“Data from drug trial testing antiviral drug remdesivir sets a new standard of care for COVID-19 patients.” — Dr. Fauci
“Far too many of the people who want to prematurely reopen the economy aren’t workers, but the powerful and wealthy — those who benefit most from exploiting workers’ labor.”
— US Representative Ilhan Omar
“Holy God. We’re about to lose everything.”
— Cheryl Dobb, Air B&B Superhost
“Give people their freedom back!” — Elon Musk
- Recent Developments and Headlines
- Numbers and Trends
- Hypoxia – By The Time You Feel It, You’re In Big Trouble
- Potential Treatments – Remdesivir Sets New Standard of Care
- Not All Vaccines Are Created Equally
- An Uncertain Fate: Will Your Immune System Kill You?
- Stories From The Frontline
- New York Failed to Act, New Yorkers Died
- The Road Back?
- Practical Tips – The 4 Second (Yes, Second) Workout
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A. Recent Developments and Headlines
Note: All changes noted in this Update are since the 4/29 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 = 3,218,184 (+2.6%) (+81,676)
- Worldwide New Cases (5 day avg) = 77,913 (-7.2%) (-6,027)
- US Total Cases = 1,064,194 (+2.7%) (+28,429)
- US New Cases (5 day avg) = 27,831 (-10.6%) (-3,281)
- Worldwide deaths = 228,030 (+4.7%) (+10,217)
- US total deaths = 61,656 (+4.0%)
- US new deaths = 2,390 (-3.2%) (-79)
- NY total deaths = 23,474 (+1.6%)
- NY new deaths = 360 (-27.6%) (-131)
- WHO Flip-Flops Again, Endorses Sweden’s Lockdown-Free Approach To Tackling Coronavirus
- Federal social distancing guidelines will not be extended beyond April 30
- Dr. Fauci Praises ‘Important’ Study on Effectiveness of Remdesivir Against Coronavirus
- Georgia coronavirus death rate could double as lockdown eases, model shows
- Utah launches program to issue free face masks to residents
- Vermont records zero new coronavirus cases for first time in nearly 7 weeks
- Japan plans to extend state of emergency
- Price-Gougers Caught Hoarding One Million Face Masks In New York
- NYC Mayor de Blasio threatens Williamsburg Jews with arrest after mass gathering
- De Blasio says slamming Jewish funeral was ‘tough love’
- Italy’s recoveries outnumber new cases for 4th time
- Starbucks to reopen 90% of US stores
- Texas sees deaths surpass 700
- Italy reports another slowdown in deaths
- Florida reports promising drop in new cases
- Latest ‘surveillance’ data shows 17% of FDNY/EMS in NYC likely infected
- Trump asks governors to ‘consider’ reopening schools before end of academic year
- UK launches massive study of 6 potential COVID-19 treatments
- Poland joins growing list of EU states with plans to reopen
- China reopens Beijing to outsiders
- UK death toll passes Italy to make Britain’s the second deadliest in Europe
- US Government Report Concludes Wuhan Lab ‘Most Likely Source’ Of Coronavirus Outbreak
- The World’s Oldest Gold Trader Is Closing
- With Superfluous Demand In Free-Fall, What’s The Upside Of Re-Opening A Small Business?
- Rabobank: The Next Phase Of The Crisis – Food Shortages In Staples Such As Rice, Sugar, Corn And Eggs
- “Don’t Trace Me, Bro” – Just Say No To Contact Tracing
- The Largest Ozone Hole Ever Recorded Over North Pole Has Finally “Healed Itself” & Closed
- UK Study Shows 18,000 Extra Cancer Deaths Possible Within A Year Because Unable to Get Screenings and Treatment
- Portland To Ban Cars On 100 Miles Of Roadway To Promote Safe Distancing
- Being Afraid & Eliminating Exposure To Germs Leads To Death by Fear & Germs…
- “What The F**k”: In Expletive-Laced Rant, Elon Musk Blasts “Fascist, Undemocratic” Shelter-In-Place Orders
- COVID-19 Rips Through Marine Boot Camp, Dozens Of New Infections
- JPMorgan: “If There Is Any Good News In This Report, Don’t Believe It”
- MSNBC Attacks Trump For Using The DPA After Criticizing Trump For Not Using The DPA
- Study: Majority of Americans Don’t Want or Can’t Use Google and Apple’s Coronavirus Tracing App
- Donald Trump to Declare Meat Processing Plants Critical Infrastructure
- Pay-Per-View Success of ‘Trolls 2’ Could Change Hollywood Forever
- CA’s Newport Beach to Keep Beaches Open Despite Gov. Newsom
- China Implements ‘Social Distancing’ Hats for Elementary Students
- Wuhan Residents: China’s Claims of Zero Coronavirus Patients ‘Fake’, a ‘Cover-Up’
- Japan Divorce Spike Amid Lockdown
- Indian Supreme Court Suggests Food Ration Cards During Lockdown
- WaPo Poll: 65 Percent of Americans Want All Immigration to U.S. Halted
- U.S. Repatriates over 70,000 Americans Stranded in 127 Countries, Territories
- Pug Dog Tests Positive for Coronavirus, May Be First Case in U.S.
- Indian Migrant Tests Positive for Coronavirus After Illegally Crossing Border into California
- How accurate is the US coronavirus death count? Some experts say it’s off by ‘tens of thousands’
- U.S. Buys 100,000 More Body Bags, Preparing for Coronavirus Worst
- Georgia’s Experiment in Human Sacrifice
- Boneless chicken is first to go scarce as coronavirus hits U.S. meat supply
- Hundreds of Americans line up for drive-thru food bank handouts as a rise in unemployment leaves Americans struggling to feed their families
- Pending home sales tank nearly 21% in March, but Realtors claim prices will hold up
- Costco to require all customers wear face masks, returns to regular hours starting Monday
- Cyberscammers: Pay Up or We’ll Infect Your Family With Coronavirus
- Most people want billionaires to pitch in to aid poverty and inequality
- Barclays boss: Big offices ‘may be a thing of the past’
- U.S. Marriage Rate Plunges to Lowest Level on Record
- Police Investigating Death of Arizona Man Who Ingested Chloroquine Phosphate Used in Fish Tanks
- Visualization shows how droplets from a single cough can infect an entire airplane
- Nearly half of global workforce risk losing livelihoods in pandemic
- Torment in Ecuador: virus dead piled up in bathrooms
- Sun worshippers: Indonesians soak up the rays to battle virus
- Bridge Was Their Passion. Then People Started to Die.
- Coronavirus ‘will become a seasonal virus’ and could blight world for a decade
- Coronavirus ‘altered the brain’ of NYC ER doc who killed herself, sister says
- Over 70 percent of tested inmates in federal prisons have coronavirus
- Oregon strip club has launched a drive-thru burlesque show featuring exotic dancers for people who order food during pandemic
- California to close all beaches and State parks after crowds ignore social distancing rules
- Los Angeles is first major US city to offer free coronavirus tests to all residents
- Sealing borders saves lives during coronavirus pandemic
- Michigan doctor charged after allegedly touting vitamin C infusions for coronavirus
- Fauci: Sports may be screwed this year
- Yankees president ‘surprised’ by Dr. Fauci’s hopeless sports forecast
- Chicago brewery uses ice cream truck-inspired van to sell beer amid coronavirus
- With homeless overwhelming NYC subways, de Blasio must embrace ‘tough love’
- Most Americans want nothing to do with contact tracing apps
- Dozens of bodies found in U-Haul trucks outside NYC funeral home
- A Covid-19 cluster is reported in Yemen, adding to its woes
- Fleeing cities, Peruvians seek safety in the countryside
- Russia’s newest black market is in ventilators
- Young Doctors Struggle to Treat Coronavirus Patients: ‘We Are Horrified and Scared’
- Food-Plant Workers Clash With Employers Over Safety
- News anchor allegedly caught cheating when half naked woman walks into live shot
- Germany’s COVID-19 infection rate increases after easing lockdowns
- Massachusetts sees spike in domestic abuse 911 calls during coronavirus lockdown
- Federal inmate with coronavirus dies after giving birth on ventilator
- Study: Coronavirus deaths may be underreported by 15,000
- Nationwide meat shortage will soon reach its peak
- New York let coronavirus-infected nurses work in upstate nursing home
- Dogs are being trained to sniff out the coronavirus at universities in Pennsylvania and in the UK
- Military to help NYC health care workers deal with coronavirus ‘combat stress’
- New Jersey reopening golf courses as part of coronavirus order
- Cuomo says MTA must scrub ‘every train, every night’
- Homicide cops probe death of man who drank chloroquine to cure coronavirus
- Anti-vaxxers fear coronavirus vaccine’s safety before it exists
- Seniors isolated in Florida will receive robotic therapy dogs
- Healthcare spending has collapsed during pandemic as “non-critical” procedures put on back burner
- If you don’t have COVID-19, good luck finding someone to care for you
- “I want to walk on the grass,” said one Beijing resident as citizens clamor to visit reopened parks and museums
- Swedish town set to dump a ton of chicken manure in park to deter crowds
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.
1. Confirmed Total Cases and New Cases
- Total Cases = 3,218,184 (+2.6%)
- New Cases = 81,676 (+10.3%) (+7,644)
- New Cases (5 day avg) = 77,913 (-7.2%) (-6,027)
- Total Cases = 1,347,380 (+1.9%)
- New Cases = 24,674 (+15.1%) (+3,239)
- New Cases (5 day avg) = 24,413 (-5.7%) (-1,473)
- Total Cases = 507,328 (+2.5%)
- New Cases = 12,554 (+8.7%) (+1,006)
- New Cases (5 day avg) = 11,822 (-0.7%) (-77)
- Total Cases = 1,064,194 (+2.7%)
- New Cases = 28,429 (+11.9%) (+3,020)
- New Cases (5 day avg) = 27,831 (-10.6%) (-3,281)
- US States & Territories:
- 45 States > 1,000 cases (+0),
- 38 States > 2,500 cases (+0), plus DC
- 28 States > 5,000 cases (+0)
- 20 States > 10,000 cases (+1): NY, NJ, MA, IL, CA, PA, MI, FL, LA, CT, TX, GA, MD, OH, IN, CO, WA, VA, TN & NC
- 13 States > 20,000 cases (+0): NY, NJ, MA, IL, CA, PA, MI, FL, LA, CT, TX, GA & MD
- 5 States With Largest Number of Total Cases:
Change in Total Cases (%)
Change in New Cases (#)
|Change in New Cases (%)|
- Top 5 States = 54.7% of Total US Cases (-0.1%)
- NY & NJ = 39.7% of Total US Cases (-0.4%)
- 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 = 59,817 (+2,852)
- US serious or critical cases = 18,671 (+3,373)
- US serious or critical cases = 2.2% of Active Cases compared with worldwide percentage of 3.0%
- Worldwide deaths = 228,030 (+4.7%) (+10,217)
- Europe deaths = 132,947 (+5.2%) (+6,525)
- US deaths = 61,656 (+4.0%) (+2,390)
- NY deaths = 23,474 (+1.6%) (+360)
- Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Spain: 519 (+9)
- Italy: 458 (+5)
- UK: 384 (+65)
- France: 369 (+7)
- US: 186 (+7)
- US Total Confirmed Case Fatality Rate = 5.8% compared with a Worldwide Confirmed Case Fatality Rate of 7.1% [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.]
- Worldwide recoveries = 1,000,033 (+4.9%) (+46,724)
- Worldwide recoveries = 31.1% of Total Worldwide Cases
- US recoveries = 147,411 (+3.6%) (+5,173)
- US recoveries = 13.9% of Total US Cases (+0.2%)
C. Hypoxia – By The Time You Feel It, You’re In Big Trouble
1. Some coronavirus patients are unable to sense their alarmingly low oxygen levels
[Note: For reasons described in this story, we highly recommend that you buy a pulse oximeter (which can be purchased on Amazon) as it is critically important to detect any reduction in oxygen levels as soon as possible.]
- Among the many surprises of the new coronavirus is one that seems to defy basic biology: infected patients with extraordinarily low blood-oxygen levels, or hypoxia, scrolling on their phones, chatting with doctors, and generally describing themselves as comfortable. Clinicians call them happy hypoxics.
- “There is a mismatch [between] what we see on the monitor and what the patient looks like in front of us,” says Reuben Strayer, an emergency physician at Maimonides Medical Center in New York City. Speaking from home while recovering from COVID-19 himself, Strayer says he was first struck by the phenomenon in March as patients streamed into his emergency room. He and other doctors are keen to understand this hypoxia, and when and how to treat it.
- A normal blood-oxygen saturation is at least 95%. In most lung diseases, such as pneumonia, falling saturations accompany other changes, including stiff or fluid-filled lungs, or rising levels of carbon dioxide because the lungs can’t expel it efficiently. It’s these features that leave us feeling short of breath—not, counterintuitively, low oxygen saturation itself, says Paul Davenport, a respiratory physiologist at the University of Florida. “The brain is tuned to monitoring the carbon dioxide with various sensors,” Davenport explains. “We don’t sense our oxygen levels.”
- In serious cases of COVID-19, patients struggle to breathe with damaged lungs, but early in the disease, low saturation isn’t always coupled with obvious respiratory difficulties. Carbon dioxide levels can be normal and breathing deeply is comfortable—“the lung is inflating so they feel OK,” says Elnara Marcia Negri, a pulmonologist at Hospital Sírio-Libanês in São Paulo. But oxygen saturation, measured by a device clipped to a finger and in many cases confirmed with blood tests, can be in the 70s, 60s, or 50s. Or even lower. Although mountain climbers can have similar readings, here the slide downward, some doctors believe, is potentially “ominous,” says Nicholas Caputo, an emergency physician at New York City Health + Hospitals/Lincoln.
- Hypotheses about what causes it are emerging. Many doctors now recognize clotting as a major feature of severe COVID-19. Negri thinks subtle clotting might begin early in the lungs, perhaps thanks to an inflammatory reaction in their fine web of blood vessels, which could set off a cascade of proteins that prompts blood to clot and prevents it from getting properly oxygenated.
- Negri developed this idea after treating a woman whose breathing troubles coincided with circulatory problems in her toes. Negri’s team gave the woman heparin, a common blood thinner, and not only her toes but her breathing recovered. Negri wondered whether heparin could boost patients’ low oxygen levels regardless of whether they were struggling to breathe. On 20 April, she posted a preprint detailing her hospital’s experience with 27 COVID-19 patients. Patients with hypoxia received heparin, and the dose was increased if they had elevated levels of D-dimer, a blood marker of excess clotting.
- One of the 27 was lost to follow-up after transferring to another hospital. But 24 others are recovering—including six of eight who needed mechanical ventilation, a better rate of positive outcomes than has been reported elsewhere. Two remain critically ill. Negri is now planning to follow more patients. And several clinical trials elsewhere will test whether blood thinners can prevent or treat complications of severe COVID-19, including respiratory problems.
- Strayer finds it reasonable to imagine that hypoxia emerges because “small blood vessels of the lung are being showered with clots.” His own hospital and others are beginning to test many admitted COVID-19 patients for markers of excess clotting and treat those who show it with blood thinners. But, “It is simply not known” whether clotting causes happy hypoxia, Strayer says. There are other possibilities. Recent imaging of a hypoxic patient showed “almost waxy-looking film all around the lungs,” Caputo says. “I don’t know what is actually going on pathophysiologically down there.”
- Caputo says this hypoxia is likely stressing a body already straining to battle the virus. What to do about it is prompting debate. An emerging view is that doctors should avoid aggressive treatment they’ve been trained to offer in other settings. Luciano Gattinoni, a guest professor in intensive care at the University of Göttingen Medical Center, is wary of what he calls a “Pavlovian response” to COVID-19 hypoxia, in which doctors may swoop in to inflate lungs with ventilators or high-pressure oxygen even when patients seem comfortable. Those measures, Gattinoni wrote 24 April online in JAMA, could harm lungs that are inflating on their own but may be needed if patients aren’t helped by noninvasive treatment.
- Simpler interventions, he and others say, are important. Strayer, Caputo, and their collaborator Richard Levitan, a physician at Littleton Regional Healthcare in New Hampshire, who spent time treating COVID-19 patients in a New York City emergency room, offered patients supplemental oxygen and also flipped them on their belly, an approach traditionally used for people on ventilators, which can open the lower lungs. This month in Academic Emergency Medicine, they reported that among 50 patients with low oxygen saturation, switching to a prone position raised average saturation significantly. However, 13 of the patients weren’t helped for long and needed intubation within 24 hours.
- Doctors are uncertain about the value of detecting low oxygen saturation early using inexpensive devices called pulse oximeters at home. Is home monitoring “going to prevent all bad outcomes in COVID? Absolutely not,” says Levitan, who wrote a 20 April op-ed in The New York Times arguing that early hypoxia can rapidly progress to pneumonia and death. “If we were able to detect them when they were less sick, they’d do better.” Negri tells her patients to monitor their oxygen saturation and visit the hospital if it drops to 93% or below. At that point, she considers blood thinners and other therapy.
- No one, however, has studied whether early detection of hypoxia might head off bad outcomes. Some physicians, including Gattinoni, believe pulse oximeters are best used with a doctor’s guidance, perhaps through telemedicine. With many COVID-19 patients frightened to visit a hospital and arriving only when their symptoms have dangerously advanced, doctors also wonder whether home monitoring could hasten treatment—and whether, for some, that could make all the difference.
D. Potential Treatments
1. Gilead’s remdesivir sets a new ‘standard of care’ for coronavirus treatment
- White House health advisor Dr. Anthony Fauci said Wednesday that data from a coronavirus drug trial testing Gilead Sciences’ antiviral drug remdesivir showed “quite good news” and sets a new standard of care for Covid-19 patients.
- Speaking to reporters from the White House, Fauci said he was told data from the trial showed a “clear-cut positive effect in diminishing time to recover.”
- Fauci said the median time of recovery for patients taking the drug was 11 days, compared with 15 days in the placebo group. He said the mortality benefit of remdesivir “has not yet reached statistical significance.”
- The results suggested a survival benefit, with a mortality rate of 8% for the group receiving remdesivir versus 11.6% for the placebo group, according to a statement from the National Institutes of Health released later Wednesday.
- “This will be the standard of care,” Fauci, director of the National Institute of Allergy and Infectious Diseases, added. “When you know a drug works, you have to let people in the placebo group know so they can take it.”
- “What it has proven is a drug can block this virus,” he said.
- U.S. health officials are expected to release the full results of a drug trial conducted by the National Institute of Allergy and Infectious Diseases later Wednesday. Gilead Sciences announced earlier in the day that the study had met its primary endpoint but did not provide further details.
- Gilead also released preliminary results from its own study, showing at least 50% of the patients treated with a five-day dosage of remdesivir improved. The clinical trial involved 397 patients with severe cases of Covid-19. The severe study is “single-arm,” meaning it did not evaluate the drug against a control group of patients who didn’t receive the drug.
- The FDA, in the meantime, has been in “sustained and ongoing” discussions with Gilead to make remdesivir available to Covid-19 patients “as quickly as possible, as appropriate,” said FDA senior advisor Michael Felberbaum.
- Remdesivir has shown some promise in treating SARS and MERS, which are also caused by coronaviruses. Some health authorities in the U.S., China and other parts of the world have been using remdesivir, which was tested as a possible treatment for the Ebola outbreak, in hopes that the drug can reduce the duration of Covid-19 in patients.
- On Tuesday, Fauci warned that the United States “could be in for a bad fall” if researchers don’t find an effective treatment to fight the coronavirus by then.
- Covid-19 is “not going to disappear from the planet,” he said, adding infectious disease experts are learning about how the virus behaves by watching emerging outbreaks in other regions such as southern Africa that are starting to enter their colder seasons.
2. FDA plans to announce the emergency use of remdesivir after a trial showed shortened recovery time
- The FDA plans to announce as early as Wednesday an emergency use authorization for remdesivir, an experimental antiviral drug that is being tested in treating patients with Covid-19, the disease caused by the coronavirus, according to a senior administration official.
- Ahead of the announcement President Trump and Dr. Anthony S. Fauci, the federal government’s leading infectious diseases scientist, on Wednesday hailed early trial results of the drug, holding out hope that it could help stem the rising death toll.
- Meeting with reporters at the White House, Dr. Fauci cautioned that the results of the study overseen by his agency, the National Institute of Allergy and Infectious Disease, still need to be properly peer reviewed but expressed optimism that it could make a difference in speeding up the recovery of some patients infected with the virus.
- Dr. Fauci said the federal trial indicated that the drug remdesivir could shorten the time to recovery by about a third. “Although a 31 percent improvement doesn’t seem like a knockout 100%, it is a very important proof of concept because what it has proven is that a drug can block this virus,” Dr. Fauci said. “This is very optimistic.”
- Mr. Trump called that a good sign. “Certainly it’s a positive, it’s a very positive event,” he said.
- In a statement, Gilead Sciences said it was “aware of positive data emerging from” the study by Dr. Fauci’s institute, known as NIAID. “We understand that the trial has met its primary endpoint and that NIAID will provide detailed information at an upcoming briefing.”
- Remdesivir is not yet licensed or approved in the United States or anywhere in the world “and has not yet been demonstrated to be safe or effective for the treatment of Covid-19,” according to Gilead.
- A representative for Gilead said in an email Wednesday that “as we have done since the beginning of the pandemic, we have been sharing information, transparently and as it becomes available, with the administration, other officials and the public.”
- The spokesman, Ryan McKeel, said the company could not speculate on what actions the federal government would take. “However, we are continuing to discuss with them the growing body of evidence for remdesivir as a potential treatment for COVID-19, with the goal of making remdesivir more broadly available for patients in urgent need of treatment.”
Source: Coronavirus News and Updates
E. Not All Vaccines Are Created Equal
1. A Graphical Guide to Different Types of Vaccines Under Development
- More than 90 vaccines are being developed against the coronavirus by research teams in companies and universities across the world. Researchers are developing and testing different technologies, some of which haven’t been used in a licensed vaccine before. At least 6 groups have already begun injecting formulations into volunteers in safety trials; others have started testing in animals.
|Graphics: Nik Spencer/Nature|
Coronavirus vaccines: a variety of approaches
- All vaccines aim to expose the body to an antigen that won’t cause disease, but will provoke an immune response that can block or kill the virus if a person becomes infected. There are at least eight types of vaccines being tried against the coronavirus, and they rely on different viruses or viral parts.
|Sources: Nature analysis based on: WHO COVID-19 Vaccine Landscape/Milken Institute COVID-19 Treatment and Vaccine Tracker/T. Thanh Le et al. Nature Rev. Drug. Disc. http://doi.org/ggrnbr (2020)/F. Amanat & F. Krammer Immunity 52, 583–589 (2020)/W. Shang et al. npj Vaccines 5, 18 (2020).|
- At least 7 teams are developing vaccines using the virus itself, in a weakened or inactivated form. Many existing vaccines are made in this way, such as those against measles and polio, but they require extensive safety testing. Sinovac Biotech in Beijing has started to test an inactivated version of the coronavirus in humans.
- Around 25 groups say they are working on viral-vector vaccines. A virus such as measles or adenovirus is genetically engineered so that it can produce coronavirus proteins in the body. These viruses are weakened so they cannot cause disease. There are two types: those that can still replicate within cells and those that cannot because key genes have been disabled.
- At least 20 teams are aiming to use genetic instructions (in the form of DNA or RNA) for a coronavirus protein that prompts an immune response. The nucleic acid is inserted into human cells, which then churn out copies of the virus protein; most of these vaccines encode the virus’s spike protein.
- Many researchers want to inject coronavirus proteins directly into the body. Fragments of proteins or protein shells that mimic the coronavirus’s outer coat can also be used.
- More than 70% of the groups leading vaccine research efforts are from industrial or private firms. Clinical trials start with small safety studies in animals and people, followed by much larger trials to determine whether a vaccine generates an immune response. Researchers are accelerating these steps and hope to have a vaccine ready in 18 months.
|Source: Fig. 2 in T. Thanh Le et al. Nature Rev. Drug. Disc. http://doi.org/ggrnbr (2020).|
F. An Uncertain Fate: Will Your Immune System Kill You?
1. Why Some People Get Sicker Than Others
- COVID-19 is, in many ways, proving to be a disease of uncertainty. According to a new study from Italy, some 43 percent of people with the virus have no symptoms. Among those who do develop symptoms, it is common to feel sick in uncomfortable but familiar ways—congestion, fever, aches, and general malaise. Many people start to feel a little bit better. Then, for many, comes a dramatic tipping point. “Some people really fall off the cliff, and we don’t have good predictors of who it’s going to happen to,” Stephen Thomas, the chair of infectious diseases at Upstate University Hospital, told me. Those people will become short of breath, their heart racing and mind detached from reality. They experience organ failure and spend weeks in the ICU, if they survive at all.
- Meanwhile, many others simply keep feeling better and eventually totally recover.
- “There’s a big difference in how people handle this virus,” says Robert Murphy, a professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University. “It’s very unusual. None of this variability really fits with any other diseases we’re used to dealing with.”
- This degree of uncertainty has less to do with the virus itself than how our bodies respond to it. As Murphy puts it, when doctors see this sort of variation in disease severity, “that’s not the virus; that’s the host.” Since the beginning of the pandemic, people around the world have heard the message that older and chronically ill people are most likely to die from COVID-19. But that is far from a complete picture of who is at risk of life-threatening disease. Understanding exactly how and why some people get so sick while others feel almost nothing will be the key to treatment.
- Hope has been put in drugs that attempt to slow the replication of the virus—those currently in clinical trials like remdesivir, ivermectin, and hydroxychloroquine. But with the flu and most other viral diseases, antiviral medications are often effective only early in the disease. Once the virus has spread widely within our body, our own immune system becomes the thing that more urgently threatens to kill us. That response cannot be fully controlled. But it can be modulated and improved.
- One of the common, perplexing experiences of COVID-19 is the loss of smell—and, then, taste. “Eating pizza was like eating cardboard,” Mahajan told me. Any common cold that causes congestion can alter these sensations to some degree. But a near-total breakdown of taste and smell is happening with coronavirus infections even in the absence of other symptoms.
- Jonathan Aviv, an ear, nose, and throat doctor based in New York, told me he has seen a surge in young people coming to him with a sudden inability to taste. He’s unsure what to tell them about what’s going on. “The non-scary scenario is that the inflammatory effect of the infection is temporarily altering the function of the olfactory nerve,” he said. “The scarier possibility is that the virus is attacking the nerve itself.” Viruses that attack nerves can cause long-term impairment, and could affect other parts of the nervous system. The coronavirus has already been reported to precipitate inflammation in the brain that leads to permanent damage.
- Though SARS-CoV-2 (the new coronavirus) isn’t reported to invade the brain and spine directly, its predecessor SARS-CoV seems to have that capacity. If nerve cells are spared by the new virus, they would be among the few that are. When the coronavirus attaches to cells, it hooks on and breaks through, then starts to replicate. It does so especially well in the cells of the nasopharynx and down into the lungs, but is also known to act on the cells of the liver, bowels, and heart.
- The virus spreads around the body for days or weeks in a sort of stealth mode, taking over host cells while evading the immune response. It can take a week or two for the body to fully recognize the extent to which it has been overwhelmed. At this point, its reaction is often not calm and measured. The immune system goes into a hyperreactive state, pulling all available alarms to mobilize the body’s defense mechanisms. This is when people suddenly crash.
- Bootsie Plunkett, a 61-year-old retiree in New Jersey with diabetes and lupus, described it to me as suffocating. We met in February, taping a TV show, and she was her typically ebullient self. A few weeks later, she developed a fever. It lasted for about two weeks, as did the body aches. She stayed at home with what she presumed was COVID-19. Then, as if out of nowhere, she was gasping for air. Her husband raced her to the hospital, and she began to slump over in the front seat. When they made it to the hospital, her blood-oxygen level was just 79 percent, well below the point when people typically require aggressive breathing support.
- Such a quick decline—especially in the later stages of an infectious disease—seems to result from the immune response suddenly kicking into overdrive. The condition tends to be dire. Half of the patients with COVID-19 who end up in the intensive-care unit at New York–Presbyterian Hospital stay for 20 days, according to Pamela Sutton-Wallace, the regional chief operating officer. (In normal times, the national average is 3.3 days). Many of these patients arrive at the hospital in near-critical condition, with their blood tests showing soaring levels of inflammatory markers. One that seems to be especially predictive of a person’s fate is a protein known as D-dimer. Doctors in Wuhan, China, where the coronavirus outbreak was first reported, have found that a fourfold increase in D-dimer is a strong predictor of mortality, suggesting in a recent paper that the test “could be an early and helpful marker” of who is entering the dangerous phases.
- These and other markers are often signs of a highly fatal immune-system process known as a cytokine storm, explains Randy Cron, the director of rheumatology at Children’s of Alabama, in Birmingham. A cytokine is a short-lived signaling molecule that the body can release to activate inflammation in an attempt to contain and eradicate a virus. In a cytokine storm, the immune system floods the body with these molecules, essentially sounding a fire alarm that continues even after the firefighters and ambulances have arrived.
- At this point, the priority for doctors shifts from hoping that a person’s immune system can fight off the virus to trying to tamp down the immune response so it doesn’t kill the person or cause permanent organ damage. As Cron puts it, “If you see a cytokine storm, you have to treat it.” But treating any infection by impeding the immune system is always treacherous. It is never ideal to let up on a virus that can directly kill our cells. The challenge is striking a balance where neither the cytokine storm nor the infection runs rampant.
- Cron and other researchers believe such a balance is possible. Cytokine storms are not unique to COVID-19. The same basic process happens in response to other viruses, such as dengue and Ebola, as well as influenza and other coronaviruses. It is life-threatening and difficult to treat, but not beyond the potential for mitigation.
- At Johns Hopkins University, the biomedical engineer Joshua Vogelstein and his colleagues have been trying to identify patterns among people who have survived cytokine storms and people who haven’t. One correlation the team noticed was that people taking the drug tamsulosin (sold as Flomax, to treat urinary retention) seemed to fare well. Vogelstein is unsure why. Cytokine storms do trigger the release of hormones such as dopamine and adrenaline, which tamsulosin can partially block. The team is launching a clinical trial to see if the approach is of any help.
- One of the more promising approaches is blocking cytokines themselves—once they’ve already been released into the blood. A popular target is one type of cytokine known as interleukin-6 (IL-6), which is known to peak at the height of respiratory failure. Benjamin Lebwohl, director of research at Columbia University’s Celiac Disease Center, says that people with immune conditions like celiac and inflammatory bowel disease may be at higher risk of severe cases of COVID-19. But he’s hopeful that medications that inhibit IL-6 or other cytokines could pare back the unhelpful responses while leaving others intact. Other researchers have seen promising preliminary results, and clinical trials are ongoing.
- If interleukin inhibitors end up playing a significant role in treating very sick people, though, we would run out. These medicines (which go by names such as tocilizumab and ruxolitinib, reading like a good draw in Scrabble) fall into a class known as “biologics.” They are traditionally used in rare cases and tend to be very expensive, sometimes costing people with immune conditions about $18,000 a year. Based on price and the short supply, Cron says, “my guess is we’re going to rely on corticosteroids at the end of the day. Because it’s what we have.”
- That is a controversial opinion. Corticosteroids (colloquially known as “steroids,” though they are of the adrenal rather than reproductive sort), can act as an emergency brake on the immune system. Their broad, sweeping action means that steroids involve more side effects than targeting one specific cytokine. Typically, a person on steroids has a higher risk of contracting another dangerous infection, and early evidence on the utility of steroids in treating COVID-19, in studies from the outbreak in China, was mixed. But some doctors are now using them to good effect. Last week, the Infectious Diseases Society of America issued guidelines on steroids, recommending them in the context of a clinical trial when the disease reaches the level of acute respiratory distress. They may have helped a 61-year-old from New Jersey. After three days on corticosteroids, she left the ICU—without ever being intubated.
- Deciding on the precise method of modulating the immune response—the exact drug, dose, and timing—is ideally informed by carefully monitoring patients before they are critically ill. People at risk of a storm could be monitored closely throughout their illness, and offered treatment immediately when signs begin to show. That could mean detecting the markers in a person’s blood before the process sends her into hallucinations—before her oxygen level fell at all.
- In typical circumstances in the United States and other industrialized nations, patients would be urged to go to the hospital sooner rather than later. But right now, to avoid catastrophic strain on an already overburdened health-care system, people are told to avoid the hospital until they feel short of breath. For those who do become critically ill and arrive at the ER in respiratory failure, health-care workers are then behind the ball. Given those circumstances, the daily basics of maintaining overall health and the best possible immune response become especially important.
1. For some governments, a happy new milestone: a day with no new local case
- With social distancing and virus testing policies in place for months in several countries, a few governments are now reporting remarkable milestones: recording zero new domestically transmitted coronavirus cases, or no new cases at all.
- South Korea on Thursday reported that for the first time since the virus’s Feb. 29 peak, it had no new domestic cases and just four cases among people who came in from outside the country. The development was a stark turnaround for a nation that was battered early on by the virus — with 909 cases on Feb. 29 alone — and quickly conducted widespread testing and contract tracing of new infections to halt the virus’s spread.
- That progress has been mirrored in Hong Kong, which on Wednesday reported that there had been no new cases in the semiautonomous Chinese territory for four straight days. The city has had more than 1,000 cases over all, and had a resurgence in infections in late March that prompted strict lockdowns on travel, including quarantining of foreign arrivals, social distancing measures and the widespread adoption of work-from-home policies.
- Hong Kong residents overwhelmingly wear masks when going outside, even with the recent plunge in new cases.
- Other countries are flirting with similar successes. Australia reported just nine new cases on Wednesday, and New Zealand had two days over the last week with just one new confirmed coronavirus infection.
H. Stories From the Frontline
1. Observations from the Atlanta Metro Area
- Georgia is leading the charge to reopen its economy. On Friday, 4/24, Gov Kemp reopened certain businesses (salons, gyms, bowling alleys), and on Monday, 4/27 private dine-in restaurants were allowed to reopen.
- 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.
- Stay tuned to our weekend Update when I will report on Friday’s opening of Atlanta’s most popular shopping mall.
- As of Tuesday, 4/29, the number of hospitalizations totaled 5,076, an increase of +180 from Monday’s total of 4,896. Note the prior day’s increase in hospitalization was an increase of +152.
Taking an antibody test in Georgia
- On Tuesday, 4/28, I received a notice from the doctor’s office that they would be offering antibody tests on a first come, first-served basis.
- I jumped at the chance and booked my appointment for Wednesday, 4/29.
- Cost of test $75.00, cash only and not covered by insurance
- The test was a non-FDA approved test.
- The test kit (shown in the far left in the pictures below), branded as “CoronaChek”, was manufactured by Hangzhou Biotest Biotech Co, based in China.
- The test involved a finger prick and a very small sample was taken in a tube and place on the applicator (noted in the picture below “S”)
- The nurse then added a solution to the applicator (middle picture below) and I waited about 15 minutes for the results. Similar to a home pregnancy test, the test results of this antibody test were not sent away to a lab.
- The test results (noted in the picture to the far right below) did not indicate a positive test for antibodies. However, were the results accurate?
The Test Kit – Is it reliable?
- As noted in yesterday’s Update, relaxed regulations intended to help expand desperately needed diagnostic and antibody testing have cleared the way for a rush of antibody tests to come to the market without FDA authorization and amid questions over their accuracy. More than 100 antibody tests are now available but only a few have been reviewed by the FDA for accuracy and reliability.
- Accuracy in antibody testing is described by two measures: specificity and sensitivity.
- Specificity: the test runs a very low-risk of reacting to antibodies to a different infection. It is very exact at picking up COVID-19 antibodies
- Sensitivity: measure of how infrequently a test fails to identify a patient who has definitely had coronavirus and should have developed antibodies to it.
- Hangzhou Biotest Biotech, claims, based on clinical tests that its tests offer Sensitivity of 100% and Specificity of 99.5%
- An antibody, most tests measure two antibodies, or immunoglobulins (“Ig”), the IgM antibody appears first, usually within 4-10 days after infections. The IgG antibody is the major antibody of the response and is very stable. The body produces IgG antibodies as part of the immune response to the virus. It usually takes around 10 to 18 days to produce enough antibodies to be detected in the blood
- Hangzhou Biotest Biotech Co’s website provided the information below regarding the Sensitivity and Specificity of the CoronaChek test kit. It would appear this test is highly accurate and worth the $75.00 for the test.
- Unfortunately, because this test has not been FDA approved, one can put little faith in the “test results” shown above.
- We highly recommend that before you take an antibody test that you ask questions of your doctor, including:
- Is the test FDA approved? [Note: pay close attention as some tests may say FDA reviewed or FDA authorized],
- Who manufactured the test kit?
- What are the sensitivities and specificities of the test results? [Note: a testing kit from China is not as rigorous as an FDA-approved test kit]
- How long will it take to receive test results and what lab will be analyzing the results? [Note: is the test analyzed in house v sent to a lab. If it’s sent to a lab, which lab?]
- We highly recommend signing up for the Quest Diagnostics test online here: COVID-19 Immune Response
- This test is FDA approved and has a specificity of 99.4%
- The cost is reasonable at $119.00 and patients can sign up online and book an appointment at one of their 2,200 testing centers.
- Results are received within 2 days and delivered via Quest’s digital portal.
I. New York Failed to Act, New Yorkers Died
1. Seattle’s Leaders Let Scientists Take the Lead. New York’s Did Not
[Note: The following is an excerpt from a story in the New Yorker]
- The initial coronavirus outbreaks in New York City emerged at roughly the same time as those in Seattle. But the cities’ experiences with the disease have markedly differed. By the second week of April, Washington State had roughly one recorded fatality per fourteen thousand residents. New York’s rate of death was nearly six times higher.
- There are many explanations for this divergence. New York is denser than Seattle and relies more heavily on public transportation, which forces commuters into close contact. In Seattle, efforts at social distancing may have been aided by local attitudes—newcomers are warned of the Seattle Freeze, which one local columnist compared to the popular girl in high school who “always smiles and says hello” but “doesn’t know your name and doesn’t care to.” New Yorkers are in your face, whether you like it or not. (“Stand back at least six feet, playa,” a sign in the window of a Bronx bodega cautioned. “covid-19 is some real shit!”) New York also has more poverty and inequality than Seattle, and more international travellers. Moreover, as Mike Famulare, a senior research scientist at the Institute for Disease Modeling, put it to me, “There’s always some element of good luck and bad luck in a pandemic.”
- It’s also true, however, that the cities’ leaders acted and communicated very differently in the early stages of the pandemic. Seattle’s leaders moved fast to persuade people to stay home and follow the scientists’ advice; New York’s leaders, despite having a highly esteemed public-health department, moved more slowly, offered more muddied messages, and let politicians’ voices dominate.
- New York’s mayor, Bill de Blasio, has long had a fraught relationship with the city’s Department of Health and Mental Hygiene, which, though technically under his control, seeks to function independently and avoid political fights. “There’s always a bit of a split between the political appointees, whose jobs are to make a mayor look good, and public-health professionals, who sometimes have to make unpopular recommendations,” a former head of the Department of Health told me. “But, with the de Blasio people, that antagonism is ten times worse. They are so much more impossible to work with than other administrations.” In 2015, when Legionnaires’ disease sickened at least a hundred and thirty New Yorkers and killed at least twelve, tensions between de Blasio and the Health Department came to a head.
- After de Blasio ordered health officials to force their way into buildings in the Bronx to test cooling towers for contamination, even though the outbreak’s source had already been identified, the officials complained that the Mayor was wasting their time in order to brag to reporters that he’d done everything possible to stamp out the disease. When the deputy commissioner for environmental health, Daniel Kass, refused City Hall’s demands, one of the city’s deputy mayors urged the commissioner of health, Mary Bassett, to fire Kass. She ignored the suggestion, but Kass eventually resigned. He later told colleagues he felt that his rebellion had made coöperation with City Hall impossible.
- “Dan Kass is one of the best environmental-health experts in the country,” Bassett, who now teaches at Harvard, said. “New York has one of the best health departments in the United States, possibly the world. We’d all be better off if we were listening really closely to them right now.”
- In early March, as Dow Constantine was asking Microsoft to close its offices and putting scientists in front of news cameras, de Blasio and New York’s governor, Andrew Cuomo, were giving speeches that deëmphasized the risks of the pandemic, even as the city was announcing its first official cases. De Blasio initially voiced caution, saying that “no one should take the coronavirus situation lightly,” but soon told residents to keep helping the city’s economy. “Go on with your lives + get out on the town despite Coronavirus,” he tweeted on March 2nd—one day after the first covid-19 diagnosis in New York. He urged people to see a movie at Lincoln Center. On the day that Seattle schools closed, de Blasio said at a press conference that “if you are not sick, if you are not in the vulnerable category, you should be going about your life.” Cuomo, meanwhile, had told reporters that “we should relax.” He said that most infected people would recover with few problems, adding, “We don’t even think it’s going to be as bad as it was in other countries.”
- De Blasio’s and Cuomo’s instincts are understandable. A political leader’s job, in most situations, is to ease citizens’ fears and buoy the economy. During a pandemic, however, all those imperatives are reversed: a politician’s job is to inflame our paranoia, because waiting until we can see the danger means holding off until it’s too late. The city’s epidemiologists were horrified by the comforting messages that de Blasio and Cuomo kept giving. Jeffrey Shaman, a disease modeller at Columbia, said, “All you had to do was look at the West Coast, and you knew it was coming for us. That’s why Seattle and San Francisco and Portland were shutting things down.” But New York “dithered instead of telling people to stay home.”
- By early March, the city’s Department of Health had sent the Mayor numerous proposals on fighting the virus’s spread. Since there weren’t enough diagnostic kits to conduct extensive testing, public-health officials proposed “sentinel surveillance”: asking local hospitals to provide the Department of Health with swabs collected from people who had flulike symptoms and had tested negative for influenza. By testing a selection of those swabs, the department could estimate how rapidly and widely the coronavirus was moving through the city. In previous outbreaks, such studies had been tremendously useful in guiding governmental responses—and this spring Los Angeles effectively deployed the strategy, as did Santa Clara County, in California, and the state of Hawaii.
- In New York City, the Health Department began collecting swabs, but the initiative met swift resistance. Under federal health laws, such swabs have to be anonymized for patients who haven’t consented to a coronavirus test. This meant that, even if city officials learned that many people were infected, officials wouldn’t be able to identify, let alone warn, any of them.
- The Mayor’s office refused to authorize testing the swabs. “They didn’t want to have to say, ‘There are hundreds, maybe thousands, of you who are positive for coronavirus, but we don’t know who,’ ” a Department of Health official told me, adding, “It was a real opportunity to communicate to New Yorkers that this is serious—you have to stay home.” The effort was blocked over fears that it might create a panic, but such alarm might have proved useful. After all, the official told me, panic is pretty effective at getting people to change their behavior. Instead, the Mayor’s office informed the Health Department that the city would sponsor a job fair to find a few new “disease detectives.” That event was held on March 12th, in Long Island City. The Department of Health official said, “We’re in the middle of a catastrophe, and their solution is to make us waste time interviewing and onboarding people!” (The Mayor’s office eventually relented on the sentinel-surveillance samples, and testing began on March 23rd—almost a month after samples were first collected. By then, the outbreak was well under way.)
- As New York City schools, bars, and restaurants remained open, relations between the Department of Health and City Hall devolved. Health supervisors were “very, very angry,” one official told me. In particular, health officials were furious that de Blasio kept telling New Yorkers to go out and get a test if they suspected they were infected. On March 4th, he tweeted, “If you feel flu-like symptoms (fever, cough and shortness of breath), and recently traveled to an area affected by coronavirus . . . go to your doctor.” This was the opposite of what city health supervisors were advising: people needed to stay inside and call their doctor if they felt sick.
- Making trips to doctors’ offices or emergency rooms only increased the odds that the virus would spread, and the city’s limited supply of tests needed to be saved for people with life-threatening conditions. De Blasio’s staff, however, had started micromanaging the department’s communications, including on Twitter. Finally, on March 15th, the Department of Health was allowed to post a thread: “If you are sick, stay home. If you do not feel better in 3 to 4 days, consult with your health care provider”; “Testing should only be used for people who need to be hospitalized”; “Everyone in NYC should act as if they have been exposed to coronavirus. . . . New Yorkers who are not sick should also stay home as much as possible.” One City Council member told me that health officials “had been trying to say that publicly for weeks, but this mayor refuses to trust the experts—it’s mind-boggling.”
- As the city’s scientists offered plans for more aggressive action and provided data showing that time was running out, the Mayor’s staff responded that the health officials were politically naïve. At one point, Dr. Marcelle Layton, the city’s assistant commissioner of communicable diseases, and an E.I.S. alum who is revered by health officials across the nation for her inventiveness and dedication, was ordered to City Hall, in case she was needed to help the Mayor answer questions from the press. She sat on a bench in a hallway for three hours, away from her team, while politicians spoke to the media. (Layton declined interview requests.) At press conferences, Layton and other physicians played minimal roles while de Blasio and Cuomo, longtime rivals, each attempted to take center stage. The two men even began publicly feuding—arguing in the press, and through aides, about who had authority over schools and workplace closures.
- Eventually, three of the top leaders of the city’s Department of Health met with de Blasio and demanded that he quickly instate social-distancing rules and begin sending clear messages to the public to stay indoors. Layton and a deputy health commissioner, Dr. Demetre Daskalakis, indicated to de Blasio’s staff that if the Mayor didn’t act promptly they would resign. (The next day, Layton’s staff greeted her with applause, and at least one employee offered to give her some money if she had to make good on the ultimatum.) De Blasio was in a corner: he had long positioned himself as a champion of the underclass, and closing schools would disproportionately hurt the poor and vulnerable. What’s more, unions representing health-care workers had threatened that nurses, orderlies, and others might stay home unless there was a plan to provide child care.
- Nevertheless, de Blasio finally acceded to the health officials’ demands. On March 16th, after a compromise was reached with the health-care unions, city schools were closed, and Cuomo ordered all gyms and similar facilities to shut down. The messaging remained jumbled, however. Right before the gym closure was set to take effect, de Blasio asked his driver to take him to the Y.M.C.A. in Park Slope, near his old home, for a final workout. Even de Blasio’s allies were outraged. A former adviser tweeted, “The mayor’s actions today are inexcusable and reckless.” Another former consultant tweeted that the gym visit was “Pathetic. Self-involved. Inexcusable.”
- De Blasio and Cuomo kept bickering. On March 17th, de Blasio told residents to “be prepared right now for the possibility of a shelter-in-place order.” The same day, Cuomo told a reporter, “There’s not going to be any ‘you must stay in your house’ rule.” Cuomo’s staff quietly told reporters that de Blasio was acting “psychotic.” Three days later, though, Cuomo announced an executive order putting the state on “pause”—which was essentially indistinguishable from stay-at-home orders issued by cities in Washington State, California, and elsewhere. (A spokesperson for de Blasio said that City Hall’s “messaging changed as the situation and the science changed” and that there was “no dithering.” A spokesperson for Cuomo said that “the Governor communicated clearly the seriousness of this pandemic” and that “the Governor has been laser focused on communicating his actions in a way that doesn’t scare people.”)
- To a certain extent, de Blasio’s and Cuomo’s tortured delays make sense. Good politicians should worry about poor children missing school just as much as they worry about the threat of an emerging disease. “That’s why E.I.S. training is so important,” Sonja Rasmussen, a former C.D.C. official, told me. In a pandemic, “the old ways of thinking get flipped around.” She added, “You have to make the kinds of choices that, if you aren’t trained for them, are really hard to make. And there’s no time to learn from your mistakes.”
- Today, New York City has the same social-distancing policies and business-closure rules as Seattle. But because New York’s recommendations came later than Seattle’s—and because communication was less consistent—it took longer to influence how people behaved. According to data collected by Google from cell phones, nearly a quarter of Seattleites were avoiding their workplaces by March 6th. In New York City, another week passed until an equivalent percentage did the same.
- Tom Frieden, the former CDC director, has estimated that, if New York had started implementing stay-at-home orders ten days earlier than it did, it might have reduced covid-19 deaths by 50 to 80%.
- Another former New York City health commissioner told me that “de Blasio was just horrible,” adding, “Maybe it was unintentional, maybe it was his arrogance. But, if you tell people to stay home and then you go to the gym, you can’t really be surprised when people keep going outside.”
- More than fifteen thousand people in New York are believed to have died from covid-19. Last week in Washington State, the estimate was fewer than seven hundred people. New Yorkers now hear constant ambulance sirens, which remind them of the invisible viral threat; residents are currently staying home at even higher rates than in Seattle. And de Blasio and Cuomo—even as they continue to squabble over, say, who gets to reopen schools—have become more forceful in their warnings. Rasmussen said, “It seems silly, but all these rules and telling people again and again to wash their hands—they make a huge difference. That’s why we study it and teach it.” She continued, “It’s really easy, with the best of intentions, to say the wrong thing or send the wrong message. And then more people die.”
J. The Road Back?
1. 8-month ‘structured lockdowns’ could halve economic damage from the coronavirus
- Enforcing eight-month “structured lockdowns” could halve the economic destruction that would be wrought by Covid-19 if no social-distancing measures were imposed, according to researchers from Cambridge University and the Federal Reserve.
- Reopening the economy has been a tension point in some countries, with economic damage being weighed against protecting public health and protests against lockdown measures being staged across the United States.
- However, according to the study, published Wednesday by economists from Cambridge University and the U.S. Federal Reserve Board, the economic price of inaction when it comes to encouraging social distancing could be twice as high as that of a “structured lockdown.”
- Using U.S. economic and population data, researchers combined macroeconomics with epidemiology to determine the economic consequences of lockdown policies. Analysts noted that their model could be applied to most developed economies.
- They found that imposing no lockdown at all would be “extremely risky” for economic output, as the spread of the virus would hit workers in sectors that were vital to keep developed economies functional.
- Without any social distancing, the core workforce would be hit hard — and the economy would shrink at a peak monthly rate of 30% as their industries came under pressure, the study projected.
- Researchers claimed that in order to protect the economy to the maximum, “core workers” — those in key industries such as health care, food and transportation — must be separated from the rest of the working population.
- “What seems clear to us is that taking no action is unacceptable from a public health perspective, and extremely risky from an economic perspective,” the report’s authors said.
- In the first scenario, 15% of core workers and 40% of the rest of the working population would work from home, while 30% of non-working age people could also be kept at home under lockdown. This would last for eight months, and would mean a third of the entire population was kept in lockdown for that period.
- In this scenario, the peak monthly economic contraction at any point in the lockdown would be halved to around 15%, compared to the peak monthly contraction of 30% if no action was taken, analysts projected. They claimed that the high levels of social distancing outside of the core workforce would act as a shield.
- Giancarlo Corsetti, professor of economics at Cambridge University and co-author of the report, said under this policy, the peak of the infected share of the population would drop from 40% to 15% — although he noted that even this level may still be “far too high” for health-care systems to cope with.
- “This milder lockdown scenario for eight months would be one in which we do not wait for the vaccine, but we hope for a form of herd immunity by exposing people very slowly to the disease,” he told CNBC in a phone call.
- “As well as containing the loss of life, committing to long-term social distancing structured to keep core workers active can significantly smooth the economic costs of the disease,” he added. “The more we can target lockdown policies toward sections of the population who are not active in the labor market, or who work outside of the core sector, the greater the benefit to the economy.”
- Researchers also modeled a scenario where infection rates were kept to a more manageable level of 1.5% of the population for 18 months — around the length of time many experts have projected it will take a vaccine to reach the market.
- In this more stringent case, 25% of core workers, 60% of non-core workers, and 47% of non-working age people would need to be locked down. If this policy was implemented, the study projected a peak monthly economic contraction of 20%.
- A “very strict lockdown” was also modeled, which would see 40% of core workers and 90% of the rest of the population locked down for three months. This scenario would be as bad for the economy as having no lockdown at all, the study found, as infection rates would simply be delayed and herd immunity would be prevented.
- However, researchers stressed that the scenarios laid out in their study were not forecasts, but should be taken as a “blueprint” for further analysis, as lingering uncertainties around how the coronavirus spreads remained.
- “One problem that is currently missing in the discussion is the ability to distinguish between essential sectors and non-core sectors, and this idea of thinking very carefully about the effect people may have by going around and infecting those essential workers — essential workers need to be protected and shielded,” he said.
- “An unmitigated, very fast spread of the disease would have been quite disastrous on the economic side — there was a high risk of a true, enormous fall in output and economic activity.”
2. We See You: China’s COVID-19 Tracking App
- For a look at how China uses tracking apps to monitor the movement of people within the country, watch the 4min video at:
3. Our Pandemic Summer [Opinion By Ed Yong, The Atlantic]
The fight against the coronavirus won’t be over when the U.S. reopens. Here’s how the nation must prepare itself.
- Early inaction left the U.S. with too many new cases, and just one recourse: Press a societal pause button to buy enough time for beleaguered hospitals to steel themselves for a sharp influx in patients. This physical-distancing strategy is working, but at such an economic cost that it can’t be sustained indefinitely. When restrictions relax, as they are set to do on April 30, the coronavirus will likely surge back, as it is now doing in Singapore, China, and other Asian states that had briefly restrained it.
- The only viable endgame is to play whack-a-mole with the coronavirus, suppressing it until a vaccine can be produced. With luck, that will take 18 to 24 months. During that time, new outbreaks will probably arise. Much about that period is unclear, but the dozens of experts whom I have interviewed agree that life as most people knew it cannot fully return. “I think people haven’t understood that this isn’t about the next couple of weeks,” said Michael Osterholm, an infectious-disease epidemiologist at the University of Minnesota. “This is about the next two years.”
- The pandemic is not a hurricane or a wildfire. It is not comparable to Pearl Harbor or 9/11. Such disasters are confined in time and space. The SARS-CoV-2 virus will linger through the year and across the world. “Everyone wants to know when this will end,” said Devi Sridhar, a public-health expert at the University of Edinburgh. “That’s not the right question. The right question is: How do we continue?”
- A lockdown is a measure of last resort, to be used only when a virus is spreading so rapidly that it cannot be controlled through other means. Having deployed that measure, albeit unevenly, the U.S. has now bought itself some time. It can use that time to address its lack of tests and medical supplies, and find less economically devastating ways of controlling COVID-19. When sufficiently braced, states could begin lifting their sweeping restrictions and focus on finding and helping people who are actually infected. But the conditions for making that switch are not clear. “We’ve never faced a pandemic like this before in modern times, so we’re going to have to be flexible,” said Caitlin Rivers of the Johns Hopkins Center for Health Security. “There’s no playbook.”
- The White House seems to be relying heavily on one mathematical model from the University of Washington that, in its first incarnation, was criticized for failing to accurately predict death rates even a day or two out. (While traditional models simulate how a disease spreads through virtual communities, this one simply made predictions based on death numbers in the U.S. and death rates in other countries.) “When we make weather predictions or plan for hurricanes, we don’t just plan based on one thing,” said Natalie Dean, a statistician at the University of Florida. Alternative models are being built, but in the meantime, it’s hard to accurately forecast how long the current phase of the pandemic will last.
- Absent any certainty, one group of health experts, led by Ezekiel Emanuel, an oncologist and former adviser to the Obama administration, argues that stay-at-home orders must continue until at least May 20. Another team, led by Scott Gottlieb, a former FDA commissioner, suggests that states should relax their restrictions only after new case counts have fallen for 14 consecutive days. Currently, the U.S. is still averaging about 30,000 new confirmed cases every day. “My sense is that we haven’t turned the corner,” said Rivers, who is a co-author on Gottlieb’s road map.
- Both groups agree that before relaxing the guidelines on social distancing the U.S. urgently needs to expand its ability to test for the virus, and to shore up hospitals with sufficient supplies. These recommendations are sensible, but they hinge on the expectation that the U.S. can recover the ground it lost due to its early inaction. It might not be able to.
- For example, with help from private companies and academic institutions, the U.S. is certainly testing more people than it was before. Over the past week, about 145,000 people have been tested every day, according to the COVID Tracking Project, a volunteer collaboration spearheaded by The Atlantic. Those numbers look to rise even further, thanks to a new, rapid test from Abbott Laboratories that can deliver results in less than 15 minutes. But as testing capacity has grown, so has the pandemic. As my colleagues Robinson Meyer and Alexis Madrigal have reported, private labs have taken on more orders than they can fulfill, and are experiencing huge backlogs. Demand for tests has ballooned, fueled by a rise in actual infections and the fact that Donald Trump keeps wrongly assuring the public that testing is no longer a problem. “The net gain just hasn’t been there,” said Kelly Wroblewski of the Association of Public Health Laboratories.
- Compounding these issues, testing companies all rely on the same chemical ingredients, which were already running low and are becoming even scarcer as the pandemic spreads. “Trying to get these materials is not about dollars and cents; it’s about physics,” Osterholm said. “You can’t just buy these things. It takes time to make them.” To be clear, there is wide consensus that testing is crucial for working out where the virus is and adequately preparing for it. In an ideal reality, testing should be done extensively. But in this reality, Osterholm noted, it might be several months before manufacturers can meet global demand. For the summer, the U.S. might have to abandon the dream that “everyone who gets sick is going to get a test and we’ll be able to count every case with a lab diagnosis,” Wroblewski said. “That might not be realistic.”
- Crucial medical drugs are also running out. According to a University of Minnesota analysis, about 40% of the 156 drugs that are essential parts of critical care are becoming limited. Many of these depend on supply chains that involve China (where the pandemic began), Italy (the hardest-hit region in Europe), or India (which halted several exports). These chains have been discharging their contents like a sputtering garden hose that has now begun to run dry. “The medium term is going to be particularly perilous,” said Nada Sanders, a professor of supply-chain management at Northeastern University. “Global demand is so high, and supply is so far behind, that it’s very hard to envision enough of a ramp-up.”
- Albuterol, the drug used in asthma inhalers, is scarce. Antibiotics, which control the secondary bacterial infections that afflict COVID-19 patients, are being depleted. Basic painkillers and sedatives, which are needed to keep patients on ventilators, are being exhausted. Hydroxychloroquine is running out, to the detriment of people with lupus and arthritis who depend on it. “It’s like everything we give to patients, we’re in short supply of,” said Esther Choo, an emergency physician at Oregon Health and Science University. “We’re now scrambling to find the backup medications, and we’ll run out of those too.”
- Meanwhile, hospitals are still struggling. There aren’t enough masks and gowns to adequately protect staff, ventilators to deliver oxygen to patients who can’t breathe, or respiratory technicians and nurses to operate those ventilators. Overwhelmed and underprotected, doctors and nurses are falling sick. In Michigan, more than 700 employees at one hospital have tested positive for the coronavirus; at another, 1,500 are out of work with consistent symptoms. Hospitals are now bringing back retired physicians, graduating medical students early, and re-tasking orthopedists and dermatologists to emergency rooms to help with the coronavirus surge.
- Even if cases abate in the summer, exhausted health-care workers will have to catch up on elective surgeries that were postponed because of the pandemic (and that are important to a hospital’s financial survival), while also treating people who delayed getting help for heart problems, cancers, and other emergencies. “Patients are putting off health concerns that really need to be seen, and they’re coming in sick,” Choo said. If the pandemic rebounds in the fall, health-care workers may have to greet it without having had a summertime respite. Hospital disaster plans “are all structured around a single discrete event that is over pretty quickly,” Choo said. “We don’t expect our diseases to be stuttering.”
- These problems—the continuing testing debacle, the drying supply chains, the relentless pressure on hospitals—should temper any impatience about reopening the country. There won’t be an obvious moment when everything is under control and regular life can safely resume. Even after case counts and death rates fall, the pandemic’s challenges will continue, and will not automatically subside on their own. After all, despite ample warning, the U.S. failed to anticipate what would happen when the coronavirus knocked on its door. It cannot afford to make that mistake again. Before the spring is over, it needs a plan for the summer and fall.
- There’s good reason to reopen the U.S. slowly and methodically. When the pandemic first hit, a wide range of social-distancing measures—closing offices, shutting schools, banning mass gatherings, implementing stay-at-home orders—were rolled out in a sudden panic. The rushed deployment was necessary, but made it hard to know which measures actually mattered. The next few months offer opportunities to find out. Communities could relax restrictions gradually, and see if the virus remains at a simmer or returns to a boil. When the virus returns, political leaders should be able to make more informed decisions about which levers to flip. “We should absolutely be throwing everything we can to figure that out,” said Jessica Metcalf, an infectious-disease ecologist at Princeton.
- The most crucial piece of missing information, and the one that most dramatically shapes the nation’s options, is what proportion of people have actually been infected. So far, the U.S. has more than 576,000 confirmed cases. But between the lack of testing and the unknown proportion of people who experience mild or nonexistent symptoms, the true number of cases is anyone’s guess.
- There’s an easy way to find out. When someone is infected, their immune system produces defensive molecules called antibodies, which recognize (and, with hope, neutralize) the virus. These antibodies endure after the infection is cleared, and should theoretically provide some degree of lasting immunity. By detecting such antibodies through what are known as serological tests, scientists can deduce how many people have been infected in these past months. (Serological tests differ from diagnostic tests, which search for pieces of the coronavirus’s genetic material to work out who is infected right now.) Such “serosurveys” are ongoing, and while preliminary data have emerged, they don’t paint a clear picture yet. In a German town that became a hot spot of the country’s outbreak in February, about 15 percent of people have been infected; in a Colorado county, the figure stands between 0.4 and 1.5 percent.
- If it turns out that, say, 20 percent of the U.S. has been infected, that would mean the coronavirus is more transmissible but less deadly than scientists think. It would also mean that a reasonable proportion of the country has some immunity. If that proportion could be slowly and safely raised to the level necessary for herd immunity—60 to 80 percent, depending on the virus’s transmissibility—the U.S. might not need to wait for a vaccine. However, if just 1 to 5 percent of the population has been infected—the range that many researchers think is likelier—that would mean “this is a truly devastating virus, and we have built up no real population immunity,” said Michael Mina, an epidemiologist and immunologist at Harvard. “Then we’re in dire straits in terms of how to move forward.”
- Even in the optimistic scenario, a quick and complete return to normalcy would be ill-advised. And even in the pessimistic scenario, controlling future outbreaks should still be possible, but only through an immense public-health effort. Epidemiologists would need to run diagnostic tests on anyone with COVID-19–like symptoms, quarantine infected people, trace everyone those people had contact with in the previous week or so, and either quarantine those contacts or test them too. These are the standard pillars of public health, but they’re complicated by the coronavirus’s ability to spread for days before causing symptoms. Every infected person has a lot of potential contacts, and may have unknowingly infected many of them.
- Tracking such a pathogen requires a lot of people, but due to chronic underfunding, local U.S. health departments lost more than 55,000 workers from 2008 to 2017. In their absence, a corps of volunteers could be quickly trained in the basics of contact tracing, as Massachusetts Governor Charlie Baker is planning to do. “It might be an opportunity to bring in people who are recently unemployed—a wartime effort where people aren’t doing their normal jobs,” said Crystal Watson of the Johns Hopkins Center for Health Security.
- If there aren’t enough tests, as seems likely in the near term, health officials could focus their attention on looking for spikes in flu-like symptoms, or for less orthodox indicators such as crowded hospital parking lots and restaurant cancellations. More controversially, they could quickly track an infected person’s contacts by comparing their cellphone activity with that of others in the same area. As South Korea and Singapore demonstrated, such methods clearly work. They undoubtedly raise privacy concerns, but as my colleague Derek Thompson argues, “Compared with our present nightmare, strategically sacrificing our privacy might be the best way to protect other freedoms.”
- Once the U.S. gets better at tracking the coronavirus, it could use social distancing more flexibly and precisely. COVID-19 counts could feature on the nightly weather report, said Stephen Kissler, an infectious-disease modeler at Harvard. “In the same way that cities issue evacuation orders a few days before a hurricane hits, they could issue distancing orders a few days before we reach the threshold that would threaten to overwhelm our ICUs,” he added.
- There’s a risk in trying to be too clever, though. Dylan Morris of Princeton, who also models infectious diseases, notes that exponentially growing epidemics are not just harder, but riskier, to control. Slight delays in action can have huge consequences, as the United Kingdom learned last month. Relying too heavily on models, the British government believed that it could precisely control the spread of COVID-19 by rolling out social restrictions at carefully chosen moments. Its hubris led to a substantial spike in cases. Now that the U.S. is slowing the pandemic, gently easing back on social distancing would be safer, Morris argues, than snapping back to business as usual when small missteps could be catastrophic. “If we’re judicious about how we lift restrictions, we might never have to go back into lockdown,” he said.
- Stay-at-home orders might lift first, allowing friends and family to reunite. Small businesses could reopen with limitations: Offices might run on shifts and still rely heavily on teleworking, while restaurants and bars could create more space between tables. Schools could restart once researchers determine if children actually spread the virus.
- This process might take several weeks to unfold, and even at the end of it, none of the experts I spoke with was comfortable with the return of crowded public spaces. Gottlieb’s road map, for example, recommends that until a vaccine or an effective treatment is produced, social gatherings should be limited to 50 people or fewer. That will be especially challenging in large cities: An average Manhattan street or subway car is the equivalent of a mass gathering. Elsewhere, concerts, conferences, summer camps, political rallies, large weddings, and major sporting events may all have to be suspended for at least this year. “It’s hard for me to imagine anyone going to Fenway Park and sitting with 30,000 fans—that will almost surely be a bad idea,” said Ashish Jha, an internist and public-health expert at Harvard. “This isn’t going to look like a normal summer in America.”
- During the long wait for a vaccine, other countermeasures could conceivably dampen the threat of COVID-19. The simplest of these is the face mask. Medical masks are still in short supply, and must be reserved for health-care workers. But homemade alternatives might help slow the spread of the coronavirus, less by preventing healthy wearers from getting infected and more by stopping unknowingly sick wearers from infecting others. As I wrote earlier this month, masks are symbols as well as shields. In East Asian countries, where they are widely worn, they signify civic-mindedness and conscientiousness. As their use grows in Western nations, they could send the message that society is collectively acting against a serious threat.
- Effective treatments for the new coronavirus could also blunt the sting of future outbreaks. As my colleague Sarah Zhang reports, “More than 100 existing and experimental drugs are being tested against COVID-19.” But it’s unlikely that any of these would be an outright cure in the way that antibiotics can be for bacterial infections. (Antibiotics do not work against viruses.)
- That’s partly because viruses are simpler than bacteria, with fewer vulnerabilities to exploit. Viruses are also more likely than bacteria to actually destroy our cells; by the time symptoms appear, viruses have caused a lot of tissue damage that isn’t easily reversed. And they are more likely to trigger cytokine storms—massive overreactions from the immune system that cause more damage than the infections they are trying to clear.
- “It’s likely that a therapeutic would only provide incremental benefit over the backbone of supportive medical care,” said Luciana Borio, a physician who served in the National Security Council’s pandemic-preparedness office, which was largely disbanded in 2018. Tamiflu, for example, shortens flu infections by just a day or two, and works best if taken before symptoms appear or shortly after. A similar drug would not obviate the need for a vaccine, or fully negate the coronavirus threat.
- More realistically, treatments might give critically ill patients a better chance of survival, or prevent some people with early symptoms from ever needing critical care at all. Either would be an important win. “If people are feeling cruddy at home, and [an anti–COVID-19 drug] can reduce their risk of progressing to hospitalization from 20 percent to 10 percent, that would feel like a massive home run,” Jha said.
- Even without antivirals, many COVID-19 patients will recover on their own. If they retain antibodies that confer lasting immunity against the coronavirus, they could conceivably be free to work, support health-care workers, or care for the elderly and other vulnerable groups. Several countries, including the U.S., are now hoping to identify immune individuals with serology tests and affirm their status with “immunity passports,” akin to the yellow card that’s issued following a yellow-fever vaccination. But such a system faces many substantial problems.
- First, antibodies aren’t always effective at neutralizing viruses. If you picture the coronavirus as a car, an antibody might slash its tires, or just gum up its wipers—and simple serology tests can’t tell which.
- Second, even if the antibodies are the right kind, no one knows what concentration you’d need to confer immunity. “Even for diseases we’ve been studying for over 100 years, like whooping cough, we still don’t know what level of antibody would indicate that you’d be protected if you got reexposed,” said Sam Scarpino of Northeastern University, who studies infectious-disease dynamics. The only way to find out is through long studies.
- Third, serological tests for the new coronavirus could be deeply misleading for individuals. Consider the test produced by Cellex—the only one thus far with emergency use authorization from the FDA. The test has a 93.8 percent chance of correctly identifying people with antibodies against the new coronavirus, and a 95.6 percent chance of correctly identifying people who lack those antibodies. Those numbers sound great, but if only a minority of Americans have been infected, the test would return far more false positives than true ones. Put it this way: If you have a positive result, the odds that you actually have any relevant antibodies are roughly one in two if 5 percent of the U.S. has been infected, and just one in six if only 1 percent has been infected. Scientists can correct for these errors if they use serological tests to assess immunity in a population, but it’s much harder on a person-by-person basis.
- Finally, any certificate that affords special status, like the ability to work while others are quarantined, will create incentives for people to deliberately infect themselves or game the system with counterfeits. Immunity passports would unfairly “favor individuals who didn’t comply with social distancing and got sick early on,” said Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases. And “the idea that there would be a midpoint where some people could resume the right to be citizens and others could not is effectively an apartheid system,” said Sharon Abramowitz, a consultant at UNICEF who studies community responses to pandemics. “It might serve specific public-health ends, but in this society would be very problematic.” History affirms that concern: When yellow fever hit the American South in the 19th century, “immunoprivilege” worsened existing forms of discrimination while creating new ones.
- Passports and antibody tests aside, it’s reasonable to assume that someone who recovers from COVID-19 would be less likely to get infected again (for some duration that is still unclear). “But we can’t assume that you won’t bring that virus to someone else,” said Mina, the Harvard immunologist. “I worry that a lot of employers are just assuming that having antibodies or having been infected means you’re good to get back to work.” A false sense of security could quicken the spread of the virus during future surges, especially if people ignore social-distancing orders on the mistaken belief that they are immune.
- These problems might be surmountable. The U.S. is still a scientific and biomedical powerhouse. To marshal that power, it needs a massive, coordinated, government-led initiative to find the cleverest ways of controlling COVID-19—a modern-day Apollo program. No such program is afoot. Former Trump- and Obama-era officials have published detailed plans. Elizabeth Warren is on her third iteration. But the White House either has no strategy or has chosen not to disclose it.
- Without a unifying vision, governors and mayors have been forced to handle the pandemic themselves. Ludicrously, states are bidding against one another—and the federal government—for precious supplies. Six states still haven’t issued any kind of stay-at-home order, while those that moved late, such as Florida, may have seeded infections in the rest of the country. “A patchwork approach to fighting a pandemic is very dangerous,” said Jeremy Konyndyk of the Center for Global Development. “It’s a recipe for a response that’s less than the sum of its parts.” While several states have created their own coordinated groups, Konyndyk’s worry, shared by others, is that there are limits to what even the most capable state leaders can do without federal coordination. “We almost need to devise a public-health government in exile which can take on the responsibility of national coordination,” said Osterholm, the University of Minnesota epidemiologist.
- That responsibility would typically fall to the CDC, but it has been strangely silent. For almost a month, the CDC’s leaders have been absent from press briefings, and its supporters fear that its reputation has been tarnished. Local leaders are making hundreds of public-health decisions—should we close this park, or open that beach?—without consulting the nation’s top public-health agency. Jha said he regularly fields calls from mayors and governors who would normally ring the CDC. “People don’t know where to turn to for expertise,” he said.
- During the Vietnam War, Vice Admiral James Stockdale spent seven years being tortured in a Hanoi prison. When asked about his experience, he noted that optimistic prison-mates eventually broke, as they passed one imagined deadline for release after another. Stockdale’s strategy, instead, was to meld hope with realism—“the need for absolute, unwavering faith that you can prevail,” as he put it, with “the discipline to begin by confronting the brutal facts, whatever they are.”
- The U.S. needs to learn that lesson, but Trump is still behaving as if he’s engaged in a brief skirmish rather than a protracted siege. On April 8, before even the first pandemic peak had subsided, he tweeted: “Once we OPEN UP OUR GREAT COUNTRY, and it will be sooner rather than later, the horror of the Invisible Enemy, except for those that sadly lost a family member or friend, must be quickly forgotten.” The enemy isn’t going anywhere. To forget it would be to beget further horror.
- In 2018, when writing about whether the U.S. was ready for the next pandemic, I noted that the country was trapped in a cycle of panic and neglect. It rises to meet each new disease, but then settles into complacency once the threat is over. With COVID-19, I fear that the U.S. might enter the neglect phase before the panic part is even finished. If the current shutdown succeeds in flattening the curve, sparing the health-care system and minimizing deaths, it will feel like an overreaction. Contrarians will use the diminished body count to argue that the panic was needless and that the public was misled. Some are already saying that.
- Others will divert responsibility from the country’s leaders and its institutions. “There’s a lot of victim-blaming in the U.S., which comes from that neoliberal perspective where it’s your fault if you have bad circumstances,” said Emily Brunson, an anthropologist at Texas State University. The virus is disproportionately killing people in low-income jobs who don’t have the privilege of working from home, but who will nonetheless be shamed for not distancing themselves. The virus is disproportionately killing black people, whose health had already been impoverished through centuries of structural racism, but who will nonetheless be personally blamed for their fate. The virus is disproportionately killing elderly people, who had already been shunted to the fringes of society, but who will nonetheless be told to endure further loneliness so that everyone else can be freer.
- If that happens, the panic-neglect cycle will inevitably continue. The U.S. will miss the chance to reexamine how systemic failures of its health-care system left so many citizens vulnerable, or to put in place measures that might forestall another resurgence. It will get hammered by the same damn virus again, and be driven into more severe lockdowns. People will tire. Compliance will fall. The nation would lose its single most effective weapon against the pandemic—the willingness of its citizens to make individual sacrifices for the sake of all. It could forcibly quarantine uncooperative people or impose criminal penalties, but “we know from past outbreaks that criminalizing public-health responses makes people go underground, perpetuates stigma, and fractures society,” Phelan said. “For the marathon we’re facing, we need solidarity.”
- Over the coming months, we need “to normalize COVID in the public psyche, and reinforce that this will be a part of our day-to-day lives,” said Kissler, the Harvard disease modeler. “Many people I’ve spoken with are aghast at the thought. We thirst for a swift and decisive ‘victory.‘ But I’m reminded of images from World War II as people in London walked to work, briefcases in hand, against a backdrop of bombed-out buildings. I think we are in store for a similar period in history, as we learn to make greater peace with the world’s chaos and our own mortality.”
- This kind of psychological resilience already exists within large groups of people who have been marginalized during periods of normalcy, and who are now the most at-risk from the pandemic. Elderly people, for example, have been most frequently cast as a vulnerable group in need of protection. But “older people have been through a lot—the civil-rights movement, the women’s movement, the Cold War,” said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security. “They are culture keepers, full of stories of how you get through major tragedies and upheavals.”
- The disability community has also noted that, at a time when their health is in jeopardy and their value is in question, abled people are struggling with a new normal that is their old normal—spatial confinement, unpredictable futures, social distance. “We know how to do community from afar, and how to organize from bed,” said Ashley Shew of Virginia Tech, who studies the intersection between technology and disability. “Instead of feeling this great vacuum, our social life hasn’t radically changed.” Disability scholars have written about “crip time”—a flexible attitude toward timekeeping that comes from uncertainty. “Everything I enter in my calendar has an asterisk in my mind,” Shew said. “Maybe it’ll happen, maybe it won’t, depending on my next cancer scan or what’s happening in my body. I already live in this world when I’m measuring in shorter increments, when my future has always been planned differently.”
- As the rest of the U.S. comes to terms with the same restless impermanence, it must abandon the question When do we go back to normal? That outlook ignores the immense disparities in what different Americans experience as normal. It wastes the rare opportunity to reimagine what a fairer and less vulnerable society might look like. It glosses over the ongoing nature of the coronavirus threat. There is no going back. The only way out is through—past a turbulent spring, across an unusual summer, and into an unsettled year beyond.
Source: Our Pandemic Summer
K. Practical Tips & Other Useful Information
1. For Those Too Busy Watching Pandemic News or Netflix to Exercise: The 4 Second (Yes, Second!) Workout [After all, what’s the point of surviving a pandemic if you’re going to have a heart attack as soon as you are allowed outside?]
- Four seconds of high-intensity exertion repeated periodically throughout the day might counteract some of the unhealthy metabolic consequences of sitting for hours, according to a surprising and timely new study of the potentially large benefits of diminutive workouts.
- The study relied on a specialized type of stationary bicycle that few of us will have available at home, but its implications remain broadly applicable and suggest that even a few minutes — or seconds — of exercise each day could help substantially to bolster our health.
- For most of us, sitting is our default posture and was, even before the shelter-at-home edicts took effect across the globe. Epidemiological studies indicate that most American adults sit for a least 10 hours a day, a total that is likely to have risen now that many of us are home all day.
- The health impacts of this inactivity can be considerable, with studies linking prolonged sitting to increased risks for heart disease, Type 2 diabetes and other metabolic disruptions. In particular, multiple hours of sitting can contribute to a later rise in the bloodstream of fatty acids, known as triglycerides, probably in part because muscles at rest produce less than contracting muscles do of a substance that breaks up triglycerides. High levels of triglycerides, in turn, are linked to an increased risk of heart disease and other metabolic problems.
- In theory, exercise should help to combat this problem, since it entails muscular contractions. But some past experiments hint that a single workout may not be enough. In studies conducted at the University of Texas at Austin in recent years, healthy young people who sat all day for the sake of science showed higher-than-normal levels of triglycerides in their blood the next day after a fatty meal. The sitting had left their metabolisms less able to break up and clear away the fat.
- Even when the young people interrupted another full day of sitting with a one-hour run, they continued to experience difficulties with fat metabolism the next day. The researchers speculated that the long hours of sitting might have changed the volunteers’ physiologies in ways that rendered them “resistant” to the expected, beneficial metabolic effects of physical activity.
- Those studies had deployed a single moderately paced workout, however. Recently, the researchers began to wonder whether more-frequent, brief spurts of exercise throughout the day, especially if they were intense, might better stave off the undesirable effects of sitting.
- So, for the new study, which was published in April in Medicine & Science in Sports & Exercise, the Texas scientists recruited eight healthy young men and women and asked them to spend a full day at the lab seated, rising only to eat or visit the bathroom. The next morning, the volunteers returned to the lab for a high-fat breakfast of melted ice cream and half and half, while the scientists monitored their bodies’ metabolic response during the next six hours.
- Then, on a separate day, the volunteers sat again, except for a few seconds each hour, when they sprinted.
- These sprints took place on an unusual type of stationary bicycle with a heavy flywheel and no resistance that has been used at the U.T. physiology lab to test the leg and lung power of professional athletes. In those tests, athletes generated a tsunami of power and achieved all-out exertion within about two seconds of pedaling.
- The scientists reasoned that if athletes needed two seconds of pedaling to reach maximum exertion, the rest of us probably would require, say, twice as much. So, they asked their volunteers to clamber on the bikes and sprint as hard as possible for four seconds, then stop pedaling, rest for 45 seconds, and sprint again, repeating that sequence five times.
- The volunteers completed these brief interval sessions once every hour for eight hours, for a total of 160 seconds of actual exercise that day. Otherwise they sat, then returned the next day to down the unctuous breakfast shake.
- Their metabolic responses differed this time, though, the researchers found. The volunteers arrived at the lab with lower blood levels of triglycerides to start with and burned more fat during the next six hours, so their triglycerides remained about 30 percent lower throughout the six hours of monitoring than on the morning after nonstop sitting.
- The results suggest that breaking up sitting with frequent, intense and extremely abbreviated exercise “can undo” some of the adverse effects of being sedentary, says Ed Coyle, a professor of kinesiology and health education at the University of Texas, who conducted the study with his graduate student Anthony Wolfe and others. (Dr. Coyle has equity in the company that manufactures the bicycles at his lab but said his stake did not influence the design of the study or reporting of results.)
- This was a small, short-term study, of course, and its results are limited. They do not tell us if the desirable metabolic outcomes after sprinting linger past the next day or whether four-second intervals represent the right dose of exercise or merely the teensiest. The study also relied on an uncommon type of bicycle. Standard stationary bicycles or spin-class versions would likely require us to sprint for more than four seconds to reach an all-out exertion level, Dr. Coyle says. So would racing up and down stairs or jogging in place.
- But the underlying theory of the study remains appealing and achievable, he adds. When you find yourself sitting for most of the day, try to rise frequently and move, preferably intensely, as often during the day as possible and for as many seconds as you can manage.
Source: The 4-Second Workout [Note: This story originally appeared in the New York Times]