2B
Saturday, February 15, 2020
The Observer & Baker City Herald
PREPARING FOR POSSIBLE CORONAVIRUS CASES IN U.S. HOSPITALS
Bracing for coronavirus
By Soumya Karlamangla
Los Angeles Times
U.S. hospitals are stocking
up on gowns and goggles and
holding refresher courses
in infection control amid a
growing outbreak of a novel
strain of coronavirus that
has already killed more than
1,360 people in China.
Since it began spreading
last year, the coronavirus
now known as COVID-19
has prompted the World
Health Organization to
declare a global health emer-
gency, caused U.S. offi cials
to strongly advise against
travel to China and led some
experts to predict a world-
wide pandemic.
In the United States, just
14 people have been diag-
nosed with the coronavirus
so far, though offi cials say
they expect those numbers
to rise. Hundreds of people
have already shown up at
American health care fa-
cilities with symptoms of the
virus, forcing staff members
to don face masks and put
patients in isolation rooms
while awaiting test results.
In addition to the 14
people confi rmed to have
the virus in the U.S. as of
Wednesday, 413 others have
been tested for it; 347 tested
negative, and results are still
pending for 66, according to
the U.S. Centers for Disease
Control and Prevention. The
virus’ symptoms, such as
fever and cough, resemble
those of the fl u, which is in
the height of its season in
the U.S.
So far, the virus does not
appear to be any more conta-
gious than the fl u or a cold,
though scientists are learn-
ing more as cases mount.
Because of the ever-evolving
situation, the CDC is recom-
mending that doctors and
hospitals adopt a “cautious
approach” when treating
coronavirus patients in their
facilities.
This is how that approach
would play out if you visited
a hospital to be treated for
the coronavirus.
STEP 1: TRIAGE
Patients suspected of
having the coronavirus are
required to wear face masks
other diseases that hospitals
regularly treat require these
precautions, Doron said.
“This isn’t something very
out of the ordinary for us,”
she said.
STEP 4: TREATING THE
PATIENT
There aren’t any treat-
ments specifi c to this novel
coronavirus, so doctors do
what they can to alleviate a
patient’s symptoms, which
could include administering
IV fl uids and monitoring
lung function. More severe
cases may need to be put
on a ventilator to help them
breathe.
Positive test results do not
Irfan Khan / Los Angeles Times-TNS change a patient’s treatment
Coronavirus health advisory posted in the emergency department at St. Joseph Medi- plan because doctors are
cal Center in Orange, California.
already treating the symp-
toms, they say.
STEP 3: KEEPING STAFF
“We always have to address those concerns for
SAFE
STEP 5: CALMING OTHER
parents. It’s really educating the families about what
All health care personnel PATIENTS
coronavirus is, as well as what are the other infectious who interact with infected
Hearing that coronavirus
patients
wear
gowns,
gloves,
patients
are in the hospital
diseases in the community at large.”
goggles and masks. Though can be scary for other pa-
—Dr. Nicholas Holmes, chief operating offi cer,
tients and their families.
the coronavirus isn’t be-
Rady Children’s Hospital in San Diego
lieved to be more contagious
Last week at Rady Chil-
than the fl u, scientists don’t dren’s Hospital San Diego, a
STEP 2: ‘NEGATIVE
and be placed in a sepa-
know everything about it
3-year-old girl and her father
PRESSURE’ ISOLATION
rate room away from other
yet.
were admitted as suspected
ROOMS
patients while they await
“We’re using what the
coronavirus cases after they
Admitted patients are
treatment. Because the virus
CDC likes to call an abun-
fl ed China last week. Both
can travel up to 6 feet in the placed in “negative pres-
dance of caution,” said Dr.
have since been cleared and
sure” rooms, which keep air Shira Doron, an infectious
air when someone coughs
discharged.
from seeping out into the
or sneezes, the CDC recom-
disease specialist at Tufts
Dr. Nicholas Holmes, the
mends maintaining at least rest of the hospital. The air
Medical Center in Boston.
hospital’s chief operating
from these special rooms is
that distance between the
In San Jose, Calif., fi ve
offi cer, said staff members
patient and all others to pre- eventually released outside health care workers at Good emphasized that they were
vent the spread of infection. instead of being recirculated Samaritan Hospital were
following proper hygiene
through the hospital.
put on two-week leave after protocol and doing every-
“If you have traveled to
Such rooms are typi-
public health offi cials deter- thing possible to limit the
China, please let us know
immediately, even before you cally used for patients with mined they had contact with spread of the virus. He said
diseases such as tuberculo-
walk into a crowded wait-
they also reminded patients
a confi rmed coronavirus
sis and measles. They are
ing room,” said Dr. Brian
patient.
and their families that the
standard in hospitals, unlike
Lee, emergency depart-
With suspected and con-
fl u is a bigger concern than
ment medical director at St. the special chambers some
fi rmed coronavirus patients, coronavirus.
facilities set up to handle
Joseph Hospital in Orange,
staff members who can enter
“We always have to ad-
Calif. “We can’t read minds.” Ebola cases in 2014.
the room are limited to the
dress those concerns for
“To the patient, it looks
A doctor then interviews
patient’s doctor and nurse.
parents,” he said. “It’s really
exactly like any other treat- Staffers keep a log of every- educating the families about
the patient about their
symptoms and travel history. ment room,” said Dr. Michael one who enters the room.
what coronavirus is, as well
Patients must meet specifi c Mesisca, emergency depart- Patients aren’t allowed
as what are the other infec-
criteria to qualify for testing, ment medical director at
visitors and are encouraged tious diseases in the commu-
including travel to China in Riverside University Health to communicate with their
nity at large.”
the last 14 days.
System Medical Center in
loved ones by phone or video
Lee, of St. Joseph Hospital,
Patients are typically
Southern California.
chat.
agreed that the fl u remains
The Riverside hospital,
admitted to the hospital for
Hospital workers don’t
a larger threat than coro-
which has been receiv-
treatment while they await
typically wear face shields or navirus for Americans and
ing people quarantined at
results of the test, which is
goggles when treating fl u pa- requires more hospital re-
usually done through a nasal March Air Reserve Base, has tients, but otherwise the pre- sources as infl uenza patients
swab. In some cases, patients tested patients for the coro- cautions are not too different continue to seek treatment.
with mild illness can self-
navirus but has had no tests from caring for people with
“Our main ask to the pub-
quarantine at home.
come back positive, he said. seasonal infl uenza. Many
lic is: Don’t panic,” he said.
Flu, or
cold?
Mayo Clinic News Network
Infl uenza and the
common cold are
respiratory illnesses
caused by viruses.
The more intense fl u
symptoms tend to come
on more abruptly than
the gradual, more mild
symptoms of a cold. Dr.
Nipunie Rajapakse, a
pediatric infectious dis-
eases specialist at Mayo
Clinic, explains these
two viral illnesses.
Flu symptoms
include:
• Fever over 100.4 F
• Aching muscles,
especially in your back,
arms and legs
• Chills and sweats
• Headache
• Dry, persistent cough
• Fatigue and weakness
• Nasal congestion
• Sore throat
• Sudden onset of
symptoms
“Once you have a viral
infection of any kind,
there is an increased
chance that you might
develop a superimposed
bacterial infection,” says
Dr. Rajapakse.“If you
seem to be recovering
from a cold or fl u, and
then suddenly start
having fevers or feeling
worse again, you should
see your health care pro-
vider to determine if you
might have developed
a bacterial superinfec-
tion.”
Cold symptoms:
• Runny or stuffy nose
• Sore throat
• Cough
• Gradual onset of
symptoms
Dr. Rajapakse says
there is no cure for the
common cold, but there
are ways to feel better.
“The best things that we
recommend for people
who have the common
cold are to get plenty of
rest, to drink plenty of
fl uids, and use symp-
tomatic relief methods
in terms of ibuprofen or
acetaminophen to help
yourself feel better until
your body’s able to fi ght
it off itself.”
Gene editing: No side effects, but no progress on cancer
CRISPR technology was invented
just eight years ago, yet the version
PHILADELPHIA — Three pa-
used by Penn is already so outmoded
tients with advanced cancer suffered
that the trial has been discontinued.
no serious side effects from being
“We learned what we wanted to
treated at the University of Pennsyl-
learn,” June said of the study, on
vania in the fi rst U.S. clinical study
which Stanford University collabo-
of cells edited with CRISPR, the
rated. “It opens up the door for a lot
gene editing technology.
of new approaches.”
But neither did they benefi t,
What they learned was mostly
according to results published this
reassuring.
month in Science. One patient
The diffi cult, many-step manu-
with a bone marrow cancer called
facturing process was feasible.
multiple myeloma has died and
CRISPR was used on T cells to cut
another has progressed. A patient
out two genes, one that codes for the
with sarcoma, a soft tissue cancer,
immune system brake, and another
also progressed.
that could hamper the T cells’ ability
Pilot clinical trials are designed to
to latch onto cancer cells. CRISPR
assess safety, not effectiveness. And
also inserted a gene that enabled
Andrew Renneisen / The Philadelphia Inquirer-TNS the T cells to recognize and target a
the inaugural U.S. test of CRISPR-
Dr. Carl June talks with members of the media before the Philadel-
edited cells in humans was so ethi-
protein found on the cancer cells but
cally and scientifi cally fraught that phia Award ceremony on May 31, 2013. June led the fi rst-in-humans not healthy cells.
clinical testing of cells edited with CRISPR.
Penn spent more than two years
These edits accidentally caused
getting necessary approvals for the
some unusual rearrangements of
January 2018 launch.
approach genetically engineers
survive and grow in patients for up DNA in a small fraction of T cells
Still, the experiment was intended immune soldiers called T cells to
to nine months. In a previous Penn — one of the biggest worries with
to combine and improve on two
recognize and attack cancer cells;
clinical trial that used engineered
CRISPR. But as the T cells took
revolutionary immune-boosting
the fi rst approved T-cell therapy,
T cells to attack multiple myeloma, hold and multiplied in patients,
approaches that showed startling
Novartis’ Kymriah, was pioneered
half the cells were dead in a week.
these rearrangements steadily
effectiveness even in early trials.
at Penn and Children’s Hospital of
Penn T-cell researcher Carl June, decreased, “suggesting that they
One approach, which cuts a natural Pennsylvania.
principal leader of the new study
conferred no growth advantage,” the
brake on the immune system, has
Although the CRISPR-edited
and previous groundbreaking work, researchers wrote.
led to a class of cancer drugs called
cells did not melt away tumors or
sees the CRISPR trial as another in-
The edited T cells did not trig-
checkpoint inhibitors. The other
stop cancer progression, the cells did cremental step in a medical odyssey. ger any of the dangerous toxicities
By Marie McCullough
The Philadelphia Inquirer
related to revving up the immune
system that are common with
checkpoint inhibitors and engi-
neered T cells.
However, the researchers
noted that a longer trial with more
patients and higher doses will be
needed “to fully assess the safety of
this approach.”
A problem that has occurred with
engineered T-cell therapies also
showed up in the CRISPR trial: One
patient’s cancer cells stopped mak-
ing the protein, called NY-ESO-1,
that the T cells had been edited to
target.
In future trials, “we would not
just use NY-ESO-1 because we’ve
learned the tumor can live without
it,” June said. “We’d want to use
multiple targets.”
Renier J. Brentjens, an oncolo-
gist and cell therapy researcher at
Memorial Sloan-Kettering Cancer
Center in New York City, called
the paper an important “proof of
principle.”
“The T cells persisted and found
the tumors. It would have been nice
to see remissions or tumor regres-
sion, but it doesn’t necessarily mean
the approach is fl awed,” Brentjens
said. “It may be that the target they
used is not suffi cient.”