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COVID-19 Update: Oleander Extract, Younger Adults

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Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today:

Oleander Extract for COVID-19? Expert Says “No”

Oleandrin, a toxic cardiac glycoside found in the poisonous oleander plant, is making headlines as a potential treatment for COVID-19 infection, raising concerns that uninformed people may eat the leaves of the plant and become ill or die.

Onset of toxicity occurs several hours after consumption, and gastrointestinal symptoms such as nausea, vomiting, abdominal pain, diarrhea (which may contain blood), and loss of appetite may be initial signs of oleandrin poisoning, Medscape Medical News reports.

Poisoning can affect the heart as well as the central nervous system, as evidenced by drowsiness, tremors, seizures, and coma leading to death.

According to Axios , President Donald J. Trump recently met with Phoenix Biotechnology’s director,  whose company manufactures oleandrin. The president reportedly “expressed enthusiasm” about the extract. Although the product has been evaluated in in vitro studies, it’s a far cry from test tube to human, one expert cautions.

Pandemic May Be Driven by Younger Adults

As the cumulative number of reported COVID-19 cases among children in the United States stands at more than 400,000, the World Health Organization (WHO) on Tuesday expressed concern that the spread of the novel coronavirus may be driven by other age groups — people in their 20s, 30s, and 40s, many of whom are unaware they are infected.

WHO officials have said that the proportion of younger people among those infected has increased globally, putting at risk vulnerable sectors of the population worldwide, including the elderly and sick people in densely populated areas with weak health services.

A surge in new cases has prompted some countries to reimpose curbs. The virus has killed more than 770,000 people and infected nearly 22 million, Reuters reports.

Stop the PPI to Lower COVID-19 Risk?

A 60-year-old patient who takes a proton pump inhibitor (PPI) hears that “these heartburn drugs can give you COVID-19” and requests an urgent telehealth visit. Although the patient acknowledges that the medication has helped her symptoms of gastroesophageal reflux disease (GERD), she wants to stop if the drug might increase her risk for COVID-19, a possibility that one study has suggested.

What is the best course of action in this scenario? Charles P. Vega, MD, describes the case, then polls readers about four treatment options, and discusses his approach.

Deep-Throat Saliva Lacks Sensitivity 

While convenient and easy to collect, deep-throat saliva specimens lack sensitivity for diagnosing COVID-19, compared with other respiratory tract specimens, according to a prospective study.

“Specimens with higher yield, such as sputum or naso/oropharyngeal swabs, should be used for high-risk persons,” an author of the study told Reuters Health.

The investigators evaluated the diagnostic performance of deep-throat saliva by comparing positive rates and viral RNA concentrations with those detected using conventional respiratory specimens collected from 50 patients with SARS-CoV-2 infection in Hong Kong.

The overall SARS-CoV-2 RT-PCR–positive rate for all specimen types was 79.2%, with the highest positive rates for sputum (89.4%), followed by pooled nasopharyngeal and throat swabs (80.9%), and deep-throat saliva (68.7%), according to the study, which was published in the Journal of Infectious Diseases.

COVID-19 Linked to Development of Myasthenia Gravis

Myasthenia gravis should be added to the growing list of potential neurological sequelae associated with COVID-19, new research suggests.

Clinicians from Italy have described what they believe are the first three reported cases of acetylcholine receptor (AChR) antibody-positive myasthenia gravis after COVID-19 infection.

“I think it is possible that there could be many more cases,” the lead author told Medscape Medical News .

Practices Still Struggle to Survive

As government assistance programs expire or wind down, physician practices across the country are struggling to stay afloat, and some offices have begun to close. Despite a rebound in face-to-face office visits, lost business is dragging down many practices, reports from a variety of sources reveal.

In a national survey conducted from July 24 to July 27 by the Primary Care Collaborative and the Larry Green Center, 20% of primary care physicians were uncertain they would have enough staff, billable work, and cash on hand to stay open for 4 more weeks.

A pain medicine specialist in Sacramento, California, who was the incoming president of the California Medical Association (CMA), resigned the post “to focus on his practice, which had been struggling financially since the pandemic,” according to a CMA statement about the decision.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Thousands throughout the world have died.

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Jake Remaly is a staff journalist at Medscape Medical News and MDedge. He can be reached at [email protected]

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