“Texas is the economic engine of America, and for America to get going, Texas has to get going. By God, Texas is getting going now.” Texas Governor Greg Abbott
“Trump Doesn’t Understand the Difficulty of Going Back to Work if You’re Dead.” Rob Reiner
“The cure is going to be worse than the disease if people are not able to go back to work. Governor, you need to open up Ohio now.” Furloughed Ohioan
“Authorities around the world are between a rock and a hard place: they need policies that both limit the spread of the coronavirus and allow their economies to “open for business.” The two demands are inherently incompatible, and so neither one can be fulfilled.” Charles Hugh Smith, author and blogger
- Recent Developments and Headlines
- Numbers and Trends
- When is the Ideal Time to End Lockdowns?
- Gazing into the Crystal Ball
- Potential New Treatments
- New Scientific Findings
- The Road Back?
- Projections & Our (Possible) Future
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Note: As there is a lot of inaccurate information circulating, we only include information that we can confirm from a credible source or that is based on data that we can verify. To the extent that we derive information from an online source, we provide a link to the source, which typically provides more detail that is included in our update. If you have any questions about any information included in an update, or if you have a different view, please let us know and we will supplement or correct as needed.
A. Recent Developments and Headlines
Note: All changes noted in this Update are since the 4/18 Update
Sources: New York Times Coronavirus Updates, New York Post Coronavirus Updates, Zero Hedge Coronavirus Updates, Drudge, Breitbart, Wall Street Journal, Coronavirus White House Task Force Briefing, NY Governor Daily Briefing, and Worldometers
- The coronavirus is affecting 210 countries and territories (+0)
- Worldwide Total Cases = 2,406,575 (+3.3%)
- US Total Cases = 767,636 (+3.5%)
- US New Cases = 25,907 (-9%) (-2,550)
- NY Total Cases = 247,215
- Cases in NY, NJ, MA, PA & CA = 57% of all US Cases
- Worldwide deaths = 165,031 (+3.1%) (+4,984)
- US deaths = 40,575 (+3.9%) (+1,534)
- NY deaths = 18,298
- VP Pence says states have enough COVID-19 tests to start phase 1 of White House recovery plan
- Dr. Fauci says tests ‘aren’t everything’ when reopening States
- MS Gov. Reeves: ‘We Can’t Wait’ Until There’s a Cure or Everyone Can Get Tested Every Day to Reopen
- South Carolina to Reopen Public Beaches, Retail Stores Tuesday
- California Not Close to Easing Measures; L.A. Deaths Hit Record
- CA Gov. Newsom tells protesters of stay-at-home order he will be swayed by science, not politics
- D.C. Mayor Muriel Bowser: City Will Have to Experience Decline in Coronavirus Cases to Reopen Economy
- Crowds Swarm Florida Beaches Amid Phased Reopening As Critics Slam “#FloridaMorons”
- Dr. Birx Defends Jacksonville, Florida Officials for Reopening Beaches
- MIT Researchers: Reopening Too Soon Could Cause “Exponential Explosion” Of US COVID-19 Cases
- U.N. warns economic downturn could kill hundreds of thousands of children in 2020
- Trump says China should face consequences if it knowingly caused pandemic
- Wuhan Lab Denies Outbreak Link: ‘Impossible’
- Peter Navarro says China used WHO to ‘hide the virus from the world’
- NY reports drop in deaths, NY Gov. reports fewer than 500 deaths
- New York Lowest Death Toll in Two Weeks
- NY to launch nation’s largest surveillance testing program for coronavirus on Monday
- NY Gov. Cuomo: “We’re on the downward slope”
- Data shows New York’s coronavirus outbreak ‘past the high point’: Cuomo
- NJ Gov: “we’re flattening the curve”
- NJ reports jump in new cases, deaths
- Homeless Shelter Finds 36 Percent Of Visitors Test Positive, Nearly All Asymptomatic
- De Blasio blasts Trump for coronavirus aid: ‘Are you telling NYC to drop dead?’
- “Just Snap A Photo” – De Blasio Explains How To Snitch On Fellow New Yorkers Breaking Social Distancing Rules
- Florida residents hit the beach while Texans protest coronavirus restrictions
- President Trump: US doing better than Europe when it comes to coronavirus death rates
- New York golf courses can reopen with coronavirus restrictions
- Singapore, Russia report big upticks in new cases
- Peru case total passes 15k
- Spain, UK see big drop in deaths
- PA reports jump in new cases, deaths
- South Korea considers extending social distancing guidelines despite drop in new cases
- Turkey passes Iran as worst-hit country in Middle East
- Italy sees slowdown in new cases, deaths
- South Africa reports largest daily increase so far
- LA reports record jump in deaths
- Spain death toll tops 20k, joining US & Italy
- Spain extends lockdown by 2 weeks
- Spain coronavirus deaths climb by lowest daily amount in a month
- Riots and looting in Cape Town as Africa suffers 1,000 coronavirus deaths
- The coronavirus is leading to dangerous shortages of key medications
- As coronavirus spreads, medical workers in Mexico face attacks, intimidation
- Data shows New York’s coronavirus outbreak ‘past the high point’: Cuomo
- De Blasio blasts Trump for coronavirus aid: ‘Are you telling NYC to drop dead?’
- Peter Navarro says China used WHO to ‘hide the virus from the world’
- Saudi Arabia reports record new cases for 4th day in a row
- 179 recovered coronavirus patients in South Korea tested positive again
- Coronavirus Fatalities in Mexico Jump 19 Percent in Single Day
- Sweden reports 606 new cases
- Belgium reports 1,000+ cases
- Japan case total passes 10k
- Italy reports drop in new cases, deaths, hospitalizations
- Iran death toll crosses 5k as country’s reopening begins
- UK reports another ~900 deaths
- COVID-19 Could Change Travel Behavior Forever… Putting 3 Million b/d Oil Demand At Risk
- Spain “Authorizes” Military Planes To Spray Disinfectants Over Cities
- New Study Shows US Coronavirus Infections “50 To 80-Fold Higher” Than Believed
- China Outraged After Largest German Newspaper Accuses Beijing Of “Exporting” Coronavirus Pandemic, Demands €149 Billion In Damages
- Cape Town Cops Fire Rubber Bullets, Teargas As South African Food Shortages Spark Riots, Looting
- Russia Sees COVID-19 Infections Explode In 8th Consecutive One-Day Record
- Greenwich Mansions Are Finally Back In Demand, But Only As Short-Term Quarantine Escapes
- “Cemeteries Simply Cannot Cope” As Ecuador’s COVID Death Rate Suddenly Quadruples
- Meat Prices Suddenly Surge As Food Processing Plants Shut Down, With 1000s Of Tons Left To Spoil
- Hormel Shutters Illinois Plant Amid COVID-19 Fears
- 24 Hour Fitness Prepares For Bankruptcy
- ‘Report: Congress Reaches Deal on Funding PPP; $470 Billion in New Spending
- Thousands Line Up for Donated Food in Texas’ Largest City
- Judge Blocks Democrat Kansas Governor’s Order Limiting Church Gatherings to 10 People
- Donald Trump: Coronavirus Exposed Dangers of Supply Chains Dependent on China
- Coronavirus Sinking Centuries-old Traditional Breweries in Europe
- Falcons Owner Arthur Blank Believes ‘There Will Be Football,’ with or Without Fans
- Violence Looms as France’s Drug Dealers Struggle Due to Coronavirus Shortages
- European Union Cracks Deepen
- Trump Defends Lockdown Protesters: Some Governors Got ‘Carried Away’
- Residents Protest at Statehouse to ‘Open Our Ohio’
- California Fills Skate Park with Sand to Block Skaters
- Pope Francis: Church Without Sacraments ‘Not the Church’
- Turkey Surges Past Iran: Highest Virus Cases in Middle East
- 20 of Afghan President’s Palace Staff Infected
- Florida Kennel Empty ‘For the First Time in History,’ All Dogs Adopted
- Trump consults faith leaders on phased-in reopening
- Pew: More Than 8-in-10 Americans Call Mass Migration a ‘Threat’ to U.S.
- Coronavirus Spreads Through ICE Jails, Slows Deportation
- Influential coronavirus model reduces Florida’s projected deaths by over 70%
- Neiman Marcus to file for bankruptcy as soon as this week
- Walmart to hire 50,000 more workers in coronavirus-driven hiring spree
- Amazon deploys thermal cameras at warehouses to scan for fevers faster
- Skin rashes could be potential sign of coronavirus, dermatologists warn
- NYPD bust large party in Brooklyn that violated coronavirus orders
- Spanish virus lockdown prolonged as toll tops 20,000
- Israelis maintain social distancing while protesting coronavirus measures
- Cops enforcing coronavirus restrictions on Florida beach nab fugitive murder suspect
- More than 1,800 inmates, 100 staff test positive for coronavirus at Ohio prison
- Thousands in Denver protest business closures over virus
- Bill Maher: Enough with the Panic Porn
- Broadway star Nick Cordero has leg amputated due to coronavirus
- ‘Scientific breakdown’ at CDC lab led to coronavirus testing delays, report
- Czech nudists told to wear face masks by police
B. Numbers & Trends
Note: All numbers in this update are worldwide unless otherwise indicated. The numbers in this update only include cases that have been (i) confirmed through testing, and (ii) reported. The actual number of cases may be materially higher than confirmed cases, which means that the number of actual deaths from COVID-19 and recoveries may both be materially higher than reported. As testing in US ramps up, confirmed cases may rise rapidly as actual but unidentified cases are confirmed.
1. Confirmed Total Cases and New Cases
- Total Cases = 2,406,575 (+3.3%)
- New Cases = 75,809 (-4%) (-3,187)
- Total Cases = 1,089,256
- Total Cases = 383,157
- Total Cases = 767,636 (+3.5%)
- New Cases = 25,907 (-9%) (-2,550)
- US States:
- 42 States > 1,000 cases (+1), plus DC & Puerto Rico
- 33 States > 2,500 cases (+4), plus DC & US Military
- 21 States > 5,000 cases (+0)
- 16 States > 10,000 cases (+2): NY, NJ, MA, PA, CA, MI, IL, FL, LA, TX, GA, CT, MD, WA, IN & OH
- 9 States > 20,000 cases (+0): NY, NJ, MA, PA, CA, MI, IL, FL & LA
- 5 States With Largest Number of Total Cases:
- NY = 247,215
- NJ = 85,301
- MA = 38,077
- PA = 32,734
- CA = 31,527
- Top 5 States = 57% of Total Cases in US
- For more information on US States and territories, see Coronavirus Dashboard & United States Coronavirus: 764,265 Cases and 40,565 Deaths
2. Serious or Critical Cases
- Worldwide serious or critical cases = 54,225 (-1,040)
- US series or critical cases = 13,369 (+15)
- US serious or critical cases = 2.1% of Active Cases, compared with worldwide percentage of 3.4%
- Worldwide deaths = 165,031 (+3.1%) (+4,984)
- Europe deaths = 101,836
- US deaths = 40,575 (+3.9%) (+1,534)
- NY deaths = 18,298
- Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Italy: 391
- Spain: 437
- US: 123
- France: 302
- Germany: 55
- US Total Confirmed Case Fatality Rate = 5.3% compared with a Worldwide Confirmed Case Fatality Rate of 6.9% [Note: The number of cases in which infected people recovered without being tested is believed to be a large number, which would substantially reduce the fatality rate. US health officials have estimated that the US actual fatality rate is 1% or less, but we do not have yet have sufficient data to confirm the actual fatality rate.]
- Worldwide recoveries = 625,098 (+4.8%) (+28,616)
- US recoveries = 71,187 (+4.3%) (+2,918)
C. When is the Ideal Time to End Lock Downs?
- The information below was prepared by JP Morgan. The chart and following information represents their views on the ideal time for countries (and, by extension, states and cities) to end a lockdown and begin opening up their economies.
- JP Morgan also projects future outbreaks, which has been discussed in prior updates and will be revisited in future updates.
- The points on the curve are described below. In JP Morgan’s view, point C is safest, but point B could be acceptable as long as infections are managed within hospital capacity.
- Point A: This is the spot where growth of net infections (= total infections – total recoveries – total death) consistently stays below 50% W/W. Based on backward calculation on the secondary infection rate in China and Korea, JPM estimates an average secondary rate (Ro) is around 2.0. Thus, once the net infection growth rate for a week has stayed below 50% W/W, it would imply high single-digit daily infection growth rate potential. In other words, new infections become small and recoveries are developing. Considering about 2-3 weeks of the virus cycle from symptoms to release, it would be viewed that the curve is in early control stage. Under the assumption that the trend would continue, discussion on relaxed forms of social distancing could be started. The risk of point A is that as daily recoveries are small and new infections are in early control, increasing social activities through the relaxation of social distancing would create possible “acceleration” of the infection curve which would put great pressure on hospital capacity and future public healthcare interventions as a “U-turn” on policy that re-introduces stricter social distancing until the curve is in better shape is deemed to be more costly. This sudden jump of the infection tally amidst the curve control stage is called a “tipping point”, recent infection statistics in Singapore could be good evidence, although we could see soon if the curve is to be in better control again.
- Point B: This is the spot where total infection growth is below low single-digits or when net infections start to decline (i.e., new infections < new recoveries). As this suggests that a smaller population has newly been in contact with infections and more infections are in the stage of recovery, with aggressive virus testing and a certain degree of social distancing, the curve could continue to move toward a recovery trend. In this curve stage the utility function could be optimized with relatively milder disagreement among stakeholders. At this stage, as total infections/ susceptible is largely under control, the curve could face potential acceleration of the infection tally, and risk would be a possible “rebound” on the curve.
- Point C: This is the curve in the full recovery stage (i.e., very few new infections, more recoveries). If there is a strong conviction that infection is only a one-time event with one curve, this could be the ideal strategy. Closing the curve clearly means that the society could remove future uncertainties related to infection risk. However, as most view that COVID-19 could last in society until a vaccine is fully available to the public with a possible series of infection waves, this could be a relatively safe point to resume the economy, although the overall level of hospital capacity and guidance on relaxed forms of social distancing would be of added importance. Compared to point A or B, the risk on curve control should be lower at point C. The caveat is that, even though re-opening of the economy resumes at this point, it does not mean that society would fully close the curve. Thus, the risk of a second wave could be a possible scenario. Perhaps, the infection curve in the real world would be similar to the one below.
- Once society takes the underlying assumption that the risk of a series of waves persists, navigating the ideal exit point for reopening the economy (or relaxation of social distancing) should be needed. It should be noted that, particularly in Asia, overall lockdown periods are now generally matching with COVID-19’s life cycle (i.e., up to 2 weeks incubation + 3 weeks from symptoms to recovery) and many countries are in the recovery stage. China and Korea are heading to the first curve end. Malaysia and Thailand have just passed the peak point.
D. Gazing into the Crystal Ball
1. What Will The New Normal Look Like?
- There are, of course, many predictions and warnings about the future, including when non-essential businesses begin to reopen and what our lives will look like going forward
- In future updates, we will endeavor to offer data driven perspectives of what lies ahead along with thoughts about how to prepare and adjust to the new normal
- As a starting point for our analysis, based on currently available data, below are some of the realities that we may have to contend with for the indefinite future:
- The coronavirus is not going anywhere – it may not become less infectious during the summer but, even if it is less infectious during warmer weather, many expect it to return in the fall/winter of each year
- The virus is highly contagious – far more contagious than the flu
- If an outbreak (e.g., a rapid acceleration in new cases) occurs in any city or county, its healthcare system may be overwhelmed
- There is no cure – an effective vaccine is unlikely to be available for at least 18 months, maybe longer
- While effective drugs and other treatments that reduce the symptoms of the virus are likely to be found over time (and some promising drugs and treatments are currently in development), a significant percentage of population is likely to remain vulnerable to serious illness and death
- It is currently unclear whether people that have been infected with the virus have immunity against future infection or, if they have immunity, the strength and duration of their immunity is unknown
- The virus may mutate into strains that are more difficult to treat or more deadly
E. Updates and Different Views
1. No need to wipe down food packaging during coronavirus pandemic
- Heads up, consumers: When running the essential errand that is grocery shopping during the coronavirus epidemic in the U.S., there’s no need to wipe down the food packaging after you’ve returned home, according to a federal agency.
- The U.S. Food and Drug Administration (FDA) attempted to quell Americans’ fears that their food packaging may be contaminated with the novel coronavirus, as recent studies have suggested it can live on certain surfaces between hours and days.
- But in a statement posted to its website on Thursday, the FDA said: “We want to reassure consumers that there is currently no evidence of human or animal food or food packaging being associated with transmission of the coronavirus that causes COVID-19.”
2. An Update on Abbott’s Work on COVID-19 Testing
April 15, 2020
- Abbott launched its third COVID-19 test and will start shipping in the U.S.
- This new test is a serology test – also called an antibody test – and helps to detect the IgG antibody to SARS-CoV-2. Detecting these IgG antibodies will help determine if a person was previously infected with the virus that causes COVID-19.
- We’re significantly scaling up our manufacturing for antibody testing and expect to ship close to 1 million tests to U.S. customers this week and 4 million of the antibody tests during April.
- Abbott plans to ramp up to 20 million antibody tests in June and beyond, and expand our testing capabilities to our Alinity i lab system.
April 13, 2020
- Abbott has continued to expand accessibility to our COVID-19 tests by ramping up production and shipping to more customers, helping healthcare providers on the front lines.
- ID NOW – Our rapid, portable testing instrument used in urgent care clinics, hospital emergency departments, and physicians’ offices
- Through Saturday, April 11, we have shipped 566,000 of our rapid ID NOW tests to all 50 states, Washington DC, Puerto Rico and the Pacific Islands. The majority of these tests have been sent to outbreak hotspots and we’ve asked that customers prioritize frontline health care workers and first responders.
- We’re currently manufacturing 50,000 tests per day, plan to increase ID NOW manufacturing capacity to 2 million tests a month by June and are working to expand beyond that.
- m2000 – Our large, high-volume laboratory instrument
- We have shipped more than 1 million tests to customers across the U.S. We’re also shipping these tests to customers throughout the world.
- There are approximately 200 m2000 instruments in hospital, academic center and reference labs throughout the U.S.
3. Hydroxychloroquine and Other Autoimmune Drugs Don’t Fully Protect Against Coronavirus, Early Data Suggest
- Data compiled by rheumatology researchers show dozens of patients who were taking Plaquenil and other drugs became infected
- Dozens of people taking hydroxychloroquine and other treatments for chronic rheumatologic diseases have become infected with Covid-19, according to an analysis of emerging data that is a sign the drugs may not protect people from the new coronavirus.
- Meanwhile, about 190 patients with the chronic diseases who were taking hydroxychloroquine reported in surveys to the alliance that they contracted Covid-19. Doctors also say they have treated individuals with coronavirus who were lupus patients taking hydroxychloroquine.
- Researchers say the published data and surveys may be small but already show that hydroxychloroquine doesn’t fully protect people from contracting the new virus.
- “It’s not a magic bullet because people that are on it are contracting the infection,” said Jinoos Yazdany, chief of the division of rheumatology at Zuckerberg San Francisco General Hospital, who is helping lead the alliance’s research.
- The published data doesn’t address whether hydroxychloroquine is effective at treating coronavirus symptoms. Doctors are using it and a similar antimalarial, chloroquine, to try to treat coronavirus patients, though neither drug is approved for that purpose.
- Researchers note the surveys and published data are early and don’t constitute a clinical trial, a test that proves whether a drug is safe and works.
- Additionally, patients with autoimmune disorders tend to be more prone to infections because their immune systems are weaker and more vulnerable, physicians say. Antimalarial drugs work on the immune system, seeking to prevent flare-ups like the ones lupus patients experience.
- Still, some rheumatologists have noted that their lupus patients aren’t getting the virus.
- Daniel Wallace, a rheumatologist at Cedars-Sinai Medical Center in Los Angeles, said he is unaware of any of the 800 lupus patients he has seen since September who contracted the disease. He said that might be “luck of the draw,” but he said he has an “instinct” that hydroxychloroquine might help protect against the virus and should be studied.
- “We could be totally wrong,” Dr. Wallace said. “We just have to keep an open mind.”
4. ‘No evidence’ antibodies give coronavirus survivors immunity, according to WHO
- WHO health experts say “nobody is sure” if humans with coronavirus antibodies could be reinfected.
- The World Health Organization issued a warning that there is currently no evidence that people who recovered from the coronavirus and have antibodies in their blood plasma will be immune to the deadly virus, which suggests that people who have contracted the disease once might not be immune from being reinfected by the virus.
- The WHO cautioned that serological tests, which look for the presence of antibodies in blood plasma, might not be as helpful in identifying immunity because there is no proof that humans can build up immunity to prevent being reinfected by COVID-19.
- During a Friday news conference in Geneva, Dr. Maria Van Kerkhove said, “There are a lot of countries that are suggesting using rapid diagnostic serological tests to be able to capture what they think will be a measure of immunity. Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection.”
- These antibody tests will be able to measure that level of seroprevalence – that level of antibodies – but that does not mean that somebody with antibodies means that they are immune,” said Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit.
- “What the use of these tests will do will measure the level of antibodies,” Van Kerkhove said. “It’s a response that the body has a week or two later after they’ve been infected with this virus.”
- Dr. Mike Ryan, executive director of WHO’s emergencies program, noted that “nobody is sure” if humans with coronavirus antibodies could be reinfected.
- “Nobody is sure whether someone with antibodies is fully protected against having the disease or being exposed again,” Ryan said on Monday. “Plus some of the tests have issues with sensitivity. They may give a false negative result.”
- “With regards to recovery and then reinfection, I believe we do not have the answers to that. That is an unknown,” Ryan said. “One would expect that a person who generates a full-blown immune response with detectable antibodies should have protection for a period of time. We just don’t know what that period of time is.”
- Van Kerkhove referenced a preliminary study of the blood plasma of 175 patients in Shanghai who had recovered from the coronavirus.
- “And that found some individuals had a strong antibody response,” Van Kerkhove stated. “Whether that antibody response actually means immunity is a separate question. That’s something that we really need to better understand is what does that antibody response look like in terms of immunity.”
5. Don’t bet on vaccine to protect us from Covid-19, says world health expert
- Humanity will have to live with the threat of coronavirus “for the foreseeable future” and adapt accordingly because there is no guarantee that a vaccine can be successfully developed, one of the world’s leading experts on the disease has warned.
- The stark message was delivered by David Nabarro, professor of global health at Imperial College, London, and an envoy for the World Health Organization on Covid-19, as the number of UK hospital deaths from the virus passed 15,000.
- In an interview with The Observer Nabarro said the public should not assume that a vaccine would definitely be developed soon – and would have to adapt to the ongoing threat.
- “You don’t necessarily develop a vaccine that is safe and effective against every virus. Some viruses are very, very difficult when it comes to vaccine development – so for the foreseeable future, we are going to have to find ways to go about our lives with this virus as a constant threat.
- “That means isolating those who show signs of the disease and also their contacts. Older people will have to be protected. In addition hospital capacity for dealing with cases will have to be ensured. That is going to be the new normal for us all.”
- Nabarro’s message is the second grim warning to come from senior ranks of the WHO in the last three days. On Friday, Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, warned that there was no evidence that antibody tests now being developed would show if a person has immunity or is no longer at risk of becoming reinfected by the Covid-19 virus.
6. Influential Covid-19 model (IHME Model) uses flawed methods and shouldn’t guide U.S. policies, critics say
- A widely followed model for projecting Covid-19 deaths in the U.S. is producing results that have been bouncing up and down like an unpredictable fever, and now epidemiologists are criticizing it as flawed and misleading for both the public and policy makers. In particular, they warn against relying on it as the basis for government decision-making, including on “re-opening America.”
- “It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to projecting Covid-19 deaths, epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health told reporters this week, referring to projections by the Institute for Health Metrics and Evaluation at the University of Washington.
- Others experts, including some colleagues of the model-makers, are even harsher. “That the IHME model keeps changing is evidence of its lack of reliability as a predictive tool,” said epidemiologist Ruth Etzioni of the Fred Hutchinson Cancer Center, who has served on a search committee for IHME. “That it is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes.”
- The IHME projections were used by the Trump administration in developing national guidelines to mitigate the outbreak. Now, they are reportedly influencing White House thinking on how and when to “re-open” the country, as President Trump announced a blueprint for on Thursday.
- The chief reason the IHME projections worry some experts, Etzioni said, is that “the fact that they overshot” — initially projecting up to 240,000 U.S. deaths, compared with fewer than 70,000 now — “will be used to suggest that the government response prevented an even greater catastrophe, when in fact the predictions were shaky in the first place.”
- Its model differs from those used by almost all other epidemiologists.
- There are two tried-and-true ways to model an epidemic. The most established, dating back a century, calculates how many people are susceptible to a virus (in the case of the new coronavirus, everyone), how many become exposed, how many of those become infected, and how many recover and therefore have immunity (at least for a while). Such “SEIR” models then use what researchers know about a virus’s behavior, such as how easily it spreads and how long it takes for symptoms of infection to appear, to calculate how long it takes for people to move from susceptible to infected to recovered (or dead).
- “The fundamental concept of infectious disease epidemiology is that infections spread when there are two things: infected people and susceptible people,” Lipsitch said.
- Newer, “agent-based models” are like the video game SimCity, but with a rampaging pathogen: using computing power unimagined even a decade ago, they simulate the interactions of millions of individuals as they work, play, travel, and otherwise go about their lives. Both of these approaches have often nailed projections of, for instance, U.S. cases of seasonal flu.
- IHME uses neither a SEIR nor an agent-based approach. It doesn’t even try to model the transmission of disease, or the incubation period, or other features of Covid-19, as SEIR and agent-based models at Imperial College London and others do. It doesn’t try to account for how many infected people interact with how many others, how many additional cases each earlier case causes, or other facts of disease transmission that have been the foundation of epidemiology models for decades.
- Instead, IHME starts with data from cities where Covid-19 struck before it hit the U.S., first Wuhan and now 19 cities in Italy and Spain. It then produces a graph showing the number of deaths rising and falling as the epidemic exploded and then dissipated in those cities, resulting in a bell curve. Then (to oversimplify somewhat) it finds where U.S. data fits on that curve. The death curves in cities outside the U.S. are assumed to describe the U.S., too, with no attempt to judge whether countermeasures —lockdowns and other social-distancing strategies — in the U.S. are and will be as effective as elsewhere, especially Wuhan.
- According to a critique by researchers at the London School of Hygiene & Tropical Medicine and Imperial College London, published this week in Annals of Internal Medicine, the IHME projections are based “on a statistical model with no epidemiologic basis.”
- “This appearance of certainty is seductive when the world is desperate to know what lies ahead,” Britta Jewell of Imperial College and her colleagues wrote in their Annals paper. But the IHME model “rests on the likely incorrect assumption that effects of social distancing policies are the same everywhere.” Because U.S. policies are looser than those elsewhere, largely due to inconsistency between states, U.S. deaths could remain at higher levels longer than they did in China, in particular.
- While other epidemiologists disagree on whether IHME’s deaths projections are too high or too low, there is consensus that their volatility has confused policy makers and the public.
- Lipsitch and some other experts worry that by failing to include disease transmission, IHME’s projections of deaths could be too low. But more and more models are projecting a less dire future. Three weeks ago a SEIR model from researchers at the Massachusetts Institute of Technology projected that total U.S. cases will plateau later this week, reaching 600,000 and then adding ever-fewer cases each day. So far it’s pretty much on the money, with the U.S. case count at 650,000 on Thursday and new daily cases remaining mostly flat.
- A different, data-driven model from researchers at the University of Washington predicts “about 1 million cases in the U.S. by the end of the epidemic, around the first week in June, with new cases peaking in mid-April,” said UW applied mathematician Ka-Kit Tung, who led the work. “By the first week of June, we project that the number of new cases will be close to zero if current social distancing policies are maintained.” That model predicted two weeks ago that the number of new daily cases would peak around now, as seems to be the case.
F. Potential Treatments and Risk Mitigation
1. Researchers find rheumatoid arthritis drug is promising coronavirus treatment
- Researchers at Georgia State University have found that auranofin, a drug approved for rheumatoid arthritis, may be an effective treatment against the coronavirus.
- The team set out to study how drugs already approved by the Food & Drug Administration interact with the virus, known among scientists as SARS-CoV-2.
- “Drug repurposing is the fastest way to get a treatment for SARS-CoV-2, because it’s already been established that these medicines are safe to use in humans,” says Mukesh Kumar, lead author of the study, in a press release on GSU’s website. Kumar and his colleagues shared their work on bioRxiv for peer review.
- Like all viruses, COVID-19 cannot self-reproduce. It needs host cells — animal or human — in order to make copies of itself.
- “Effective drugs need to interfere with this replication process, shutting down the virus’ ability to proliferate inside the host,” says Hussin Rothan, a co-author of the study.
- With auranofin, the coronavirus was cut down by 95% in human cells within 48 hours, and inflammation caused by the disease was significantly mitigated.
- One of the primary causes of death in COVID-19 patients is a syndrome called a “cytokine storm,” wherein the body’s healing response to illness goes haywire, causing immune cells to attack healthy tissue, leading to organ failure. Cells treated with auranofin, however, saw a significant drop in cytokines, the proteins that signal immune cells to attack.
- “This shows that the drug not only could inhibit replication of SARS-CoV-2, mitigating the infection, but also reduce the associated lung damage that often leads to severe respiratory distress and even death,” says Kumar.
- Auranofin, including the brand-name drug Ridaura, was approved by the FDA in 1985. The drug is unique for being partially composed of gold particles, which have been used for centuries for their anti-inflammatory properties. Treatments involving gold compounds have also been considered for use against HIV, cancer, neurodegenerative disorders, and parasitic and bacterial infections.
- The team at Georgia State University says they plan to continue their study on how auranofin impacts the coronavirus in animal models
2. Regular exercise can help protect from severe coronavirus complication
- When it comes to fighting the coronavirus, exercise is preventative medicine, according to one new study.
- Regular cardiovascular workouts may help protect future coronavirus patients from developing a severe complication and major cause of death known as acute respiratory distress syndrome (ARDS), according to research from Zhen Yan of the University of Virginia School of Medicine.
- Yan, the director of the Center for Skeletal Muscle Research at UVA’s Robert M. Berne Cardiovascular Research Center, recommends 30 minutes of cardiovascular training every day to help ward off the respiratory disease.
- “We cannot live in isolation forever,” he said. “Regular exercise has far more health benefits than we know. The protection against this severe respiratory disease condition is just one of the many examples.”
- Humans naturally produce the antioxidant, known as “extracellular superoxide dismutase” (EcSOD) — and exercise ramps up the production, Yan said.
- Yan told Newsweek a session of biking, rowing or any other aerobic exercise can help prevent or at least reduce the severity of the lung disease (ARDS).
- The Centers for Disease Control and Prevention has estimated between 20 and 42 percent of all patients hospitalized with COVID-19 will develop ARDS.
G. New Scientific Findings and Other Advancements
1. Antibody study suggests coronavirus rate 50 to 80 times higher than previously believed
- Many more people may have been infected by the coronavirus than previously believed, a new study shows.
- A recent study tested the blood of 3,300 volunteers in Santa Clara County, Calif., and found that between 2.5 and 4 percent of them had the antibodies that show they’ve recovered from COVID-19.
- In a county the size of Santa Clara, where the population numbers 2 million, that rate of infection would mean between 48,000 and 81,000 people have fought off the virus — far more than the 1,000 who have officially tested positive there.
- “Our findings suggest that there is somewhere between 50- and 80-fold more infections in our county than what’s known by the number of cases than are reported by our department of public health,” Dr. Eran Bendavid, the associate professor of medicine at Stanford University who led the study, said in an interview with ABC News.
- The results, while limited, back a popular belief among health experts that significantly more people have been infected than testing shows — due to some people being asymptomatic and to the country’s limited testing capacity.
- Dr. John Brownstein, an epidemiologist and ABC News contributor, cautioned that the results for the California county are not necessarily representative of the country’s population — but he said the study is “adding to this confirmation of what we’ve expected, which is a much larger number of cases than we ever anticipated.”
- “These antibody tests will be able to measure that level of serology presence, that level of antibodies, but that does not mean that somebody with antibodies” is immune, said Dr. Maria Van Kerkhove, the head of the WHO’s emerging diseases unit.
2. Testicles may make men more vulnerable to coronavirus
- The coronavirus could linger in the testicles, making men prone to longer, more severe cases of the illness, according to a new study.
- Researchers tracked the recovery of 68 patients in Mumbai, India, to study the gender disparity of the virus, which has taken a worse toll on men, according to a preliminary report posted on MedRxix, which hosts unpublished medical research papers that have not been peer reviewed.
- Dr. Aditi Shastri, an oncologist at Montefiore Medical Center in the Bronx, and her mother, Dr. Jayanthi Shastri — a microbiologist at the Kasturba Hospital for Infectious Diseases in Mumbai — said the virus attaches itself to a protein that occurs in high levels in the testicles.
- This protein, known as angiotensin converting enzyme 2, or ACE2, is present in the lungs, the gastrointestinal tract and the heart in addition to large quantities in the testicles.
- But since testicles are walled off from the immune system, the virus could harbor there for longer periods than the rest of the body, according to the study.
- The mother-daughter researchers said these findings may explain why women bounce back from the virus more quickly than men.
- They determined that the average amount of time for female patients to be cleared of the virus was four days, while men saw recoveries that on average were two days longer, the report said.
- These observations demonstrate that male subjects have delayed viral clearance,” the authors wrote, adding that the testicles may be serving as “reservoirs” for the virus.
- The study may offer an explanation for reports out of Italy, South Korea, and New York City that men are dying at higher rates from the virus.
- Others have suggested that men are more vulnerable because they are more likely to smoke, have high blood pressure or suffer coronary artery disease.
3. IDF Project Transforms Simple Breathing Devices into Ventilators
- Israel’s military has developed a system for converting CPAP breath regulators into respirators in the case that the health system is faced with a shortage of ventilators.
- The “Breathable Air” project, developed by the IDF’s Military Intelligence Directorate’s 81st Technological Unit over the past four weeks, converts CPAP — continuous positive airway pressure — machines, typically used by first responders for breathing assistance into unique respirators.
- The first hundred converted devices will be delivered to Tel Hashomer Medical Center on Sunday, the report cited a commander named only as Major S. as saying.
- Dr. Amit Zabatani, project leader for Sheba Hospital, described the ad hoc devices as “first class invasive respirators.”
- “After realizing that there would not be enough ventilators in Israel, we held joint meetings with the army unit. The idea is to use the already existing simple respiratory devices for the military and to convert them into respiratory sensing and monitoring devices.”
- “We hope we will not have to use any of these devices but should we run out of our existing machines and ventilators to treat patients,” Zabatani said. “We feel much more confident that we will be able to cope by relying on these new military devices.”
- Major S. added: “The idea was to develop a simple product that already exists in high supply so that our solution can be implemented in the shortest possible time.”
- The system also has monitors which track the patient’s breathing and the information can then be transmitted to the hospital staff.
- The Health Ministry has already put in an order for 1000 more monitors to upgrade existing systems.
4. Ultraviolet-LED Maker Demonstrates 30-Second Coronavirus Kill
- Robots and stranger machines have been using a particular band of ultraviolet light to sterilize surfaces that might be contaminated with coronavirus. Those that must decontaminate large spaces, such as hospital rooms or aircraft cabins, use large, power-hungry mercury lamps to produce ultraviolet-C light. Companies around the world are working to improve the abilities of UV-C producing LEDs, to offer a more compact and efficient alternative. Earlier this month, Seoul Viosys showed what it says is the first 99.9 percent sterilization of SARS-COV-2, the coronavirus that causes COVID-19, using ultraviolet LEDs.
- UV LEDs are deadly to viruses and bacteria, because the 100-280 nanometer wavelength C-band shreds genetic material. Unfortunately, it’s also strongly absorbed by nitrogen in the air, so sources have to be powerful to have an effect at a distance. (Air is such a strong barrier, that the sun’s UV-C doesn’t reach the Earth’s surface.) Working with researchers at Korea University, in Seoul, the company showed that its Violed LED modules could eliminate 99.9 percent of the SARS-COV-2 virus using a 30-second dose from a distance of three centimeters.
- Unfortunately, the company did not disclose how many of its LEDs were used to achieve that. Assuming that it and the university researchers used a single Violed CMD-FSC-CO1A integrated LED module, a 30-second dose would have delivered at most 600 millijoules of energy. This is somewhat in-line with expectations. A study of UVC’s ability to kill influenza A viruses on N95 respirator masks indicated that about 1 joule per square centimeter would do the job.
- While the 3-centimeter distance may work in tight spaces such as an air filter or water purifier—products that UV LEDs already serve—it won’t do for hospital-room-sterilizing robots. The GermFalcon airplane cabin sterilizer, for example, needs to bathe an aircraft cabin in light strong enough to kill the virus in seconds from a distance of about 30 centimeters, its inventor Dr. Arthur Kreitenberg told IEEE Spectrum last month. Today’s UV-C LEDs can’t produce enough light for the job, he said. But with the GermFalcon’s mercury lamps, which measure output in watts, that power comes at a large cost in energy and bulk. The system’s iron-phosphate battery pack has to deliver 100 amperes to produce the needed UV power.
H. The Road Back?
1. Sweden Says Controversial Covid-19 Strategy Is Proving Effective
- Sweden’s unusual approach to fighting the coronavirus pandemic is starting to yield results, according to the country’s top epidemiologist.
- Anders Tegnell, the architect behind Sweden’s relatively relaxed response to Covid-19, told local media the latest figures on infection rates and fatalities indicate the situation is starting to stabilize.
- “We’re on a sort of plateau,” Tegnell told Swedish news agency TT.
- Sweden has left its schools, gyms, cafes, bars and restaurants open throughout the spread of the pandemic. Instead, the government has urged citizens to act responsibly and follow social distancing guidelines.
- It’s unclear which strategy will ultimately prove most effective, and even experts in Sweden warn it’s too early to draw conclusions. But given the huge economic damage caused by strict lockdowns, the Swedish approach has drawn considerable interest around the world.
- As of Sunday, Sweden had reported 1,540 deaths tied to Covid-19, an increase of 29 from Saturday. That’s considerably more than in the rest of Scandinavia, but much less than in Italy, Spain and the U.K., both in absolute and relative terms.
- Tegnell isn’t the only high-level official in Sweden to claim the country may be over the worst.
- Just two weeks ago, the picture was considerably bleaker, and Prime Minister Stefan Lofven suggested the government may need to review its approach amid the prospect of thousands of Swedish deaths. But Lofven’s personal popularity has soared, suggesting Swedes approve of his decisions.
- “I have very high confidence in the Swedish authorities that manage this,” Volvo Cars CEO Hakan Samuelsson said in a phone interview. “It’s a hard balance to strike, but I have full confidence in the measures that Sweden has taken.”
- “Our measures are all based on individuals taking responsibility, and that is also an important part of the Swedish model,” Samuelsson said.
- Sweden’s Covid-19 strategy may ultimately result in a smaller — albeit historically deep — economic contraction than the rest of Europe is now facing, according to HSBC Global Research economist James Pomeroy.
- “While Sweden’s unwillingness to lock down the country could ultimately prove to be ill-judged, for now, if the infection curve flattens out soon, the economy could be better placed to rebound,” he said.
- Pomeroy pointed to some Swedish characteristics that may be helping the country deal with the current crisis. More than half of Swedish households are single-person, making social distancing easier to carry out. More people work from home than anywhere else in Europe, and everyone has access to fast Internet, which helps large chunks of the workforce stay productive away from the office.
- And while many other countries have introduced strict laws, including hefty fines if people are caught breaching newly minted social-distancing laws, Swedes appear to be following such guidelines without the need for legislation. Trips from Stockholm to Gotland — a popular vacation destination — dropped by 96% over the Easter weekend, according to data from the country’s largest mobile operator, Telia Company. And online service Citymapper’s statistics indicate an almost 75% drop in mobility in the capital.
- Sweden also recently pushed back against the notion that there’s little to no social distancing going on.
- “We don’t have a radically different view,” Foreign Minister Ann Linde said in an interview with Radio Sweden. “The government has made a series of decisions that affect the whole society. It’s a myth that life goes on as normal in Sweden.”
2. Governments are starting to ease restrictions
- After spending the long Easter break cooped up at home some Spaniards went back to work this week. They were greeted at transport hubs by police officers and Red Cross volunteers handing out face-masks. Though reported as a “relaxing” of the lockdown imposed a month ago, the government insists that it is not. Only those who cannot work from home are allowed to go back to their workplaces. Most shops remain closed, as do schools, bars, restaurants and hotels. Outdoor exercise is still banned and enforcement is tight: between March 14th and April 6th the police arrested 3,267 people and levied 340,000 fines for breaking the lockdown.
- Spain seems to have turned a corner in one of the worst outbreaks of covid-19. The daily number of cases has begun to fall, compared with a daily increase of around 30% a month ago. Hospitals which were overwhelmed a fortnight ago now have some spare capacity. But Pedro Sánchez, the prime minister, was clear. “We aren’t even beginning the second phase,” he said on April 12th. “De-escalation will begin in a fortnight at the earliest, and it will be gradual and cautious,” Mr Sánchez insisted.
- Governments around the world are trying to work out how to exit their covid-19 lockdowns. Several other European countries, including Austria, Germany, Norway and the Czech Republic, are reopening nurseries, schools and shops as their efforts to stop the spread of covid-19 start, as in Spain, to pay off (see table). In various American states discussions of exit strategies are gaining traction. In New York state, where covid-19 has killed more than 10,000 people in just a month, the total number of cases in hospitals is starting to plateau. On April 13th, along with five other states on the east coast, it disclosed it was working on a strategy for reopening the region’s economy. On the same day three states on the west coast, including California, announced a similar project.
- The big unknown is whether any of the exit strategies being considered or implemented will avoid a second wave of infections. Researchers at Imperial College London estimate that, even when the many infections that were never registered are added to the total, just 1-15% of people in Europe had some immunity to covid-19 at the end of March. Until a vaccine is available, governments will need to keep sufficient numbers of infected people tightly quarantined to prevent new outbreaks that would overwhelm their health systems. But most failed to do this during the early days of covid-19. That is why the epidemics grew so bad that they needed to implement full lockdowns to save hospitals from disaster. It is not yet clear that they will do well enough the second time around to prevent a resurgence of the disease.
- Governments in countries that are already past the peak of the first wave of their epidemics have some breathing space to plan for their post-lockdown future. More important, they have better data. They have a clearer sense of how their hospitals will cope with a certain number of cases of covid-19. They no longer need to rely on data from China to make educated guesses about how their populations and health systems might fare. Such experience matters for all sorts of reasons. For example, the spread of the disease among the close-knit intergenerational households in southern Europe is different from the paths it takes in the insular societies of northern Europe where a large share of old people live alone or in care homes.
- Even with these data, however, government planners do not know which restrictions they should begin to ease and when. “There are no absolutes here,” says Mike Ryan of the World Health Organisation (WHO); the evidence that when countries reach a specific number of cases they should take particular actions does not yet exist. The accepted wisdom is that countries can begin to consider easing restrictions when the number of new cases is tapering off, and their hospitals have free beds—in other words, when they can accommodate a surge in infections that could follow the easing of a lockdown.
- Those easing lockdowns are using one principle: the epidemic must be under control. Austria was the first European country to announce a comprehensive plan detailing when various sectors would be allowed to reopen. In the first week of April tests of a random sample of about 1,600 people found that fewer than 1% had active covid-19 infections. Norway decided to begin reopening kindergartens from April 20th after scientists advising the government reported that the epidemic’s reproduction rate—the number of new infections generated by each case—had fallen to 0.7. If the reproduction rate of a contagion is lower than one then an epidemic will die down over time. Spain’s health ministry plans to test a sample of at least 30,000 families around the country over the next three weeks to get a sense of the real scale of the outbreak and the extent to which the population has acquired any immunity.
- Harder than the decision about when to lift restrictions is choosing which to lift first. The reasoning varies from country to country, but the conclusions are often the same. Norway’s commission, which assessed the long-term costs to society of various combinations of restrictions, found that closing primary schools and nurseries were among the costliest policies. In Denmark, too, nurseries and primary schools opened first on April 15th; older children may be allowed back to school a month later. (Not all parents were impressed; 40,000 Danes have joined a Facebook group called “My kid is not going to be a Guinea Pig for Covid-19”.) And in Germany, which outlined an exit strategy on April 15th, schools will start to reopen on May 4th, but only for those children facing exams. “Emergency” services for the parents of younger children will be expanded.
Back to abnormal
- Nowhere, however, is the slow lifting of lockdowns a return to business as usual. Europeans going back to shops, trains and offices will have to follow new hygiene and social-distancing rules—some of which were introduced during the lockdowns. Austrians and Czechs are already required to wear face-masks in public spaces, including at work; Spain is considering a similar requirement. Shops in many countries will have to limit the number of customers in at any one time. Norway’s guidelines, released on April 15th, say that children in nurseries must be split into smaller cohorts, with three-year-olds in groups of three and older children in groups of six; each group will be assigned one adult. Changes to the cohorts will be permitted no more than once a week.
- Like the lockdowns themselves, many of these new rules are transplants from China, which has, its government says, avoided a second wave of infections. In Beijing employers must keep their employees separated, so many firms have only a fraction of their workers on-site each day, with the rest working at home where possible. Restaurants must limit the number of customers to keep them apart. Chinese schools which have welcomed back their students have introduced measures to minimise infections: constant ventilation of classrooms; extra spacing between desks; frequent cleaning and disinfecting; the reduction of the size of classes; staggered dismissal times, to avoid crowding; assigned seating and installation of partitions in dining areas. The list goes on and on. And officials stress that they will pull back and make adjustments if they see signs of a second wave.
- There is no solid evidence that any one of these measures alone is particularly effective in reducing the transmission of the new coronavirus. The hope is that in combination they could work reasonably well. In China, however, the easing of lockdown has been accompanied by stringent efforts to identify and quarantine those infected and their close contacts. In some areas restaurants must sign in every customer—and if any later test positive to notify those who visited at the same time. China’s strategy suggests that Europe and America’s plans to stop infections after they lift their lockdowns with masks, good hygiene and social distancing may not be enough.
- Instead post-lockdown life might more closely resemble that in South Korea, a democracy with a population similar in size to England’s, throughout its covid-19 outbreak. Unlike America and much of Europe, South Korea has never instituted a complete lockdown. Even at the height of the outbreak people remained mostly free to go about their lives thanks to extensive testing, tracing and isolation of infections. In only 10% of cases have public-health investigators been unable to determine the source of infection. New daily infections are now below 30.
It’s life, Jim, but not as we know it
- Despite the pandemic on April 15th South Korea held legislative elections. But schools, universities, museums and many churches have been closed for weeks, and there are no plans to reopen them. Travellers returning from abroad must quarantine themselves for two weeks, either at home or in government-provided facilities. Breaking quarantine can lead to fines, jail or, for foreigners, deportation. The government advice still discourages leaving home for non-essential reasons, especially socialising in groups.
- Compliance with social-distancing recommendations, however, is flagging. Using data gathered from mobile-phone masts, South Korea’s disaster-response agency estimates that people moved around about 16% more in the last week of March compared with the last week of February, which was the height of the outbreak. That number is likely to have ticked up further in recent days. Seoul’s restaurants are filling up again. Hiking trails teemed with people over the weekend.
- And yet of the roughly 57,000 people currently in strict self-isolation, just over 100 have been caught violating it. After various groups voiced concerns about privacy, the government abandoned a plan to issue electronic wristbands to everyone in quarantine. Instead, it will now provide them only to those who have broken their quarantine and even then only with the person’s consent. The public supports the idea either way; in a poll conducted by the culture ministry, more than 80% said the wristbands were a good idea.
- South Korea’s experience has prompted some European countries and a few American states to begin ramping up their contact-tracing capacity as they prepare to lift their lockdowns. That requires expanding public-health departments; calling everyone an infected person has been in close contact with—and checking on them regularly during their 14-day quarantine—is hugely labor-intensive.
Is antibody out there?
- It is not a highly skilled job; anyone with a secondary-school education can be trained in a day. But with a disease that spreads as easily as covid-19, enormous numbers of workers are needed. Public-health departments in America are currently doing this sort of work for outbreaks of sexually transmitted diseases, tuberculosis and the occasional measles outbreak. But the numbers involved are minuscule compared with a respiratory bug like covid-19. Calculating on the basis of the number of contact-tracers used to contain the outbreak in Wuhan, the Chinese city hit hardest by the country’s epidemic, public-health experts recently convened by Johns Hopkins University estimated that more than 260,000 new hires would be needed at local and state public-health departments in America—up from just 2,200 at present. To make a start, they recommend that America recruits 100,000 such new hires dedicated to covid-19. Their salaries for a year would add up to $3.6bn—a rounding error on the cost of shutting down the American economy.
- Massachusetts has begun hiring 1,000 additional contact-tracers and social workers who would support people under quarantine by shopping for food and collecting medications, for example. American universities are developing crash training courses for contact-tracers. Similar efforts are starting to appear in Europe. In March Germany’s public-health institute put out a job advertisement aimed at students for “containment scouts” to do contact-tracing; 10,000 applied. Germany plans to have at least one five-person team per 20,000 inhabitants to help with contact-tracing. In badly affected areas the army and other personnel will be called in. The Czech Republic may also use army recruits.
- Apps that will help health officials track where hotspots of covid-19 may be emerging and trace the contacts of infected people are being developed. Such apps are already widely used in China. They can make contact-tracing more efficient, says Anita Cicero of Johns Hopkins University, but they cannot replace the traditional methods of contact-tracing—nor the humans who do it. The European Commission, which on April 15th unveiled a “road map” to ensure that EU member-states co-ordinate the lifting of their restrictions, wants them to agree on a common framework for such an app; at the moment, many countries are forging ahead with their own plans.
- Many experts doubt that such apps, which people will have to install voluntarily, would be popular. “I don’t think Americans are going to go for that,” says Michael Fraser of the Association of State and Territorial Health Officials in America. “I’ve been surprised before, though,” he concedes. If the alternative is being cooped up at home, lots may opt in. Almost two-thirds of Germans told one survey they would forgo the privacy of their data to protect the lives of others; a separate poll found that 70% of respondents would be happy to install a contact-tracing app.
- But organizing quarantines on the scale required by covid-19 would require more than just manpower and technology, notes Mr Fraser. Most of the new contact-tracers can work from home, by phone or using other technologies. Some, however, would need to go to people’s homes. For that, they would need face-masks and gloves to protect them—which are in short supply globally. At a local level, isolation facilities are needed for people who cannot isolate themselves at home. These must be safe, private and comfortable.
- Above all, every country that wants to contain a second wave will need to test everyone suspected of being infected with covid-19 and their contacts. This will have to be rapid diagnostic testing, says Ms Cicero, where people get the results in less than an hour. Testing sites would need to be set up in every health-care facility. The way things are now in America, people often wait for their results for several days—too long for a virus that they can spread before they develop symptoms.
- Testing capacity everywhere has been growing. But at its current pace America will take months to attain the level needed for effective contact-tracing, says Mr Fraser. In many countries, the crimped global supply of materials, including reagents (chemicals necessary for tests), means that testing is reserved primarily for those hospitalised with covid-19 and health-care workers. The dearth of reagents means that Austria may not be able to increase its testing as planned, even though it has the capacity to carry out ten times the number of tests it conducts now.
- Reagents are not the only thing in short supply. Swabs to take samples from patients, glass tubes, machines and trained technicians with protective masks and gloves are also scarce. With so many different inputs, bottlenecks can easily occur. And when every single country in the world needs enormous supplies, it will be a while before there is no shortage of them.
Corona and out
- Every plan and guideline for what a country must have in place before it lifts its lockdown puts expanded testing near the top of the list, but few outline how to do this fast. For countries hoping to be rid of both their lockdowns and a runaway covid-19 epidemic, no problem is as urgent.
1. How to test everyone for the coronavirus
- Entrepreneurs and academic gene jockeys are hatching schemes for population-level coronavirus testing.
- Rothberg is a high-energy biotech entrepreneur who has been trapped in quarantine on his super-yacht, the Gene Machine, since mid-March, when we first reached him by phone. The creator of a fast DNA sequencing machine and, more recently, a revolutionary cheap ultrasound wand, Rothberg had been cruising in the Caribbean when the pandemic hit.
- Since then, he has been directing a team of about 60 at one of his companies, HomoDeus, to try to create an at-home genetic test for the virus.
- Right now, gene tests—the most accurate kind—are run only in labs or on special hospital instruments. But Rothberg’s is one of several attempts to create a test that’s simple, foolproof, and cheap enough for anyone to do at home.
- To Rothberg, it is obvious that tests need to become as ubiquitous as mobile phones if we want to get the world out of lockdown. “We can and will give everyone the ability to diagnose themselves now and in the future,” he said on Twitter, where he posts pictures from his boat and gives progress updates. “Any place. Any time.”
Who will do it?
- The US badly fumbled the rollout of testing for the coronavirus. Tests remain limited, and so now the possibility that everyone can be tested, all the time, appears to ride on private initiative, including ideas from a crew of clever entrepreneurs and top academic genome centers.
- Proposals for getting back to a new normal, such as one advanced in Harvard Business Review, say doing so depends on being able to mitigate the infection. Key factors include avoiding overflow at hospitals, having masks for all workers and “the availability of sufficient testing capability” to identify anyone who is or has been, infected.
- Exactly how much testing is that? Commercial labs and health departments are now testing around 140,000 people a day in the US, according to the COVID Tracking Project, and they can still enlarge their operations. But under a get-back-to-work plan we will need to go much, much bigger. While there isn’t a consensus on how big, some forecasts say we should be testing millions of people every day to catch the new infections.
- On April 11, Admiral Brett Giroir, the administration’s testing czar, said testing levels would rise in May to levels needed to support reopening, but he said testing everyone is “physically impossible” and a poor strategy.
- Mass testing, even if it’s expensive, could actually be one of the cheaper ways out of the crisis. MIT professor Erik Brynjolfsson says if tests cost $3 each, everyone in the US could be tested 10 times over six months for $9 billion. “That’s 0.3% of the cost of the recent bailout,” he tweeted.
- Although there isn’t a clear federal or state plan for testing everyone, several research centers are on their way to establishing technologies they say can make it possible. “I think there are two ways to do it,” says Feng Zhang, a researcher at MIT’s Broad Institute. One is to “collect samples from many people and process them in one place” using ultra-fast genome sequencing machines. “Another way is to have a home test, a nucleic acid test that people can run in their homes, which is inexpensive and easy to do.”
- Think of the first scheme as massive centralized testing. To drastically cut the cost of tests, Zhang’s lab and others are demonstrating how to look for the coronavirus using powerful next-generation sequencing machines, typically used to decode the billions of DNA letters in a human or animal genome.
- The high-horsepower machines read out hundreds of millions of bits of DNA at once. Last week Zhang’s lab described an approach in which they could add individual molecular bar codes to patient samples, pool them, and then sequence them all at once. In theory, one sequencing instrument could test 100,000 samples at once, in about a day, for $7 each.
- Jonathan Schmid-Burgk, who developed the method in Zhang’s lab, says the technology “could let you screen the whole population of the US every three months.”
- One drawback of centralized schemes is there’s still going to be a delay in collecting and pooling samples and getting results back. Still, because of its large scale, it could be useful to create a covid-19 heat map that could alert governors when they need to re-institute social distancing measures. “There is a question of how to scale it up, but the next-generation sequencing is already there. What you need is an academic center and a logistics partner,” says Schmid-Burgk, who is now in Germany and talking to partners there.
Testing at home
- The other way to get massive testing under way is to make it decentralized—that is, let everyone test at home, whenever they need to. An at-home genetic test would let everyone make their own decisions. “If it’s cheap enough,” says Zhang, “people could do two tests a day, one in the morning and one in the evening. Then they can decide if they’re going to work the next day.”
- “You want to get information back to people, so they can use that information to not spread it to other people,” he says.
- A demonstration of genetic testing using CRISPR. Researchers at the Broad Institute hope to adapt the technology as an at-home test for covid-19.
- One type of test that’s possible to do at home—with a finger prick—is called an antibody test. It looks for signs in your blood that you were already infected. These signs don’t develop for a week. By contrast, genetic tests look directly for the genetic material of the coronavirus. They are more accurate and can identify infected people even before they show any symptoms.
- Right now, though, there is no genetic test of any kind for home use. That’s because most gene testing methods require several laboratory steps and a PCR machine to rapidly heat and cool a sample (a step to help copy or amplify the genetic material). But researchers including Zhang say they are close to demonstrating at-home technology for covid-19 using new types of chemistry that skip the heating and cooling cycles.
- Zhang’s lab is best known for its role in developing the gene-editing tool CRISPR, which he and others have crafted into a new type of genetic diagnostic method (if a gene from the coronavirus is present, the CRISPR molecule cuts it and sets off a molecular alert). Zhang says he started working on a CRISPR-based coronavirus test in January “when I first heard about the virus,” and by Valentine’s Day had uploaded a CRISPR protocol for detecting the virus in a laboratory.
- It’s a fairly simple test that takes only hour, but it still involves a mixing step and heating up the sample once, to about 65 °C, to break open the virus and release its RNA. Now the lab is trying to simplify the process further to demo a potential at-home CRISPR test. “The goal is one-step reaction: you run it, open the tube, put in a paper strip,” he says. “That is something that we have been focused on in the lab for a couple of months.”
- [Note: To learn more about CRISPR and its ability to detect COVID-19, read more here: CRISPR–Cas12-based detection of SARS-CoV-2]
The spit problem
- To create a home DNA test, Rothberg redirected the efforts of HomoDeus, which had been trying to develop gene therapies using special enzymes called recombinases, a type of gene-editing tool. The chemicals also offered a path to do home gene tests, but before the pandemic, Rothberg says, he didn’t pursue it because it’s hard to make money on diagnostic tests.
- Since last week, the new chemistry developed by HomoDeus has entered tests at Yale University on swabs from covid-19 patients. The chemical components are mostly solved but performing the test still involves some moving and mixing of fluids. “We still have a process a 17-year-old could do, but not a 70-year-old,” he says.
- Rothberg says there is still “huge technical risk” in the project, but it’s not whether the chemistry works; the problems are more practical ones. It’s easiest for someone at home to spit in a tube, but it’s unclear if that will yield enough of the virus to test for. “If they just ate a chicken sandwich it could throw things off,” Rothberg says.
- He says instead he’s leaning on the Gates Foundation, which has been working to prove that a soft swab passed inside the nose can serve as the basis for either mail-in tests or at-home ones.
- After the slow rollout of testing in the US, the Food and Drug Administration began offering “emergency” authorizations so companies could introduce new test formats much faster. Rothberg says he anticipates little resistance to an at-home coronavirus gene test and says the agency has been helping him. “I am pretty confident our problem isn’t regulatory; it’s technology,” he says.
- So how soon will it be ready? He’s challenged his team to have 10,000 prototype kits made next month, along with an accompanying phone app. “This is like conquering smallpox,” he says. “It’s going to be a project.”
J. Projections and Our (Possible) Future
1. Updated IHME (Murray) Model (4/17/20): Turning the Corner
- The IHME Projection Model is a model that includes projections of (i) the resources (e.g., the number of hospital beds, ICU beds and ventilators) that will be required by each State, (ii) the date on which the maximum number of resources will be required by each State (the “peak day”), (iii) the number of deaths for each State, and (iv) the date on which social distancing may be possible with containment strategies that include testing, contact tracing, isolation, and limiting gathering size.
- The next set of results for countries for which IHME is already producing estimates will be published on Wednesday, April 20.
- The current version of the IHME Model projections can be found at COVID-19 Projections
- The White House Coronavirus Task Force has referenced the model in its daily briefings and appears to be using the model to develop plans and guidance in response to the coronavirus epidemic. The Gates Foundation is funding the development of the IHME Model.
[Note: We continue to report on updates to the IHME model because of its potential impact on policies at the National, State and County/City levels. However, as discussed above, in light of material inaccuracies in prior projections, we believe that IHME model should be viewed with a rather large grain of salt if not skepticism.]
Predicting when the current epidemic phase will end: Initial Estimates on When We Could Shift to Containment Strategies in the US
- Social distancing policies, which can range from restrictions on large gatherings to strict stay-at-home orders and closure of all non-essential businesses, have been used as a mechanism to substantially reduce the spread – and thus the immediate toll – of COVID-19. We are now entering the phase of the epidemic when government officials are considering when certain types of distancing policies may be eased. With today’s release, we provide initial estimates that can serve as an input to such considerations in the US.
- These estimates assume that when social distancing policies will be eased, such actions will occur in conjunction with public health containment strategies. Such measures include widespread testing, contact tracing, and isolation of new cases to minimize the risk of resurgence while maintaining at least some social distancing policies to reduce the risk of large-scale transmission (e.g., bans on mass gatherings).
- To learn more about the specific changes to the models and the methodologies, go here: COVID-19 Projections
April 17 IHME Update — Changing Its Focus to Containment
- A total of 33 states have passed their peak daily death totals and another 12 states are expected to peak within the next week.
- As a result of the majority of states passing the peak daily death totals, the IHME introduced a new metric in the April 17 update: Predicting the time when COVID-19 infections fall below 1 prevalent case per million
- IHME is now using estimates from its COVID-19 death models and estimates of infection fatality ratio (IFR) to produce estimates of COVID-19 incidence and prevalence. It then uses these estimates to identify the date after which the number of COVID-19 infections is predicted to fall below 1 per 1,000,000 people in each location. This date can be viewed as the earliest time that locations could consider easing social distancing restrictions – conditional on containment measures already in place to avert potential resurgence of the virus. Such necessary containment efforts include extensive testing, robust contact tracing and isolation of new cases, and maintaining restrictions on mass gatherings of people.
When can states begin relaxing social distancing methods?
- Based on the new methodologies, the IHME has made the following recommendations of when each state can begin relaxing social distancing methodologies.