The evidence is in. WHO says corticosteroids really do save lives of people critically ill with COVID-19



Shutterstock

Andrew McLachlan, University of Sydney

Readily available drugs, which dampen the runaway inflammatory response in patients severely ill with COVID-19, save lives, according to evidence released this week.

An analysis by the World Health Organisation (WHO), which drew together results from several studies, confirms the benefit of this group of anti-inflammatory steroid drugs, known as corticosteroids.

While earlier studies showed the apparent benefit of one of these drugs, dexamethasone, this latest evidence goes further.

It shows other cheap and readily available corticosteroid drugs, including hydrocortisone, could benefit patients at the life-threatening stages of coronavirus infection.

Remind me again, what are corticosteroids?

Corticosteroids have been used for decades to treat a variety of inflammatory conditions. These include severe forms of lung inflammation, such as pneumonia, shock due to infection, and severe respiratory syndromes. They are also used to treat more common conditions, including asthma and eczema.

These medicines are on the WHO list of essential medicines, meaning they are widely available (usually at low cost).




Read more:
What medicines would we pack for a trip to Mars?


What do we already know about corticosteroids for COVID-19?

In June, early release of results from the RECOVERY trial showed dexamethasone reduced the risk of death by up to a third in people hospitalised with COVID-19 who needed a ventilator to help them breathe.

Results of the dexamethasone trial were released early.

Despite the early release of the trial results, and limited details at the time, the findings were compelling and clinical practice changed.

Several other trials were stopped. All patients switched to receive active treatment with a corticosteroid.

The results of the RECOVERY trial have since been formally peer reviewed and published.




Read more:
Dexamethasone: the cheap, old and boring drug that’s a potential coronavirus treatment


What does the latest evidence say?

The WHO drew together results from seven randomised clinical trials, including data from 1,703 critically ill patients with COVID-19.

This is a powerful and compelling way to combine information and truly address the question of whether these medicines benefit people in hospital critically unwell with COVID-19.




Read more:
ICU ventilators: what they are, how they work and why it’s hard to make more


The study, which included patients from Australia and New Zealand, found almost 33% of people treated with corticosteroids died within 28 days of treatment. This was compared with 41% of patients who received supportive care (or placebo). Corticosteroid treatment helped patients whether or not they needed ventilation or oxygen.

Importantly, the analysis also concluded the benefits were not specific to one corticosteroid drug but were the same for dexamethasone and hydrocortisone.

Corticosteroids can also have an impact on the immune system. So the researchers looked at the risk of infection from other causes, for example bacterial pneumonia, and found it was not a major concern.

What does this mean for patients?

The weight of evidence has led WHO guidelines this week to strongly recommend using corticosteroids to treat people with severe or critical COVID-19.

This aligns with current Australian guidelines for treating hospitalised patients with COVID-19 needing oxygen support.

Corticosteroids are not for everyone and are not a cure

It is important to remember these findings only apply to using corticosteroids in critically ill people hospitalised with COVID-19. There is currently limited information to suggest these medicines are appropriate for people with mild COVID-19.

While corticosteroids help treat the body’s response to the coronavirus infection, they are not antiviral drugs. They do not inhibit the virus itself, so they are not a cure.




Read more:
In the fight against coronavirus, antivirals are as important as a vaccine. Here’s where the science is up to


A new way of doing research

Usually, several clinical trials on a common theme are published over a series of years. Then a meta-analysis draws together their results, publishing these combined results much later.

But the amazing thing about this latest evidence is the meta-analysis included data from clinical trials published at the same time. This shows a degree of co-operation and collaboration between researchers to share data to urgently address important research questions that guide clinical care.

Evidence to guide the best treatments and management for people with COVID-19 continues to emerge. You can follow the evidence and how it’s applied in Australia here.




Read more:
Ivermectin is still not a miracle cure for COVID-19, despite what you may have read


The Conversation


Andrew McLachlan, Head of School and Dean of Pharmacy, University of Sydney

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

The evidence is clear: the medevac law saves lives. But even this isn’t enough to alleviate refugee suffering



Protesters holding a vigil last year for deceased asylum seeker Hamid Khazaei, who died in a Brisbane hospital due to an infection at the Manus Island detention centre in 2014.
Darren England/AAP

Sara Dehm, University of Technology Sydney

Tasmanian Senator Jacqui Lambie has some sobering reading to do over the coming weeks: an 88-page Senate report into the government-sponsored bill to repeal the medevac law that allow refugees and asylum seekers in Papua New Guinea and Nauru to seek medical care in Australia. The publication of the report last Friday paves the way for a Senate vote on the bill in mid-November.

As predicted, the Senate committee that issued the report split along party lines, with the Coalition majority calling for the medevac provisions to be repealed and the ALP, Greens and Centre Alliance senators releasing dissenting reports.




Read more:
Lambie stays mute on medevac vote after Senate inquiry splits on party lines


What is less predictable is how the report will influence Lambie’s deciding vote. She has indicated she will approach the bill as a conscience vote, saying

Tasmanians don’t want deals done over humanity.

An overwhelming health crisis in offshore detention

The medevac law allows a person to be transferred to Australia for medical treatment or assessment if two Australian-registered doctors recommend such care is necessary and unavailable in PNG or Nauru. There are limited exceptions for the minister of home affairs to reject a transfer on security and character grounds.

Since the law came into effect in March, over 130 people have been transferred for care.

The Coalition government maintains the pre-medevac medical transfer policy for refugees was adequate. This allowed transfers only in life-threatening cases in which the required specialist medical care could not be provided on PNG, Nauru or a third country like Taiwan.

However, evidence given to the Senate committee showed a drastic drop in medical transfers to Australia from 2015 to mid-2018, despite clear medical need.

Statistics given to the committee by the National Justice Project, a not-for-profit legal service that acts on behalf of refugees, documented how some patients had to wait more than four years for medical transfers to Australia.

Tony Bartone, the Australian Medical Association president, described the government’s pre-Medevac process as “torturous” and involving “long periods of delay,” without any appropriate oversight.

Court injunctions and prospective litigation from mid-2018 onwards did compel the government to bring around 350 people to Australia for urgent medical treatment or as an accompanying family member. But such court interventions can be costly, slow and resource-intensive for those in need of immediate medical attention.




Read more:
Peter Dutton is whipping up fear on the medevac law, but it defies logic and compassion


And that need is still extremely high for those refugees remaining in offshore detention. An independent health assessment in June found a staggering 97% of those in detention and processing facilities have been diagnosed with physical health conditions. A further 91% were experiencing mental health problems, including severe depression and PTSD.

All but two of the 95 public submissions received by the committee were strongly in favour of retaining the medevac law.

Tellingly, those two submissions were from the Department of Home Affairs and the International Health and Medical Service, a government-contracted health provider on Nauru.

Overlooked refugee suffering in Australia

What is missing from the Senate report is any mention of the intolerable situation that refugees and asylum seekers face even after they have been transferred to Australia.

Although people can access critical medical treatment here, most remain in community detention, facing economic insecurity and legal uncertainty about their future. Research shows such legal limbo can lead to feelings of despair and dehumanisation.

The day before the report’s release, 32-year-old Afghan doctor Sayed Mirwais Rohani died in Brisbane, the victim of an apparent suicide. Rohani had come to Australia for medical treatment two years ago, after spending four years in immigration detention on Manus Island.

After his death, his former roommate posted on Facebook:

We shared same pain for long time, long enough to destroy someone’s life.

Rohani’s death was at least the 13th among refugees held in offshore detention on Manus or Nauru.

‘Trying to kill themselves because they’ve lost hope’

No doubt the government will use the Senate report to convince Lambie to support its bill when the vote happens next month.

So far, Lambie has remained relatively reticent, even if she did rebuff Dutton’s claim that the “vast majority of veterans” want her to vote to repeal medevac.




Read more:
Explainer: how will the ‘medevac’ bill actually affect ill asylum seekers?


Instead, Lambie indicated she would look to “national security” considerations in weighing up the report’s findings, including the dissenting reports. She has in the past called for children not to be in immigration detention and voted against the Coalition government’s bill to introduce temporary refugee visas in 2014.

Even if the medevac provisions stay in place, the status quo of Australia’s offshore detention regime remains unsustainable and inhumane.

As former MP Kerryn Phelps, a key architect of the medevac law during her brief time in parliament, stated in her evidence to the Senate committee, refugees and asylum seekers are

not trying to make a point; they’re trying to kill themselves because they’ve lost hope.The Conversation

Sara Dehm, Lecturer, University of Technology Sydney

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

Australia: NSW – Bushfire Story (One Person’s Story)


The link below is to an article that reports on one person’s experience in the devastating bushfires currently impacting on homes and lives in NSW, Australia.

For more visit:
http://www.biblesociety.org.au/news/im-christian-house-just-burned

Iran: Latest Persecution News


The link below is to an article on the latest persecution news out of Iran, which looks at how persecution in that country is impacting on the lives of families.

For more visit:
http://www.christiantelegraph.com/issue16990.html

Pastor, Church Official Shot Dead in Nigeria


Muslim militants of Boko Haram blamed for killings in Borno state.

JOS, Nigeria, June 10 (CDN) — Muslim extremists from the Boko Haram sect on Tuesday (June 7) shot and killed a Church of Christ in Nigeria (COCIN) pastor and his church secretary in Maiduguri, in northeastern Nigeria’s Borno state.

The Rev. David Usman, 45, and church secretary Hamman Andrew were the latest casualties in an upsurge of Islamic militancy that has engulfed northern Nigeria this year, resulting in the destruction of church buildings and the killing and maiming of Christians.

The Rev. Titus Dama Pona, pastor with the Evangelical Church Winning All (ECWA) in Maiduguri, told Compass that Pastor Usman was shot and killed by the members of the Boko Haram near an area of Maiduguri called the Railway Quarters, where the slain pastor’s church is located.

Pona said Christians in Maiduguri have become full of dread over the violence of Boko Haram, which seeks to impose sharia (Islamic law) on northern Nigeria.

“Christians have become the targets of these Muslim militants – we no longer feel free moving around the city, and most churches no longer carry out worship service for fear of becoming targets of these unprovoked attacks,” Pona said.

Officials at COCIN’s national headquarters in Jos, Plateau state, confirmed the killing of Pastor Usman. The Rev. Logan Gongchi of a COCIN congregation in Kerang, Jos, told Compass that area Christians were shocked at the news.

Gongchi said he attended Gindiri Theological College with Pastor Usman beginning in August 2003, and that both of them were ordained into pastoral ministry on Nov. 27, 2009.

“We knew him to be very gentle, an introvert, who was always silent in the class and only spoke while answering questions from our teachers,” Gongchi said. “He had a simple lifestyle and was easygoing with other students. He was very accommodating and ready at all times to withstand life’s pressures – this is in addition to being very jovial.”

Gongchi described Usman as “a pastor to the core because of his humility. I remember he once told me that he was not used to working with peasant farmers’ working tools, like the hoe. But with time he adapted to the reality of working with these tools on the farm in the school.”

Pastor Usman was excellent at counseling Christians and others while they were at the COCIN theological college, Gongchi said, adding that the pastor greatly encouraged him when he was suffering a long illness from 2005 to 2007.

“His encouraging words kept my faith alive, and the Lord saw me overcoming my ill health,” he said. “So when I heard the news about his murder, I cried.”

 

Motives

The late pastor had once complained about the activities of Boko Haram, saying that unless the Nigerian government faced up to the challenge of its attacks, the extremist group would consume the lives of innocent persons, according to Gongchi.

“Pastor Usman once commented on the activities of the Boko Haram, which he said has undermined the church not only in Maiduguri, but in Borno state,” Gongchi said. “At the time, he urged us to pray for them, as they did not know how the problem will end.”

Gongchi advised the Nigerian government to find a lasting solution to Boko Haram’s violence, which has also claimed the lives of moderate Muslim leaders and police.

The Railway Quarters area in Maiduguri housed the seat of Boko Haram until 2009, when Nigerian security agencies and the military demolished its headquarters and captured and killed the sect’s leader, Mohammed Yusuf, and some of his followers.

The killing of Pastor Usman marked the second attack on his church premises by the Muslim militants. The first attack came on July 29, 2009, when Boko Haram militants burned the church building and killed some members of his congregation.

On Monday (June 6), the militants had bombed the St. Patrick’s Catholic Church, along with other areas in Maiduguri, killing three people. In all, 14 people were killed in three explosions at the church and police stations, and authorities have arrested 14 people.

The Boko Haram name is interpreted figuratively as “against Western education,” but some say it can also refer to the forbidding of the Judeo-Christian faith. They say the word “Boko” is a corruption in Hausa language for the English word “Book,” referring to the Islamic scripture’s description of Jews and Christians as “people of the Book,” while “Haram” is a Hausa word derived from Arabic meaning, “forbidding.”

Boko Haram leaders have openly declared that they want to establish an Islamic theocratic state in Nigeria, and they reject democratic institutions, which they associate with Christianity. Their bombings and suspected involvement in April’s post-election violence in Nigeria were aimed at stifling democracy, which they see as a system of government built on the foundation of Christian scripture.

Christians as well as Muslims suffered many casualties after supporters of Muslim presidential candidate Muhammudu Buhari lost the April 16 federal election to Goodluck Jonathan, a Christian. Primarily Muslim rioters claimed vote fraud, although international observers praised the polls as the fairest since 1999.

Nigeria’s population of more than 158.2 million is almost evenly divided between Christians, who make up 51.3 percent of the population and live mainly in the south, and Muslims, who account for 45 percent of the population and live mainly in the north. The percentages may be less, however, as those practicing indigenous religions may be as high as 10 percent of the total population, according to Operation World.

Report From Compass Direct News
http://www.compassdirect.org/

 

Suspected Islamists Burn Down Two Homes in Ethiopia


Two thatched-grass structures belonged to evangelist who received threats.

NAIROBI, Kenya, April 21 (CDN) — A Christian near Ethiopia’s southern town of Moyale said suspected Islamic extremists on March 29 burned down his two thatched-grass homes.

Evangelist Wako Hanake of the Mekane Yesus Church told Compass he had been receiving anonymous messages warning him to stop converting Muslims to Christ. The Muslims who became Christians included several children.

“Inside the house were iron sheets and timber stored in preparation for putting up a permanent house,” said Hanake, who is in his late 30s. “I have lost everything.”

The incident in Tuka, five kilometers (nearly three miles) from Moyale in southern Ethiopia’s Oromia Region, happened while Hanake was away on an evangelistic trip. A neighbor said he and others rescued Hanake’s wife and children ages 8, 6 and 2.

“We had to rescue the wife with her three children who were inside one of the houses that the fire was already beginning to burn,” said the neighbor, who requested anonymity.

Church leaders said neighbors are still housing Hanake and his family.

“The family has lost everything, and they feel fearful for their lives,” said a local church leader. “We are doing all we can to provide clothing and food to them. We are appealing to all well wishers to support Hanake’s family.”

Hanake said he has reported the case to Moyale police.

“I hope the culprits will be found,” he said.

An area church leader who requested anonymity told Compass that Christians in Moyale are concerned that those in Tuka are especially vulnerable to a harsh environment in which religious rights are routinely violated.

“The Ethiopian constitution allows for religious tolerance,” said another area church leader, also under condition of anonymity, “but we are concerned that such ugly incidents like this might go unpunished. To date no action has been taken.”

Tuka village, on Ethiopia’s border with Kenya, is populated mainly by ethnic Oromo who are predominantly Muslim. The area Muslims restrict the preaching of non-Muslim faiths, in spite of provisions for religious freedom in Ethiopia’s constitution.

Hostility toward those spreading faiths different from Islam is a common occurrence in predominantly Muslim areas of Ethiopia and neighboring countries, area Christians said, adding that they are often subject to harassment and intimidation.

Ethiopia’s constitution, laws and policies generally respect freedom of religion, but occasionally some local authorities infringe on this right, according to the U.S. Department of State’s 2010 International Religious Freedom Report.

According to Operation World, nearly 40 percent of Ethiopia’s population affiliates with the Ethiopian Orthodox Church, 19 percent are evangelical and Pentecostal and 34 percent are Sunni Muslim. The remainder are Catholic (3 percent) and ethno-religious (3.7 percent).

 

Jimma Violence

In Jimma Zone in the country’s southwest, where thousands of Christians in and around Asendabo have been displaced as a result of attacks that began on March 2 after Muslims accused a Christian of desecrating the Quran, the number of churches burned has reached 71, and two people have reportedly been killed. Their identities, however, were still unconfirmed.

When the anti-Christian violence of thousands of Muslims subsided by the end of March, 30 homes had reportedly been destroyed and as many as 10,000 Christians may have been displaced from Asendabo, Chiltie, Gilgel Gibe, Gibe, Nada, Dimtu, Uragay, Busa and Koticha.

Report from Compass Direct News
http://www.compassdirect.org

Suspected Drug Traffickers Kidnap Pastor


Michoacan state church leader abducted during Sunday service.

MEXICO CITY, April 15 (CDN) — Some 500 worshippers were gathered for last Sunday’s (April 10) worship service at the Christian Center El Shaddai in the Mexican city of Lázaro Cárdenas, Michoacan at about 8:15 a.m. when four masked men burst in firing machine guns into the air.

Before the frightened believers realized what was happening, their pastor, Josué Ramírez Santiago, had been whisked away. Divergent press reports indicated the kidnappers, suspected drug traffickers active in the state, were about 10 in number.

The following day, the pastor’s family received news that the criminals wanted a ransom of 20 million pesos (US$1.7 million). Even if the family could raise such an immense sum – considered doubtful – payment would not guarantee that the victim would be returned alive.

Arturo Farela, director of the National Fraternity of Evangelical Churches, has asserted that organized crime syndicates and drug cartels have targeted Christians because they view churches as revenue centers and because churches support programs for the rehabilitation of drug addicts and alcoholics.

“The majority of rehabilitation centers that have been attacked by organized crime in Ciudad Juarez, Tijuana, Tepic and other places belong to the evangelical community,” Farela said in a declaration regarding the kidnapping of Ramirez. “Furthermore, some 100 Mexican or foreign pastors who lived in Ciudad Juarez have had to abandon the city because of the threats and demands for money. And of course many pastors and their families have been victims of extortion, threats, kidnapping and homicide.”

Farela has stated that 100 Mexican clergymen have been kidnapped in recent years, with 15 of them losing their lives to organized crime. Asked if Compass could review his records of these crimes, Farela said he was not authorized to permit it.

In numerous other cases, children of pastors have been kidnapped, including one from Matehuala, San Luis Potosi, who has not been heard from for some six months. The college-age daughter of a prominent pastor in Mexico City was held by kidnappers for a week but was released when the criminals grew tired of the father’s prayers every time they telephoned him; the family has not revealed whether money was given for her return.

Michoacan, the state where the most recent abduction took place, has been a center of much criminal activity and also of severe reprisals by elements of the Mexican army. The state where President Felipe Calderon was born, Michoacan was the first to implement an anti-drug military operation that expanded to northern and eastern states.

In spite of the operation, more than 34,600 people nationwide have reportedly been assassinated since it was implemented in December 2006, with most of those crimes tied to drug traffickers “settling accounts.”

Report from Compass Direct News
http://www.compassdirect.org