Author: tazche11

As the world battles COVID-19, there is a large risk of measles outbreaks across the world. There are several countries that are deciding to pause the Measles Mumps Rubella (MMR) vaccine to attend to COVID-19. These countries include Brazil, Cambodia, Ethiopia, Mexico and more. Other countries are expected to be delayed as well. This leaves over 117 million children unvaccinated and at risk for obtaining the measles. All it takes is a small decline in vaccination to lead to an outbreak, especially because the measles could spread very easily among children. The measles is highly contagious and the most at risk are the unvaccinated. The MMR vaccine lead to a 73% drop in measles in death between 2000 and 2018. However this progress can slowly be eliminated through the pause of the vaccine. Since there is not a specific treatment either for measles, there is not an effective way to treat those who newly become infected because of the lack of vaccination. It is important to always have a contingency plan with diseases because how can a preventative vaccine be paused when there is no antiviral treatment to support those who become infected.

Governments such as the UK are going to continue administering the vaccine to vulnerable population. UNICEF is encouraging the countries who are pausing the vaccine to do the same so the vaccine is not cut cold. WHO recommends that vaccine campaigns be temporarily paused as long as there is no active outbreak.

The measles is declared a Global Situation by WHO. As of November 413, 308 confirmed cases of the Measles in places such as Brazil. A country that is planning to pause the MMR Vaccination. As of November 2019 there were 11,887 cases of the measles with a vaccination response on the way. How can the country go from developing a vaccination response to pausing the vaccine? This is putting even more people at risk.

Healthcare resources are thin and extremely stretched. But does that mean we leave other diseases on the back burner? How is it possible to determine what is more important when hundreds of millions of lives are at risk in all situations and outcomes? Through pausing vaccines you are putting even more people at risk than before. It is impossible to value one life over another. Tough choices have to be made however I just do not see the practicality of pausing vaccinations for other diseases. I understand people not wanting to take their children to be vaccinated due to chances of becoming infected with COVID-19 but that should be the parent’s and or guardian’s choice not the government.

Natalizumab is an injection for those with Multiple Sclerosis. It is a monoclonal antibody. An antibody is a protein produced by the body’s own immune response in response to antigens. They are your body’s personal warriors to fight off infections. With modern day science scientists are able to produce antibodies in a lab. Monoclonal antibodies are man made antibodies that bind to one antigen. They are synthesized from cloned immune cells. Hence “mono” meaning 1 antigen and “clonal” meaning cloned. These cloned immune cells often come from mice who first are injected with human genes that produce certain antibodies then the mice is vaccinated with the antigen that induces the immune cells of the mice to produce the desired antibody. The antibodies are then extracted to be used as medications.

MS impacts the central nervous system (CNS). It induces an immune mediated process that causes an abnormal response of the immune system directed at the CNS (brain, spinal cord and optic nerves). The immune system causes inflammation that damages myelin that surrounds nerve fibers which negatively impacts communication between the brain and the body.

Natalizumab impacts the acquired immune response. It decreases the number of CD4+ and CD8+ T lymphocytes, CD19+ B cells and CD138+ plasma cells in the CSF of patients natalizumab therapy. The drug is to suppress the immune response to prevent or limit the immune system from attacking the myelin sheaths of the nerves which communicate from the brain and body. It binds to the subunits on integrins expressed on the surface of leukocytes. This prevents select integrins from binding to their counter receptors. This limits the immune response within the body.

Side Effects

Increases your chance of getting Progressive Multifocal Leukoencephalopathy (PML) a rare brain infection that causes death or severe disability

Since Natalizumab is an immunosuppressant it weakens the immune response to limit the attack on self cells. However it leaves the body more susceptible to other infections as well. It is important to monitor symptoms during treatment because it can lead to UTI’s, herpes infections, increased infections of the brain and more due to the suppressed immune response. This leads patients to not be able to fight off infections they typically would with not problem. Natalizumab is not a cure for MS but a treatment to limit and or eliminate the effects of it.

PML is caused by the JC virus. Often this virus remains inactive until conditions in the body such as a weakened immune system allow it to be reactivated and begin to multiply. JC can be activated by natalizumab, an immunosuppressants that suppresses the immune system. However short term use of natalizumab has limited risk of developing PML. It is long term use past 8 months where there is risk of developing PML is substantially higher. PML is an opportunist infection therefore it caused by pathogens that would not cause illness in a healthy person. Therefore extended use of immunosuppressant drugs gives the JC virus more ability to activate and cause an even more severe infection. It is not the MS that makes a person more susceptible to PML but the drugs that fight the MS that lead to more infections and even more severe ones at that.

Medicines can be as harmful as they are helpful. Medicine is not perfect but when used properly and effectively it can be lifesaving. Decisions on treatment can be scary and intense especially when the side effects can be worse than the disease itself. This is why education and the right team of doctors is so important on making decisions best for you. With treatment there always will be pros and there will always be the cons, but in the end it is the patient’s choice if those pros outweigh the cons in the end.

In the midst of the COVID-19 pandemic, the FDA took a major step in advancing the prevention of Shiga toxin producing E. coli or STEC. The FDA released the 2020 Leafy Greens STEC Action Plan. It is an outlined plan to advance the safety of leafy greens. It has three main focuses to advance work in prevention, response and addressing knowledge gaps.

Leafy green are essential to a well balanced diet, yet they are major carriers for STEC. Between 2018 and 2019 there were 40 STEC infection outbreaks linked to leafy greens in the US. STEC is spread fecally-orally and then the feces can infect surfaces, food and. water. A focus of the 2020 Leafy Greens STEC Action Plan is educating the industry on the important of agricultural water quality as well as the impact of potential use of adjacent land. If infected water is used to water the greens then they can become infected with STEC. This can lead to outbreaks unknowingly. By further observing water and soil quality and improving testing techniques the amount of STEC outbreaks can be minimized. The FDA is working to further understand the pathogenies of STEC within the environment to work to prevent the indirect spread of the pathogen. The initial initiatives are focused in primary leafy greens growing regions such as Yuma, Arizona.

It is important that the prevention and research of other diseases is still prevalent amongst the COVID-19 pandemic. Often time and resources for legislation is pushed to the side to work through world crisis. I was surprised to see how recent the FDA passed this Act especially in the midst of approval for vaccines and tests for COVID-19. This shows the importance of departments within federal agencies, research corporations, and the health care industry this allows for life to continue on as much as it can. It allows for other equally as important and possibly more deadly diseases to still be researched and worked further on.

COVID-19 has medical researchers pulling out all the stops to identify, contain, treat, and cure the disease. The FDA recently approved an antibody test to identify if a person has COVID-19, has ever been introduced to COVID-19 or have never been introduced to it. The test provides a titer antibody report after the collection of a person’s blood. The report records the amount of antibody produced within the blood. The ideal part about identifying infections through antibodies is that the body will only produce antibodies for COVID-19 if it has been exposed to it. However the body takes days to produce antibodies for diseases. Therefore it is not as efficient to test if someone currently has COVID-19 because the body simply could not have developed the antibody response yet. This test is important especially for those who do not show symptoms to COVID-19 but they have been exposed and yet their body had a proper immune response. This is groundbreaking in terms of identifying asymptomatic carriers and putting them on quarantine to limit the spread of the virus. Often in times like this where the main RNA tests are limited it is important to develop new techniques to test people even if they are not the most efficient.

How The Test Works?

The blood test works to identify the presence, if any, of the specific IgG and IgM antibodies which are recruited to fight off COVID-19. IgM is the first and quickest antibody to respond to the infection. Then the IgG antibody is then produced and replaces the IgM antibody. The results for the test are as followed:

Negative result: No presence of COVID-19 IgM or IgG present. Therefore no COVID-19 has been introduced to the body, yet.

Positive Result, IgM only: the COVID-19 IgM antibody has been identified. It can be assumed a person is in the early stage of infection due to IgMs quicker response to infection.

Positive Result IgG only: the COVID-19 IgG antibody has been identified. Person is in the last stage of infection or is over the infection.

Positive Result IgM and IgG only: both COVID-19 antibodies have been identified. Person is likely in the middle of the infection.

Anytime a person’s test is positive they are contagious and should self quarantine. However we must be careful when interpreting the results because of the time frame it takes to produce antibodies a negative test does not fully confirm someone is virus free because their body may have just not produced antibodies. Also antibodies could have possible amino acid mutations to allow them not to be recognized by the test. The CDC recommends two tests obtained within 24 hours for the most accurate result of the test. These reasons are why it is important not use this test solely for identification. But it will be an influential tool in identifying carriers as well as determining if people are clear of the disease as well.

With over 1 million cases in the world, COVID-19 is taking the world by storm. Hospitals are running out of beds, health care professionals are becoming infected themselves, PPE resources are running low, and people are placing themselves at risk simply to earn an income. It is truly a scary thing. We are watching resources drain before our own eyes. The best measures we can do now is do our best to prevent the spread anymore by “flattening the curve.” The implications of COVID-19 were truly underestimated by Government officials and now groups are rushing to be the first to develop, test and get approved their COVID-19 vaccine.

There are currently 3 vaccines currently in their first round of human trials. Yes human trials, these vaccines are on an accelerated tract. Most vaccines take a year or more to just be developed for testing…. not months. The front runner the mRNA-173 vaccine was developed by Moderna Therapeutics and backed by the NIAID. This vaccine codes for the “spike protein” on the virus that links it to a human cell. The kicker with this vaccine is that an mRNA based virus has never been approved for use in humans. And the mRNA-1273 vaccine skipped animal testing and went right to a human trial. This is truly a representative of desperate times calls for desperate measures because the rapidly growing urgent threat of the virus is causing researchers to skip crucial safety steps in vaccine development. In reality we are putting more lives in danger in an attempt to save lives.

The 2nd vaccine in human trials and the global front runner is Ad5-nCoV developed by the Beijing Institute of Biotech and CanSino Biologics. Ad5-nCov uses a viral vector which delivers genetic material to the recipient. There is much promise because CanSino has developed an identical vaccine Ad5-EBOV to protect against Ebola and it is in its Phase 2 of Testing. The 3rd vaccine is produced by the University of Oxford it being simultaneously being tested for Safety (phase 1) and efficacy (phase 2). It is an inactivated vaccine that contains the key protein genetic material. This vaccine was derived from chimpanzees.

Trump administration is claiming eighteen months for a developed coronavirus vaccine. But this is bringing a lot of skepticism from experienced professionals. Dr. Peter Hotez an expert on infectious disease and vaccine development states the claim is possible “maybe if all the stars align, but probably longer.” Dr. Emily Erbelding an expert at NIAID said a typical vaccine takes 8-10 years to develop. How are we safely expediting a 10 year process into a year? As we are racing against the clock, it is important that we do not rush too much that quality is gone just to produce results. Because if these vaccines deem more hurtful than helpful we are back at square one.

Vaccines are important to preventing a second round of COVID-19, but ultimately it is up to us as people to stop the spread. It is up to us to follow the governmental instructions to social distance and limit our trips outside our homes. Because ultimately a vaccine will not be ready in time to protect us from this first wave of COVID-19.

Chimeric antigen receptor (CAR) T cell Therapy, is enhancing cancer treatment before our eyes. It is providing patients diagnosed with cancer a stronger fighting chance against the aggression and spread of tumors specifically in, lymphoma and acute lymphoblastic leukemia. However treatment is being expanded to other types of cancer. T cells are lasting longing in the body and proving to be more persistent and effective. Patients treated with CAR-T Therapy have reported a progression in quality of life after treatment in areas such as general health, vitality, social function and physical function. Patients have also been able to return to an almost normal life.

How It Works?

The big picture of CAR-T Therapy is pretty simple. The patient’s blood is drawn and T cells are then isolated from it. Then the T cells are genetically engineered to produce CARs on its surface. CARs allows the T cell to recognize and attach to antigens and or proteins on tumor cells. The the CAR induced T cells are then multiplied and infused back into the patient. Once in the body they would multiply more and begin to recognize cancerous cells. CAR-T therapy is fusing a personal approach to care with the modern day knowledge of today. Cancer treatment is not a “one-size fits all” approach. This shows how strong the human body is. The body in this case the best warrior and all the doctors are doing are enhancing its natural mechanisms to make it even stronger. This is changing the way we look at medical treatment. Sometimes it is important to stem away from the new advances of drugs and medication and go back to the source, the human body.

Side Effects

CAR-T Therapy is an intensive treatment with risks to match. As the CAR-T cells are released into the body and multiply they cause large amounts of cytokines to be released into the blood. This stimulates a very strong immune response which can lead to very high fevers and extremely low blood pressure. It also can impact neurotoxicity changes in the brain that can cause confusion, swelling, severe headaches and seizures. Ultimately, it is up to the patient and their care team to determine if CAR-T Therapy is best for the patient.

The Numbers

A SINGLE treatment can cost in a range of $375,000 – 475,000. This is NOT including hospital fees, any complications that could arise, medication costs etc. Overall projected costs could be up to 1.5 million dollars for treatment. Unfortunately, this price gouge stems from hospitals’ need for profits due to the high expenses of a single treatment. It is a tragic system to have to pay so much for something you truly cannot control. No one wants to be in this situation and no one especially wants to pay so much for it. But, the healthcare industry has managed to put a price on health and ultimately a price tag on life. In 2019, the Centers For Medicare and Medicaid Services (CMS) began Medicare coverage CAR-T Therapy in healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies (REMS) for FDA-approved indications. CAR-T Therapy is an FDA approved treatment.

I am an introvert at heart with plenty of Netflix to watch and assignments to do. I have enjoyed the relaxation and time for self reflection. I do not need social interaction everyday which has allowed me to be successful in coping with social isolation. During this time I refuse to let myself become bored. Boredom was never allowed when I was growing up, so I have been doing my best to keep myself preoccupied. I began listening to podcasts, reading more, and studying for the PCAT which I hopefully will be taking in July. However with SATs/ACTs, MCATs and other large assessments getting cancelled. I am terrified that I will not be able to take mine, and then not be able to apply for pharmacy school in the Fall. This is one of the many fears I have, but I will remain positive and cross that bridge when I get there.

The most important thing I have been trying to do is stay busy and not let myself get overwhelmed. I cannot dwell on the dangers of COVID-19, but attempt to stay informed by reading the news daily and making myself aware of the conditions in my immediate area. However, the news makes me more frustrated as the government’s initial lack of urgency and their inability to develop and enact a COVID-19 rescue package to financially assist the people of the United States is placing us now in grave danger. My biggest my fear is indirectly spreading COVID-19. This has left me in my apartment for days with minimal trips to the grocery store for essentials. The trips to the store have brought me great anxiety as I intensely wipe the cart down with Clorox wipes and wipe all of the items I purchased. In this time, my philosophy is better to be safe than sorry.

This time has brought every emotion under the sun. From fear, to frustration, to happiness, to sadness, to hope and much more. I am frustrated that people cannot grasp the severity of this. I am happy to spend more time with my family and be able to talk with friends. I am sad that a lot of important life events are getting cancelled for myself and my friends. I am scared of rapid spread of COVID-19. But I am hopeful that this will be over soon. I am hopeful we all will become stronger from this experience. At this point, hope is bringing me strength and peace and that is all I can ask for at this time.

COVID-19 has impacted every possible sector of life. As more hospital beds are filled, more tests are being processed, more research is required, more funds are needed for treatment and research, the teams and people working to battle other diseases are at major risk. Forbes claims TB could be one of the biggest causalities to the adverse affects of routine health services due to COVID-19. Resources have become limited for TB testing, patients are unable to get to health care providers, and funding has diminished for TB research. COVID-19 is taking priority across the globe but how do we balance that treatment to treatment for every other infectious disease impacting our world?

In China and South Korea, laboratory testing for TB was halted or disrupted to process tests for COVID-19. Also hospitals were no longer able to hold patients infected with MDR-TB, even though South Korea requires a 2 week hospitalization for TB. This will not be seen in just these areas, but everywhere in the future. COVID-19 will limit hospital resources such as labs and beds available for other diseases. Keertan Dheda ,a TB, expert hypothesizes that there will be spike in TB incidence due to the delayed diagnosis leading to higher transmission.

This is where anticipation of these consequences comes in handy and health care teams need to understand how COVID-19 can affect TB and have backup plans to be able to help everyone in these times. TB and COVID-19 are both respiratory infections spread through respiratory droplets. TB patients and survivors often have lung damage which can lead them to be more susceptible to COVID-19. Over 95% of cases of TB happen in developing nations. To have their limited TB resources stripped further we are consequently putting more people at risk for COVID-19. We are trying to fight a war, and we are being attacked on all sides. It is up to the health care world to determine which sides to attack back however in health care that is not easy because lives are at risk in all cases. Which is why we as people need to do our part in this war by social distancing, quarantining and self isolation as needed.

This is why prevention is so crucial, we truly do not have the resources to help everyone and someone is going to have to be put on the back burner and this can lead to increased prevalence and even death. This would add to the preventable deaths already being seen in COVID-19 because people refuse to stay home or socially distance themselves. This is having much larger implications because now we are impacting those with health conditions other than TB. TB is curable and the WHO has a Sustainable Development Goal to end the TB epidemic by 2030. So let’s stay on track with that goal and please stay home we only have so many doctors, nurses, labs, hospital beds to treat everyone and every time you leave you possibly add to the number infected. Let us leave the beds for those who need it and not for those who still wanted to hang out with friends and go to the beach.

Doctors in the United Kingdom believe they have cured the 2nd person ever of HIV. Timothy Brown was the first person to be cured occurred 12 years ago in Germany. 40 year old Adam Castillejo was “cured” of HIV as of recent. However doctors claim this “cure” is a long term remission. Mainly because to say a cure has been fully developed is a large claim to make for a disease that impacts millions and it known as “incurable.” There is no guarantee that the remission will persist but doctors have confidence because there is similarities to Brown’s recovery. It is still a milestone nonetheless.

How did they do it?

A commonality between Brown and Castillejo is the both has cancer. The HIV was “cured” through a bone marrow transplant done to treat the cancer. The Bone Marrow donor had a mutation in the CCR5 protein. HIV uses the CCR5 protein to enter into immune cells however the mutation in the CCR5 protein prevents HIV to latching on. Castillejo’s transplant was in May 2016 and he has been off the anti-HIV drugs since September 2017. Him and Brown are the only patients to stay HIV free a year after stopping the drugs.

Is this a cure? Or a commonality?

The two cures had cancer and a bone marrow transplant and were males in common to lead to that result. This is not representative of the living population with HIV which includes men, women, children and the elderly as well as those with varying health and mental conditions. It is presumptuous to claim there is a cure when HIV has only been cured in two males of roughly the same age. However, science is taking large steps to determining a cure for HIV. The commonality has allowed for a new approach to be discovered to provide a widespread cure for HIV. Based off of these findings, China is attempting to use CRISPR a gene editing technology to treated a person with HIV. CRISPR would engineer HIV resistant blood stem cells from normal donors, to make this cure more accessible. They were able to edit 17.8% of the donor’s stem cells. The target cell for mutation is the CCR5 protein to either rid of it or mutate it. Yet through trials the edited stem cells only compromised 5-8% of the recipients total cell’s. This would still help cure cancer but the HIV is still present.

The cure of HIV was an indirect consequence of the cancer treatment. This demonstrates the interconnectedness of diseases and disease treatment. The connection is opening doors for medical treatments and cures for diseases that seemed incurable. It brings light to a new way of medical research and disease study that allows doctors and researchers to use what they know to treat and cure diseases they originally thought they couldn’t.

Current Treatment and Prevention to New Beginnings

HIV treatment is called antiretroviral therapy (ART). The components of ART include taking a combination of HIV medicines everyday. It does not cure HIV but it helps people with HIV live longer and healthier lives and reduces the risk of HIV. There is no vaccine are approved for use outside of clinical trials. Scientists and doctors are working on a vaccine but nothing is in the market yet. The realm of HIV treatment is evolving. The two men who have been cured are giving hope to the millions living with HIV today. Sometimes hope is the best medicine you can give someone. Hope gives a person mental strength and peace to combat any battles they are in. Researchers and doctors are giving people hope and that is sometimes the biggest treatment of them all.

COVID-19 destroyed the Spring Break plans of thousands of college kids around the country including myself. However trips will come and go, but the safety our loved ones is not guaranteed. So how much do college kids value their spring break? Enough that the streets of Miami, Florida were flooded with youth enjoying their spring break. Although they are now upset that bars and beaches are closing and their fun is coming to end. Their mindset of “If I Get Corona, I Get Corona” is not slowing the party. A young adult’s sense of invincibility is one of the most dangerous threats to slowing the spread of COVID-19. This is extremely selfish as it is not essentially us, we should be worried about but spreading the disease unintentionally to our grandparents, the immunocompromised, and even our parents. They say they will wash their hands and be diligent but it is hard to protect yourself from something you cannot even see. It is our vacations we can take again, but stopping the spread of this pandemic is something we need to do right now. As this pandemic becomes more serious, spring breakers fearlessness has aided in the inevitable widespread of COVID-19.

The CDC recommends social distancing to slow the spread of COVID-19. this includes staying home when possible, not crowding at stores, ordering food to go and so much more Yet rarely anyone listened initially. Now the White House is advising the public to avoid groups larger than 10 to slow the pandemic and encourages socially distancing of 6 feet. The government finally taking a strong stance on COVID-19 is finally showing the American people how serious and detrimental the virus is. The people will follow their government and the government’s lack of urgency towards COVID-19 is ultimately why so many students still took their Spring Break trips at the beginning of March. It takes the efforts of all not just a select few to slow a virus down and to stop its spread and the government needs to be the leader of the efforts.

How is COVID-19 Evolving Now?

Scientists in China have found 2 strains of the COVID-19 a highly aggressive (faster spreading) “L” strain prevalent in Wuhan in late 2019 and a less aggressive “S” strain. The frequency of the more aggressive virus has decreased. This drop is because of China’s strict measures and attempts to control the virus. However the strains studied were only taken from China, scientists have yet to determine if the same strains are spreading worldwide. All that is known is that the COVID-19 has been mutating throughout its progression.

The virus is present in all 50 states. The widespread transmission of COVID-19 has had serious consequences not only on those effected but the health care industry, schools, workplaces, mass gatherings and more. Universities and K-12 schools are moving to online instruction and many students are displaced from their university residential housing. This pandemic goes beyond the scope of healthcare but is impacting the fluidity and normalcy of the world. As grocery store shelves are bare, classrooms are empty, restaurants are closing, hospitals and clinics are full and life as we know it is no longer the same.