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# COVID-19: Expertise

Welcome to our dedicated page where experts provide insight on the latest vaccine developments, treatments and clinical practice during the pandemic. Read on for a top selection of our latest research articles, reviews and interviews on COVID-19.

## >Post-COVID-19 Pulmonary Fibrosis: Report of Two Cases

13 September 2021

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 has led to a pandemic situation worldwide. However, remarkable progress has been made in evolving policies, strengthening healthcare efforts, and pharmacotherapy. As more patients are recovering from COVID-19, clearer concepts about possible short- and long-term complications are emerging. Respiratory failure is the most common morbidity in hospitalised patients, and post-COVID-19 pulmonary fibrosis is the most common respiratory complication after recovery. The authors report two cases of COVID-19 pneumonia with respiratory failure who were cured but developed pulmonary fibrosis with restrictive lung disease in the follow-up period.

## >SARS-CoV-2 and Cystic Fibrosis: Expectations Versus Reality, a Literature Review

30 August 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the COVID-19 pandemic, is expected to cause severe illness in people with cystic fibrosis (CF). The infection prevalence and clinical outcomes of this patient cohort to SARS-CoV-2 were explored, alongside contributing factors to the observed response.

## >Rare Cases of Myocarditis Following mRNA COVID-19 Vaccination

19 July 2021

REPORTING of adverse events associated with the new COVID-19 vaccines is crucial to inform public health programmes aimed at guaranteeing patient safety while promoting the appropriate use of vaccines globally. For this reason, a retrospective case series evaluated individuals enrolled in the United States’ Military Health System who experienced myocarditis symptoms within 4 days (12–96 hours) of receiving the second dose of a mRNA COVID-19 vaccine.

## >Relating Ventilatory Support and Drug Treatment Strategies to the Fundamental Pathophysiology in COVID-19 Illness

31 May 2021

This article relates the current pathophysiologic and radiologic findings to the fundamental idea of acute lung epithelial infection, alveolar inflammation causing leak into the interstitial space, and subsequent secondary or concurrent endothelial infection and dysfunction. Understanding the mechanisms and timings of alveolar damage can better inform the types of ventilatory support required and timing of targeted pharmacotherapies.

## >Oxy-hydrogen Gas: The Rationale Behind Its Use as a Novel and Sustainable Treatment for COVID-19 and Other Respiratory Diseases

10 May 2021

Oxy-hydrogen gas (HHO) is a gaseous mixture of molecular hydrogen and molecular oxygen that is generated by the electrolysis of water and delivered in a 2:1 ratio (66% and 33%, respectively) through the use of noninvasive inhalation devices such as nasal cannulas or nebulisers. Although there is a paucity of scientific evidence supporting this new and emerging therapy, initial investigations indicate that HHO proffers cytoprotective qualities, typically by reducing oxidative stress and attenuating the inflammatory response. These aspects are particularly favourable when considering respiratory medicine because underlying inflammation is known to drive the pathological progress of numerous respiratory conditions, including asthma, chronic obstructive pulmonary disorder, and, pertinently, coronavirus disease (COVID-19). Direct delivery to the lung parenchyma is also likely to increase the effectiveness of this emerging medical therapy.

## >Prominent Cutaneous Manifestation of COVID-19: A Case Report

03 May 2021

Extrapulmonary signs of coronavirus disease are becoming an important tool for patient diagnosis; this is particularly true for skin manifestations as they are visible to both the patient and physician. In this case report, the authors describe a case in which cutaneous manifestations were the most noticeable and prominent symptom in a patient with coronavirus disease.

## >Mother and Baby Protected with mRNA COVID-19 Vaccine

12 April 2021

mRNA coronavirus disease (COVID-19) vaccines are highly effective at producing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnant and lactating women, a new study, the largest of its kind to date, has reported. Researchers at Massachusetts General Hospital, Brigham and Women’s Hospital, Boston, and the Ragon Institute of Massachusetts General Hospital, MIT, Boston, and Harvard, CambridgeMassachusetts, USA, studied 131 females of reproductive age (84 pregnant, 31 lactating, and 16 nonpregnant), all of whom had received an mRNA vaccine (Pfizer/BioNTech or Moderna); all three groups showed the same levels of antibodies, and side effects were rare and comparable across all the participants.

## >Massive Alveolar Haemorrhage Presenting During the COVID-19 Pandemic

12 April 2021

The coronavirus disease (COVID-19) pandemic has challenged healthcare systems and has resulted in complex diagnostic processes for patients with non-COVID-19 pathology. Here, we demonstrate a case of massive alveolar haemorrhage secondary to antineutrophil cytoplasmic antibody-positive vasculitis, presented to a district general hospital in the UK during the first wave of the global pandemic. This case highlights some of the difficulties clinicians may face when diagnosing life-threatening antineutrophil cytoplasmic antibody-positive vasculitis amidst the COVID-19 pandemic. The authors place emphasis on the careful interpretation of chemical biomarkers such as troponin and D-dimer when assessing patients with acute respiratory distress. They also aim to highlight the importance of CT thorax imaging when seeking an alternate diagnosis to COVID-19.

## >Could Skin Swabbing be the Next COVID-19 Diagnostic Test?

31 MARCH 2021

MASS testing for coronavirus disease (COVID-19) has been identified by the World Health Organization (WHO) and many governments as a key strategy to contain outbreaks and minimise hospitalisations. Currently, the most widely used approach to detect viral RNA requires PCR testing. Despite being highly selective for COVID-19 and easily deployable, PCR approaches suffer from a substantial proportion of false negative events.

## >Gross, Histopathological, and Ultrastructural Features in Patients with COVID-19: A Literature Review

29 MARCH 2021

The coronavirus disease (COVID-19) outbreak has led to swift efforts to learn about its clinical course, prognostic markers, and complications. Consequently, there is a lot of scattered information available regarding severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) but its pathophysiology is still poorly understood. Gross and microscopic findings are very important for understanding any disease, including COVID-19. This literature review examines and summarises the biopsy, gross autopsy, and other histopathological findings that have been reported in various organs in COVID-19 patients to increase the understanding of the disease. Many histopathological findings in various organs were nonspecific, especially in the liver and brain, while others were particular to SARS-CoV-2. Therefore, further histopathological studies and autopsies are necessary to obtain consistent and reliable findings in those with COVID-19 to fully understand the pathogenesis of the disease and the impact it has on individual organs.

## >An Interview with Major (Retd) Sally Orange

19 MARCH 2021

It is important to remember that it can take quite some time to recover from COVID-19, and that patients can still feel breathless, can get tired very quickly, and can be affected by that sense of loss of smell, loss of taste, swallowing difficulties with eating or drinking [after ventilator support], and might still have the cough. It will all be very individual though. With breathlessness, avoid holding your breath with activity. For some people, it becomes a bit of a cycle that they get breathless and then get anxious, so then hold their breath more and then become more anxious; it basically becomes a vicious cycle…

## >Webinar: Covid-19 Challenges to Cancer and Car-T Patients

03 MARCH 2021

This webinar has been funded by Novartis and focusses on the challenges posed by COVID-19 to cancer and CAR-T patients. Dr. Jonathan Sackier (UK) chairs this session and is joined by Amit Patel (UK), Natacha Bolanos (Spain), and Simona Paratore (Italy) who discuss (i) the management of CAR-T Patients during COVID; (ii) Referring cancer patients during COVID; and (iii) the patient perspective.

## >Extending Symptoms List Trigger Early Detection of COVID-19

01 MARCH 2021

DETECTION of SARS-CoV-2 infection through PCR eligibility triad symptoms of cough, fever, and loss of smell has been deemed ineffective by a group of researchers at King’s College London, London, UK following an advanced study using the COVID Symptom Study app designed by the university, ZOE. The researchers advised that if the triad symptoms were extended to include fatigue, sore throat, headaches, and diarrhoea, the first 3 days of illness would have detected 96% of symptomatic cases. Although the PCR swab testing is currently the most authentic way of exposing a SARS-CoV-2 infection, this study stated that by using the limited symptoms list, almost one-third of coronavirus disease (COVID-19) cases are missed by the UK’s National Health Service (NHS).

## >Gastrointestinal Manifestations and Liver Injury: Correlation with Mortality and Clinical Outcomes in Patients with COVID-19

01 MARCH 2021

Background and aims: Reports indicate that patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection present with gastrointestinal (GI) manifestations and abnormal liver function; however, the impact on clinical findings is unclear. The aim of this study is to report the impact of gastrointestinal and liver injury (LI) associated with coronavirus disease (COVID-19). Material and methods: The authors retrospectively evaluated patients who presented to the emergency department and were diagnosed with COVID-19 by PCR nasopharyngeal swab. Primary outcomes were the impact of GI findings and LI on in-hospital mortality. Secondary outcomes were length of stay in hospital and need for intensive care unit (ICU) level care.

## > Podcast: COVID-19’s Impact on Atopic Dermatitis

15 FEBRUARY 2021

This episode, sponsored by an educational grant from Sanofi Genzyme and Regeneron, is the first of a five-part series exploring dermatology and the subject of atopic dermatitis (AD). Hear from Dr Miriam Wittmann, Associate Professor, Inflammatory Skin Diseases, The University of Leeds, who focuses on the COVID-19 pandemic and its impact on AD research.

## >The Rise of Telemedicine: Lessons from a Global Pandemic

09 FEBRUARY 2021

Telemedicine has been available for healthcare systems to assist patient care for many years; however, it was not until recently that the field of telemedicine exploded. Inconsistent coverage of telemedicine services as well as a general level of unfamiliarity with the technology required to perform telemedicine services contributed to the lack of its widespread use. The coronavirus disease (COVID-19) pandemic drove the institution of telemedicine in all areas of healthcare. Healthcare institutions around the world adapted both inpatient and outpatient services in order to utilise telemedicine.

## >Therapeutic Plasma Exchange Using Convalescent Plasma Replacement Therapy in Severe COVID-19 Infections: A Potential Therapeutic Option

09 FEBRUARY 2021

Currently, the coronavirus disease (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), is a major global public health emergency. Cytokine storm is a key factor and plays a major role in disease severity and clinical outcome. Recently, the literature reveals the use of therapeutic plasma exchange to reduce the inflammatory markers. Evidence also exists for the use of convalescent plasma therapy in patients with severe COVID-19. This brief communication explores the advantages on therapeutic plasma exchange with convalescent plasma in patients with moderate-to-severe COVID-19.

## >Rapid Reconfiguration of Paediatric Services in a District General Hospital During COVID-19, Addressing Challenges, and Seeing Opportunities

09 FEBRUARY 2021

The scale, speed, and impact of the coronavirus disease (COVID-19) pandemic disruption to healthcare services has been unprecedented, placing significant additional pressures on the National Health Service (NHS). COVID-19 presented exceptional challenges to vulnerable families and is placing increasing pressure on children’s services. The child population does not seem to have been severely impacted by COVID-19; however, some will require hospital care in addition to the current caseload. It is imperative that steps are taken to ensure continued delivery of urgent and emergency paediatric services and the associated maternity and neonatal services at local levels throughout the pandemic. A rapid reconfiguration of services was necessary when the pandemic reached the NHS.

## >General Practice Services in England During the COVID-19 Pandemic and Beyond: Patient Access and Barriers

09 FEBRUARY 2021

During the coronavirus disease (COVID-19) pandemic, primary care services have been forced to operate differently, limiting face-to-face consultations and relying on telemedicine. This has impacted the care received by patients in need of primary care. The aim of this article was to assess the patient needs during the pandemic, their perspectives on current interactions with primary care, and the readiness for change in operating general practices in the future.

## >Catheter-Based Local Delivery of Therapeutics to the Lungs for Severe or Critically Ill Patients with COVID-19

09 FEBRUARY 2021

Currently, the majority of treatment strategies reported for coronavirus disease (COVID-19) involve the systemic administration of drugs, in addition to other approaches including convalescent plasma.1,2 The pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was believed to be largely localised in the lungs. Retrospective observational studies from Wuhan, China have shown subgroups of patients with symptoms affecting the cardiovascular, renal, nervous, and digestive systems.3,4 Yet the most critical cases largely encompass those suffering from acute respiratory distress syndrome (ARDS). Therefore, the authors propose a combination of local delivery of therapeutics directly to the lungs and adjunct systemic administration (i.e., intravenous infusion).

## > Information and Communication Technology in the Fight Against the COVID-19 Pandemic/Infodemic

09 FEBRUARY 2021

A new coronavirus infection named coronavirus disease (COVID-19) was discovered in Wuhan, China at the end of 2019, and has rapidly progressed. The World Health Organization (WHO) declared COVID-19 a pandemic in March 2020. COVID-19 was characterised by the rapidity of the outbreak that was accelerated by transportation networks worldwide. Researchers have attempted various approaches to manage COVID-19, such as genome analyses, diagnostic methods, treatments, and prevention. An ‘infodemic’ situation has developed, whereby misinformation has caused logistical disruptions and resulted in health hazards and shortages of supplies.

## > COVID-19 and the mRNA Vaccine Legacy

09 FEBRUARY 2021

FREQUENTLY pitted as the only way of eradicating the coronavirus disease (COVID-19) that arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the world is holding its breath as the first vaccination programmes of 2021 are rolled out in the UK, Germany, Italy, Poland, Denmark, and many other countries in Europe and further afield.

## > The Correlation Between Stroke and Coronavirus Disease (Covid-19): Where is the Evidence?

01 FEBRUARY 2021

STROKE is the second leading cause of death globally. Despite the decreasing trend in stroke mortality, its incidence and prevalence follow an upwards trajectory that is envisaged to continue for years to come. Previous literature has suggested a role for infectious disease in stroke aetiology; however, the pathophysiological basis for this has never fully been understood. Emerging infections, such as coronavirus disease (COVID-19), present new challenges that must be addressed, to prevent them from contributing to the predicted rise in stroke incidence. Almost one in 20 patients diagnosed with COVID-19 experience a stroke thereafter, hence achieving better understanding of the interactions between these disease entities is of major clinical significance.

## > ‘Dry’ Pericarditis With Rapid Progression to Tamponade as a Feature Of COVID-19

25 JANUARY 2021

PERICARDIAL inflammation is a recognised feature of coronavirus disease (COVID-19). The authors herein present the case of a female with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection who developed a large and life-threatening pericardial effusion over a few days following the onset of pericarditis, despite prompt commencement of treatment. This was successfully drained, and she was discharged in stable condition on oral nonsteroidal anti-inflammatory drugs and colchicine. At 6-week follow-up she had made a full recovery, and repeat echocardiography demonstrated no recurrence of effusion or evidence of constrictive physiology.

## > Could Pressure on Hospitals Due to COVID-19 Increase Cardiovascular Deaths?

25 JANUARY 2021

CORONAVIRUS disease (COVID-19) has posed a severe health threat over the last year, with millions of associated deaths recorded. However, a recent study in the USA has highlighted that the increased mortality rate seen during the pandemic cannot be explained by the infectious disease alone, and instead may be the result of the impact that it has had on healthcare systems. In the observational study, researchers from the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts, USA, compared the rate of cardiovascular-related deaths that occurred after the onset of the pandemic (mid-March to June 2020) with the 11 weeks immediately preceding the pandemic. This was then compared with the same time periods of the previous year.

## > The Correlation Between Diet, Illnesses, and the Gut Microbiome

15 JANUARY 2021

‘HEALTHY’ and plant-based diets promote a microbiome linked to lower risks of common illnesses, such as heart disease, obesity, and Type 2 diabetes mellitus, according to a recent study from epidemiologists and nutritional scientists. Microbes in the gut are shaped by diet and influence host metabolism; however, these links are complex and can be unique to everyone. Therefore, in their study, the researchers performed deep metagenomic sequencing of 1,203 gut microbiomes from 1,098 individuals enrolled in the PREDICT 1 study, whose detailed long-term dietary habits as well as cardiometabolic blood marker measurements were available.

## > Could Targeting Endothelial Cells Diminish COVID-19 Symptoms?

15 DECEMBER 2020

TARGETING endothelial cells in patients with coronavirus disease (COVID-19) with severe lung disease may provide a novel approach to restoring normal lung function, according to a recent study from Stony Brook University, Stony Brook, New York, USA. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2) receptors to infect and damage epithelial cells in the upper respiratory track. Within alveoli, the tiny air sacs in the lung, oxygen and carbon dioxide molecules are exchanged to and from the bloodstream across an epithelial–endothelial barrier. However, the process by which SARS-CoV-2 dysregulates vascular function causing an acute respiratory distress syndrome in COVID-19 patients remains to be solved.

## > Patients with Sickle Cell Disease Identified as a Vulnerable COVID-19 Population

15 DECEMBER 2020

HOSPITALISATION of patients with sickle cell disease (SCD) who have coronavirus disease (COVID-19) is reported to be notably higher than the average Black population, according to a new study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting.The study used data from individuals with SCD in the international Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE) Registry. The researchers set out to characterise the COVID-19 hospitalisation and case fatality rates of patients with SCD and compare these to the rates seen in the general Black population (using COVID-NET; n=19,514). In addition to COVID-19 hospitalisation, severity, and mortality, data on patient demographics, disease management strategies, and information related to SCD complications were obtained from the SECURE-SCD registry.

## > Review of European Academy of Dermatology and Venereology (EADV) 2020 Virtual Congress

15 DECEMBER 2020

VIENNA, Austria, is a city with unquestionable spirit, influence, and grandiosity, and would have been a spectacular host to this year’s European Academy of Dermatology and Venereology (EADV) 29th Congress. In light of the restrictions on travel and large gatherings during the coronavirus disease (COVID-19) pandemic, and valuing the safety of their members, the EADV took the hard decision to make the congress fully virtual this year for the first time in its history. We bore witness to the effects of the hard work that made this congress a success as it proudly provided an outstanding educational learning experience in a marvellous all-virtual framework. Creative strokes of genius allowed EADV to cross borders as we were greeted with a virtual welcome to the platform by Prof Carle Paul, EADV President (2020), University of Athens, Athens, Greece, upon first entering.

## > EADV Congress Interview: Asst Prof Asli Bilgic, Prof Dedee Murrell, Prof Marie-Aleth Richard, and Assoc Prof Myrto Trakatelli

15 DECEMBER 2020

We were responsible for the creation and/or collection of material for publication on the EADV Virtual COVID-19 resource centre. We created an anonymous questionnaire investigating the impact of COVID-19 on European dermatologists. The survey results were presented at the EADV 29th Virtual Congress… In 2020, having to manage the cancellation or postponement of all of our face-to-face courses, we had to rapidly refocus and produce a series of ‘long-distance learning’ activities and I am proud to say that the Education Committee managed to deliver many educational activities to our members and dermatologists all over the world. We created a special COVID-19 series that informed and supported colleagues on different aspects of the coronavirus impacting our specialty.

## > EADV Congress Interview: Prof Alexander Stratigos

15 DECEMBER 2020

It is an honour to be president of the EADV, one of the most influential and prestigious academies in dermatology and venereology. My goal during my 2-year term is to strengthen the role of our Academy as the educational leader in dermatology-venereology and expand this role further in the digital era. Willingly or unwillingly, the coronavirus disease (COVID-19) pandemic will certainly be an important priority for next year, and the EADV will continue to support our members and colleagues so that they can deliver the best possible care to their patients in these unprecedented times. Based on the success of the first EADV Virtual Congress that took place a few weeks ago, we plan to develop and provide a comprehensive programme of webinars, online tools, and e-learning opportunities to help our members optimise patient care and improve their knowledge and expertise.

## > National Early Warning Score Effective for COVID-19 Patients

11 DECEMBER 2020

THE PORTSMOUTH Academic Consortium for Investigating COVID-19 (PACIFIC-19) team have shown that a universal assessment score, used to measure a patient’s severity of illness, can be applied to patients with coronavirus disease (COVID-19), without modification. The National Early Warning Score (NEWS) was developed 14 years ago and has since been recommended by the UK National Health Service (NHS), the Royal College of Physicians (RCP), and the World Health Organization (WHO). The assessment involves taking vital sign readings, including pulse, blood pressure, temperature, and breathing rate, and converting them into a value between 0 and 20. A higher score is indicative of greater risk of adverse clinical outcomes.

## > Can the Yellow Fever Vaccine Protect Against COVID-19?

11 DECEMBER 2020

GENETICALLY altering the yellow fever vaccine has shown to be protective against coronavirus disease (COVID-19) in animal models after a single shot; this is according to researchers from the Rega Institute, Leuven, Belgium. After providing immunity to COVID-19 in hamsters, mice, and monkeys, the next steps for the vaccine will be clinical trials in humans. Provisionally called RegaVax, the vaccine was created using the standard yellow fever virus and then inserting a genetic sequence from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. Following a single dose of this vaccine in hamsters, the researchers then infected the animals with SARS-CoV-2; 3 weeks later, all animals were immune to the coronavirus.

## > Interview: Prof Ilona Kickbush

10 DECEMBER 2020

You developed the settings-based approach to health promotion in the WHO, creating initiatives for healthy cities, healthy schools, and healthy workplaces. Do you think that this settings focus is the best strategy for addressing the COVID-19 pandemic, or is it more effective to focus on the behaviour and education of individuals? Again, this is not ‘either or’: all good public health is a mix of strategies that support one another. The settings approach built on the understanding of creating supportive and enabling environments for people’s health behaviours. This also applies during COVID-19; we have the combination of things people need to do (social distancing, hand washing, wearing masks) and the settings related to it, as expressed in the Japanese strategy of avoiding the three C’s: closed spaces, crowded places, and close-contact settings.

## > Triggers, Timescales, and Treatments for Cytokine-mediated Tissue Damage

09 DECEMBER 2020

Inflammation, an essential cytokine-mediated process for generating a neutralising immune response against pathogens, is generally protective. However, aberrant or excessive production of proinflammatory cytokines is associated with uncontrolled local and systemic inflammation, resulting in cell death and often irreversible tissue damage. Uncontrolled inflammation can manifest over timescales spanning hours to years and is primarily dependent on the triggering event. Rapid and potentially lethal increases in cytokine production, or ‘cytokine storm’, develops in hours to days, and is associated with cancer cell-based immunotherapies, such as chimeric antigen receptor T-cell therapy.

## > Female Reproductive Steroids May Protect Against COVID-19 Symptoms

04 DECEMBER 2020

CORONAVIRUS disease (COVID-19) symptom severity and mortality is suggested to be more frequent in males according to existing literature. Prof Graziano Pinna, University of Illinois at Chicago, Chicago, Illinois, USA analysed the literature and found an indication that female reproductive steroids may play a protective role. Prof Pinna began researching the topic of reproductive steroids in COVID-19 pathology early this year when cases of asymptomatic pregnant females with COVID-19 escalated to severe symptoms immediately postpartum. Existing research was reviewed to assess why COVID-19 symptom severity and mortality were more frequent in males than females and the elderly.

## > Impact of COVID-19 on Patients with Inflammatory Bowel Disease: Update from an International Registry

01 DECEMBER 2020

Patients with inflammatory bowel disease (IBD) are frequently on immunosuppressive treatments that increase the risks of infection. To date, there are limited data on the disease course of coronavirus disease (COVID-19) in patients with IBD, including the impact of clinical characteristics and medications. The authors utilised the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD), an international registry of patients with IBD who have had COVID-19, to evaluate the association of demographics, clinical characteristics, and immunosuppressant treatments on COVID-19 outcomes. This work was an updated analysis of SECURE-IBD following the first publication from this database.

## > Review of the United European Gastroenterology (UEG) Week Virtual 2020

01 DECEMBER 2020

DELAYS in receiving fundamental medical care have been experienced worldwide this year because of resources being reallocated to tackle the coronavirus disease (COVID-19) pandemic. One service in particular that has seen such delays is the screening of colorectal cancer (CRC), and according to research presented at UEG Week Virtual 2020 and reported in a press release dated the 12th October, these delays could have a significant negative impact on CRC mortality.

## > Webinar: Are We Virtually There Yet? Part 2 of 2

27 NOVEMBER 2020

Telemedicine, telehealth and virtual medical consults have become a part of the Covid-19 lexicon. Prior to the pandemic, these were considered either only suitable for extreme environments, research projects or the ultra-wealthy. Whereas the entertainment industry, banking and travel had embraced digital transactions, medicine lagged behind. Until now. This two-part webinar features experts who have been on the leading edge of technology in medicine and share their thoughts on where telemedicine was, where it is now and where it is going. Dr. Scott Parazynski has served as an emergency room physician, climbed Everest, managed healthcare in the extremes of the Antarctic and flew five missions on the Space Shuttle. Dr. Yulun Wang developed the world’s first operating theatre robot, advanced that technology to allow for distant operation, then developed a mobile telemedicine platform that combined robotics, virtual care and internet use and took that company to a massive acquisition. Join our host, Dr. Jonathan Sackier, as he discusses all aspects of telehealth from remote environments on earth and in space as well as the World Telehealth Initiative that seeks to democratize healthcare provision across the globe. Read more.

## > Primer on the Pathogenesis of Severe COVID-19: Part Two

23 NOVEMBER 2020

In Part One of this narrative review examining the pathogenesis of severe coronavirus disease (COVID-19), the author addressed the mechanism by which the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus subverts the innate immune response while remaining largely invulnerable to its effector functions. Critical SARS/SARS-CoV-2 infection is notable for an apparent biphasic (dysregulated) immune response, initially characterised by muted interferon-ß (IFNß) production which becomes robust and persistent (mostly derived from plasmacytoid dendritic cells) with the advent of clinical features.

## > Interview: Prof Kiran Patel

23 NOVEMBER 2020

The NHS is focussed on combatting coronavirus and nonurgent procedures have been postponed or cancelled to maximise capacity for treating patients with COVID-19. What are the dangers of this?
So, we did have a pause on elective care for a few weeks, but we are rapidly starting to deliver elective care again based upon clinical need, as are most organisations across the NHS. We are delivering most of our cancer care now, and also starting cardiac surgery and cardiology procedures too. One concern we have is that the number of patients presenting with acute conditions such as heart attacks and strokes dropped off for several weeks, suggesting that patients were avoiding coming to hospital when they needed care. We have therefore undertaken a lot of public communication articulating that we are open for business as usual, to deliver care if patients need it and, fortunately, things are getting back to how they were. Yesterday we had returned to seeing the same number of ambulances as normal which is good news.

## > Diabetes and Hypertension May Increase risk of Neurological Complications in Patients with COVID-19

20 NOVEMBER 2020

NEUROLOGICAL complication risk in patients with coronavirus disease (COVID-19) may be increased in those with a history of hypertension and Type 2 diabetes mellitus, according to new research from Penn Medicine, Philadelphia, Pennsylvania, USA. It has been established that COVID-19 is a disease that primarily affects the respiratory system leading to inflammation of the lungs. However, the impact the virus on other body systems has also been recognised. “While complications in the brain are rare, they are an increasingly reported and potentially devastating consequence of COVID-19 infection,” stated Dr Colbey W. Freeman, Department of Radiology, Penn Medicine.

## > Primer on the Pathogenesis of Severe COVID-19: Part One

16 NOVEMBER 2020

Our Editor’s Pick for this EMJ flagship issue is a two-part review by Walsh that discusses the pathogenesis of coronavirus disease (COVID-19) by firstly providing a breakdown of the complex cellular host–viral interactions, before discussing the key mediators of specific pathogenicity. With the search for a vaccine remaining top of the agenda worldwide, an increased understanding of the pathophysiology of this disease is essential in guiding the therapeutic approaches being put in place to stem the spread of this pandemic. We hope that you enjoy reading this timely review.

## > Almost 20% of COVID-19 Patients Present With Only Gastrointestinal Symptoms

12 NOVEMBER 2020

ABDOMINAL radiologists are being urged to remain vigilant for signs of coronavirus disease (COVID-19) after a review of published academic studies has found that as many as one in five patients with COVID-19 may only display gastrointestinal symptoms. Researchers at the University of Alberta Faculty of Medicine and Dentistry, Edmonton, Canada examined the results of 36 radiology studies on COVID-19 that had been published up to July 15th 2020 and analysed the reported data. It was found that 18% of patients presented with gastrointestinal symptoms such as loss of appetite, nausea, vomiting, diarrhoea, and generalised abdominal pain. Of note, 16% of the COVID-19 cases presented with only abdominal symptoms.

## > Psychological Aspects of Diabetes

10 NOVEMBER 2020

Patients with diabetes have been uniquely affected by the current coronavirus disease (COVID-19) pandemic. Complete lockdowns, restrictions on travel and movement, and general anxiety about the pandemic directly and indirectly have all affected clinical aspects of diabetes and self-care. Access to medical services such as physician consultations, antidiabetic drugs, testing and monitoring services, and self-care behaviours such as outdoor physical activities, were all differentially hampered.59 As a result, the COVID-19 pandemic affected glycaemic control of diabetic patients, which was associated with poorer clinical outcomes such as the need for intensive care and even death.60 The anxiety caused by lack or irregularity of medical services, fear of being vulnerable to poorer COVID-19 outcomes, and greater mortality rates may have added to pre-existing diabetes distress and further exacerbated the mental health issues of patients with diabetes.

## > Navigating Through the COVID-19 Pandemic: New Lessons on Diabetes and the Cardiovascular System

10 NOVEMBER 2020

MULTIDISCIPLINARY care is the future of medicine, as it becomes increasingly apparent that a single patient treated by a single doctor is an old-fashioned and restrictive approach. This year’s European Association for the Study of Diabetes (EASD) Virtual Meeting showcased the importance of such cross-disciplinary care by timetabling multiple cross-curricular sessions, including ‘Navigating Through the COVID-19 Pandemic and New Lessons from Cardiovascular Outcome Trials’, which served to update clinicians across the endocrinology and cardiology therapeutic areas on coronavirus disease (COVID-19) patient management.

## > EASD Congress Interview: Prof Chantal Mathieu

10 NOVEMBER 2020

In the EUDF, we have three big pillars where we see diabetes care going. The first pillar is the fact that we need data. In Europe, we don’t have Centers for Disease Control and Prevention (CDC) like in the USA, so we have no clue on prevalence, evolution, or complications of diabetes, for example. Several countries have these registries or data but getting this on a European level would help us to organise care. We want to put effort into co-ordinating this. Second is that, as the COVID-19 epidemic has shown us, digital health and novel technologies are very helpful in diabetes care. In EUDF, we also want to put emphasis on digital health, how this can help digital healthcare, and how this can help people with diabetes. We saw it with COVID-19; we had to switch to teleconsultations from Day 0, and so now we have data on how digital health has benefits in reaching patients, but also has limitations

## > EASD Congress Interview: Ms Beatriz Merino Antolín

10 NOVEMBER 2020

What effect did COVID-19 have on this important project and the work you were able to carry out? What were some of the unique challenges? COVID-19 affected us with the closure of the laboratory during confinement, this meant that we have had to delay some important experiments including the start of the Rising Star project funded by the EFSD. Fortunately, the EFSD has had no problem giving us the flexibility we needed in this special situation. We hope to begin developing our mouse model for studying endocrine pancreas development in the coming months.

## > EASD Congress Interview: Prof Rodica Pop-Busui

10 NOVEMBER 2020

The coronavirus 2019 (COVID-19) pandemic has been extremely pressurising for healthcare professionals and you recently co-authored an article titled “COVID-19 and Diabetes: A Collision and Collusion of Two Diseases”. What makes patients with diabetes highly susceptible to COVID-19 and how has the pandemic complicated the treatment of patients with diabetes this year? What were the take-home messages of this article? Overall, there is a consensus from clinical studies and meta-analyses that diabetes is a risk factor for serious COVID-19 infection and mortality. Although research is ongoing, several common risk factors are contributing and include the fact that patients with diabetes frequently suffer from comorbidities such as obesity, hypertension, cardiovascular disease, and chronic kidney disease, and dyslipidaemia, which predispose them to poorer COVID-19 outcomes. In addition, the low-grade inflammation and degree of glucose control and hyperglycaemia at infection time all promote more severe forms of infection and a higher release of inflammatory mediators.

## > Review of the European Association for the Study of Diabetes (EASD) Virtual Meeting 2020

10 NOVEMBER 2020

VIENNA, Austria’s cultural, economic, and political centre is rich in architectural ensembles, including Baroque palaces and gardens, casting a spell on all its visitors with its majestic charm. More famous composers have lived here than in any other city in the world, including the likes of Wolfgang Amadeus Mozart, Ludwig van Beethoven, Joseph Haydn, Franz Schubert, and Johann Straus, earning the city the prestigious title of the ‘World’s Capital of Music’. Vienna is also known as the ‘City of Dreams’, serving as the home to the world’s first psychoanalyst, Sigmund Freud. Accommodating over 1,000 research facilities and 35% of Austria’s research and development expenses, the city is a major hotpot for science and research. Annually, over 2,000 large-scale meetings and events are hosted here, and between 2005 and 2013 Vienna was the world’s primary destination for international congresses and conventions. It should come as no surprise that the European Association for the Study of Diabetes (EASD) chose Vienna as the host city for their 56th annual meeting.

## > How Long Do Antibodies Persist After COVID-19?

6 NOVEMBER 2020

RAPIDLY falling levels of antibodies have been demonstrated in the plasma of patients recovering from coronavirus disease (COVID-19). The recent study findings have implications for the use of convalescent plasma therapy in the treatment of severe cases of COVID-19.Antibodies that develop against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) target the spike protein of the virus to impede invasion of host cells. Previous studies have suggested that levels of these antibodies peak 2 or 3 weeks after symptom onset, while another study suggested that the efficacy of convalescent plasma therapy fell significantly 3–6 weeks after symptom onset.

## > COVID-19: Impact on Cancer Patients and Oncology Professionals

5 NOVEMBER 2020

TRANSFORMATIVE is a term that appropriately describes the striking developments made in the oncology field in recent years. Yet again the agile field has needed to evolve in the face of new challenges, but the challenge this time was to ensure that patients are cared for during the ongoing coronavirus disease (COVID-19) pandemic. Over two ‘SARS-CoV-2 and cancer’ proffered paper sessions at the European Society of Medical Oncology (ESMO) Virtual Congress 2020, oncology experts came together to discuss how the COVID-19 pandemic has affected the delivery of cancer care, the well-being of cancer patients and healthcare professionals, and the risk factors for mortality in this uniquely susceptible group.

## > Review of the European Society for Medical Oncology (ESMO) Virtual Congress 2020

5 NOVEMBER 2020

MADRID’S stunning boulevards and awe-inspiring galleries and museums were a sorely-missed backdrop for this year’s European Society for Medical Oncology (ESMO) Virtual Congress 2020. Once home to Nobel laureate Severo Ochoa, jointly awarded the prize in 1959 for his discovery of the mechanisms of synthesis of RNA and DNA, the beautiful city was unable to host this year’s congress because of the ongoing impact of the coronavirus disease (COVID-19) pandemic. Undaunted, >30,000 people from 150 countries formed a community online for a virtual ESMO 2020. Despite the limitations and separations of a global pandemic, the new digital format massively increased education and access for oncologists and cancer care professionals worldwide, as 49,000 hours of streamed content were watched over the 3-day science weekend.

## > ESMO Congress Interview: Professor John B.A.B. Haanen

5 NOVEMBER 2020

You spoke at ESMO about coronavirus disease (COVID-19) and cancer research. Could you tell our readers the key take-home messages of this talk? This year is about COVID-19. Our lives have changed because of COVID-19, both personal and work lives. Patients are affected, societies are affected, and healthcare workers like oncologists have been affected. We have shown that despite the impact that COVID-19 had and still has on our work, including in cancer research, we are highly resilient, flexible, and creative in bringing new research and insight into how cancer treatments impact COVID-19 and how COVID-19 impacts cancer patients, their treatment, and their doctors. Unfortunately, the price is high: [there have been] far less cancer diagnoses, less treatment, and more burn-out in oncologists; but, some good things came out of this, including telemedicine, no impact of targeted and immunotherapies on the outcome of COVID-19, and more working from home for oncologists.

## > Next-Generation Sequencing Standard of Care for Molecular Profiling

5 NOVEMBER 2020

Today, the need for robust and reproducible, but also timely, molecular testing to accurately identify treatment-eligible patients is largely acknowledged within the oncology community. This year’s European Society for Medical Oncology (ESMO) annual congress, in its virtual debut, gathered healthcare professionals spanning a range of disciplines and stakeholder groups together to learn from over 200 invited speakers and approximately 2,000 e-abstracts. In the coronavirus disease (COVID-19) era, attention has been focussed on the importance of appropriate molecular testing as part of an integrated cancer care workflow aiming to effectively stratify patients and enable optimal treatment selection. Additionally, emphasis was placed on the unique challenges posed by the COVID-19 pandemic to cancer care. Throughout the event, it became clear that the medical community did not begin 2020 with full appreciation of how much a crisis such as COVID-19 would have on the capacity to rapidly reveal the fragility of the cancer testing ecosystem, highlighting the urgent need to integrate the siloed stakeholders who are so dependent upon it. A major question addressed by numerous speakers, with preliminary sets of data, was: “How does COVID-19 impact the prognosis of patients with cancer?”

## > Webinar: Are We Virtually There Yet? Part 1 of 2

04 NOVEMBER 2020

Telemedicine, telehealth and virtual medical consults have become a part of the Covid-19 lexicon. Prior to the pandemic, these were considered either only suitable for extreme environments, research projects or the ultra-wealthy. Whereas the entertainment industry, banking and travel had embraced digital transactions, medicine lagged behind. Until now. This two-part webinar features experts who have been on the leading edge of technology in medicine and share their thoughts on where telemedicine was, where it is now and where it is going. Dr. Scott Parazynski has served as an emergency room physician, climbed Everest, managed healthcare in the extremes of the Antarctic and flew five missions on the Space Shuttle. Dr. Yulun Wang developed the world’s first operating theatre robot, advanced that technology to allow for distant operation, then developed a mobile telemedicine platform that combined robotics, virtual care and internet use and took that company to a massive acquisition. Join our host, Dr. Jonathan Sackier, as he discusses all aspects of telehealth from remote environments on earth and in space as well as the World Telehealth Initiative that seeks to democratize healthcare provision across the globe.

## > Webinar: COVID-19 Beyond Personal Protective Equipment (PPE)

2 NOVEMBER 2020

As there is currently no vaccine to prevent infection with SARS-CoV-2 virus, the cause of Coronavirus Disease 2019 (COVID-19), the best way to prevent it is to avoid being exposed to this virus. Additionally, basic infection prevention measures, such as frequent handwashing and rigorous environmental cleaning and disinfection, must be emphasized in order to prevent virus transmission. This webinar will present some updates on SARS-CoV-2, it will answer questions about the value of oral hygiene by gargling and the possible need for augmenting protocols recommended by the World Health Organization by using products with proven in vitro virucidal activity against SARS-CoV-2. You will also learn more about the big challenges facing antiseptics in 2020.

## > Cytokine Storm Criteria Enable Early COVID-19 Diagnosis

30 OCTOBER 2020

CYTOKINE storm is the term given to immune responses triggered by escalated infections, such as in the coronavirus disease (COVID-19). Severe immune manifestations can be observed in approximately 20–30% of patients hospitalised with COVID-19 and may lead to a cytokine storm with risks of fatal organ damage and mortality. In a new study, researchers have developed and validated predictive criteria for early identification of patients with COVID-19 who are developing hyperimmune responses. Dr Roberto Caricchio, lead author of the study and Chief of the Section of Rheumatology, Lewis Katz School of Medicine at Temple University (LKSOM), Philadelphia, Pennsylvania, USA explained the prospect of early therapeutic intervention: “If we can anticipate a cytokine storm, we can apply treatment sooner and possibly decrease mortality.” The investigation is the first of its kind to identify criteria for clinical practice to potentially protect against the unfavourable hyperimmune attack in COVID-19.

## > My Whole Career Has Been Focussed on How We Can Develop Therapies That Enable Us to Do Better

29 OCTOBER 2020

Mace Rothenberg is the Chief Medical Officer at Pfizer. Mace spoke to us about his sustained passion for advancing the field of oncology, the importance of diverse representation in patient groups, and the challenges of balancing lifespan with health span. What drew you to research, the focus of your early career, and how has your passion for medicine been sustained over the past 40 years? My attraction to research began during my specialty registrar training when I was assigned to the oncology in-patient unit. The patients were so sick and the therapies were so limited, but what really caught my attention was that we had access to new therapies that had not been available 5 years earlier. While some people viewed oncology as a depressing and hopeless area, that experience gave me a very different perspective. I saw it to be a hopeful and promising area with the potential for better outcomes with newer therapies.

## > Joining Forces with the NHS

29 OCTOBER 2020

The zebras in Sub-Saharan Africa and the native oxpecker birds have one thing in common: an innate desire to survive. The pair have formed a symbiotic relationship, where the birds eat ticks inhabiting the zebra’s skin and, in return, fly above the herds and let out warning calls when danger is near. The animals rely on one another to survive. The pharmaceutical industry’s relationship with the NHS, while lacking in warning calls and ticks, shares the same principle: a common goal that is expedited by working in symbiosis. Just as for the fauna of Africa, there are ever-threatening challenges for the ecosystems of healthcare around the world, from ageing populations and rising costs to the COVID-19 pandemic. Can pharma further cultivate this partnership to create fruitful outcomes for all?

## > Uniting Competitors, Creating Allies

29 OCTOBER 2020

During 2020, there has been an augmented display of collaboration between big pharma companies, who have shifted from competitors to partners in the face of the coronavirus pandemic. Forming partnerships in such a highly regulated and competitive industry is a complex operation but the benefits are infinite.

## > Leadership in a Crisis

29 OCTOBER 2020

When crisis hits, it can be difficult to know exactly how to respond; in such times, we turn to our leaders for direction and guidance. For many pharmaceutical executives, the coronavirus pandemic presented a challenge unlike any in living memory, testing the industry but also paving the way for positive change. Here, three thought leaders share what they have learnt about leadership during this time, as they continue to care for their teams, patients, and themselves.

## > Pharma’s Recession Resilience

29 OCTOBER 2020

Recession resilience is coveted across all industries, and the pharmaceutical industry is in a stronger position than most to weather economic turbulence. Whether the world is being tested by a housing market crash or a global pandemic, diseases will always exist and patients will always need treatment. But how ‘recession-proof’ is pharma, and what challenges has COVID-19 posed to this famously robust industry?

## > ‘The New Normal’ for KPIs

29 OCTOBER 2020

In the middle part of this year, it was near impossible to brew your morning coffee before encountering talk of ‘the new normal’. The phrase polluted televisions, radios, and newspapers. Zoom was alight with strategy meetings to decipher how this new state of affairs would be navigated. What was less talked about was KPIs and how the new normal would impact both their structure and usage. This absence from thought was best encapsulated during an interview at Cannes Lions Live 2020 with Bozoma Saint John, who was, at that time, CMO, Endeavor. When asked about what success metrics her company were using amidst the pandemic, she laughs: “Success is still being alive. Success is still having a business at the end of this thing.”

## > The Plastic Pandemic Emergency

29 OCTOBER 2020

As the public reaches for their blue face masks and frontline workers pull on their hazmat suits, there is a united sense that safety and protection are, at present, our most pressing and top priority – but at what cost? Until we find a vaccine, facemasks and PPE may be our only defence against the COVID-19 virus, but healthcare industries must remain mindful and vigilant about the increased consumption of plastic and the environmental consequences. How can the pharmaceutical industry assist and leverage their influence so that we do not regress on all the positive progress we have made when it comes to sustainability?

## > 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 Universityand 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.

28 JULY 2020

## > 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…