Tag: 8/1/21

A Four Century Old Manual for Social Distancing Rules

A feature article from the BBC details how one doctor in the era of the Plague created an eerily familiar set of social distancing guidelines that matches a lot of our non-pharmaceutical COVID controls.

Staying at home and only sending out one person to do the shopping, keeping six feet apart and disinfecting goods – all of these feature in a manual created over four centuries ago to help protect Alghero, a small Italian town against the plague. The methods by a doctor named  Quinto Tiberio Angelerio, published in a 57-page booklet on his methods, titled Ectypa Pestilentis Status Algheriae Sardiniae.

Unlike most plague outbreaks, it failed to spread to neighbouring areas and died out within eight months – though not without claiming about 60% of the town’s initial population of 6000. Angelerio’s rules are thought to be at least partly responsible.

Ravaging Europe as well as Asia and North Africa, the plague left an unimaginable mark on Western society; tunnelling projects in London regularly run into mass graves of plague victims. Italian poet Francesco Petrarca wrote that future generations would likely not be able to grasp the scale of the calamity, and he is probably right in that regard. The plague continued to reappear, and devastated regions when it did – The Great Plague of London saw 24% of its populace dying over 1665 to 1666.

Although the germ theory of disease was then still centuries in the future, and bathing in urine was thought to be effective treatment, physicians in Europe believed in the contagion theory, thinking that diseases were spread through “miasmas” or “bad air”. This enabled them to come up with the idea of quarantines, from the Italian for “forty days” which was the standard isolation period.

Facing huge obstacles from a recalcitrant citizenry, Angelerio nevertheless persevered and soon a lockdown was enacted. This was not unique, as whole cities would be quarantined. Other rules that were enforced included a social distancing of six feet (as measured by a pole to be carried around by anyone outside), advising people to be careful shaking hands during mass, as well as railing preventing customers coming into contact with shopkeepers. He also used superstition to keep people in line, as European people of the time believed the plague to be divine punishment – although rule breakers were common, as they are now with COVID. He also advised cleaning and disinfecting houses, and household goods (or burning if replaceable), in addition to the contemporary practice of disinfecting newly arrived cargo. This was accomplished by fire or exposure to the wind, among others. However, the common practice of killing cats in response to plague was likely counterproductive, as rats hosted plague-carrying fleas.

Nevertheless, Angelero’s work was ahead of its time, and helped lay the foundations of modern disease control.

.Source: BBC Future

Nearly a Fifth of Cancer Patients on Opioids Misuse Them

A new report reveals that 19% of cancer patients receiving opioids are misusing them, referred to a nonmedical opioid use (NMOU) behaviour. 

Opioid addiction remains a persistent and serious problem in the United States, and is growing elsewhere in the world, with some 16 million individuals worldwide suffering from opioid misuse disorder.
The study,  led by Sriram Yennurajalingam, MD, MS, of MD Anderson Cancer Center in Houston, included 1554 patients at a supportive care clinic for a comprehensive cancer centre. Of those engaging in NMOU behaviour, the most common (29%) was an early request for a refill, followed by self-directed dose escalation (15%), co-using illicit or non-prescribed drugs (13%), and impaired daily function due to opioids (11%).

Independent risk factors that increased the risk of NMOU behaviour included being single or divorced, as well as pain levels, opioid risk screening score, and morphine equivalent daily dose.

In their recommendations, Yennurajalingam and co-authors wrote: “Based on these findings, a universal screening, setting limits on opioid use by limiting supply, more intense follow-up with an interdisciplinary team to provide optimal use of medications for pain and symptom management, and the provision of counseling and support to patients and their family members may help prevent the development of these NMOU behaviors.”

Source: MedPage Today

Journal information: Yennurajalingam S, et al. Frequency of and factors associated with nonmedical opioid use behavior among patients with cancer receiving opioids for cancer pain, JAMA Oncol 2020; DOI: 10.1001/jamaoncol.2020.6789.

New Treatment for Severe COVID with Tocilizumab and Sarilumab

Following clinical trials, the NHS is to use tocilizumab and sarilumab, two anti-inflammatory drugs for severe COVID treatment. The treatments can cut the risk of death from severe COVID by a quarter, saving one patient for every 12 treated. Dexamethasone, the first drug found to effectively treat severe COVID, was found to cut deaths by a third if on ventilators and by a fifth if on oxygen.

The UK government is working with the drugs’ manufacturer to ensure an adequate supply for its patients – currently standing at 30 000 COVID cases in hospitals. It has also placed an export ban on the medicines, preventing its purchase and resale overseas for a profit.

Using an innovative adaptive trial design, the REMAP-CAP trial involved 4858 total patients, 4089 of which had suspected or proven COVID and over 800.

Compared to dexamethasone at £5 per dose (R100), the drugs are extremely expensive, however, at £750 to £1000 (R15 000 to R20 000) per patient – but this is less than half the cost of an ICU bed per day in the UK.Prof Stephen Powis, national medical director of the NHS, said: “The fact there is now another drug that can help to reduce mortality for patients with Covid-19 is hugely welcome news and another positive development in the continued fight against the virus.”

As a result of the successful trial, UK doctors are being advised to administer  tocilizumab and sarilumab should dexamethasone prove insufficient for treating severe COVID cases. The anti-inflammatory drugs reduce the damaging lung inflammation caused by severe COVID.

UK Health and Social Care Secretary Matt Hancock said: “Today’s results are yet another landmark development in finding a way out of this pandemic and, when added to the armoury of vaccines and treatments already being rolled out, will play a significant role in defeating this virus.”

Source: BBC News