A new analysis, published in The Lancet, includes 99 patients with laboratory-confirmed 2019 novel coronavirus (2019-nCoV) who were transferred to Jinyintan Hospital, an adult infectious disease hospital admitting the first 2019-nCoV cases from hospitals across Wuhan, between January 1 and January 20, 2020. The study includes the first 41 cases from Wuhan reported in The Lancet last week.
31 jan 2020--The authors combined clinical records, laboratory results, and imaging findings with epidemiological data. Most patients were middle-aged (average age 55.5 years) and male (67 patients), and around half had a history of exposure to the Huanan seafood market (49 patients)—most of whom (46 patients) worked at the market as managers or salespeople.
Around half of cases (50 cases) occurred in people with underlying chronic diseases including cardiovascular and cerebrovascular diseases (40 patients) and diabetes (12 patients). All patients admitted to hospital had pneumonia—most were infected in both lungs (74 patients). The majority also had fever (82 patients), cough (81), and a third experienced shortness of breath (31). Five critically ill patients also experienced coinfections with bacteria (1 patient) and fungi (4).
Most patients were treated with antivirals (75 patients), antibiotics (70), and oxygen therapy (75), and had a good prognosis. However, 17 patients developed acute respiratory distress syndrome (ARDS), 11 of whom died of multiple organ failure.
More than half of patients (57 patients) are still in hospital, and almost a third (31 patients) have been discharged, as of 25 January, 2020.
The authors point out that while this is the largest study of its kind, involving 99 confirmed cases of 2019-nCoV, larger studies including patients from other cities and countries are needed to obtain a more comprehensive understanding of this novel coronavirus.
More information:The Lancet (2020). DOI: 10.1016/S0140-6736(20)30211-7 , https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
Journal information: The Lancet
Provided by Lancet
Thursday, January 30, 2020
2019 novel coronavirus is genetically different to SARS and should be considered a new human-infecting coronavirus
A new genetic analysis of 10 genome sequences of novel coronavirus (2019-nCoV) from nine patients in Wuhan finds that the virus is most closely related to two bat-derived SARS-like coronaviruses, according to a study published in The Lancet.
30 JAN 2020--The authors say that although their analysis suggests that bats might be the original host of the virus, an animal sold at the Huanan seafood market in Wuhan might represent an intermediate host that enables the emergence of the virus in humans. For this reason, the future evolution, adaptation and spread of this virus requires urgent investigation.
In the study, the authors report the epidemiological data of nine patients who were diagnosed with viral pneumonia of unidentified cause. Cell and secretion samples were taken from the patients' lungs to harvest samples of the 2019-nCoV virus, which were analysed to determine the origin of the virus and how it enters human cells.
Eight of the patients had visited the Huanan seafood market. One patient had never visited the market, but had stayed in a hotel near the market before the onset of their illness.
The authors found 2019-nCoV in all 10 genetic samples taken from the patients—including eight complete genomes, and two partial genomes. The genetic sequences of the samples were nearly identical (shared more than 99.98% of the same genetic sequence) - which indicates a very recent emergence of the virus into humans.
"It is striking that the sequences of 2019-nCoV described here from different patients were almost identical. This finding suggests that 2019-nCoV originated from one source within a very short period and was detected relatively rapidly. However, as the virus transmits to more individuals, constant surveillance of mutations arising is needed," says one of lead authors Professor Weifeng Shi, Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Shandong First Medical University and Shandong Academy of Medical Sciences, China.
Comparing the 2019-nCoV genetic sequence with a library of viruses, the authors found that the most closely related viruses were two SARS-like coronaviruses of bat origin—bat-SL-CoVZC45 and bat-SL-CoVZXC21—which shared 88% of the genetic sequence. 2019-nCoV was more genetically distant to the human SARS virus (which shared about 79% of the genetic sequence) and the Middle East respiratory syndrome (MERS) virus (which shared about 50% of the genetic sequence).
Studying the spike protein of the virus (how it binds then enters human cells), the authors found that 2019-nCoV and human SARS virus have similar structures, despite some small differences. As a result, the authors suggest that 2019-nCoV might use the same molecular doorway to enter the cells as SARS (a receptor called ACE2), but note that this will require confirmation.
Based on their data, the authors say that it seems likely that the 2019-nCoV causing the Wuhan outbreak might also be initially hosted by bats and transmitted to humans via a currently unknown wild animal sold at the Huanan seafood market.
They say that it is more likely that bat coronaviruses are mutating, than 2019-nCoV—meaning that 2019-nCoV is unlikely to have emerged due to a chance mutation. However, more information is needed, and if a more closely related animal virus is identified, this suggestion could be wrong.
"These data are consistent with a bat reservoir for coronaviruses in general and 2019-nCoV in particular. However, despite the importance of bats, it seems likely that another animal host is acting as an intermediate host between bats and humans," says Professor Guizhen Wu, Chinese Center for Disease Control and Prevention.
Explaining this she notes: "First, the outbreak was first reported in late December, 2019, when most bat species in Wuhan are hibernating. Second, no bats were sold or found at the Huanan seafood market, whereas many non-aquatic animals (including mammals) were. Third, the similarities in the genetic sequences between 2019-nCoV and its close relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21 were less than 90%, meaningthese two bat-derived coronaviruses are not direct ancestors of 2019-nCoV. Fourth, in both SARS and MERS, bats acted as the natural reservoir, with another animal acting as an intermediate host, and with humans as terminal hosts.This again highlights the hidden virus reservoir in wild animals and their potential to spill over into human populations."
More information:The Lancet (2020). DOI: 10.1016/S0140-6736(20)30251-8 , https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30251-8/fulltext
Journal information: The Lancet
Provided by Lancet
Wednesday, January 29, 2020
How contagious is the Wuhan coronavirus and can you spread it before symptoms start?
Cases of the Wuhan coronavirus have increased dramatically over the past week, prompting concerns about how contagious the virus is and how it spreads.
29 JAN 2020--According to theWorld Health Organisation, 16-21% of people with thevirusin China became severely ill and 2-3% of those infected have died.
A key factor that influences transmission is whether the virus can spread in the absence of symptoms—either during the incubation period (the days before people become visibly ill) or in people who never get sick.
On Sunday, Chinese officials said transmission had occurred during the incubation period.
So what does the evidence tell us so far?
Can you transmit it before you get symptoms?
Influenza is the classic example of a virus that can spread when people have no symptoms at all.
No published scientific data are available to support China's claim transmission of the Wuhan coronavirus occurred during the incubation period.
However, one study published in the Lancet medical journal showed children may be shedding (or transmitting) the virus while asymptomatic. The researchers found one child in an infected family had no symptoms but a chest CT scan revealed he had pneumonia and his test for the virus came back positive.
This is different to transmission in the incubation period, as the child never got ill, but it suggests it's possible for children and young people to be infectious without having any symptoms.
This is a concern because if someone gets sick, you want to be able to identify them and track their contacts. If someone transmits the virus but never gets sick, they may not be on the radar at all.
It also makes airport screening less useful because people who are infectious but don't have symptoms would not be detected.
How infectious is it?
The Wuhan coronavirus epidemic began when people exposed to an unknown source at a seafood market in Wuhan began falling ill in early December.
Researchers and public health officials determine how contagious a virus is by calculating a reproduction number, or R0. The R0 is the average number of other people that one infected person will infect, in a completely non-immune population.
Different experts have estimated the R0 of the Wuhan coronavirus is anywhere from 1.4 to over five, however the World Health Organisation believes the RO is between 1.4 and 2.5.
Here's how a virus with a R0 of two spreads:
If the R0 was higher than 2-3, we should have seen more cases globally by mid January, given Wuhan is a travel and trade hub of 11 million people.
How is it transmitted?
Of the person-to-person modes of transmission, we fear respiratory transmission the most, because infections spread most rapidly this way.
Two kinds of respiratory transmission are through large droplets, which is thought to be short-range, and airborne transmission on much smaller particles over longer distances. Airborne transmission is the most difficult to control.
SARS was considered to be transmitted by contact and over short distances by droplets but can also be transmitted through smaller aerosols over long distances. In Hong Kong, infection was transmitted from one floor of a building to the next.
Initially, most cases of the Wuhan coronavirus were assumed to be from an animal source, localised to the seafood market in Wuhan.
We now know it can spread from person to person in some cases. The Chinese government announced it can be spread by touching and contact. We don't know how much transmission is person to person, but we have some clues.
Coronaviruses are respiratory viruses, so they can be found in the nose, throat and lungs.
The amount of Wuhan coronavirus appears to be higher in the lungs than in the nose or throat. If the virus in the lungs is expelled, it could possibly be spread via fine, airborne particles, which are inhaled into the lungs of the recipient.
How did the virus spread so rapidly?
The continuing surge of cases in China since January 18—despite the lockdowns, extended holidays, travel bans and banning of the wildlife trade—could be explained by several factors, or a combination of:
increased travel for New Year, resulting in the spread of cases around China and globally. Travel is a major factor in the spread of infections
asymptomatic transmissions through children and young people. Such transmissions would not be detected by contact tracing because health authorities can only identify contacts of people who are visibly ill
increased detection, testing and reporting of cases. There has been increased capacity for this by doctors and nurses coming in from all over China to help with the response in Wuhan
substantial person-to-person transmission
continued environmental or animal exposure to a source of infection.
However, with an incubation period as short as one to two days, if the Wuhan coronavirus was highly contagious, we would expect to already have seen widespread transmission or outbreaks in other countries.
Rather, the increase in transmission is likely due to a combination of the factors above, to different degrees. The situation is changing daily, and we need to analyse the transmission data as it becomes available.
Viruses are quick studies. They're prolific at adapting to new environments and infecting new hosts. As a result they are able to jump the species divide from animals to humans—as the new coronavirus in China is showing.
28 jan 2020--It'sestimated that 89%of one particular family of viruses, known asRNA viruses, are zoonotic in origin. This means that they started in animals and have since become established among humans. RNA viruses are notorious for being able to mutate in a range of environments. This family of viruses includes everything from Ebola andWest Nile Feverto measles and the common cold.
The Severe acute respiratory syndrome-related coronavirus (or SARS-CoV) that broke out in Asia in 2003 is also an RNA virus; so too is the significantly more virulent and fatal Middle East respiratory syndrome coronavirus (MERS‐CoV), first identified in Saudi Arabia in 2012. Both are zoonotic. SARS-CoV is believed—although it's never been confirmed—to have originated in bats. Infected dromedary camels are thought to have been the source for MERS-CoV.
Overall around 10% of those infected with SARS died. The mortality rate for MERS is estimated to be around 35%.
Seven human coronaviruses (HCoVs) have been identified to date: two in the 1960s, and five since SARS in 2003. It is the seventh that is now making headlines.
Latest virus on the block
In December 2019, a number of people fell ill with what was soon confirmed to be a newly identified coronavirus, provisionally dubbed 2019-nCoV. At this stage, it's suspected but not confirmed that the outbreak originated in one seafood market in Wuhan, a city some 700 miles south of Beijing. The market has been closed since January 1.
As of 26 January 2020, 2,014 laboratory-confirmed cases of 2019-nCoV have been reported by the World Health Organisation, with 56 fatalities. The virus has, thanks to modern international travel, reportedly spread to five other countries: Thailand, Japan, South Korea, Taiwan and the US. On the African continent, authorities in Ivory Coast were on 27 January testing a suspected case of the virus in a student who returned to the country from China over the weekend.
As with other coronaviruses, 2019-nCoV is zoonotic in origin. While it's too early to confirm, it appears that 2019-CoV is what's known as a recombinant virus. This means it bears the genetic material of both bats and snakes, suggesting that the virus jumped from bats to snakes in the wild—and then, of course, to humans.
Coronaviruses were originally associated with a wide spectrum of respiratory, intestinal, liver and neurological diseases in animals. In the 1960s, with the advancement of laboratory techniques, the first two HCoVs (HCoV-229E and HCoV-OC43) were isolated from patients. These were associated with upper respiratory tract infections, causing mild cold-like symptoms. For this reason, the circulation of HCoVs in the human population was not monitored and no vaccines or drugs were developed to treat CoV infections.
Then, since the outbreak of severe acute respiratory syndrome in China in 2003, five additional human coronaviruses were identified—SARS-CoV (2003), HCoV-NL63 (2004), HCoV-HKU1 (2004), MERS-CoV (2012), and now 2019-nCoV.
As with SARS, the elderly, especially those with existing health conditions, are the most vulnerable with 2019-nCoV.
The outbreak is not entirely unexpected. Coronaviruses are among the emerging pathogens that the World Health Organisation in 2015 identified as likely to cause severe outbreaksin the near future.
For a long time is was difficult to identify the causative agent of infectious diseases. The rapid development of various molecular detection tools has enabled researchers to identify several new respiratory viruses. It has also helped with the characterisation of novel emergent strains.
This was what scientists were able to do within weeks of the first case of the Wuhan coronavirus.
An emerging infection
Coronavirus infections also fall within the crop of diseases known as emerging infectious diseases or newly emerging infectious diseases. These are infections that:
have recently appeared within a population, or
whose incidence or geographic range is rapidly increasing, or
at the very least threaten to increase in the near future.
As with SARS and MERS, many emerging diseases arise when infectious agents in animals known as zoonoses are passed to humans. As the human population expands and populates new geographical regions—often at the expense of wildlife—the possibility that humans will come into close contact with animal species that are potential hosts of an infectious agent increases.
Combined with increases in human density and mobility, it is easy to see that this combination poses a serious threat to human health.
Each of these diseases has come with societal and economic repercussions. Apart from illnesses and deaths, travel, business and daily life are affected. There's also always the risk of public fear and economic losses.
High risk
There's an ever-increasing diversity of animal coronavirus species, especially in bats. So the likelihood of viral genetic recombination leading to future outbreaks is high. The threat of future pandemics is real as highly pathogenic coronaviruses continue to spill over from animal sources into the human population.
Misdiagnosis of future outbreaks poses an additional threat to healthcare workers, with hospital-based spread to other patients putting further pressure on already strained healthcare systems.
A man working as a volunteer delivering medicine waits outside a pharmacy in Wuhan
China expanded drastic travel restrictions Sunday to contain an epidemic that has killed 56 people and infected nearly 2,000, as the US, France and Japan prepared to evacuate their citizens from a quarantined city at the outbreak's epicentre.
26 jan 2020--China has locked down the hard-hit province of Hubei in the country's centre in an unprecedented operation affecting tens of millions of people in a bid to slow the spread of the respiratory virus.
Its ability to spread appears to be "getting stronger" though it is "not as powerful as SARS", top Chinese health officials said at a press conference.
The previously unknown virus has caused global concern because of its similarity to the Severe Acute Respiratory Syndrome (SARS) pathogen, which killed hundreds across mainland China and Hong Kong in 2002-2003.
Outside the epicentre, Shandong province and four cities—Beijing, Shanghai, Xi'an and Tianjin—announced bans on long-distance buses entering or leaving, a move that will affect millions of people travelling over the Lunar New Year holiday.
The populous southern province of Guangdong, Jiangxi in the centre, and three cities made it mandatory for residents to wear face masks in public.
Originating in Hubei's capital of Wuhan, the virus has spread throughout China and across the world—with cases confirmed in around a dozen countries including as far away as the United States.
The US State Department said Sunday it was arranging a flight from Wuhan to San Francisco for consulate staff and other Americans in the city.
France's government and the French carmaker PSA also said they planned to evacuate staff and families, who will be quarantined in a city in a neighbouring province.
Symptoms of the coronavirus, common signs of infection, severe cases and treatment.
Japan is coordinating with Beijing to swiftly evacuate its citizens, Prime Minister Shinzo Abe said.
South Korea's consulate in Wuhan said it was conducting an online poll of its citizens there to gauge demand for a chartered flight out.
Fear in Wuhan
Instead of New Year revelry, Wuhan has been seized by an eerie calm that deepened on Sunday as new restrictions banned most road traffic in the metropolis of 11 million.
Loudspeakers broke the silence by offering tips slathered with bravado.
"Do not believe in rumours. Do not spread rumours. If you feel unwell, go to the hospital in time," the message said.
"Wuhan is a city that dares to face difficulties and keeps overcoming them," the female voice added, mentioning the deadly 2002-03 SARS epidemic and 1998 Yangtze River flooding.
The health emergency has overwhelmed Wuhan's hospitals with patients, prompting authorities to send hundreds of medical reinforcements, including military doctors, and start construction on two field hospitals.
The number of confirmed cases in the city could rise by 1,000, Wuhan's mayor Zhou Xianwang predicted Sunday, based on the number currently undergoing observation in hospital.
The virus has continued to spread across China despite the drastic travel restrictions and people wearing face masks
He also said around five million people had left the city during the new year travel rush.
Speaking at a press conference and wearing a face mask, Zhou said the city's medical staff were "very strained and tired".
With non-essential vehicles banned from the road, volunteers stepped up to drive sick fellow citizens to hospitals.
"There has to be someone who does this," Zhang Lin, 48, told AFP journalists as he waited for a patient to emerge from a clinic for the drive back home in nearly deserted streets.
Some foreigners in Wuhan expressed deep concern, saying they feared going outside.
"We want to be evacuated as soon as possible, because either the virus, the hunger or the fear will kill us," Mashal Jamalzai, a political science student from Afghanistan at Central China Normal University, told AFP.
The outbreak is suspected to have originated in a Wuhan market where animals including rats, snakes and hedgehogs were reportedly sold.
China said Sunday it was banning all trade in wildlife until the emergency is over, but conservationists complain that China has previously failed to deliver on pledges to get tough.
Animal rights groups called for the ban to be made permanent, saying it could end the possibility of future outbreaks.
Beijing has suspended long-distance bus services into and out of the capital
Another Disneyland closes
Health officials said the virus has since become transmissible between humans.
"From what we see now, this disease is indeed... not as powerful as SARS," said Gao Fu, head of China's Centre for Disease Control and Prevention, at a press briefing in Beijing.
However, it also appears that the "spreading ability of the virus is getting stronger," said Ma Xiaowei, head of China's national health commission.
The government says most deaths involved the elderly or people with existing ailments.
Fearing a repeat of SARS, China has dramatically scaled back celebrations and travel associated with the New Year holiday, which began Friday, while tourist sites like Beijing's Forbidden City and a section of the Great Wall have closed.
In Hong Kong, Disneyland announced Sunday it had closed as a precaution after the city declared an emergency to combat the crisis. Shanghai's Disneyland park had already closed Saturday.
Also in Hong Kong, protesters opposed to government plans to use a newly built public housing facility as a quarantine centre threw petrol bombs at the building, showing how fearful people are of the virus.
A new working group to tackle the epidemic, chaired by Chinese Premier Li Keqiang, called for local authorities to consider "extending the Spring Festival holiday", in order to prevent the movement of people.
Several cities responded, with new school terms delayed in Beijing, Shanghai and the city of Suzhou in eastern Jiangsu province—which also ordered companies to extend the end of the holiday until February 9.
The global spread of the coronavirus: Where is it?
A SARS-like virus that has claimed 41 lives since emerging in a market in the Chinese city of Wuhan has spread around the world.
26 jan 2020--Here are the places that have confirmed cases of 2019 Novel Coronavirus:
China
As of Saturday, almost 1,300 people have been infected across China, the bulk of them in and around Wuhan.
Nearly all of those who died were in the Wuhan region, but officials have confirmed two deaths elsewhere.
The city of Macau, a gambling hub hugely popular with mainland tourists, has confirmed two cases.
In Hong Kong, five people are known to have the disease. Three of those cases were confirmed in the 24 hours to Saturday morning.
France
There are three known cases of the coronavirus in France, the first European country to be affected by the outbreak.
One person is sick in Bordeaux and another is ill in Paris. A third person, who is a close relative of one of the other two, has also been confirmed to have the virus.
All three had recently travelled to China and had now been placed in isolation.
Japan
Japan's health authorities confirmed the country's third case on Saturday.
One man was hospitalised on January 10, four days after his return from a visit to Wuhan.
Two people from the Chinese city—a man in his 40s and a woman in her 30s—have been treated in hospital for fever.
Australia
Australia on Saturday confirmed its first case of the virus, a man who arrived in Melbourne from China a week ago.
Authorities said they were contacting people who had travelled on the same plane from China and offering advice.
Malaysia
Malaysia confirmed its first three cases on Saturday. All are Chinese nationals on holiday from Wuhan who arrived in the country from Singapore two days earlier.
A 66-year-old woman and two boys, aged two and 11, are in a stable condition and are being kept in an isolation ward at a public hospital, Malaysia's health minister said.
Nepal
Nepal said a 32-year-old man arriving from Wuhan had the deadly disease.
The patient, who was initially quarantined, recovered and was discharged. The government said that surveillance has been increased at the airport "and suspicious patients entering Nepal are being monitored".
Singapore
Singapore has announced at least three cases—a 66-year-old man and his 37-year-old son, who arrived in Singapore on Monday from Wuhan, and a 52-year-old Wuhan woman, who arrived in the city-state on Tuesday.
South Korea
South Korea confirmed its second case of the virus on Friday.
The health ministry said a South Korean man in his 50s started experiencing symptoms while working in Wuhan on Jan 10. He was tested after his return earlier this week, and the virus was confirmed.
The country reported its first case on January 20—a 35-year-old woman who flew in from Wuhan.
Both remain in treatment and are in stable conditions.
Taiwan
Taiwan has uncovered three cases so far. It has since advised against travel to Wuhan and Hubei province and on Friday said any arrivals from Wuhan would be rejected by immigration.
All arrivals from the rest of China—including Hong Kong and Macau—must fill out health declaration forms on arrival.
It has also banned the export of face masks for a month to ensure domestic supplies.
Thailand
Thailand has detected five cases so far—four Chinese nationals from Wuhan and a 73-year-old Thai woman who came back from the Chinese city this month.
Two of the Chinese patients were treated, and have since recovered and travelled back to China, the Thai health ministry said this week.
United States
On Tuesday US health officials announced the country's first case, a man in his 30s living near Seattle. On Friday a second case was announced—a woman in her 60s living in Chicago.
Both were treated and are recovering.
Vietnam
Vietnam confirmed two cases of the virus on Thursday. An infected man from Wuhan travelled to Ho Chi Minh City earlier this month and passed the virus on to his son.
Both are being treated in hospital and are stable, Vietnam health officials said.
A new flu-like strain of the coronavirus has been reported in China, South Korea, Taiwan, Japan, Thailand and the US.
26 jan 2020--Currently, there are no reported cases in Canada, although several people are being monitored for signs they may have contracted thevirus.
McMaster's Environmental & Occupational Health Support Services is continuing to monitor the situation and will follow any recommendations made by Canadian public health agencies.
What is the coronavirus?
Coronaviruses are a large family of viruses that can cause diseases like the common cold and pneumonia. They typically affect the upper respiratory tract and can range in severity from mild to severe.
Risk of severe disease may be higher in people with weakened immune systems, such as older adults and people with chronic disease.
The symptoms of this new virus, originally identified in Wuhan, China, include:
As with any virus, here's what to do if you feel ill:
Stay home and do your best to avoid close contact with others
Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands. If you don't have a tissue, sneeze or cough into your elbow.
Clean and disinfect objects and surfaces
Help prevent the spread of illness
Wash your hands often. Wash for at least 20 seconds with soap and water. Use alcohol-based hand sanitizer only if water is not available
Don't touch your eyes, nose or mouth with unwashed hands
Over a third of people would want to know they had Alzheimer's disease 15 years before symptoms show, according to new findings from Alzheimer's Research UK.
23 jan 2020--The UK's leading dementia research charity published a report, Detecting and diagnosing Alzheimer's disease, revealing the public's attitudes toward early detection and diagnosis of Alzheimer's, the most common cause of dementia. The report calls for action to improve communication about dementia, support research efforts into earlier diagnosis and prepare the NHS for future treatments.
The report reveals that the public has a strong appetite to find out if they would develop Alzheimer's disease, although most want tests to be accurate and to give certainty about disease progression.
Despite there currently being no treatments to slow, stop or prevent Alzheimer's, 74 percent of UK adults would want to know they had the disease before symptoms appear. Upon further questioning, 33 percent said they would want to know two years before, while 38 percent would want to know 15 years before.
Currently Alzheimer's is diagnosed when symptoms such as memory loss appear, but the disease can begin damaging the brain years and perhaps decades before this point. Research suggests that being able to pick up these changes earlier has the potential to transform how and when we treat the disease.
Research in this area is progressing at pace and new diagnostic tools, such as blood tests, are on the horizon—while pharmaceutical company Biogen will soon file for FDA approval for the drug aducanumab, designed to be given in the early stages of Alzheimer's.
Alzheimer's Research UK, along with pharmaceutical company MSD, set out to get a clearer picture of people's attitudes in an effort to understand potential barriers that could hold back research and delay future treatments.
Other key findings from focus groups and a Populus survey of 2,106 people include:
At least 75 percent of people would be willing to undertake cognitive tests, brain imaging, blood tests and eye tests if they could help identify their risk of Alzheimer's.
Most people (84 percent) would be willing have an eye test if it could reveal their risk of developing dementia and least (40 percent) would be willing to have cerebrospinal fluid sampling.
But the results also highlighted a lack of understanding about the progression of Alzheimer's. Over half of UK adults (51 percent) surveyed didn't know or disagreed with the statement, "Alzheimer's begins decades before symptoms emerge."
The report highlights the important role doctors play in talking to people about early diagnosis and helping to shape public understanding of the different tests that are available now, or that research might deliver in the near future. It also makes recommendations on how the NHS can better inform the public about this topic, including recommending language guidance on how to talk about early detection and diagnosis.
Prof Jonathan Schott, Chief Medical Officer at Alzheimer's Research UK and Clinical Neurologist at the UCL Queen Square Institute of Neurology, said:
"For many people dementia, which is most commonly caused by Alzheimer's disease, is the most feared health condition. This can make it hard to start the important conversation about why we might want to start diagnosing Alzheimer's early.
"But this challenge is one we must overcome. Research suggests that our best shot at bringing about life-changing treatments and transforming the outlook for people with dementia may start by picking up diseases like Alzheimer's very early, and perhaps even before symptoms start. These efforts are particularly timely in light of recent preliminary but encouraging results from clinical trials of new treatments in people with early stage Alzheimer's.
"It's vital that we begin discussions with the public about why and how we can start to make an earlier diagnosis of Alzheimer's. This report suggests that the public is ready for this discussion—and that clinicians have a vital role to play."
Ian Wilson, Chief Executive at Alzheimer's Research UK, said:
"Right now, we face the frightening reality that one in three people born today will develop dementia in their lifetime, unless we find new preventions and treatments. To achieve this feat, we must be diagnosing diseases like Alzheimer's much earlier than we can today. This is a major focus for Alzheimer's Research UK and we're investing millions of pounds in research to make breakthroughs in this area.
"While we are making rapid progress, it's essential that we also act now to prepare both the public and the NHS for when these groundbreaking tests become available. That's why our report includes recommendations for how the NHS can support early diagnosis, and we're urging the Department of Health and Social Care to look now at what changes need to be made to the diagnostic pathway to support access to current and future dementia treatments. With life-changing drugs on the horizon, we don't have time to lose."
It is not often that one witnesses a transformational advance in medicine. But the application of artificial intelligence (AI) to improve the early detection of disease is exactly that.
19 jan 2020--I was a co-author of the paper recently published in Nature showing that an AI system developed by Googlewas better at spotting breast tumors than doctors. Now, researchers in the US have reported that AI-supported laser scanners arefaster than doctors at detecting brain tumors. These are very exciting developments that will, ultimately, have a big impact on the accuracy, logistics and speed of diagnosis.
There are a multitude of similar projects underway that employ artificial intelligence in the early detection of macular degeneration, acute kidney failure, skin cancer, sepsis, Alzheimer's disease and depression, among others.
Healthcare provides especially fertile territory for these advances because of the sheer volume and complexity of medical knowledge. No clinician, however smart, can hope to master it. The aim is not to replace the doctor (yet, at least) but to enhance their medical expertise.
Saving lives, and costs
As well as speeding up diagnosis and making it more accurate, potential savings of around US$400 billion in the US healthcare sector alone might be made from these developments, according to some estimates.
To achieve this, however, scientists need access to data. Data is as vital to artificial intelligence as coal was to the railways and oil to the motorcar. To fulfill the promise of AI in healthcare, medical data will need to be treated as precious to our health as drinking water, says Etta Pisano, chief research officer at the American College of Radiology, in a commentary published alongside our paper in Nature.
It is a striking image: our global medical records may be as vital to our health as the water we drink and the air we breathe. And just as we seek to protect our drinking water from contamination and our air from pollution, we must protect our records from abuse. I know, as a researcher, that the risk is real when it comes to keeping patient records confidential. And, as a patient, I know the safety of our data is paramount.
For our research on AI in breast cancer detection, we studied over 29,000 mammograms from women in the UK and the US. All the records were anonymized and no woman could be identified—a standard procedure to protect patient confidentiality. But the research could not have gone ahead without access to this vital data.
We need to demonstrate why data sharing is a social benefit, if we are to generate the growth that these innovations could deliver. There is a moral imperative to improve care for others through research. The biggest challenge, however, is to devise a system of data governance that protects the interests of patients, provides access for researchers, distributes the fruits of success fairly and wins the confidence of the public.
As set out in its 2017 industrial strategy, the UK government has established an Artificial Intelligence Council to boost growth of AI in the UK and its ethical use, and a Centre for Data Ethics to establish a governance regime for data driven technologies. This is a welcome recognition of the central importance of adopting an ethical approach to the development of these technologies.
But we need to go further. Public trust demands more transparency and the creation of incentives to allow data to be shared—for example, by giving the NHS a share of any commercial benefits gained from use of NHS data. There also needs to be a health-specific data charter, with clear rules, norms and standards, setting out what can be done, what should be done and what may not be done. The government should offer an absolute guarantee that patient information will not be shared outside the health, care and research systems. Users of NHS data should be required to prove that they are using it to improve quality, safety and efficiency.
There are huge opportunities in these technologies to advance healthcare, benefit health systems and improve the outlook for millions of patients. But unless we establish clear rules from the outset, we risk sacrificing public trust, surrendering vital clinical gains and squandering the potential in the vast quantities of medical data we have spent decades accumulating.
