A multi centre randomized open label trial of chloroquine for the treatment of adults with SARS-CoV-2 infection in Vietnam

Background: COVID-19 is a respiratory disease caused by a novel coronavirus (SARS-CoV-2) and causes substantial morbidity and mortality. There is currently no vaccine to prevent COVID-19 or therapeutic agent to treat COVID-19. This clinical trial is designed to evaluate chloroquine as a potential therapeutic for the treatment of hospitalised people with COVID-19. We hypothesise that chloroquine slows viral replication in patients with COVID-19, attenuating the infection, and resulting in more rapid decline of viral load in throat/nose swabs. This viral attenuation should be associated with improved patient outcomes. Method: The study will start with a 10-patient prospective observational pilot study following the same entry and exclusion criteria as for the randomized trial and undergoing the same procedures. The main study is an open label, randomised, controlled trial with two parallel arms of standard of care (control arm) versus standard of care with 10 days of chloroquine (intervention arm) with a loading dose over the first 24 hours, followed by 300mg base orally once daily for nine days. The study will recruit patients in three sites in Ho Chi Minh City, Vietnam: the Hospital for Tropical Diseases, the Cu Chi Field Hospital, and the Can Gio COVID hospital. The primary endpoint is the time to viral clearance from throat/nose swab, defined as the time following randomization until the midpoint between the last positive and the first of the negative throat/nose swabs. Viral presence will be determined using RT-PCR to detect SARS-CoV-2 RNA. Discussion: The results of the study will add to the evidence-based guidelines for management of COVID-19. Given the enormous experience of its use in malaria chemoprophylaxis, excellent safety and tolerability profile, and its very low cost, if proved effective then chloroquine would be a readily deployable and affordable treatment for patients with COVID-19. Trial registration: Clinicaltrials.gov NCT04328493 31/03/202

Regenerating the Socio-Ecological Quality of Urban Streams : The Potential of a Social Learning Approach

The degradation of urban streams is a pressing problem in many cities around the world. Particularly in the so-called Global South, this degradation is associated with factors such as poverty, unplanned settlements, social exclusion, lack of basic sanitation infrastructure, poor management of water resources and inefficiencies in environmental governance systems. Responses to this urban challenge involve the participation of diverse stakeholders in a complex process of dialogue and learning that must deal with the multifaceted ecological and social issues affecting urban water systems and populations inhabiting their surroundings. In this context, social learning is considered a relevant approach to inform collective action towards the sustainability of these socio-ecological systems. The goal of this chapter is to identify potentialities and challenges in utilising a social learning approach to facilitate dialogue between a range of stakeholders involved in the restoration of an urban stream in a context of socio-ecological vulnerability. Our analysis is built on a representative case from urban Brazil: the Taquara Stream, in the city of Porto Alegre. This case involves a community-based initiative enacted by a group of citizens who are collectively seeking solutions to regenerate the socio-ecological quality of this local stream and watershed

Observations of climate change among subsistence-oriented communities around the world

The study of climate change has been based strongly on data collected from instruments, but how local people perceive such changes remains poorly quantified. We conducted a meta-analysis of climatic changes observed by subsistence-oriented communities. Our review of 10,660 observations from 2,230 localities in 137 countries shows that increases in temperature and changes in seasonality and rainfall patterns are widespread (≈70% of localities across 122 countries). Observations of increased temperature show patterns consistent with simulated trends in surface air temperature taken from the ensemble average of CMIP5 models, for the period 1955-2005. Secondary impacts of climatic changes on both wild and domesticated plants and animals are extensive and threaten the food security of subsistence-oriented communities. Collectively, our results suggest that climate change is having profound disruptive effects at local levels and that local observations can make an important contribution to understanding the pervasiveness of climate change on ecosystems and societies