- New Scientific Findings & Research
- Collateral Damage
- Herd Immunity
- Lockdowns vs. Reopenings
- Swimming in a Pandemic
- Wishful Thinking?
- Practical Tips & Other Useful Information
- John Hopkins Daily COVID-19 Update (see Annex I)
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1. Oxford vaccine protects monkeys against C19 pneumonia
- A single dose of ChAdOx1 nCoV-19 (the “Oxford Vaccine”), an investigational vaccine against the coronavirus, has protected six rhesus macaques from pneumonia caused by the virus, according to National Institutes of Health scientists and University of Oxford collaborators. SARS-CoV-2 is the virus that causes C19. The researchers posted their data to the preprint server bioRxiv(link is external). The findings are not yet peer-reviewed but are being shared to assist the public health response to C19. Based on these data, a Phase 1 trial of the candidate vaccine began on April 23 in healthy volunteers in the United Kingdom.
- The vaccine was developed at the University of Oxford Jenner Institute. It uses a replication-deficient chimpanzee adenovirus to deliver a coronavirus protein to induce a protective immune response. ChAdOx1 has been used to develop investigational vaccines against several pathogens, including a closely related coronavirus that causes Middle East respiratory syndrome (MERS). The scientists quickly adapted the platform to the coronavirus when the first cases of C19 emerged. They showed that the vaccine rapidly induced immune responses against the coronavirus in mice and rhesus macaques. They then conducted vaccine efficacy testing on the macaques at NIAID’s Rocky Mountain Laboratories (RML) in Hamilton, Montana. Six animals that received the investigational vaccine 28 days before being infected with the coronavirus were compared with 3 control animals that did not receive the vaccine. The vaccinated animals showed no signs of virus replication in the lungs, significantly lower levels of respiratory disease and no lung damage compared to control animals.
- Oxford University has entered into a partnership with UK-based global biopharmaceutical company AstraZeneca for the further development, large-scale manufacture and potential distribution of the vaccine.
2. Potential vaccine using tobacco leaves ready for human trials
- World’s No.2 cigarette company British American Tobacco said on Friday it was ready to test its potential C19 vaccine using proteins from tobacco leaves on humans, after it generated a positive immune response in pre-clinical trials.
- The maker of Lucky Strike cigarette said once it gets approval from the FDA for the vaccine, it would progress to Phase 1 trials or testing on humans.
- The company raised eyebrows in April when it said it was developing a C19 vaccine from tobacco leaves and could produce 1 million to 3 million doses per week if it got the support of government agencies and the right manufacturers.
- On Friday, London-based BAT said it had submitted a pre-investigative new drug application to the FDA and that the agency had acknowledged the submission. BAT said it was also talking with other government agencies around the world about the vaccine.
- The company said it has committed funds to conduct clinical trials, which it expects to start as early as late June, and invested in additional equipment to boost capacity.
B. New Scientific Findings & Research
1. T cells found in C19 patients ‘bode well’ for long-term immunity
- Immune warriors known as T cells help us fight some viruses, but their importance for battling the coronavirus has been unclear. Now, two studies reveal infected people harbor T cells that target the virus—and may help them recover. Both studies also found some people never infected with the coronavirus have these cellular defenses, most likely because they were previously infected with other coronaviruses.
- “This is encouraging data,” says virologist Angela Rasmussen of Columbia University. Although the studies don’t clarify whether people who clear a coronavirus infection can ward off the virus in the future, both identified strong T cell responses to it, which “bodes well for the development of long-term protective immunity,” Rasmussen says. The findings could also help researchers create better vaccines.
- The more than 100 C19 vaccines in development mainly focus on another immune response: antibodies. These proteins are made by B cells and ideally latch onto coronavirus and prevent it from entering cells. T cells, in contrast, thwart infections in two different ways. Helper T cells spur B cells and other immune defenders into action, whereas killer T cells target and destroy infected cells. The severity of disease can depend on the strength of these T cell responses.
- Using bioinformatics tools, a team led by Shane Crotty and Alessandro Sette, immunologists at the La Jolla Institute for Immunology, predicted which viral protein pieces would provoke the most powerful T cell responses. They then exposed immune cells from 10 patients who had recovered from mild cases of C19 to these viral snippets.
- All of the patients carried helper T cells that recognized the coronavirus spike protein, which enables the virus to infiltrate our cells. They also harbored helper T cells that react to other coronavirus proteins. And the team detected virus-specific killer T cells in 70% of the subjects, they report today in Cell. “The immune system sees this virus and mounts an effective immune response,” Sette says.
- The results jibe with those of a study posted as a preprint on medRxiv on 22 April by immunologist Andreas Thiel of the Charité University Hospital in Berlin and colleagues. They identified helper T cells targeting the spike protein in 15 out of 18 patients hospitalized with C19.
- The teams also asked whether people who haven’t been infected with the coronavirus also produce cells that combat it. Thiel and colleagues analyzed blood from 68 uninfected people and found that 34% hosted helper T cells that recognized the coronavirus. The La Jolla team detected this cross reactivity in about half of stored blood samples collected between 2015 and 2018, well before the current pandemic began. The researchers think these cells were likely triggered by past infection with one of the four human coronaviruses that cause colds; proteins in these viruses resemble those of the coronavirus.
- The results suggest “one reason that a large chunk of the population may be able to deal with the virus is that we may have some small residual immunity from our exposure to common cold viruses,” says viral immunologist Steven Varga of the University of Iowa. However, neither of the studies attempted to establish that people with crossreactivity don’t become as ill from C19.
- Before these studies, researchers didn’t know whether T cells played a role in eliminating the coronavirus, or even whether they could provoke a dangerous immune system overreaction. “These papers are really helpful because they start to define the T cell component of the immune response,” Rasmussen says. But she and other scientists caution that the results do not mean that people who have recovered from C19 are protected from reinfection.
- To spark production of antibodies, vaccines against the virus need to stimulate helper T cells, Crotty notes. “It is encouraging that we are seeing good helper T cell responses against the coronavirus in C19 cases,” he says. The results have other significant implications for vaccine design, says molecular virologist Rachel Graham of the University of North Carolina, Chapel Hill. Most vaccines under development aim to elicit an immune response against spike, but the La Jolla group’s study determined that T cells reacted to several viral proteins, suggesting vaccines that sic the immune system on these proteins as well could be more effective. “It is important to not just concentrate on one protein,” Graham says.
2. Can Non-Thermal Plasma Destroy Coronavirus in HVAC Systems?
- Part of Herek Clack’s research is focused on using non-thermal plasma as a means to inactivate airborne viruses. His team at the University of Michigan demonstrated this technique against MS2, a virus that infects bacteria and is known to be particularly difficult to inactivate. In a second study, Clack proved that non-thermal plasma could also inactivate the porcine reproductive and respiratory syndrome virus (PRRSv), which affects pigs. Now, many curious people are reaching out to Clack with the same question in mind: could non-thermal plasma inactivate the novel coronavirus, SARS-COV-2?
- Plasma is a state of matter whereby high enough energy levels cause electrons to be knocked out of their orbits and enter a free state. Unsurprisingly, these radical electrons can be damaging to DNA and RNA. The ability for non-thermal plasma to disrupt the infectiousness of a virus was first demonstrated by a group of Chinese researchers in 2015, and Clack’s team has since been exploring its potential use to deactivate viruses in the agricultural setting. Their idea is to incorporate non-thermal plasma devices into the ventilation systems of pig farms, to limit the spread of infectious diseases like PRRSv.
- Clack says the exact mechanism by which the plasma deactivates these viruses is still being explored. “But the thinking is that it interrupts the ability for the virus to dock with its host cell,” he says. “Our studies show that the number of infectious virus dropped more than two log, or more than 99%, if you compare before and after plasma treatment.”
- While the ability of both MS2 and PRRSv to infect cells was substantially reduced in Clack’s studies, the overall amount of viral genetic material was hardly affected. This suggests that non-thermal plasma, at just the right intensity, may be altering the proteins on the surface of the viruses, which the viruses use to enter its host cell. Without those proteins intact, the virus can no longer infect its host cell.
- As it became increasingly clear that the novel coronavirus is airborne, and it was detected in the air vents of hospitals, more people have reached out to inquire about the applicability of Clack’s research to the coronavirus. Could non-thermal plasma devices inside air ventilation systems, for example in hospitals, help reduce the spread of the virus? Exploring this possibility is intriguing, but would be riddled with many hurdles.
- “C19 is… highly contagious, with no innate population immunity, potentially deadly health outcomes, and no vaccine in sight—so gaining approval to work with it is not a mundane undertaking,” Clack emphasizes. It would require a carefully regulated study in a Level 3 biosafety lab, which he notes is expensive and difficult to gain clearance for.
- Nevertheless, the possibility of pursuing such a study has crossed his mind.
- The major question, Clack notes, is where in the queue of many scientists, with many C19-related research questions, does this potential study fall? Research to find a vaccine is clearly a priority—but may also take some time to develop and implement. In the meantime, Clack points out that our only protection against the virus is social distancing, face covering and self-quarantine. “And so that’s where our technology really could have the most impact—by providing protection where the vaccines aren’t yet ready,” he says.
- Despite the need for more ways to combat the coronavirus, the challenges of using non-thermal plasma in the context of the current pandemic may prove too cumbersome. The high queue of C19 research proposals, the need for FDA approval of non-thermal plasma devices in human settings, and limited ways to produce such devices for air ventilation systems remain major short-term barriers.
3. Dogs caught coronavirus from their owners
- The first two dogs reported to have coronavirus probably caught the infection from their owners, say researchers who studied the animals and members of the infected households in Hong Kong. An analysis of viral genetic sequences from the dogs showed them to be identical to those in the infected people.
- Researchers suspected that the infection had been passed from the owners to the dogs, and the direct genomic link strongly supports that, says Malik Peiris, a virologist at the University of Hong Kong who led the study, which is published today in Nature1.
- The study showed no evidence that dogs can pass the infection to other dogs or people, but it is impossible to be certain in which direction the virus traveled “so we have to keep an open mind”, says Peiris.
- Although the analysis confirms that people with C19 can infect dogs, the probability of this happening is low, says Arjan Stegeman, a veterinary epidemiologist at Utrecht University in the Netherlands. In the study only 2 of the 15 dogs who lived with infected people caught the disease.
- But other scientists say the possibility that pets might spread the virus between each other, and to people, needs to be properly investigated as part of managing future outbreaks.
- Since the infections in the two canines in Hong Kong — a Pomeranian and a German shepherd — were reported, other pets have tested positive for the coronavirus, including a cat in Hong Kong and another two in New York state. Four tigers and three lions at New York City’s Bronx Zoo also tested positive. Studies in cats have found that they can pass the virus to other felines without showing symptoms.
- The Hong Kong study detected viral RNA and antibodies in both dogs, and live virus in one of them. Neither dog became noticeably sick.
- The findings support the results of an April study, in which researchers in China deliberately infected dogs with the coronavirus, says Thomas Mettenleiter, a virologist who heads the Federal Research Institute for Animal Health in Riems, Germany. Dog owners who test positive for the coronavirus should be cautious when handling their pets, he says.
- The American Veterinary Medical Association recommends that people who have C19 wear a mask when caring for their pets. It says sick people should also avoid petting, hugging or sharing food with animals, and should wash their hands before and after contact with them.
Role of animals
- Beyond protecting pets from the virus, there is an urgent need to test more animals that are in close contact with people, including working animals and livestock, to understand whether they have a role in spreading the virus, says Jürgen Richt, a veterinary virologist at Kansas State University in Manhattan. To do this, specialist diagnostic kits for testing animals will be required, he says.
- Richt would also like to see research into whether pets become sick or experience particular symptoms. A common C19 symptom in people is loss of smell. If dogs experience similar symptoms, Richt says this might affect working detector dogs that sniff out drugs, explosives and other illicit items.
C. Collateral Damage
1. Fear, Isolation, Depression: The Mental Health Fallout of a Worldwide Pandemic
- Nationwide, mental health call and text centers, the first lines of defense for many people feeling jittery during a crisis, offer an early picture of how Americans are coping with the coronavirus pandemic.
- Many crisis centers are reporting 30% to 40% increases in the number of people seeking help. The helpline at Provident is experiencing a tenfold increase compared with this time last year, when no national disaster was occurring. So far, the nation’s most heavily used helpline, the National Suicide Prevention Lifeline, has not seen a spike in call volume.
- But mental health experts predict an avalanche of mental health needs as the pandemic progresses.
- Ultimately, the psychological impact of the pandemic will harm far more people than the virus itself. And the widespread emotional trauma it’s evoking will be long lasting, experts say. Already, more than 4 in 10 Americans say that stress related to the pandemic has had a negative impact on their mental health, according to an April poll by the Kaiser Family Foundation.
- “There’s no doubt that the coronavirus pandemic will be the most psychologically toxic disaster in anyone’s lifetime,” said George Everly, who teaches disaster mental health and human resilience at the Johns Hopkins Bloomberg School of Public Health.
- “This pandemic is a disaster of uncertainty,” he explained, “and the greater the uncertainty surrounding a disaster, the greater the psychological casualties.”
- Based on Americans’ reactions to previous disasters, the emotional phases people can be expected to go through are predictable, Everly said. “But how many weeks or months those phases will last, I can’t tell you.”
- For now, starting the third month of the crisis, a sense of shared experience and a felt need to stay strong and fight a common enemy may be keeping many people from emotional collapse and suicide.
- But as time wears on, more extreme psychological effects of the pandemic’s widespread trauma can be expected to surface, said Jerry Reed, senior vice president at the Education Development Center and member of the National Action Alliance for Suicide Prevention.
- “When the pandemic wanes and most Americans return to work and school, disillusionment, depression and despair will likely arise for some people,” Reed said. “That’s when we could see an increase in suicides.
- “But that’s only if we fail to prepare. We know that suicide is preventable,” he said. “Let’s take advantage of the time we have now and try to get ahead of the curve rather than waiting.”
- More than 47,000 people in the United States died by suicide in 2017, making it the 10th-leading cause of death, according to the Centers for Disease Control and Prevention. The same year, 1.4 million adults attempted suicide and 10.6 million reported seriously considering suicide, according to the Substance Abuse and Mental Health Services Administration.
- The suicide rate in the United States has risen 30% since 2000, with the highest prevalence among middle-aged white men. At the same time, deaths from drug overdoses and alcohol abuse have risen sharply, resulting in a decrease in American life expectancy for three consecutive years.
- This rise in what are called deaths of despair, social scientists say, is caused by worsening economic conditions and social isolation in much of the nation over the past two decades.
- Last week, a mental health advocacy nonprofit released an analysis predicting that the massive job losses resulting from the economic shutdown during the pandemic, compounded by increased social isolation, could lead to an even sharper increase in deaths of despair.
- The coronavirus pandemic, which has killed about 79,000 Americans, could lead to another 75,000 deaths from alcohol and drug misuse and suicide, the analysis projected.
- National disasters in the past have resulted in higher suicide rates in the months and years after the initial crisis. But it’s too soon to know whether this pandemic already is causing more suicides. National data on the cause of deaths is collected by the CDC from state death certificates and lags two years behind.
- Roughly 11.2 million Americans, including many who are homeless or in prisons, live with serious mental illness. They are the most vulnerable to the psychological effects of the pandemic, said Dawn Brown, who runs a crisis call line for NAMI.
- But during this pandemic, she said, even people who have never experienced a mental disorder are beginning to feel many of the same symptoms as people with serious mental illness. Some callers are saying they’re having panic attacks, some report short emotional fuses, and others say they’re unable to get out of bed in the morning. “The good news is we know how to treat those symptoms,” Brown said.
- People who may have been able to manage their depression through exercise, or keep their anxiety in check with meditation, are finding that’s no longer enough, she said.
- “In the beginning it was full-on anxiety about catching the virus,” she said. In early March, the key words were “asthma” and “cough.” Later, texters started expressing fears about their loved ones catching the virus. The trending words then were “grandma” and “grandpa.”
- Next came financial worries, with trending words “quarantine” and “laid off.”
- Now, Womble said, “People are telling us they feel isolated, anxious and depressed because there’s nothing they can do, and they don’t know when this will end.
2. The COVID Pandemic Could Lead to 75,000 Additional Deaths from Alcohol and Drug Misuse and Suicide
- Alongside the thousands of deaths from COVID-19, the growing epidemic of “deaths of despair” is increasing due to the pandemic—as many as 75,000 more people will die from drug or alcohol misuse and suicide, according to new research released by Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
- The brief notes that if the country fails to invest in solutions that can help heal the nation’s isolation, pain, and suffering, the collective impact of COVID-19 will be even more devastating. Three factors, already at work, are exacerbating deaths of despair: unprecedented economic failure paired with massive unemployment, mandated social isolation for months and possible residual isolation for years, and uncertainty caused by the sudden emergence of a novel, previously unknown microbe.
- “Undeniably policymakers must place a large focus on mitigating the effects of COVID. However, if the country continues to ignore the collateral damage—specifically our nation’s mental health—we will not come out of this stronger,” said Benjamin F. Miller, PsyD, chief strategy officer, WBT. “If we work to put in place healthy community conditions, good healthcare coverage, and inclusive policies, we can improve mental health and well-being. With all the other COVID-related investments, it’s time for the federal government to fully support a framework for excellence in mental health and well-being and invest in mental health now.”
- The study combined information on deaths of despair from 2018 as a baseline (n=181,686), projected levels of unemployment from 2020 to 2029 and then estimated the additional annual number of deaths based on economic modeling. Across nine different scenarios, the additional deaths of despair range from 27,644 (quick recovery, smallest impact of unemployment on deaths of despair) to 154,037 (slow recovery, greatest impact of unemployment on deaths of despair), with 75,000 being the most likely. When considering the negative impact of isolation and uncertainty, a higher estimate may be more accurate.
3. Why Has C19 Hit Seniors So Hard?
- The C19 pandemic presents a doubly complicated situation for older people: Not only are they at higher risk of contracting the disease, and more likely to develop severe infections and die from it, but they are also the most likely to struggle with—and suffer from— the consequences of prevention strategies like social distancing. For people with dementia, Alzheimer’s disease, or severely reduced mobility, social-distancing guidelines can be impractical and nearly impossible to follow, making prevention and treatment even more complicated.
- Seniors, especially those above age 80, have been hard hit by the virus. That’s in part because they often have comorbidities like diabetes and hypertension, which make them more likely to be hospitalized. Doctors aren’t sure why those conditions make the effects of the virus worse, but both conditions are associated with greater expression of the ACE2 receptor, a protein on human cells that the coronavirus latches onto to start replicating.
- Many older adults also have chronic, low-grade inflammation, a state called “inflammaging,” in which the body is unable to control the release of cytokines, small proteins that are supposed to help modulate the body’s immune response. This dysregulation could put seniors at great risk of “cytokine storms,” a condition reported in severe C19 cases during which a patient’s immune system spins out of control and starts damaging healthy organs.
- Seniors are also more vulnerable because of immunosenescence, a slow deterioration of the immune system that is a normal part of aging. When people are young, the immune system has a big reservoir of T-cells and B-cells ready to fight infections. These are called “naive cells,” meaning they haven’t encountered any bacteria, viruses, or other pathogens yet. When those naive cells encounter an infection, some of them learn to recognize that pathogen and become ready to fight it off if the body gets exposed to it again. “As we age, we lose that reservoir of T-cells and B-cells,” says Wayne McCormick, head of Gerontology and Geriatric Medicine at the University of Washington. “It’s hard for us to make new ones, although some people seem to retain that capacity better than others.” That means the person’s body may mount a less robust immune system response than it would have done when they were younger.
- Immunosenescence also means that diseases present differently in seniors, which may make it difficult for their doctors or caretakers to recognize a C19 infection. While many C19 cases include fever, for example, in seniors the symptoms might also include confusion, delirium, sleepiness, or loss of appetite. That may be because the virus has reached important organs like the brain, kidneys, or digestive system. “As one gets older, the virus can invade without being resisted as much, and then some really bad things begin to happen,” says William Greenough, clinical chief of the ventilator rehabilitation unit at Johns Hopkins Bayview Medical Center. “Particularly in older people, we’re seeing clogging of blood vessels in the brain and kidneys.”
- There’s still a lot scientists and doctors don’t understand about the new coronavirus, but Greenough says the virus appears to be much more complicated, and to affect more parts of the body, than previously thought. Recent reports of “Covid toe,” stroke, and blood clots suggest the virus affects the vascular system in addition to the respiratory system. For older adults who have more wear and tear on their blood vessels, or who may have constricted vessels, this could be particularly destructive.
- Not only are seniors more biologically susceptible, but many of them live in situations that make catching the virus more likely because they interact daily with other people, many of whom are themselves more likely to catch the virus. Some seniors live in their own homes and get assistance from health aides who may take public transit, serve multiple clients, and—like many other essential workers—are unable to shelter in place while doing their job. “They were subject to getting Covid early in the epidemic and brought it home,” says Jacobs.
- The situation is analogous to what has happened in some long-term care facilities, where the coronavirus has spread like wildfire between staff and residents, Jacobs continues. Even though seniors are more likely to develop a severe infection, many are instead asymptomatic carriers, making it hard to catch the virus without testing an entire facility. One of the worst early outbreaks happened at a long-term care facility in Kirkland, Washington, and by mid-April half of the state’s C19 deaths occurred in such facilities. Other serious outbreaks have happened at senior homes in Connecticut, New Jersey, and Maine, due in part to dense living conditions, understaffing, and a lack of personal protective equipment. And recently, health authorities have realized that the virus is spreading rapidly in work communities where employees are housed in crowded conditions, share long commutes on shuttles, or cannot easily socially distance, like meat packing or farmwork.
- Whether they live in a long-term care facility, nursing home, or in a family home, many seniors have unique needs that make it impossible for them to socially distance. Some need help eating, washing, going to the bathroom, or moving around. “You can’t do that using Facetime,” says Eric Widera, a professor at the University of California San Francisco who specializes in geriatric and palliative medicine.
- Yet for older adults living in their homes, social distancing can cause isolation and loneliness. Most of the places people would go to socialize—senior centers, libraries, churches, temples, or synagogues—are closed. Families are discouraged from visiting. “We’re worried it’s going to cause a wave of true loneliness,” says Widera, which can lead to serious health problems including worse cognitive function, higher blood pressure, and heart disease.
- While older adults are the most likely to catch C19, they also may be less likely to benefit from a vaccine. Because seniors don’t raise the same immune response that younger adults and children do, they generally don’t respond as well to vaccines. They also aren’t always included in clinical trials. “If you look at the last many decades of research, the vast majority of randomized control trials do not include older adults. And if they do, they don’t include frail older adults, who are at risk for this,” says Widera. “That’s one of our worries: That we’ll be looking at potential treatments, vaccines, but not actually testing it on the people who are at the most risk of developing this disease.”
- For people with dementia or other kinds of cognitive decline, things get even more complicated. Widera points out that people with dementia may not remember they need to wash their hands more often or refrain from touching their face. And dementia patients often wander. In communal living or care facilities, they might walk in and out of other patients’ rooms, down the hall, or into common living areas, all of which increase the likelihood of catching and transmitting the disease. Diagnosing C19 in those patients could be even harder, too. “People with cognitive impairment may not be able to report their symptoms very well,” says McCormick. “Even if they had a cough an hour ago, they may not remember that they did.”
- Patients with dementia also have unique challenges if they end up in the hospital. C19 symptoms can worsen their confusion and delirium, as can being in an unfamiliar setting like a hospital room. These patients may be terrified when they’re separated from their family or their usual caregivers and are being tended to by staff covered head-to-toe in protective gowns and masks. With nurses trying to limit patient interactions to reduce the need for this protective gear, patients are often isolated for much of the day.
- Martine Sanon, a professor of geriatric and palliative medicine at the Mount Sinai Hospital in New York, says that usually they encourage family members to be part of the care team and to help orient and comfort their loved ones, but with limited protective equipment, and with fears about spreading the virus, those options aren’t available. “The families have been tremendously wonderful,” she says, often using FaceTime to play favorite music in the background or to call patients by a familiar nickname. “That does help.”
- At Hackensack University Medical Center, Jacobs says usually they try to use non-pharmacological methods to help soothe distressed and confused patients. “The way we manage that usually in the hospital is basically staff sitting with a patient, reorienting them, using music, using touch,” she says. But with C19, it’s too dangerous to have someone sit with a contagious patient all day. Instead, the hospital now relies on medication to calm patients down.
- While mortality rates are higher for older adults with C19, many do survive. What recovery looks like for them is more complicated. “That’s the other shoe to drop,” says William Greenough of Johns Hopkins. Older adults are likely to be weaker and to recover more slowly after a hospitalization, he says. With so many hospital gyms, rehab, and physical therapy facilities closed, that’s going to make their progress even more difficult.
- None of these issues—loneliness, immunosenescence, difficulty recovering from hospital stays—are new problems, and none are unique to the virus. But the novel coronavirus exacerbates the many challenges older patients already face. “C19 intensifies and complicates everything,” says Greenough.
D. Herd Immunity
1. Early Herd Immunity against C19: A Dangerous Misconception
By David Dowdy, Department of Epidemiology, John Hopkins Bloomberg School of Public Health
- We have listened with concern to voices erroneously suggesting that herd immunity may “soon slow the spread”1 of C19. As infectious disease epidemiologists, we wish to state clearly that herd immunity against COVID-19 will not be achieved at a population level in 2020, barring a public health catastrophe.
- Although more than 2.5 million confirmed cases of C19 have been reported worldwide, studies suggest that (as of early April 2020) no more than 2-4%3–5 of any country’s population has been infected with the coronavirus. Even in hotspots like New York City that have been hit hardest by the pandemic, initial studies suggest that perhaps 15-21%6,7 of people have been exposed so far. In getting to that level of exposure, more than 17,500 of the 8.4 million people in New York City (about 1 in every 500 New Yorkers) have died, with the overall death rate in the city suggesting deaths may be undercounted and mortality may be even higher.8
- Some have entertained the idea of “controlled voluntary infection,”9 akin to the “chickenpox parties” of the 1980s. However, COVID-19 is 100 times more lethal than the chickenpox. For example, on the Diamond Princess cruise ship, the mortality rate among those infected with the coronavirus was 1%. Someone who goes to a “coronavirus party” to get infected would not only be substantially increasing their own chance of dying in the next month, they would also be putting their families and friends at risk. C19 is now the leading cause of death in the United States, killing almost 2,000 Americans every day. Chickenpox never killed more than 150 Americans in a year.9
- To reach herd immunity for COVID-19, likely 70% or more of the population would need to be immune. Without a vaccine, over 200,000,000 Americans would have to get infected before we reach this threshold. Put another way, even if the current pace of the C19 pandemic continues in the United States – with over 25,000 confirmed cases a day – it will be well into 2021 before we reach herd immunity. If current daily death rates continue, over 500,000 Americans would be dead from C19 by that time.
- As we discuss when and how to phase in re-opening, it is important to understand how vulnerable we remain. Increased testing will help us better understand the scope of infection, but it is clear this pandemic is still only beginning to unfold.
E. Lockdowns vs. Reopenings
1. Sweden’s Coronavirus Strategy Will Soon Be the World’s
Herd Immunity Is the Only Realistic Option—the Question Is How to Get There Safely
- China placed 50 million people under quarantine in Hubei Province in January. Since then, many liberal democracies have taken aggressive authoritarian measures of their own to fight the novel coronavirus. By mid-March, almost all Organization for Economic Cooperation and Development (OECD) countries had implemented some combination of school, university, workplace, and public transportation closures; restrictions on public events; and limits on domestic and international travel. One country, however, stands out as an exception in the West.
- Rather than declare a lockdown or a state of emergency, Sweden asked its citizens to practice social distancing on a mostly voluntary basis. Swedish authorities imposed some restrictions designed to flatten the curve: no public gatherings of more than 50 people, no bar service, distance learning in high schools and universities, and so on. But they eschewed harsh controls, fines, and policing. Swedes have changed their behavior, but not as profoundly as the citizens of other Western democracies. Many restaurants remain open, although they are lightly trafficked; young children are still in school. And in contrast to neighboring Norway (and some Asian countries), Sweden has not introduced location-tracing technologies or apps, thus avoiding threats to privacy and personal autonomy.
- Swedish authorities have not officially declared a goal of reaching herd immunity, which most scientists believe is achieved when more than 60% of the population has had the virus. But augmenting immunity is no doubt part of the government’s broader strategy—or at least a likely consequence of keeping schools, restaurants, and most businesses open. Anders Tegnell, the chief epidemiologist at Sweden’s Public Health Agency, has projected that the city of Stockholm could reach herd immunity as early as this month. Based on updated behavioral assumptions (social-distancing norms are changing how Swedes behave), the Stockholm University mathematician Tom Britton has calculated that 40% immunity in the capital could be enough to stop the virus’s spread there and that this could happen by mid-June.
- Sweden has won praise in some quarters for preserving at least some semblance of economic normalcy and keeping its per capita death rate lower than those of Belgium, France, Italy, the Netherlands, Spain, and the United Kingdom. But it has come in for criticism in other quarters for exceeding the per capita death rates of other Nordic countries and in particular, for failing to protect its elderly and immigrant populations. People receiving nursing and elder-care services account for upward of 50% of C19 deaths in Sweden, according to Tegnell, in part because many facilities were grievously slow to implement basic protective measures such as mask wearing.
- Immigrants have also suffered disproportionately, mainly because they are poorer on average and tend to work in the service sector, where working remotely is usually impossible. But Swedish authorities have argued that the country’s higher death rate will appear comparatively lower in hindsight. Efforts to contain the virus are doomed to fail in many countries, and a large percentage of people will be infected in the end. When much of the world experiences a deadly second wave, Sweden will have the worst of the pandemic behind it.
- Sweden’s response has not been perfect, but it has succeeded in bolstering immunity among the young and the healthy—those at the lowest risk of serious complications from C19—while also flattening the curve. The country’s intensive care units have not been overrun, and hospital staffs, although under strain, have at least not had to juggle additional childcare responsibilities because daycares and lower schools continue to operate.
- Whether or not they have openly embraced the Swedish approach, many other countries are now trying to emulate aspects of it. Both Denmark and Finland have reopened schools for young children. Germany is allowing small shops to reopen. Italy will soon reopen parks, and France has a plan to allow some nonessential businesses to reopen, including farmers’ markets and small museums, as well as schools and daycare centers. In the United States, which has by far the highest absolute number of reported C19 deaths, several states are easing restrictions at the urging of President Donald Trump, who despite bashing the Swedish model, is pushing the country toward something very similar.
- There are good reasons for countries to begin easing their restrictions. It will take several years to tally the total number of deaths, bankruptcies, layoffs, suicides, mental health problems, losses to GDP and investments, and other costs attributable not just to the virus but to the measures used to fight it. It should already be obvious, however, that the economic and social costs of lockdowns are enormous: estimates from the OECD suggest that every month of pandemic-related restrictions will shrink the economies of advanced countries by 2%. France, Germany, Italy, Spain, the United Kingdom, and the United States, according to the OECD, will see their economies shrink by more than 25 percent within a year. Unemployment is rising to levels unheard of since the 1930s—fueling political backlash and deepening social divisions.
- Lockdowns are simply not sustainable for the amount of time that it will likely take to develop a vaccine. Letting up will reduce economic, social, and political pressures. It may also allow populations to build an immunity that will end up being the least bad way of fighting C19 in the long run. Much about the disease remains poorly understood, but countries that are locked down now could very well face new and even more severe outbreaks down the road. If these countries follow the Swedish path to herd immunity, the total cost of the pandemic will decrease, and it will likely end sooner.
- Sweden’s approach to C19 reflects the country’s distinctive culture, and aspects of it may not be easy to replicate elsewhere. In particular, reliance on official recommendations and individual responsibility may not travel well beyond Scandinavia. Sweden is a special country characterized by high levels of trust—not just between people but between people and government institutions. Swedes were primed to take voluntary recommendations seriously in a way that citizens of other nations may not be.
- Swedes are also generally healthier than citizens of many other countries, so additional precautions may be necessary to protect the infirm in other parts of the world. Countries lifting restrictions should also learn from Sweden’s missteps when it comes to the elderly and immigrants: masks and other protective equipment should be made immediately available in nursing homes, and greater emphasis should be placed on protecting service-sector workers who are at higher risk because of age or infirmity. But the emphasis must be on helping at-risk people stay safe and out of harm’s way, not locking entire societies down.
- As scientists learn more about the virus and authorities develop new and better ways to work around the contagion—altering the parameters for calculating herd immunity to account for behavioral changes, for instance—the justification for general lockdowns grows weaker and weaker. Even in places like the United States and the United Kingdom, where the pool of at-risk people is much larger, the cost of protecting these people is much lower than forcing everyone to stay home. Managing the path to herd immunity means, above all, protecting the vulnerable. Sweden learned that the hard way, but the situation there is now under control.
- As the pain of national lockdowns grows intolerable and countries realize that managing—rather than defeating—the pandemic is the only realistic option, more and more of them will begin to open up. Smart social distancing to keep health-care systems from being overwhelmed, improved therapies for the afflicted, and better protections for at-risk groups can help reduce the human toll. But at the end of the day, increased—and ultimately, herd—immunity may be the only viable defense against the disease, so long as vulnerable groups are protected along the way. Whatever marks Sweden deserves for managing the pandemic, other nations are beginning to see that it is ahead of the curve.
2. The Lockdown Skeptic They Couldn’t Silence
- Does a pandemic demand the strong medicine of censorship? Social-media companies seem to think so. They’re taking steps to control speech in the name of combating the spread of medical misinformation. Facebook employs “fact checkers” to review posts, makes those that don’t pass their test harder to find, and directs users to purportedly reliable sources like the World Health Organization. YouTube has taken down videos it deems inconsistent with science. Twitter plans to add warning labels to tweets that don’t pass muster with “subject-matter experts, such as public health authorities.”
- Aaron Ginn’s story is a cautionary tale that even well-intended censorship can overreach, suppressing the search for truth. Mr. Ginn, 32, is the Silicon Valley technologist who posted an essay on March 20 titled “Evidence over hysteria—COVID-19” on the Medium website. Citing academic research and government data, Mr. Ginn argued that public-health experts were focusing too much on “flattening the curve . . . while ignoring the economic shock to our system” of shuttering businesses and schools and ordering Americans to stay home.
- “When 13% of Americans believe they are currently infected with C19 (mathematically impossible),” he wrote, “full-on panic is blocking our ability to think clearly and determine how to deploy our resources to stop this virus.” The message was well-timed—the day he posted it, Gov. Andrew Cuomo ordered “nonessential” New York businesses to close.
- Mr. Ginn’s essay drew 2.6 million page views in 24 hours—and a barrage of liberal criticism. Carl T. Bergstrom, a University of Washington biologist, called it “Shakespeare run through google translate into Japanese, then translated back to English by someone who’d never heard of Shakespeare.” Then Medium took it down, saying it violated rules under a “risk analysis framework we use for ‘Controversial, Suspect and Extreme content.’ ”
- Yet if Medium meant to stifle debate, its action backfired. Mr. Ginn has since become an informal organizer of a small battalion of well-credentialed dissenters. They include Michael Levitt (a Stanford biologist and the 2013 Nobel laureate in chemistry), John Ioannidis and Jay Bhattacharya (both Stanford professors of medicine), Joel Hay (a University of Southern California professor of pharmacy and health economics) and Neeraj Sood (a USC health economist). They and other researchers have been advising state and local governments on easing their lockdowns. On Thursday Dr. Bhattacharya and Messrs. Hay and Sood fielded questions from the Arizona Legislature about how to reopen the state’s economy.
- On one side, Mr. Ginn says, are ideologues heavily invested in the idea of lockdown, regardless of the cost. On the other are scientists with data that the lockdowns are overkill. Mr. Ginn himself is a generalist who’s spent the past decade in Silicon Valley as a product engineer and “growth hacker”—argot for a marketing strategist. But he was aware of the coronavirus early—he says he started following it as soon as it was reported in China in January.
- Soon after Beijing quarantined Wuhan and other cities in Hubei province on Jan. 23, cases started popping up in Europe and other Asian countries. “I was concerned, but I did not think that it was going to escalate this quickly,” Mr. Ginn says. Then in late February towns in Northern Italy started locking down.
- Mr. Ginn was disturbed that Western governments were relying on questionable Chinese data on infections and fatalities to develop their epidemiological models and reflexively copying its response to the virus.
- He saw no evidence that the lockdowns suppressed the virus’s spread or reduced fatalities. China has reported new cases since lifting its Wuhan lockdown late last month, Mr. Ginn notes, though its data are still unreliable.
- “There was actually lots of good evidence that we knew about the virus that we were ignoring, that I included in my original Medium piece as things that we should consider, in terms of moderation,” he says. Nobody challenged his data, he says, only his interpretation of it.
- “I believe in the free expression of ideas,” he says. “I had a more positive view of the data than the broader norms were, but its removal was not justified.” He acknowledges that some of his inferences may prove wrong—but notes that’s equally true of his critics. “Science is the process of understanding the data and testing hypotheses and making sure that our underlying biases are being controlled for as much as possible.”
- Mr. Ginn spends his days sifting through coronavirus studies, news stories and data, which he compiles in exhaustive daily news feeds that he sends to policy makers, including White House officials as well as state and city lawmakers. His goal is to balance the media’s prevailing pro-lockdown bias by amplifying the voices of skeptical experts.
- One of his priorities is reopening schools. “When it comes to children, the data coming out of Europe is very, very strong,” he says. “You have, I would say, near-unanimous consensus among European scientists, public-health officials—including in Australia, South Korea and Japan—that children, for some reason, while they do get infected, they are not very infectious.”
- A recent study from Australia identified only 18 cases (nine children and nine staff) across 15 schools, and only two of the infected children’s 863 close contacts at the schools became ill. Another review last month, published by the Royal College of Paediatricians and Child Health, couldn’t find an instance of a child passing on the virus to adults and noted that the evidence “consistently demonstrates reduced infection and infectivity of children in the transmission chain.”
- Mr. Ginn has been closely following Sweden, which has kept children under 16 in school and let most businesses stay open while restricting gatherings of more than 50 people. His daily briefings frequently cite Sweden’s state epidemiologist, Anders Tegnell, who has argued that government lockdowns lack a “scientific basis” and “people should be able to keep a reasonably normal life.” Dr. Tegnell recently estimated that 40% of Stockholm’s population would be immune to the virus by the end of May.
- That could bring Sweden closer to “herd immunity” than countries that have sought to suppress spread altogether. “We need to ‘segment and shield,’ ” Mr. Ginn says, “and let the epidemic go through”: “The question is: How are you going to best protect those that are vulnerable in the larger population?”
- Some scientists say herd immunity would require 60% to 70% of the population to be infected, which would entail massive deaths. Mr. Ginn says those numbers are up for debate.
- A recent study from a large team of international researchers including some at Oxford and the National Institutes of Health (which hasn’t undergone peer review) estimates that “variation in susceptibility or exposure to infection can reduce these estimates” so that some populations may achieve herd immunity with an infection rate of only 10% to 20%.
- A paper last week by Stockholm University mathematicians estimates herd immunity could be around 43% if young, socially active people mix more and gain immunity, protecting older, less socially active people. In other words, Stockholm may have already achieved herd immunity. Dr. Tegnell said this week that the declining number of cases in Stockholm supports this possibility.
- Many studies Mr. Ginn includes in his briefings defy conventional wisdom, and most support his opinion that the lockdowns are too sweeping. But he notes that scientists who support lockdowns are having no problem getting heard. He also cautions that he doesn’t endorse everything he cites: “You can think of all of these as retweets. I think it’s interesting, but I don’t necessarily 100% agree with it.”
- Some belittle him as an “armchair epidemiologist.” He retorts that “facts and data are independent of your credentials.” Knowledge of the virus is evolving, and “we should always take in new evidence and judge it, and figure out what’s the sort of best policy prescription. A lot of things that we originally thought we were right on were wrong.” Take the “6-foot rule” for maintaining personal social distancing, which Mr. Ginn says isn’t supported by scientific evidence. The World Health Organization recommends 1 meter (3 feet, 3 inches), while Germany and Australia suggest 1.5 meters (just under 5 feet). Sweden recommends that people use “good judgment.”
- There’s evidence his briefings are having an impact. One of his email threads highlighted the low probability of viral spread outdoors. A follower shared it with the City Council of Newport Beach, Calif. Days later, the council voted to reopen its beach. A woman used his briefs to persuade her homeowner association in Houston to reopen a neighborhood playground.
- Avik Roy of the Foundation for Research on Equal Opportunity notes that a European study Mr. Ginn highlighted several weeks ago found “roughly half of all deaths due to C19 in reporting countries was taking place in nursing homes.” That prompted Mr. Roy’s group to conduct a similar survey of the U.S., which estimated that 40% of American deaths were in nursing homes.
- John Allison, former CEO of BB&T bank who sits on President Trump’s Great American Economic Revival Commission, credits Mr. Ginn with providing “a balance in his analysis, weighing both the economic and health burdens of lockdowns and shelter-in-place.”
- “I want this to be an open dialogue,” Mr. Ginn says. “But we shouldn’t have public-health people making economic policy. We need to have the policy makers who people vote for make those determinations.” After all, “we’re a democracy—we’re not China.”
- As for social-media censorship, the internet never forgets. You can still find Mr. Ginn’s Medium essay at Archive.org.
F. Swimming in a Pandemic
1. How Risky Is Swimming? The Water May Be Safe, But….
- As temperatures heat up and summer sets in, people will be looking for ways to cool off. As swimming facilities consider reopening and swimmers ponder a dip, it’s worth understanding how swimming influences your risk of catching or spreading C19.
- Swimming itself, in a pool or body of natural water, doesn’t appear to pose any extra risks virus-wise. But that doesn’t mean pool parties get the green light, scientists caution.
- Ernest Blatchley is an environmental engineer at Purdue University who studies how disinfectants in swimming pools react with contaminants and pathogens.
- “In a well-operated pool, the water itself should present minimal risk and probably an acceptable risk for most people,” Blatchley tells Inverse.
- “But the risks for disease transmission in a pool setting are not zero because we don’t spend all our time underwater.”
- Swimmers might become infected with C19 from a viral droplet from a strangers’ sneeze, or by touching surfaces in the changing room or shower. Research shows the C19 virus can survive for up to 72 hours on plastic and stainless steel surfaces, which may include a pool ladder, deck chair, or door handle.
- “There’s nothing about a pool that would eliminate the need for social distancing, avoiding contaminated surfaces, or not breathing air from somebody who’s close by,” Blatchley says.
- According to the CDC, there is “no evidence” that the virus that causes C19 can be spread to people through the water in pools, hot tubs, spas, or water play areas.
- That’s because chlorine and other common disinfectants, like bromine, ozone, or UV sanitizers, likely kill the coronavirus in treated water. Chlorine is thought to disarm microorganisms in as little as 30 minutes.
- Charles Gerba is a microbiologist and virologist at the University of Arizona who studies how viruses survive in water. He tells Inverse that chlorine does “an excellent job of killing bacteria and viruses — even viruses that are more difficult to kill than coronaviruses like SAR-CoV-2.”
- But while chlorine is a potent and popular disinfectant, how the chemical actually deactivates viruses isn’t well understood.
- It’s theorized that chlorine damages viral proteins and nucleic acids, which can keep the virus from infecting a host cell and inhibits their reproduction — effectively rendering them harmless, Blatchley explains.
- UV light — from UV pool sanitizers or the sun — also damages bacteria and virus’s nuclear material. It’s often used in tandem with chlorine to wipe out microorganisms in water. Exposure to sunlight may generally make surfaces around outdoor pools less risky virus-wise compared to indoor pools, Blatchley says.
- “But that’s going to be different in North Dakota than it’s going to be in Miami,” he says. “And it’s going to be different on a cloudy day than on a sunny day.”
- Currently, there’s no data exploring how common water disinfectants affect the C19 virus specifically, Blatchley says. But data on other viruses with similar structure suggests SARS-CoV-2 would be killed by these disinfectants.
- “There’s nothing about this virus that I know of that would prevent it from being effectively inactivated by these conventional disinfectants that we use,” Blatchley explains. That is, unless there’s something “really weird,” like a possible resistance to disinfectants in certain parts of the virus.
- It’s possible that the virus may be more sensitive to chlorine and other common water disinfectants than other viruses because it has an envelope structure. Enveloped viruses tend to be sort of “wimpy viruses,” Blatchley says. They’re relatively fragile, sensitive to physical or chemical stress, and tend to be inactivated quickly by disinfectants.
- Saltwater pools are also likely to be low-risk, because the salt and water react to generate chlorine. Meanwhile, swimming in a river, lake, or ocean isn’t likely to be radically different risk-wise to pool water.
- “Viruses which infect humans usually survive less in seawater than freshwater — so seawater contamination would be seen as a lower risk,” Gerba says.
- Some of these venues might also be safer as they tend to be less crowded.
- “I don’t see the risk really coming from the water itself,” Blatchley says. “It’s really the things that surround the water that present the risk.”
- If you’re in a crowded area, you have increased your risk of becoming infected, Blatchley says.
- “It doesn’t matter that you happen to be standing in water or standing at the mall,” he points out. “It’s really that air that you’re breathing that other people are affecting.”
G. Wishful Thinking?
1. Mouthwash could protect against C19
- Mouthwash has the potential to protect against C19 infection by killing the coronavirus before it can infect human cells, according to a new report.
- Coronaviruses belong to the class of ‘enveloped viruses’, meaning they are covered by a fatty layer that is vulnerable to certain chemicals.
- A team of international researchers say mouthwash could destroy the outermost layer or ‘envelope’ of the virus, preventing its replication in the mouth and throat.
- The scientists say there is an urgent need to test the effectiveness of mouthwash in trials, although there is currently no clinical evidence that it would be successful.
- The World Health Organization (WHO) has already said: ‘There is no evidence that using mouthwash will protect you from infection with the new coronavirus.’
- The study authors do not say that current commercially-available mouthwash prevents C19, but that further research into mouthwash chemicals could be beneficial.
- Writing in Function, the study authors, led by Cardiff University, say oral rinses are an ‘under-researched area of major clinical need’.
- The team is backed by virologists, lipid specialists and healthcare experts from Cardiff University’s School of Medicine, along with the universities of Nottingham, Colorado, Ottawa, Barcelona and Cambridge’s Babraham Institute.
- ‘Safe use of mouthwash – as in gargling – has so far not been considered by public health bodies in the UK,’ said lead author Professor O’Donnell, co-director of Cardiff University’s Systems Immunity Research Institute.
- ‘In test tube experiments and limited clinical studies, some mouthwashes contain enough of known virucidal ingredients to effectively target lipids in similar enveloped viruses.
- ‘What we don’t know yet is whether existing mouthwashes are active against the lipid membrane of the coronavirus.
- ‘Our review of the literature suggests that research is needed as a matter of urgency to determine its potential for use against this new virus.’
- ‘This is an under-researched area of major clinical need – and we hope that research projects will be quickly mobilised to further evaluate this.’
- The ingredients of dental mouthwashes, including chlorhexidine, cetylpyridinium chloride, hydrogen peroxide and povidone-iodine, all have the potential to prevent infection and several ‘deserve clinical evaluation’, according to the researchers.
- In particular, these chemicals disrupt the outer lipid membrane, known as the ‘viral envelope’ or ‘lipid envelope’ of the coronavirus.
- The lipid envelope helps several viruses, including coronaviruses, bind to human cells while avoiding the host immune system.
- Specific spike proteins called ‘glycoproteins’ on the surface of the envelope identify and bind to receptor sites on the host’s cell membrane, which allows infection.
- Mouthwash chemicals could potentially modify the ability of the spike glycoproteins to interact with receptors on host cells.
- The researchers said there had so far been ‘no discussion’ about the potential role of damaging the fatty membrane as a possible way to inactivate the virus.
- The lipid envelope does not change when viruses mutate, meaning mouthwash could still work against any new coronavirus strains that emerge from this pandemic.
- The WHO has previously debunked the suggestion that mouthwash can prevent infection by SARS CoV-2, the coronavirus that causes C19.
- ‘Some brands of mousthwash can eliminate certain microbes for a few minutes in the saliva in your mouth,’ it said.
- ‘However, this does not mean they protect you from 2019-nCoV infection.’
- WHO has emphatically debunked the theory that gargling mouthwash can prevent infection by the coronavirus
- Research in this area appears to be largely unexplored – Listerine, one of the biggest mouthwash brands, says on its website that none of its products have been tested against any strains of coronavirus.
- ‘Listerine mouthwash is not intended to be used, nor would it be beneficial as a hand sanitizer or surface disinfectant,’ it says.
- Common mouthwashes contain the same key ingredient as coronavirus-killing hand santiser – alcohol.
- However, CDC recommends a hand sanitizer that contains at least 60% alcohol for effective protection, and Listerine’s products consist of only around 20% alcohol.
- The WHO also stresses that drinking pure alcohol, along with methanol or bleach, is incredibly dangerous.
- These substances do not prevent or cure C19 and can lead to disability and death.
- ‘Methanol, ethanol, and bleach are sometimes used in cleaning products to kill the virus on surfaces – however you should never drink them,’ WHO says on its website.
- ‘They will not kill the virus in your body and they will harm your internal organs.’
H. Practical Tips & Other Useful Information
1. WHO’s Coronavirus Myth Busters
- There are currently no drugs licensed for the treatment or prevention of C19.
- Adding pepper to your soup or other meals does not prevent or cure C19.
- C19 is not transmitted through houseflies.
- Spraying and introducing bleach or another disinfectant into your body will not protect you against C19 and can be dangerous.
- Drinking methanol, ethanol or bleach does not prevent or cure C19 and can be extremely dangerous.
- 5G mobile networks do not spread C19.
- Exposing yourself to the sun or to temperatures higher than 25C degrees does not prevent the C19.
- You can recover from the coronavirus disease (C19). Catching the new coronavirus does not mean you will have it for life.
- Being able to hold your breath for 10 seconds or more without coughing or feeling discomfort does not mean you are free from the coronavirus disease (C19) or any other lung disease.
- Drinking alcohol does not protect you against C19 and can be dangerous.
- The new coronavirus cannot be transmitted through mosquito bites.
- Hand dryers, a hot bath, and cold weather or snow are not effective in killing the new coronavirus.
- Ultra-violet (UV) lamps should not be used to disinfect hands or other areas of your skin.
- Thermal scanners cannot detect C19.
- Vaccines against pneumonia do not protect you against the new coronavirus.
- There is no evidence that regularly rinsing the nose with saline or eating garlic has protected people from infection with the new coronavirus.
- Antibiotics do not work against viruses, only bacteria.
- To date, there is no specific medicine recommended to prevent or treat the new coronavirus.
Annex I. John Hopkins Daily C19 Update
May 15, 2020
EPI UPDATE The WHO COVID-19 Situation Report for May 14 reports 4.25 million confirmed cases (77,965 new) and 292,046 deaths (4,647 new). The global total could potentially reach 300,000 deaths by Saturday’s Situation Report.
While most European countries—including those that were hit particularly hard early in the pandemic, such as Spain, Italy, and Germany—have a decreasing trend in daily incidence, several are not. Armenia, Belarus, and Moldova have reported steadily increasing incidence for more than a month. Poland, Romania, Sweden, and Ukraine appear to have reached a plateau—although the reports have fluctuated from day to day, making it somewhat difficult to identify longer-term trends. Additionally, Armenia, Belarus, Moldova, and Sweden are exhibiting elevated per capita daily incidence. Moldova is reporting approximately 4 times the global per capita daily incidence, Armenia approximately 5 times the global average, Sweden 6 times the global average, and Belarus nearly 10 times the global average. For reference, the United States is currently reporting approximately 6-7 times the global average.
Russia reported 10,598 new cases, continuing its recent trend of elevated incidence. The United Kingdom continues to report steadily decreasing daily incidence and deaths, which would be the fourth consecutive week. India reported nearly 4,000 new cases, continuing its recent trend of elevated and increasing daily incidence. India could surpass China’s total case counts tomorrow. Tamil Nadu state, where a large outbreak has been linked to one of Asia’s largest markets, reported 447 new cases.
Singapore reported 793 new cases, including 791 (99.7%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing COVID-19 epidemic. Singapore estimates that the cases confirmed so far represent 7.60% of the total population across all migrant worker dormitories, compared to only 0.03% of the general public population. Of the 26,891 total COVID-19 cases reported in Singapore, 24,549 (91.3%) are among residents of migrant worker dormitories. Over the past 2 weeks, Singapore has reported 9,703 COVID-19 cases among migrant workers (including 58 not living in dormitories), compared to only 86 community cases.
The US CDC reported 1.38 million total cases (20,869 new) and 83,947 deaths (1,701 new). The United States could potentially reach 1.5 million cases by Tuesday next week. If the current trend continues, the United States could record its second consecutive week of decreasing incidence. In total, 9 states reported more than 40,000 cases, including New York with more than 300,000; New Jersey with more than 125,000; and Illinois and Massachusetts with more than 75,000. Additionally, 36 states (increase of 1), plus Guam, are reporting widespread community transmission.
The New York Times continues to track state-level COVID-19 incidence, with a focus on state policies regarding social distancing.
The Johns Hopkins CSSE dashboard is reporting 1.42 million US cases and 85,974 deaths as of 10:30am on May 15.
SLOVENIA DECLARES END TO COVID-19 EPIDEMIC Slovenia declared an end to its COVID-19 epidemic and will lift a number of social distancing and other protective measures. Yesterday, Prime Minister Janez Janša addressed the National Assembly and stated that the epidemic could be declared over by the end of the month. In his remarks, he emphasized that Slovenia is “transitioning into a phase where there is a danger of individual outbreaks occurring in the second wave” and cited recent outbreaks in South Korea as evidence of the risk. Today, the Slovenian government officially declared the end of the epidemic. As part of the declaration, Slovenia removed the mandatory 7-day quarantine for travelers arriving from Europe that had been in place since mid-April. Additionally, many children will return to school starting May 18, and additional classes will resume on May 25.
COVID-19 IN AFRICA According to a modeling study accepted for publication in BMJ Global Health there could be as many as 250 million COVID-19 cases and 190,000 deaths across Africa in the first year of the pandemic. As of April 29, 45 of the 47 countries in the WHO Africa Region have reported cases of COVID-19. Additionally Djibouti, Egypt, Libya, Morocco, Somalia, Sudan, and Tunisia have reported cases but are not members of the WHO Africa Region. The researchers estimated that 4.6-5.5 million could require hospitalization, which would quickly overwhelm healthcare resources and potentially impact other health campaigns, including for HIV, tuberculosis, and malaria control. The study estimates that younger, seemingly healthy individuals in Africa could be at elevated risk due to undiagnosed health conditions. The researchers estimate that geographic and socio-ecological effects could result in slower spread across the continent, but the epidemic could persist for a longer period of time than in other parts of the world.
LOCKDOWN IN CHILE Chile’s capital city, Santiago, has been placed under complete lockdown with mandatory quarantine imposed for the entire province. The decision was made to implement the lockdown after a 60% increase in COVID-19 incidence, including 2,660 new cases reported in a 24-hour period. Of the approximately 34,000 reported cases of COVID-19 in Chile, 80% are reported in the city of Santiago. During the lockdown, residents will only be permitted to leave their homes for essential supplies like food and medication. Previously, Chile implemented containment measures, including quarantine, based on the COVID-19 risk in specific areas. In addition to the Santiago lockdown, Chile will enforce mandatory quarantine measures nationwide for individuals over the age of 75. Chile has conducted 313,750 tests to date, one of the highest totals in Latin America.
COVID-19 IN ROHINGYA CAMPS COVID-19 cases have reportedly been detected in individuals living in or near refugee camps in Cox’s Bazar, Bangladesh. These camps are home to nearly 1 million Rohingya refugees, and one expert estimates that the population density could be 8 times that of Wuhan, China. The refugee camps have very few public health or healthcare resources. Sanitation infrastructure is largely non-existent, making it would be extremely difficult to contain a COVID-19 outbreak in these communities. According to one report, at least 2 cases have been identified in or near the camps, and both cases were placed in isolation. The camps have been “under a complete lockdown” since early April, and health experts fear a major humanitarian disaster if the virus is able to take root in the camps. At the national level, Bangladesh’s epidemic is accelerating, and the country reported more than 1,200 new cases today, its highest daily total.
ABBOTT POINT-OF-CARE TEST The US FDA released an alert after data suggested that results from the Abbott Laboratories ID NOW point-of-care test for SRS-CoV-2 can return a high proportion of false negatives. To promote transparency, the FDA is releasing an alert while actively communicating with Abbott to further investigate the issue, and Abbott will also be conducting their own studies. The FDA has received 15 adverse event reports suggesting inaccurate negative results for patients. Users of the Abbott point-of-care test will receive a notification to alert them that patients may need additional confirmatory testing, if a negative test result does not align with the patients’ clinical presentation. The alert is not meant to state that the Abbott rapid test should not be used; but to remind users that clinical management decisions should be made with consideration of both patient presentation and test results, including additional confirmatory testing if necessary. The Abbott test has reportedly been used to screen White House staff. US Secretary of Health and Human Services Alex Azar commented today that the false negative results may be a result of “user error” and that the White House still has confidence in the test’s accuracy.
COVID-19 STIGMA Stigma against persons and places associated with cases of COVID-19 has created additional challenges for adequately controlling transmission in the community. In Haiti, the Director General of the Ministry of Public Health and Population identified the fight against stigma as the greatest battle in the management of the epidemic. COVID-19 patients have experienced harassment, which has resulted in a reticence to come forward to receive treatment and disclose potential contacts who may be infected. Medical centers have opted not to open COVID-19 treatment units after opposition from local communities sparked fear of violence. Healthcare workers have received threats of attack, and there is a need for additional security at healthcare facilities to ensure the safety of staff and patients. Stigma is also preventing safe and dignified burials of COVID-19 victims.
CDC SOCIAL DISTANCING DECISION TOOLS The US CDC published a series of “decision trees” to provide guidance to state and local governments, schools and child care services, restaurants and other businesses, and others regarding when and how to safely relax social distancing measures for various aspects of society. The guidance documents address public transit, workplaces, restaurants and bars, schools, child care, and camps and other youth programs. Each document provides guidance regarding criteria and metrics to consider with determining whether or not it is appropriate to resume operations as well as recommended “safeguards” for both health and safety and disease monitoring. Most of the guidance is consistent across all sectors—including hygiene, disinfection, and social/physical distancing measures—but guidance for each sector also includes tailored recommendations. For example, the guidance for child care addresses the need to limit the sharing of toys and other objects between children. While not nearly as comprehensive as the unreleased draft guidance that has circulated among news media outlets over the past week or so, this appears to be among the most concrete guidance issued by the CDC with respect to efforts to safely relax social distancing measures.
STATES RELAXING SOCIAL DISTANCING US states are continuing to advance plans to relax social distancing measures implemented in response to COVID-19. New York Governor Andrew Cuomo announced that several regions in the state will be able to start relaxing social distancing measures beginning today. In total, 5 regions have met the state’s criteria to move into Phase 1 of the recovery plan, which would allow them to begin reopening non-essential businesses and easing other restrictions. The “NYS on PAUSE” order expires today, but the remaining 5 regions, including New York City, will stay under more restrictive social distancing measures until they meet the criteria necessary to move into Phase 1. Notably, the New York Stock Exchange is scheduled to reopen its trading floor on May 26, albeit with a fraction of the usual personnel and with additional social distancing measures.
Ohio and Rhode Island both announced new efforts to ease social distancing measures. In Ohio, child care; gyms, pools, and non-contact/limited contact sports; campgrounds; Bureau of Motor Vehicles offices; and horse racing (without spectators) will be permitted to resume operations by the end of May. Outdoor dining at restaurants as well as barber shops, hair and nail salons, spas, and tanning facilities are permitted to resume operations starting today. Indoor dining at restaurants will resume on May 21. In Rhode Island, summer camps and other youth programs are scheduled to resume starting June 29, and libraries are beginning to expand operations, including in-person browsing and computer access.
In Michigan, armed protesters once again gathered at the state house to oppose the ongoing statewide “stay at home” order. The gathering was reportedly smaller than previous protests. Michigan’s stay at home order is scheduled to expire on May 28. The state has exhibited several weeks of declining daily incidence, but it still remains elevated compared to many other states. Analysis published in Health Affairs found that social distancing measures had significant effects in reducing SARS-CoV-2 transmission. Based on analysis conducted at the county level in the United States, the researchers concluded that “shelter in place” orders (eg, “stay at home” or “safer at home” orders) that restricted community activity to essential services and the closure of restaurants, bars, gyms, and entertainment businesses were both associated with statistically significant reductions in community transmission after they were implemented.