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While coronavirus rages on throughout the world, a recent meningitis outbreak is causing serious problems in Ghana.  Medical officials in Ghana have confirmed 258 cases of the Cerebrospinal Meningitis, with 40 deaths as well.  Meningitis is a disease characterized by inflammation of the coverings of the brain and spinal cord.  The disease is normally very hard to contract since the bacteria must cross the blood-brain barrier in order to get to the CNS.  I think this outbreak is very interesting and unfortunate.  It has come at a very inopportune time where many health officials are focused on coronavirus, therefore this outbreak may not get the attention that it deserves.

              Many countries would simply ignore this outbreak, given the current situation with coronavirus.  The Center for Policy Advocacy and Governance is trying to convince the government to take to take this seriously.  They are calling on the Ghanaian government to create a plan to fight this epidemic.  Some of their suggestions include: intensifying surveillance for early reports and preparing a stimulus package for front-liners in the epidemic belt.  They have asked the media to devote part of their airtime to intensify public education and sensitization on the mode of transmission, signs and symptoms and preventative measures of the epidemic.  I think the idea to appeal to the media is a great one.  The media controls the public to an extent, if the media starts to provide the public with updates about the meningitis update along with coronavirus, people will start to take the meningitis epidemic seriously.  When the public starts to take it seriously, the government will be forced to do take action. 

              Until they receive the proper aid from the government, the Ghana Health Service (GHS) is prepared to take matters into their own hands in order to contain the outbreak.  Last week the GHS started a death audit on the cerebrospinal meningitis related deaths.  A death audit is a detailed death record analysis that gathers information about the professional activities of hospitals.  The death audit gives specific information about facilities where patients are dying from this disease and it can help the facilities see if there is anything they can do to prevent these deaths.  The regional director is also concerned with people not adhering to the safety protocols put in place to prevent the spread of meningitis.  “When we mention social distancing, it should also work for meningitis, but unfortunately from the field visits that we have conducted, we realized that people are not adhering to social distancing.”  I think it is sad that people will not listen to medical officials when they are given advice about dangerous diseases.  Unless people take this seriously, the meningitis will continue to spread in Ghana.  Hopefully their government will get involved in the fight soon as well, that would be a great help. 

For this blog I will be discussing the drug alemtuzumab (Campath), a monoclonal antibody.  A monoclonal antibody is an antibody that has been synthesized from the clones of B cells from an immune animal.  Since B cells only make antibodies for one specific antigen, therefore monoclonal antibodies can only recognize one specific epitope.  Campath is a drug that is used to treat B-cell chronic lymphocytic leukemia by slowing or stopping the growth of cancer cells.  It can also help with relapses of multiple sclerosis, making the relapses occur less frequently.  I think monoclonal antibodies such as Campath are a great medical development.  Some people’s immune systems do not function as they should, so getting monoclonal antibodies for the antigen that infects them is the next best thing.  However, the development of monoclonal antibodies is expensive and hard, so monoclonal antibodies are only made for common diseases. 

              Campath works by binding to CD52, an antigen present on the surface of almost all B and T cells, and many other cells in the immune system, as well as some bone marrow cells and male reproductive tissue.  After the antibody binds to the surface of leukemic cells, the cancerous cells undergo antibody-dependent lysis.  Possible side-effects may include:

• Hematologic Toxicity: Serious pancytopenia/ marrow hypoplasia, autoimmune idiopathic thrombocytopenia, and autoimmune hemolytic anemia have occurred in patients
• doses of more than 30 mg in one dose or 90 mg per week have been linked to higher incidence of pancytopenia
• Infusion Reactions: it can cause serious infusion reactions, patients should be closely monitored during infusion
• Infections, Opportunistic Infections: Serious bacterial, viral, fungal, and protozoan infections have been reported
• Fever, chills, flushing, dizziness, shortness of breath, nausea, vomiting, or mild rash/itching
• Depression/anxiety, muscle pain, numbness in extremities, irregular heartbeat, weight change
• May increase of getting progressive multifocal leukoencephalopathy brain infection

All of these side-effects are bad, however the autoimmune complications are directly related to the treatment that the drug provides.  Since the antibody attacks all immune cells with a CD52 glycoprotein, this can cause the destruction of cancerous cells as well as healthy immune cells.  Low counts of blood cells lead to the complications of pancytopenia, marrow hypoplasia and autoimmune idiopathic thrombocytopenia.  I think this drug does have a lot of risks associated with it, therefore I think any doctor that would prescribe it must believe that the benefits outweigh the risks of side effects; this drug is mainly used to fight cancer so that makes sense.

              Since this drug attacks the cells of the immune system and the bone marrow, it will make anyone who takes it more susceptible to infection.  This drug attacks cells of the both the innate and acquired immune system, T cells, B cells, macrophages, dendritic cells, NK cells, monocytes and more.  Therefore, the drug should NOT be taken if the patient has HIV, had a vaccine recently or has tuberculosis.  I think the development of monoclonal antibodies will continue to progress and they will become more widely used.  Hopefully the cost of production will decrease and the developmental process will become more efficient.  If that happens, lots of people will be able to get antibodies for illnesses that their body does not already have and more people will survive serious diseases.

With coronavirus taking up all the space in the news, it is easy to forget about other diseases.  However, diseases do not stop spreading when the news stops talking about them.  So this blog will give you some updates about 2 non-COVID diseases.  It is important to stay informed on things outside of COVID, some of these diseases are just as dangerous or more dangerous and should be followed closely.  If you get too caught up on coronavirus, you will leave yourself vulnerable to infection from some other common diseases. 

              Some countries are suspending the vaccine campaigns of other diseases in response to the COVID pandemic.  The WHO organization recently recommended suspending all measles, polio and HPV vaccines in order to stop the spread of coronavirus.  Seth Berkley called the decision “A devil’s choice”.  On the one hand, poor countries need these mass vaccination efforts to get rid of these other diseases.  However, by doing these large-scale vaccinations for polio, measles and other diseases, they are risking the spread of COVID-19 inadvertently.  Due to this suspension of vaccinations, experts expect there to be a surge in cases of polio and measles, as well as other diseases where vaccination has temporarily ceased.  I think this is an unfortunate and unexpected complication of the coronavirus pandemic.  People are being denied other important vaccines in order to stop the spread of COVID-19.  I think I do agree with this decision, it is important to address the matter at hand, COVID is the big and immediate danger at the moment.  However, the sooner we can restart vaccinations for other diseases, the better.

              The USDA has recently confirmed the presence of highly pathogenic avian influenza in commercial turkey flock in South Carolina.  These are the first confirmed cases of this disease in the US since 2017.  Scientists believe that this strain of avian influenza mutated from a low pathogenic strain found in poultry in the same area recently.  While no cases of this disease have been detected yet, it is important to note that humans can indeed contract this disease and should be cautious when handling and cooking poultry and eggs.  In a time where most Americans are eating from home, people should make sure to cook their food thoroughly to kill all potential pathogens. 

Coronavirus continues to spread all over the world and the immune systems of people who are unfortunate enough to be infected are responding to this with antibodies.  Antibodies are the weapon used by the B cells in acquired immune system to fight antigens that invade the body.  Doctors are using antibody tests to determine whether people have COVID or have recovered from it.  Determining whether or not a person is infected with COVID is important for many people looking to return to work/school.  Some people are proposing a proof of immunity in order for people to be able to return to work and school.  That way people can start going back to their normal daily lives without fear of contracting the virus or spreading it to others.  I think this is great because testing for immunity will give people the peace of mind to return to normal living.  The problem with this is still getting everyone to take the test, if everyone doesn’t take the test and infected people go back into the world then we are right back to where we started.

              Antibody tests work by detecting the body’s immune response to the infection caused by the virus.  This is different than the other COVID detection test, which is a swab that looks for the presence of the virus in the nose.  IgM is the first antibody produced by the body in response to infection when B cells are partially activated, after B cells are fully activated by helper T cells they will secrete IgG antibodies. IgG antibodies are more effective and can perform more antibody functions than IgM.  However, IgG takes some time to be produced by the body, so if only IgM antibodies are present that means a person is in the early stages of COVID infection.  If a person has both IgM and IgG antibodies against COVID that means they are in the peak of infection and are very contagious.  A person with only IgG antibodies has fought off the virus and developed memory B cells against the virus and is not contagious to others.  I think this is a great way to test for immunity and infection at the same time, something the original test cannot do. 

              The goal of these tests is to determine the number of people who have been infected and determine who is immune.  However, the test does have some potential problems.  For one, if the antibody test is given in the first few days of infection there may be a false negative.  This is because it takes a few days for any antibodies to be produced, so this limits the effectiveness of these tests.  Another potential problem with this test is cross-reaction among antibodies.  There are many types of coronaviruses and scientists still do not know if this will cause the tests to give false-positives or false-negatives.  If these tests can be made available to everyone, using these tests in addition to the other COVID detection test would vastly decrease the number of coronavirus cases.  That way, the government could mandate who is allowed to leave the house, limiting the number of people who could get infected.

The Covid-19 pandemic has gotten a lot worse since my last blog post, the number of confirmed cases in the US has skyrocketed to over 300,000.  Despite having a much later outbreak than countries such as Italy, Spain and China, the US now has the most confirmed cases in the world.  Worldwide death toll has reached 70,000 and the world is scrambling to find a solution to this new and dangerous virus.  Researchers are in the early stages of developing vaccines and testing antiviral drugs to fight the virus.  I think it is great that scientists are so committed to finding vaccines and treatment that are effective against the coronavirus.  However, I know this process will take a long time and the world will have to hold out until this process is done.

The Toyama Chemical Company has announced that they are now entering phase 3 trials to evaluate the safety and effectiveness of the influenza antiviral drug Avigan for coronavirus patients.  This drug inhibits the RNA polymerase of the influenza virus; however, coronavirus also uses RNA polymerase to replicate, so they believe it can be effective against the coronavirus as well.  The company wants to supply their drug to the Japanese government as well as other countries to stop the spread of coronavirus.  I think this is rather interesting, you have a company researching the effectiveness of its own product against coronavirus.  This is a tricky situation because there is obviously going to be some biased in the research since the company is trying to prove their drug’s effectiveness in order to cell it all over the world.  If the antiviral drug actually works that is great, however you do not want this company to rush through their research and make a mistake that could hurt more people and waste valuable time and resources. 

UVA recently joined a national clinical trial to treat patients with remdesivir, an antiviral drug used to treat patients with Ebola. This particular antiviral drug showed promise in animal testing against SARS and MERS, two different types of coronavirus.  UVA will randomly assign coronavirus patients to either receive remdesivir or a placebo, then they will monitor their conditions.  I think the fact that this antiviral drug has been tested on other types of coronaviruses is very promising.  However, since the testing was only done on animals a lot more research and testing will be needed to make a definitive statement about its effectiveness.  The whole world knows that finding an effective treatment is very important in the fight against Covid-19.  It is great to see scientists all over the world working diligently to find an effective treatment, this pandemic is the top priority at the moment in the world of medicine.

T cell therapy is a new form of immunotherapy that uses genetically engineered T cells to fight disease.  T cell therapy is still developing and at the moment it is mainly used to fight forms of cancer.  The therapy has shown promising results so far, however serious side effects have also been associated with this form of therapy.  Due to the adverse side effects associated with T cell therapy, it is not widely used in the medical community.  I believe that T cell therapy could be important in reducing the amount of deaths in people with cancer.  It is great that scientists are researching new ways to treat cancer, chemotherapy can be such a long and draining process.  If scientists can perfect T cell therapy and reduce the amount of results that have side-effects, then this could be the future of cancer treatment. 

A study was recently done on patients with mantle cell lymphoma (MCL) that were treated with CAR T-cell therapy.  CAR T-cell therapy works by removing a patient’s T-cells, then modifying them to recognize and attack cancer cells.  Then, the modified T-cells are injected back into the patient.  Results of this therapy showed that more than 90% of patients had no disease progression after 12 months.  While these results are promising, a 12-month follow-up revealed the survival rate of patients was down 19% from the projection.  Severe and life-threatening side-effects due to the T-cell therapy were found in 15-30% of patients.  Side-effects included cytopenia (reduction in certain blood cells), infections, neurological events and cytokine release syndrome.  Furthermore, some T-cell therapy patients were shown to have relapses.  I think at this point in the T-cell therapy development, the risks far outweigh the rewards.  For people with other medical problems, the side-effects of the T-cell therapy could kill them. 

While T-cell therapy is promising, it may not be accessible to wide groups of people.  Some estimates say that T-cell therapy could cost up to $375,000 for just one treatment.  This is a lot of money for one treatment, some people will not even be cured by T-cell therapy and others could relapse after being cured initially.  Having 2 or 3 treatments of T-cell therapy could cost upwards of $1 million, this is just too much money for most people in the world.  This insanely high cost coupled with the adverse side-effects associated with T-cell therapy is why the treatment is not used by more people.  I hope researchers can make the treatment more cost effective and reliable so it can be distributed to more people.

With the coronavirus pandemic taking up all the attention in the news, other diseases become overshadowed.  However, this past week, on March 24^th was World Tuberculosis Day.  March 24^th is significant to tuberculosis because this the day that Dr. Robert Koch announced that he had discovered the bacterium that causes TB in 1882.  The purpose of World TB day is to raise awareness for the disease and try to stop the disease for good.  TB is the deadliest infectious disease killer in the world today, it kills more than 4,000 people every day.  That is very interesting to me, I had no idea that TB was such a problem today and killed so many people, I rarely hear about it in the news.  I think it is great that WHO recognizes World TB Day so that people such as myself can learn more about the disease.

Recently, 5 employees at a Michigan wildlife disease lab were diagnosed with TB.  The workers likely contracted the disease from the deer they were researching, who had bovine TB.  The workers who contracted the disease have been undergoing antibiotic treatment for the last few months to fight the disease.  The lab is still trying to figure out exactly how the workers were infected with TB, there were no documented incidents or mistakes that could help pinpoint how it happened.  The workers were only diagnosed with latent TB; this is good because only about 5-10% of latent TB infections ever become active.  This case is a perfect example of why lab safety is important.  If you are working with diseases or animals that may carry diseases, you have to wear proper PPE and follow protocol to protect yourself. 

In honor of World TB day, the WHO released new recommendations to help prevent TB.  Among the new guidelines, they recommend an uptick in preventative treatment for at-risk populations such as people with HIV or compromised immunity.  They also recommend a new type of tuberculin skin test be implemented in order to test for TB.  This tuberculin skin test is likely to help those in need of TB preventative treatment and this test is easily accessible.  I think it is great that the WHO releases these new guidelines every year on World TB Day in order to help people fight this disease.  If you keep people informed, they will be better prepared to fight infection and eventually we can stop TB for good.

The coronavirus pandemic has completely thrown off the way of life for many people, including me.  UNC and most other universities around the country have shut down for the remainder of the school year.  I am actually quite upset about this because it is my senior year and I wanted to finish the semester on campus with my friends and get the normal college experience one last time.  The ending was so abrupt and surprising that I did not get to say goodbye to a lot of people that I may never see again.  However, I am grateful that we can continue to do classes online and I can graduate this spring, even though online classes are not ideal.  I was also on the club swim team and these year’s college club swim nationals were cancelled due to coronavirus.  To be honest this upset as much as UNC closing did, I love swimming and I wanted to have one more swim meet in my career before I stop, but I won’t get that chance.  However, I’m happy that I have swum since I was 7 and made many great friends and had many great experiences. 

              Adjusting to having classes online has been a struggle to say the least.  It is very hard for me to focus on schoolwork when I am home with my parents.  At UNC I could go to the library or study with others to keep my motivated/focused, however there is nobody at home to make me do my work, so it is hard to force myself to study.  I was also used to the routine I had at school, I had the same cycle of homework and quizzes every week.  However, now since we are doing online classes everything has been changed around and I have to be careful to check due dates often, since they have all changed.  The workload has also increased since we missed a week of school due to the virus.  The hardest thing about adjusting to online classes has been the lack of in-person lectures.  Only some of my teachers are doing classes through Zoom, the rest have assigned readings in place of lectures.  This is hard for me because I am a visual learner, reading does not really help me much.  However, there are only 4 weeks left of classes and I know I can hold on until then.

              Since all of the gyms and swimming pools have been shut down, it has been really hard for me to get any exercise.  I am basically limited to running, yoga and the small weights I have in my house.  I do not enjoy running so it has been hard for me to get back into exercising since UNC closed.  While UNC was open I was swimming almost every day and going to the gym 3 times a week.  I will have to find a new routine for exercise using the recourses I have at my disposal.  Overall, I would say that I am in still in great spirits, while the situation caused by the virus is not ideal, it could be a lot worse.  I am a pretty positive person and I am not going to let this faze me.  If anything, this whole ordeal has made me appreciate the routine of daily living a lot more.

These are some of the funniest memes I’ve seen about the coronavirus pandemic:

When I see 11 people standing together in public pic.twitter.com/tcxHgZEzOJ

— Tommy Singleton (@TommySingleton) March 20, 2020

when you cough in 2020 pic.twitter.com/qB6302oxsk

— ً (@anidaiIy) March 24, 2020

How we watching ESPN after they cancelled every other sport 🤦🏾‍♂️😂 pic.twitter.com/jsCbg9cbIV

— Mark Phillips (@SupremeDreams_1) March 13, 2020

The coronavirus, or Covid-19, has taken the world by storm over the past few months, and on March 11^th it was declared a pandemic by WHO.  While the US was able to avoid the outbreak for the first few months, the number of cases in the US have skyrocketed over the last few weeks.  This has led to widespread panic and closures all over the country.  Major sports leagues such as the NBA, MLB, NHL have all suspended their seasons, and the NCAA has cancelled all sports for the rest of the school year, leaving many athletes heart broken.  In addition to sporting events being cancelled and postponed, schools all over the world are being shut down or switched to online teachings.  Covid-19 has forced a change in the way of life for many people and panic is starting to set in for some people.  The virus has affected me in multiple ways as well, my club sport championships were cancelled, something I was really looking forward to.  The closure of UNC is also very disappointing to me since it is my last semester as an undergraduate. 

              At the moment, the country being hit the hardest by Covid-19 is Italy, so far there are an estimated 1,800 virus-related deaths and over 350 people died on Saturday, March 14^th alone.  However, the spread of the virus appears to be slowing down in China and Korea.  The CDC in the US has urged people to stop gathering in groups of more than 50 people and to practice “social-distancing” in order to stop the spread of the virus here.  NYC has taken measures to stop the spread of the virus by closing nightclubs and theaters, as well as limiting eating establishments to takeout only.  I think a lot of people in the US are frustrated with the way the government is handling the pandemic because there is not any uniform policy for people to follow.  Some states are placing restrictions like those in NYC while other states are doing nothing at all.  I think people just want the leadership to come up with a policy for everyone that will help everyone.

              With the coronavirus getting worse and spreading farther throughout the world, the race to create a vaccine/cure is on.  According to government officials in the US, the first vaccination trial for Covid-19 is set to take place on Monday, March 16^th.  Last week, two Canadian doctors were able to successfully isolate and reproduce the coronavirus in their lab.  This is significant because this isolated coronavirus can now serve as a tool to help test vaccines and therapies for patients.  While some people may be excited about this news I know that developing a vaccine is not that simple.  It takes months and sometimes years of testing in order to develop a vaccine that can actually be deployed against the virus, let alone one that can be successful.  However, these are promising developments and perhaps this news can give people hope and relieve some stress about the virus.

STDs are extremely common and the number of cases are continuing to grow, however many people have no idea of this fact.  According to the studies from the CDC in 2018, 2.5 million Americans have an STD, chlamydia is one of the most common with over 1.8 million cases.  Americans had increased cases of nearly all STDs in 2018, however only 36% of Americans knew that STDs have become more common over the last decade.  Cases of chlamydia specifically have increased by 42% over the last decade.  Many health officials believe that the rise in STDs is due to a lack of care and effort by young adults to prevent these diseases.  It is not surprising to me that so many people are not educated about STDs, even I did not know that chlamydia was so common in Americans. 

Baker University in Kansas is doing their part to stop the chlamydia outbreak in the US.  Jamie Pellikan, a student there, believes that the rise of cases in chlamydia can be contributed to poor sex education courses.  Baker University officials are trying to get health officials to come to campus and educate students on STDs and the factors surrounding them.  They are also encouraging students to be more mindful about STDs by getting tested more often and keeping the sexual partners informed about their testing status.  Chlamydia is common, however it can be harmful if it is not treated correctly with physician-prescribed medications.  It is also possible for chlamydia to come back after treatment has been completed.  Baker University is keeping students informed about these chlamydia facts and more by sending emails to students about the dangers of chlamydia and ways to prevent it.  I definitely agree with the claim that sex education is not doing a good job of properly educating people on STDs.  In my schools growing up, the sex ed courses were short and relatively unhelpful. 

Chlamydia, and all other STDs, are preventable.  The one and only way sure-fire way to prevent an STD is by practicing abstinence, there is no way you can get an STD if you do not have sex.  Another way to prevent getting STDs is by wearing a condom, however these do not always work.  Many people do not wear condoms correctly and some STDs can be transmitted through the part of the genitals that the condom does not cover.  You can also prevent the spread of STDs by getting tested regularly and being honest with your sexual partner about history of STDs.  By educating themselves and practicing safe sex, it is possible for people to decrease the amount of STDs being transmitted in the US.