Companies with experience in the “at-home” testing market began announcing in mid-March that they would be offering direct-to-consumer test kits for Covid-19.
With panic running high and tests at hospitals and doctors’ offices hard to come by, the appeal was obvious.
The kits were touted as a way for consumers to manage this difficult situation themselves: there would be no struggle to see the doctor, or calls to the health department, or waiting in line at a drive-thru test site.
Instead, consumers could collect their own samples, by either swabbing the throat or cheek or spitting into a cup. The samples would then be mailed back to the companies’ partner laboratories, which would test for coronavirus. Prices ranged from $135 to $181.Advertisement
But criticism was swift. Questions were asked about whether at-home tests could be skimming the resources needed for lab-based tests. There was also the possibility of people collecting their samples incorrectly and questions about follow-up care.
Not to mention the risk of inaccurate results.
The Food and Drug Administration responded with a 20 March press release, which stated that the FDA had not authorized any test “that is available to purchase for testing yourself at home for Covid-19”.
At least four companies, Nurx, EverlyWell, Forward and Carbon Health, have since said they halted sales – though two of the companies still had information about the tests on their websites as of Monday afternoon.
While these companies are legitimate and have a track record for at-home testing and providing medical care, there may be others out there hawking products that do not.
“Some are coming from reputable places and some are not, and that’s hard for the average consumer to tell,” said Eric Topol, director and founder of the Scripps Research Translational Institute.
For example, a number of questionable internet reports related to coronavirus tests, vaccines and “miracle” cures are already circulating on social media.
And for scared consumers, it may be difficult to tell the difference. “There’s a lot of bunk, junk and crank stuff out there,” said Arthur Caplan, founding head of the division of medical ethics at the New York University school of medicine in New York City.
The FDA said, for instance, in its 20 March release that it “is beginning to see unauthorized fraudulent test kits that are being marketed to test for Covid-19 in the home”.
One key sign that an at-home kit is a sham is that it will offer consumers an almost immediate test result. “That would not be possible,” said Topol.
Websites touting miracle cures and preventives – herbs, teas, essential oils, tinctures and colloidal silver – are prevalent.
QAnon conspiracy theorists on YouTube and Twitter have irresponsibly told viewers to buy and drink “Miracle Mineral Solution”, an industrial bleach product, to ward off coronavirus. Facebook and Instagram posts claim that marijuana, cocaine or vitamin C can kill or prevent the coronavirus. Salespeople have been offering fake N95 masks.
To be clear, the FDA said in 1999 that any products containing colloidal silver are not “safe or effective”, and the National Institutes of Health has said there are no known benefits to ingesting silver supplements and it can cause serious side-effects. The FDA also warned consumers in 2019 not to buy or ingest “Miracle Mineral Solution” because it can cause severe health effects.
The FDA and the Federal Trade Commission jointly issued warning letters on 9 March to seven companies for selling “products that fraudulently claim to prevent, treat or cure Covid-19”.
One of the warning letters was issued to Jim Bakker, a prominent televangelist who allowed a guest to promote colloidal silver as a cure for Covid-19, and then sold it during a 12 February broadcast of The Jim Bakker Show. The state of Missouri has since filed a lawsuit against Bakker for “falsely promising to consumers that Silver Solution can cure, eliminate, kill or deactivate coronavirus”.
The conservative radio host Alex Jones received a cease-and-desist letter on 12 March from the New York attorney general’s office for selling products on his website that contain colloidal silver and claim to treat or cure coronavirus infections.
“There is nothing homeopathic or nutritional that can help you with the virus,” said Caplan. “The idea that people are floating some kind of diagnostic solution or magic or therapy on the internet, it’s all total crap.”
There have also been reports of consumers buying up a fish tank cleaner on eBay that has the same active ingredient as the antimalarial drug chloroquine, which President Donald Trump touted as a possible treatment for Covid-19. An Arizona man recently died after ingesting the fish tank additive, thinking that it would prevent coronavirus.
In an update issued on 24 March, the FDA said it was aware of people buying the fish tank cleaning product and advised consumers: “Don’t take any form of chloroquine unless it has been prescribed for you by your health care provider and obtained from legitimate sources.”
On 20 March, the US Department of Justice announced that the attorney general, William Barr, had asked all US attorneys “to prioritize the investigation and prosecution of Coronavirus-related fraud schemes”.
The DoJ detailed its first enforcement action on 22 March for a Covid-19 fraud against one website that claimed to be selling coronavirus vaccine kits from the World Health Organization.
Despite all the false promises about these products, it’s important for consumers to remember that there is no FDA-approved treatment or vaccine for the novel coronavirus.
And the best way to prevent the spread of coronavirus is to practice physical distancing and wash your hands, public health experts say.
Regaining a sense of control is a motivator
Consumers may be motivated to buy these types of items because they are trying to regain control in an uncertain situation, explained April Thames, an associate professor of psychology at the University of Southern California’s Dornsife College of Letters, Arts and Sciences.
“People have this heightened anxiety and they are willing to try anything out there that’s a possible treatment or cure,” said Thames. It creates an opening for scam artists “to market products that sound like they are effective.
But Caplan’s ultimate advice to consumers who see coronavirus-related products on the internet? “Anything online, ignore it.”
COVID-19 vaccinations in patients with inflammatory bowel disease
Advances in the treatment of patients with inflammatory bowel disease (IBD) have substantially improved disease activity and quality of life, and reduced hospitalization rates and the need for surgery. However, prolonged immunosuppression in these patients can result in increased susceptibility to opportunistic infections. Many of these infections are preventable through vaccination and immunization strategies that should be undertaken as early as possible after diagnosis because the risk of opportunistic infections increases following the first year of immunosuppressive therapy.
The COVID-19 pandemic has led to substantial concerns for patients with IBD who are on immunosuppressive medications, many of whom are using additional protective measures. Although early COVID-19 studies have suggested that immunosuppressive medications are safe, robust and reproducible data are not available to adequately risk stratify patients with IBD, and current measures are mostly based on observational studies and theoretical risk.
Large scale, prospective, population-based registry studies, and meta-analyses have identified key risk factors associated with a higher probability of mortality from COVID-19, including age, socioeconomic deprivation, diabetes, respiratory disease, obesity, and being from a Black, Asian, or other minority ethnic group.
One of the best ways to mitigate the risk of COVID-19 is the rapid development of safe and effective vaccines. Although initial phase 1/2 studies are promising,
patients on immunosuppressant medications have largely been excluded from these studies, creating potential future concerns regarding the safety and generalisability of outcomes for individuals with IBD.
To achieve a sufficient degree of herd immunity, vaccination programs are primarily successful only when there are high rates of coverage and acceptance. The importance of patients with IBD being included in vaccine trials is compounded by the concern that these patients have a lower response to vaccinations and that vaccinations are generally underused in this population. Melmed and colleagues
showed that in patients with IBD there was an uptake of only 22–46% for the influenza vaccination, and a mere 9% were vaccinated for pneumococcal pneumonia, despite both vaccines being recommended in the British and European IBD guidelines for vaccinating patients.
A patient survey showed a perceived lack of benefit from a vaccination as the most frequent reason for low vaccine uptake, as well as concerns regarding side-effects, risk of disease flares, needle aversion, and inconvenience.
However, in the present pandemic, both perception of risk and health awareness might be very different, with implications for vaccine acceptance.
In patients with IBD who were vaccinated against influenza, an immune response was induced, but the use of concomitant infliximab and immunomodulatory therapy were associated with inadequate rates of seroconversion.
In adult populations vaccinated with the pneumococcal vaccine PSV-23, an impaired immune response was shown in patients with Crohn’s disease taking combination immunosuppressive therapy.
Other vaccines such as those against hepatitis A and B virus, tetanus, and herpes zoster have also been shown to be potentially less effective in patients with IBD than in control groups.
The extent to which medications might affect vaccine response, independent of underlying disease activity, is unclear. Of note, concurrent anemia, which is a common finding in patients with active IBD, might impair response to vaccinations.
There is therefore an urgent need for a better understanding of both the effectiveness of potential vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with underlying health conditions, as well as the potential impact of effective disease control on rates of vaccine response.
Currently, the candidate vaccines in phase 3 trials include inactivated, mRNA, or vector-based approaches. The classic inactivated or live-attenuated vaccines raise safety concerns due to possible induction of the disease. However, the ChAdOx1 nCoV-19 trial vaccine uses a replication-deficient chimpanzee adenovirus to deliver a SARS-CoV-2 protein to induce a protective immune response. This vaccine seems to be promising for patients with IBD because adenovirus vectors do not integrate the viral genomic DNA into the host’s genome, are highly immunogenic, and can induce robust innate and adaptive immune responses. The same adenovirus vaccine platform is also being assessed for use against malaria, HIV, influenza, and the Ebola virus.
Nevertheless, the phase 1/2 trials of the ChAdOx1 nCoV-19 vaccine were done on young, healthy volunteers and as such do not address the potential immunity concerns in patients with chronic diseases or those on immunosuppressants.
Moreover, we cannot assume that data on one vaccine type in a specific group of people can be extrapolated to other vaccine types.
There needs to be a stronger emphasis on vaccinating patients with IBD within the broader health-care preventative scheme. These factors must be considered when policymakers and national health services start to design and develop future COVID-19 vaccination programs. Equitable access to COVID-19 vaccination programs should be endorsed. If this is not feasible, then we propose that future community vaccination programs support and promote vaccines that can be used by the high-risk cohort of patients with IBD.
Having been under virtual house arrest for some time, it’s easy to get carried away with the excitement of a short break, post Covid-19. You’re taking in new sights, sounds, smells and tastes. It’s an adventure for the soul. But rich foods and drinks, lack of exercise and the stress of travel, particularly with young children, can take a toll on your health. To avoid paying for it later on, take a few steps to remain healthy.
REMEMBER TO GET ENOUGH SLEEP
A holiday after such a stressful period for everyone might be much welcomed, but don’t neglect your sleep patterns. Aim for six to nine hours a night and take a short nap in the afternoon if you need it.
WASH YOUR HANDS OFTEN
Stop germs in their tracks. Remember: wet, lather, scrub, rinse, and dry. This isn’t just good advice in a pandemic, it’s important every single day of your life. Practice it frequently throughout the day to prevent spread of diarrhea and respiratory disease, too. PACK SMART While it’s great to finally be free to enjoy a break, beware of the holiday cheer. Many hotels offer complimentary drinks, snacks or cakes. The result can be hard on your system. Pack Udo’s Choice Ultimate Digestive Enzyme Blend, to aid your digestion. A unique blend of seven plant-based digestive enzymes assist in the breakdown of proteins, fats, carbohydrates and fibre. Udo’s Choice Super 8 Microbiotic is a hi-count microbiotic blend that contains eight strains of lacto and bifido bacteria. Each daily capsule contains 42 billion ‘friendly’ bacteria. Both products can be found in your local health food store or pharmacy.
ALWAYS KEEP HYDRATED
Drink lots of water. Spending hours travelling can dehydrate you. Carry a large bottle of water to have throughout your journey, and pack Manuka Lozenges with vitamin C for an added immune boost and try to choose caffeine free drinks throughout the day.
If you’re staying by the sea, eat lots of fresh grilled fish. Oily fish –including sardines, fresh tuna, salmon and mackerel – is particularly good as it’s rich in Omega 3, which keeps your skin hydrated and encourages healthy digestion as well as weight loss. Try to eat a variety of different coloured fruits and vegetables – oranges, red peppers, green courgettes, yellow sweet corn – to get a wide range of antioxidants.
PROTECT FROM THE SUN
Lying in the sunshine feels great but you only need 10 minutes of unprotected sun to get your daily dose of vitamin D. After that you should use sunblock. As we get older, the collagen in our skin breaks down more rapidly, leading to lines, wrinkles and discolouring. To prevent the breaking down of collagen, eat lots of purple fruits, such as fresh blackberries, blueberries and black grapes.
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