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Switzerland quarantine rule ‘could stop terminally ill accessing assisted death’

Travel restrictions imposed on people returning from Switzerland could prevent terminally ill patients from having an assisted death, campaigners have said.Travel restrictions imposed on people returning from Switzerland could prevent terminally ill patients from having an assisted death, campaigners have said.

Travellers arriving in England after 4am on Saturday will need to self-isolate for 14 days, a rule which was also enforced in Scotland last week. Dignity in Dying said the rule change, announced late on Thursday for England, has made it “impossible to plan” for terminally ill patients hoping to travel to the Dignitas clinic in Switzerland.

It added that jobs and caring responsibilities, coupled with an average cost of £10,000 at Dignitas, could put the option of assisted dying out of reach for some people. Jane Parker was diagnosed with motor neurone disease in October 2019 and had been considering travelling to the clinic for an assisted death, which is illegal in the UK.

“I am now unable to speak and swallowing has become very difficult as the muscles continue to weaken,” the 68-year-old told the PA news agency.“I do not want to suffer a protracted, traumatic death but my options are severely limited, even more so since lockdown.

“Travelling to Switzerland for a legal assisted death, for example, is made even more difficult, particularly with this recently announced quarantine and travel restrictions changing practically every week.” This is how difficult planning an assisted death overseas was before the pandemic. 

Ms Parker, who has three daughters and three grandchildren and lives with her husband Adrian in Devon, said: “I want to die at home, and am genuinely considering the idea of refusing food and water – a legal option under the current law.
“How can we allow people to starve and dehydrate to death, but not allow someone to slip away, quickly and peacefully in their sleep?” Dignity in Dying campaigns manager Ellie Ball told PA: “It’s just another source of anxiety about an option that is already so fraught with difficulty.

“For those who have the resources and strength to avail themselves of this choice, it takes many months of meticulous planning, often in secret. But with travel restrictions changing by the day, it makes planning almost impossible. “And for loved ones returning to the UK… imagine losing a dear relative, having to leave their body behind in a foreign land and then dealing with your grief completely alone with your support network?”
Ms Ball said the best solution is for assisted dying options to become available in the UK for “terminally ill, mentally competent people” in their final months.

In UK law, helping someone end their life is punishable by up to 14 years in prison.Before the coronavirus pandemic, Ms Ball said one Briton a week was travelling to Switzerland for an assisted death.
She added that each year around 300 terminally ill people end their own lives in the UK, often involving “multiple, incredibly traumatic attempts”.

The Government ruled out changing the law on assisted dying in 2019 after the high-profile case of Anne Whaley. Ms Whaley, then 76, was interviewed by police ahead of a planned journey with her 80-year-old husband Geoff Whaley, who had motor neurone disease, to Switzerland to end his life.

Before his death, Mr Whaley told the Times the stress of police involvement had “destroyed everything we had done to prepare ourselves”. 

Reference: P A Media: By Edd Dracott, PA 2 days ago: 28/08/2020

Passenger caught coronavirus in plane toilet, says study

A woman is believed to have caught coronavirus in the toilet of a plane according to a study published by the US Centers for Disease Control.A woman is believed to have caught coronavirus in the toilet of a plane according to a study published by the US Centers for Disease Control.

The study was based on evidence collected on an evacuation flight from Milan, Italy, to Incheon, South Korea, and at the government quarantine facility passengers were taken to after landing.

A total of 310 passengers were scheduled to the board the flight on 31 March, at the height of the pandemic.

It was “conducted under strict infection control procedures by the Korea Centers for Disease Control and Prevention (KCDC), based on the guidelines of the World Health Organization (WHO)” according to the research led by Dr. Sung Hwan Bae, a physician with the Soonchunhyang University College of Medicine in Seoul, South Korea.

Pre-boarding, passengers were examined by medical staff at the airport, which involved physical examinations, medical interviews and body temperature checks out of the airport.Eleven passengers who exhibited Covid-19 symptoms were removed from the flight, while 299 asymptomatic passengers were permitted to board the 11-hour flight to South Korea.

All passengers were given N95 respirators and kept 2m apart at the airport and on the plane.

“Most passengers wore the N95 respirators except at mealtimes and when using the toilet during the flight,” according to the study.Upon landing, all the passengers were taken directly to a government facility to quarantine in isolation and were tested for Covid on the 1st and 14th day of quarantine.

Six of the passengers tested positive for Covid on day one – they were transferred to hospital straight away but showed zero symptoms of coronavirus for the next 14 days and have since been classed as asymptomatic.The 28-year-old woman in question did not show symptoms when she boarded the flight in Italy, and had tested negative for Covid-19 when she began her 14-day quarantine.

But on the 14th day, tests came back positive.

Given the conditions, researchers believed that she picked up Covid-19 after using the plane toilet that an asymptomatic carrier had used.The woman is said to have worn the N95 mask throughout the flight, except when she used the toilet.The study said: “The toilet was shared by passengers sitting nearby, including an asymptomatic patient. She was seated three rows away from the asymptomatic patient.

 “Given that she did not go outside and had self-quarantined for three weeks alone at her home in Italy before the flight and did not use public transportation to get to the airport, it is highly likely that her infection was transmitted in the flight via indirect contact with an asymptomatic patient.”

The only alternative explanation, which researchers said was less likely, was that she had a longer than usual incubation period. In light of the findings, researchers recommended that to minimise transmission on aircraft, masks should be worn during the flight, hand hygiene should be maintained and social distancing measures should be maintained before boarding and after disembarkation.

Reference: Independent: Qin Xie 2 days ago: 27/08/2020

Unique clusters of type 2 diabetes identified in Indians

Researchers have identified distinct forms of type 2 diabetes unique to Asian Indians which could have implications for managing the disease.Researchers have identified distinct forms of type 2 diabetes unique to Asian Indians which could have implications for managing the disease.

Scientists said that Type 2 diabetes in Asian Indians, referred to as the “Asian Indian Phenotype”, differs from that in white Caucasians in a number of significant ways, however the majority of knowledge surrounding diabetes and its cardiovascular complications has been accumulated from studying white populations with Western European ancestry.

In the latest study, led by the University of Dundee’s Inspired project, researchers found that type 2 diabetes in Asian Indians can be classified into four distinct phenotypic clusters. While two of the clusters correspond to clusters identified in the European populations, the other two are novel sub-groups unique to Asian Indians.

The Asian Indian Phenotype is characterised by high levels of abdominal fat and increased insulin resistance even at low levels of body mass index (BMI), and it has been suggested this is the main reason for increased propensity to develop type 2 diabetes at younger age.

Researchers said classifying Asian Indians with type 2 diabetes into phenotypic clusters could help in predicting the risk of complications and in focusing more attention on individuals with the highest risk of developing these.

Professor Colin Palmer, of the University of Dundee’s School of Medicine, said: “These findings appear to be unique to Indians as they differ significantly from the findings published earlier in the European population.

“We recently reported that Asians respond better to DPP4 inhibitors and SGLT2 inhibitors. “The findings of this study confirm the greater insulin secretory defect and the younger age at onset of diabetes in South Asians.”

Inspired seeks to improve diabetes outcomes in India by working to better understand who gets diabetes, how it progresses, why some people respond better than others to treatments, and why some patients develop complications.

The university said the project sees Dundee’s expertise in the use of medical records to deliver improved care in diabetes “twinned” with the large patient data set (covering more than 450,000 Indian patients) collected by Dr Mohan’s Diabetes Specialities Centres, the largest clinical network of diabetes care in India.

The four clusters identified in the study are Severe Insulin Deficient Diabetes (SIDD), Insulin Resistant Obese Diabetes (IROD), Combined Insulin Resistant and Deficient Diabetes (CIRDD) and Mild Age-Related Diabetes (MARD).

SIDD and MARD correspond to the clusters identified in the Europeans populations, while the other two are novel sub-groups unique to the Asian Indian population.Researchers said CIRDD is of particular importance as it is

characterised by difficult-to-control hyperglycemia and increased risk of both diabetes eye and kidney disease.

Lead author Dr Viswanathan Mohan, chairman of Dr Mohan’s Diabetes Specialities Centre and President of Madras Diabetes Research Foundation, said: “These subgroups of type 2 diabetes have implications as far as treatment is concerned and the choice of anti-diabetic drugs.”

The study is published in BMJ Open Diabetes Research and Care. The research was funded by the National Institute for Health Research. 

Reference: PA Media: By Lucinda Cameron, PA Scotland 2 days ago:26th August 2020