“The danger is we’re overstating the risks of the virus, and we’re underestimating the damage that’s being done by a closed economy.” US Senator Pat Toomey (PA)
“I am scared of COVID-19. But I am even more terrified about what is coming after the rage of millions tears this country apart. Because for many Americans, the lockdown is a luxury they can’t afford.” Paula Froelich, New York Post
- Potential Treatments
- Testing & Vaccines
- New Scientific Findings
- The Fatality Rate of C19 and Implications for Reopening Strategies
- Concerns & Unknowns
- Strategies Come Full Circle As Lockdowns Are Not Sustainable
- The Road Back?
- The Cost of Lockdowns
- Georgia Reopens and Speeds Ahead
- Comparing Strategies and Outcomes
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A. Potential Treatments
1. Triple combination therapy shows promise for C19 patients with less severe illnesses
- As scientists scramble to find C19 treatments among existing approved drugs, researchers in Hong Kong may have found a winning combination. Early data shows that a triple antiviral therapy may be safe and effective in treating patients with mild to moderate cases of C19, according to a study published Friday in Lancet.
- All three drugs used in the study are already approved to treat other illnesses. Interferon beta 1b is a drug commonly used to treat multiple sclerosis, lopinavir-ritonavir is an anti-retroviral medication used to treat HIV and ribavirin is commonly used to treat hepatitis C.
- Researchers from six different hospitals in Hong Kong assigned over 120 patients to one of two treatment groups. They gave one group of patients suffering mild to moderate C19 symptoms a cocktail of all three drugs, and gave the other group only lopinavir-ritonavir.
- Doctors tested the amount of virus in samples taken from the patient’s nose, saliva, back of the throat and stool on a machine that can detect the presence of viral genetic material.
- When researchers compared the two groups, they found that the typical patient given the three drug-combo tested negative for the virus five days earlier than those who received just a single drug. In addition, the triple therapy treatment group had shorter hospital stays and reported that their symptoms disappeared much faster than the control group.
- The study offers a promising sign that the drug cocktail helped their bodies beat back the virus faster.
- Experts are cautiously optimistic about these results, but pointed out that more rigorous studies will be needed to know for sure if this drug combination works.
- They believe that one of the driving factors in the success of the triple combination therapy groups was early treatment. Treatment was started within seven days of symptom onset for the majority of patients in both groups.
- “The most important thing in treating any viral diseases is that you want to treat it early. If you don’t treat it early, you’re probably going to miss the window to treat it. And then you have to deal with its complications,” said Dr. David Bernstein, vice chair of medicine for clinical trials and chief of hepatology and director of the Sandra Atlas Bass Center for Liver Diseases at Northwell Health.
- Another welcome finding was the lack of significant negative side effects. The main negative side effects of the medications were nausea and diarrhea, but there was no difference between the two groups, and none of the patients in the study died.
- “Patients often do not tolerate these medications terribly well,” said Dr. Nathan Erdmann, an assistant professor in the division of infectious diseases at the University of Alabama at Birmingham.
- Dr. Todd Ellerin, chief of infectious diseases at South Shore Health agreed: “Interferons have significant adverse side effects such as flu-like illness and have never really gained traction in and of themselves for the treatment of viral diseases.”
- Lopinavir-ritonavir appears to have caused most of the side effects, he said.
- However, there are some significant issues with the study. Experts say it was too small to draw any definitive conclusions.
- “I will say, at this stage, I would not recommend rapid uptake of this treatment as standard therapy because of the limited sample size,” said Erdmann.
- Bernstein agreed, “This is a first study proving a concept, and now it has to be validated. And it has to be validated in large numbers.”
B. Testing & Vaccines
1. FDA Greenlights a CRISPR-Based Test to Diagnose C19
- A test that can diagnose the coronavirus within an hour using the gene-editing technology known as CRISPR has received emergency use authorization from the FDA.
- The test was developed by Sherlock Biosciences, a biotech company launched in March 2019 by CRISPR pioneer Feng Zhang, a researcher at MIT and the Broad Institute.
- In recent years, CRISPR has been imagined as a way to treat all kinds of diseases because of its ability to precisely cut DNA. It does that by using a molecular guide that searches for and locks onto a particular DNA sequence. Once there, an enzyme attached to the guide cuts the DNA at the right spot.
- The technology can be used to snip out sections of DNA or replace genetic sequences entirely. A handful of early-stage clinical trials are testing the technique to treat certain cancer, blood disorders, and a type of inherited blindness. But researchers have also been experimenting with CRISPR as a way to diagnose diseases.
- Sherlock Biosciences’ test works by programming CRISPR’s molecular guide to detect the presence of a specific genetic signature — in this case, the genetic signature for SARS-CoV-2 — in a nasal or throat swab. When that’s found, the CRISPR enzyme is activated and releases a signal. The test gives a result in an hour and can be run on basic equipment that most labs already have. The company says its test provides true positive and true negatives with 100% accuracy in patient samples, though it has not published data on the claim yet.
- “The promise of CRISPR has been talked about for years now,” Rahul Dhanda, CEO and co-founder of Sherlock Biosciences, said in an interview, “We’ve been able to take the steps necessary to show that that promise is real.”
- Currently, most tests to diagnose C19 relies on a method called polymerase chain reaction, or PCR, which works by amplifying a tiny amount of viral genetic material so that it can be detected. While it’s a highly accurate and reliable lab technique, it’s also rather slow. It can take six to eight hours to run.
- Companies like Abbott Laboratories and Cepheid have developed tests that render a result in just 15 minutes or less, but they use special machines that are expensive and not available everywhere. Public health experts agree that much more testing is needed in the United States, around the order of millions of tests a day, in order for cities and states to safely reopen. The country is currently testing over 200,000 people a day, according to estimates. Fast new tests could help in that effort, as well as track the spread of the disease over time.
- The Cambridge, Massachusetts-based Sherlock Biosciences is working to rapidly scale the production of its test kits to make them available soon. Dhanda says the company will focus on rolling them out at high-volume testing locations around the country. Another startup, Mammoth Biosciences of San Francisco, is working on a similar CRISPR-based coronavirus test that could provide a result in around 45 minutes. That group, which is also seeking FDA authorization, published a paper in mid-April detailing promising results of its test on patient samples.
- Meanwhile, Zhang’s group at MIT is working on an even simpler version of a CRISPR test called STOPCovid that’s similar to a pregnancy test and costs less than $10. It uses a nasal swab or saliva sample and does not require any lab equipment. For now, it’s only available to scientists for research purposes, but the goal is for the test to be used in pharmacies, emergency rooms, or eventually at home.
2. FDA Grants Emergency-Use Status for First Coronavirus Antigen Test
- The Food and Drug Administration has granted emergency-use authorization to Quidel Corp. for the first antigen test for the C19 virus.
- An antigen test looks for the disease itself, as opposed to antibody tests that look for traces of past exposure.
- The announcement comes as national testing efforts continue to fall far short of the levels recommended by public health doctors.
- San Diego-based Quidel, which specializes in tests for flu, strep and infectious diseases among other conditions relies on a decades-old technology to detect the disease with its test. Other current tests are more complex both to conduct and analyze.
- Leading public-health authorities have recommended that the U.S. do a minimum of four million or more tests every week.
- Quidel already has placed about 36,000 test-analyzer instruments around the U.S. in places like hospital labs, emergency departments and doctors’ offices.
- “We are ramping up manufacturing to go from 200,000 tests next week [week of May 11] to more than a million a week within several weeks,” said Douglas Bryant, Quidel’s chief executive, in an interview.
- In its announcement, the FDA said the step was the first emergency use authorization for a C19 antigen test. The agency said antigen tests are “a new type of diagnostic test designed for rapid detection of the virus that causes C19.”
- It said that the most commonly-used test for C19 until now, known as a PCR test, magnifies virus particles to ease their detection. The agency added it “can be incredibly accurate, but running the tests and analyzing the results can take time.”
- The agency also noted that these antigen tests can normally be produced at lower prices than PCR tests and “can potentially scale to test millions of Americans per day due to their simpler design, helping our country better identify infection rates closer to real time.”
3. Front-Runners Emerge in the Race for a C19 Vaccine
- IT’S BEEN FOUR months since researchers in China sequenced the novel coronavirus now known as SARS-CoV-2. Doctors have been trying lots of existing drugs—from malaria medications to anti-influenza pills to Ebola treatments—in an effort to save patients from the ravages of the disease, which can damage the heart, kidneys, brain, and lungs. But so far, no blockbusters have emerged. Researchers are still testing hundreds of potential candidates in search of a cure.
- A vaccine, which would teach people’s immune systems to recognize and fend off the virus before an infection can take hold, would be even better. An inoculated public could get back to work, stop sheltering in place, resume normal life. Developing a safe, effective vaccine against a new pathogen typically takes years, if not decades. That’s because, unlike with experimental treatments, it’s impossible to know right away if a vaccine has worked. During testing, researchers have to wait for participants to encounter the real virus in the wild, which if people are sheltering in place or an outbreak has ended, can take a very long time.
- Clinical testing generally has three stages: Phase I involves a few dozen healthy volunteers, Phase II expands to several hundred in an outbreak area, and Phase III repeats the experiment with several thousand. Then US Food and Drug Administration officials must review the data and decide if the shot is safe and effective enough to approve.
- But in the face of the current global pandemic, scientists, pharmaceutical companies, and regulators are sprinting at record-shattering speeds to test hundreds of vaccine candidates. Without clinical trial data, it’s impossible to predict which contenders will emerge from the onslaught of experiments as the most successful. For the front-runners, that information could arrive as early as this fall. Here’s what you need to know:
Phase II candidates: Moderna gets the green light, joining Oxford group and CanSino Biologics
- On Thursday, Boston biopharma company Moderna announced that its vaccine candidate, mRNA-1273, had been cleared by the FDA to move into a Phase II trial. The study, which will begin enrolling 600 participants in the coming weeks, is designed to begin assessing whether or not the potential vaccine can induce a person’s immune system to produce antibodies that recognize SARS-CoV-2.
- With the news, Moderna pulls neck and neck with the current coronavirus vaccine leader: Oxford University’s Jenner Institute. Scientists there had a head start, as The New York Times reported last month. Having already acquired safety data from human trials of similar vaccines for the related coronavirus that causes MERS, Oxford researchers convinced British regulators to push forward with a large Phase II study involving 6,000 people while the outbreak in the UK is still raging. The vaccine is based on a technology that involves genetically modifying a harmless virus to create a SARS-CoV-2 look-alike that doesn’t cause disease but does trigger an immune response.
- Moderna’s vaccine candidate, which was developed in collaboration with scientists at the National Institutes of Allergy and Infectious Disease, is made out of messenger RNA, hence the phrase mRNA in the vaccine’s name. This molecule is responsible for carrying the genetic recipes for making different proteins to a cell’s protein production factories. The version inside Moderna’s vaccine carries the instructions for making a little bit of the spike protein that SARS-CoV-2 uses to infect human tissues. The idea is that a vaccine recipient’s cells will produce this partial spike protein, which will train their bodies’ immune systems to recognize the virus and attack it the next time it shows up.
- Still a new strategy, this kind of vaccine has never been approved for use or manufactured at scale. But Moderna’s safety trial, which began in March—the first SARS-CoV-2 vaccine to be injected into human volunteers—appears to have gone well enough that the FDA has greenlit the next phase. In a statement to WIRED, Moderna’s CEO, Stéphane Bancel, called this a “crucial step” that puts the company on track to start its pivotal Phase III study sometime this summer. It hopes to gain approval as soon as 2021. But Moderna’s not waiting for those results to start ramping up manufacturing. Last week, the company announced a 10-year partnership with Swiss drugmaker Lonza, which it expects to boost its production to tens of millions of doses per month in 2020 and hundreds of millions per month in 2021.
- On the same day Moderna administered its first-out-of-the-gate vaccine, a company in China called CanSino Biologics got the green light to begin Phase I tests of two of its vaccine candidates. Like Oxford’s, they consist of a harmless viral vector that’s been genetically tweaked to look just enough like SARS-CoV-2 to trigger an immune response. In April, one of these vaccines entered Phase II, and researchers in Hubei province are now trying to recruit 500 people for the study.
Phase I candidates: Safety testing begins on two other genetic vaccines
- Other vaccine efforts are also showing early promise. On Monday, 15 healthy volunteers in New York received the first doses of an mRNA-based vaccine similar to Moderna’s, called BNT162. Produced by Pfizer and a German pharma company called BioNTech, BNT162 is one of four genetic vaccine candidates the two companies are jointly developing to fight SARS-CoV-2. Over the next few weeks, the Phase I trial will enroll 360 people in four different research hospitals to see how safe these different variations are compared to a placebo.
- Researchers will monitor patients for the next two years, looking for signs of side effects as well as any antibodies their bodies produce against SARS-CoV-2. But since most bad reactions happen right away, the scientists should know in three to four months if the vaccine candidates are safe. They’ll also have an idea of which one of the four works best. That’s the one they’ll move into a larger study with more people, which could happen as soon as this fall, says Mark J. Mulligan, director of the Vaccine Center at NYU Langone Health. Mulligan is leading the NYU Langone Tisch Hospital trial site. “We’re doing in months what typically takes years,” he says.
- A few hours away, at the University of Pennsylvania, researchers are also testing the safety of another genetic vaccine, produced by the nearby biotech company Inovio. Codenamed INO-4800, the vaccine is made out of synthetic DNA instead of RNA, though the principle is the same. Packaged into the DNA is a section of the SARS-CoV-2 spike protein. Inovio is testing two doses of INO-4800 in 40 healthy volunteers split between UPenn and the Center for Pharmaceutical Research in Kansas City, Missouri.
- Because it’s a bit tricker to get DNA into cells, doctors have to deliver a tiny electrical impulse following the injection. That little jolt opens the pores of the cell membranes, allowing the DNA to slip inside. The first volunteer for this Phase I trial received the shot and subsequent zap on April 6. Though the other 39 participants have now also received at least the first dose, it will take another few weeks for everyone in the study to hit the point where you’d expect to start seeing a surge in antibodies, says Pablo Tebas, an infectious disease doctor at UPenn and the trial’s principal investigator.
- But the researchers and Inovio are already starting to plan a Phase II trial for later this summer that would primarily enroll doctors, nurses, police officers, and other essential workers with a high chance of C19 exposure. “Traditionally, these would not be done in parallel,” says Tebas. “But all the prevailing ideas about taking the time to do them in sequence have gone by the wayside with this epidemic. Making antibodies is one thing, but we really need to know if those antibodies protect you from infection.”
- In addition to these vaccine candidates, there are also two others currently in human trials in China. Both are chemically inactivated versions of the virus, one developed by Sinovac and one developed at the Beijing Institute of Biological Products. According to a list assembled by the World Health Organization, there are a further 71 vaccine candidates that could soon follow.
WHO sees a speedier way forward with “challenge trials”
- Another way to accelerate vaccine development is by skipping the step of waiting around for trial participants to have a chance encounter with the pathogen in the wild in order to prove how effective the vaccine is. Instead, so-called challenge trials involve inoculating healthy participants and then deliberately infecting them in a controlled environment. Since some of the participants will get a placebo vaccine, ethics rules typically dictate that challenge studies be reserved for diseases that aren’t that serious or for which effective treatments exist.
- C19, with its devastating death toll, unpredictable symptoms, and many remaining unknowns, has some bioethicists questioning this conventional wisdom. They have proposed the consideration of challenge trials for C19, although no such tests have yet been authorized. “This pandemic feels unprecedented in many ways,” says Seema Shah, a medical ethicist at Northwestern University and Laurie Children’s Hospital of Chicago and an author of a new paper in the journal Science that lays out an ethical framework for how challenge trials might be used to combat C19.
- Shah is also part of a working group for the World Health Organization that published a similar report Thursday detailing the prerequisites required to move forward. The eight conditions that would need to be fulfilled include ensuring that the scientific benefit is worth it and minimizing risks as much as possible for trial participants. That would mean limiting recruitment to young healthy people and those who already face a higher probability of infection, like health care workers. While not a stance on whether or not challenge trials should take place, the WHO report offers guidance to any researchers and vaccine developers considering the option.
- Shah is more convinced they’re worth doing. “The potential value of doing them is amplified above almost any other case you can think of,” she says. Beyond assessing a single vaccine candidate’s efficacy, she believes such studies could help scientists better understand the course of the disease and develop immune system markers that could be helpful in evaluating and accelerating other candidates. Or challenge trials could be used to narrow down a field of promising candidates quickly, so that only the best one moves into full Phase III trials. “So even though we’d be crossing a boundary that has been in place for a very long time, we think there’s enough reason to start investing in laying the groundwork for them now,” says Shah.
- No such trials are planned yet, but more than 14,000 people who signed an online call for volunteers, organized by a grassroots group of researchers called 1 Day Sooner, have said they’d participate in one if given the opportunity. The effort isn’t actually recruiting study participants, just demonstrating to legislators and regulators that the idea has public support. Any trials that adopted a design that includes intentionally infecting participants would still have to obey all the existing constraints of normal safety and efficacy trials, which remain governed by the FDA.
- In the US, the decision of whether to allow such trials will ultimately rest with the FDA. Michael Felberbaum, a spokesman for the agency, told WIRED in an email that challenge trials are one of the methods the FDA is considering to speed up the development of C19 vaccines and that the agency will work with anyone interested in conducting them to consider the potential scientific, logistical, and ethical challenges. “A formal determination about any specific human challenge trial proposal would be made by the FDA in the context of all the information that is available at that time,” he wrote.
C. New Scientific Findings & Other Advances
1. Warmer weather does NOT stop coronavirus spreading: Two separate studies dash hopes of killer infection dying out in summer
- Warm weather does not kill off the coronavirus or hamper its ability to spread, two separate studies have found.
- US and Canadian researchers said the transmission risk was only reduced by about 1.5 per cent for every degree Fahrenheit above 77F (25C).
- They analysed more than 370,000 cases in thousands of different cities in North America to come to the conclusion ‘summer is not going to make this go away.’
- It dashes hopes of the global pandemic petering out in the coming months – a theory that has been touted by the US Government.
- President Donald Trump said last month that research had suggested a combination of ultraviolet (UV) light and warmer temperatures killed off the virus in minutes.
- In one of the latest studies, researchers from the University of Toronto looked at a total of more than 375,600 confirmed C19 cases in the US and Canada in March.
- They compared the effect of temperature, humidity, school closures, restrictions of mass gatherings, and social distancing on the spread of the disease.
- The results showed no link between temperature with a rise in infections and a negligible difference between humidity and cases.
- Professor Dionne Gesink, an epidemiologist at the Canadian university, said: ‘Summer is not going to make this go away, it’s important people know that.
- ‘On the other hand, the more public health interventions an area had in place, the bigger the impact on slowing the epidemic growth.
- ‘These public health interventions are really important because they’re the only thing working right now to slow the epidemic.’
- Co-author Dr. Peter Jüni added: ‘We had conducted a preliminary study that suggested both latitude and temperature could play a role.
- ‘But when we repeated the study under much more rigorous conditions, we got the opposite result.’ Their study was published in the Canadian Medical Association Journal.
- American researchers came to a similar conclusion in a paper that has not yet been published in a journal or scrutinised by other scientists.
- Lead researcher Hazhir Rahmandad, an associate professor of system dynamics at MIT Sloan School of Management, and his team analysed data on virus transmission and weather statistics across more than 3,700 locations between last December and April 22.
- They found only a slightly lower transmission risk, about a 1.7 per cent reduction per 1 degree Fahrenheit, once temperatures rose above 77 degrees F.
- ‘Even though high temperatures and humidity can moderately reduce the transmission rates of coronavirus, the pandemic is not likely to diminish solely due to summer weather,’ Rahmandad said in an MIT news release.
- ‘Policymakers and the public should remain vigilant in their responses to the health emergency, rather than assuming that the summer climate naturally prevents transmission,’ he said. ‘
- At best, weather plays only a secondary role in the control of the pandemic.’
- Commenting on the findings, Dr Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, said the results were not surprising.
- He said: ‘Because this is a novel virus, without population immunity, we can’t expect to see a full suppression of transmission based on seasonality.
- ‘Though certain environmental conditions might be less conducive to spread from surfaces during summer months, the sheer fact that so many people are susceptible may not make as much of a difference because person-to-person spread will continue.
- ‘It will be important that even in the summer months, states remain vigilant regarding the number of cases that are occurring with full situational awareness of the rate of hospitalizations, to prevent hospitals from going into a stress mode of functioning,’ Adalja noted.
1. Would You Get a Covid-19 Vaccine? An Alarming Number of Americans Say They Wouldnt
- As Big Pharma races to develop a C19 vaccine that could save millions of lives globally, nearly 20% of Americans are saying they won’t get vaccinated if and when it arrives.
- According to a YouGov-Yahoo News joint poll, only 55% of Americans responded “Yes” when asked whether they would take the critical public safety step. Of the other 45%, 19% responded “No,” and 26% said they weren’t sure.
- Given that much of the conversation around coronavirus containment measures (including devastating social distancing guidelines that have torn families apart and disastrous shutdowns that have put 33 million people out of work) is structured around that glorious, pivotal future point at which a vaccine is finally achieved, this news hits like a sack of bricks and has us wondering what we’ve all been doing these past few months. Obviously, vaccines won’t change anything unless people go out and get them.
- Nineteen percent of Americans equates to 62 million people. With tens of millions of uninoculated, possible coronavirus carriers freely roaming the U.S.—and beyond its borders, efforts to contain C19 could be completely undermined not just in our country, but in ones more ill-equipped to handle the disease (think Bangladesh, Venezuela, South Sudan). However, as Yahoo News pointed out, a January Gallup poll showed that 84% of Americans said vaccinating children, in general terms, was “important,” so the number that would get C19 vaccines could increase as vaccine prospects—which are being fast-tracked through a typically multiyear process—are proven safe and effective.
- However, the Gallup poll also noted that 84% of Americans is down from 94% of Americans in 2001, illustrating an unsettling trend as the anti-vaxxing movement has gained momentum over the past decade. While some anti-vaxxers have said the coronavirus pandemic caused them to rethink their beliefs, others have been turning up at anti-lockdown protests across the country, spewing freedom-of-choice rhetoric and filling the hallways of Capitol Hill with unvaccinated children. This, despite vast evidence that existing vaccines are safe and save lives.
- The poll was based on a sample of 1,573 U.S. adults and conducted May 4-5. You can see the full results here.
E. The Fatality Rate of C19 and Implications for Reopening Strategies
- The deadliness of C19, measured by the “Infected Fatality Rate” or what percentage of infected people end up dying, has become an issue of global significance.
- At UnHerd, we’ve spoken to experts at both ends of the range of estimates, from Neil Ferguson (who believes the IFR to be just under 1%, perhaps 0.8-0.9%) to Johan Giesecke who maintains that it is nearer 0.1%, or one in a thousand.
- This may sound like splitting hairs — they are both under 1% after all — but in reality the difference between these estimates changes everything. At the lower end, a much more laissez-faire policy becomes possible, and at 30,000 deaths it starts to look like the UK has already been through the worst of it; at the higher end, a policy of continued ultra-caution is necessary because a more relaxed approach could mean hundreds of thousands of additional deaths.
- That’s why the study conducted by Professor Hendrik Streeck of the University of Bonn is so significant: a representative sample population within Germany was tested and examined in great detail to determine what percentage had already been infected with C19.
- The headline result is that 15% of that population was infected, which implies an Infection Fatality Rate of 0.36%. This would put him somewhat in the middle of the previous experts we have spoken to. Professor Streeck was keen to point out, however, that he still believes this is a conservative estimate, and thinks it may be closer to 0.24-0.26% and may come down further still as we know more. He published the higher number to err on the side of caution: “it is more important to have the most conservative estimate and see the virus as more dangerous than it is,” he said.
- To show just how significant every percentage point difference makes, if the 0.36% is correct for the UK, and we have had 30,000 C19 deaths, that would mean around 8.3 million people have been infected, or 12.5% of the population — not enough to start feeling confident of much immunity in the community. If the lower estimate is correct, 0.24%, and there has actually been closer to 50,000 C19 deaths (as per the FT’s speculations) then that figure suddenly rises to over 20 million, which at around a third of the population would fundamentally change the calculus of how bold we can be coming out of lockdown.
Lockdown Came ‘Too Fast’
- Contrary to the main critique of the UK government, that it was too slow in implementing lockdown, Professor Streeck feels that lockdown measures were introduced too fast, meaning that we didn’t have enough time to assess whether the individual components (such as better hygiene and some social distancing) were sufficient to slow the spread.
- He also places great emphasis on the viral load that you are initially exposed to as a determinant of how serious your infection becomes, and has noticed the importance of ‘super-spreading events’ in spreading the disease. These tend to be indoor events with bad circulation, and people dancing or being close together, singing, shouting or (in the case of one of the German carnivals he studied) kissing.
- This means that, in Professor Streeck’s view, a more feasible approach than attempting to suppress the virus completely until a vaccine (which he is not confident will arrive), allowing the gradual spread of the disease with lower doses, through continued hygiene measures, could lead to a widespread of partial immunity. This would eventually have the effect of downgrading C19 to just another virus that circulates within the human population but, like influenza and other coronaviruses, is a manageable ongoing threat.
- I am convinced that we are not going to get rid of coronavirus, so it is going to become an endemic virus — which means it is going to live in our population, and we have to start living with it and find measures so that people are not dying of it but at the same time we can achieve normality.
F. Concerns & Unknowns
1. How do children spread the coronavirus? The science still isn’t clear
- The role of children in spreading the coronavirus has been a key question since the early days of the pandemic. Now, as some countries allow schools to begin reopening after weeks in lockdown, scientists are racing to figure this out.
- Children represent a small fraction of confirmed C19 cases — less than 2% of reported infections in China, Italy and the United States have been in people under 18 years old.
- But researchers are divided on whether children are less likely than adults to get infected and to spread the virus. Some say that a growing body of evidence suggests children are at lower risk. They are not responsible for the majority of transmission and the data support opening schools, says Alasdair Munro, a paediatric infectious-diseases researcher at University Hospital Southampton, UK.
- Children in Germany and Denmark have already returned to school, and students in some areas of Australia and France are set to go back gradually over the coming weeks.
- Other scientists argue against a rushed return to classrooms. They say the incidence of infection in children is lower than in adults partly because they haven’t been exposed to the virus as much — especially with many schools closed. And children are not getting tested as often as adults, because they tend to have mild or no symptoms, the researchers say.
- “I do not see any strong biological or epidemiological reason to believe that children don’t get as infected,” says Gary Wong, a researcher in paediatric respiratory medicine at the Chinese University of Hong Kong. “As long as there is community transmission in the adult population, reopening of schools will likely facilitate transmission, as respiratory viruses are known to circulate in schools and day cares.” He says good surveillance and testing systems should be in place before schools reopen.
- If children are driving the spread of the virus, infections will probably spike in the next few weeks in countries where children have already returned to school, say scientists.
- But settling the debate will require large, high-quality population studies — some of which are already under way — that include tests for the presence of antibodies in the blood as a marker of previous infection.
- Other scientists are studying children’s immune responses to find out why they have milder symptoms than adults when infected, and whether that offers clues to potential therapies.
- A study published on 27 April in The Lancet Infectious Diseases, which was first posted as a preprint in early March, analysed households with confirmed C19 cases in Shenzhen, China. It found that children younger than ten were just as likely as adults to get infected, but less likely to have severe symptoms.
- “That preprint really scared everybody,” says Munro, because it suggested that children could be silently spreading the infection.
- But other studies, including some from South Korea, Italy and Iceland, where testing was more widespread, have observed lower infection rates among children. Some studies from China also support the suggestion that children are less susceptible to infection. One, published in Science on 29 April2, analysed data from Hunan, where the contacts of people with known infections had been traced and tested for the virus. The authors found that for every infected child under the age of 15, there were close to 3 people infected between the ages of 20 and 64.
- But the data are less conclusive for teenagers aged 15 years or older, and suggest that their risk of infection is similar to that of adults, says Munro.
- Even less well understood is whether infected children spread the virus in a similar way to adults. A study of a cluster of cases in the French Alps describes one nine-year-old who attended three schools and a skiing class while showing symptoms of C19, but did not infect a single person. “It would be almost unheard of for an adult to be exposed to that many people and not infect anyone else,” says Munro.
- Kirsty Short, a virologist at the University of Queensland in Brisbane, Australia, led an as-yet unpublished meta-analysis of several household studies, including some from countries that had not closed schools at the time, such as Singapore. She found that children are rarely the first person to bring the infection into a home; they had the first identified case in only roughly 8% of households. By comparison, children had the first identified case during outbreaks of H5N1 avian influenza in some 50% of households, the study reports.
- “The household studies are reassuring because even if there are a lot of infected children, they are not going home and infecting others,” says Munro.
- But Wong argues that such research is biased, because the households weren’t randomly selected but picked because there was already a known infected adult there. So it is also very difficult to establish who introduced the virus, he says. School and day-care closures could also explain why children aren’t often the main source of infection with SARS-CoV-2. Other respiratory viruses can transmit from adults to children and back, so “I don’t believe this virus is an exception”, he says.
- In fact, two preprints have reported that children with C19 symptoms can have similar levels of viral RNA to adults. “Based on these results, we have to caution against an unlimited re-opening of schools and kindergartens in the present situation. Children may be as infectious as adults,” note the authors of one of the studies, led by Christian Drosten, a virologist at the Charité hospital in Berlin. However, it is not yet clear whether high levels of viral RNA are an indicator of how infectious a person is, notes Harish Nair, an epidemiologist at the University of Edinburgh, UK.
- Few studies exist of transmission from schools to the broader community, but an Australian report from an ongoing investigation suggests that it’s limited, and much lower than with other respiratory viruses, such as influenza. Among more than 850 people who had been in contact with 9 students and 9 staff members confirmed to have C19 in primary and high schools in the state of New South Wales, only two cases of C19 were recorded among those contacts, both in children.
- On the basis of the evidence, Munro says children should be allowed back to school. “Children have the least to gain from lockdowns, and they have a lot to lose,” such as missing out on education and not getting added social support such as free school meals, he says.
- Schools reopening does not mean a return to normal, says Short. There will be lots of restrictions and changes, such as moving desks apart in classrooms and closing playgrounds, to reduce transmission risk, she says. Studies of transmission in schools as they reopen will also be important, says Wong. Researchers in the Netherlands plan to closely monitor this as schools open gradually over the coming weeks.
- Researchers do agree, however, that children tend to deal with C19 better than adults. The majority of infected children have mild or no symptoms, but some do get very ill or even die. There have been reports of a small number of children in London and New York developing an inflammatory response similar to the rare childhood illness Kawasaki disease.
- “I would not be surprised if C19 is associated with Kawasaki disease, because many other viral infections have been associated with it,” says Wong. If the association proves to be genuine, it could have been missed in China, Japan and South Korea because Kawasaki disease is much more prevalent in Asia, he says.
- One theory for why most children have milder symptoms, says Wong, is that children’s lungs might contain fewer or less-mature ACE2 receptors, proteins that the SARS-CoV-2 virus uses to enter cells. But to confirm this, researchers would need to study tissue samples from children, says Wong, and these are very difficult to get.
- Others have suggested that children are more routinely exposed to other coronaviruses, such as those that cause the common cold, which protects them from serious disease. “But that doesn’t seem to hold much water, because even newborn babies don’t seem to get very severe disease” from the C19 coronavirus, says Munro.
- Wong suggests that children might mount a more appropriate immune response to the infection — strong enough to fight the virus, but not so strong that it causes major damage to their organs. His preliminary analysis of 300 individuals infected with C19 has found that children produce much lower levels of cytokines, proteins released by the immune system. Patients of all ages with severe disease tend to have higher cytokine levels, he says. But he still needs to tease out the cause and effect. “Are they sicker because they have higher cytokine levels, or do they have higher cytokine levels because they are sicker?”
G. Strategies Come Full Circle As Lockdowns Are Not Sustainable
1. When Governments Switched Their Story from “Flatten the Curve” to “Lockdown until Vaccine” (And Then Back Again)
- In the early days of the C19 panic—back in mid-March—articles began to appear pushing the idea of “flattening the curve” (the Washington Post ran an article called “Flatten the Curve” on March 14). This idea was premised on spreading out the total number of C19 infections over time, so as to not overburden the healthcare infrastructure. A March 11 article for Statnews, summed it up:
- “I think the whole notion of flattening the curve is to slow things down so that this doesn’t hit us like a brick wall,” said Michael Mina, associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital. “It’s really all borne out of the risk of our health care infrastructure pulling apart at the seams if the virus spreads too quickly and too many people start showing up at the emergency room at any given time.”
- In those days, it was still considered madness to suggest outlawing jobs for millions of Americans or “shutting down” entire national economies in an effort to flatten the curve. Thus, the article lists far more moderate mitigation strategies:
- By taking certain steps—canceling large public gatherings, for instance, and encouraging some people to restrict their contact with others—governments have a shot at stamping out new chains of transmission, while also trying to mitigate the damage of the spread that isn’t under control.
- What we got, of course, was something much more far reaching, radical, and disastrous for both the economy and for long-term health problems.
- For the next two weeks or so, governments mostly sold the idea of forced social distancing as a measure to flatten the curve and the phrase began appearing everywhere in social media, media publications and government announcements.
- Many people found this message reasonable enough, especially when coupled with claims that hospitals and governments would seek to buy up large numbers of ventilators and expand capacity with temporary hospitals. This flatten-the-curve narrative persisted for two weeks or so, but at some point in late March and early April, the narrative switched to something new.
- The new narrative was this: the death toll will simply be too gruesome and unbearable to allow people to continue on with some semblance of an ordinary life. So, we must keep society locked down indefinitely until a vaccine is found or until there can be enough testing and tracking of infections among the entire population. Until then, only minimal “essential” activities will be allowed. This could last eighteen months, or two years, or more. And even then, there will need to be “COVID passports” and official freedom-to-work documents issued by governments. The future is one in which every move must be controlled and monitored to prevent the spread of this disease.
- Thus, on April 2, Anthony Fauci, one of the lead bureaucrats on the White House’s C19 advisory commission insisted that mandatory social distancing could not be eased until further notice:
- “If we get to the part of the curve where it goes down to essentially no new cases, no deaths for a period of time, I think it makes sense that you have to relax social distancing,” [Fauci] added. “The one thing we hope to have in place, and I believe we will have in place, is a much more robust system to be able to identify someone who is infected, isolate them, and then do contact tracing.” [emphasis added.]
- Similarly, former presidential advisor and physician Ezekiel Emmanuel flatly stated that there is “no choice” but to stay locked down indefinitely:
- Realistically, C19 will be here for the next 18 months or more. We will not be able to return to normalcy until we find a vaccine or effective medications. I know that’s dreadful news to hear. How are people supposed to find work if this goes on in some form for a year and a half? Is all that economic pain worth trying to stop C19? The truth is we have no choice. [emphasis added.]
- This messaging was used at the state level as well. On April 9, the Hawaii Department of Education, echoing Fauci, announced that all “public schools are expected to stay shut until C19 is no longer spreading in the community, defined as four weeks with no new cases.”
- Needless to say, such a situation is unlikely to happen any time that’s soon enough to save Hawaii from an economic implosion.
- Similarly, in Colorado, during an April 1 briefing, Governor Jared Polis stated that when it comes to C19 his policy is “stamping this out,” and claimed that mandatory social distancing could not be eased until total cases were falling.
- This switcheroo on the reason for the lockdowns was a great victory for the World Health Organization (WHO) and advocates for widespread state controls on the economy and daily life. Already by early March, some WHO officials had come out in favor of the Chinese approach of draconian lockdowns imposed by the Chinese police state and surveillance state. As noted by Statnews, Mike Ryan, the head of the WHO’s health emergencies program, embraced the Chinese “containment” strategy and denounced flatten-the-curve style “mitigation” strategies as “counterproductive.”
- Perhaps not surprisingly, by early April we had leading national figures in the US insisting that China-style lockdowns were the only way to deal with the disease. “Flatten the curve” was still used as a slogan, but its meaning had changed.
- By early May, it was clear that the “containment” strategy was failing, since, in the United States at least, few elected officials were prepared to stomach the idea of keeping their economies locked down until a vaccine appeared or until new cases disappeared completely. After all, as unemployment numbers skyrocketed and state and local government budgets cratered, “lockdown until vaccine” didn’t seem like such a viable strategy anymore.
- Indeed, two weeks earlier, the Hawaii Department of Education had already abandoned its declaration about the need for no new cases, with the department director backpedaling furiously and stating:
- “We would expect to be living with C19 for a long time, and to have to wait for the last case to have occurred and another 28 days probably is not going to happen, so I believe that was really a placeholder.”
- By late April, numerous states’ governors and municipal officials were discussing ways to scale back their lockdowns. Many governors and mayors nonetheless continued to claim that they would not allow any easing of the lockdowns until cases began to decline, or until testing became widespread. Neither of those things has happened, yet governments have already begun to significantly loosen lockdowns. In many states, total deaths have plateaued but show no sign of disappearing.
The Sweden Model Is the Future
- “Flatten the curve” remains a popular goal among policymakers, but now we’re back to the old definition: fear remains that hospitals and healthcare personnel will be overwhelmed. The preferred political solution lies in both continuing to encourage social distancing and in prohibiting larger gatherings. But the idea that everyone will sit at home until a vaccine is found has at the moment fallen out of favor except in the most dogmatically leftist areas. Hard-left activist Matthew Yglesias, for example, complained this week that flattening the curve “isn’t good enough.”
- Indeed, the Chinese-style containment strategy has failed so completely that even the WHO has abandoned it. The WHO now endorses the Swedish model, which is based on increasing healthcare capacity while relying primarily on voluntary social distancing. The Financial Times reported on April 29:
- The WHO has defended Sweden’s approach to tackling C19, saying it has implemented “strong measures” to tackle the virus….
- The director of the WHO’s health emergencies program said on Wednesday there was a perception that Sweden had not done enough to contain coronavirus, but “nothing could be further from the truth”. Sweden has put in place a “very strong public health policy”, Mike Ryan said, but unlike many other countries has chosen to rely on its “relationship with its citizenry” and trust them to self-regulate.
- Its healthcare system has not been overwhelmed, he said, adding that its approach could be a “model” for other countries when lockdowns begin to relax.
- In other words, the containment strategy favored by Fauci and Emanuel is dead (for now). Although it has not happened by design, the US is moving toward a Sweden model.
- Nonetheless, one is still likely to encounter rabid “COVID warriors” on social media, who think that interminable lockdowns will (somehow) significantly reduce the overall total deaths from C19. But it increasingly seems that such a scenario is wishful thinking.
- In a new article posted at The Lancet on Tuesday, Swedish infectious disease clinician Johan Giesecke writes on how lockdowns don’t really reduce overall total deaths, and says that when it’s all over, non lockdown jurisdictions are likely to have similar death rates to lockdown areas:
- It has become clear that a hard lockdown does not protect old and frail people living in care homes—a population the lockdown was designed to protect.
- Neither does it decrease mortality from C19, which is evident when comparing the UK’s experience with that of other European countries.
- PCR testing and some straightforward assumptions indicate that, as of April 29, 2020, more than half a million people in Stockholm county, Sweden, which is about 20–25% of the population, have been infected (Hansson D, Swedish Public Health Agency, personal communication). 98–99% of these people are probably unaware or uncertain of having had the infection; they either had symptoms that were severe, but not severe enough for them to go to a hospital and get tested, or no symptoms at all. Serology testing is now supporting these assumptions.
- These facts have led me to the following conclusions. Everyone will be exposed to severe acute respiratory syndrome coronavirus, and most people will become infected. C19 is spreading like wildfire in all countries, but we do not see it—it almost always spreads from younger people with no or weak symptoms to other people who will also have mild symptoms.
- This is the real pandemic, but it goes on beneath the surface, and is probably at its peak now in many European countries. There is very little we can do to prevent this spread: a lockdown might delay severe cases for a while, but once restrictions are eased, cases will reappear. I expect that when we count the number of deaths from C19 in each country in 1 year from now, the figures will be similar, regardless of measures taken.
H. The Road Back?
1. Lockdown Is a Blunt Tool. We Have a Sharper One. [Opinion By Tom Frieden and Kelly Henning]
[Dr. Frieden is a former director of the CDC, and Dr. Henning is director of public health at Bloomberg Philanthropies]
- We’ve been dealt a bad hand with the coronavirus pandemic. Until we have a vaccine or effective treatment, we have limited tools to fight it. Closing large segments of our society and having people shelter at home is a blunt tool that works, but it inflicts severe hardship on individuals and the economy.
- We have a sharper tool, the four-cornered Box It In strategy, to stop chains of transmission by widespread testing, isolation of cases, contact tracing and quarantine of contacts. It works, but it doesn’t work perfectly. Some say it’s hopeless to even try contact tracing on this scale. But contact tracing can work — if we do it right. Some states, like New York, Massachusetts and California, are moving quickly to expand these services.
- We typically hear four doubts as we work to scale up this critical service. Let’s take each of them in turn:
There are just too many cases to handle.
- For many places right now, that’s correct. The numbers are overwhelming. But sheltering in place is working. We project that in New York City, perhaps the hardest-hit area of the world and still documenting more than a thousand new infections per day, the number of new cases will continue to decrease — if we continue to apply the blunt instrument and stay at home — to the low hundreds per day. Combined with an urgent and extensive scale-up of contact tracing capacity, we may be able to manage that number. For areas of the country and the world that haven’t yet experienced explosive spread, extensive contact tracing can help limit the need for widespread sheltering in place.
Contact tracers won’t be able to find cases (and contacts) quickly enough.
- Contact tracing won’t stop all spread of the coronavirus. But just because you can’t fix an entire problem doesn’t mean you shouldn’t fix some of it. Every time contact tracing results in an infected person’s being isolated or a contact’s being quarantined when that person develops infection, a web of transmission is broken. The best evidence is that most people with the coronavirus don’t spread the infection at all, but a few spread it widely in superspreading events. These events are most devastating when they occur in congregate facilities that house medically vulnerable people — in particular, nursing homes, homeless shelters and correctional facilities. Contact tracing can quickly sound the alarm so that outbreaks can be either prevented or stopped early, limiting disease spread both within and outside these places.
With asymptomatic spread, it will be impossible to contain the coronavirus by contact tracing.
- Spread by people without symptoms is a wild card that makes contact tracing harder because we have to identify and isolate infected people regardless of whether or not they have symptoms — but it doesn’t make it impossible. Many infected people eventually develop symptoms. Use of masks by all can reduce spread from people who are asymptomatic. Additional testing (for example, during an outbreak at a nursing home or a homeless shelter) can identify people with asymptomatic infection. Asymptomatic infection and transmission means that we may need to test every contact of every case for infection when first identified and also before the end of quarantine. This is the kind of operational detail that can be optimized as we conduct contact tracing more extensively.
Public health departments are too under-resourced to do this.
- Contact tracing is intense work, and we have underinvested in public health at the national, state and local levels for decades. So yes, this is going to be hard. But our safety and our economy depend on getting it right — so we’re optimistic that we will. Contact tracing isn’t easy. It requires effective communication to build trust, good people skills, access to resources for patient and contacts, sophisticated knowledge of health (including mental health), sensitivity to social and confidentiality concerns, and resourcefulness.
- Effective programs treat patients and contacts as the V.I.P.s of the program and provide extensive support services — carrots and sometimes sticks — to encourage people to stay separated and stop the spread of infection. As highlighted in Centers for Disease Control and Prevention guidance, contact tracing will not be successful unless we support patients with a modernized version of historical quarantine so that they can remain separate successfully. Some people will be unable to maintain physical distancing, including nursing home residents and those living in crowded households with medically vulnerable people; we must provide these individuals with alternative housing, such as hotel rooms, for the duration of their isolation.
- A promising approach is the use of call centers with specially trained and supervised staff, augmented by in-person public health specialists to visit as needed, with handoff to skilled disease detectives in the case of possible outbreaks in congregate facilities. Contact tracing will require active engagement and participation by patients and their contacts. This can be increased if people throughout society understand that this is a service to patients and their contacts to support them and reduce the chance that they spread the infection to their families and others. The more readily people participate, the faster and more effective contact tracing will be.
- Newer technologies may help increase the efficiency and effectiveness, but person-to-person interaction will always be required. For example, technologies that help contact tracers communicate with patients and contacts and allow contacts to report their status and seek assistance can make the process more efficient. In contrast, ambitious efforts to detect contacts automatically by tracking Bluetooth connections are unproven, raise important privacy concerns and will be limited by the proportion of people participating, although they could potentially be important to contact tracing in the future.
- We need to start this process in every community and scale it up so that as cases decline and capacity increases, we’re able to interview every case, provide safe isolation, warn contacts and quarantine them, and support cases, contacts and the workers who help them. We need to continue physical distancing until we reduce new cases to a manageably low number — flattening the curve so that we’re at a simmer, not a boil. This is an adaptive response — basing our actions on what pandemic stage we’re in. If cases surge, we may need to pause contact tracing and resume sheltering in place until cases again decrease to a manageable number.
- A role of government is to protect individuals and their families as well as health care workers and other essential workers. The hard, skilled work of contact tracing is akin to hurricane warnings: People are alerted so they can protect themselves and their families. Contact tracing is an essential component of our public health response to C19, and we must begin it rapidly. It works, but not perfectly. But as C19 shows, we don’t live in a perfect world. We need to play the hand we’ve been dealt as well as we possibly can to save lives, reduce spread and help restore our economy.
I. The Cost of Lockdowns
1. The coronavirus lockdown is a luxury many Americans can’t afford [Opinion By Paula Froelich]
- This month there has been a distinct dissonance in the national atmosphere — even more so than usual, which is saying something. It went from resigned despair to collective rage and protests. Protests which, for the most part, are not unreasonable.
- I’m not talking about those carrying nooses, swastikas and guns — especially assault rifles. The group in Texas who guarded an illegally opened bar while reportedly brandishing loaded AR-15 type weapons, and people who marched outside without masks to scream at healthcare workers, assaulting them with their airborne saliva, are terrorists who aim to threaten people into doing what they want. They seem to forget that living in a community means abiding by a set of rules and giving up certain things for the common good — and the “freedom” they’re screaming about is actually anarchy.
- But there are also people like Texas salon owner Shelley Luther — who peacefully opened her hair salon in Dallas despite a stay-at-home order in a state with 34,000 cases of C19 and 946 deaths. She was sentenced to 7 days in jail and a $7,000 fine but the judge told her he would commute her sentence if she admitted her actions were selfish — to which she replied (while wearing a face mask): “I have to disagree with you, sir, when you say that I am selfish because feeding my kids is not selfish. I have hair stylists that are going hungry because they’d rather feed their kids… So sir, if you think the law is more important than kids being fed, then please go ahead with your decision. But I’m not going to shut the salon.”
- Luther later told local television station ABC13: “’I can’t afford to not stay open, and my stylists can’t afford to stop working anymore. We’re about to lose everything and haven’t gotten any help, so I had to make a decision.” Luther was jailed although the state’s attorney general and governor called for her release, which came two days later. AG Ken Paxton said: “I find it outrageous and out of touch that during this national pandemic, a judge, in a county that actually released hardened criminals for fear of contracting C19, would jail a mother for operating her hair salon in an attempt to put food on her family’s table.”
- The prolonged lockdown has caused massive fissures in our society — mainly between those who can afford to stay home and those who can’t.
- Working-class and blue-collar people, many of whom live month to month, are destitute right now. Mortgages and rent are due (or will be very soon) and there are miles-long lines for food banks in several states.
- As one friend, a wedding cake designer and baker who lives near me in New York City and has prioritized food over rent, told me, “In a month the bill for three months will come due and I haven’t worked in four months — how am I going to cobble together that money? I will be on the street.”
- Meanwhile, a very wealthy man who is riding the lockdown out in his beachfront mansion in Georgia uttered this jaw-dropping nonsense while we discussed the financial repercussions of the pandemic: “I just never got myself into a situation where I would ever have to live week-to-week so I guess I just don’t know what that’s like.”
- In a nation where the median annual salary was $56,516, many people don’t have the option of not getting themselves into “that situation.” While we are in the midst of a terrifying pandemic, starving without shelter is just as dangerous in the long run as C19.
- If we expect people to stay home to help society then society should be doing its part for them.
- In March, Washington enacted the largest economic stimulus package in US history, with $2 trillion in coronavirus aid. This led to a $1,200 check for individual citizens — an amount that doesn’t begin to cover rent, food, health insurance, car payments and other monthly bills Americans have — while huge bailouts were issued to large companies (many of whom, like the cruise lines, avoid paying tax by registering ships in other countries). Meanwhile, New York state paid $69 million to electrical engineer Yaron Oren-Pines for ventilators that didn’t even show up, and is now trying to claw back that money. (Oren-Pines maintains that he acted in good faith to procure the medical equipment, and claims he is being victimized by a false media narrative.)
- Meanwhile, this spring has become the season of scam artists, snake oil salesmen and hucksters out to make a quick buck that should have been earmarked for individuals.
- Some of our allies have put their citizens first — and eradicated the middle man of corporations. The UK has committed to paying 80% of workers’ salaries, the Netherlands is funding 90% of salaries, Denmark is covering 70 to 90% of wages while South Korea is paying 70 percent. Meanwhile, Canada is giving its citizens $2,000 a month until the crisis ends.
- US has approximately 150 million adults, so if we had done what Canada did and just given out $2,000 a month with that $2 trillion in aid, we would have spent the same and been better off.
- Since COVID hit, 33,000,000 Americans have sought unemployment. There needs to be a more comprehensive plan on the federal level, because leaving decisions up to the states has been disastrous as governors fight and claw for money and favors like a bunch of rabid children. The cash spigot to large corporations more concerned about their stock value than their workers must stop. And safety protocols need to be put into place so we can get back to work without putting our lives on the line. If people want to exercise their right to peacefully protest with masks on, so be it. Those who can afford to stay home or can work from home, should. But the system as it stands is not set up for national unity.
- I am scared of C19. But I am even more terrified about what is coming after the rage of millions tears this country apart. Because for many Americans, the lockdown is a luxury they can’t afford.
J. Georgia Reopens and Speeds Ahead
- It has been approximately 14 days since GA Governor Kemp reopened certain businesses like salons, gyms, and bowling alleys (4/24) and dine-in service at restaurants (4/27). The shelter-in-place order expired for most residents on 5/1.
- We are following Georgia’s progress because 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 C19 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 a result, we will be following those metrics closely.
- As of Saturday, May 9:
- Georgia had (i) total cases of 32,568, an increase of +390 cases since the prior day, and (ii) total deaths of 1,401, an increase of +2 since the prior day.
- There are 1,203 people currently hospitalized for C19. GA also has the lowest number of ventilators in use since April — a total of 897 out of 1,945 available respirators [Note: GA has not been reporting current hospitalization usage]
- The total number of hospitalizations for C19 totaled 5,988, an increase of +12 from Friday’s total of 5,976. Note the prior day’s increase in hospitalization was an increase of +111.
- The number of cases in Georgia is the 11th highest in the country. Georgia has 3,067 cases per 1 million in population while the US has 4,069 per 1 million in population, and Georgia has 132 deaths per 1 million in population compared while the US has 242 deaths per 1 million in population.
- In addition, Georgia has tested approx. 235,324 people, which translates into 22,164 tests per million in population while the US has done 26,930 per 1 million in population.
- According the IHME Model, as of April 28, Georgia had 8,323 hospital beds and 590 ICU beds available for C19, 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.
|Source: AJC.com, GA Department of Health based on 3-day averages (used to smooth out reporting differences)|
1. Fewest C19 patients in Georgia hospitals since early April
- Gov. Brian Kemp said Saturday that Georgia has its lowest number of hospitalized patients positive for the coronavirus since hospitals across the state started reporting the number in early April.
- In a tweet, Kemp said 1,203 people are currently hospitalized for C19 in the state. Georgia also has the lowest number of ventilators in use since April — a total of 897 out of 1,945 available respirators, the governor said.
- “We will win this fight together!” Kemp said in the tweet, which featured a photo of the governor, masked, with members of the Georgia Army and Air Force National Guard.
- Georgia has ramped up testing for C19 and late this week Kemp urged everyone to get tested, even in they do not show symptoms.
- Kemp’s shelter-in-place order ended and the governor has allowed businesses such as restaurants to open for in-person dining, with new restrictions, and allowed other businesses such as salons, bowling alleys, tattoo parlors and fitness centers to reopen with some conditions.
- Public health experts have warned the state risks triggering a new wave of cases with the loosened restrictions, though any potential spike in cases might take a week or longer to appear. Cases of C19 are now confirmed in all 159 Georgia counties.
2. A View from North Metro Atlanta
- On Friday evening, 5/8, I took my boys to Stars and Strikes, a local family entertainment center with a bowling alley, video arcade, laser tag and bumper cars.
- On a typical Friday evening, Stars and Strikes would be full of families and children. We were one of only three families. Here is a view of the bowling alley:
The New Normal?
- Star and Strikes decided to wait to open:
- All employees are wearing masks
- The menu had to be redesigned, all food is now delivered in sealed containers
- The bowling alleys allow for every other lane. All balls are sanitized, including the holes, every group finishes its game. Tables and chairs are also sanitized. As you can see in the picture above, S&S covers the bowling balls when not in use.
- Arcade games are limited to 15 players and each machine is sanitized at least once every hour
- The Manager told me the following:
- Pre-C19 they could have up to 1200 people among the various games. Corporate events are the primary profit contributor.
- Under social distancing rules, S&S can have up to 300 people (25% of the 1200 max capacity) in the facility.
- Lack of PPE – S&S is having a hard time securing enough face masks for its employees
- He feels that families and groups will come back. The key factor right now is that they need to feel safe
- The Payroll Protection Program definitely helped this business stay afloat. The Manager said it’s hard to convince employees to come back when they’re able to make more money on unemployment
- Businesses that reopen will need to reinvent their entire operations. This will include hiring extra staff to monitor, clean, and serve customers.
- With social distancing and capacity caps, revenue will not approach pre-C19 levels for a long time (post vaccine) — we wonder how a business can even be profitable even if they max their capacity (25% is the max at S&S)
- The Manager was confident customers will return, but when and how many are very much in question. On top of that, can the business make a profit or achieve positive cash flow?
K. Comparing Strategies and Outcomes
1. Florida vs. New York [By William Bennett & Seth Liebsohn]
[Note: Although this editorial was published a couple of weeks ago, the analysis still applies.]
- A forgotten principle of public policy reform: focus on failure and you will get failure, focus on success and you will get success. Looking at the past two months of our state responses to the coronavirus, it is time to revive that idea.
- There’s one state in America that has a larger elderly population than New York, that is more ethnically diverse than New York, and that has two million more people than New York. Yet its death rate from COVID-19 is 5 percent that of New York. That state is Florida.
- The tale of these two states, New York and Florida, illustrates that perhaps the media should have been less adulatory of New York Gov. Andrew Cuomo and given Florida Gov. Ron DeSantis more attention. Instead, the facts and statistics reveal the media got this backward.
- In March, Florida was projected to be the second-worst state for C19 deaths, with predictions of 174 per day and a total of nearly 7,000 by the end of the summer. Nothing like this has transpired and it will not come to pass.
- Meanwhile, Cuomo’s daily press briefings have been covered in full, and he has been lauded as everything from “The Golden Governor” to “The Politician of the Moment.” DeSantis, however, receives headlines such as “Florida Governor Issues Coronavirus Stay at Home Order After Heavy Criticism” and “Florida Governor Keeps Hitting New Lows In the Battle Against Coronavirus.”
- Yet while New York kept chalking up bigger and bigger infection rates and deaths, Florida contained its problems early and without the heavy hand so many urged.
- While one might be tempted to point out the ways in which New York and Florida are different, and there are differences, a few things of a comparative nature are not well-understood. As is well documented, the most vulnerable population for the coronavirus is in the 65-plus age group.
- Only one state has a higher percentage of elder Americans living in it than Florida — Maine. In Florida, that population constitutes over 20% of the state. In New York, it’s just over 16%. Florida is also more ethnically diverse than New York. While 17% of Florida’s population is African-American and New York’s is just under 18%, Florida’s Hispanic population is 26% to New York’s 19.2%. Florida is also a much more populous state than New York with about 2 million more residents.
- But Florida has done well with the coronavirus, as the media is quiet to report, while New York has not. Of the 55,425 C19 deaths in America, New York (with over 22,000 deaths) is responsible for over 40% while Florida (with nearly 1,100 deaths) is responsible for just under 2%. Yet, Florida shut down its state much later than New York, almost two weeks later. And there was much criticism for its delay. The shutdown in Florida was also much less severe than New York’s. Florida did not close churches and synagogues, nor did it order the shuttering of most of its beaches.
- What DeSantis did do was take a much more vertical approach to the virus than others, like Cuomo. In early March, DeSantis put out targeted and preventative messaging to his elder population, advising them to stay at home. In places like The Villages (home to over 125,000 retirees), DeSantis implemented golf-cart drive-through coronavirus testing. He deployed the National Guard to help institute testing in the state’s nursing homes where, unlike New York, older C19 patients were not sent.
- Early on, DeSantis suspended visitation and ordered staff screening at long-term care facilities. He also dispatched millions of masks and gloves and hundreds of thousands of face shields and gowns, also known as personal protective equipment, to nursing homes and other centers caring for the elderly. These actions, among others, led Florida to a 93% better per capita long-term care facility death rate than New York.
- Florida’s worst day was nearly two weeks ago with 72 deaths, and its total deaths are seven times less than predicted. Indeed, Florida has 94% less the per capita C19 death rate than New York. Still, DeSantis was being criticized for being late in his “shutdown.” Wrong: It wasn’t late, it was targeted to the vulnerable population, and was less restrictive overall.
- Now, having been wrongly criticized for issuing orders “so late” in the coronavirus panic-passion play, DeSantis is working not on further clampdowns and shutdowns but, rather, reopening as much of the state as possible. Perhaps more in the media can open their gaze and more fairly assess his administration’s and state’s actions and record now, too.
- For Florida, DeSantis was much more ready, and, as Shakespeare says, readiness is all.