, we believe that nursing home residents undergoing dialysis are more likely than others in a facility to have repeated and prolonged exposures to the SARS-CoV-2 virus, and therefore may be at greater risk of infection and subsequent COVID-19.”

## > A New Track for Scientific Exchange

27 AUGUST 2020

The transition from one period to another can bring about a spell of reflection, much like watching the countryside fly by from a train window. The COVID-19 pandemic has plunged medical affairs into one such transition, forcing them to switch track to virtual engagement tools to ensure ongoing scientific exchange in a time of crisis. This switch has presented challenges, starting with morphing medical education from a physical to an online experience: “One of the major logistical and resource barriers to online external engagement is building targeted awareness, sharing of voice, and gaining attention in an environment where there is an abundance of noise, as nearly all engagements are going virtual,” says Mansi Jamindar, Associate Director, Global Medical Communications Lead, Sanofi Genzyme.

## > Awakening Creativity to Combat the Crisis

27 AUGUST 2020

As industries around the world have come together to combat the COVID-19 crisis, marketers have been experiencing an awakening of creativity. Many companies are channelling this influx of creativity for good, from encouraging social distancing to providing much-needed PPE and health products for front-line workers. When the bubonic plague struck 17th century England, Isaac Newton found himself in a year-long quarantine that proved to be rife with inspiration. It was during this time that his theory of gravity spawned, said to have been inspired by an apple tree outside his window. Amidst the COVID-19 lockdown, creativity is shining through once more, bringing a little light to these devastating times. Marketers are not sitting still, waiting for the apple to drop and yield a stroke of inspiration; they are sowing seeds of creativity and sprouting campaigns with a positive purpose. The fruits of their labours may well change the landscape of healthcare marketing forever.

## > The March of the CMOs

27 AUGUST 2020

On 11th March 2020, WHO declared the coronavirus outbreak a pandemic and Chief Marketing Officers across all industries had to abandon their forecasts, KPIs, and 5-year plans, in favour of a more agile and intuitive approach to marketing. Before COVID-19, we may have eye-rolled at calls for a corporate ‘pivot’, but the pandemic has transformed this into a mantra, aligning CMOs in their mission to ensure their brands are valuable in a time of crisis. This collective refocus has led to an increased need for cross-industry learning, a thirst that was quenched by Cannes Lions Live 2020. The event hand-picked leading CMOs from all corners of the business world to come and share their experiences for the benefit of their contemporaries.

## > Virtual or Face-to-Face in the Post COVID-19 World?

26 AUGUST 2020

Niccolo Machiavelli and Winston Churchill have both been credited with the advice: “Never waste the opportunity offered by a good crisis.” It would be a mistake for clinicians to ignore this advice. Suddenly, faced by the COVID-19 pandemic, general practitioners and hospital specialists have had to identify patients at risk in a very short time; redeploy staff; and reduce clinic opening hours substantially by deciding which patients can consult by telephone, which must be seen, and which could safely wait, often without clear service statistics.

## > Interview: Prof Andrew Shennan

25 AUGUST 2020

In 2017 you were awarded the prestigious Newton Prize, a fund for excellence in research and innovation in support of academic development and social welfare. Please tell us more about your work in low- and middle-income countries?  You probably have gathered my real passion is global health. Many individuals contributed to the success of this prize. More than 35,000 of our CRADLE Vital Signs Alert (VSA) device (to detect shock and blood pressure) have been disseminated in over 40 countries, and we are developing its use outside pregnancy (e.g., to detect malaria in refugee camps in Uganda, and anaemia in India). 3,000 devices in Sierra Leone have been redeployed to help with the COVID-19 crisis.

## > Podcast: Talking to Dario Safaric

18 AUGUST 2020

This week, we speak to Dario Safaric, Chairman of the NEXT Pharma Summit, about his journey starting a conference from scratch, Croatia’s historical relationship with the pharmaceutical industry, and the future outlook for medical conferences in the post-COVID-19 era.

Listen here.

## > Reinventing Engagement with Virtual Communication

10 AUGUST 2020

For years, pharmaceutical companies have remained unwavering in their preference for traditional communication techniques, relying on tried and tested face-to-face personal interactions. While some companies have dipped their toes in the AI pond, virtual communication has not been embraced by all. However, the COVID-19 pandemic has thrown companies in at the deep end – forcing them to explore and utilise new digital communication solutions to maintain engagement with HCPs during the crisis. Their benefit is being realised now, but will these new strategies reinvent the nature of personal engagement in the post-COVID world?

## > Distinct Immune Response Profiles Correlate with COVID-19 Disease Severity

7 AUGUST 2020

DIFFERING immune system responses of patients with COVID-19 indicate which patients are at greater risk of developing severe forms of the illness. According to researchers at Yale University, New Haven, Connecticut, USA, these findings may help identify those at high risk of severe illness early during their hospitalisation and help to suggest drugs to treat COVID-19. For the study, the immune system responses of 113 patients admitted to Yale New Haven Hospital were examined during their entire hospital stay: from admittance to discharge or death. Immune profiling revealed that all patients shared a common COVID-19 immune system activity ‘signature’, including increased innate cell lineages with a concomitant reduction in T-cell number during the beginning of the disease course. Patients who went on to have moderate symptoms experienced diminishing immune system responses and viral load over time, while those who developed severe cases of the disease maintained these elevated responses throughout the course of the disease.

## > Can Exposure to Common Cold Human Coronaviruses Lead to Immunological Memory in SARS-CoV-2?

7 AUGUST 2020

MEMORY T cells that recognise common cold coronaviruses may teach the immune system to recognise matching sites on SARS-CoV-2, potentially explaining why some people have milder COVID-19 symptoms. Although the researchers at La Jolla Institute for Immunology, San Diego, California, USA, emphasise that this is speculation and their research requires more data, their results have preliminarily shown that memory helper T cells that recognise common cold coronaviruses also recognise SARS-CoV-2, the virus that causes COVID-19. “Immune reactivity may translate to different degrees of protection, having a strong T-cell response, or a better T-cell response may give you the opportunity to mount a much quicker and stronger response,” stated Prof Alessandro Sette.

## > Video: Patients with CV Conditions & COVID-19: What Have We Learned From Patients’ & Doctors’ Experiences?

7 AUGUST 2020

Cardiovascular patients, Winfried Klausnitzer and Patricia Vlasman, join Neil Johnson, Director, Development & Strategy, Global Heart Hub and Professor Salvatore Di Somma, Professor of Medicine, Sapienza University of Rome, to share their respective experiences of facing the COVID-19 pandemic, in this webinar, facilitated by Professor Jonathan Sackier.

## > Healthcare’s Hidden Gem During (and After) the COVID-19 Crisis

3 AUGUST 2020

The novel coronavirus pandemic has highlighted many of the structural inefficiencies and shortcomings of the modern USA healthcare systems. News accounts have been replete with references to shortages of supplies, equipment, and medications. However, these barriers also represent lessons to be learned, and opportunities to improve the healthcare system on the other side of the crisis. This is particularly true with members of an often-overlooked discipline: the respiratory therapists who manage invasive ventilation and other therapies critical to optimal COVID-19 treatment, and who hold the clinical expertise to help COVID-19 survivors thrive in their post-intensive care unit lives.

## > Functional MRI May Help Predict COVID-19 Prognosis

31 JULY 2020

RECOVERY of neurological impairments in COVID-19 remains an area of emerging understanding, but a recent case report described the role of resting-state functional MRI (rs-fMRI) in predicting recovery. Functional MRI has become an important tool in determining impairment and chance of recovery in states of altered consciousness. A 47-year-old male patient fluctuated between coma and minimal consciousness for several weeks following respiratory failure caused by severe COVID-19. Despite profound clinical and structural neurological impairments, rs-fMRI revealed strong functional connectivity within the default mode network; this connectivity was similar to that seen in healthy patients. Other research has revealed that better default mode network connectivity predicts better neurologic recovery in disorders of consciousness. The findings in this case suggested a potential for a more positive prognosis than was otherwise evident.

## > Is Tocilizumab Beneficial to Critically Ill COVID-19 Patients?

31 JULY 2020

Tocilizumab, an immunosuppressant originally developed as a rheumatoid arthritis treatment, has demonstrated further benefits in treating patients critically ill with COVID-19. In the study by researchers at the University of Michigan, Ann Arbor, Michigan, USA, patients who received tocilizumab were 45% less likely to die and more likely to be well enough to be withdrawn from ventilation within 28 days, compared to those who did not receive the drug. The retrospective, single-centre study included 154 critically ill patients with a confirmed COVID-19 diagnosis. One-half of the patients received intravenous tocilizumab, with many receiving this within 24 hours intubation. The patients were monitored for 28 days following their intubation and, by the end of this period, 18% of patients who received tocilizumab had died, compared to 36% of patients who had not received the drug, representing a 45% reduction in mortality (adjusted for health characteristics). Furthermore, 82% of patients treated with tocilizumab who were still in the hospital were able to be withdrawn from ventilation, compared to 53% who did not receive the drug.

## > EMG-Health Podcast: Planet Health

31 JULY 2020

This week, Jonathan Sackier sits down with Sir Andy Haines, Professor at LSHTM and climate change expert, to explore the intrinsic connection between climate change and human health. Together, they discuss the impact of COVID-19, the positives of our increasingly digital world, and the effect of both diet and public policy when it comes to our own health and that of our planet.

## > Concerns Regarding the Management of β-Thalassaemia Patients in the Era of COVID-19

30 JULY 2020

Many cases of pneumonia clustered in the city of Wuhan, China, were reported in December 2019, and source tracing has showed Huanan Seafood Market, Wuhan, China, as the origin. In this work, the authors summarise their concerns for thalassaemia patients, a unique group with several heart, liver, and blood comorbidities. Thalassaemia (from the Greek word thalassa [sea]) represents a group of genetic haemoglobinopathies that have emerged in certain regions of the world (Sub-Saharan Africa, the Indian subcontinent, Southeast Asia, and the Mediterranean region) where malaria was (or is) endemic. Thalassaemia is the most widely known haemoglobinopathy and several changes in the human immune system have been associated with thalassaemia, including a reduction in neutrophil counts, changes in the number and function of natural killer cells, increase in the number and function of CD8 suppression cells, dysfunction of macrophages, chemotaxis, and phagocytosis, and production of INF-γ.

## > Coagulopathy and Hyperinflammation in COVID-19

30 JULY 2020

MORTALITY in novel coronavirus disease 2019 (COVID-19) is impacted by haematological complications and therefore, addressing these may improve patient survival. In shared presentations at the 25th European Hematology Association (EHA) Annual Congress, expert haematologists discussed clinical and scientific findings in the global experience of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, analysed data to articulate current understanding, and provided insights for care and management of affected patients. The final stage of a three-part programme was a presentation titled “Treatment of COVID-19: Current and Future”, which included detailed examinations of thrombosis management, immunotherapy, and the value of haematologists’ expertise in combatting this current pandemic.

## > Review of the European Hematology Association (EHA) Virtual Congress 2020

30 JULY 2020

ADULT patients with the severe inherited blood disorders sickle cell disease (SCD) and thalassaemia could be at risk of experiencing severe outcomes from COVID-19. National data collected by the newly launched National Haemoglobinopathy Panel (NHP) were analysed by researchers at Queen Mary University of London, London, UK and outlined in a EHA25 Virtual press release dated 13th June 2020. The survey of 199 patients with SCD and 26 patients with thalassaemia revealed that most confirmed and suspected cases of COVID-19, as classified by the World Health Organization (WHO) surveillance criteria, were mild. There was no associated increased risk in paediatric patients; however, adults with SCD appeared to be at increased risk of adverse outcomes of the virus. Cases included in the study were reported up to 5th June 2020.

## > Is Immunotherapy Safe For COVID-19 Patients?

29 JULY 2020

COMORBID COVID-19 and cancer is complicated by immunotherapy treatment, which activates an immune system response that may already be overactive because of the viral infection. However, preliminary data from researchers at the University of Cincinnati Cancer Center, Cincinnati, Ohio, USA, have shown that immunotherapy does not exacerbate complications in this patient population. COVID-19 symptoms are often a consequence of a heightened immune response, which leads to an increased production of cytokines: cell signalling proteins of the immune system. Dr Layne Weatherford, one of the authors of the study, further explained the consequences of this response: “Increased production of these proteins can cause issues like respiratory failure.” It was therefore thought that cancer immunotherapy might lead to poorer patient health outcomes.

## > How Much Have I Learned?

28 JULY 2020

The other day I asked a handful of individuals, all non-medical, about their worries. What troubled them most? “The late effects,” one replied. “What about those?” “Which ones?” I queried. “Fertility,” came the reply. “The first SARS was said to reduce fertility, certainly in men. How about Covid-19?” I shrugged my shoulders, unable to reply. It is true that the original SARS affected fertility and there is talk about Covid-19 doing the same. “And neurology,” said another. “How do I know that I am not going to develop some ghastly disease later in my life?” Again, I shrugged my shoulders. The questioner’s worry may be justified. Barely a week passes without another neurological effect of Covid-19 being declared. How do we know that those who happen to be asymptomatic now, and are feeling thoroughly immortal, will not turn out to be harbouring some neurological ghastly, which will declare itself in 20 years’ time? I was interested that no one mentioned pneumonia as a worry. “The politicians are rubbish,” said another. “How do you mean?” I asked. “They are busy playing the blame game,” came the reply. “They have stopped listening to medical advice,” said another. All I could do was nod. I now see senior medics and scientists holding conferences without politicians being present. There is a little less of the, “We are following scientific advice,” coming from the bigwigs.

## > EAACI Interview: Prof Dr. Hab. Ioana Agache

28 JULY 2020

As a response to the COVID-19 outbreak, EAACI 2020 will now take place virtually. Do you think this will encourage EAACI to host more virtual events in the future? Not necessarily. I believe that we should keep a balance between live and virtual events in order to ensure direct networking and communication, whilst outreaching remotely to those who cannot attend in person. Whether through personal mobile devices or sophisticated virtual meeting suites, technology is revolutionising the way meeting content is communicated, both in and out of the meeting room. Not only are people outside the room drawn in, but those within the room have access to a heightened degree of interaction. Hybrid meetings are already a tradition and we will continue on that path. COVID-19 is not only impacting clinicians, but also scientific researchers. What impacts will the COVID-19 pandemic have on the course and direction of your research, or the field of asthma in general? I saw recently a very interesting headline: “The confrontation between the pandemics and the chronic disease.” Both healthcare professionals and patients with asthma were caught in the middle and we all had to adapt fast to ensure optimal care for asthma whilst coping with the pandemic’s harsh restrictions, meant to ensure safety at a population level.

## > EAACI Interview: Prof Antonella Muraro

28 JULY 2020

The COVID-19 pandemic has impacted numerous clinical therapeutic areas, in particular immunology. Are EAACI putting together guidelines or resources to help educate and advise clinicians with how to either treat COVID-19 or continue treatment of their existing patients? EAACI has put in place an effort to provide articles with free access at the EAACI COVID-19 resource centre. In addition, the EAACI Section on Pediatrics has recently published a very useful practical guide for managing allergies and immunodeficiencies in children in daily practice. In the UK, a law that will require prepackaged foods to be labelled with allergens in more detail will come into effect from October 2021. What impact do allergen labelling laws such as this have on those who have a food allergy? This will be a landmark step. All patients with food allergies will have the opportunity to check the full list of the ingredients and allergens of prepackaged food. According to the current law, it is mandatory to include in the list of the ingredients only 14 food allergens acknowledged by the European Commission. Patients who are allergic to allergens different from the 14 have still the risk of an inadvertent reaction by accidental ingestion not being able to detect their specific food allergen. This law would reduce the burden for the patients and their families, hopefully preventing anaphylactic reactions and saving lives.

## > EAACI Interview: Prof Antonella Muraro

28 JULY 2020

The COVID-19 pandemic has impacted numerous clinical therapeutic areas, in particular immunology. Are EAACI putting together guidelines or resources to help educate and advise clinicians with how to either treat COVID-19 or continue treatment of their existing patients? EAACI has put in place an effort to provide articles with free access at the EAACI COVID-19 resource centre. In addition, the EAACI Section on Pediatrics has recently published a very useful practical guide for managing allergies and immunodeficiencies in children in daily practice. In the UK, a law that will require prepackaged foods to be labelled with allergens in more detail will come into effect from October 2021. What impact do allergen labelling laws such as this have on those who have a food allergy? This will be a landmark step. All patients with food allergies will have the opportunity to check the full list of the ingredients and allergens of prepackaged food. According to the current law, it is mandatory to include in the list of the ingredients only 14 food allergens acknowledged by the European Commission. Patients who are allergic to allergens different from the 14 have still the risk of an inadvertent reaction by accidental ingestion not being able to detect their specific food allergen. This law would reduce the burden for the patients and their families, hopefully preventing anaphylactic reactions and saving lives.

## > Review of the European Academy of Allergy and Clinical Immunology (EAACI) Digital Congress 2020

28 JULY 2020

During the welcome message, Nobel Prize Laurate Sir Gregory P. Winter, University of Cambridge, Cambridge, UK, presented the first keynote lecture, in which he discussed the history of biologicals and their place in modern medicine, adding recently learned knowledge about SARS-CoV-2. The second keynote lecture about coronavirus and their influence in lung inflammation was delivered by Prof Peter Openshaw, Imperial College London, London, UK. Finally, Prof Jutel explored the recent data on immune modulation in the era of COVID-19. This year, Prof Santiago Quirce, Prof George du Toit, Prof Mübeccel Akdis, and Prof José María Olaguibel were respectively awarded the Clemens von Pirquet, Daniel Bovet, Paul Ehrlich, and Charles Blackley awards for their contributions to allergy and immunology. Other allergists honoured at this year’s congress included Dr Rodrigo Jimenez Saiz (Allergopharma Award), Dr Paul Turner (PhARF Award), and Dr Giorgio Walter Canonica, Dr Claudia Traidl-Hoffmann, Dr Sebastian Johnston, and Dr Nikos Papadopoulos (EAACI Fellow Award). Compelling research presented at the congress included the consideration of the role of allergy in the current COVID-19 pandemic, and in wider clinical fields; the role of air pollution in COVID-19 outcomes; bathing frequency of infants and the risk of atopic dermatitis; and proangiogenic features of B cells that may contribute to cancer and inflammation. Additionally, EAACI launched their guidelines for the use of biologic therapies in asthma at the congress.

## > Is Immunotherapy Safe For COVID-19 Patients?

24 JULY 2020

COMORBID COVID-19 and cancer is complicated by immunotherapy treatment, which activates an immune system response that may already be overactive because of the viral infection. However, preliminary data from researchers at the University of Cincinnati Cancer Center, Cincinnati, Ohio, USA, have shown that immunotherapy does not exacerbate complications in this patient population. COVID-19 symptoms are often a consequence of a heightened immune response, which leads to an increased production of cytokines: cell signalling proteins of the immune system. Dr Layne Weatherford, one of the authors of the study, further explained the consequences of this response: “Increased production of these proteins can cause issues like respiratory failure.” It was therefore thought that cancer immunotherapy might lead to poorer patient health outcomes.

## > Interview: Prof Hamid Rabb

23 JULY 2020

Regarding the current COVID-19 pandemic, could you explain how the virus affects the kidneys, and the result this has in those infected? Severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) can affect the kidneys in a number of ways: 1) patients with COVID-19 pneumonia have generalised inflammation and pro-coagulant status, which in turn causes kidney inflammation, injury, and decreased function; 2) patients with severe COVID-19 infections can have fluctuations and drops in blood pressure, impairing kidney blood flow and thus causing kidney dysfunction; 3) the SARS Co-V-2 can directly infect kidney tubular cells and podocytes, causing damage, white blood cell infiltration, and acute kidney injury.

## > Review of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Virtual Congress 2020

23 JULY 2020

Prof Loreto Gesualdo, President of ERA-EDTA, greeted viewers in the Opening Plenary session, and admitted that “deciding not to give up our annual congress and to turn it into a special digital edition has been an act of courage, as well as a bet.” He also paid respect to the country’s healthcare workers, “who have been, and are still, in the front-line in the fight against the virus,” and explained that the SARS-coronavirus-2 (CoV-2) virus has “forced us to adopt innovative and digital solutions” and “only accelerated a process that was already underway.” The pandemic has put a spotlight on nephrological expertise and highlighted its importance, as early observations have shown that the virus can cause kidney injury, albuminuria, and elevated creatinine levels. Therefore, the programme was subject to last-minute changes to accommodate for topical discussions and collaborations regarding COVID-19, including sessions on acute kidney injury and end-stage kidney disease in severe COVID-19, the particular risk of dialysis patients, and the prognosis for patients with kidney replacement therapy, as well as cytokine storm and the role of haemoperfusion.

## > EULAR COVID-19 Recommendations

21 JULY 2020

TREATING patients with autoimmune diseases, the rheumatology community is naturally concerned with the spread of COVID-19; as Prof Robert Landewé of the University of Amsterdam, Amsterdam, the Netherlands stated: “immunosuppression and infection do not go along very well.” On April 3rd 2020, EULAR President-Elect Prof Hans Bijlsma founded a task force to create a comprehensive set of guidelines for clinicians treating patients with rheumatic disease and COVID-19, though not in a typical manner. Using Microsoft Teams and teleconferences, the newly founded committee set out to create a comprehensive set of recommendations. Time was of the essence, as the virus continued to spread and rheumatologists looked to EULAR for guidance. Exactly 3 months later the guidelines were presented at the EULAR 2020 virtual congress on 3rd June 2020.

## > Interview: Clinical Prof Daniel Wallace

21 JULY 2020

You were recently in the news, discussing low rates of COVID-19 in your patients with lupus. What has been your experience of COVID-19 in this population, and what patterns have you spotted that may help inform prevention or care? In my experience and those of my colleagues, there may be less COVID-19 among our rheumatic disease patients, and their cases may be milder. I am part of a LuCIN initiative that is currently looking into this. It may have something to do with higher levels of interferon-a among some of the patients that protects them from certain viruses, but we really don’t know.

## > Does COVID-19 Increase Mortality in Stroke?

17 JULY 2020

GLOBAL COVID-19 Stroke Registry data show that acute ischaemic strokes (AIS) that occur in conjunction with COVID-19 are more severe and associated with higher mortality. Patients with COVID-19 and AIS have worse functional outcomes because of the diverse range of complications associated with the viral disease. Severe stroke is typically linked with poor prognosis; given the recent pathophysiological association between COVID-19 and AIS from small case studies, confirmation of this relationship is pivotal. To determine the clinical characteristics and outcomes of patients with COVID-19 and AIS, researchers analysed COVID-19 patient data from 28 healthcare centres in 16 countries, using the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry, and compared them to patients without COVID-19.

## > How Safe is Air Conditioning

16 JULY 2020

When all this started, I remember being told that Covid-19 could only be transmitted by direct contact with a sufferer, or from a fomite, or from large droplets that a sufferer would emit. There was no need for masks as they were ineffective and as long as I kept my distance all should be OK. I first had an inkling of suspicion that things may be different when I heard of transmission in a Guangzhou restaurant. All those who caught Covid-19 had been sitting in the path of an air conditioner. It was either blowing very hard, and taking large droplets before it, or fine aerosols might have played a part. The paper itself concluded: “The airflow direction was consistent with droplet transmission.” It is known that ventilation systems can spread Legionnaire’s disease, pulmonary aspergillosis and they can also spread toxins, even in public places such as London’s Piccadilly Circus. In 2006, researchers from Germany warned that there was a growing danger of large building terrorism that might use air conditioning systems to transmit toxins.

## > Higher Doses of Protein Pump Inhibitors May Increase COVID-19 Risk

14 JULY 2020

PROTEIN-PUMP inhibitors (PPI) taken by those with indigestion may increase an individual’s risk of developing COVID-19. According to a new study published by scientists at Cedars-Sinai Medical Center, Los Angeles, California, USA, the greater the dosage of PPI, the greater the chance of testing positive for COVID-19, although absolute risk remains small. The study used an online survey and enrolled over 86,000 people. Of the participants, 53,000 reported abdominal pain or discomfort, acid reflux, heartburn, or regurgitation, and provided information on their medication for relief of these specific symptoms; over 3,300 of those 53,000 tested positive for COVID-19. After data analysis, the results concluded that participants using medication to treat heartburn had an up to 2–4 times increased risk of testing positive for COVID-19 compared to those not using the medication.

## > COVID-19-Associated Neurological Manifestations

13 JULY 2020

SINCE the first observations of neurological manifestations were reported in China in April 2020, concerns over the impact of COVID-19 on the nervous system have been growing. Evidence has been mounting, with many clinicians publishing case reports of their patients who had exhibited a variety of neurological complications associated with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. In a bid to collate and summarise the findings to date, the European Academy of Neurology (EAN) held two sessions at the 2020 EAN Virtual Congress specifically dedicated to the neurological manifestations of COVID-19.

## > Threat to the Nervous System

09 JULY 2020

I should have thought harder when I noticed patients’ symptoms were changing. I overlooked that the nature of the scientific literature was shifting at the same time. At the start, nearer the beginning of 2020, the pandemic was simple. It was awful, for sure, but it was easy. We were advised that the virus was a respiratory pathogen and you either had pneumonia, or you did not. Some sadly would not make it, but the majority certainly would. Then things began to change. Loss of smell (anosmia) or taste (ageusia) became a recognised symptom, and it was clear that SARS-CoV-2 was behaving differently. Now, half a year on, the virus’ neurological effects are becoming mainstream. Barely a week goes by without a scientific paper reporting the damage to the human nervous system created by this new beast. Why is this important? I’ll tell you why. Because becoming infected may not trouble you now, but it might become a problem in future.

## > COVID-19 and Cardiovascular Interventions – Current Situation and Future Management – New Experiences from Across Europe

09 JULY 2020

Hosted by Prof Andreas Baumbach, President of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and released in a webinar on 29th April 2020 by EAPCI/the European Society of Cardiology (ESC), this session on COVID-19 and cardiovascular interventions updated participants on building patient confidence for acute cardiac procedures during the COVID-19 pandemic, patient risk assessment, the perspectives on the environment and resource constraints, and reprioritising elective cardiac interventions.

## > Management of CV Patients in the Context of COVID-19: What Have We Learnt?

07 JULY 2020

In this webinar, John McMurray and Giuseppe Mancia discuss the management of CV patients in the context of COVID-19, focussing on renin-angiotensin system blockers inhibitors and the latest evidence in COVID-19 and hypertension management.

## > Multiple Antivirals That Terminate SARS-CoV-2 Polymerase Reaction Identified

07 JULY 2020

POLYMERASE, a protein used by the SARS-CoV-2 virus to replicate its genome while inside infected human cells, is a target that researchers from Columbia University, New York City, New York, USA, and University of Wisconsin-Madison, Madison, Wisconsin, USA, have been investigating for its potential in the elimination of the virus. It is thought that by terminating this polymerase, the virus will stop replicating and the human host’s immune system can eradicate the virus. The researchers have identified a library of molecules that have the capability of shutting down the SARS-CoV-2 polymerase reaction, a key step in the research and development pipeline of COVID-19 therapeutics. Of the identified compounds, five were U.S. Food and Drug Administration (FDA)-approved antivirals for other viral infections.

## > How Technology is Transforming the Approach to Coming Out of Lockdown

06 JULY 2020

The Stationers’ Industry Committee hosted a ‘Rising to the Challenge’ webinar on 29th June 2020 discussing how COVID-19 is acting as a catalyst in how we are interacting with healthcare and the NHS. The pandemic has meant embracing virtual solutions and technology to deliver care so, with a particular focus on how technology is being used in tracing apps and services, the panel shared their insights into the types of apps, how this digital transformation has been delivered in partnership with innovative data experts, and how this is changing our behaviours and expectations to technology and to privacy.

## > Mischief for the Future

06 JULY 2020

When Covid-19 first appeared, all the discussion was respiratory. The chances were, if you caught the bug, you might make it through in one piece. If you were old or had some debilitating disease, your odds went down. If you were male, or had blood group A, you would do worse than blood-group-O ladies, but the chit-chat was largely about lungs. The world talked ventilators and oxygen, as if there was nothing else to consider. Then in came the loss of taste or smell as an extra symptom, and slowly society realised there was more to Covid-19 then a simple respiratory illness. Some folk took forever to recover and began to show symptoms that did not match a severe pneumonia. The UK Government then opened the Seacole Centre at Headley Court in Surrey, specifically to rehabilitate patients after Covid-19. It was the first of its kind in England.

## > The Forgotten Sector

04 JULY 2020

When I feel it is time to have a snapshot view of my country, I make a beeline for the Office for National Statistics (ONS) and its coronavirus (COVID-19) roundup. There I can find all manner of bits and pieces that show the effect of the pandemic on our nation. It rarely makes for happy reading. The good news is that the number of registered deaths is now below the five-year weekly average for the first time in more than three months. Of the registered deaths, 8.4% of the total mentioned Covid-19 on their death certificate, the lowest for three months. I am trying to sound optimistic as I write this, but the data released by the ONS is for the week ending on 19 June 2020 and is two weeks out of date. Much has happened since then, which might influence these figures.

## > Reaching the Virtual Summit

25 JUNE 2020

Events around the world were brought to a grounding halt in 2020 when the COVID-19 pandemic forced us into lockdown. While some have chosen to cancel, many conferences have chosen to embrace the power of virtual, ensuring the continuation of education and collaboration. ‘Even the darkest night will end, and the sun will rise’ – Victor Hugo’s poignant words resonate more deeply than ever as the COVID-19 pandemic casts its ominous shadow over 2020. Faced with the introduction of lockdown measures, healthcare congresses and pharmaceutical conferences have had to contend with the reality of cancellations and postponements. But the industry has proven to be agile and adaptable, with virtual events emerging from the shadows as a beacon of hope. As the age of webinars and remote working dawns, pharma must embrace the opportunity to educate and collaborate through the power of virtual.

## > Putting Virtual on Trial

25 JUNE 2020

Virtual clinical trials are being adopted as an answer to the imposed limitations of lockdown measures brought on by the the coronavirus pandemic. The industry is testing these remote methods and finally unlocking the virtual future of clinical trials. The word ‘crisis’ in Chinese is comprised of two characters: one meaning danger, the other, opportunity. COVID-19 has created tragedy across the world, forcing us to rethink our way of life; but from some of the hardest times come some of the greatest innovations. As the pharmaceutical industry guides the world through these troubled waters, the power of virtual is proving to be a steady oar. Virtual clinical trials have been implemented out of necessity, but once lockdown measures are lifted and life returns to some form of normality, will remote trials sink or swim?

## > EMG GOLD Podcast: Talking to Dr Gino Martini

23 JUNE 2020

In this episode of the EMG GOLD podcast our CEO, Spencer Gore, talks to Dr Gino Martini, Chief Scientific Officer for the Royal Pharmaceutical Society and Professor of Pharmaceutical Innovation at King’s College. Dr Martini also has an extensive background in the pharmaceutical industry having spent more than 17 years at GlaxoSmithKline, Roche, and Shire in commercial, innovation technology, and medical affair based roles. They discuss the rapid data generation of COVID-19, the value of digital for HCPs, and why Dr Martini thinks there will be much to reflect on after the pandemic has passed.

## > You Ain’t Seen Nothing Yet

23 JUNE 2020

The Prime Minister has done it, at least he has so far. From 4 July the nation’s lockdown status is being radically reduced in an attempt to kick life back into the economy. People are talking about this widely, as if the virus has disappeared and yet, once again, I only have to look at the global figures to see what is waiting right around the corner for UK. Just look at the resurgences. In Texas, the rate of positive virus tests has almost doubled and now sits at 9%. This figure was roughly half this, one month ago. Its public health officials have described the outlook as dire. The USA is generally seeing its positivity rates increasing, which is not the result of increased testing. It suggests that community spread is underway. Meanwhile, the WHO has reported the largest one-day increase in infections worldwide, with 183,020 cases. Ouch..

## > An Unacceptable Failure

17 JUNE 2020

I went for a drive today, not something I do commonly these days, and was astonished by what I saw. It was a long drive, from Cumbria in the north to London further south. The two locations are chalk and cheese. The traffic en route was clearly increasing. No longer was it just a line of lorries as it had been when I last drove, freight being shifted from one part of the land to another. Cars were increasing, motorbikes whizzing by, as were occasional families with squealing children in the back seat. The youngsters were generally unaware they were distracting the unhappy adult in the front, who was doing their best to stay on the road and not bounce down a passing embankment, or crunch into the central reservation. The nation may say it is still in lockdown, but its behaviour is far from solitary. As I drove south, I could see that people were trying to return to something that might approximate as normal. The nation was on the move.

## > Unscrupulous Operators

16 JUNE 2020

At a time when there is so much bad news, anything good is welcome. Consequently, when the Prime Minister announced today that a major breakthrough had occurred in the management of Covid-19, I was all ears. In March this year a study called RECOVERY was set up by the National Institute for Health Research. RECOVERY stands for Randomised Evaluation of COVid-19 thERapY. The aim was to look at a range of possible treatments for Covid-19. The study was undertaken by Oxford University and looked at the effects of six different medications. For the academically minded, these were, and if you can pronounce them: Lopinavir-Ritonavir (used to treat HIV), Hydroxychloroquine (President Trump’s cure-all), Azithromycin (an antibiotic), Tocilizumab (an injectable anti-inflammatory), Convalescent plasma (from previous Covid-19 sufferers), Low-dose dexamethasone (it has been around longer than me).

## > Convalescent Plasma Transfusion Therapy for COVID-19 Shows Promise

15 JUNE 2020

CONVALESCENT plasma transfusion for the treatment of severe COVID-19 is currently being trialled in the UK and a trial in the USA has recently been completed, with promising results. In the study from the USA, which took place at the Houston Methodist Hospital, Houston, Texas, 25 patients with severe of life-threatening COVID-19 were treated with convalescent plasma, which is antibody-rich plasma obtained from patients who have recovered from COVID-19. Of these patients, 19 showed improvements after treatment with no significant side-effects, demonstrating the safety of the treatment. A controlled trial is needed to definitively prove its effectiveness, but the initial results show that the improvement in symptoms following convalescent plasma transfusion is similar to that observed with the antiviral drug remdesivir.

## > It’s Still Easy to Catch This Virus

13 JUNE 2020

I find it odd that the nation is largely talking as if the virus has gone, and the thing has vanished forever. I only have to look at the global figures to know that any respite is transient. Global cases are increasing by up to 150,000 daily, and those are the ones we know about. There will be many others that remain hidden. All I known about this pandemic is that nobody truly knows anything. Nations are having to respond to changes at a moment’s notice. Because a nation seems good today does not mean it will be good tomorrow. While all this goes on, society is wishing life better. Look at the south-west of England. For the moment, in London we are sitting happily. Two months ago, when the capital was badly affected, the south-west was fine, and no one would touch Londoners with a barge pole. Yet thanks to the easing of lockdown restrictions, and the dash of many thousands of covidiots to the seaside in recent weeks, the boffins have projected that the south-west will soon have the highest viral reproduction rate in the land. Once largely untouched, the region is now said to have an R rate of 0.8-1.1, which is not a happy value. Anything above 1.0 means that the bug is on the rise.

## > Fake Scientific News

10 JUNE 2020

This morning I awoke at some unearthly hour when my computer went “Ping!” Normally I would turn away, but for some reason I scrabbled in the half dark, turned on the machine, and there was the paper from Harvard. Generally, I do not read science in bed. I saw the research’s title, I read its text, and instantly I was awake. What Harvard said was not definitive, but the pieces began falling into firmer place. Anyone who has read these diaries will know I feel there is more to Covid-19 than an infection that started life in a Wuhan seafood market. Those who believe that will believe anything. The Harvard paper was a simple concept. The researchers looked at the use of car parks in six Wuhan hospitals as a measure of hospital activity. The method, in the context of respiratory illness, was used in Chile, Argentina and Mexico in 2015. Harvard also looked at Chinese internet search volumes, and two words in particular, “cough” and “diarrhea”. Diarrhoea is a known feature of Covid-19, although not as common as cough. Web and mobile search queries are logged on something called Baidu’s database. Baidu Researchis an international organisation that is based in Beijing, Seattle and Silicon Valley. The Harvard findings were astonishing.

## > A New World Order

09 JUNE 2020

How times change. A few weeks ago, it was touch and go. Now, if public behaviour is to be believed, the UK’s troubles are almost over. Around the world there are public demonstrations declaring, “Black Lives Matter,” in the wake of the somewhat dubious killing of a Minneapolis criminal by a white policeman. Many thousands of demonstrators have made their feelings known in many hundreds of locations worldwide, and plenty in this country. Most have paid scant attention to social distancing. Social unrest is clear for all to see and I now understand how second waves occur. The UK is feeling much better about itself at the moment than it was a short time ago. Many wish to return to normal.

## > What I Learnt About Personal Wellbeing from COVID-19

09 JUNE 2020

One week ago, I sat on the side of my bed and measured my oxygen saturation (sats). Our local COVID-19 pathway, which I was involved in creating, stated that a safe level was 94%. Mine was 89%. Strictly speaking, I should have rung 999 and been taken to hospital. One week later, as I write this, my wife and I are recovering from what we do not doubt was COVID-19.

## > EMG GOLD Podcast: Talking to Sarah Rickwood

09 JUNE 2020

In this week’s episode of the EMG GOLD podcast, we interview Sarah Rickwood, Vice President of Thought Leadership and Marketing, IQVIA. With a degree in Biochemistry from the University of Oxford, Sarah began her career in healthcare research at Accenture, before joining IMS Health, now known as IQVIA. We talk to Sarah about the key trends and challenges that have shaped the past decade in pharma. We discuss RWE, multi-channel marketing, and the future of drug launch post-COVID-19.

## > COVID-19: Is it Time to Revisit the Research on Calcium Channel Drug Targets?

08 JUNE 2020

As the COVID-19 outbreak continues to endanger global health and hamper the world economy, there are concerns and reconsiderations for medication taken by patients with cardiometabolic disorders as they are more vulnerable to COVID-19.

## >The Evolving Primary Care Landscape in the Wake of COVID-19

05 JUNE 2020

Primary care has undergone more change in the last few weeks than in the preceding decade, a huge reaction catalysed by COVID-19. The NHS landscape is changing rapidly and dramatically, some of it forever. There is much to admire, much to lament, and some big unanswered questions.

## > I’m Positive but I’m not

05 JUNE 2020

A question I am commonly asked, and one with which I see politicians struggle, is whether having Covid-19 confers immunity to the sufferer. If so, for how long would a patient remain immune? What is more, for how long does a patient remain infectious? I am in contact right now with several patients who have recovered from the disease, and yet their tests for Covid-19 remain positive. For those responsible for their care, understanding the infectivity of a patient, who can pose a risk to a carer, is critical to all involved. In simple terms, a virus is an antigen. When the human body encounters an antigen, its immediate reaction is to produce antibodies to fight it.

## > Hypertensive Patients with COVID-19 Recent Evidence

04 JUNE 2020

In this webinar, Stéphane Laurent and Giuseppe Mancia discuss hypertensive patients with COVID-19, focussing on current knowledge and the importance of clinical data.

## > Learning the Truth

04 JUNE 2020

Some weeks ago, at the evening government briefing, a graph that had once been shown regularly, simply vanished. There was no explanation. It just went. The graph had shown death comparisons by country. For a while the UK was looking good and our line was below the others. Then we rose a bit, started to parallel Italy and were reassured by the bigwigs that we were two weeks behind the Italians. At the time this seemed to be true. Then ever so slowly, the UK began to pick up speed. We overtook Spain, started to fare worse than Italy and head evermore steeply. The only country above us on the chart was the USA and, anyway, Trump was being blamed for everything, including the moon, sun and planets, as well as Covid-19. Germany and Sweden were goodie goodies, and then…I blinked…the graph had disappeared.

## > Leave the Windows Open

03 JUNE 2020

I am one of those annoying people who has to sleep with a window open, whatever the temperature outside. I have sometimes come to blows in mountain refuges, especially with the French, when fellow sleepers in a bunkroom have insisted on keeping the windows closed. The French, it appears, adore sleeping in a fug. Yet now, in the middle of a Covid-19 pandemic, I sense opinion is going my way. There is plentiful evidence amassing that there is a much higher chance of becoming infected indoors rather than outside. If there is a next time for me in a mountain refuge, I will make a beeline for France and see if the locals have now changed their ways and are happy to sleep with open windows. Roughly two months ago some research came out of China and Hong Kong, which looked at 318 outbreaks that involved three or more cases. The aim was to establish the environment in which the disease had been acquired. The results were fascinating.

## > The Report Without a Solution

02 JUNE 2020

I came across an interesting report today, with results that I had long anticipated. In fact, the whole country has been waiting to learn of its findings. Its title was “Disparities in the risk and outcomes of COVID-19” and was produced by Public Health England (PHE). My special concern was for the BAME (Black, Asian and Minority Ethnic) community, as that has taken it hard over the past few months and no one seems able to explain why. PHE does not make it easy, as the report covers 89 pages, but the basic messages are clear.Top of the list was age. People like me have a problem. Anyone aged 80 years is 70 times more likely to die from Covid-19 than someone under the age of 40. Men fare worse than ladies and the more deprived your area, the less likely it is that you will make it through. BAME groups do worse than White, which surprised the report writers. Normally, mortality is higher in White ethnic groups, so for some reason this virus is targeting BAME. It seems that Bangladeshi ethnicity has nearly twice the risk of death as those of White British origin. Chinese, Indian, Pakistani, Other Asian Caribbean and Other Black ethnicity had a 10-50% higher risk of death when compared with White British.

## > Artificial Intelligence Technology Service to be Supplied to Over 71 Hospitals in India

26 MAY 2020

INSTANT triage of patients with suspected COVID-19 may be achieved with artificial intelligence (AI)-based chest X-ray technology developed by a UK-based company. The red dot® algorithm developed by behold.ai (London, UK) will be supplied to a network of 71 hospitals in India, and a selection of government-run hospitals, and may be able to help radiologists to provide immediate information about patients with suspected COVID-19. In 30 seconds, the algorithm is able to “rapidly diagnose chest X-rays as ‘normal’ or ‘abnormal’ accurately,” explained Mr Simon Rasalingham, chairman and chief executive of behold.ai. The speed with which these chest X-rays can be evaluated could lead to faster diagnoses and more appropriate allocation of hospital resources in healthcare systems.

## > Benefits do not Outweigh Risks

25 MAY 2020

There are times when I read things that horrify me. At other times reading is fun. My horror began in 2005, a long time before Covid-19 had been considered as a possible threat to mankind. It was an article written by an engineering organisation about biosafety laboratories.I cannot recall why I was reading it. The 9/11 attacks, followed by an anthrax-mailing campaign one week later, had encouraged the US government to invest more in biological research. There was talk of constructing BSL-4 (BioSafety Laboratory-4) research laboratories, establishments that are supposed to be as secure as they get. It was here that I learned that the US National Institutes of Health (NIH) was proud that after 634,500 personnel hours in BSL-3 facilities, the next layer of security down, there had only been 11 staff exposed to three treatable infections.

## > Anyone for out-of-date PPE?

22 MAY 2020

Sometimes, what I see forces me to double take, especially as we Londoners are being reassured that life is inching better. For so long I have heard the sound of ambulances in the background as yet another sad case of Covid-19 is fast-tracked to hospital. Those are fewer now, as the capital’s hospital admissions are steadily declining. Today I saw no ambulance, but I did see a hearse outside a house. The sight brought it home that so much of what my country has been doing, over the past few months, has been to stop folk from dying. Today was evidence of failure, there have been plenty of those in past weeks, as another unfortunate had chosen to die at home. The hearse was my reminder that there is still a way to go.

## > The Stigma of COVID-19

21 MAY 2020

Well I have done it. I managed to escape from London. Just for a day, as I needed to get back, but I had to make it to Cumbria to see a house, which gave me a chance to view life outside the metropolis. Amazingly, I have discovered that there is an existence beyond the capital’s boundaries and that people other than Londoners exist. They are actually quite pleasant and are not a different species at all. My brain has definitely drifted since lockdown started all those weeks ago. I have lived a solitary existence. I have talked but not met. I have greeted but not hugged. I have shouted rather than spoken. I have gone to meetings by looking at tiny faces looking sallow and exhausted on my computer screen. I have discussed, argued, cajoled and begged on my mobile, seemingly for hours each day. Body language has gone. Voice language is the way of things, both for now and likely for the future. Life in lockdown is unreal.

## > Science is Not Infallible

19 MAY 2020

Every morning, when I go for my regular stagger-stumble, I meet many of the same people in roughly the same spot. I do not know who they are, nor do they know me, but we wave, nod, smile, and exchange brief pleasantries. With social distancing in full throttle, it is not possible to have a quiet word with anyone these days. Everything is conducted at a shout. There is the elderly woman, probably younger than me, who passes in the opposite direction each day. She has a spring to her step, walks at a fearsome pace, and we exchange, “Good morning!” at speed. She smiles, I smile, but neither of us has a clue about the other. I sometimes wonder if one day we will meet more formally yet realise it is unlikely to happen.

## > New Guidelines for Stroke Care During the COVID-19 Pandemic

19 MAY 2020

BLOOD clotting increases have been observed in patients with COVID-19, which raises their risk of conditions such as stroke. Based on international research on the link between stroke and COVID-19, a team of stroke experts developed recommendations for the evaluation of patients with acute ischaemic stroke with suspected or confirmed COVID-19 infection. The international panel comprised stroke experts from 18 countries with documented COVID-19 outbreaks and was led by Prof Adnan I. Qureshi, University of Missouri School of Medicine, Columbia, Missouri, USA. Evidence found by the research team showed that ischaemic stroke with clots in the arteries of the brain are being experienced by young people who do not have previous risk factors for stroke; this is thought to be related to the patient having a COVID-19 infection. The average onset of stroke in patients with COVID-19 occurred on Day 10 of infection; however, in some cases stroke was the initial symptom of a COVID-19 infection.

## > The COVID-19 Conundrum and Cancer – Making Perfect Sense Out of Imperfect Data

18 MAY 2020

March 11th 2020 marked the day that the World Health Organization (WHO) escalated the coronavirus SARS-CoV-2 (COVID-19) outbreak from a public health emergency to a global pandemic. Since first identified in December 2019 in Wuhan, China, the confirmed cases of COVID-19 have reached a staggering 1,097,909, while claiming a total of 59,131 lives, at the time of writing.1 Of the numerous countries afflicted, the USA is presently the worst affected with 276,995 confirmed cases and expected logarithmic expansion as widespread testing capabilities take traction.

## > The Bug is Way Ahead

18 MAY 2020

I received a message today from a good friend in Scandinavia. He has spent the last four weeks recovering from Covid-19. His message was very simple: “I hope you are well and please stay away from Covid-19 – it is a tough one!” The poor guy, who is normally extraordinarily fit, has been put through his paces with the virus. He is now through and out the other side but, by all accounts, it was a close one. When good friends are affected, and even more so family, it brings home the importance of social distancing and the need for this thing called “quarantine”. The media these days is filled with talk about quarantine for new arrivals from overseas and how this may lead to the death of the travel industry. The word on the street is that by the end of this month, anyone arriving in the UK from any country, apart from the Republic of Ireland, will have to self-isolate in a private residence for 14 days.

17 MAY 2020

Now I know. I have a 37% chance of catching Covid-19 and a 3.621% chance of dying from it. This must be true as my computer says so. It also says, to make me feel optimistic and with my glass half full, that I have a 98.66% chance of survival. I think I will go with that. The Covid-19 survival calculator is seeing big business, as the nation decides its chances of popping off. The tool has been designed by University College London and has used data from 3.8 million health records. Its conclusions are based on the assumptions that in England there will be an infection rate of 10%, and that 20% of people have a high-risk condition. I am unsure about either of these assumptions but at least I know I have more chance of staying alive than of popping off.

## > Lockdown is a Form of Incarceration

16 MAY 2020

I looked at my watch today. It is one of those analogue designs that has hour and minute hands, plus a tiny window that reminds me of the date.  This morning the date declared it to be 15 May. I looked at the number several times, sure that I was misreading. Yet the number was clear. My left wrist was certain it was yesterday. I had, of course, simply forgotten to change the date more than two weeks ago, when April with 30 days became May with 31.

## > Whistle-blowers are in Danger

15 MAY 2020

It is difficult to understand body language when I look at a government politician, as they are well trained to avoid that degree of inspection. Yet if I had to take a stab at the Health Secretary’s thoughts this evening, throughout the 1700 hours Downing Street briefing, I would say he was sounding unsettled. As he spoke, a brief newsflash came across the screen, that scientific advisers had said the virus transmission rate had increased. Then came the R number, which had previously had a maximum value of 0.9. It had risen to a value of 1.0.

## > A Third Wave Already?

14 MAY 2020

In Switzerland, we’re not bothered by a second wave,” said my colleague. He was looking tired, although I was even more so. It had been a long videoconference. I had planned on 30 minutes and it had lasted over three hours. “In UK we are,” I replied. “Our government is now telling us about the risk daily.” “In Switzerland,” my colleague continued, “we are worried about a third wave, and a fourth. Who knows, there may even be a fifth.”

## > The Momentum of Maximum Risk

13 MAY 2020

Officially, today was the day when the nation could return to work, or at least some of us. The reality is that plenty of folk have already gone back. The country is in a form of honeymoon period, when it is trying to pretend life is normal although in practice it is not. The nation’s death toll is increasing, and we are way in excess of other countries in Europe. Most telling, perhaps, is the government’s evening briefing when the figures of the day are presented. The presentation is generally good but for the last two days the national comparisons have been lacking. They were once always a feature of the update but have now vanished. My guess is that this is to avoid awkward questions. The only excuse left for the government for such a disparity is that different countries collect their data in different ways. They may be right but when headline figures are inspected, the UK is not doing well.

## > EMG GOLD Podcast: Talking to Biljana Naumovic

12 MAY 2020

In this week’s episode of the EMG GOLD podcast, we talk to Biljana Naumovic, VP Oncology EMEA, Commercial Strategy Lead, Janssen, about her journey from physician to pharma leader and how she sees the role of commercial evolving as a result of COVID-19. After studying medicine, Biljana began her career in the Medical Military Hospital in Serbia, before specialising in Neurology at the Clinical Centre of Serbia. In 2002, she moved into the pharmaceutical industry and spent 6 years at Roche working in sales, marketing, and various medical roles. She then went on to complete an 11 year stint at AstraZeneca, where she climbed the ranks from Medical Manager to Vice President Commercial Europe.

## > Stay Away From Windows

12 MAY 2020

Five years ago, a polling organisation called YouGov, undertook a survey of the self-image of various nations. A selection of adults in eight countries was polled and asked if they considered themselves friendly, intelligent, confident, funny, attractive and disciplined. Brits were bottom of the pile when it came to thinking they were attractive but third, and ahead of Germany, when asked if they were disciplined. The YouGov result has puzzled me, especially when I have seen my fellow countrymen in lockdown, as all around me are folk attempting to cheat. Say one thing and a Brit will do another. It is perhaps why British military discipline is known to be some of the best in the world. The only way of keeping a soldier in order is to have the tightest rules and regulations. Once that control is released, Brits explode like a cork from a bottle of fine, but shaken champagne.

## > Some Have Difficulty with English

11 MAY 2020

What part of the word “alert” do politicians not understand? Would they prefer “watchful”, “vigilant”, “attentive”, or simply “on your toes”? Yesterday evening, the Prime Minister gave a get-up-and-go speech to the country and by the end of it I felt things were moving. Here was someone who had been through the disease, admitted that he was uncertain what the future held, but was relying on me to be sensible and to follow certain rules. The problem started at the beginning of lockdown, when the government introduced three connected phrases to make a slogan. Every minister, politician and bigwig used the slogan whenever they could. It went as follows: Stay Home – Protect the NHS – Save Lives. This slogan has been judged as one of the most successful in modern political history.

## > Yann Le Cam CEO of EURORDIS-Rare Diseases Europe

06 MAY 2020

My eldest daughter is living with cystic fibrosis. I have experienced first-hand what it means to get a diagnosis, and to organise day-to-day medical care and self-care, as well as the reality of what it means to build a holistic approach to that care so that she can live to her full potential…

## > EMG GOLD Podcast: Pharma’s Month in Review

05 MAY 2020

At the beginning of each month we review the top pharma headlines from the previous month in EMG GOLD. This episode takes a look back at April, where headlines continue to be dominated by COVID-19. Our host, Sen Boyaci, brings you a roundup of the COVID-19 vaccine and drug development news, plus some positive advancements in the field of oncology.

## > Keeping Frankenstein’s Monster at Bay

28 APRIL 2020

I am not a fatalist, I do not believe things happen for a reason, but I do believe we can find reason in the things that happen. In 1815, Mount Tambora erupted and caused global climactic changes…

## > EMG GOLD Podcast: Talking to Emma Clayton

28 APRIL 2020

This week, we speak to Emma Clayton, CEO of Grey Bear Consultancy, about the journey to starting her own agency, pharma communications in the COVID-19 era, and empowering women to succeed in the workplace.

## > In Vitro Fertilisation and Covid-19: Insights From An Embryologist

23 APRIL 2020

We interviewed clinical embryologist Prof George Anifandis, who discussed some of the key advances and challenges in reproductive medicine and delineated how COVID-19 has impacted fertility treatment and the effects it may have on in vitro fertilisation outcomes…

## > Medical Affairs in the Age of COVID-19

21 APRIL 2020

‘Put your mask on first before you take care of others…’ When it comes to leadership during a crisis, this aeroplane saying has become strikingly fitting…

## > How a ‘Portable’ Intervention (Deep Diaphragmatic Breathing) Could Help Clinicians in the Time of Stress Related to the COVID-19 Pandemic

08 APRIL 2020

At a time of uncertainty and fear during the COVID-19 pandemic, medical practitioners experience major unexpected changes in the working environment and their own personal lives…

## > EMG GOLD Podcast: Pharma’s Month in Review

08 APRIL 2020

Sen Boyaci looks back at the past month in pharma in this week’s edition of the EMG GOLD podcast, examining the progress of treatment and vaccine efforts against COVID-19, and highlighting some positive industry news that has emerged despite the on-going pandemic.

## > Bonus Episode! EMG-Health Podcast: The Frontline of Coronavirus

02 APRIL 2020

In this special episode, Spencer interviews an NHS doctor on the frontline of COVID-19 and a patient who has just recovered from the virus, unpacking this unprecedented situation from both perspectives.

## > Rheumatology in Cyprus amid the COVID-19 pandemic

01 APRIL 2020

In March 2020, the COVID-19 pandemic arrived in Cyprus. Suddenly, our lives and our way of life has been affected in an unprecedented way…

## > The People Versus COVID-19

31 MARCH 2020

DOMINATING headlines since January has been coronavirus and its global spread. Geographical knowledge has been sharpened by daily maps bleeding red further across borders, and the average person has become…

## > The Digital Legacy of COVID-19

27 MARCH 2020

REMOTE communication tools have flourished following the rapid spread of the novel coronavirus, keeping individuals informed and united across the globe. Information providers NHS Digital and NHSX are making headway with a range of digital solutions for tracking, diagnostics, and management of the disease…

## > Gloves in the Time of Corona

26 MARCH 2020

Love in the Time of Cholera, the widely known 1985 novel by one of my favourite authors, Gabriel García Márquez, primarily details the affairs of three main characters, their obligations and acts, both good and bad…

## > Vaccines for COVID-19: Perspectives, Prospects, and Challenges Based on Candidate SARS, MERS, and Animal Coronavirus Vaccines

24 MARCH 2020

Several coronaviruses (CoV) are widespread in humans and cause only mild upper respiratory infections and colds; however, pandemic outbreaks of more severe coronavirus infections in humans have become more prevalent…

## > EMG-Health Podcast: Congress Postponed… What Next?

09 MARCH 2020

Following the coronavirus outbreak, European congress attendance is down and events are being postponed. We sit down with Professor Jonathan Sackier to dispel the myths around the virus and discuss why it’s important for pharma to find alternative ways of sharing their research.

Listen now.

## > Expert Update for Doctors on COVID-19: A Summary of the Event

06 MARCH 2020

In light of the rapid developments of the coronavirus disease 2019 (COVID-19) epidemic in China, a panel of experts came together on 12th February at the Royal College of Physicians in London, UK. The experts discussed current data on COVID-19 and the measures being taken by Public Health England (PHE)….

## > Will Coronavirus Impact Congress Attendance?

26 FEBRUARY 2020

New cases of coronavirus are appearing in all corners of the world and the disease is now on the brink of becoming a pandemic. Along with schools, offices, and cruise liners in quarantine, travel is being monitored and restricted in many countries to avoid further spread…

## > Present Therapies in the Fight Against Coronavirus

24 FEBRUARY 2020

CORONAVIRUS disease 2019 (COVID-19), a pandemic currently gripping the world, has accentuated the need for novel approaches to treat outbreaks caused by new viruses…