Meta-analytic magic, ivermectin, and socially responsible reporting.

Some clinicians prescribe ivermectin for COVID-19 despite a lack of support from any credible South African professional body. They argue that when faced by clinical urgency, weak signals of efficacy should trigger action if harm is unlikely. Several recent reviews found an apparent mortality benefit by including studies at high risk of bias and with active rather than placebo controls. If these studies are discounted, the pooled mortality effect is no longer statistically significant, and evidence of benefit is very weak. Relying on this evidence could cause clinical harm if used to justify vaccine hesitancy. Clinicians remain responsible for ensuring that guidance they follow is both legitimate and reliable. In the ivermectin debate, evidence-based medicine (EBM) principles have largely been ignored under the guise thatin a pandemic the 'rules are different', probably to the detriment of vulnerable patients and certainly to the detriment of the profession's image. Medical schools and professional interest groups are responsible for transforming EBM from a taught but seldom-used tool into a process of lifelong learning, promoting a consistent call for evidence-based and unconflicted debate integral to clinical practice.

The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis in Ireland: real-world data from the Irish cystic fibrosis registry

Objectives: The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis (PWCF) in Ireland was investigated by comparing the utilisation of regular hospital facilities in 2020, with data collected in 2019. Methods: All data were collated by the Cystic Fibrosis Registry of Ireland (CFRI). Comparisons were made between PWCF's access to regular hospital facilities utilised for the treatment and management of their condition prior to the outbreak of the pandemic in 2019, and preliminary data during the pandemic in 2020. A descriptive analysis of the differences between key outcome measure data was conducted. The outcome measures analysed were (i) the number and type of encounters, (ii) the number of virtual clinics, (iii) the number of pulmonary function tests (PFTs) carried out, (iv) the number of hospital admissions, and (v) the number of individuals receiving home intravenous antibiotic treatment. Results: In 2019, encounter data were recorded for 1,254 individuals, compared to 1,143 in 2020. Overall, fewer encounters took place in 2020 (5,346) than in 2019 (7,947). Decreases were observed across all in-person hospital encounter types in 2020, when compared with 2019 (annual review: 273 vs 747;day-unit review: 1,792 vs 2,864;drop-in: 115 vs 277;OPD appointment: 1,064 vs 3,289). However, since the outbreak of the pandemic, 1,696 virtual encounters occurred. Significantly, the number of PFTs carried out decreased by 58% in 2020 (2,283), when compared with 2019 (5,458). Of the 1,696 virtual encounters, only 183 (10.8%) saw PFTs carried out. Conclusion: Our analysis has shown a clear reduction in the utilisation of usually regular hospital resources by PWCF in 2020 when compared with 2019. In-person hospital encounters have decreased by 55% in total, highlighting the significant impact that the SARS-CoV-2 pandemic has had on PWCF.

Essential medicine selection during the COVID-19 pandemic: Enabling access in uncharted territory

The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions.

Is COVID-19 the long overdue wake-up call for pharma supply chains?

This paper describes how the exclusive focus on non-clinical and clinical data collection during the development of medicines and healthcare products results in supply chains that are riddled with risk and issues. In the main, this is due to little awareness among actors in the development process of the seminal impact decisions taken here can have on the quality, cost and lead-time performance of the future commercial supply chain. In the author’s experience, things will only begin to improve if product developers open their minds to a totally new model for product development – one that begins with its end-users – patients and healthcare professionals. The paper concludes with a call for strategic supply chain management being exercised from the inception of a development programme. © 2020, Euromed Communications. All rights reserved.

The role of serological testing in the SARS-CoV-2 outbreak.

Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies.

The COVID-19 pandemic: Research and health development in the world health organisation Africa Region

Concerns have been expressed about the view point of WHO AFRO concerning research for health in the African Region. WHO AFRO considers research a critical component in the improvement of health in the Africa region. Ensuring the effectiveness of our strategies, policies and programmes requires evidence. In the context of the ongoing COVID-19 outbreak, WHO research interests cover key areas of the response. The WHO AFRO consider research as critical in our efforts at protecting people against health emergencies and pandemics like the COVID-19 and ensuring universal access to proven interventions. In view of this, the WHO has taken steps to strengthen capacity for research in the region. The results of these efforts may take time to manifest but will surely do as we persist in our drive, with support from our partners.