Coronavirus Update 4-28

Every State’s Current Plan For Lifting The Lockdown can be found at: Here’s Every State’s Plan For Lifting The Lockdown

“The more we learn about the virus, the less we know.” — Ohio Governor DeWine

“Reopening downstate New York is going to be complicated.” — NY Governor Cuomo

“The pandemic has highlighted the many things that are broken in our city and in our country. We don’t just need a recovery, we need a transformation.” — NYC Mayor De Blasio

“Freedom isn’t everything, but without freedom, everything is nothing.” — German Protestors

“The food supply chain is breaking.” — John Tyson, chairman of Tyson Foods Inc., the largest U.S. meat producer

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Available Resource: Having put together almost 70 daily updates, our team has compiled and distributed a tremendous amount of information about the coronavirus and COVID-19 and we are happy to share what we know. So, if you have any questions regarding the virus or disease, please feel free to contact either pwduval@gmail.com or brian.sivy@gmail.com. We’d be happy to respond by email or arrange a call with you or anyone you know as soon as we can.

A. Recent Developments and Headlines

Note: All changes noted in this Update are since the 4/27 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

Worldwide Total Cases = 3,062,476 (+2.3%) (+69,214)
Worldwide New Cases (3 day avg) = 77,953 (-15.4%) (-14,199)
US Total Cases = 1,010,356 (+2.4%) (+23,196)
US New Cases (3 day avg) = 28,439 (-20.2%) (-7,213)
Worldwide deaths = 211,449 (+2.2%) (+4,534)
US deaths = 56,797 (+2.5%) (+1,384)
NY deaths = 22,623 (+1.6%) (+348)
WHO warns ‘children will die’ as countries halt vaccine efforts
New York deaths drop for 3rd straight day
Dr. Birx says some social distancing measures will likely remain in effect until end of summer
NY Gov. Cuomo: virus may have infected around 25% of NYC residents
NYC Mayor de Blasio: NYC will start ‘self-swab’ coronavirus tests this week
Gov. Abbott: Texas Kicking Off Phase One of Reopening this Week
Restaurants, Malls, Retail Stores Can Reopen May 1, Bars, Gyms Later, Abbott Says
Tennessee, Mississippi, Montana reopen some businesses following other states easing coronavirus restrictions
Ohio releases plan to reopen economy
California Gov. Newsom Threatens ‘Lockdown Crackdown’ As Thousands Crowd Southern California Beaches
UPS Drones To Deliver CVS Meds To Florida Retirement Community
“We Ran Out Of Room”: Boston Globe Prints 21 Pages Of COVID Death Notices In One Day
AG Barr Sics Federal Prosecutors On States With ‘Unconstitutional’ Lockdowns
Judge Rules Against Illinois Gov. J.B. Pritzker’s Lockdown Extension
New York State Board of Elections cancels Democratic Primary
San Francisco Marathon postponed
New Zealand to lift lockdown at midnight
Several of Australia’s provinces unveil plans to gradually reopen
PM Abe says Japan will approve remdesivir for coronavirus treatment
Singapore now home to third-worst outbreak in Asia
Norway extends ban on gatherings of 500+ until September
CDC releases 6 new ‘official’ COVID-19 symptoms
India plans to finally repatriate citizens stranded abroad
French Grand Prix latest Formula One racing event to be cancelled
Spain records second-lowest daily death toll in a month
Nearly 20 US states begin reopening push
Citing Privacy Concerns, Israel Ends Cellphone Location-Tracking For Quarantine Enforcement
Boeing CEO Warns Aviation Rebound Will Take Years
Tyson Foods Warns “Food Supply Chain Is Breaking”
$6 Trillion Contraction Could Be “Too Optimistic”, Economists Warn Eyeing Second COVID-19 Wave
Freight Trucking Demand Plunges To All Time Lows; Rates Crash And Industry Grapples With Lockdown
Bill Gates Says His Foundation Is Abandoning Other Initiatives To ‘Focus 100%’ On Coronavirus
Southern European Tourism Is On Its Knees
“I Want My Life Back” – German Anti-Lockdown Protests Worsen
A Navy Destroyer Is Heading To Port, Crippled By Another COVID-19 Outbreak At Sea
Coronavirus Deaths Likely 60% Higher Than Official Numbers Reflect, Financial Times Finds
Al Gore: ‘Climate Crisis and the COVID-19 Pandemic Are Linked’
Coronavirus Testing in 4 State Prison Systems Reveal 96% Asymptomatic
Migration, Poverty, Crowded Housing Spread Coronavirus Pandemic in U.S.
President Trump on Coronavirus: We Are Not Happy with China, Could Have Been Stopped at the Source
NYC Hospital System ‘Quietly’ Testing Over-the-Counter Heartburn Drug Pepcid Against Coronavirus
Producers Warn America Is Facing Protein Shortage in Coronavirus Era
Coronavirus: Apple-Google Contact Tracing Tech Picks Up Steam as Germany Buys In
My North Carolina Lockdown’s Been Extended for No Valid Reason
Andrew Cuomo Blames Nursing Homes’ Greed for Not Rejecting Coronavirus Patients State Made Them Accept
Back to the Beach: San Diego County Reopens for Swimming, Surfing, Fishing — Not Sunbathing
Georgia Restaurants Begin to Offer Limited Dine-in Services
Murder, Burglary Soars in New York City During Coronavirus Lockdown
NYT’s Friedman: ‘Depths of Despair’ by Crushing Economy Will Kill More People Than Virus
NBA Training Facilities to Begin to Reopen Friday
NBA’s first step toward reopening might already be in shambles
Behar: Trump ‘Losing It’ — He Is Like Grandpa Who Walks Around with His Pants Off
Indiana U. Profs Ordered to Report Students Who Join Online Classes Naked
‘Brew Dogs’ Deliver Beer, Smiles to Brewery Customers During Pandemic
Coronavirus Vaccine Unlikely to Be Ready Until Next Year, Says U.K. Medical Adviser
China Warns Australia: Drop Coronavirus Probe or Pay an Economic Price
Top Manhattan ER doc commits suicide, shaken by coronavirus onslaught
Case fatality rates rise as coronavirus runs deadly course
Masks, temperature checks mark new normal at restaurants
Brazil edges toward being the next big coronavirus hot spot
Harvard to Have a Fall Semester, but may be online
On the road to Las Vegas, rural residents think coronavirus fears are overblown
Troubling trend: Coronavirus deaths doubled in L.A. County over last week
San Francisco counties extend shelter-in-place orders through the end of May
Mysterious blood clots are COVID-19’s latest lethal surprise
‘Burn it to the ground.’ Rumors over COVID-19 spur threats against church in rural North Carolina
Stocks bounce as parts of Europe, US loosen coronavirus lockdowns
El Salvador inmates crammed in lockdown despite coronavirus
Biggest Hurdle to Bringing People Back to the Office Might Be the Commute
Backlash grows as pandemic relief stumbles
JetBlue becomes first US airline to require passenger face coverings
Undercover Cops Arrest 2 Women for Operating Home Beauty Businesses In Violation of Coronavirus Lockdown Order
Ashley Madison says cyber affairs have surged under coronavirus quarantine
Online porn traffic surges during coronavirus closures, but for the performers, ‘there’s not a huge pandemic payday’
Coronavirus: New Zealand claims no community cases as lockdown eases
Boris Johnson warns against lockdown impatience as Brits are at maximum risk
Mobile military units will go to schools, care homes and offices in UK as part of rapid-response testing drive to prevent a resurgence of the disease
Sweden cracks down on bars as crowds flout corona rules
Fake coronavirus cure kills 700 in Iran
No more bodies on the streets. But coronavirus batters Ecuador with disproportionate force
Africa is poised to potentially become the next epicenter of the pandemic
I’ve worked the coronavirus front line — and I say it’s time to start opening up
Leader of quarantine protests sidelined by coronavirus
Argentina extends strict flight ban to September
Japan delayed the Olympics to 2021, but even that timeline may be optimistic
Nigeria could ease lockdowns in Lagos and Abuja next week
Fear and uncertainty as India considers a partial reopening
States cautiously move ahead with plans to reopen
Some students return to school in China’s major cities
Bangladesh lets garment factories, a pillar of its economy, reopen, but workers fear infection
Phone location data shows that some Americans have ‘quarantine fatigue
Mexico empties migrant detention centers to prevent the spread of the virus
California governor blasts beachgoers who fled to shore over the weekend
We’re destroying hospitals in the name of fighting the coronavirus
Coronavirus is expected to reduce meat selection and raise prices
NBAMost Americans think coronavirus stimulus is too little too late, study finds
YouTube to host virtual film festival with Tribeca, Sundance and Cannes
Cuomo blames his refusal to help coronavirus-hit nursing home on Navy protocol
Coronavirus shutdown to be extended for parts of New York
Fiat Chrysler restarts Italy factory with new coronavirus safety precautions
Chinese pupils wear 3-foot-wide hats to keep safe distance with others
New Jersey priest gives last rites to coronavirus patient through window
Never-ending line of cars seen heading to Utah state park
Critics accuse NJ mayor of campaigning door-to-door in surgical mask amid coronavirus
De Blasio says NYC aims to open 100 miles of streets for pedestrians
Hollywood quietly turns to video-game tech to restart movie shoots
Man busted in Spain for taking goldfish for a walk during lockdown

B. Numbers & Trends

Note: 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.

Sources: Worldometers and ncov2019.live

1. Confirmed Total Cases and New Cases

Worldwide:
- Total Cases = 3,062,476 (+2.3%)
- New Cases = 69,214 (-6.3%) (-4,644)
- New Cases (3 day average) = 77,953 (-15.4%) (-14,199)
Europe:
- Total Cases = 1,301,271 (+1.9%)
- New Cases = 24,463 (+0.6%) (+152)
- New Cases (3 day average) = 25,319 (-0.9%) (-2,525)
Asia:
- Total Cases = 483,226 (+2.3%)
- New Cases = 10,950 (-5.7%) (-662)
- New Cases (3 day average) = 11,670 (-5.4%) (-663)
US:
- Total Cases = 1,010,356 (+2.4%)
- New Cases = 23,196 (-12.5%) (-3,313)
- New Cases (3 day average) = 28,439 (-20.2%) (-7,213)
US States & Territories:
- 44 States > 1,000 cases (+2),
- 38 States > 2,500 cases (+5), plus DC
- 28 States > 5,000 cases (+7)
- 18 States > 10,000 cases (+2): NY, NJ, MA, IL, CA, PA, MI, FL, LA, CT, TX, GA, MD, OH, IN, CO, WA & VA
- 12 States > 20,000 cases (+3): NY, NJ, MA, IL, CA, PA, MI, FL, LA, CT, TX & GA
- 5 States With Largest Number of Total Cases:

State	Total Cases	Change in Total Cases (%)	New Cases	Change in New Cases (#)	Change in New Cases (%)
NY	298,044	1.4%	4,013	(1,665)	(29.3%)
NJ	111,188	2.0%	2,150	(1,365)	(38.8%)
MA	56,462	2.8%	1,590	(66)	(4.2%)
IL	45,883	4.5%	1,980	(146)	(7.4%)
CA	45,006	3.4%	1,465	275	23.1%
Total	556,543	2.1%	11,579	(3,531)	(23.4)

Top 5 States = 55.1% of Total US Cases (-0.2%)
NY & NJ = 40.5% of Total US Cases (-0.3%)
For more information on US States and territories, see https://ncov2019.live/data & https://www.worldometers.info/coronavirus/country/us/

2. Serious or Critical Cases

Worldwide serious or critical cases = 56,297 (-1,303)
US series or critical cases = 14,186 (-957)
US serious or critical cases = 1.7% of Active Cases compared with worldwide percentage of 2.9%

3. Deaths

Worldwide deaths = 211,449 (+2.2%) (+4,534)
Europe deaths = 123,997 (+1.7%) (+2,112)
US deaths = 56,797 (+2.5%) (+1,384)
NY deaths = 22,623 (+1.6%) (+348)
Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Spain: 503 (+7)
- Italy: 446 (+5)
- France: 357 (+7)
- US: 172 (+5)
- Germany: 73 (+2)
US Total Confirmed Case Fatality Rate = 5.6% 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 calculate or estimate the actual fatality rate.]

4. Recoveries

Worldwide recoveries = 921,314 (+5.0%) (+43,903)
Worldwide recoveries = 30.1% of Total Worldwide Cases
US recoveries = 138,990 (+17.0%) (+20,209)
US recoveries = 13.8% of Total US Cases (+1.8%)

C. Potential Treatments

1. Oxford Group Leaps Ahead in Race for a Coronavirus Vaccine

In the worldwide race for a vaccine to stop the coronavirus, the laboratory sprinting fastest is at Oxford University.
Most other teams have had to start with small clinical trials of a few hundred participants to demonstrate safety. But scientists at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans.
That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.
The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.
Now, they have received promising news suggesting that it might.
Scientists at the National Institutes of Health’s Rocky Mountain Laboratory in Montana last month inoculated six rhesus macaque monkeys with single doses of the Oxford vaccine. The animals were then exposed to heavy quantities of the virus that is causing the pandemic — exposure that had consistently sickened other monkeys in the lab. But more than 28 days later all six were healthy, said Vincent Munster, the researcher who conducted the test.
“The rhesus macaque is pretty much the closest thing we have to humans,” Dr. Munster said, noting that scientists were still analyzing the result. He said he expected to share it with other scientists next week and then submit it to a peer-reviewed journal.
Immunity in monkeys is no guarantee that a vaccine will provide the same degree of protection for humans. A Chinese company that recently started a clinical trial with 144 participants, SinoVac, has also said that its vaccine was effective in rhesus macaques. But with dozens of efforts now underway to find a vaccine, the monkey results are the latest indication that Oxford’s accelerated venture is emerging as a bellwether.
“It is a very, very fast clinical program,” said Emilio Emini, a director of the vaccine program at the Bill and Melinda Gates Foundation, which is providing financial support to many competing efforts.
Which potential vaccine will emerge from the scramble as the most successful is impossible to know until clinical trial data becomes available.
More than one vaccine would be needed in any case, Dr. Emini argued. Some may work more effectively than others in groups like children or older people, or at different costs and dosages. Having more than one variety of vaccine in production will also help avoid bottlenecks in manufacturing, he said.

D. New Scientific Findings & Potential Advances

1. Coronavirus antibodies afford ‘some level of protection’

Coronavirus patients should have “some level of protection” after they recover from the illness — but it’s unclear how long that immunity lasts, the World Health Organization said Monday.
Dr. Maria Van Kerkhove, the WHO’s technical lead on COVID-19, said there are a number of studies underway about what the presence of antibodies means in terms of immunity for recovered patients.
“We expect people who have been infected with COVID-19 to develop a response that has some level of protection,” Van Kerkhove told reporters. “What we don’t know is how strong that protection is, and if that is seen in everyone that is infected and how long that lasts.”
“Right now, we are not able to say that someone who has antibodies is immune,” she added, citing a lack of research.
The agency warned Saturday that there’s no evidence that recovered patients won’t catch the virus again.
“Some governments have suggested that the detection of antibodies … could serve as the basis for an ‘immunity passport’ or ‘risk-free certificate,’” the WHO said.
“There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”

Source: Coronavirus antibodies afford ‘some level of protection’: WHO

2. New idea to speed up coronavirus vaccine research is bold but dangerous

A vaccine for the novel coronavirus will be the kind of drug that can help eradicate the virus for good. A vaccine would prevent infection and the more people who get it, the less likely it is for the virus to spread.
The good news is that some 77 vaccines are already in testing, including six that have reached at least phase I of human trials. Also good is the fact that the virus isn’t showing significant mutations that would hinder vaccine efficacy.
However, the first COVID-19 vaccines won’t be ready for mass inoculations for up to 18 months. Some of them could be deployed as soon as this fall, but only specific categories of patients will be allowed to get one, including health care workers who are constantly exposed to the virus.
The vaccines can’t come sooner than that because authorities need to make sure they’re safe, not just effective against the vaccine. The last thing we need to treat COVID-19 is a vaccine that can cause unexpected side effects. You’d never hear the end of it from anti-vaxxers, not to mention that such an event might delay other vaccine work. But there is an idea to speed up coronavirus research that’s both bold and dangerous.
Some lawmakers and scientists believe that informed volunteers could be given vaccine candidates and then the SARS-CoV-2 virus to see if the vaccine is effective at generating an immune response and preventing infection. This type of study is called “challenge trial,” and it has been done before, The Hill explains.
Challenge trails can be approved for diseases that already have cures aside from a potential vaccine, such as malaria. The problem with COVID-19 is that researchers would have to infect a few hundred young, healthy volunteers with the virus and only some of them would be given the vaccine. Others would receive a placebo drug so that the results can be compared.
Such a study would require the isolation of the patients before applying the vaccine to ensure that nobody already has the disease. Then they’d have to be isolated while the vaccine is administered and during their COVID-19 convalescence. Scientists will have to perform routine tests and observe the evolution of each patient.
The problem with the whole idea is that COVID-19 can kill young, healthy patients as well as older people, and there’s no treatment for it. Even if patients agree to take part in such a study fully knowing what the implications are, it could end up being a death sentence. Also, there’s no guarantee the vaccine will be effective.
A website called 1 Day Sooner is already up in support of vaccine challenge trials, and nearly 3,500 people from 52 countries have signed up for it. The site offers the following comparison between traditional vaccine research and challenge trials:
With the number of vaccine candidates increasing at a rapid pace, such challenge trials would not be possible for all proposed drugs. Having to isolate hundreds of people for weeks for each vaccine challenge trial would also rob hospitals of resources that could be used to treat regular COVID-19 patients.
The most recent good news surrounding coronavirus vaccines comes from China, where monkeys were given the virus after the vaccine candidate. The monkeys were not infected or they only developed mild symptoms, depending on the vaccine dose. The same sort of study could be applied to humans if this challenge study idea is approved. But even with that particular drug, which is now in phase I testing, it’s still too early to tell whether it’ll work on humans.
The Hill explains that 35 House lawmakers led by Reps. Bill Foster (D-Ill.) and Donna Shalala (D-Fla.) wrote to the Food and Drug Administration in support of the idea.
“Our situation in this pandemic is analogous to war, in which there is a long tradition of volunteers risking their health and lives on dangerous missions for which they understand the risks and are willing to do so in order to help save the lives of others,” the letter reads.
It’s not just politicians who think the challenge trial idea has merit. Scientists including the vaccinologist Stanley Plotkin who helped invent the rubella vaccine endorse it. Plotkin and New York University bioethicist Arthur Caplan penned an article in Vaccine in support of the idea. Similarly, Harvard University professor Marc Lipsitch co-authored an article in the Journal of Infectious Diseases in support of the idea.
The FDA is resisting this train of thought for now. “The FDA is exploring all possible options to most efficiently advance the development of safe and effective vaccines that will prevent COVID-19,” agency spokesman Michael Felberbaum told The Hill. “Human challenge studies used to develop a COVID-19 vaccine may present ethical and feasibility issues that can be avoided with the use of animal models.”

Source: New idea to speed up coronavirus vaccine research is bold but dangerous

3. Study of twins reveals genetic impact on coronavirus symptoms

Genes are partially to blame for which coronavirus symptoms people experience, according to a new study that used twins to explore how genetics impact patients’ response to the virus.
The study, which was not peer-reviewed, looked at 2,633 identical and fraternal twins who were diagnosed with COVID-19, according to a report in the pre-publication server MedRix.
“The idea was to basically look at the similarities in symptoms or non-symptoms between the identical twins, who share 100 percent of their genes, and the non-identical twins, who only share half of their genes,” King’s College London Professor Tim Spector, one of the researchers, told the Guardian.
The research group asked twins participating in another study to upload their symptoms to an app that tracks the illness.
The team took into account whether the twins lived in the same household as well as whether they had contact with one other, the report said.
Researchers determined genes were 50 percent responsible for whether participants suffered symptoms such as fever, diarrhea and delirium — as well as the loss of taste and smell.
“This disease is very weird, the way it has a very different presentation in the population in different people — what we are showing is that isn’t random,” Spector told the Guardian. “It is not mainly due to where you live or who you have seen; a lot of it is something innate about you.
However, other symptoms, such as cough, lack of appetite, chest pain and abdominal pain, didn’t prove to be related to genetics, according to the researchers, who attributed them to other factors, such as the surrounding environment.
Researchers said the findings could help others work to find out why the virus impacts some people severely while others show no symptoms.
“It reassures everyone that it is worth exploring this whole triangle of genes, immune system and gut microbes,” Spector told the outlet.

Source: Study of twins reveals genetic impact on coronavirus symptoms

E. New Concerns

1. Research indicates that immunity to COVID-19 may not last

Starting in the fall of 2016 and continuing into 2018, researchers at Columbia University in Manhattan began collecting nasal swabs from 191 children, teachers, and emergency workers, asking them to record when they sneezed or had sore throats. The point was to create a map of common respiratory viruses and their symptoms, and how long people who recovered stayed immune to each one.
The research included four coronaviruses, HKU1, NL63, OC42, and C229E, which circulate widely every year but don’t get much attention because they only cause common colds. But now that a new coronavirus in the same broad family, SARS-CoV-2, has the world on lockdown, information about the mild viruses is among our clues to how the pandemic might unfold.
What the Columbia researchers now describe in a preliminary report is cause for concern. They found that people frequently got reinfected with the same coronavirus, even in the same year, and sometimes more than once. Over a year and a half, a dozen of the volunteers tested positive two or three times for the same virus, in one case with just four weeks between positive results.
That’s a stark difference from the pattern with infections like measles or chicken pox, where people who recover can expect to be immune for life.
For the coronaviruses “immunity seems to wane quickly,” says Jeffrey Shaman, who carried out the research with Marta Galanti, a postdoctoral researcher.
Whether COVID-19 will follow the same pattern is unknown, but the Columbia results suggest one way that much of the public discussion about the pandemic could be misleading. There is talk of getting “past the peak” and “immunity passports” for those who’ve recovered. At the same time, some hope the infection is more widespread than generally known, and that only a tolerable death total stands between us and high enough levels of population immunity for the virus to stop spreading.
All that presumes immunity is long-lived, but what if it is fleeting instead?
“What I have been telling everyone—and no one believes me, but it’s true—is we get coronaviruses every winter even though we’re seroconverted,” says Matthew Frieman, who studies the virus family at the University of Maryland. That is, even though most people have previously developed antibodies to them, they get the viruses again. “We really don’t understand whether it is a change in the virus over time or antibodies that don’t protect from infection,” he says.

Critical factor

We’re currently in the pandemic phase. That’s when a new virus, which humans are entirely susceptible to, rockets around the planet. And humanity is still a greenfield for COVID-19—as of April 26, there were about three million confirmed cases, or one in 2,500 people on the planet. (Even though the true number of infections is undoubtedly higher, it’s still probably only a small fraction of the population.) Takeshi Kasai, the World Health Organization’s regional director for the Western Pacific, recently warned that until a vaccine is available, the world should get ready for a “new way of living.”
Further out, though, changes like social distancing or grounding airline flights may not be the biggest factor in our fate. Whether or not people acquire immunity to the virus, and for how long, will be what finally determines the toll of the disease, some researchers say.
Early evidence points to at least temporary protection against reinfection. Since the first cases were described in China in December, there has been no cut-and-dried case of someone being infected twice. While some people, including in South Korea, have tested positive a second time, that could be due to testing errors or persistence of the virus in their bodies.
“There are a lot of people who were infected and survived, and they are walking around, and they don’t seem to be getting reinfected or infecting other people,” says Mark Davis, a researcher at Stanford University. As of April 26, more than 800,000 people had officially recovered from the disease, according to the Johns Hopkins case-tracking dashboard.
Researchers in China also tested directly whether macaque monkeys resisted a second exposure to the new coronavirus. They infected the monkeys with the virus, and then four weeks later, after they recovered, tried again. The second time, the monkeys didn’t develop symptoms, and researchers couldn’t find any virus in their throats.
What’s unknown is how long immunity lasts—and only five months into the outbreak, there is no way to know. If it’s for life, then every survivor will add to a permanent bulwark against the pathogen’s spread. But if immunity is short, as it is for the common coronaviruses, COVID-19 could set itself up as a seasonal superflu with a high fatality rate—one that emerges in a nasty wave winter after winter.
The latest computer models of the pandemic find that the duration of immunity will be a key factor, and maybe the critical one. One model, from Harvard University and published in Science, shows the COVID-19 virus becoming seasonal—that is, staging a winter resurgence every year or two as immunity in the population builds up and then ebbs away.
After testing different scenarios, the Harvard group concluded that their projections of how many people end up getting COVID-19 in the coming years depended “most crucially” on “the extent of population immunity, whether immunity wanes, and at what rate.” In other words, the critical factor in projecting the path of the outbreak is also a total unknown.

Seasonal virus

Because so many other human coronaviruses are mild, they haven’t gotten the same attention as influenza, a shape-shifting virus that is closely followed and genetically analyzed to create a new vaccine each year. But it’s not even known, for instance, whether the common coronaviruses mutate in ways that let them evade the immune system, or whether there are other reasons immunity is so short-lived.
“There is no global surveillance of coronavirus,” says Burtram Fielding, a virologist at the University of the Western Cape, in South Africa, who tracks scientific reports in the field. “Even though the common cold costs the US $20 billion a year, these viruses don’t kill, and anything that does not kill, we don’t have surveillance for.”
The Global Virome Project in Manhattan, led by Shaman with funding from the Defense Department, has been an exception. It set out to detect respiratory viruses with the eventual aim of “nowcasting,” or having a live tracker on common infections circulating in the city.
One finding of the research is that people who got the same coronavirus twice didn’t have fewer symptoms the second time. Instead, some people never got symptoms at all; others had bad colds two or three times. Shaman says the severity of infection tended to run in families, suggesting a genetic basis.
The big question is what this fizzling, short-lived resistance to common cold viruses means for COVID-19. Is there a chance the disease will turn into a killer version of the common cold, constantly out there, infecting 10% or 20% of the population each year, but also continuing to kill one in a hundred? If so, it would amount to a plague capable of shaving the current rate of world population growth by a tenth.
Some scientists find the question too dark to contemplate. Shaman didn’t want to guess at how COVID-19 will behave either. “Basically, we have some unresolved questions,” he wrote in an email. “Are people one and done with this virus? If not, how often will we experience repeat infections? Finally, will those repeat infections be milder, just as severe, or even worse?”

Immune surveys

Big studies of immunity are already under way to try to answer those questions. Germany has plans to survey its population for antibodies to the virus, and in North America, 10,000 players and other employees of Major League Baseball are giving pinprick blood samples for study. In April, the US National Institutes of Health launched the COVID-19 Pandemic Serum Sampling Study, which it says will collect blood from 10,000 people, too.
By checking for antibodies in people’s blood, such serosurveys can determine how many people have been exposed to the virus, including those who had no symptoms or only mild ones.
Researchers will also be scavenging through the blood of COVID-19 cases in order to measure the nature and intensity of immune responses, and to figure out if there’s a connection to how sick people got. “What we are seeing right now with the coronavirus is the need for immune monitoring, because some people are shrugging this off and others are dying,” Davis says. “The gradient is serious and no one really understands why.”
Our immune system has different mechanisms for responding to germs we’ve never seen before. Antibodies, made by B cells, coat a virus and don’t let it infect cells. T cells, meanwhile, regulate the immune response or destroy infected cells. Once an infection is past, long-term “memory” versions of either type of cell can form.
What sort of immune memory will COVID-19 cause? Stephen Elledge, a geneticist at Harvard University says the severity of the disease could put it in a different category from the ordinary cold. “You might have a cold for a week, whereas if you go through three weeks of hell, that may give you more of a memory for longer,” he says.
Other clues come from the 2002-03 outbreak of SARS, a respiratory infection even more deadly than COVID-19. Six years after the SARS outbreak, doctors in Beijing went hunting for an immune response among survivors. They found no antibodies or long-lived memory B cells, but they did find memory T cells.
Because doctors managed to stop the SARS outbreak after about 8,000 cases, there’s never been a chance for anyone to get infected a second time, but those T cells could be a sign of ongoing immunity. A later vaccine study in mice found that memory T cells protected the animals from the worst effects when scientists tried infecting them again with SARS.
To Frieman, at the University of Maryland, all this uncertainty about immune response to coronaviruses means there’s still little chance of predicting when, or how, the outbreak ends. “I don’t know when this goes away, and if anyone says they know, they don’t know what they are talking about,” he says.

Source: MIT Technology Review here.

2. Barely sick with COVID-19, young and middle-aged people are dying of strokes

[Note: It is extremely important that you recognize the symptoms of a stroke (described below) as it can often be effectively treated, but only if treated quickly.]

Doctors sound alarm about patients in their 30s and 40s left debilitated or dead. Some didn’t even know they were infected.
Thomas Oxley wasn’t even on call the day he received the page to come to Mount Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors to treat all the emergency stroke patients, and he was needed in the operating room.
The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head.
Oxley gasped when he got to the patient’s age and COVID-19 status: 44, positive.
The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.
As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.
“This is crazy,” he remembers telling his boss.

Stroke surge

Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of the disease it causes. The numbers of those affected are small but nonetheless remarkable because they challenge how doctors understand the virus. Even as it has infected nearly 2.8 million people worldwide and killed about 195,000 as of Friday, its biological mechanisms continue to elude top scientific minds. Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body.
Until recently, there was little hard data on strokes and COVID-19.
There was one report out of Wuhan, China, that showed that some hospitalized patients had experienced strokes, with many being seriously ill and elderly. But the linkage was considered more of “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a University of Pittsburgh Medical Center neurologist and critical care doctor.
Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. There are only a few dozen cases per location, but they provide new insights into what the virus does to our bodies.
Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere.
A stroke, which is a sudden interruption of the blood supply, is a complex problem with numerous causes and presentations. It can be caused by heart problems, clogged arteries due to cholesterol, even substance abuse. Mini-strokes often don’t cause permanent damage and can resolve on their own within 24 hours. But bigger ones can be catastrophic.
The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.
Many researchers suspect strokes in COVID-19 patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.
Clots that form on vessel walls fly upward. One that started in the calves might migrate to the lungs, causing a blockage called a pulmonary embolism that arrests breathing — a known cause of death in COVID-19 patients. Clots in or near the heart might lead to a heart attack, another common cause of death. Anything above that would probably go to the brain, leading to a stroke.
Robert Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore, called strokes “one of the most dramatic manifestations” of the blood-clotting issues. “We’ve also taken care of patients in their 30s with stroke and COVID-19, and this was extremely surprising,” he said.
Many doctors expressed worry that as the New York City Fire Department was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because few autopsies were conducted.
Chou said one question is whether the clotting is because of a direct attack on the blood vessels, or a “friendly-fire problem” caused by the patient’s immune response.
“In your body’s attempt to fight off the virus, does the immune response end up hurting your brain?” she asked. Chou is hoping to answer such questions through a review of strokes and other neurological complications in thousands of COVID-19 patients treated at 68 medical centers in 17 countries.
Thomas Jefferson University Hospitals, which operates 14 medical centers in Philadelphia, and NYU Langone Health in New York City, found that 12 of their patients treated for large blood blockages in their brains during a three-week period had the virus. 40% were under 50, and they had few or no risk factors. Their paper is under review by a medical journal, said Pascal Jabbour, a neurosurgeon at Thomas Jefferson.
In the vast majority of younger adults, COVID-19 appears to result in mild illness with the risk of more severe consequences rising with every decade of age. According to CDC data, 0.8% of U.S. deaths as of Apr. 18 were in people ages 25 to 34; 2% among those 35 to 44; and 5.4% among those 45 to 54.
Jabbour and his co-author Eytan Raz, an assistant professor of neuroradiology at NYU Langone, said that strokes in COVID-19 patients challenge conventional thinking. “We are used to thinking of 60 as a young patient when it comes to large vessel occlusions,” Raz said of the deadliest strokes. “We have never seen so many in their 50s, 40s and late 30s.”
Raz wondered whether they are seeing more young patients because they are more resistant than the elderly to the respiratory distress caused by COVID-19: “So they survive the lung side, and in time develop other issues.”
A mysterious blood-clotting complication is killing coronavirus patients.
Jabbour said many cases he has treated have unusual characteristics. Brain clots usually appear in the arteries, which carry blood away from the heart. But in COVID-19 patients, he is also seeing them in the veins, which carry blood in the opposite direction and are trickier to treat. Some patients are also developing more than one large clot in their heads, which is highly unusual.
“We’ll be treating a blood vessel and it will go fine, but then the patient will have a major stroke” because of a clot in another part of the brain, he said.
On average, the COVID-19 stroke patients were 15 years younger than stroke patients without the virus.
In a letter to be published in the New England Journal of Medicine next week, the Mount Sinai team details 5 case studies of young patients who had strokes at home from March 23 to April 7. They make for difficult reading: The victims’ ages are 33, 37, 39, 44 and 49, and they were all home when they began to experience sudden symptoms, including slurred speech, confusion, drooping on one side of the face and a dead feeling in one arm.
One died, two are still hospitalized, one was released to rehabilitation, and one was released home to the care of his brother. Only one of the five, a 33-year-old woman, is able to speak.
Oxley, the interventional neurologist, said one striking aspect of the cases is how long many waited before seeking emergency care.
The 33-year-old woman was previously healthy but had a cough and headache for about a week. Over the course of 28 hours, she noticed her speech was slurred and that she was going numb and weak on her left side but, the researchers wrote, “delayed seeking emergency care due to fear of the COVID-19 outbreak.”
It turned out she was already infected.
By the time she arrived at the hospital, a CT scan showed she had two clots in her brain and patchy “ground glass” in her lungs — the opacity in CT scans that is a hallmark of COVID-19 infection. She was given two different types of therapy to try to break up the clots and by Day 10, she was well enough to be discharged.
Oxley said the most important thing for people to understand is that large strokes are very treatable. Doctors are often able to reopen blocked blood vessels through techniques such as pulling out clots or inserting stents. But it has to be done quickly, ideally within 6 hours, but no longer than 24 hours: “The message we are trying to get out is if you have symptoms of stroke, you need to call the ambulance urgently.”

Source: Young people with coronavirus are dying from strokes – The

3. Coronavirus-related ‘inflammatory syndrome’ emerges among UK children

A serious coronavirus-related “inflammatory syndrome” is emerging among young people, according to a new report.
“[Over the] last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK,” reads a “significant alert” issued to general practitioners in North London by the UK’s clinical commissioning group.
“There is a growing concern that a [COVID-19]- related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases,” continues the letter, which was first obtained by the Health Service Journal.
Those infected experience “overlapping features” of toxic syndrome and atypical Kawasaki disease — an illness that causes swelling and redness of the blood vessels — “with blood parameters consistent with severe COVID-19 in children,” according to the alert.
Children with the condition have also experienced stomach pain, gastrointestinal symptoms and cardiac inflammation, the notification says.
Some of the children have tested positive for COVID-19, and others appear to have had the virus in the past — though some have not.
The message, which has since been sent to doctors more widely and confirmed in a separate “urgent alert” issued Sunday night by the Pediatric Intensive Care Society, urged doctors to “please refer children presenting with these symptoms as a matter of urgency.”
The society called for “early discussion” of possible cases “with regional [pediatric] infectious disease and critical care teams.”
It’s unclear how widespread the condition has been, though a very small number of children are thought to be infected overall, pediatrics sources told the Journal.
As has been the case since the start of the outbreak, coronavirus generally causes relatively few severe effects or deaths in children, according to the report.

Source: Coronavirus-related ‘inflammatory syndrome’ emerges among UK children

E. The Road Back?

1. Secret Group of Scientists and Billionaires Pushes a Manhattan Project for COVID-19

They are working to cull the world’s most promising research on the pandemic, passing on their findings to policy makers and the White House
A dozen of America’s top scientists and a collection of billionaires and industry titans say they have the answer to the coronavirus pandemic, and they found a backdoor to deliver their plan to the White House.
The eclectic group is led by a 33-year-old physician-turned-venture capitalist, Tom Cahill, who lives far from the public eye in a one-bedroom rental near Boston’s Fenway Park. He owns just one suit, but he has enough lofty connections to influence government decisions in the war against COVID-19.
These scientists and their backers describe their work as a lockdown-era Manhattan Project, a nod to the World War II group of scientists who helped develop the atomic bomb. This time around, the scientists are marshaling brains and money to distill unorthodox ideas gleaned from around the globe.
They call themselves Scientists to Stop COVID-19, and they include chemical biologists, an immunobiologist, a neurobiologist, a chronobiologist, an oncologist, a gastroenterologist, an epidemiologist and a nuclear scientist. Of the scientists at the center of the project, biologist Michael Rosbash, a 2017 Nobel Prize winner, said, “There’s no question that I’m the least qualified.”
This group, whose work hasn’t been previously reported, has acted as the go-between for pharmaceutical companies looking for a reputable link to Trump administration decision makers. They are working remotely as an ad hoc review board for the flood of research on the coronavirus, weeding out flawed studies before they reach policy makers.
The group has compiled a confidential 17-page report that calls for a number of unorthodox methods against the virus. One big idea is treating patients with powerful drugs previously used against Ebola, with far heftier dosages than have been tried in the past. [Note: A copy of the 17-page report by the Scientists to Stop COVID-19 is attached to this update and also can be ready here.]
The FDA and the VA have already implemented specific recommendations, such as slashing manufacturing regulations and requirements for specific coronavirus drugs.
National Institutes of Health Director Francis Collins told people this month that he agreed with most of the recommendations in the report, according to documents reviewed by The Wall Street Journal and people familiar with the matter. The report was delivered to cabinet members and Vice President Mike Pence, head of the administration’s coronavirus task force.
Dr. Cahill’s primary asset is a young lifetime of connections through his investment firm. They include such billionaires as Peter Thiel, Jim Palotta and Michael Milken—financiers who afforded him the legitimacy to reach officials in the middle of the crisis. Dr. Cahill and his group have frequently advised Nick Ayers, Mr. Pence’s longtime aide, and agency heads through phone calls over the past month.
No one involved with the group stands to gain financially. They say they are motivated by the chance to add their own connections and levelheaded science to a coronavirus battle effort that has, on both state and federal levels, been strained.
“We may fail,” said Stuart Schreiber, a Harvard University chemist and a member of the group. “But if it succeeds, it could change the world.”
Steve Pagliuca, co-owner of the Boston Celtics and the co-chairman of Bain Capital—as well as one of Dr. Cahill’s investors—helped copy edit drafts of their report, and he passed a version to Goldman Sachs Group Inc. Chief Executive David Solomon. Mr. Solomon got it to Treasury Secretary Steven Mnuchin.
The group’s members say they are aware that many of their ideas may not be implemented, and could be ignored altogether by the Trump administration.
This account is based on interviews with scientists, businesspeople, government officials, as well as a review of related documents.

Break out

Only two years ago, Dr. Cahill was studying for his M.D. and PhD. at Duke University, conducting research on rare genetic diseases and wearing $20 Costco slacks. He assumed he would continue the work after graduation.
Instead, he reconnected with a friend who introduced him to a job at his father’s company, the blue-chip investment firm the Raptor Group.
Dr. Cahill got hooked on investing, particularly in life sciences. He reasoned he could make a bigger impact by identifying promising scientists and helping them troubleshoot problems—both scientific and financial—than doing research himself.
After a stint at Raptor, he formed his own fund, Newpath Partners, with $125 million from a small group of wealthy investors, including Silicon Valley stalwart Mr. Thiel and private-equity founders like Mr. Pagliuca. They were attracted to his blunt approach, as well as his interest in tackling intractable problems.
In early March, as the COVID-19 death toll mounted, Dr. Cahill was intrigued and a little depressed with the state of research on the virus. “Science and medicine were the furthest things removed from everything happening,” he said.
His investors peppered him with questions about the virus, and he organized a conference call to share some against-the-grain ideas on how to accelerate drug development and the like. He expected about 20 people.
When Dr. Cahill tried to dial in the meeting, he was rejected because the call had reached capacity. Then his cellphone buzzed from a New York number. It was National Basketball Association Commissioner Adam Silver. He, too, wanted the meeting’s access code. Dr. Cahill later gave him a personal briefing.
Newpath’s deep-pocketed investor base had spread word of the call, and hundreds of people were on the line, most of whom he had never met, including Mr. Milken.
When he finally got on the call, Dr. Cahill took a deep breath and said he had been working with friends to whittle down potential COVID-19 treatments to the most promising. He said he largely dropped his investing work to focus on a hunt for a cure.
After an hour, he hung up and found his email inbox full of ideas and offers to help, including from Mr. Milken’s team. “For the 50 years I’ve been involved in medical research I have never seen collaboration as we have today,” Mr. Milken said.
Dr. Cahill received a handful of notes from advisers to the vice president. They also had been on the call.
The scientist-investor had gained a platform. All he needed was a plan.

Tracing contacts

One of Dr. Cahill’s first calls was to Mr. Schreiber, a founder of several private companies.
Mr. Schreiber looped in a longtime friend, Edward Scolnick, former head of research and development at pharmaceutical giant Merck & Co., where he helped develop 28 new drugs and vaccines. Dr. Scolnick was blunt: A vaccine would take at least 18 months to hit the market under normal circumstances, he told Mr. Schreiber, “if you’re damn lucky.”
Mr. Schreiber responded, “What about six months?”
The team drew up a list of roughly two dozen companies that could benefit from their recommendations and pledged to sell any shares in them immediately. One early member said he couldn’t and was kicked out.
Much of the early work involved divvying up hundreds of scientific papers on the crisis from around the world. They separated promising ideas from dubious ones. Each member blazed through as many as 20 papers a day, around 10 times the pace they would in their day jobs. They gathered to debate via videoconference, text messages—“like a bunch of teenagers,” Mr. Rosbash said—and phone calls.
Personal hygiene went by the wayside. Michael Lin, a Stanford University neurobiologist, began disabling the camera on his phone to protect his vanity. “A couple of days, I’ve had seven or eight Zoom meetings, which will itself I’m sure cause some kind of disease,” joked David Liu, a Harvard University chemical biologist.
Debates haven’t always been purely science. The group discussed, for instance, whether to suggest that public-health authorities rename the virus “SARS-2,” after the 2003 China animal virus. To them, the name sounded scarier and might get more people to wear face masks. They dropped it.
The team pledged to try to block out politics—not an easy task in the noise and fury of a presidential election year.
Hydroxychloroquine, a malaria drug promoted by the president, was dismissed after the group’s resident expert, Ben Cravatt of Scripps Research in La Jolla, Calif., determined it was a long shot at best. The drug received only a passing mention in the group’s final report.
The group also disparaged the idea of using antibody testing to allow people back to work if their results showed they had recovered from the virus. Mr. Cravatt, a chemical biologist, declared it “the worst idea I’ve ever heard.” He said that prior exposure may not prevent people from giving the virus to others, and that overemphasizing antibody testing might tempt some people to intentionally infect themselves to later obtain a clean bill of health.
The group’s initial three phases of recommendations, contained in its report, center on leveraging the scale of the federal government. For instance, buy medicines not yet proven effective as a way to encourage manufacturers to ramp up production without worrying about losing money if the drugs fail. Another is to slash the time required for a clinical review of new drugs to a week from nine months or a year.
The group next needed to get their recommendations to the right people in the Trump administration. For that, Dr. Cahill tapped another well-placed billionaire.

An introduction

Brian Sheth, co-founder of private-equity firm Vista Equity Partners, and a Democrat, had been watching the effort gather steam from his home in Austin, Texas. He was an early investor in Dr. Cahill’s fund and had been on the first call. His expertise was technology, though, not immunology.
He had become friendly with Thomas Hicks Jr., the Dallas businessman and co-chairman of the Republican National Committee. Mr. Sheth introduced Mr. Hicks to Dr. Cahill’s group.
The connection cinched ties between a group of mostly liberal scientists from left-leaning institutions with a Republican stalwart who hunts birds with Donald Trump Jr.
In his first chat with the group, Mr. Hicks said, “I’m not a scientist. Make it clear enough for me, and then tell me where the red tape is.”
A major concern of the scientists was the FDA. The scientists had in their research identified monoclonal antibody drugs that latch onto virus cells as the most promising treatment. But to make the medicine in sufficient quantities, one drugmaker, Regeneron Pharmaceuticals Inc., would have to shift some of its existing manufacturing to Ireland. FDA rules required a monthslong wait for approval.
Mr. Scolnick, who had tussled with bureaucracy during the AIDS epidemic, tried reaching the FDA. The call ended poorly after the bureaucrats told the group they already had the pandemic under control. In a group call afterward, one of the scientists said, of the FDA: “They’re the problem here.”
Dr. Cahill got in touch with Mr. Ayers. Once the group briefed the vice president’s aide on the bottleneck, Mr. Ayers said he knew who to call. That evening, March 27, Regeneron received a call from the FDA. They had permission, starting immediately, to shift production to Dublin.
“That was proof positive that what we were doing was starting to work,” Mr. Rosbash said.
The group also made inroads with the VA, the largest health care system in the U.S. The scientists pushed the division’s medical staff to allow veterans with COVID-19 to join existing studies in such areas as prostate cancer, to see if already-approved drugs might be effective against the virus. They spoke to the VA’s chief medical officer and secretary about the proposal and learned the initiative was being fast-tracked.
Mr. Pagliuca spoke to Charles Baker, the Republican governor of Massachusetts, on the phone about the report. The governor, Mr. Pagliuca said, planned to adopt elements of the plan.
With much of their scientific proposals under advisement, or already in the process, the group has an eye on the post-COVID-19 world. Mr. Pagliuca pushed the scientists to add a fourth phase to the plan—reopening America.
The ideas include development of a saliva test, and scheduling tests at the end of the workday so results are available by morning. They also have suggested a nationwide smartphone app that requires residents to confirm each day that they don’t have any of 14 symptoms of a cold or fever.
Group members have continued their discussions with administration officials in recent days, hoping their confidential plan turns to action.
“We need the entire nation—government, business and science—to unite to defeat this,” Mr. Pagliuca said.

Source: WSJ here.

2. Here Are The Three Steps For An “Exit Plan” Toward Full Economic Re-opening

And as many states are on the cusp of reopening, JPMorgan has enumerated a three step “exit plan” framework incorporating community transmissions, imported cases and time to relax social distancing. However, as before, the bank’s central thesis is that until a specific vaccine is available, the potential risk of a second wave should be the main determinant of strategy.
First, some big picture thoughts: broadly speaking, once community transmission is confirmed, the strategy on public health intervention has been focused on slowing the infection curve to a smaller scale (i.e., curve flattening) so as to manage the infection under hospital capacity and to reduce potential mortality risk in the community under strong boarder control. As local infections are brought under control, a series of curve control relaxation measures would be under consideration.
JPM’s MW Kin visualizes three steps of an “exit plan” building in stages of community transmission, imported cases, and relaxing social distances.
The three steps toward a full economy reopening are shown below:

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More details below:

Community transmission: For a country with fewer new infections under adequate hospital capacity, the infection curve would be under control. Thus, it would likely be appropriate for the governor to consider lifting the city lockdown or relaxing social distancing. In this process, the net infection tally (=total infection-recovery death) could remain at a certain level, thus the re-opening plan should be based on a conservative approach so as to reduce the transmission rate. If not, there exists the risk of curve rebound or re-acceleration. The concerning re-acceleration in local infections in Singapore for the last two weeks is supporting evidence for the risk outcome.
Imported case: Once community transmission is under strong control, the next step would be relaxation on border control. Due to asymptomatic cases and the latent period (~2 weeks) of COVID-19, even when community transmission is under strong control, there exists risks of a second wave from imported cases. As each country is at a different stage in the infection curve, the relaxation on border control should not be immediately implemented with re-opening of the economy. Instead, in JPM’s opinion, it should be considered only when most countries’ infection curves are under strong control. Meanwhile, it should be highly encouraged to ask passengers to take the virus test at the airport (i.e., full scale of test at arrival should be maintained for a while despite the inconvenience) and to maintain the 14 day self-quarantine rule. This is perhaps the best way to minimize the risk of a second wave
Social distancing voluntary: With COVID-19 assumed to last for a while in the community, JPMorgan believes that it is essential for the public to maintain social distancing. In this stage, the format of social distancing could shift from “compulsory” by law to “voluntary” at the individual/community level, instead of entirely ending this practice. Also, in theory, if COVID-19 test kits would be largely available to the public, at affordable prices, and test results could be confirmed in a few minutes, this could be one of the most powerful solutions to re-activate the economy post the first curve.

Source: Here Are The Three Steps For An “Exit Plan” Torward Full Economic Re-opening

3. Big unknowns about virus complicate getting back to normal

Reopening the U.S. economy is complicated by some troubling scientific questions about the new coronavirus that go beyond the logistics of whether enough tests are available.
In an ideal world, we’d get vaccinated and then get back to normal. But, despite unprecedented efforts, no vaccine will be ready any time soon.
“We’re all going to be wearing masks for a while,” Dr. Rochelle Walensky, infectious diseases chief at Massachusetts General Hospital, predicted during a podcast with the Journal of the American Medical Association.
Three big unknowns top the worry list:

WHO’S CONTAGIOUS?

“The really unknown in this, to be completely transparent,” is asymptomatic spread, said Dr. Deborah Birx, the White House coronavirus task force coordinator.

From the beginning, authorities have rightly told people to stay home if they’re sick. But according to Dr. Anthony Fauci of the National Institutes of Health, somewhere between 25% and half of infected people might not show symptoms.
That means there’s no way to tell if you’re standing next to someone who’s contagious in the checkout line.
And even in people who eventually develop symptoms, it’s not clear exactly how soon after infection they can spread the virus. That’s one reason U.S. officials recently encouraged people to wear cloth masks in public, even as they try to keep 6 feet away from others.
To reopen the economy, officials are emphasizing the availability of more virus tests. That’s key to spotting and isolating the infected, and tracing and quarantining the people they may have exposed. But it’s not a panacea.
“If you get a test today, that does not mean that tomorrow or the next day or the next day or the next day as you get exposed, perhaps from someone who may not even know they’re infected, that that means ‘I’m negative,’” Fauci said at a recent White House briefing.

WHO’S IMMUNE?

Doctors assume people who had COVID-19 will have some immunity against a repeat infection. But they don’t know how much protection or how long it will last.
Another key question: Do people who survive a severe infection have stronger immunity than those who had mild symptoms — or those who had no obvious symptoms at all?
To tell, scientists are rolling out blood tests that look for antibodies, proteins that the immune system makes to fight off infection. They don’t detect active infection like the tests needed for the currently sick. They’re intended to tell who already was infected whether they knew it or not — including those who had few or no symptoms and those who were sick but couldn’t get a diagnostic test.
As they test more people, researchers will look for the level of antibodies that seems to be the key threshold for protection. They’re also trying to tell if having certain types of antibodies are more critical than an overall count.
“How long is the protection — one month, three months, six months, a year?” Fauci said. “We need to be humble and modest that we don’t know everything.”
Another hurdle: Dozens of antibody tests are being sold without proof that they work as promised. Some countries have reported wildly inaccurate results from certain tests. Among other things, scientists must prove the tests don’t confuse antibodies against another respiratory bug for COVID-19 protection.
The situation is so worrisome that FDA Commissioner Stephen Hahn recently warned that his agency has given “emergency use authorization” backing to just four tests — and that urgent work to validate others is underway.

WHO’S AT-RISK?

One early warning has borne out: Older adults are especially susceptible to COVID-19. So are people of any age who have certain health troubles, such as lung disease, heart problems or diabetes.
But being young and apparently healthy is no guarantee. Plenty of 20- and 30-somethings, and even some children, get infected and occasionally die.
“Some people do extremely well and some people completely crash,” Fauci told The Associated Press in a recent interview. “It’s something more than just age and underlying condition.”
There are theories. Maybe genetic differences play a role in how the body responds to this infection, particularly the overactive immune response — what’s called a “cytokine storm” — that is blamed for many deaths. Some scientists are looking into variations in cell receptors, the docking ports that allow the virus to stick to a cell and burrow inside.
Whatever the culprit, there’s no way to predict who’s going to crash. Yet that will become increasingly important if some of the experimental therapies being studied pan out, Fauci said, because doctors would need to know whether to focus treatment on the seriously ill or try to reach the newly infected quickly.
“If this acts like any other virus, you always want to hit it early,” he noted.

Source: Big unknowns about virus complicate getting back to normal

4. New York Plans For Economic Reopening, As Cuomo Says It’s “Complicated” While De Blasio Talks Transformation

Reopening the coronavirus epicenter of New York state is going to be tricky, Gov. Andrew Cuomo said on Sunday. The needs of the downstate and dense cities are far different than the rural upstate locations.
But the governor offered a rough roadmap on how he’ll navigate the issue, and said some businesses in the state could open by mid-May.
Meanwhile, New York City Mayor Bill de Blasio appointed his wife to a task force focused on racial inclusion and equity. When the city reopens, de Blasio said he wants a “better and more just society than the one we left behind.”
The Mayor’s wife is a controversial choice. Her city-funded Thrive mental health organization has been accused of blowing through a billion dollars without much in the way of accomplishments or transparency in its dealings. It is unclear if this new position is voluntary or comes with a stipend or a budget.
Cuomo said construction and manufacturing may be able to resume in certain regions of the state after May 15. That’s the date when his statewide shutdown order expires.
The trigger for reopening are the number of hospitalizations, the results of antibody testing, and the overall number of infections in the state. Cuomo said if the less-densely populated regions have 14 consecutive days of declining hospitalization numbers heading into May 15, they may be headed toward reopening.
“Phase one of reopening will involve construction and manufacturing activities, and within construction and manufacturing, those businesses that have a low risk,” said Cuomo.
Once reopened, the state will keep a close watch on things to see if any flare-ups of the disease occur. “Phase two would then be more a business-by-business analysis,” said Cuomo, saying which businesses would open would be a matter of “how essential a service does that business provide, and how risky is that business.”
New York City and its near suburbs will likely be among the last areas to be given clearance, Cuomo indicated.
“Downstate New York is going to be more complicated,” he said. “You can’t do anything in New York City that you don’t do in Suffolk, you don’t do in Nassau, you don’t do in Westchester.”
Bill de Blasio said in his Sunday comments that working groups will start meeting in days to plan the reopening. The pandemic has highlighted the “many things that are broken in our city and in our country,” he added. “We don’t just need a recovery, we need a transformation.”
The mayor declined to estimate a timeline for fully reopening New York City.

Source: New York Plans For Economic “Complicated” And “Transforming” Reopening

5. There States Are Most At Risk From The Economic “Reopening”

Since the conventionally accepted explanation for the shutdown of the US economy was to minimize human interaction in hopes of dramatically reducing the transmission of the coronavirus, and force social distancing during the period of potential covid incubation to prevent its spread among the population, it stands to reason that States in the US that are most at risk from a second wave of infections once the economy reopens, are those where a high level of physical contact makes social distancing difficult if not impossible.
To quantify said risk, Deutsche Bank has analyzed US states from the perspective of contact intensive occupations, and broken down the results in terms of low to high “contact” states. The results, shown in the map below, demonstrate which states have the highest risk of a new breakout (in black) and where an early reopening (light gray) may not have adverse consequences.

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Source: Which States Are Most At Risk From The Economic “Reopening”

5. College Campuses Must Reopen in the Fall [Opinion by Brown University President]

Across the country, college campuses have become ghost towns. Students and professors are hunkered down inside, teaching and learning online. University administrators are tabulating the financial costs of the COVID-19 pandemic, which already exceed the CARES Act’s support for higher education.
The toll of this pandemic is high and will continue to rise. But another crisis looms for students, higher education and the economy if colleges and universities cannot reopen their campuses in the fall.
As amazing as videoconferencing technology has become, students face financial, practical and psychological barriers as they try to learn remotely. This is especially true for lower-income students who may not have reliable internet access or private spaces in which to study. If they can’t come back to campus, some students may choose — or be forced by circumstances — to forgo starting college or delay completing their degrees.
The extent of the crisis in higher education will become evident in September. The basic business model for most colleges and universities is simple — tuition comes due twice a year at the beginning of each semester. Most colleges and universities are tuition dependent. Remaining closed in the fall means losing as much as half of our revenue.
This loss, only a part of which might be recouped through online courses, would be catastrophic, especially for the many institutions that were in precarious financial positions before the pandemic. It’s not a question of whether institutions will be forced to permanently close, it’s how many.
Higher education is also important to the U.S. economy. The sector employs about three million people and as recently as the 2017-18 school year pumped more than $600 billion of spending into the national gross domestic product. Colleges and universities are some of the most stable employers in municipalities and states. Our missions of education and research drive innovation, advance technology and support economic development. The spread of education, including college and graduate education, enables upward mobility and is an essential contributor to the upward march of living standards in the United States and around the world.
The reopening of college and university campuses in the fall should be a national priority. Institutions should develop public health plans now that build on three basic elements of controlling the spread of infection: test, trace and separate.
These plans must be based on the reality that there will be upticks or resurgences in infection until a vaccine is developed, even after we succeed in flattening the curve. We can’t simply send students home and shift to remote learning every time this happens. Colleges and universities must be able to safely handle the possibility of infection on campus while maintaining the continuity of their core academic functions.
They must also be sensitive to the particular challenge of controlling the spread of disease on a college campus. A typical dormitory has shared living and study spaces. A traditional lecture hall is not conducive to social distancing. Neither are college parties, to say the least. We must take particular care to prevent and control infection in this environment.
Although a vast majority of residential college students will experience only mild symptoms if they contract the coronavirus, students regularly interact with individuals on and off campus who are at high risk of severe illness, or worse. Administrators should be concerned not only for the students in their charge, but also for the broader community they interact with.
I am cautiously optimistic that campuses can reopen in the fall, but only if careful planning is done now. Fortunately, evidence-based public health protocols for the control of infectious disease have been known for decades. They can be applied to college campuses provided the right resources are in place and administrators are willing to make bold changes to how they manage their campuses.
Testing is an absolute prerequisite. All campuses must be able to conduct rapid testing for the coronavirus for all students, when they first arrive on campus and at regular intervals throughout the year. Testing only those with symptoms will not be sufficient. We now know that many people who have the disease are asymptomatic. Regular testing is the only way to prevent the disease from spreading silently through dormitories and classrooms.
Traditional contact tracing is not sufficient on a college campus, where students may not know who they sat next to in a lecture or attended a party with. Digital technology can help. Several states are working to adapt mobile apps created by private companies to trace the spread of disease, and colleges and universities can play a role by collaborating with their state health departments and rolling out tracing technology on their campuses.
Testing and tracing will be useful only if students who are ill or who have been exposed to the virus can be separated from others. Traditional dormitories with shared bedrooms and bathrooms are not adequate. Setting aside appropriate spaces for isolation and quarantine (e.g. hotel rooms) may be costly, but necessary. It will also be necessary to ensure that students abide by the rigorous requirements of isolation and quarantine.
Aggressive testing, technology-enabled contact tracing and requirements for isolation and quarantine are likely to raise concerns about threats to civil liberty, an ideal that is rightly prized on college campuses. Administrators, faculty and students will have to grapple with whether the benefits of a heavy-handed approach to public health are worth it. In my view, if this is what it takes to safely reopen our campuses, and provided that students’ privacy is scrupulously protected, it is worthwhile.
Our students will have to understand that until a vaccine is developed, campus life will be different. Students and employees may have to wear masks on campus. Large lecture classes may remain online even after campuses open. Traditional aspects of collegiate life — athletic competitions, concerts and yes, parties — may occur, but in much different fashions. Imagine athletics events taking place in empty stadiums, recital halls with patrons spaced rows apart and virtual social activities replacing parties.
But students will still benefit from all that makes in-person education so valuable: the fierce intellectual debates that just aren’t the same on Zoom, the research opportunities in university laboratories and libraries and the personal interactions among students with different perspectives and life experiences.
Taking these necessary steps will be difficult and costly, and it will force institutions to innovate as we have never done before. But colleges and universities are up to the challenge. Campuses were among the first to shutter during the COVID-19 pandemic. The rapid response that occurred across the country stemmed from our concern for the health of our students and communities, and our recognition that college campuses pose special challenges for addressing infectious disease.
Our duty now is to marshal the resources and expertise to make it possible to reopen our campuses, safely, as soon as possible. Our students, and our local economies, depend on it.
This editorial is written by Christina Paxson, who is the president and a professor of economics and public policy at Brown University, deputy chair of the Federal Reserve Bank of Boston’s board of directors and vice chair of the Association of American Universities.

Source: NY Times here.

F. The Vaccine Race

1. America Needs to Win the Coronavirus Vaccine Race [Opinion By Dr. Scott Gottlieb]

[Note: Dr. Gottlieb is a resident fellow at the American Enterprise Institute and was commissioner of the Food and Drug Administration, 2017-19. He serves on the boards of Pfizer and Illumina and is a partner at the venture-capital firm New Enterprise Associates.]

The first nation to develop a vaccine for Covid-19 could have an economic advantage as well as a tremendous public-health achievement. Doses will be limited initially as suppliers ramp up, and a country will focus on inoculating most of its own population first. Even with extraordinary international collaboration among multiple companies, it could be years before a vaccine is produced at a scale sufficient to help the entire world. The first country to the finish line will be first to restore its economy and global influence. America risks being second.
China is making rapid progress, with three vaccines entering advanced development. Chinese officials say they could have a vaccine available for widespread use next year. The Europeans are also making progress. While friendly nations will try to share a successful product—to a point—the U.S. can’t rely on vaccines from China or even Europe being available in America quickly. So it’s important to take steps to speed up progress in the U.S., and to prepare to manufacture such a vaccine on a global scale. A more prepared U.S. could inoculate Americans quickly and share the product with others, particularly low-income nations that can’t develop their own vaccines and need protection.
More than 70 companies and research teams are working on a vaccine, but fewer than 20 have the experience and manufacturing scale to pull a product through development. Only five or six operate primarily in the U.S., which means foreign governments might try to make a claim on a vaccine before America can. Each company is taking a slightly different approach, spreading bets and increasing the chance for success. (I serve on the board of one of them, Pfizer Inc. )
To win the race to a vaccine, America needs to engineer a development and regulatory process that is unprecedented in scope and urgency. Testing six or more candidate vaccines at once during a pandemic has never been tried anywhere. But it can be done.
First, the Food and Drug Administration should work with companies to conduct early safety testing while the vaccines are evaluated in laboratory and animal models to assess the full strength of their immunity. This parallel development process will save time and reveal more about the vaccines sooner. Regulators can also allow manufacturers to share common platforms for conducting the necessary studies. The FDA has developed good measures for potency using laboratory tests and animal models for the virus. These platforms should be adopted across industry, which will let regulators get clear answers more quickly.
Next, this effort will require novel approaches to clinical testing that allow us to build a large safety database and get an earlier answer on whether a product is working in people. Given that this vaccine will be deployed for mass inoculation of entire populations, a vaccine will need to be tested in tens of thousands of patients before it is approved for general use. An unsafe product could cause significant harm. The urgency to develop a vaccine quickly is eclipsed only by the need to make sure it is very safe.
Large Covid-19 outbreaks in American cities this fall may be inevitable. Against this grim backdrop, one approach to testing a vaccine is a “stepped wedge cluster.” Under this kind of clinical trial, a vaccine would be administered in the setting of an outbreak. The point is to provide some potential benefit while building a large and rigorous data set to evaluate its safety and effectiveness. This could be done as soon as a vaccine has cleared early safety trials.
The idea is to take a large number of doses and hold a trial in an outbreak city by serially vaccinating big groups of people—perhaps 25,000 at a time—with each cohort spaced two weeks apart, until 100,000 people have been inoculated over about six weeks. To see if the vaccine works, researchers compare the four groups and assess if timing of inoculation had a discernible impact on someone’s likelihood of contracting Covid-19.
The next massive challenge is making enough vaccines. Congress has set aside more than $3.5 billion for this purpose as part of the Cares Act. This allows the government to secure doses in advance of a product’s approval, which is essential for rolling out a vaccine the minute it’s approved. The money will be used to support investments in large-scale manufacturing. Johnson & Johnson recently announced a major collaboration with the Health and Human Services Department’s Biomedical Advanced Research and Development Authority to secure an early supply of vaccines. The government should also give grants to manufacturers with the most promising vaccines to rush the construction of large factories and other facilities.
Covid-19 has altered world history. It’s now evident that public health is part of national security. A successful vaccine will allow Americans to reclaim the country’s safety and sovereignty. The first country to reach this prize will be the first nation to recover.

Source: Opinion | America Needs to Win the Coronavirus Vaccine Race

G. Stories From The Frontline

1. Observations from Atlanta Metro Area: Georgia Restaurants Reopen

[Note 1: Georgia is one of the State leading the charge to reopen its economy. On Friday, 4/24, Governor Kemp reopened certain businesses (salons, gyms, bowling alleys). While the path taken by Georgia (the “Georgia Model”) is unquestionably controversial, only time will tell if the model is a good strategy or too aggressive. The stakes are high, particularly in light of President Trump’s criticism of some aspects of the plan, Much will depend on its success or failure of the Georgia Model as the outcome will undoubtedly influence the approach taken by other States. As a key contributor to our Updates (Brian Sivy) lives in the Atlanta Metro Area, we will be able to get some on the ground reporting on the reopening. Below is his second report.]

[Note 2: As of Monday, 4/27, the number of hospitalizations totaled 4,744, an increase of +367 from Sunday’s total of 4,377. Note the prior day’s increase in hospitalization was an increase of +223.]

Pursuant to Gov. Kemp’s order to allow the opening of private dine-in restaurants, we noted only a few restaurants that were offering dine-in services
I talked with an owner of a popular bar/restaurant in Buckhead, Atlanta. Here were her comments:
- The owner was planning to have a “soft-opening” tonight. Soft-opening meaning the opening wasn’t promoted. She would see how the week goes before doing any promotions for next week.
- Staff, waiters and anyone having contact with the customers are required to wear masks.
- The restaurant has an outdoor patio, which will serve as the primary seating area for customers. There is an indoor space that will be spread out to maintain social distancing.
- The owner maintained take-out/delivery services during the lockdown
- The restaurant paid its April rent and plans to pay its May rent.
- The owner secured a PPP-loan under the CARES Act. She felt this was an important tool to helping her stay open during this period. Her PPP loan was obtained via a small-community bank based in Savannah.
- When asked about employees, she said that a couple of employees were nervous about coming back, but she didn’t have problems finding employees to work.
As a resident of Roswell, a suburb north of downtown Atlanta, here are my observations:
- Roswell has a popular restaurant district in which a number of family-style restaurants are normally packed on a late-April evening.
- Only 2 restaurants out of the 17 restaurants on Canton St were offering dine-in services
  - Patrons were largely sitting outside, spaced approximately 6ft apart
  - None of the waiters at these restaurants were wearing masks
- There were 5 restaurants who were providing takeout/deliver services
Here are some pictures that show the two restaurants that were providing dine-in services:

H. Projections and Our (Possible) Future

1. Another blow dealt to public faith in scientific models [Opinion by Miranda Devine]

The random antibody testing of 3,000 people across the state of New York has delivered yet another blow to the faith we placed in the computer models that Governor Cuomo and President Trump used to shut down the economy and place all of America under virtual home detention.
The tests show 2.7 million in New York state have developed antibodies through exposure. Meaning, with 16,000 COVID-19 deaths, the state’s mortality rate is a little less than 0.6%. Nowhere near as lethal as the dire 3.4% death rate the World Health Organization was billing early last month, and these figures will keep changing as more data comes to hand.
And it wasn’t all because we are perfect practitioners of self-isolation and hand washing.
The President’s coronavirus task force took into account those mitigation measures when it used an amalgam of models to predict that between 100,000 and 240,000 Americans likely would die.
A model from the University of Washington has since revised the projected death toll to 60,000 down from an initial 162,000.
As of Friday, 51,000 Americans had lost their lives, and now the updated models are edging closer to grim reality.
Of course, every death is one too many. But what we have seen over the past two months is that computer models are unreliable when it comes to predicting the future, and the premise we agreed on to vaporize 25 million jobs exaggerated the risks.
For people who understand how models work, their imperfections are no surprise.
Coronavirus task force tsar Dr Anthony Fauci last month admitted that exaggeration was built into every computer model of diseases he’s dealt with: “They always overshoot,” he told CNN. Computer models are not crystal balls, only a useful tool. Fauci calls them a “hypothesis.” They allow you to test scenarios and provide an approximation of alternative realities. But they are no substitute for common sense and prudent judgment.
So, since the models were used as the rationale for shutting down our $23 trillion economy, we should at least understand their methodology. What were the assumptions fed into the models that led to such an overestimation of the risk? And did they include a scenario which allowed for a less drastic intervention than a total shutdown of the economy?
We know now that 64% of those who have died in New York were aged over 70. Of patients hospitalized with the disease, 94% had underlying conditions such as obesity or diabetes. Did the models include a scenario in which we focused efforts on protecting the elderly and infirm while allowing the young and healthy to keep the economy ticking?
We know now that less populated rural states have suffered less than New York, California and Michigan, so did the models consider targeted shutdowns and travel restrictions in hard-hit or dense areas, while allowing the economy to breathe in the rest of the country?
The consequences of overreach are dire. The International Monetary Fund this week warned the coronavirus has plunged the world into the worst economic crisis since the Great Depression. Famine, war and human misery are sure to follow.
As we emerge blinking in the sunlight in coming weeks to survey the smoldering remains of our economy, it’s not unreasonable to ask the question: did alarmist models persuade us to err too far on the side of caution?
The next challenge is to re-open the economy, and Cuomo reportedly wants to spend money we don’t have on consultants, McKinsey & Co, to create — you guessed it — a computer model to tell him the best way to move forward. This time lets demand to know what are the assumptions and political calculations that go into these new models before they are used to determine our future.
Or better yet, forget McKinsey, and trust the innate common sense of the American people.

Source: Coronavirus models deal another blow to faith of Americans: Devine