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Dexamethasone – At Last?
By Shlomo Maital
Two hours ago, the New York Times printed this news story, by Benjamin Mueller:
LONDON — “Scientists at the University of Oxford said on Tuesday that they had identified what they called the first drug proven to reduce coronavirus-related deaths, after a 6,000-patient trial in Britain showed that a low-cost steroid prevented the deaths of some hospitalized patients. The steroid, dexamethasone, a well-known anti-inflammatory drug, appeared to help patients with severe cases of the virus: It reduced deaths by a third in patients receiving ventilation, and by a fifth in patients receiving standard oxygen treatment, the scientists said. They found no benefit from the drug for patients who did not need respiratory support.”
How does it work? Apparently, as a steroid drug, it prevents the body’s immune system from over-reacting and making the patient even more ill. “Experts said it appeared that the steroid tamped down the overactive inflammatory response to the virus in some patients, known as a cytokine storm, rather than inhibiting the virus itself.”
Dexamethasone was first made in 1957 and was approved for medical use in 1961. So it is nearly 60 years old! Dexamethasone is cheap! In the United States, a month of medication typically costs less than US$25. In India, a course of treatment costs about 50 cents US. This is because the drug is now available as a generic. More than a million prescriptions a year are given in the US.
Creativity Is the Answer: Oxford’s New Ventilator!
By Shlomo Maital
Prof. Andrew Farmery OxVent: simple, effective
In times of crisis, like the ones we are living today, resources and time are scarce – but creativity is plentiful. For example: Creative British doctors and scientists who have designed a primitive, simple, easy-to-produce ventilator, which SONY may mass produce. NY Governor Andrew Cuomo said today that his state has 10,000 ventilators, but it needs 30,000, as the coronavirus is spreading rapidly in his state – and the US Federal Govt. (FEMA) has sent…400 of them, even though there are 20,000 of them in an emergency US stockpile.
[A ventilator is a device that pumps air into the lungs of coronavirus victims, who struggle to breathe].
Here is the story.
Interviewer: “In just one week, a team at Oxford University and King’s College London have built a simple ventilator that could potentially save thousands of lives as part of the UK and the world’s fight against coronavirus. The OxVent is a rapid prototype ventilator that could keep people breathing while they battle the worst impacts of COVID-19. Andrew Farmery of the University of Oxford, one of the people involved in its development, talks about its past, present, and potential. … How are you?
Prof. Andrew Farmery: ” I’m very well, although slightly knackered. It’s been a very long week. It’s been absolutely incredible, from nothing a week ago when we first had an idle chat Monday morning last week, to this afternoon, when we pitched it to the Cabinet and the MHRA (Medicines and Healthcare Products Regulatory Agency). We’re waiting to hear whether they think it’s a goer or not.”
Farmery: “It’s laughably simple in some ways. It’s a compressible bag, a bit like a child’s rugby ball. It’s a compressible squeezy bag – the sort you use to resuscitate patients who have collapsed from cardiac arrest. Ambulances carry them around. But we’ve trapped it inside a rigid Perspex box and we inject compressed air into the rigid Perspex box that squeezes this bladder and pushes air out through some valves which we already have, and inflates the patient’s chest. There’s a second set of valves that allows gas to come out of the patient’s chest and also out of the rigid Perspex box. So it’s a sort of electro-pneumatic device. The air is injected into the box through what’s called a solenoid valve, which is controlled electronically, and we can regulate the flow of air compression gas that goes into the box, the speed with which it goes in, how much time is allowed for inspiration and expiration. We can control the pressures generated in the patient’s airway. All the things you would want, and we’re just doing it with this simple feedback controller.”
Farmery continues: “As well as an academic, I’m also a consultant anaesthetist, so I deal with ventilating patients every week. That’s what I do. The design had come out of what the clinicians want. We were slightly worried at the start when Boris [Johnson, UK PM] announced Land Rover and JCB were going to be making ventilators. I was slightly alarmed that they knew sod-all about ventilators and nobody had really taken the opinions of people like me and doctors and anesthetists around the country.”
“The electronics is based around a very simple circuit board called an Arduino – basically a tiny little circuit board used to teach kids about coding and electronics. It’s basically a toy, but that’s what the prototype is based on. We might even base the whole thing on that. It depends on whether we can knock PCBs out quickly enough. So the control engineers are still working on that, refining it. You’ve got to tell the solenoid valve what to do and then you’ve got to measure and monitor the pressures at various points with sensors to make sure that the solenoid is doing what you told it to do. That’s classic control engineering and they love that sort of thing, and they’re off on it already.”
SONY is exploring the possibility of making 5,000 of the new ventilators weekly I hope the design can be shared with other countries, including my own, Israel.
TIMnovate 