Pubblicato in: Medicina e Biologia, Unione Europea

Ecdc. Coronavirus. Situazione aggiornata al 4 aprile.

Giuseppe Sandro Mela

2020-04-04.

2020-04-04__Covid 001

European Centre for Disease Prevention and Control. An agency of the European Union.

Situation update for the EU/EEA and the UK, as of 4 April 2020.

The data presented on this page has been collected between 6:00 and 10:00 CET.

As of 04 April 2020, 517 443 cases have been reported in the EU/EEA and the UK: Italy (119 827), Spain (117 710), Germany (79 696), France (64 338), United Kingdom (38 168), Belgium (16 770), Netherlands (15 723), Austria (11 525), Portugal (9 886), Sweden (6 078), Norway (5 208), Ireland (4 273), Czech Republic (4 190), Denmark (3 757), Poland (3 383), Romania (3 183), Luxembourg (2 612), Finland (1 615), Greece (1 613), Iceland (1 364), Croatia (1 079), Estonia (961), Slovenia (934), Lithuania (771), Hungary (678), Latvia (493), Bulgaria (485), Slovakia (450), Cyprus (396), Malta (202) and Liechtenstein (75).

As of 04 April 2020, 40 903 deaths have been reported in the EU/EEA and the UK: Italy (14 681), Spain (10 935), France (6 507), United Kingdom (3 605), Netherlands (1 487), Belgium (1 143), Germany (1 017), Sweden (333), Portugal (246), Austria (168), Denmark (139), Romania (133), Ireland (120), Poland (71), Greece (59), Czech Republic (53), Norway (44), Hungary (32), Luxembourg (31), Finland (20), Slovenia (20), Bulgaria (14), Estonia (12), Cyprus (11), Lithuania (9), Croatia (8), Iceland (4) and Latvia (1).

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Due elementi da valorizzare:

– con 117,710 casi la Spagna ha quasi raggiunto l’Italia, 119,827 contagiati;

– oggi si assiste ad un altro picco dei contagi. Questa è una ulteriore evidenza di quanta prudenza debba essere usata nell’inferire che si sia raggiunto il picco massimo e sia iniziata la fase di discesa.

Pubblicato in: Devoluzione socialismo, Medicina e Biologia, Problemia Energetici

Coronavirus. La crisi spinge il carbon fossile.

Giuseppe Sandro Mela.

2020-04-04.

Carbone Miniera 001

«The COVID-19 pandemic has shaken energy markets to the core this year, creating incredible volatility for fuel prices»

«The one energy source that hasn’t blinked though is coal, a fuel that may come out stronger through the current crisis»

«The price of coal was already depressed before the corona virus crisis, and the demand curtailment in China during the lockdowns was accompanied by a domestic production drop, balancing the market»

«With ARA prices already so low, any cost decrease will potentially give struggling producers selling to Europe a little breathing room, rather than allowing prices to move down any further»

«The large falls in the currency of the major coal exporting countries like Australia and Russia is a significant, but often overlooked factor with regards to coal prices and margins»

«International coal trades are priced in US dollars, whereas the majority of production costs are generally denominated in local currency terms»

«Therefore, a weaker exchange rate versus the US dollar usually means higher local currency revenues (or lower costs when converted to US dollars)»

* * * * * * *

Romania. Il Green Deal è una ‘true religion’. Il gesto del dito.

La depressione economica indotta dal coronavirus e lo shock petrolifero, unitamente a dollaro forte e valute dei paesi estrattori deboli, spingono verso un maggiore utilizzo del carbone fossile.

A parte ancora qualche cascame politico nell’Unione Europea, i progetti di decarbonizzazione stanno evidenziano il loro punto debole: costi troppo alti per potersi permettere quel lusso, in un momento in cui tutte le risorse sono utilizzate per cercare di bloccare gli effetti della pandemia.

Tutti questi elementi concorrono a formulare la previsione che, quanto meno, la sua produzione e costi resteranno quasi inalterati, ma anche probabilmente incrementati per sopperire le esigenze energetiche.

Il mondo non è l’Unione Europea.

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Oil Price. Foreign Coal Producers Get Boost From Coronavirus.

The COVID-19 pandemic has shaken energy markets to the core this year, creating incredible volatility for fuel prices. The one energy source that hasn’t blinked though is coal, a fuel that may come out stronger through the current crisis, a Rystad Energy analysis shows.

The price of coal was already depressed before the corona virus crisis, and the demand curtailment in China during the lockdowns was accompanied by a domestic production drop, balancing the market. Oil, which is used as a fuel in coal mining, has grown cheaper and is seen by Rystad Energy as reducing coal output costs by a few dollars per ton.

“With ARA prices already so low, any cost decrease will potentially give struggling producers selling to Europe a little breathing room, rather than allowing prices to move down any further,” says Steve Hulton, Rystad Energy’s Head of Global coal research.

The large falls in the currency of the major coal exporting countries like Australia and Russia is a significant, but often overlooked factor with regards to coal prices and margins. In mid-March, the Australian dollar hit a 17-year low as international investors sought the traditional safety of US dollars; the Russian ruble has also reached new record lows due to the collapsing oil price.

International coal trades are priced in US dollars, whereas the majority of production costs are generally denominated in local currency terms. Therefore, a weaker exchange rate versus the US dollar usually means higher local currency revenues (or lower costs when converted to US dollars).

Pubblicato in: Medicina e Biologia, Unione Europea

Ecdc. Coronavirus. Situazione aggiornata al 3 aprile.

Giuseppe Sandro Mela.

2020-04-03.

2020-04-03__Ecdc 001

Oggi 3 aprile sembrerebbe esserci stato un qualche miglioramento.

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ECDC. Situation update for the EU/EEA and the UK, as of 3 April 2020.

The data presented on this page has been collected between 6:00 and 10:00 CET.

As of 03 April 2020, 482 016 cases have been reported in the EU/EEA and the UK: Italy (115 242), Spain (110 238), Germany (73 522), France (59 105), United Kingdom (33 718), Belgium (15 348), Netherlands (14 697), Austria (11 129), Portugal (9 034), Sweden (5 466), Norway (4 935), Czech Republic (3 858), Ireland (3 849), Denmark (3 386), Poland (2 946), Romania (2 738), Luxembourg (2 487), Finland (1 518), Greece (1 514), Iceland (1 319), Croatia (1 011), Slovenia (897), Estonia (858), Lithuania (649), Hungary (585), Latvia (458), Bulgaria (457), Slovakia (426), Cyprus (356), Malta (195) and Liechtenstein (75).

As of 03 April 2020, 35 862 deaths have been reported in the EU/EEA and the UK: Italy (13 917), Spain (10 003), France (4 503), United Kingdom (2 921), Netherlands (1 339), Belgium (1 011), Germany (872), Sweden (282), Portugal (209), Austria (158), Denmark (123), Ireland (98), Romania (94), Poland (57), Greece (53), Czech Republic (44), Norway (42), Luxembourg (30), Hungary (21), Finland (19), Slovenia (16), Estonia (11), Bulgaria (10), Cyprus (9), Lithuania (9), Croatia (7) and Iceland (4).

Pubblicato in: Devoluzione socialismo, Medicina e Biologia, Unione Europea

Sinistre europee. ‘No better time to go green’. Green è la panacea.

Giuseppe Sandro Mela.

2020-04-03.

Animali_che_Ridono__006_Muli

Occorre dare atto ai liberal socialisti di non deflettere di un micron dalla loro ideologia.

Se il coronavirus contraddice l’ideologia liberal, tanto peggio per il coronavirus.

«For European governments battling to brace economies pummeled by the coronavirus, there might be no better time to go green.»

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«As Europe fights coronavirus and climate, is ‘green stimulus’ the way?»

«For European governments battling to brace economies pummeled by the coronavirus, there might be no better time to go green.»

«Many also face the challenge of ploughing billions of euros into climate schemes to keep carbon reduction pledges.»

«For budget hawks preparing to throw out the traditional fiscal rule book to fight the pandemic, green bonds – raising debt for funding projects such as renewable energy and public transport – might be a palatable option»

«Britain, meanwhile, has promised to pay 80% of wages for employees facing layoffs as a result of lockdown measures, to be funded by selling more debt»

«The rationale for green gilts is to target projects which actively contribute to the aspiration to bring greenhouse gas emissions to net zero by 2050»

«Those projects should be part of green infrastructure spending and associated with fiscal stimulus»

* * * * * * *

Riassumendo il pensiero liberal, è inutile spendere un sacco di soldi per combattere il coronavirus e per cercare di risollevare i sistemi economici vulnerati: si investa nel green e tutto andrà per il meglio.

Si potrebbe dire che questo sia la panacea contro la pandemia.

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Reuters. As Europe fights coronavirus and climate, is ‘green stimulus’ the way?

For European governments battling to brace economies pummeled by the coronavirus, there might be no better time to go green.

Normally thrifty countries, such as Germany, accept they will have to spend heavily to weather the economic shock of the coronavirus. Many also face the challenge of ploughing billions of euros into climate schemes to keep carbon reduction pledges.

Could “green stimulus” be the answer?

For budget hawks preparing to throw out the traditional fiscal rule book to fight the pandemic, green bonds – raising debt for funding projects such as renewable energy and public transport – might be a palatable option.

Coronavirus has taken some focus away from environmental issues but pressure is now mounting to design spending around climate change. On Tuesday, UK government adviser Chris Stark urged governments to “look to green stimulus”.

Germany is pulling out the stops, eyeing around 350 billion euros of new debt to finance stimulus. Europe’s biggest economy separately aims to cut greenhouse gas emissions to 55% of 1990 levels by 2030.

Britain, meanwhile, has promised to pay 80% of wages for employees facing layoffs as a result of lockdown measures, to be funded by selling more debt. It has also previously pledged to bring carbon emissions to almost zero by 2050.

Simon Bond, director of responsible investment portfolio management at London-based Columbia Threadneedle, wrote last year to the UK Treasury urging it to issue “green gilts”.

He said now was the time to roll them out given the pressing need for stimulus due to the virus outbreak.

“The rationale for green gilts is to target projects which actively contribute to the aspiration to bring greenhouse gas emissions to net zero by 2050,” Bond told Reuters. “Those projects should be part of green infrastructure spending and associated with fiscal stimulus.”

GREEN YIELD CURVE

So far governments have been relatively slow to embrace green debt; there are just 12 sovereign green bond issuers worldwide, amounting to less than a tenth of the green bond market, which also includes debt from companies and other entities and saw $250 billion in new issuances last year.

But debt agencies say change is on its way.

Germany plans to issue a green bond in the second half of 2020 as does Italy; other candidates are Spain, Sweden, Denmark and Britain.

Germany’s debt agency told Reuters its green bond plans would go ahead despite the coronavirus outbreak. It has just published an update, announcing Germany would “substantially strengthen and decisively develop” the green and sustainable investment market.

It also hopes to establish a green yield curve for the euro area, as its chart below shows.

‘GREEN AGENDA GROWING’

Green bonds currently comprise less than 0.1% of total sovereign debt, according to S&P Global. Given governments have some $9 trillion of outstanding debt worldwide, going green on even a small portion of that would give the market a huge boost.

What’s held them back so far is fear that green bonds will damage mainstream issuance programs by stealing trading volumes from those markets, eventually raising overall borrowing costs, officials from five European debt agencies told Reuters.

It could also further fragment a market already thinned out by the European Central Bank’s asset purchase program.

Even in Britain, home to a $2 trillion gilt market, debt agency chief, Robert Stheeman, has expressed doubts that issuing green gilts would be cost effective.

But debt agencies have come up with strategies that could allow green borrowing without the associated risks.

Denmark is considering an issue whose proceeds may not be earmarked directly for environmental projects but would come with a pledge for equivalent green spending, said Thorsten Meyer Larsen, head of monetary policy operations and government debt at Denmark’s central bank.

Under this idea, it would attach a green certificate to a standard government bond.

“Everyone can see that the green agenda is growing and we want to be part of that, but not in a way that’s detrimental to our existing bonds and bondholders,” Meyer Larsen said.

“So if you buy that (equivalent spending) idea then that’s a bit more straightforward.”

INVESTMENT CLAMOR

Germany is, meanwhile, exploring an option to sell twin bonds: so a green issue with the same maturity and coupon as its conventional peer and replacing part of the conventional bond’s auction volume, according to a market participant with knowledge of the country’s plans.

The person said that during a crisis, perhaps like the ongoing volatility, investors could switch from the green bond to the conventional issue, which would have better trading volumes.

Liquidity tends to be less concerning for companies as they rely less on bond markets for their funding, said Geraint Thomas, EMEA head of green loans and bonds at MUFG.

But concerns of green bond programs boosting borrowing costs may be unfounded, according to some analysts and investors.

The investment industry is clamoring for green securities, as pension funds, sovereign investors or family offices request more environmentally friendly securities. Demand for top-rated sovereign names is likely to be high.

Bram Bos, lead portfolio manager of green bond strategy at NN Investment Partners, also expects the stimulus programs to bring more governments to the market, raising its size.

“More green expenditure could lead to more green bond issuance and less concerns around liquidity of green bonds.”

Pubblicato in: Medicina e Biologia

Pandemia Covid-19. Principali studi clinici in essere sul Tocilizumab.

Giuseppe Sandro Mela.

2020-04-03.

2020-04-02__Tocilizumab 001

Sono numerosi i report informali di casi di pazienti infetti da Covid-19 che sarebbero stati trattati con beneficio utilizzando il Tocilizumab, un farmaco anti-artritico. Da queste comunicazioni orali, spesso rilasciate alla stampa, sembrerebbe che il Tocilizumab dimostri una certa quale efficacia nelle fasi iniziali della malattia.

Nei giorni scorsi la Fda, Food & Drug Administration, ha autorizzato uno studio di ampie dimensioni per verificare queste prime impressioni. I risultati potrebbero essere disponibili per fine aprile o metà maggio.

Vi sono inoltre altri studi in essere sempre su tale molecola.

A seguito riportiamo alcune citazioni per facilitare un approfondimento del tema.

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Roche. Roche initiates Phase III clinical trial of Actemra/RoActemra in hospitalised patients with severe COVID-19 pneumonia.

«Basel, 19 March 2020- Roche (SIX: RO, ROG; OTCQX: RHHBY) today announced  we are working with the Food & Drug Administration (FDA) to initiate a randomised, double-blind, placebo-controlled Phase III clinical trial in collaboration with the Biomedical Advanced Research and Development Authority (BARDA), a part of the US Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR), to evaluate the safety and efficacy of Actemra®/RoActemra® (tocilizumab) plus standard of care in hospitalised adult patients with severe COVID-19 pneumonia compared to placebo plus standard of care.

This is the first global study of Actemra/RoActemra in this setting and is expected to begin enrolling as soon as possible in early April with a target of approximately 330 patients globally, including the US. The primary and secondary endpoints include clinical status, mortality, mechanical ventilation and intensive care unit (ICU) variables.»

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Cancer Network. Journal Oncology. FDA Approves Phase III Clinical Trial of Tocilizumab for COVID-19 Pneumonia

«The FDA has approved a randomized, double-blind, placebo-controlled phase III clinical trial to evaluate the safety and efficacy of intravenous (IV) tocilizumab (Actemra) plus standard of care in hospitalized adult patients with severe coronavirus disease 2019 (COVID-19) pneumonia, according to Genentech, the agent’s developer.

The clinical trial, called COVACTA, is being conducted in collaboration with the Biomedical Advanced Research and Development Authority (BARDA) to evaluate tocilizumab combined with standard of care versus placebo plus standard of care.

Genentech has also indicated that they will provide 10,000 vials of tocilizumab to the US Strategic National Stockpile for future use at the direction of the US Department of Health and Human Services to further support the COVID-19 response efforts.

“We thank the FDA for rapidly expediting the approval of this clinical trial to evaluate Actemra in critically ill patients suffering from pneumonia following coronavirus infection and we’re moving forward to enroll as quickly as possible,” Alexander Hardy, chief executive officer of Genentech, said in a press release. “Conducting this clinical trial in partnership with BARDA and providing Actemra to support the national stockpile, through the efforts of Secretary Azar and HHS, are important examples of how the US government, the biotechnology industry, and healthcare communities are working together in response to this public health crisis.”

According to Genentech, COVACTA is the first global trial in this setting. Enrollment is anticipated to start as early as April 2020, with a target accrual of 330 patients across the US and other countries. 

The primary and secondary endpoints of the phase III study include clinical status, mortality, mechanical ventilation, and intensive care unit (ICU) variables.»

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Aifa. Protocol Title: “Multicenter study on the efficacy and tolerability of tocilizumab in the treatment of patients with COVID-19 pneumonia”

«Pneumonia is the most frequent and serious complication of COVID-19, a disease that results from SARS-CoV-2 infection. In particular, SARS-CoV-2 infection induces an excessive and aberrant host immune response that is associated with an acute respiratory distress syndrome, with typical radiological findings and, in most critical patients, with a so-called “cytokine storm”, characterized by the plasma increase of many cytokines that produce long-term damage and fibrosis of lung tissue. ….

Tocilizumab is indicated for the treatment of severe rheumatoid arthritis, systemic juvenile idiopathic arthritis, juvenile idiopathic polyarthritis and for the treatment of the severe or life threatening cytokine release syndrome (CRS)induced by the chimeric antigen receptor T-cell (CAR-T) in adults and pediatric patients 2 years of age or older.In an experience disclosed by Chinese researchers (Xiaoling Xu1, Mingfeng Han, Tiantian Li et al. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. ChinaXiv: 202003.00026v1) 21 patients with severe or critical COVID-19pneumonia were treated with tocilizumab 400 mg iv (i.e. the expected dose for the treatment of CRS) with reduction of oxygen requirement (15/20), resolution of CT lesions (19/21), normalization of lymphocyte count (10/19), reduction of C-reactive protein levels (16/19), hospital discharge (19/21) with an average hospitalization duration of 13.5 days. These results are considered by the Chinese authors to be very positive and rised to the design of a randomized trial (tocilizumab vs control) which will include approximately 190 patients and is expected to reach the planned accrual by mid-May 2020.»

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Clinical Trials. Tocilizumab in COVID-19 Pneumonia (TOCIVID-19) (TOCIVID-19)

«Phase 2 study: this is a multicenter, single-arm, open-label, phase 2 study. All the patients enrolled are treated with tocilizumab. One-month mortality rate is the primary endpoint.

Observational cohort study: patients who are not eligible for the phase 2 study because: (a) emergency conditions or infrastructural or operational limits prevented registration before the administration of the experimental drug or (b) they had been intubated more than 48 hours before registration. The same information planned for the phase 2 cohort is in principle required also for the observational cohort study. The sample size of the observational study is not defined a priori and the cohort will close at the end of the overall project.

In both study groups (phase 2 and observational study), participants will receive two doses of Tocilizumab 8 mg/kg (up to a maximum of 800mg per dose), with an interval of 12 hours.

330 participants. Single Group Assignment. This is a multicenter, single-arm, open-label, phase 2 study. All the patients enrolled are treated with tocilizumab»

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Thailand Medical News. Covid-19 Drug Research: Tocilizumab (Actemra) By Roche Emerging As The Best Drug Candidate For Treating Covid-19 So Far While Others Are Simply Misleading

«The global medical industry has in the past months evolved into a ‘Wild Wild West’ or ‘circus’ with more unprecedented and unprofessional medical practices being conducted as a result of the Covid-19 crisis. Experimental drugs that have not been properly evaluated are being adopted as main treatment protocols in certain countries merely based on certain none properly clinically studied recommendations by China. To a certain extent it is also being suspected that China has not been properly forthcoming and that a lot of data and research studies that were being supplied had been ‘adulterated’ to suit their commercial needs and diplomatic superiority.

For instant, take Avigan or Favipiravir, an antiviral drug that was developed to treat influenza by Toyoma Chemicals in Japan. It was never fully embraced by the medical community due to its known  teratogenicity and embryotoxicity effects and although there were many more better suited antivirals to test, use and assess, China quickly adopted Favipiravir despite no proper supporting studies or real formal clinical trial evaluations simply because it could procur a generic licence for the drug and also control raw material supplies to the main Japanese company, indirectly totally controlling the drug supply and using it as a diplomatic and commercial  leverage tool. It influenced preprint studies and then gave away small amounts (between 1000 to 5000 doses) to desperate countries as a ‘goodwill’ while negotiating deals with foreign governments for further orders. It was speculated that in certain corrupted governments, kick-backs were also assured for such massive orders using tax payers’ monies.»

Pubblicato in: Medicina e Biologia, Unione Europea

ECDC. Europa. Coronavirus. Situazione al 2 aprile.

Giuseppe Sandro Mela.

2020-04-02.

2020-04-02__Covid 19 curva 001

Lo European Centre for Disease Prevention and Control ha rilasciato i dati epidemiologici aggiornati a tutto il 2 aprile.

Si noti come il picco degli ultimi due giorni si stia consolidando.

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European Centre for Disease Prevention and Control. An agency of the European Union.

The data presented on this page has been collected between 6:00 and 10:00 CET.

As of 02 April 2020, 455 901 cases have been reported in the EU/EEA and the UK: Italy (110 574), Spain (102 136), Germany (73 522), France (56 989), United Kingdom (29 474), Belgium (13 964), Netherlands (13 614), Austria (10 711), Portugal (8 251), Sweden (4 947), Norway (4 665), Czech Republic (3 589), Ireland (3 447), Denmark (3 107), Poland (2 554), Romania (2 460), Luxembourg (2 319), Finland (1 446), Greece (1 375), Iceland (1 220), Croatia (963), Slovenia (841), Estonia (779), Lithuania (581), Hungary (525), Latvia (446), Bulgaria (422), Slovakia (400), Cyprus (320), Malta (188) and Liechtenstein (72).

As of 02 April 2020, 32 778 deaths have been reported in the EU/EEA and the UK: Italy (13 157), Spain (9 053), France (4 032), United Kingdom (2 532), Netherlands (1 173), Germany (872), Belgium (828), Sweden (239), Portugal (187), Austria (146), Denmark (104), Ireland (85), Romania (85), Greece (50), Poland (43), Czech Republic (39), Norway (32), Luxembourg (29), Hungary (20), Finland (17), Slovenia (15), Bulgaria (10), Cyprus (9), Lithuania (8), Croatia (6), Estonia (5) and Iceland (2).

Pubblicato in: Medicina e Biologia

WHO lancia quattro trial clinici di grandi dimensioni. – Science.

Giuseppe Sandro Mela.

2020-04-02.

2020-03-30__Science 001

La pandemia da Covid-19 è caratterizzata dal fatto che non si dispone di un vaccino di comprovata efficacia né si hanno a disposizione farmaci la efficienza dei quali sia comprovata da dati inoppugnabili.

Non solo.

La quasi totalità dei farmaci provati a mo’ di tentativo presentano tutti effetti collaterali anche molto severi, la gravità dei quali controindica il loro uso, che peraltro al momento sembrerebbe essere di ben misera portata.

«On Friday, the World Health Organization (WHO) announced a large global trial, called SOLIDARITY, to find out whether any can treat infections with the new coronavirus for the dangerous respiratory disease»

«It’s an unprecedented effort—an all-out, coordinated push to collect robust scientific data rapidly during a pandemic»

«The study, which could include many thousands of patients in dozens of countries, has been designed to be as simple as possible so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate»

* * * * * * *

Lo studio prende in considerazione quattro trattamenti:

– Remdesivir

– Chloroquine, hydroxychloroquine

– Lopinavir-ritonavir

– Ritonavir/lopinavir and interferon-beta

* * * * * * *

I risultati sono attesi tra due mesi circa.

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Kai Kupferschmidt, Jon Cohen. WHO launches global megatrial of the four most promising coronavirus treatments. Science.

A drug combo already used against HIV. A malaria treatment first tested during World War II. A new antiviral whose promise against Ebola fizzled last year.

Could any of these drugs hold the key to saving coronavirus disease 2019 (COVID-19) patients from serious harm or death? On Friday, the World Health Organization (WHO) announced a large global trial, called SOLIDARITY, to find out whether any can treat infections with the new coronavirus for the dangerous respiratory disease. It’s an unprecedented effort—an all-out, coordinated push to collect robust scientific data rapidly during a pandemic. The study, which could include many thousands of patients in dozens of countries, has been designed to be as simple as possible so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate.

With about 15% of COVID-19 patients suffering from severe disease and hospitals being overwhelmed, treatments are desperately needed. So rather than coming up with compounds from scratch that may take years to develop and test, researchers and public health agencies are looking to repurpose drugs already approved for other diseases and known to be largely safe. They’re also looking at unapproved drugs that have performed well in animal studies with the other two deadly coronaviruses, which cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Drugs that slow or kill the novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could save the lives of severely ill patients, but might also be given prophylactically to protect health care workers and others at high risk of infection. Treatments may also reduce the time patients spend in intensive care units, freeing critical hospital beds.

Scientists have suggested dozens of existing compounds for testing, but WHO is focusing on what it says are the four most promising therapies: an experimental antiviral compound called remdesivir; the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir; and that same combination plus interferon-beta, an immune system messenger that can help cripple viruses. Some data on their use in COVID-19 patients have already emerged—the HIV combo failed in a small study in China—but WHO believes a large trial with a greater variety of patients is warranted.

Enrolling subjects in SOLIDARITY will be easy. When a person with a confirmed case of COVID-19 is deemed eligible, the physician can enter the patient’s data into a WHO website, including any underlying condition that could change the course of the disease, such as diabetes or HIV infection. The participant has to sign an informed consent form that is scanned and sent to WHO electronically. After the physician states which drugs are available at his or her hospital, the website will randomize the patient to one of the drugs available or to the local standard care for COVID-19.

“After that, no more measurements or documentation are required,” says Ana Maria Henao Restrepo, a medical officer at WHO’s Emergencies Programme. Physicians will record the day the patient left the hospital or died, the duration of the hospital stay, and whether the patient required oxygen or ventilation, she says. “That’s all.”

The design is not double-blind, the gold standard in medical research, so there could be placebo effects from patients knowing they received a candidate drug. But WHO says it had to balance scientific rigor against speed. The idea for SOLIDARITY came up less than 2 weeks ago, Henao Restrepo says, and the agency hopes to have supporting documentation and data management centers set up next week. “We are doing this in record time,” she says.

Arthur Caplan, a bioethicist at New York University Langone Medical Center, says he likes the study’s design. “No one wants to tax the frontline caregiver who’s overwhelmed and taking risks anyway,” Caplan says. Hospitals that aren’t overburdened might be able to record more data on disease progression, for instance by following the level of virus in the body, Caplan suggests. But for public health, the simple outcomes WHO seeks to measure are the only relevant ones for now, says virologist Christian Drosten of the Charité University Hospital in Berlin: “We don’t really know enough about this disease to be sure what it means when the viral load decreases in the throat, for instance.”

On Sunday, INSERM, the French biomedical research agency, announced it will coordinate an add-on trial in Europe, named Discovery, that will follow WHO’s example and will include 3200 patients from at least seven countries, including 800 from France. That trial will test the same drugs, with the exception of chloroquine. Other countries or groups of hospitals could organize add-on studies as well, Heneo-Restrepo says. They are free to do additional measurements or observations, for instance on virology, blood gases, chemistry, and lung imaging. “While well-organized additional research studies of the natural history of the disease or of the effects of the trial treatments could well be valuable, they are not core requirements,” she says.

The list of drugs to test was first put together for WHO by a panel of scientists who have been assessing the evidence for candidate therapies since January, Heneo-Restrepo says. The group of selected drugs that had the highest likelihood of working, had the most safety data from previous use, and are likely to be available in supplies sufficient to treat substantial numbers of patients if the trial shows they work.

Here are the treatments that SOLIDARITY will test:

Remdesivir

The new coronavirus is giving this compound a second chance to shine. Originally developed by Gilead Sciences to combat Ebola and related viruses, remdesivir shuts down viral replication by inhibiting a key viral enzyme, the RNA-dependent RNA polymerase.

Researchers tested remdesivir last year during the Ebola outbreak in the Democratic Republic of the Congo, along with three other treatments. It did not show any effect. (Two others did.) But the enzyme it targets is similar in other viruses, and in 2017 researchers at the University of North Carolina, Chapel Hill, showed in test tube and animal studies that the drug can inhibit the coronaviruses that cause SARS and MERS.

The first COVID-19 patient diagnosed in the United States—a young man in Snohomish county in Washington—was given remdesivir when his condition worsened; he improved the next day, according to a case report in The New England Journal of Medicine (NEJM). A Californian patient who received remdesivir—and who doctors thought might not survive—recovered as well.

Such evidence from individual cases doesn’t prove a drug is safe and effective. Still, from the drugs in the SOLIDARITY trial, “remdesivir has the best potential to be used in clinics” says Jiang Shibo of Fudan University, who has long worked on coronavirus therapeutics. Jiang particularly likes that high doses of the drug can likely be given without causing toxicities.

However, it may be much more potent if given early in an infection, like most other drugs, says Stanley Perlman, a coronavirus researcher at the University of Iowa. “What you really want to do is give a drug like that to people who walk in with mild symptoms,” he says. “And you can’t do that because it’s an [intravenous] drug, it’s expensive and 85 out of 100 people don’t need it.”

Chloroquine and hydroxychloroquine

At a press conference on Friday, President Donald Trump called chloroquine and hydroxychloroquine a “game changer.” “I feel good about it,” Trump said. His remarks have led to a rush in demand for the decades-old antimalarials. (“It reminds me a little bit of the toilet paper phenomenon and everybody’s running to the store,” Caplan says.)

The WHO scientific panel designing SOLIDARITY had originally decided to leave the duo out of the trial, but had a change of heart at a meeting in Geneva on 13 March, because the drugs “received significant attention” in many countries, according to the report of a WHO working group that looked into the drugs’ potential. The widespread interested prompted “the need to examine emerging evidence to inform a decision on its potential role.”

The available data are thin. The drugs work by decreasing the acidity in endosomes, compartments inside cells that they use to ingest outside material and that some viruses can coopt to enter a cell. But the main entryway for SARS-CoV-2 is a different one, using its so-called spike protein to attach to a receptor on the surface of human cells. Studies in cell culture have suggested chloroquines have some activity against SARS-CoV-2, but the doses needed are usually high—and could cause serious toxicities.

Encouraging cell study results with chloroquines against two other viral diseases, dengue and chikungunya, didn’t pan out in people in randomized clinical trials. And nonhuman primates infected with chikungunya did worse when given chloroquine. “Researchers have tried this drug on virus after virus, and it never works out in humans. The dose needed is just too high,” says Susanne Herold, an expert on pulmonary infections at the University of Giessen.

Results from COVID-19 patients are murky. Chinese researchers who report treating more than 100 patients with chloroquine touted its benefits in a  letter in BioScience, but the data underlying the claim have not been published. All in all, more than 20 COVID-19 studies in China used chloroquine or hydroxychloroquine, WHO notes, but their results have been hard to come by. “WHO is engaging with Chinese colleagues at the mission in Geneva and have received assurances of improved collaboration; however, no data has been shared regarding the chloroquine studies.”

Researchers in France have published a study in which they treated 20 COVID-19 patients with hydroxychloroquine. They concluded that the drug significantly reduced viral load in nasal swabs. But it was not a randomized controlled trial and it didn’t report clinical outcomes such as deaths. In guidance published on Friday, the U.S. Society of Critical Care Medicine said “there is insufficient evidence to issue a recommendation on the use of chloroquine or hydroxychloroquine in critically ill adults with COVID-19.”

Hydroxychloroquine, in particular, might do more harm than good. The drug has a variety of side effects and can in rare cases harm the heart. Because people with heart conditions are at higher risk of severe COVID-19, that is a concern, says David Smith, an infectious disease physician at the University of California, San Diego. “This is a warning signal, but we still need to do the trial,” he says. What’s more, a rush to use the drug for COVID-19 might make it harder for the people who need it to treat their rheumatoid arthritis or malaria.

Ritonavir/lopinavir

This combination drug, sold under the brand name Kaletra, was approved in the United States in 2000 to treat HIV infections. Abbott Laboratories developed lopinavir specifically to inhibit the protease of HIV, an important enzyme that cleaves a long protein chain into peptides during the assembly of new viruses. Because lopinavir is quickly broken down in the human body by our own proteases, it is given with low levels of ritonavir, another protease inhibitor, that lets lopinavir persist longer.

The combination can inhibit the protease of other viruses as well, specifically coronaviruses. It has shown efficacy in marmosets infected with the MERS virus, and has also been tested in SARS and MERS patients, though results from those trials are ambiguous.

The first trial with COVD-19 was not encouraging, however. Doctors in Wuhan, China, gave 199 patients two pills of lopinavir/ritonavir twice a day plus standard care, or standard care alone. There was no significant difference between the groups, they reported in NEJM on 15 March. But the authors caution that patients were very ill—more than one-fifth of them died—and so the treatment may have been given too late to help. Although the drug is generally safe it may interact with drugs usually given to severely ill patients, and doctors have warned it could cause significant liver damage.

Ritonavir/lopinavir and interferon-beta

SOLIDARITY will also have an arm that combines the two antivirals with interferon-beta, a molecule involved in regulating inflammation in the body that has also shown an effect in marmosets infected with MERS. A combination of the three drugs is now being tested in MERS patients in Saudi Arabia in the first randomized controlled trial for that disease.

But the use of interferon-beta on patients with severe COVID-19 might be risky, Herold says. “If it is given late in the disease it could easily lead to worse tissue damage instead of helping patients,” she cautions.

Thousands of patients

The design of the SOLIDARITY trial can change at any time. A global data safety monitoring board will look at interim results at regular intervals and decide whether any member of the quartet has a clear effect, or whether one can be dropped because it clearly does not. Several other drugs, including the influenza drug favipiravir, produced by Japan’s Toyama Chemical, may be added to the trial.

To get robust results from the study, several thousands of patients will likely have to be recruited, Henao Restrepo says. Argentina, Iran, South Africa, and several other non-European countries have already signed up. WHO is also hoping to do a prevention trial to test drugs that might protect health care workers from infection, using the same basic protocol, Henao Restrepo says.

The trial’s European counterpart, Discovery, will recruit patients from France, Spain, the United Kingdom, Germany, and the Benelux countries, according to an INSERM press release today. The trial will be led Florence Ader, an infectious diseases researcher at the University Hospital Center in Lyon.

Doing rigorous clinical research during an outbreak is always a challenge, Henao Restrepo says, but it’s the best way to make headway against the virus: “It will be important to get answers quickly, to try to find out what works and what doesn’t work. We think that randomized evidence is the best way to do that.”

Pubblicato in: Devoluzione socialismo, Medicina e Biologia, Unione Europea

Francia. Picco si avvicina. 241 gerontocomi colpiti dai contagi.

Giuseppe Sandro Mela.

2020-04-02.

2020-03-31__Francia Coronavirus 001

L’epidemia da Covid-19 sta sviluppandosi in Francia, sfasata di circa un mese dall’Italia. Pur non avendo preso misure contenitive severe, la popolazione inizia a percepire il coronavirus come un pericolo incombente, ed iniziano a notarsi i primi segnali di una diffusa paura.

Gli ospedali hanno bloccato interventi e ricoveri di elezione, restando disponibili quasi esclusivamente per i trattamenti degli infetti da Covid-19. Università e scuola sono chiuse in gran parte degli stati della Francia.

* * * * * * *

«La morte della sedicenne Julie scuote il Paese dove il numero di contagi e morti cresce rapidamente»

«In Francia, che attende per la prossima settimana “un’ondata estremamente alta” di casi di Covid-19, la situazione sanitaria si sta rapidamente deteriorando e il governo a prorogare il confinamento fino al 15 aprile»

«E si susseguono dichiarazioni allarmiste di responsabili degli ospedali dell’Ile de France e del premier Edouard Philippe, in un clima di crescenti tensioni sociali per la morte di due lavoratori e la mancanza di protezioni adeguate»

«Nelle prossime 24-48 ore la capacità di accoglienza degli ospedali dell’hinterland parigino arriverà a saturazione, riproponendo lo stesso scenario del Grande Est, dove la sanità è già al collasso»

«un’ondata estremamente alta dilagherà sulla Francia. La situazione sarà molto difficile nei prossimi giorni»

«la crisi durerà nel tempo e la situazione sanitaria non migliorerà rapidamente»

«La Francia non ha ancora raggiunto il picco dei contagi ma l’epidemia ha già causato 1.995 vittime e 32.964 contagi, dei quali 3.787 sono in terapia intensiva in gravi condizioni»

«Nell’Ile de France i “numeri sono vertiginosi” ha avvertito l’Agenzia della salute regionale (Ars), con un bilancio di 1.300 pazienti in rianimazione e almeno 241 case di cure per anziani (Ehpad) già colpite dall’epidemia di nuovo coronavirus»

* * * * * * *

La Francia registra solo i deceduti in ospedale. Mattanza nei gerontocomi.

In Francia sono ad oggi registrati 37,575 contagi, 29,561 dei quali in fase attiva, con 2,314 morti e 5,700 guariti.

«almeno 241 case di cure per anziani (Ehpad) già colpite dall’epidemia di nuovo coronavirus»

Il dato relativo ai gerontocomi è impressionante: in molti di essi i provvedimenti restrittivi sono stati del tutto insufficienti. Eppure gli anziani ricoverati, oltre ai problemi legati all’età, sono tutti portatori di gravi patologie organiche, fatto questo che li rende particolarmente vulnerabili al contagio.

*


La Francia in trincea attende l’ondata “estremamente alta”.

La morte della sedicenne Julie scuote il Paese dove il numero di contagi e morti cresce rapidamente. Nelle prossime 24-48 ore la capacità di accoglienza degli ospedali dell’hinterland parigino arriverà a saturazione.

In Francia, che attende per la prossima settimana “un’ondata estremamente alta” di casi di Covid-19, la situazione sanitaria si sta rapidamente deteriorando e il governo a prorogare il confinamento fino al 15 aprile. Intanto il Paese è scosso dalla morte di Julie, appena 16enne, la più giovane vittima francese per il coronavirus.

E si susseguono dichiarazioni allarmiste di responsabili degli ospedali dell’Ile de France e del premier Edouard Philippe, in un clima di crescenti tensioni sociali per la morte di due lavoratori e la mancanza di protezioni adeguate. Nelle prossime 24-48 ore la capacità di accoglienza degli ospedali dell’hinterland parigino arriverà a saturazione, riproponendo lo stesso scenario del Grande Est, dove la sanità è già al collasso.

L’unica soluzione, ha detto Frederic Valletoux, presidente della Federazione ospedaliera di Francia (Fhf), “è un’estrema solidarietà tra regioni e ospedali: dobbiamo moltiplicare le operazioni di trasferimento dei pazienti, altrimenti sarà una catastrofe”.

Oggi e nel fine settimana proseguirà l’evacuazione dei malati dal Grande Est verso strutture della Nuova Aquitania e in altre regioni con posti disponibili. Il capo del governo ha invece avvertito che “un’ondata estremamente alta dilagherà sulla Francia. La situazione sarà molto difficile nei prossimi giorni”.

Con grande realismo Philippe ha riconosciuto che “la crisi durerà nel tempo e la situazione sanitaria non migliorerà rapidamente” e ha invitato tutti a “resistere”. La Francia non ha ancora raggiunto il picco dei contagi ma l’epidemia ha già causato 1.995 vittime e 32.964 contagi, dei quali 3.787 sono in terapia intensiva in gravi condizioni. Nell’Ile de France i “numeri sono vertiginosi” ha avvertito l’Agenzia della salute regionale (Ars), con un bilancio di 1.300 pazienti in rianimazione e almeno 241 case di cure per anziani (Ehpad) già colpite dall’epidemia di nuovo coronavirus.

Di fronte all’impennata di casi di Covid-19, il via libera del governo alle cure con idrossiclorochina e in associazione lopinavir/ritonavir – rispettivamente utilizzate contro la malaria e l’Hiv – è passata quasi inosservata e non basta a dare speranze. Del resto l’autorizzazione del ministero della Salute è stata valutata da alcuni media e osservatori come inattesa e precipitosa. In Francia sono tutt’ora in corso decine di test clinici il cui esito non è noto al momento, mentre sono noti gli effetti dannosi della clorochina sulla salute se assunta erroneamente. Intanto le tensioni sociali stanno crescendo in reazione agli ultimi provvedimenti del governo per “far lavorare di piu'” alcuni settori, in modo da vincere una “guerra economica”.

Oggi a scatenare l’ira dei sindacati è stato il decesso per Covid-19 di un dipendente Carrefour a Saint-Denis e di un lavoratore interinale Manpower impegnato con Fedex a Roissy, oltre al contagio confermato di un dipendente di Amazon a Saran vicino a Orleans. I sindacati, Cgt in primis, chiedono migliori protezioni per i lavoratori: oltre a mascherine la limitazione di orari e giorni di apertura dei supermercati, magari concentrando l’offerta sui soli prodotti essenziali.

Il segretario generale della Cgt, Philippe Martinez, ha proposto di scioperare per denunciare “la mancanza di protezioni” per i lavoratori. A lanciare un appello allarmista sono anche le autorità della Normandia e di altre regioni dove un milione di residenti di Parigi e dintorni si sono ‘rifugiati’ per trascorrere il periodo di confinamento, facendo temere il propagarsi dell’epidemia in zone finora immuni o poco colpite. Dopo la fuga della scorsa settimana, “ogni giorno circa 300 parigini arrivano ancora in Normandia e da 48 ore registriamo un boom dei pazienti nei nostri reparti di rianimazione” ha deplorato il presidente della regione, Hervè Morin.

Pubblicato in: Medicina e Biologia, Unione Europea

EU. Coronavirus. Situazione al 1° aprile. Presenza di un picco anomalo.

Giuseppe Sandro Mela.

2020-04-02.

2020-04-01__Ecdc 001

Lo European Centre for Disease Prevention and Control, an agency of the European Union, ha rilasciato i dati sull’epidemia da coronavirus in Europa aggiornati alle ore 10:00 del 1° aprile.

Situation update for the EU/EEA and the UK, as of 1 April 2020.

«As of 01 April 2020, 421 808 cases have been reported in the EU/EEA and the UK: Italy (105 792), Spain (94 417), Germany (67 366), France (52 128), United Kingdom (25 150), Belgium (12 775), Netherlands (12 595), Austria (10 182), Portugal (7 443), Norway (4 447), Sweden (4 435), Czech Republic (3 308), Ireland (3 235), Denmark (2 860), Poland (2 311), Romania (2 245), Luxembourg (2 178), Finland (1 384), Greece (1 314), Iceland (1 135), Croatia (867), Slovenia (814), Estonia (745), Lithuania (533), Hungary (492), Bulgaria (399), Latvia (398), Slovakia (363), Cyprus (262), Malta (167) and Liechtenstein (68).

As of 01 April 2020, 29 350 deaths have been reported in the EU/EEA and the UK: Italy (12 430), Spain (8 189), France (3 523), United Kingdom (1 789), Netherlands (1 039), Germany (732), Belgium (705), Sweden (180), Portugal (160), Austria (128), Denmark (90), Ireland (71), Romania (69), Greece (49), Poland (33), Czech Republic (31), Norway (28), Luxembourg (23), Finland (17), Hungary (16), Slovenia (13), Bulgaria (8), Cyprus (8), Lithuania (7), Croatia (6), Estonia (4) and Iceland (2).»

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Sono stati conteggiati 421,808 casi, con 29,350 decessi.

L’elemento da valorizzare sarebbe esposto nel diagramma allegato.

Negli ultimi cinque giorni di marzo il numero dei casi di contagio era diminuito in modo statisticamente significativo, lasciando adito a fondate speranze di inizio del contenimento del processo pandemico, che coinvolge al momento quasi l’uno per mille della popolazione europea.

Il primo di aprile, al contrario, si assiste ad un nuovo picco dei contagi.

Potrebbe essere semplicemente un dato anomalo, ma è anche un invito a leggere codesti andamenti con grande prudenza.

Pubblicato in: Medicina e Biologia, Senza categoria, Unione Europea

Catalogna. Generalitat. Intubare solo chi ha probabilità di vita.

Giuseppe Sandro Mela.

2020-04-01.

Catalogna Catalunya

ISS. Analisi dei pazienti deceduti per coronavirus. Elaborati 68,801 casi.

«– sono stati studiati 6,801 casi di decessi in pazienti positivi al Covid-19;

– l’età mediana è 78 anni, donne 82, uomini 78;

– solo 84/6,801 (1.2%) dei pazienti aveva età inferiore ai 50 anni;

– il 50.7% dei pazienti presentava tre o più gravi patologie, il 25.9% due gravi patologie, il 21.3% una grave patologia.»

* * *

«Un documento della Generalitat con le istruzioni al personale sanitario e ai lettighieri»

«Non stiamo scegliendo chi deve vivere e chi no, ma il sistema non può collassare»

«I posti in rianimazione scarseggiano e la Catalogna mette gli ottantenni in fondo alla fila»

«un documento della Generalitat, il governo di Barcellona, con le istruzioni al personale sanitario e ai lettighieri su come convincere le famiglie a non pretendere il ricovero dei più anziani nei reparti di terapia intensiva sta suscitando clamore in Spagna. E divide l’opinione pubblica tra scandalizzati e pragmatici (o cinici).»

«Non stiamo scegliendo chi deve vivere e chi no, …. ma solo chi può sostenere meglio trattamenti aggressivi»

«Il primo triage, insomma è ormai a domicilio e soltanto chi, per età e condizioni generali, mostra concrete possibilità di sopravvivere può sperare di essere intubato»

«Non è mai esistita una cosa simile …. non trasportare al pronto soccorso chi aveva una prognosi grave o poche speranze di vita …. Prima portavamo in ospedale qualunque anziano non autonomo e si tentava di tutto per salvarlo, come se avesse un’aspettativa di vita fino a 200 anni. Adesso si soppesa la qualità del paziente perché il sistema non collassi»

* * * * * * *

Spagna. Costretta a scegliere chi curare.

«Ad impossibilia nemo tenetur»: nessuno può essere costretto a cose impossibili. Questo è un aforisma alla base del diritto delle obbligazioni.

Durante una emergenza quale quella attuale, le usuali regole perdono il loro valore indicativo: è semplicemente impossibile attuarle.»

Ogniqualvolta si tratti della vita umana, ogni scelta, anche la più razionale, è sempre drammatica: ogni caso è una situazione a sé, unica ed irripetibile.

Se il criterio dell’ordine di arrivo ha una sua intrinseca validità, quello di dare la precedenza ai casi curabili o più urgenti è altrettanto valido e, verosimilmente, più corretto.

La quasi totalità dei pazienti ultraottantenni presenta oltre al quadro polmonare da coronavirus una o più gravi patologie, dall’insufficienza renale a quella epatica al diabete mellito scompensato: la rianimazione di tali pazienti non consente di norma di ottenere risultato alcuno. Ma intanto un letto della rianimazione è stato occupato, lasciando fuori casi che avrebbero potuto riprendersi, se intubati.

Curare i pazienti in ordine di arrivo è sicuramente un metodo comodo, perché evita di dover prendere decisioni: la responsabilità della scelta ricade sul caso. Diciamolo francamente: è una fuga dalle proprie responsabilità.

Sicuramente chiunque sia costretto dai fatti a dover prendere una decisione è esposto a commettere degli errori, ma nessuna azione umane sfugge a questa evenienza: del senno di poi son piene le fosse.

A nostro sommesso avviso, la Generalitat ha optato per una scelta comportamentale coraggiosa e responsabile.

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Coronavirus, la Catalogna sceglie chi intubare e chi no. Ultimi gli ultraottantenni

Un documento della Generalitat con le istruzioni al personale sanitario e ai lettighieri. «Non stiamo scegliendo chi deve vivere e chi no, ma il sistema non può collassare».

I posti in rianimazione scarseggiano e la Catalogna mette gli ottantenni in fondo alla fila: un documento della Generalitat, il governo di Barcellona, con le istruzioni al personale sanitario e ai lettighieri su come convincere le famiglie a non pretendere il ricovero dei più anziani nei reparti di terapia intensiva sta suscitando clamore in Spagna. E divide l’opinione pubblica tra scandalizzati e pragmatici (o cinici).

Le direttive, su carta intestata e in catalano, esortano gli operatori delle ambulanze, chiamati a domicilio per nuovi casi sospetti di contagio da coronavirus, a non accennare al fatto che «i letti in rianimazione non bastano per tutti» come motivo per il mancato ricovero, limitandosi a sconsigliare «cure invasive, come la ventilazione meccanica», se il malato ha più di 80 anni e patologie pregresse. E a suggerire che, in momenti come questi, «morire a casa è l’opzione migliore, se è possibile controllare i sintomi». Per vincere le eventuali insistenze di fronte al diniego, dovrà essere ricordato che al pronto soccorso i parenti non possono entrare e tantomeno visitare il paziente o accompagnarlo nei suoi ultimi momenti. «Non stiamo scegliendo chi deve vivere e chi no – si giustificano gli autori del protocollo -, ma solo chi può sostenere meglio trattamenti aggressivi».

Agli esclusi le squadre d’emergenza sono autorizzate a somministrare ossigeno con la maschera; e poi, dai famigliari distrutti, si congederanno indicando la terapia farmacologia da somministrare ai loro cari per placare la sensazione di annegamento. Il primo triage, insomma è ormai a domicilio e soltanto chi, per età e condizioni generali, mostra concrete possibilità di sopravvivere può sperare di essere intubato.

«Non è mai esistita una cosa simile – ha detto un’infermiera, intervistata da El Mundo, che già qualche giorno fa aveva rivelato le raccomandazioni della Generalitat di non trasportare al pronto soccorso chi aveva una prognosi grave o “poche speranze di vita” -. Prima portavamo in ospedale qualunque anziano non autonomo e si tentava di tutto per salvarlo, come se avesse un’aspettativa di vita fino a 200 anni. Adesso si soppesa la qualità del paziente perché il sistema non collassi».