Coronavirus Update 5-1

“Just wanted to thank you for your COVID reports and let you know that, thanks to you, I got my pulse oximeter from Amazon today. Thanks for all the great information! Stay healthy!”
— CV Update Reader

“I felt the negative effects of not having our economy starting to open up was beginning to have the same weight as the virus itself, especially if you weren’t in the medically fragile category or someone in a long-term care facility.” — Georgia Governor Kemp

“Shut down the lockdown. No work no freedom. Tyrants get the rope.” — Michigan protesters

Today’s Features

Recent Developments and Headlines
Numbers and Trends
Race To Develop Vaccines – Operation Warp Speed
Testing – Just Spit & Wait
Concerns & Unknowns
New Scientific Findings
The Road Back? — WHO Hails Sweden as Model for Other Countries
Georgia Reopens
The Risks of Reopening
Ideology of Safetyism vs. the Facts
Projections & Our (Possible) Future – Can AI identify emerging hotspots?
Practical Tips – What to do if someone in your home becomes infected

Connect with us and receive the Coronavirus Update in your inbox every morning– send us an email at info.dailycovid19post@gmail.com.

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

A. Recent Developments and Headlines

Note: All changes noted in this Update are since the 4/30 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 = 3,304,220 (+2.7%) (+86,036)
Worldwide New Cases (5 day avg) = 76,963 (-1.2%) (-950)
US Total Cases = 1,095,023 (+2.9%) (+30,829)
US New Cases (5 day avg) = 26,874 (-3.4%) (-957)
Worldwide deaths = 233,830 (+2.5%) (+5,800)
US deaths = 63,856 (+3.6%)
US new deaths = 2,200 (-8.0%) (-190)
NY deaths = 23,474 (+1.6%)
NY new deaths = 306 (-15.0%) (-54)
Trump said U.S. officials and scientists are fast-tracking work to produce a coronavirus vaccine in “Operation Warp Speed”
White House Phasing Out Lockdown Guidelines
President Trump Confirms “High Degree Of Confidence” That COVID-19 Originated In Wuhan Lab
Georgia Governor Allows Shelter-In-Place Order To Expire
Florida Governor DeSantis Unveils Plan to Gradually Open the State
Hundreds of protesters crowd Michigan capital as lawmakers vote on state of emergency extension
Michigan House Won’t Extend State of Emergency, Votes to Sue Gov. Gretchen Whitmer
Report: Gavin Newsom to Close All Beaches, State Parks
CA Gov. Newsom Backs Down; ‘Hard Close’ of Orange County Beaches Only
Northern California Counties Begin to Loosen Restrictions
LA becomes first US city to offer county-wide testing
New York to Hire ‘Army of Tracers’ to Combat Coronavirus
Painkillers, sedatives in short supply during COVID-19 pandemic
Gilead says it can produce ‘several million’ rounds of remdesivir coronavirus treatments next year
Report: North Korea to Lock Down Through 2020 Despite ‘Zero’ Coronavirus Cases
Venezuela: Maduro Claims Miracle Halt in Coronavirus Cases in 24 Hours
Capitol physician says Senate lacks capacity to test all senators
DC May Not Reopen for Another 3 Months, Officials Say
Where’s the Beef?
Russia passes 100,000 cases
UK Prime Minister Boris Johnson lays out reopening plan
California reports another spike in new cases deaths
New Jersey reports record jump in deaths
VA Cracks on Coronavirus Shutdown: Governor Admits State Met Metrics for Phase One Reopening
N. Carolina Meets Guidelines for Phase One Reopening, Democrat Gov. Cooper Will Not Consider Until May 8
North Carolina County to Defy Governor’s Stay-at-Home Orders, Reopen Businesses
Sen. Mike Braun Urges Trump to Make Canned Fruit and Vegetable Supply Critical Infrastructure
Nevada Governor Extends Stay-at-Home Order
New Jersey Allowing State Parks, Golf Courses to Reopen
USDA Says Meatpacking Plants Will Reopen In “Days Not Weeks”
Russia reports another record single-day batch of cases
Sri Lanka reimposes lockdown measures
Brazil’s Neighbors Close Borders As Latin America’s Biggest COVID-19 “Hot Spot” Reopens
Italy reports another encouraging drop in new cases and deaths
Pentagon orders another 100,000 body bags for “worst case” scenario
DHS acting secretary says social distancing will last for ‘months’
Spain sees curve continue to flatten
NYC hands out free masks
Florida reports uptick in cases, deaths
South Korea: No Coronavirus Cases Linked to In-Person National Election
New data suggests 1 in 6 US nursing homes suffered COVID-19 clusters
UN warns about virus spreading in Syria, Yemen
Las Vegas Transforms Casino Into Food Bank As Working Poor Line Up For Miles
Mayday On May-Day: “Unprecedented Strikes” Planned At Amazon, Walmart On Friday As Working-Poor Snub Rent Payments
Freezer Truck Packed With 50 Dead Bodies Discovered Outside Brooklyn Funeral Home
Chinese Communist Party Knew That Their Bio-Labs Were A Ticking Time Bomb In October
Virus Lockdowns Smash German Jobs, Lead To Record Drop In Eurozone Economy
No, Your City Isn’t “Two Weeks Behind New York” On COVID-19 Deaths
All Of The Coronavirus Models Were Wrong (Yes, All Of Them)
Dozens Of Patients In Wuhan Have Developed ‘Chronic’ Coronavirus Infections
Coronavirus Pushes Colleges to the Breaking Point, Forcing Hard Choices about Education
‘Full Of $hit’ – Swedish City Spreads Manure On Parks To Stop Crowds Gathering
Swiss Health & Tranquility Law Sparks “Desperate” Snitching To Counter Lockdown-Deniers
CDC Extends Social Distancing Guidelines To Apply To Pets
China Refuses WHO Request To Take Part In Coronavirus Origin Probe
Time For A Gap Year: Harvard Tells Students Prepare For Likelihood Of Online Only Fall Courses
Restaurant Recovery Begins As Money Spent On Dining Posts First Increase In Weeks
Las Vegas Transforms Casino Into Food Bank As Working Poor Line Up For Miles
Michigan House Won’t Extend State of Emergency, Votes to Sue Gov. Gretchen Whitmer Instead
Gov. Phil Murphy Thanks Donald Trump for Coronavirus Help ‘In Our Darkest Hour of Need’
Little League World Series Canceled for 1st Time
NASCAR to Resume Season May 17 with Seven Races in 10 Days
NY Gov. Cuomo Finally Orders Deep Cleaning of New York City Subway Trains
NYC plans to close subways between 1am and 5am for cleaning
New York’s homeless flock to empty subway trains
UK Prime Minister Boris Johnson: ‘We Are Past Peak of This Disease’ — But End of Lockdown Distant
Illinois Gov. Pritzker: It’s ‘Inappropriate’ to Ask if My Wife Dodged My Stay-at-Home Order
Waffle House CEO at White House: Restaurants Will Lead the Way to Reopen America
U.K. Contact Tracing App Data Will be Stored on Govt. Servers
Report: NY Nursing Home Let Infected Staff Treat Residents
Michigan Senate Leader: ‘Dictator’ Gov. Gretchen Whitmer Gave Us ‘Double Middle Finger’ over Coronavirus Collaboration
Crenshaw: Pelosi Hesitation in Returning House to Capitol Hill ‘Cowardice’
Putin: Russia Has a ‘Deficit in All Sorts’ of Medical Gear
The pandemic saps Putin’s image as a man of action
Teachers’ Union Head: Scream Bloody Murder if Schools Reopen Prematurely
POTUS Hopes for 25,000-Person Rallies Before November Election
CNN’s Lemon: Not Holding Coronavirus Briefings ‘Part of the Plan for You to Think That This Is Over’
Stair Climbs, Masks, No Bars: Welcome to Post-Lockdown Hotel
After lockdown, a world of masks
Finally! Mike Pence puts on a mask to tour GM plant making ventilators after outrage at his bare-faced tour of the Mayo Clinic
Military hospital ship leaves New York as virus cases decline
Major US airlines to require passengers to wear face masks — American, Delta and United to follow the lead of JetBlue
Food Lines a Mile Long in America’s Second-Wealthiest State (NJ)
Blood of supposedly recovered coronavirus patients being sold on dark web
Swiss researchers see sewage as early warning sign for C19 hotspots
In lockdown, ‘desperate’ Swiss turn to snooping and snitching
‘So what?’: Bolsonaro shrugs off Brazil’s rising coronavirus death toll
Open-air classes for Denmark’s students
Veterinarian warns one dog breed (pugs) could be more susceptible to coronavirus
Condom sales go limp as coronavirus keeps hookups on lockdown
Michelle Obama Asks D.C. Residents to ‘Stay Home’ — While Barack Golfs
Macy’s to Reopen 68 Stores; Plans for All 775 in Next Six Weeks
Intel Community: May Be Result of a ‘Laboratory Accident in Wuhan’
NHL discussing delayed start to next season
Distillery turns stale beer into whiskey amid coronavirus pandemic
Nearly 900 workers at a Tyson Foods pork plant test positive for coronavirus
Soccer diehards fill empty stadium with cardboard-cutouts of fans
Michigan is sending free condoms to your house during coronavirus lockdown
New York health chief Howard Zucker: call him Dr. Death
Long Island landlord busted in sex for rent scheme amid coronavirus
Connecticut starting phased reopening of coronavirus lockdown in late May
Trump announces plan to protect seniors in nursing homes
Maryland mandates ‘universal testing’ for all nursing home residents, staff
Masks are making it difficult for deaf people to communicate
Coronavirus has struck one in six US nursing homes
Grocery store cashiers work inside plastic tents for safety amid coronavirus
Cops hunt for person wearing creepy 17th-century plague doctor costume
Coronavirus puts damper on global smartphone production
Europe flooded with cocaine despite coronavirus trade disruptions
De Blasio’s promise of 50K coronavirus tests per week falls short
Majority of field hospitals will be shut down after going unused
India’s lockdown fails to flatten curve as coronavirus cases rise
People are sick of being shamed for going outside during coronavirus lockdown
NYC will start to crack down on large gatherings in public parks
Georgia teens no longer need to take road tests to get driver’s license due to coronavirus
De Blasio marks ‘very good day’ as coronavirus hospitalizations fall
Michigan to launch modern-day GI Bill for workers on front lines
De Blasio rips funeral home’s ‘unacceptable’ U-Haul corpse storage
Couple opening ‘COVID-19-safe restaurant’ in a meadow with 1 chair, 1 table
Coronavirus could kill livelihoods of almost half the global workforce
U-Haul blasts funeral home that stored bodies in truck: ‘Inhumane’
Cristina Cuomo defends using bleach baths, holistic remedies as coronavirus treatment
Millions who had risen out of poverty are pulled back in by the pandemic
As its neighbors cautiously step back from lockdowns, Britain signals that it needs more time
U.S. presses Mexico to keep factories open despite illnesses
The U.N. says $90 billion is needed to help poor regions weather the economic meltdown. It has $1 billion.
Can children hug their grandparents? The W.H.O. is exploring a safe way
France tries to nudge jittery commuters into bike lanes

B. Numbers & Trends

Note: The numbers in this update only include cases that have been (i) confirmed through testing, and (ii) reported. The actual number of cases may be materially higher than confirmed cases, which means that the number of actual deaths from COVID-19 and recoveries may both be materially higher than reported.

Sources: Worldometers and ncov2019.live

1. Confirmed Total Cases and New Cases

Worldwide:
- Total Cases = 3,304,220 (+2.7%)
- New Cases = 86,036 (+5.3%) (+4,360)
- New Cases (5 day avg) = 76,963 (-1.2%) (-950)
Europe:
- Total Cases = 1,373,444 (+1.9%)
- New Cases = 26,064 (+5.6%) (+1,390)
- New Cases (5 day avg) = 24,189 (-0.9%) (-224)
Asia:
- Total Cases = 520,050 (+2.5%)
- New Cases = 12,772 (+1.3%) (+168)
- New Cases (5 day avg) = 11,822 (-0.7%) (-77)
US:
- Total Cases = 1,095,023 (+2.9%)
- New Cases = 30,829 (+8.4%) (+2,400)
- New Cases (5 day avg) = 26,874 (-3.4%) (-957)
US States & Territories:
- 45 States > 1,000 cases (+0),
- 39 States > 2,500 cases (+1), plus DC
- 29 States > 5,000 cases (+1)
- 20 States > 10,000 cases (+0): 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:

State	Total Cases	Change in Total Cases (%)	New Cases	Change in New Cases (#)	Change in New Cases (%)
NY	310,839	1.5%	4,618	(27)	(0.6%)
NJ	118,652	2.1%	2,388	(20)	(0.8%)
MA	62,205	3.2%	1,940	(23)	(1.7%)
IL	52,918	5.1%	2,563	310	12.1%
CA	50,129	5.0%	1,564	(838)	(34.9%)
Total	594,743	2.3%	13,136	(598)	(4.4%)

Top 5 States = 54.3% of Total US Cases (-0.4%)
NY & NJ = 39.2% of Total US Cases (-0.5%)
Trends: Top 5 States and NY/NJ percentages of total cases are declining as their number of new cases continue to decrease while new cases in other States are increasing
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 = 50,944 (-8,873)
US serious or critical cases = 15,226 (-3,445)
US serious or critical cases = 1.7% of Active Cases compared with worldwide percentage of 2.5%

3. Deaths

Worldwide deaths = 233,830 (+2.5%)
Worldwide new deaths = 5,800 (-43.2%) (-4,417)
Europe deaths = 135,235 (+1.7%) (+2,288)
US deaths = 63,856 (+3.6%)
US new deaths = 2,200 (-8.0%) (-190)
NY deaths = 23,474 (+1.6%)
NY new deaths = 306 (-15.0%) (-54)
Deaths per 1M population of 5 Countries with Largest Number of Confirmed Cases:
- Spain: 525 (+6)
- Italy: 463 (+5)
- UK: 394 (+10)
- France: 373 (+4)
- US: 193 (+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.]

4. Recoveries

Worldwide recoveries = 1,039,055 (+3.9%) (+39,022)
Worldwide recoveries = 31.5% of Total Worldwide Cases
US recoveries = 152,324 (+3.3%) (+4,913)
US recoveries = 13.9% of Total US Cases (+0.0%)

C. Race to Develop Vaccines

1. Operation Warp Speed Aims to Rush Coronavirus Vaccine

The Trump administration is organizing a Manhattan Project-style effort to drastically cut the time needed to develop a coronavirus vaccine, with a goal of making enough doses for most Americans by year’s end.
Called “Operation Warp Speed,” the program will pull together private pharmaceutical companies, government agencies and the military to try to cut the development time for a vaccine by as much as 8 months, according to two people familiar with the matter.
As part of the arrangement, taxpayers will shoulder much of the financial risk that vaccine candidates may fail, instead of drug companies.
The project’s goal is to have 300 million doses of vaccine available by January, according to one administration official. There is no precedent for such rapid development of a vaccine.
President Donald Trump’s top medical advisers, led by the infectious disease expert Anthony Fauci, have repeatedly said that a coronavirus vaccine won’t be ready for 12 to 18 months at best. Until then, White House guidelines envision some economically damaging social-distancing practices maintained even as the U.S. begins to resume a more normal social and business life.
Last month, Trump directed Health and Human Services Secretary Alex Azar to speed development of a vaccine, and administration officials have been meeting on the effort for 3 to 4 weeks, one of the people said. A meeting on the project was scheduled at the White House on Wednesday.
The people familiar with the project and the administration officials asked not to be identified because it hasn’t yet been publicly announced.
A spokesman for the Department of Health and Human Services, Michael Caputo, said the president refused to accept the timeline for standard vaccine development and encouraged a breakthrough process.

Speeding Up

Vaccine development is typically slow and high risk. The project’s goal is to cut out the slow part, the people said. Operation Warp Speed will use government resources to quickly test the world’s most promising experimental vaccines in animals, then launch coordinated human clinical trials to winnow down the candidates.
The project will cost billions of dollars, one of the people said. And it will almost certainly result in significant waste by making inoculations at scale before knowing if they’ll be safe and effective — meaning that vaccines that fail will be useless. But it could mean having doses of vaccine available for the American public by the end of this year, instead of by next summer.
The group is discussing which Americans might be vaccinated first, as the medicines would likely roll off production lines in batches, one of the people said. The project would be funded from money already available to the government and won’t require new authority from Congress, one of the people said.
There are at least 70 different coronavirus vaccines in development by drugmakers and research groups, according to the World Health Organization. But drugmakers have not coordinated their efforts to the extent they could through the Warp Speed project, one of the people said.
Under the effort, the Defense Department would make its animal research resources available for pre-clinical work on vaccines.
The group is also discussing the use of what’s known as a master protocol to test the vaccines. Instead of multiple clinical trials run by each drugmaker, competing for patients and resources, the government would organize one large trial to test several vaccines at once and advance the most promising ones.

Oxford Vaccine

The Trump administration isn’t alone in trying to fast-track a vaccine. One of the world’s most promising vaccine candidates has been developed by a team at Oxford University in London. Last month, scientists at the U.S. National Institutes of Health innoculated 6 rhesus macaques with the Oxford vaccine and then exposed them to the coronavirus.
All 6 were healthy more than four weeks later. The researchers are currently testing their vaccine in 1,000 patients and plan to expand to stage two and three clinical trials next month involving about 5,000 more people.
The Oxford group told the NY Times they could have several million doses of their vaccine produced and approved by regulators as early as September.
In the U.S., the Bill & Melinda Gates Foundation has meanwhile shifted much of its research effort to the coronavirus virus.
One of the people familiar with Operation Warp Speed drew a distinction with the Oxford group, describing the U.S. effort as broader in scope. It’s unclear which vaccine candidates would be part of Operation Warp Speed, or whether it would include the Oxford vaccine.
More than 1,000,000 cases of coronavirus have been confirmed in the U.S., and at least 58,000 people have died from the illness it causes in the last two months. Widespread social-distancing measures have helped slow the spread, but at the cost of millions of jobs and losses to the economy that experts fear will take years to recover.
Along with wider diagnostic testing for the virus and an effective therapeutic drug, a vaccine is one of the key tools for reducing long-term risk from the virus. Testing can help contain an outbreak in its early stages, or after it’s been curbed enough to manage. A therapy can help those who get sick, reducing the risk of death and the burden on hospitals.
Gilead Sciences Inc. announced Wednesday that in a trial conducted by Fauci’s agency, the U.S. National Institute of Allergy and Infectious Diseases, its experimental coronavirus therapy remdesivir helped patients recover faster than under standard care.

Optimistic Timetable

Vaccines are one of the most effective tools against viral disease, as they can prevent people from becoming sick at all. They’re a shortcut to the immunity that most people acquire after they’re sickened by a virus and recover. During the illness, the immune system produces antibodies that it can subsequently use to fight off later exposure to the same pathogen.
Vaccines use a live, weakened virus, a dead one, or pieces of the pathogen to trick the body into building defenses without having to get sick.
But even Fauci’s prospective 12-to-18-month timetable would be years faster than typical vaccine development. A vaccine for the Ebola virus that went into clinical trials in 2014 received approval from U.S. regulators in December — a five-year effort considered remarkable for its speed.
And the new coronavirus poses fresh challenges. How many people get immunity after exposure, how robust the pathogen is, and how long it lasts are all still questions. Some research has shown that immunity to other coronaviruses, including those that cause SARS, MERS and forms of the common cold, may be limited or only last for a relatively short time.
It’s not clear how much of Operation Warp Speed is new and how much will involve ongoing projects, such as investments made by BARDA, the Biomedical Advanced Research and Development Authority.
BARDA has already handed out hundreds of millions of dollars to drugmakers including Moderna Inc. and Johnson & Johnson. The money is meant to fund both research and large-scale manufacturing at the same time, hopefully to accelerate vaccine production.

Source: Trump Coronavirus Vaccine: ‘Operation Warp Speed’ Project News

2. Oxford University, AstraZeneca Join Forces for Coronavirus Vaccine

AstraZeneca PLC has agreed to manufacture and distribute an experimental coronavirus vaccine from the University of Oxford—one of the most advanced candidates—in a partnership aimed at accelerating the widespread availability of the shot if it proves effective.
The involvement of the British pharmaceutical giant, announced Thursday, helps to overcome the biggest concern for vaccines under development at academic research laboratories: that even if they work, the institutions developing them lack the capacity to make them widely available.
“Our scale and global footprint will enable us to manufacture this at scale,” said Mene Pangalos, who heads biopharmaceuticals research and development at AstraZeneca. “How we’ll do that exactly is too soon to tell.”
AstraZeneca didn’t disclose the commercial terms of the agreement, but it and the university said they would make the vaccine available on a nonprofit basis during the course of the pandemic.
The Oxford vaccine is one of a small number of candidates that are already in human testing. Researchers last week began vaccinating volunteers for a 1,100-subject study to test its safety and get an early read on its effectiveness. If that stage passes muster, they plan to start a 5,000-person trial to get a definitive answer on whether it works by late May.
The researchers say they could learn whether the vaccine works as soon as September and begin emergency distribution at that point, although this is unlikely to stretch beyond around a 1,000,000 doses. That timetable means it could be the first proven vaccine in the world. Pfizer Inc. on Tuesday said its vaccine candidate could also be ready for emergency distribution as early as the fall.
The Oxford vaccine moved quickly because the researchers behind it had already used the same platform for vaccines directed against other diseases. It started work on the coronavirus in January, as soon as Chinese researchers released the genetic sequence of the new virus.
Still, it is unlikely that any single vaccine will meet the global demand. “As in a horse race, the first horse out of the box isn’t necessarily the horse that wins the race,” said Adam Finn, who leads vaccines and immunization at the World Health Organization’s Regional Office for Europe, at a media briefing Thursday. “We are not so interested in the winner as to how many horses we can get to that finishing line.”

Source: Oxford University, AstraZeneca Join Forces for Coronavirus Vaccine

3. Views from Wall Street

Hot on the heels of positive-sounding news on Gilead’s anti-viral therapy drug Remdesivir, Salveen Richter, GS lead analyst for the US Biotechnology sector, answers key questions on where we are on US testing, treatments and vaccines for C19.
On the therapy side, there are two broad groups for C19—prophylactic vaccines and treatment. Prophylactic vaccines are intended to provide protection from infection and confer immunity in people who have not been exposed to C19, while treatments address the different symptoms associated with C19, such as acute respiratory distress syndrome (ARDS). According to the Milken Institute COVID-19 tracker, there were over 250 therapies in the pipeline as of April 27, with 96 of these being vaccines and 55 antibodies. We note that according to the WHO, there are 89 vaccines currently in the pipeline, seven of which are in clinical development.

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Question: What are the most promising vaccines currently in development, and what is the earliest timeline we can expect to see for getting a vaccine to the public?

Answer: With several vaccines in development, we believe Moderna’s mRNA-based vaccine (mRNA-127) and Johnson & Johnson’s vaccine candidate, which uses established and validated AdVac technology, are the leading contenders to address the public health needs of the global community. Moderna has previously issued guidance on the potential for emergency vaccine use in primary populations (including physicians) as early as fall 2020, following the release of Phase 1 safety data in the spring and immunogenicity data in the summer and Phase 2 initiation in 2Q20. We expect Johnson & Johnson to initiate Phase 1 trials in September, with topline safety and immunogenicity data expected by the end of 2020, and note the vaccine could be available under the emergency use authorization of the FDA in early 2021.

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Question: Will any vaccine need to be administered every year, like a flu vaccine, or will it be effective over a multi-year period?

Answer: On the duration of efficacy, it is unclear if the C19 vaccine will be similar to the yearly flu vaccine or whether it will be able to confer multi-year efficacy. While some experts believe multi-year protection is likely, more research is needed to determine if this is the case based on what we know about similar viruses. Using the 2002 SARS and 2012 MERS epidemics as analogs is not helpful in this case because there is not much known about their reinfection rates given the limited epidemiological details of both – there were >8,000 cases of SARS over 3 months, and only 2,500 observed cases of MERS over 8 years.

For full story, see Goldman Answers Key Questions On COVID Testing, Treatments, & Vaccines

D. Testing

1. Just Spit and Wait: New Coronavirus Test Offers Advantages

A new test for the coronavirus is so simple and straightforward, almost anyone could do it: Spit a glob of saliva into a cup, close the lid and hand it over.
While not as fast to process as the speediest swab tests, saliva tests could transform the diagnosis of C19. If manufactured in enough numbers and processed by enough labs across the country, they could alleviate the diagnostic shortages that have hampered containment of the pandemic and offer a less onerous way for companies to see if workers are infected.
The first saliva-based test, already being offered in parts of New Jersey, detects genetic material from the virus, just as the existing tests do, but it avoids a long swab that reaches disturbingly far up a person’s nose. For the saliva-based, health care workers do not need to wear and discard precious gowns and masks. And early evidence suggests it is just as sensitive, if not more so, than the swabs.
Because the saliva test relies on equipment that is widely available, it also offers the hope of a nationwide rollout without encountering the supply problems that have plagued the swabs.
Starting about two weeks ago, New Jersey has offered the saliva test at a walk-up site in New Brunswick; drive-through sites in Somerset and Edison; the state’s Department of Corrections; 30 long-term care facilities; and even the American Dream mall.
Experts not involved with the test praised it as a welcome solution to diagnostic shortages across the country.
“If people are going back to work, and they’re going to be tested presumably on a regular basis, we really do need to less invasive sampling methods than the swabs,” said Angela Rasmussen, a virologist at Columbia University. “To have to do nasopharyngeal swabs twice a week? No, thanks.”
The next step would be an at-home saliva test kit that skirts even the need to go to a walk-in center, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security.
Dr. Adalja noted that LabCorp, one of the nation’s largest commercial laboratories, now offers an at-home test that people can use to swab their own nose. “If we can do nasal swabs unsupervised, there’s no reason why we can’t do these tests unsupervised as well,” he said.
On April 13, the FDA granted an emergency-use authorization, waiving some usual requirements, to a saliva test made by a Rutgers University lab, RUCDR Infinite Biologics.
The Rutgers lab has already processed close to 90,000 tests, according to its chief executive, Andrew Brooks, and expects to ramp up eventually to 30,000 tests per day. Results are available within 72 hours, although they could be sped up to just a few hours with enough infrastructure in place. By contrast, some rapid tests that rely on swabs deliver results in minutes.
Other states are expressing interest. Working with Rutgers, Oklahoma has begun validating a version of the test, and the Rutgers researchers have fielded questions from the White House’s coronavirus task force, from Indiana, Illinois, California and from several large companies. In New Jersey, the test is available for between $65 and $100.
After a disastrously slow start, the United States is starting to see an increase in testing types and capacity. The National Institutes of Health on Wednesday announced a new $1.5 billion “shark tank” style program aimed at encouraging swift innovation in coronavirus testing, with a goal of new tests by the end of summer. Also Wednesday, the testing manufacturer Hologic said that it had a new test that could allow labs to begin running up to 1 million additional tests per week.
The nasopharyngeal swabs that have mostly been used to test for the coronavirus are invasive and uncomfortable, and may be difficult for severely ill people to tolerate. They also put health care workers at high risk of infection and require them to wear gloves, gowns and masks.
The saliva test, by contrast, doesn’t require any interaction with a health care worker. And it’s easy enough that New Jersey has also started using it at developmental centers with residents who have intellectual and developmental disabilities.
The saliva is immersed in a liquid that preserves it until it can be analyzed. This will be particularly important for developing tests that people can use at home and mail or drop off at a lab, or when dealing with large numbers of samples.
“When you’re testing 10,000 at a drive-through a day, when you’re at a correctional facility collecting it from 1,500 people per day, the use of a preservation agent is really critical,” Dr. Brooks said.
He said that the preservative in the Rutgers test is “a secret sauce” made by a Utah-based partner, Spectrum Solutions, but that the ingredients are easily available and unlikely to pose supply problems.
However, some of the PCR machines, which amplify viral genetic material, require labs to use the manufacturer’s own reagents. “That could potentially be a supply issue,” Dr. Rasmussen said.
The Rutgers test was validated in people who were severely ill, but the saliva test often yielded a stronger signal than the swab, suggesting that it is more sensitive — yielding fewer false negatives — than the swab. It also generated no false positives in all of the samples tested.
False negatives in particular have been a problem with the nasopharyngeal swabs. (A different type of test for antibodies, which can say whether a person was exposed to the virus and has recovered, is riddled with false positives.)
In separate research, a Yale University team reported that saliva may be able to detect the virus in people who are only mildly ill, while a nasopharyngeal swab cannot.
In their study, the team compared swabs and saliva samples from patients. They needed only a few drops of saliva for their test, an advantage for people who may have trouble producing more. Thinking about a favorite meal can often do the trick, said Anne Wyllie, the Yale team’s leader.
ImageA health worker instructed a patient how to use the saliva-based test at the site in Edison, N.J. One of the test’s advantages is that it doesn’t require close interaction to collect.
The swabs are known to produce false negatives — perhaps in part because of errors by health care workers under stress. The saliva test appeared to be more consistent and accurate over a longer period of time, detecting infections even after the amounts of the virus have waned, than the swab.
“The nasopharyngeal swab is subject to so much more variability in how well it’s obtained,” Dr. Wyllie said. A saliva test is “definitely more reliable.”
In one case, the team found a health care worker who twice tested negative using a nasopharyngeal swab before finally testing positive on a third day. But the worker’s saliva tested positive all three days, Dr. Wyllie said. She underlined the risks of asymptomatic health care workers getting a false negative and continuing to care for patients. “You can imagine the implications,” she said.
While the Yale team did not compare saliva tests with the shorter swabs used in some tests, Dr. Wyllie said she expected that saliva tests would prove superior there as well. Most people with C19 do not have runny noses, which might influence how much virus a short swab can collect, she said.
Saliva tests would also be a preferred choice for at-home tests, Dr. Adalja added. A saliva test for H.I.V. is the only at-home test approved for an infectious disease, he said, but before the pandemic, the federal Biomedical Advanced Research and Development Authority had funded two companies to develop at-home nasal swab tests for influenza.
“It’s not a high bar to repurpose home testing for the coronavirus,” he said. “It’s not something that’s out of reach.”

Source: Just Spit and Wait: New Coronavirus Test Offers Advantages

E. Concerns & Unknowns

1. Second-week crash can happen quickly with little warning, and no one knows why

During the first week she had C19, Morgan Blue felt weak, with a severe backache and a fever. The symptoms did not alarm doctors at her local emergency department, however. They sent her home after she showed up at the hospital.
But on Day 8, she abruptly felt like she was choking.
“That day, I suddenly couldn’t breathe,” said the 26-year-old customer service representative from Flint, Michigan. An ambulance took her to the hospital, where she spent eight days, four of them in intensive care, before she recovered and was able to go home.
For people who suffer the most severe reactions to the novel coronavirus – and their caregivers – the second week of the disease can become a time of sudden peril and heightened concern, when some of those who seem stable or mending can suddenly become critically ill.
There is little consensus among doctors and experts about why days five through 10, or thereabouts, seem to be so dangerous for some people with C19, the disease caused by the virus. But everyone from critical care specialists to EMTs is aware of this frightening aspect of the disease.
“This second-week crash has certainly been well described, but 2 1/2 months in, why it happens we’re still not entirely sure,” said Ebbing Lautenbach, chief of the division of infectious diseases at the University of Pennsylvania’s Perelman School of Medicine.
Learning on the fly as they confront the new virus, clinicians interviewed by The Washington Post speculated about the influence of an individual’s genes, the virus’s effect on lung tissue, overactive immune responses, blood clotting and even the impact of the ventilators used to save patients’ lives.
There is little, if any, current research to guide them.
“I’ve been thinking about this a lot,” said Naftali Kaminski, chief of pulmonary critical care and sleep medicine at the Yale School of Medicine, who studies the genomics of lung disease. “There’s an early stage of infection and the virus sits somewhere. You can almost look at the virus as a fifth column coming in, securing its stronghold and then slowly inducing more cells to let it in.
“Because of this lurking nature, your genetic makeup and preexisting conditions will affect presentation of the disease,” he said.
Doctors say the overwhelming majority of C19 cases do not require hospitalization. According to the CDC, U.S. C19 patients are currently hospitalized at a rate of 29.2 per 100,000 people, or just under 10% of the 1,000,000 known cases so far. Of those, only a small percentage require intensive care or ventilators, and only some will experience a rapid downturn in their health.
But people with C19 can crash before or after they are hospitalized. Doctors report seeing patients who wait too long to seek care, including those who do not feel the symptoms of plummeting oxygen levels, such as shortness of breath, until they are in crisis. No one is sure why. Many people’s lungs remain flexible for a while, allowing carbon dioxide out and forestalling the sensation they aren’t getting enough oxygen.
“The people who actually crash, they’ve actually been sick a while,” said Merceditas Villanueva, an associate professor of medicine at the Yale School of Medicine. “They’ve underestimated how sick they are, or they’ve just waited.”
The virus may be killing the cells that line the air sacs of the lungs, which keep them open and allow for the exchange of oxygen and carbon dioxide, said Russell G. Buhr, a pulmonary and critical care physician at Ronald Reagan UCLA Medical Center in Santa Monica, California.
At some point, the body simply can’t regenerate those cells as quickly as they die, he said, and a stable situation turns life-threatening. That may also help explain why C19 patients can linger on ventilators for up to four weeks, much longer than in other respiratory diseases, he said.
“Some of that may be direct lung toxicity effect,” Buhr said. “You need more time to regenerate those cells.”
Another line of thought focuses on the virus’s possible effect on the cardiovascular system. Researchers have suggested that some crashes are caused by events such as heart attacks, strokes and clots related to blood complications.
Eytan Raz, a neurointerventional radiologist at NYU Langone Health, said one theory is that some of the blood clotting complications may be due to an over-reactive immune response that comes after the virus has settled in, multiplied and triggered a defensive army of antibodies to fight back.
An April 17 paper in the medical journal, The Lancet, said that C19 appears to have the ability to attack the lining of blood vessels anywhere in the body. Frank Ruschitzka, a researcher from University Hospital Zurich, and his co-authors wrote that this may be why so many organs, including the lungs, kidneys and intestines, are affected in patients with severe illness.
It also could explain why people with cardiovascular disease, diabetes and obesity, as well as smokers, are more likely to have severe illness.
Michael Bell, chief of critical care at Children’s National Hospital, speculated that this is why the second week crash and C19 itself, are rarely seen in children.
“We’ve had several dozen kids on our medical floor and have been on pins and needles that they were going to have a big collapse after week one. We haven’t seen any of that,” he said. “My best explanation is children in general have pretty healthy blood vessels.”
Ventilators themselves also may contribute to the crash, Buhr said, especially in overwhelmed hospitals where doctors cannot spend enough time fine-tuning the devices that force oxygen into the lungs. Too much pressure on inflamed lungs can produce more of the inflammatory response to the coronavirus, worsening the clogging of air sacs called alveoli.
“We don’t like to talk about that one as much, but treatment of critically ill people is very complicated,” Buhr said. “Ventilators don’t work like meds. Adjusting the ventilator requires a lot of hands-on effort. And, in particular when hospitals are under stress, it’s much more difficult to provide that level of care.”
Within the field, a debate has broken out about whether physicians are turning to ventilators too often and too early, driven by the traditional response to remarkably low blood oxygen levels in some patients who show none of the symptoms of oxygen deprivation. Some doctors have advocated a more conservative initial response that would spare more patients the sedation, intubation and side effects of mechanical ventilation.
Aware of the hazards of the second week of the disease, hospitals have employed a number of tactics. Some are putting patients on oxygen earlier and using blood thinners prophylactically to prevent clots. At UCLA, caregivers more aggressively monitor ventilator pressure and use proning – placing patients on their stomachs – as much as 16 hours a day, Buhr said. The technique has been shown to increase the amount of oxygen getting into the lungs of patients with acute respiratory distress syndrome, a hallmark of severe C19.
Many of these specialists expect to continue adjusting their approach to the disease and to the unpredictability of its second week.
“There’s a lot that we don’t know,” Villanueva said.
Blue, the woman from Flint, has been out of the hospital for nearly a month but still gets short of breath and suffers heart palpitations and anxiety. She said she knows of 10 people in her community who have died of C19.
Last week, she ventured out to the grocery store for the first time since mid-March and saw people without masks. She said she felt such distress that she left the store without buying most of what was on her list.
“There are still people who aren’t taking this seriously, which is mind-blowing to me,” she said.

Source: Second-week crash: Some covid-19 patients become critically ill with little warning – The

2. Over a third of coronavirus patients show neurological symptoms

As case numbers of C19 continue to rise around the world, we are starting to see an increasing number of reports of neurological symptoms. Some studies report that over a third of patients show neurological symptoms.
In the vast majority of cases, C19 is a respiratory infection that causes fever, aches, tiredness, sore throat, cough, and, in more severe cases, shortness of breath and respiratory distress. Yet we now understand that C19 can also infect cells outside of the respiratory tract and cause a wide range of symptoms from the gastrointestinal disease (diarrhea and nausea) to heart damage and blood clotting disorders. It appears that we have to add neurological symptoms to this list, too.
Several recent studies have identified the presence of neurological symptoms in C19 cases. Some of these studies are case reports where symptoms are observed in individuals. Several reports have described C19 patients suffering from Guillain–Barré syndrome. Guillain–Barré syndrome is a neurological disorder where the immune system responds to an infection and ends up mistakenly attacking nerve cells, resulting in muscle weakness and eventually paralysis.
Other case studies have described severe C19 encephalitis (brain inflammation and swelling) and stroke in healthy young people with otherwise mild C19 symptoms.
Larger studies from China and France have also investigated the prevalence of neurological disorders in C19 patients. These studies have shown that 36% of patients have neurological symptoms. Many of these symptoms were mild and include things like headaches or dizziness that could be caused by a robust immune response. Other more specific and severe symptoms were also seen and include loss of smell or taste, muscle weakness, stroke, seizure, and hallucinations.
These symptoms are seen more often in severe cases, with estimates ranging from 46% to 84% of severe cases showing neurological symptoms. Changes in consciousness, such as disorientation, inattention, and movement disorders, were also seen in severe cases and found to persist after recovery.

Crossing the blood-brain barrier

SARS-CoV-2, the coronavirus that causes C19, may cause neurological disorders by directly infecting the brain or as a result of the strong activation of the immune system.
Recent studies have found the novel coronavirus in the brains of fatal cases of C19. It has also been suggested that infection of olfactory neurons in the nose may enable the virus to spread from the respiratory tract to the brain.
Cells in the human brain express the ACE2 protein on their surface. ACE2 is a protein involved in blood pressure regulation and is the receptor the virus uses to enter and infect cells. ACE2 is also found on endothelial cells that line blood vessels. Infection of endothelial cells may allow the virus to pass from the respiratory tract to the blood and then across the blood-brain barrier into the brain. Once in the brain, replication of the virus may cause neurological disorders.
SARS-CoV-2 infection also results in a very strong response by the immune system. This immune response may directly cause neurological disorders in the form of Guillain–Barré syndrome. But brain inflammation might also indirectly cause neurological damage, such as through brain swelling. And it’s associated with – though doesn’t necessarily cause – neurodegenerative diseases such as Alzheimer’s and Parkinson’s.

Not unique, but still worrying

SARS-CoV-2 is not unique in being a respiratory virus that can also infect the brain. Influenza, measles, and respiratory syncytial viruses can all infect the brain or central nervous system and cause neurological disease.
Other coronaviruses have also been found to infect the brain and cause neurological disorders. The related seasonal coronavirus, HCoV-OC43, typically causes very mild respiratory symptoms but can also cause encephalitis in humans. Similarly, the coronavirus that causes Mers and the 2003 Sars virus can cause severe neurological disorders.
Respiratory viruses getting into the brain is thankfully a rare occurrence. But with millions of C19 infections worldwide, there is the risk of significant neurological disease, especially in severe cases.
It is important to be aware of the possibility of neurological manifestations of C19, both during acute illness as well as the possibility of long-term effects. This also highlights the continued importance of preventing viral transmission and identifying those who are and have been infected.

Source: Over a third of coronavirus patients show neurological symptoms, study reports

3. He was symptom free, but the virus stayed in his body for 40 days

By his second day in the hospital with C19, Charles Pignal’s mild cough and 102-degree fever had disappeared. Bored and “bouncing off the walls” of his room in the isolation ward at Singapore’s National Center for Infectious Diseases, he felt like he could go out and play a set of tennis.
The 42-year-old footwear executive told his mother on the phone, “I’ll be out of here in a couple of days.”
But Pignal would test positive for the coronavirus for five more weeks, despite developing no further symptoms. He wasn’t released until the 40th day after he first fell ill, when he finally tested negative two days in a row.
Cases like his are coming under increasing scrutiny as medical researchers worldwide puzzle over why the coronavirus — which typically lasts about two weeks in the body — appears to endure longer in some patients, even relatively young, healthy ones.
With studies showing that asymptomatic patients can transmit the SARS-CoV-2 virus, understanding how the virus leaves the body is among the most urgent mysteries facing researchers as governments in the United States and across the world begin to reopen their economies.
Although studies show that the average recovery time from C19 is two weeks, and nearly all patients are virus-free within a month, “less than 1% to 2%, for reasons that we do not know, continue to shed virus after that,” said Hsu Li Yang, an infectious diseases physician at the Saw Swee Hock School of Public Health at the National University of Singapore.
In recent weeks, China and South Korea have reported that some patients who had recovered from C19 tested positive again in follow-up visits. In extreme cases, patients in the Chinese city of Wuhan, where the outbreak began late last year, reportedly tested positive 70 days after recovery.
Doctors in both countries said they didn’t believe the patients had been reinfected, a worrisome possibility because of its implications for building widespread immunity to a disease for which there is no vaccine. They also had no evidence that the patients had infected others.
South Korean doctors have played down the results, saying that their standard genetic tests are designed to detect even small quantities of the virus and don’t always distinguish between dead fragments of the virus and particles that are still infectious. Patients who were diagnosed as recovered could still have had fragments of SARS-CoV-2 in their system.
“Many of the so-called relapsed cases in South Korea probably reflect this phenomenon,” Hsu said.
Studies indicate that C19 patients are most infectious at the start of the illness, when their viral load is highest, but researchers don’t yet know whether people who shed the virus for several weeks remain contagious until the end.
One study from Hong Kong found the virus’ nucleic acid in the saliva of a patient whose symptoms appeared 25 days earlier. A Southern California man who was infected aboard the Diamond Princess cruise ship took 29 days to test negative despite showing almost no symptoms.
“If these people can continue to transmit the virus, that in part could fuel this pandemic,” said Lokesh Kumar Sharma, an instructor at the Yale School of Medicine.
In a study Sharma co-authored last month of 16 patients from Beijing who had mild infections, half the patients continued to shed the virus even after their fevers, coughs and other symptoms went away. The study’s authors said the results were a reminder that recovered patients needed to be treated “as carefully as symptomatic patients.”
That poses a challenge for health systems dealing with growing epidemics.
In Singapore, C19 infections have swelled from 1,000 at the start of April to more than 15,000 due to a giant outbreak among low-wage foreign workers. Authorities in the city-state are racing to expand temporary isolation facilities at hotels and convention centers for patients with mild symptoms so that hospital beds can be reserved for more serious cases.
As of Wednesday, at least 200 patients remained in hospitals or isolation facilities more than a month after admission.
Pignal, a Frenchman who first developed symptoms while flying from London to his home in Singapore in early March, asked a doctor around his 15th day in the hospital whether he was still infectious even though he felt perfectly healthy.
“He said we don’t know, but there’s no evidence that what you’re shedding is contagious,” Pignal said.
Yet the daily nasal swabs continued to show the virus was in his system. A negative test on Day 23 was nullified by a positive result the next day.
He passed the time by reading and posting videos to his Instagram account, where he normally reviews books but suddenly found himself discussing his illness and confinement with thousands of new followers.
“I feel absolutely great,” he said in one post. “It’s just that the virus is still positive, right here in my nose. It’s not going anywhere …. I could be here another day, another week another two weeks, nobody knows. So that’s really quite distressing.”
Then, told that beds in the isolation ward were scarce and he was considered low risk, Pignal was moved to a hotel where he shared a room with another infected person.
But there were no doctors or nurses there, tests were administered only every four days, and Pignal began to grow distressed as he entered his second month of confinement. The spartan decor and security guards roaming the grounds added to his sense of isolation.
“Frankly,” he said in a post on Day 27, “I’m starting to get a little bit scared.”
His fiancee put together a lip-sync video featuring friends and family to cheer him up. He plowed through “The Brothers Karamazov.”
On April 11, Day 39, he was told he had tested negative and administered a second test to confirm the result. The next morning brought relief: negative again. He was virus-free and sent home.

Source: Why some patients keep testing positive for the coronavirus

F. New Scientific Findings and Theories

1. Tiny airborne particles may carry the new coronavirus

A study in Wuhan, China, detected genetic material of the new coronavirus in airborne suspensions, or aerosols, in hospitals and public spaces. The finding reinforces the importance of thorough sterilization of infection hotspots, good ventilation, and avoidance of crowding.
To date, scientists have established three ways in which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) — the virus that causes coronavirus disease 19 (C19) — can be transmitted:
- inhalation of liquid droplets from the coughing or sneezing of a person with the infection
- close contact with a person who has the infection
- contact with surfaces that contain the virus
According to a recent study in China, aerosols may offer a fourth transmission route for the virus.
Aerosols are airborne particles that measure around 1 micrometer (one-thousandth of a millimeter) in diameter at most. Because they are much smaller than droplets, they remain suspended in the air for longer and can travel farther.
In their study, the researchers detected genetic material, RNA, of the virus in aerosols sampled from two hospitals and various public places in the city of Wuhan, where the outbreak started.
Because of the relevance of their findings to the ongoing public health emergency, the researchers posted a full, unedited preprint of their study paper on the server bioRxiv on March 10, 2020. An unedited abstract of the paper was also recently published in the journal Nature.

Aerosol traps

The scientists used air filtration devices called aerosol traps to collect a total of 35 samples from 31 locations between February 17 and March 2, 2020.
The number of samples was relatively low because access to hospitals became tightly restricted at the peak of the outbreak.
In addition, the researchers emphasize that their study did not establish whether the virus-laden aerosols were capable of infecting people.
In confined spaces, however, aerosols are known to transmit other pathogens, including those that cause tuberculosis, measles, and chickenpox.
Aerosol transmission may also have played a role in the spread of the coronavirus that caused an outbreak of the respiratory infection SARS in Hong Kong in 2003.
The senior author of the present study was Dr. Ke Lan, of Wuhan University’s Modern Virology Research Center, and the team also featured public health experts from Shanghai and Hong Kong.
They collected aerosol samples from two hospitals where C19 patients were being treated.
One hospital was for patients with severe illness. The other, a temporary field hospital in a converted sports stadium, was for the quarantine and treatment of patients with mild symptoms.

Good ventilation

The concentration of virus-containing aerosols was generally very low, or even undetectable, in patient wards, which the authors attribute to effective isolation procedures and good ventilation.
However, there were high concentrations in unventilated portable toilets at the field hospital.
In their preprint, the scientists write:
- “Our finding has confirmed the aerosol transmission as an important pathway for surface contamination. We call for extra care and attention on the proper design, use, and disinfection of the toilets in hospitals and in communities to minimize the potential source of the virus-laden aerosol.”
The scientists also detected high levels of airborne viral RNA at the field hospital in areas used by medical staff to take off personal protective equipment.
This suggests that virus particles in droplets or aerosols were deposited on the equipment during long hours spent close to patients. The particles were then resuspended in the air when the equipment was removed, the authors propose.
However, after the introduction of more frequent and thorough sanitation procedures, they report, levels of virus-laden aerosols in these areas became undetectable.
The team recommends disinfecting protective apparel before removing it to avoid the propagation of virus-laden aerosols.

Crowded places

The scientists also placed aerosol traps in public spaces, including a supermarket and residential building.
Most of these had undetectable or very low concentrations of SARS-CoV-2 aerosols. Two exceptions were sites where people came together in relatively large numbers: one close to the entrance of a department store and another in a public area near one of the hospitals.
This suggests that people who had the infection but experienced no symptoms were nonetheless breathing out virus-laden aerosols.
The team concludes:
- “The results showed overall low risks in the public venues but do reinforce the importance of avoiding crowded gatherings and implementing early identification and diagnosis of asymptomatic carriers for early quarantine or treatment. Personal protection equipment, such as wearing masks in public places or while in transit, may reduce aerosol exposure and transmission.”
Taken together, the scientists’ findings indicate that thorough cleaning of surfaces, good ventilation, and avoiding crowds could reduce the risk of exposure to airborne virus particles.
However, commenting on the methods employed in this study, some experts have pointed out that — even when the researchers were able to detect viral particles — the particles may no longer have been infectious.
Lawrence Young, a professor at the University of Warwick, in the United Kingdom, for instance, explains that “Detecting the virus’ genetic material (RNA) with a very sensitive test (RT-PCR) is not the same as detecting [an] infectious virus. [A] dead or degraded virus would still be detected with this technique.”
“In fact,” Prof. Young adds, “this method is so sensitive that there needs to be stringent control measures to prevent sample cross-contamination.”
“The sampling of aerosols is subject to enormous variation, and the small sample size in this study also means that the data needs to be interpreted with caution,” he notes.

Source: Tiny airborne particles may carry the new coronavirus

2. Dead Coronavirus Particles Muddy the Outcome of Test Results

Coronavirus patients who remain positive weeks after diagnosis may harbor dead virus particles that can’t be distinguished from infectious ones in standard tests, scientists in South Korea found.
The so-called SARS-CoV-2 virus dies one-to-two weeks after infecting and proliferating inside respiratory cells, doctors at the National Medical Center in Seoul told reporters Wednesday. Pieces of the virus’s genetic material, or RNA, may remain in cells and be detected by a nucleic acid test a month or two after infection, underscoring the limitation of testing, they said.
Some C19 patients have continued to test positive over more than a month, said Peter Collignon, a professor of clinical medicine at the Australian National University Medical School in Canberra, who advises the Australian government on infection control. It’s possible the virus detected in these patients isn’t viable or capable of causing an infection, “but we need better animal models to see if it’s dead or alive,” he said.
“The finding from South Korea fits in with most of the current thinking, but there are still a lot of unanswered questions about the duration of infectiousness,” Collignon said in an interview.
How long an individual excretes infectious virus in their respiratory secretions and fecal matter is key to determining the optimal time an infected person should self-isolate or be quarantined. Previous studies indicate that very ill patients typically remain infectious longer than people who experience only a mild illness.
The Korean Centers for Disease Control and Prevention said earlier this month that the coronavirus may be reactivating in people who have been cured of the illness. At the time, the agency found that about 51 patients classed as having been cured tested positive again. It concluded that, rather than being infected again, the virus may have been reactivated in these people.
“There have been more than 200 reconfirmed cases, and there were discussions on how to explain them,” Oh Myoung-don, a professor of internal medicine at Seoul National University, said during Wednesday’s briefing. “I can tell you the possibility of being reinfected after recovery is low.”

Reactivation or Reinfection?

The issue of reactivation and reinfection has been difficult to pin down in part due to the unreliability of testing, with results showing positive one day and negative the next.
Fear of re-infection in recovered patients has also emerged in China, where the virus first appeared last December, after reports that some tested positive again — and even died from the disease — after supposedly recovering and leaving the hospital.
Epidemiologists around the world are in a race to find out more about the virus that causes C19. In addition to research on possible reinfections, health experts are also focusing on patients who contract the virus but display few or atypical symptoms.
Korea has been at the forefront of tracking these cases, and the issue has raised particular concern in China as the country tries to prevent a second wave of infections.
South Korea was one of the earliest countries to see a large-scale coronavirus outbreak, but it has been one of the most effective in controlling the pathogen. One of the world’s most expansive testing programs and a tech-driven approach to tracing infections has seen Korea contain its epidemic without lockdowns or shuttering businesses.

Source: Dead Coronavirus Particles Muddy the Outcome of Test Results

3. Reports on Virus in Kids Fuel Uncertainty on Schools

Children with the new coronavirus may be as infectious as adults, according to a study from Germany that stoked confusion over kids’ role in the pandemic.
Levels of virus in the respiratory tract — the main route via which the pathogen is transmitted — don’t appear significantly different across age groups, Christian Drosten, director of the Institute of Virology at Berlin’s Charite hospital, and colleagues found. They advised caution in reopening schools and kindergartens.
The findings add to a contradictory body of work over children’s response to C19 and the role they play in its spread, with another report showing kids aren’t passing the virus to adults. The World Health Organization said Wednesday more research was needed on the topic.
“All we really know at this point is that with a small number of exceptions, children are mildly affected by this infection,” said Adam Finn, a professor of pediatrics at the University of Bristol and chairman of the WHO’s European Technical Advisory Group of Experts on Immunization. “What is much less clear is how often they get infection and how infectious they are to each other and to other people in their families.”

Source: New Reports on Virus in Kids Fuel Uncertainty on Schools (1)

G. The Road Back?

1. WHO Hails No-Lockdown Sweden as ‘Model’ for Other Nations

The worldwide debate about how to best manage the Wuhan coronavirus pandemic grew more complicated on Wednesday when top World Health Organization (WHO) official Dr. Mike Ryan, emergencies program executive director, praised Sweden as a “model” for other nations to follow.
Sweden famously chose not to impose lockdowns or freeze their national economy as the United States and most other countries have.
Ryan lavishing praise on every aspect of Sweden’s approach to the coronavirus:
- “I think if we are to reach a new normal, I think in many ways Sweden represents a future model of — if we wish to get back to a society in which we don’t have lockdowns.”
- Ryan praised Sweden’s health care system and credited Sweden with making all the right moves from the beginning of the outbreak.
- “They’ve been doing the testing, they’ve ramped up their capacity to do intensive care quite significantly,” he added. “And their health system has always remained within its capacity to respond to the number of cases that they’ve been experiencing.”
Sweden is a very meaty bone of contention in arguments about pandemic response, with critics arguing that its refusal to impose lockdowns has resulted in a high number of infections and deaths, even though its total of 21,092 confirmed cases and 2,586 fatalities as of Friday remains lower than most other European countries in absolute terms. The validity of comparing Sweden with other countries is hotly contested by all sides of the coronavirus argument.
Ryan felt the criticism of Sweden for taking a careless approach to the pandemic is unfair, given the results.
“Sweden has put in place a very strong public policy around social distancing, around caring and protecting for people in long term care facilities and many other things. What it has done differently is it has very much relied on its relationship with its citizenry and the ability and willingness of citizens to implement physical distancing and to self-regulate,” he said.
Opinions on Sweden vary depending on who the opinion-giver decides to compare it with and how the numbers are calculated. The New York Times (NYT) on Wednesday said Sweden’s death rate is comparable to Ireland’s low numbers and “far better than in Britain or France,” while Sweden’s critics prefer to compare it with other Scandinavian countries and calculate a Swedish death rate that is several times higher than Denmark, Norway, or Finland, all of which imposed strict lockdowns.
The NYT further complicated these comparisons by suggesting Sweden’s numbers are higher because it has more aggressively and accurately reported its numbers of infections and deaths than its neighbors, who have all been obliged to make sizable upward revisions after discovering the number of deaths was undercounted.
No sooner had Politico drawn partisan battle lines around Sweden on Thursday by declaring that American conservatives “have developed a fascination with Sweden’s hands-off approach to the coronavirus” than President Donald Trump announced himself to be one of Sweden’s critics on Twitter, lining up with those who believe the Swedish approach compares poorly with the other Scandinavian lockdowns.
Besides arguing if Sweden’s refusal to impose lockdowns was a humanitarian disaster – or addressing the far more difficult argument of if the country made a reasonable decision to accept more coronavirus cases to avoid the economic and humanitarian damage from a lockdown – observers are puzzled as to how Sweden managed to do so much better than most models predicted.
The New York Times speculated Sweden might have benefited from being a “high-trust society” whose citizens did not have to be coerced into taking effective social distancing measures, but then noticed the Swedes do not seem to be socially distancing all that much. The streets of Stockholm were filled on Tuesday with shoppers, strollers, and diners enjoying a lovely spring day and pronouncing themselves quite satisfied with the decision to avoid a lockdown:
While other countries were slamming on the brakes, Sweden kept its borders open, allowed restaurants and bars to keep serving, left preschools and grade schools in session and placed no limits on public transport or outings in local parks. Hairdressers, yoga studios, gyms and even some cinemas have remained open.
Gatherings of more than 50 people are banned. Museums have closed and sporting events have been canceled. At the end of March, the authorities banned visits to nursing homes.
That’s roughly it. There are almost no fines, and police officers can only ask people to oblige. Pedestrians wearing masks are generally stared at as if they have just landed from Mars.
“Once you get into a lockdown, it’s difficult to get out of it. How do you reopen? When?” asked Swedish state epidemiologist Anders Tegnell, echoing the questions just about everyone in the Western world is asking right now.
Sweden’s answer was to avoid lockdowns altogether, and however its statistics might measure up against countries of comparable size, the Times noted Sweden unquestionably managed to “flatten the curve” because its intensive care units never came anywhere near filling to capacity.
The primary goal of the lockdowns in other countries was said to be avoiding a disastrous overstraining of ICUs by a flood of patients, as occurred in Italy. According to health officials, Sweden still has hundreds of empty hospital beds. Tegnell said the biggest regret among health experts at the moment is the high toll the coronavirus has taken on the elderly population.

Source: WHO Hails No-Lockdown Sweden as ‘Model’ for Other Nations

2. NY Governor Cuomo, Michael Bloomberg detail plan to trace C19 contacts

New York is preparing to deploy thousands of state workers and others to trace the movements of those who have come into close contact with individuals with C19.
Gov. Andrew Cuomo said Thursday that the tracing effort, led by former New York City Mayor Mike Bloomberg, will require anywhere from 6,400 to 17,000 tracers depending on projected cases, a baseline of about 30 for every 100,000 people in infected areas. The tracing effort will be a key part of the state’s reopening strategy.
Some public health experts have cautioned that focusing too much on large-scale contact tracing could divert needed resources and attention away from other important efforts to combat the spread of C19.
Cuomo told reporters that the “army” of tracers will be needed.
“Yesterday we tested 4,681 people who were positive. … How do you communicate with 4,681 people, trace back all the people they’ve been in close contact with in the last 14 days and contact those people?” he said at a morning news conference. “That is an overwhelming scale to an operation that has never existed before.”
Cuomo noted that even with thousands of tracers, it will remain challenging to trace, contact and isolate all individuals who may have been exposed to the virus over the two-week period, particularly those who were in public settings.
“My instinct is, if you were in Target and you don’t know any names of who you came into contact with, I don’t know what you would do with that,” he said.
Bloomberg Philanthropies will work with Johns Hopkins University and the state Department of Health to immediately begin recruiting, interviewing and training tracers, who will be sent out across the tri-state region. Cuomo said the state will tap NY Department of Health employees and other government workers for the effort, in addition to hiring new tracers.
Bloomberg, who joined Cuomo via video conference for the announcement, said he’s working with a staffing organization, as well as with SUNY and CUNY, to recruit and identify contact tracers. Once hired, those individuals must complete and pass a training class developed by Johns Hopkins, which can be done remotely.
Bloomberg said a “comprehensive playbook” for the tracing strategy — which utilizes new smartphone reporting and data collecting applications — will be made available to all local, state and international leaders looking to track the spread of C19.
“That way the work we do here in New York really can help fight the virus globally,” he said.
New York City Mayor Bill de Blasio, who also spoke briefly at Cuomo’s news conference, noted that the city is hiring 1,000 contract tracers with health care backgrounds “to supercharge this effort.” De Blasio and Cuomo both announced plans to ramp up contact tracing for the coronavirus last week.
“The test and trace approach is going to change everything,” the mayor said via video conference.
But Marc Lipsitch, a professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard University’s T.H. Chan School of Public Health, said he believes contact tracing “in this current setting, is going to be a fairly modest contributor [to reopenings] because it quickly can overwhelm.”
“It’s easy to overwhelm a relatively constrained group of people trying to do contract tracing,” he said in a call with reporters. “And because it’s so resource-intensive, it diverts public health efforts away from other activities.”

Source: Politico here.

H. Georgia Reopens

1. Background

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.
Effective as of Friday, 5/1, Gov Kemp will lift the shelter-in-place order for most residents (see the article below).
We are following Georgia’s progress because as the success or failure of its approach (the “Georgia Model”) will undoubtedly influence the approach taken by other States. While the path taken by Georgia 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 and the fact that polls show that a majority of voters do not support reopening the Georgia economy at this time.
Cases of the CV19 and deaths will inevitably increase as the Georgia economy reopens. We believe that success or failure of the Georgia Model will depend in large part on how the public reacts to the increase in cases/deaths and whether the healthcare system can effectively manage the increase in cases. As are result, we will be following those metrics closely.
As of Thursday, 4/30:
- Georgia had (i) total cases of 26,264, an increase of 613 cases since the prior day, and (ii) total deaths of 1,132, an increase of 34 since the prior day. The number of cases in Georgia is the 12^th highest in the country. Georgia has 2,551 cases per 1 million in population while the US has 3,308 per 1 million in population, and Georgia has 110 deaths per 1 million in population compared while the US has 193 deaths per 1 million in population. In addition, Georgia has tested approx. 164,500 people, which translates into 15,971 tests per million in population while the US has done 19,311 per 1 million in population.
- The number of hospitalizations for CV19 totaled 5,190, an increase of +114 from Wednesday’s total of 5,076. Note the prior day’s increase in hospitalization was an increase of +180. According the IHME Model, as of April 28, Georgia had 8,323 hospital beds and 590 ICU beds available for CV19, and no shortage of hospital or ICU beds is currently projected. The IHME Model also projects that Georgia’s peak hospital resource data was on April 28.
- Consequently, as of this Update, Georgia cases and deaths are less than the national average, but its testing is less than the national average. With an aggressive reopening plan, Georgia may need to ramp up its testing in order to identify and react to the development of hotspots in an effectively and timely manner.
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 next Update when Brian will report on Friday’s opening of Atlanta’s most popular shopping mall.

2. Shelter-in-place order to be lifted for most Georgians on Friday, 5/1

Gov. Brian Kemp will lift a statewide shelter-in-place order for most of Georgia’s 10.6 million residents starting Friday as he continues to roll back coronavirus restrictions, though he urges Georgians to stay at home when possible to contain the pandemic.
The order requires elderly and “medically fragile” residents to shelter in place until June 12, and calls for businesses to follow a host of restrictions already in place through May 13 in order to remain open. But Kemp told The Atlanta Journal-Constitution that it was time to lift other measures to help revive Georgia’s tattered economy, stressing that an increase in testing and increased hospital capacity factored into his decision. “What we’ve done has worked,” Kemp said in the interview. “It’s given us time to build our hospital infrastructure capacity, get ventilators and ramp up testing. That’s what really drove our decision.”
His order also renewed requirements that nursing homes and long-term care facilities take aggressive steps to curb the spread of the virus until June 12.
In the interview, Kemp cited state figures that show roughly one-fifth of Georgia’s coronavirus cases and 43% of the deaths are linked to nursing homes and other long-term care facilities where the virus has preyed on elderly. His order, extended through June, bars visitors and non-essential workers from entering nursing homes, restricts group activities and meals and requires any worker who tests positive for the virus to be quarantined. “I felt like the negative effects of not having our economy starting to open up was beginning to have the same weight of the virus itself, especially if you weren’t in the medically fragile category or someone in a long-term care facility,” he said. “For most of the rest of Georgia, the effect has been minimal.”

Source: Kemp to lift statewide shelter-in-place for most Georgians on Friday

3. Georgia issuing driver’s licenses without road tests during coronavirus crisis

Georgia drivers will be able to get their license on a partial honor system for the next few weeks, after the governor removed the road test requirement until the state of emergency put in place due to the coronavirus pandemic has been lifted.
Under the temporary rules, teen learner’s permit holders will be allowed to upgrade to a provisional license by providing an affidavit from their parent, guardian or driving instructor that they have completed 40 hours of supervised driving. A clean driving record of at least one year and one day is also required. Permit holders over the age of 18 can sign their own affidavit.
The commissioner of the state’s Department of Driver Services, Spencer Moore, told WSB-TV that social distancing guidelines currently make it impossible to conduct the in-person tests, and that there is a backlog of 30,000 applicants, with an average of 5,000 teens having taken the exam every week prior to the shutdown. Moore said the first time pass rate for the road test typically runs over 80 percent.
Georgia’s state of emergency is set to expire on May 13, but could be extended by the governor as circumstances dictate.

Source: Georgia issuing driver’s licenses without road tests during coronavirus crisis

I. The Risks of Reopening

1. Countries deal with increase in coronavirus cases after lockdowns are lifted

The dangers of easing restrictions have been highlighted this week after Germany and Spain saw cases spike as they try to edge out of quarantine, while China was forced to tighten regulations to fight off a “second wave”.

Germany

[Note Germany’s use of the virus reproduction rate to calculate whether and when the healthcare system will be overwhelmed. While we have not previously seen this methodology used by policy makers to determine when restrictions should be lifted or reimposed, it is an interesting concept that could provide a reasonable measure of certainty as we obtain a better understanding of the disease dynamics.]

Germany has slowly been easing its lockdown after faring better than its European neighbors, allowing non-essential businesses to reopen around a week ago.
But the country reported 1,304 new cases of the virus on Wednesday – up from 1,144 on Tuesday and 1,018 on Monday.
The country’s virus reproduction rate – known as “R” – which measures how many people the average person with C19 infects has also bounced back to just below 1.0.
That means one person with the virus infects one other, on average. Earlier this month, the rate was at 0.7.
Chancellor Angela Merkel has warned if the R rate increases even slightly above 1.0 then the country’s health service faces being overwhelmed.
She said: “If we get to a point where each patient is infecting 1.1 people, then by October we will be back at the limits of our health system in terms of intensive-care beds.
“If we get to 1.2 . . . then we will hit the full capacity of our health system as early as July.”
There has also been a steady rise in the number of deaths from 117 on April 25 to 188 on April 28 and the country has already been planning for a second wave of killer coronavirus.

Spain

In Spain – which has allowed some non-essential workers to go back to work – the death toll rose by 453 on Wednesday – up from 301 the previous day.
The number of new infections also shot up by 4,771 – compared to 2,706 and 2,793 the previous two days.
The figures come as the country prepares to ease restrictions further, with hairdressers and other small businesses due to start reopening next month.
Spanish PM Pedro Sanchez announced on Tuesday a four-phase plan to lift the lockdown.
The implementation will vary from province to province depending on the infection and death rates, as well as other things like hospital capacity.

Japan

One island in Japan has also been hit by a second wave of coronavirus after taking the decision to lift its lockdown.
Hokkaido eased restrictions on March 19, allowing businesses and schools to reopen after cases fell to one or two a day.
But 26 days later, the island has re-enforced its lockdown after 135 new cases were reported in a week.
Dr Kiyoshi Nagase, chairman of the Hokkaido Medical Association, told TIME: “Now I regret it, we should not have lifted the first state of emergency.
“It really may not be until next year that we can safely lift these lockdowns.”

China

In China too – where the deadly bug originated – there have been signs of a feared “second wave” after lockdown restrictions were eased in recent weeks.
A city of 11 million was put on lockdown last week after a “silent super spreader” infected 70 people.
And China has shut down gyms and swimming pools in Beijing this week amid fears of a fresh outbreak.
It’s feared these actions show the Chinese authorities are battling a fresh spike in cases.
But the true extent of the spread there is impossible to know for sure, with many questioning the validity of official figures.

Hope?

In Austria, new cases have remained below 100 for nearly two weeks now since reopening some non-essential shops.
The country plans to ease more restrictions throughout May, allowing more businesses and even hotels to reopen and abandoning restrictions on non-essential movement.
And in Denmark, the number of new daily cases have stayed under 200 for almost a week, apart from a spike of 235 on April 25.
It began lifting its restrictions on April 15 by reopening schools, before allowing more shops and hairdressers to reopen this week.
Norway, the Czech Republic, and Poland are also seeing tentative signs of success.

Watching Closely

The UK Government and others are nervously watching nations where restrictions have been lifted to see if there is a dreaded “second wave”.
Foreign Secretary Dominic Raab told a press conference yesterday: “This issue of a second spike and the need to avoid it – it’s not a theoretical risk, and it is not confined to the UK.
“Having relaxed restrictions in Germany over the past week, they have seen a rise in the transmission rate of coronavirus.
“And Chancellor Merkel has said publically, and she has made it clear, that they might need a second lockdown in Germany if the infection rate continues to rise.
“So, this risk is very real.”
France is also looking to ease its own lockdown from May 11, with the country divided into “green” and “red” zones that will have restrictions lifted at different speeds.
But the country’s PM Edouard Philippe said it was a delicate balancing act which rested “on a knife’s edge”.
“We must protect the French people without paralyzing France to the point that it collapses. A little too much carefreeness and the epidemic takes off again. Too much prudence and the whole country buckles.”

Source: World on a ‘knife edge’ as coronavirus cases spike and cities shut down again after lockdowns are lifted

J. Ideology of Safety vs. The Facts

1. The Paranoid Style in COVID-19 America

Opinion by Heather Mac Donald, Atlantic Spectator

We are in a race between the ideology of safetyism and the facts. The future depends on which side prevails.
The data is clear. The coronavirus danger is narrowly targeted at a very specific portion of the national population: the elderly infirm, especially those located in New York City and its surrounding suburbs. It possesses minimal risk to everyone else. New York State accounted for 42 percent of the national death toll on April 24, with 77 percent of those New York State deaths occurring in New York City.
The average death rate from coronavirus in New York City is 128 per 100,000. In New York State, it is 71 per 100,000. To put those numbers in perspective, the national death rate for all causes was 723.6 per 100,000 in 2018; for heart disease it was 163.6 per 100,000. New York’s coronavirus death rates bear no resemblance to the country at large, despite New York governor Andrew Cuomo’s recent pronouncement that ‘an outbreak anywhere is an outbreak everywhere’.
California’s coronavirus death rate is four deaths per 100,000; Pennsylvania’s, 13 deaths per 100,000; Utah’s, one death per 100,000; Washington State’s, nine deaths per 100,000; Wisconsin’s, four deaths per 100,000; Georgia’s, which we are supposed to believe is about to unleash a mortal plague upon the country, eight deaths per 100,000; Texas’s, two deaths per 100,000; and Florida’s, four deaths per 100,000, despite its elderly population. An MSNBC pundit gleefully predicted several weeks ago that Missouri would succumb because it had not halted its economy soon enough. Its virus death rate stands at four deaths per 100,000.
For further perspective on those state rates, the death rate of flu and pneumonia in 2018 was 14.4 per 100,000, for kidney disease it was 13 per 100,000, and for diabetes it was 21.4 per 100,000. In other words, most of the country has suffered a toll from coronavirus that is markedly lower than the annual deaths from the flu and a host of other ailments.
New York City’s average coronavirus death rate conceals vast differences in risk, as is true everywhere. The rate for people 75 and older is 950 per 100,000. That is seven times higher than the city-wide average, itself greatly influenced by that highest rate. For those 17 and younger the coronavirus death rate is zero. This age-based disparity is typical. The average age of confirmed coronavirus decedents in Massachusetts was 82, as of April 23.
Individuals with no preexisting conditions are at almost no risk. As of April 23, 99% of all coronavirus deaths in New York City had preexisting conditions, where the presence or absence of such conditions was known. In Massachusetts, 98 percent of all coronavirus deaths had underlying conditions, as of April 23.
Nursing homes are ground zero for the disease since their populations are exclusively the elderly infirm. 23% of all coronavirus deaths nationwide were in nursing homes, according to a Wall Street Journal analysis. In Minnesota, 73% of total deaths were linked to long-term care facilities. In Massachusetts, 55% of all deaths were in such facilities.
To cancel most of the country’s economy for a problem, however tragic, that is highly localized was a devastating policy blunder that must be immediately corrected.
The lockdowns are taking a scythe to everything that makes human existence both possible and meaningful. Lives are being lost to the overreaction.
Heart attack and stroke victims shrink from calling 911 lest they burden hospitals now dedicated exclusively to C19 cases. Cancer victims have had their stem cell transplants put on hold; heart surgeries are being postponed indefinitely.
The cancellation of ‘nonessential’ procedures has prevented the diagnosis of life-threatening diseases, writes a former chief of neuroradiology at the Stanford University Medical Center.
Tumors and potentially deadly brain aneurysms are going undetected.
Drug abuse deaths from economic despair and isolation may already be rising, as data out of Ohio suggests.
The United Nations predicts tens of millions more lives globally stunted by extreme poverty and hundreds of thousands of childhood deaths.
US unemployment is at depression levels. Small businessmen who risked their savings and credit in the hope of creating a successful enterprise have had their efforts destroyed. Up to a third of local businesses may never reopen. The damage to supply chains grows deeper by the day. Farmers are plowing under cabbages and strawberries, pouring out milk, and destroying eggs because they have lost their markets. It is almost impossible to plan future production with demand so irrationally depressed. Retail sales registered their biggest monthly drop on record in March. Department stores and local newspapers may become relics.
Many cultural institutions — small theaters, regional orchestras, and opera companies — will never rise again. Demand for progressive causes such as public transit and dense, multi-unit housing will evaporate the longer that fear is stoked.
Yet the safetyism rhetoric is unabating. ‘The vast majority of people want to feel safe,’ a doctor told MSNBC anchor Stephanie Ruhle on April 23. ‘Hopefully people will turn to public health authorities and scientists for [safety] strategies.’ Those same authorities dole out positive reinforcement to keep the populace compliant. ‘Americans have done such a wonderful job’ of social distancing, Dr Deborah Birx, the White House coronavirus task force director, encouragingly announced, ‘so we don’t want to jeopardize their efforts with a hasty reopening’, she added.
To be sure, a revolt is brewing against the idea that perfect safety is the precondition for social and economic life. Even residents of blue states are chafing under their mandates, provoking sniffy rebukes from their public health masters. But enough people have embraced fear to destroy the necessary demand side of an economic recovery. The lockdowns signal that it is not safe to shop, travel, or socialize — a message that in most places is false.
The bans must be lifted, while protective efforts are targeted intensely at the vulnerable elderly. As a harbinger of liberation, any true public health expert would tell those Central Park joggers and those solo drivers in their cars to tear off their masks and breathe free.

For full story, see The paranoid style in COVID-19 America

K. Projections & Our (Possible) Future

1. Artificial Intelligence used to identify 22 emerging hotspots in small cities or rural areas in 8 states that are lifting lockdown restrictions

There could be up to 22 emerging coronavirus hotspots in small cities and rural counties across eight US states that are lifting lockdown restrictions, data researchers have found.
An analysis conducted by data firm Dataminr used artificial intelligence to examine social media posts related to coronavirus and predicts the smaller areas where infections are set to increase.
The firm identified the areas based on clusters of public social media posts that directly referenced, among other things, firsthand accounts of symptoms, relatives who have been infected and testing supply shortages.
The small cities or counties – located in Florida, Georgia, Indiana, Michigan, Ohio, South Carolina, Tennessee and Texas – had all seen an increase in the number of social media posts related to COVID-19.

There could be up to 22 emerging coronavirus hotspots in small cities and rural counties across eight US states that are lifting lockdown restrictions, data researchers have found

For full story, see: Emerging COVID-19 hotspots could be in small areas, analysis finds

L. Practical Tips & Other Useful Information

1. What to do if you think you or someone you live with has C19

As coronavirus case numbers continue to grow, and we learn more about the symptoms the virus can cause, you may be more concerned about what to do if you or someone you live with becomes infected with C19 — or thinks they might be. If that does happen, it’s important to know which steps to take to avoid spreading the virus to others, as well as how to care for that person, or how others should help care for you.
This includes calling the doctor to see if you’re eligible for C19 testing, monitoring your symptoms and isolating yourself from others until your symptoms have subsided the appropriate length of time.
Some of these common recommendations may be impractical if you have a roommate (or three), or live in a household with your family or a significant other. You should already be practicing social distancing as best you can in a roommate situation, but it isn’t always possible. And if you’re helping care for others in your family, self-isolation can be extra hard.
We’ve drawn suggestions from the Centers for Disease Control and Prevention, as well as first-hand advice from people we know who have recovered from the coronavirus. Here are recommendations for how to adjust if you suspect someone in your household has C19, but is not sick enough for hospitalization. Note this is not an exhaustive list and guidance from public health agencies is changing over time.

Contact the doctor

At the first sign of what could be coronavirus, contact the doctor immediately to list symptoms and ask for advice on whether you should pursue C19 testing. In many cases, the doctor will need to order the test for you (more on this below).
If the patient has underlying health conditions that put them at higher risk for fatality, the doctor will also be able to weigh in on which medications they should and shouldn’t take and how they’ll need to adjust their lifestyle, including what kind of vital signs you should monitor as the illness progresses.

Isolate the person who’s sick

As soon as you or someone you live with suspects they have symptoms of C19 (or tests positive for the coronavirus), they need to isolate from others until they test negative, or until the symptoms are long gone (more details below).
They should wear a face mask or cloth covering if they’re in the same room as you or your housemates and everyone needs to make sure they’ve thoroughly washed their hands for 20 seconds after interacting. It’s also important to keep the house sanitized. A healthy person could reduce contact with a sick person by filling a water pitcher and preparing food for the patient, leaving both at a safe distance for the member of your household to collect.
The CDC suggests isolating in a bedroom away from others. We understand that’s not always an option — for example, if you live in a studio apartment with a significant other or share a small house with many others.
If there isn’t an extra room to stay in, make sure to maintain a six-foot distance at all times to practice social distancing. Unfortunately, that might mean someone’s sleeping on the couch, on a mattress on the floor or so on.

What if you only have one bathroom?

The CDC recommends the presumptive coronavirus patient use a different bathroom if possible. However, if you only have one bathroom, the person who’s ill should wear a mask when they leave their isolation room. After they leave the bathroom, make sure the toilet, sink, shower, handles and soap dispensers get sanitized.
Wash your hands for at least 20 seconds and avoid touching your mouth, nose and eyes. Also, avoid using the same hand towel as the potentially infected person. You may need to set up a caddy for items that only the sick person uses, like a separate soap dispenser, towel, toothpaste tube and so on.

How to care for a person with presumed or confirmed C19

If there are multiple people who live in your home, the CDC suggests only one person should take care of the sick one to limit the number of people who might come in contact with the virus. That includes bringing them food or medicine; checking their temperature, vitals and blood pressure; and laundering their clothes and bedding.
It’s a good idea, however, for the carer to wear gloves and a face mask when coming in contact with anything the infected person has touched, before washing their hands directly after.
When you bring food, for example, you can place it inside the room they’re staying in, but avoid contact with them and make sure your nose and mouth are covered — theirs, too.
While in isolation, your roommate may start to feel lonely, so make sure you’re comforting them by sending them texts, calling to talk from the next room, or even talking to them outside the door. Michigan Health suggests opening a window for air circulation.
You’ll need to check the infected person’s temperature daily to see if they have a fever.

Monitor their symptoms

It’s important to note that many hospitals don’t want you to go to the emergency room or arrive for a C19 test without a doctor’s order, or an advanced state of symptoms, like high fever over 102 degrees. [NOTE: Or if your blood oxygen saturation number falls below 93 — buy a pulse oximeter to monitor]. In many places, the number of tests are limited and hospitals must follow protocols to limit the exposure of sick people to the rest of the hospital population.
The CDC and hospitals such as Cedars-Sinai in Los Angeles suggest contacting your primary care provider about symptoms and the next steps you should take.
Symptoms that typically warrant a C19 test include:
- Trouble breathing
- Persistent pain or pressure in the chest
- Confusion or lack of energy
- Bluish lips or face

Everyone needs to stay home

If the person you live with has contracted the coronavirus, it’s possible you and other housemates have already been exposed. The World Health Organization states the incubation period for someone with coronavirus is between one to 14 days. This is the time between catching the virus and seeing symptoms. This means you need to quarantine yourself for two weeks to prevent spreading the virus to others.
To avoid going out, have your food and groceries delivered to your door. The CDC says once everyone is symptom-free for at least 72 hours and testing negative for coronavirus, you can leave the house for necessities again.
Coronavirus symptoms include coughing, difficult breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat and loss of taste or smell.

Disinfect surfaces often

Make sure you’re cleaning and disinfecting high traffic surfaces in your home daily. This includes doorknobs, remote controls, bathroom surfaces, kitchen counters, appliances and your phone. Use products from the EPA’s approved list of disinfectants to help kill coronavirus.
The American Red Cross says to avoid sharing household items, such as glasses, utensils, towels and bedding. If an ill person uses any of these items, they should be washed thoroughly.

When is it OK to stop self-isolating?

If the infected person doesn’t have access to testing, the CDC states they can leave their home if they’ve had no fever for at least 72 hours (without medicine), symptoms like coughing have improved and at least seven days have passed since their symptoms first appeared.

Source: Think you or someone you live with has coronavirus? Here’s what to know and do