Coronavirus Update

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Coronavirus Update 5-18

“So what the president was making the point on is, everything does not depend on a vaccine.” 

HHS Secretary Azar

“Reality check: By the time this is all over the poor will be poorer, the middle class smaller, the country horrifically in debt, unemployment much higher than before and the top 1% will be largely fine.”  

Sven Henrich, Northman Trader

“Early on in this crisis, the CDC, which really had the most trusted brand around the world in this space, really let the country down with the testing. Because not only did they keep the testing within the bureaucracy, they had a bad test. And that did set us back.” 

Peter Navarro, White House Advisor

Today’s Features

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A. Recent Developments and Headlines

B. Numbers & Trends

Note: All changes noted in this Update are since the 5/17 Update

Sources: Worldometers

1. Confirmed Total Cases, New Cases and Tests

  • Worldwide:  
    • Total Cases = 4,799,266 (+1.7%)
    • New Cases = 82,257 (-14.0%) (-13,338)
    • New Cases (5 day avg) = 92,332 (-0.7%) (-605)
  • US: 
    • Total Cases = 1,527,664 (+1.3%)
    • New Cases = 19,891 (-15.3%) (-3,957)
    • New Cases (5 day avg) = 23,806 (-2.4%) (-582)
  • Number of Tests = 11,875,580 (+412,229)

2. Deaths

  • Worldwide Deaths = 316,520 (+1.2%) 
    • New Deaths = 3,618 (-23.8%) (-1,130)
    • New Deaths (5 day avg) = 4,814 (-6.6%) (-339)
  • US Deaths = 90,978 (+1.0%) 
    • New Deaths = 865 (-46.1%) (-741)
    • New Deaths (5 day avg) = 1,511 (-9.2%) (-153)
  • 5 Countries with Largest Number of Confirmed Deaths: 
CountryTotal DeathsDeaths Per 1M Population
US90,978 (+865)275 
UK34,636 (+170)511
Italy31,908 (+145)528
France28,108 (+483)431
Spain27,650 (+87)591
Worldwide316,520 (+3,618)40.6
  • 5 Countries = 67.4% of Worldwide Total Confirmed Deaths (-0.8%)
  • US = 24.2% of Worldwide Total Confirmed Deaths (-4.5%)
  • 5 States with Largest Number of Confirmed Deaths: 
StateTotal  DeathsNew Deaths (5 Day Average)Deaths Per 1M Population
New York28,325 (+191)230 (+4)1,456
New Jersey10,366 (+106)165 (-19)1,167
Massachusetts5,797 (+92)131 (+12)841
Michigan4,891 (+11)43 (-16)490
Pennsylvania4,503 (+147)117 (-13)352
US90,978 (+865) 275
  • 5 States = 61.9% of US Total Confirmed Deaths (+1.8%)
  • NY = 31.6% of US Total Confirmed Deaths (-0.4%)

3. Countries/States To Watch

  • Sweden [Note: The World Health Organization has cited the Swedish approach as a model for reopening economies]
    • Total Cases = 30,143 (+466)
    • Deaths = 3,679 (+5)
    • New Deaths (5 day avg) = 73 (-12.4%) (-10)
    • Deaths per 1M population = 365 
  • Below are 5 of the States moving quickly to reopen their economies (and OK never locked down).   
StateTotal CasesTotal  DeathsNew Deaths (5 Day Avg)Deaths Per 1M Pop
Georgia37,701 (+489)1,609 (+11)23 (-8)152
Florida45,588 (+777)1,973 (+8)38 (-8)92
Texas48,677 (+1,005)1,360 (+20)36 (-1)47
Ohio27,929 (+451)1,628 (+14)38 (-13)139
Oklahoma4,962 (+110)288 (+0)2 (-1)73 
US1,527,664 (+19,891)90,978 (+865) 275
  • 5 States = 10.8% of US Total Confirmed Cases (+0.1%)
  • 5 States = 7.5% of US Total Confirmed Deaths (+0%)

C. New Scientific Findings & Research

1. You Can Get Virus Just By Talking  

  • The simple act of speaking, especially loudly, can help spread coronavirus, according to a new study.
  • The study published in the Proceedings of the National Academy of Sciences of the United States of America found that speech droplets generated by those asymptomatic for C19 are “increasingly considered to be a likely mode of disease transmission.”
  • The study found that “loud speech can emit thousands of oral fluid droplets per second.” In a closed, stagnant air environment, those droplets remained active for between 8 and 14 minutes.
  • “Speech can release thousands of oral fluid droplets into the air too, and the researchers were interested in seeing how many were produced and how long they could remain airborne,” the study found, with researchers noting that “the study was also run in a tightly controlled environment, and it did not account for the types of air circulation and temperature changes you would find in nearly any real-world environment.”
  • “It raises serious concerns that the mere act of an infected patient talking could be dangerously effective in transmitting coronavirus to others.
  • “The researchers write that their estimates are conservative; with some patients producing a much larger amount of the virus than average, which could increase the number of virus-containing droplets “to well over 100,000 per minute of speaking.

Source: COVID-19: You Can Get Virus Just By Talking, New Study Says

2. Masks Can Reduce Rate of Airborne Infection by Up to 75%  

  • Hong Kong scientists conducting research on hamsters have offered the first proof of what many residents have believed all along – that wearing surgical masks can significantly reduce the rate of airborne C19 transmission.
  • The study, which the team called the first of its kind, found the rate of non-contact transmission – in which the virus was transmitted via respiratory droplets or airborne particles – dropped by as much as 75% when masks were present.
  • “The findings implied to the world and the public is that the effectiveness of mask-wearing against the coronavirus pandemic is huge,” Dr Yuen Kwok-yung of Hong Kong University said on Sunday, while cautioning a risk of infection remains even with masks.
  • The top microbiologist said the team carried out the study as the necessity of wearing masks, something he had long advocated, was being challenged worldwide, including by the World Health Organization.
  • In their experiment, partitions made of surgical masks were set up between cages in an isolated facility, with an infected hamster on one side, and three healthy hamsters on the other. A fan was then placed in between to make sure the virus would “transmit” between cages.
  • 52 hamsters were used in the tests, which were carried out under three scenarios designed to replicate real-life situations: with mask barriers placed only on cages that held infected subjects; with partitions placed only on the uninfected side; and with no partition at all.
  • After seven days, 10 out of 15 healthy hamsters, or 66.7%, placed in cages with no partition had become infected.
  • But when surgical mask barriers were placed on the infected hamsters’ side, only 2 of 12 subjects in the adjoining cage, or 16.7%, tested positive for the coronavirus.
  • That number rose to 4 of 12 when the partition was placed only on the cage with healthy subjects.
  • “In our hamster experiment, it shows very clearly that if infected hamsters or humans – especially asymptomatic or symptomatic ones – put on masks, they actually protect other people. That’s the strongest result we showed here,” Yuen said.
  • The study also found that hamsters infected with C19 via direct injection had more severe symptoms than those that contracted it through the mask partitions. The latter group experienced lower clinical scores, milder histopathological changes, and lower viral loads in respiratory tract tissues.
  • He also said he had noticed the public becoming less cautious, with the percentage of Hongkongers wearing masks dipping from 97% to less than 90% in recent days.
  • Residents, he warned, should remain alert, particularly as the virus could have many “silent” transmitters.
  • “I know wearing masks will be difficult during the summer time. My advice is especially when you are in an indoor or closed environment where there’s no free air exchange, in crowded places or on public transport, you must wear a mask.”
  • The research team led by Yuen previously established the world’s first golden Syrian hamster model for C19 in February, showing hamsters – which have enzyme receptors very similar to those in humans – could transmit the virus from one to another through direct or indirect contact.

Source: Coronavirus: hamster research shows effectiveness of masks ‘huge’ in Covid-19 battle, Hong Kong scientists say 

3. Biomarkers predict C19 patients with high risk of mortality  

  • A recently published study may hold the key to helping predict the severity of a patient’s battle with the coronavirus, by examining specific biological markers within a drop of their blood. 
  • The study, which was published on Thursday by Chinese researchers in a journal called Nature Machine Intelligence, claims to have found a way to determine how sick a patient with C19 might get more than 10 days before they actually do. It also boasts a 90% accuracy rate.
  • “This study leverages a database of blood samples from 485 infected patients in the region of Wuhan, China, to identify crucial predictive biomarkers of disease mortality,” the study’s authors wrote.
  • “For this purpose, machine learning tools selected three biomarkers that predict the mortality of individual patients more than 10 days in advance with more than 90% accuracy: lactic dehydrogenase (LDH), lymphocyte and high-sensitivity C-reactive protein (hs-CRP),” researchers said.
  • High levels of LDH play a role in determining what cases might require immediate care and what patients need to be prioritized, according to the study. High levels of LDH are also associated with tissue breakdown and could help provide clues as to what patients can expect going forward.
  • Overall, this study suggests a simple and operable decision rule to quickly predict patients at the highest risk, allowing them to be prioritized and potentially reducing the mortality rate.

Note: you can read the study here: An interpretable mortality prediction model for COVID-19 patients

Source: These indicators in a patient’s blood could help determine how sick they might get from COVID-19, study finds 

D. Projections & Our (Possible) Future

1. Will People Flee Big Cities or Blue States? 

  • The coronavirus is upending our jobs, canceling our pastimes and messing with our social lives. Some of these effects might linger for months, even years, becoming the new normal. But the pandemic isn’t simply likely to change how we live—it could also alter where we live.
  • As we contemplate all the ways that C19 could change the world, big and small, we should consider that the pandemic’s combined effect on public health, the economy and social behavior may cause fundamental shifts in our human geography. Why choose to stay in a crowded city where body bags piled high during the worst parts of the pandemic? Why especially, when C19 has shown many employers that remote work is a serious possibility?
  • This may seem ironic given the unprecedented current global standstill: Migration has ground to a halt. Chinese have returned to China, Americans to America. Trump is signing an executive order to ban almost all immigration.
  • But the tide of migration is a force as intrinsic to human nature as climate change is to the planet. And right now, like passengers clamoring to get off the cruise ships stranded at sea for the past several months, mankind more than ever is itching to move out of dangerous areas. Indeed, most of humanity today is a bit like those cruise ship passengers: densely packed into areas known as cities. And just as many people will think twice before getting on a cruise ship again, so too will many rethink where they presently live depending on how their city, or country, handled the pandemic.
  • We are about to witness a great experiment. The world population has temporarily reset according to nationality or country of residence. At some point (hopefully soon), the lockdown will end. Travel restrictions will be lifted, and planes will start flying again. At the same time, people may end up with more say over where they live than ever before, as companies consciously choose to maintain low overhead, canceling real estate leases and favoring the lower overhead cost of virtual teams. In this new normal, where will people buy one-way tickets from … and to?
  • Public health is top of mind, and reason No. 1 why people might be looking to make a move. The coronavirus pandemic has divided the world into “red zones,” which failed to effectively test, quarantine and treat C19 patients, and “green zones,” which performed well under the circumstances and flattened the curve. The daily news tells us which is which—and can help you choose which green zone to move to.
  • Chances are, you might want to abandon crowded cities. It’s now obvious, if it weren’t before, that staying in big cities can be bad for your health. The density of social contact in urban areas—home to almost 60% of the global population—makes them Petri dishes for the spread of contagious diseases. The C19 “attack rate” in New York City was five (5) times the national average. (Similarly, depopulated Eastern European countries have far lower fatality rates from C19 than more densely populated Western Europe.)
  • Of course, some cities are stickier than others. New York City may have become the Wuhan of the Western Hemisphere, but that doesn’t mean that most New Yorkers won’t stay and lobby officials to be better prepared for future catastrophes, whether viruses or hurricanes.
  • But other cities might not be so lucky. Milan, Madrid, Tokyo and Seattle are other wealthy, modern cities that have nonetheless become virus hot spots. Their appeal to professionals may diminish given their high cost of living and potential under-preparedness for the next virus wave.
  • Plus, if you’re going to be regularly quarantined, it might as well be someplace where you can enjoy a nice walk in nature. As Silicon Valley venture capitalist Balaji Srinivasan put it in a pithy tweet, “Sell city, buy country.”
  • He meant “countryside,” but it might not be a bad idea to change countries altogether. For example, America’s smaller second-tier cities and towns might be less dangerous if you’re worried about a pandemic spreading, but they don’t offer better medical care than wealthier cities; and, in the rural United States, health care can be much worse. By contrast, in countries with proper national health systems such as Canada, Germany and Britain, there is greater parity in medical care across the nation. Texas has been attracting droves of Rust Belt migrants since the financial crisis, but in terms of medical care, you’d be better off in Canada’s cowboy province of Alberta.
  • Furthermore, countries that signal significant investments in improving health care moving forward will attract mobile millennials and Gen-Zers who are looking for places that will ensure their well-being as they get older. But that might not always work: Even if Italy, Iran, Brazil and other countries whose municipal and federal governments have been overwhelmed by the virus seize upon public health as a national priority in the coming years, it’s a safe bet that Italians, Iranians, Brazilians and others who lived through similar chaos will still try harder to emigrate.
  • It is also worth exploring whether countries with low population density and less intensive participation in global supply chains are safer places to live. The areas at roughly 27 degrees latitude have the highest concentration of the world population, and thus are inherently more vulnerable to pandemics than less dense latitudes. By contrast, countries north of 50 degrees latitude—such as Canada—have a relatively low infection rate. Russia, though, which shares Canada’s latitude, has recently seen a spike in Covid infections and now ranks fourth in Europe in total cases.
  • In the Southern Hemisphere, New Zealand has a very low infection rate, and has the added virtue of being able to cut itself off with relative ease. But whereas New Zealand is hard to reach, Canada, which has an enviably effective health care system, has become an immigration superpower. In 2018, its net immigration was 350,000, higher than America’s 250,000 even though Canada has 1/10 the U.S. population. About 1 million Americans already live in Canada, with numbers ticking up . In the years ahead, more Yanks may head north and become Canucks or move even further abroad. As one real estate executive mused on a webinar, “My job is selling U.S. properties to foreigners, but I’d be better off selling properties overseas to Americans.”
  • Health care isn’t the only factor that will motivate our next moves. Cost of living is a decisive issue as well. For youth, especially, the coronavirus economic shock is proving far more devastating than even the financial crisis. A decade ago, baby boomers and Gen-Xers who were foreclosed upon in the Northeast and Rust Belt migrated to the Sun Belt, many resettling in cheaper states and some becoming homeless. 
  • Looking ahead, millennials and Gen-Z—most of whom work in the gig economy—can’t afford to stay in place waiting for “the economy to reopen,” especially when they know that far fewer jobs are likely to be created than hoped. Indeed, New York, Los Angeles and Chicago—America’s three largest metro areas—have been losing people for nearly a decade. Some of the outflow has been backfilled by new arrivals, but not enough to keep population levels in those cities from dropping. A new inflow of arrivals into our most expensive cities is far less likely today, with unemployment potentially hovering at 20% for the foreseeable future and immigration grinding to a halt. Populations in America’s largest and most expensive cities could plunge.
  • Yet another reason to pick your next place of residence carefully: food supply. Climate change has introduced constant volatility into our agricultural systems. Droughts have been ravaging crops in the world’s largest food producing countries—the U.S., Brazil, India, Australia and China. In recent weeks, the coronavirus has only added stress to our agricultural supply chains. Farms from California to France are short of seasonal farm workers, leaving high-quality crops to rot. Major food producing countries such as Russia as well as smaller ones like Serbia have begun to ban the export of wheat, vegetables and food oils. This April, rice prices reached a 7-year high as the pandemic drove many to stockpile food supplies. The United States is facing a widespread meat shortage, as the virus requires closure of meat processing facilities.
  • Food shortages can be devastating: A decade ago, Russia’s wheat export ban sent prices skyrocketing for some of its largest customers. Six months later, revolutions driven by rising food prices engulfed Tunisia and Egypt. 
  • Even if commodities markets stabilize, countries self-sufficient in food and water will have greater appeal. Look for places that are investing in drought resistant crops as well as new hydroponic food production for everything from lettuce to fish farms and plant-based proteins.
  • Migration has numerous fundamental drivers that have profoundly remapped the human population in just the 75 years since World War II. Demographic imbalances and labor shortages have pulled workers and their families from Latin America into the U.S. and from Turkey into Europe; conflict and civil war have pushed tens of millions of refugees from Central and South America, as well as Afghanistan and Arab nations, into North America and Western Europe; the simultaneous dislocations emanating from the offshoring and automating labor, coupled with the financial crisis, have forced millions to relocate as well; and climate change has already created more refugees and internally displaced peoples than warfare. Not only are all of these factors still acting strongly upon humanity, but they are now interacting in complex ways with one another. And now we have the coronavirus thrown into the mix.
  • Imagine millions of Iranians fleeing into Turkey or the Central Asian republics such as Uzbekistan; blue state American urbanites decamping en masse to red states such as Oklahoma; and Chinese pushing across the Amur River into Russia. The coronavirus won’t necessarily be the main cause of these potential demographic flows, but it could trigger these next migration tides.
  • A once-a-century (or even once-a-half-century) pandemic is probably not sufficient cause to move to Greenland, but the many awakenings the coronavirus has brought may well inspire millions of people to eye Earth’s bounteous and uninhabited places as ideal for a fresh start. 
  • The brilliant Duke University mathematician Adrian Bejan argues that all natural systems seek entropy, the diffusion from a concentrated point to a broad area. From the Big Bang that created our endless universe to the shape of trees and the flow of water in streams, nature innately seeks to maximize its own flow. Mankind has spent the past centuries settling in dense cities in the temperate and tropical latitudes. The current pandemic is just one more reason why humanity may have reached a turning point.

Source:  How Coronavirus Could Make People Move – POLITICO

E. The Road Back?

1. We won’t end C19 with ‘test and trace’  

  • To hear public health experts describe it, defeating the coronavirus is a massive but straightforward problem, difficult but not impossible while waiting for a vaccine.
  • First, administer tens of millions of tests to find out who has the disease. Then trace all their recent contacts, using a cellphone app that tells the government whom they met. Finally, track down all those people and order them into isolation for 14 days, possibly in a quarantine hotel.
  • In a country where armed men are marching to defend their right not to wear masks, how will intrusive measures like those go down?
  • Answer: Not easily.
  • “My public health friends are working out brilliant solutions for the technical problems, but they haven’t confronted the challenge of political culture,” Keith Humphreys, a professor of psychiatry at Stanford’s Medical School, told me.
  • “What are we going to do if millions of people refuse to take the tests? What are we going to do if they refuse to isolate themselves or close their businesses?”
  • He’s right. Our political culture often puts individual rights before communal interests. We’re not obedient people by heritage; the Constitution enshrines our right to rebel.
  • That’s not a complaint. Our small-L libertarian streak, by which I mean our attachment to the Bill of Rights, is one of the glories of American life.
  • But in the face of a pandemic, it gets in the way of protecting the larger community.
  • We’ve already seen widespread protests against the shutdown orders imposed by many governors — protests encouraged, bizarrely, by President Trump, even though the governors are following White House guidelines.
  • There’s been scattered violence by hotheads who refuse shop owners’ requests to wear masks.
  • A security guard at a Family Dollar store in Flint, Mich., was shot and killed after he ordered a maskless customer to leave. A clerk at a Target in Van Nuys ended up with a broken arm after he was slugged by another mask-averse knucklehead.
  • Even before widespread contact tracing has begun, some have denounced the idea — especially the proposed phone app — as an unwarranted data grab by Google and Apple.
  • And conspiracy theorists are busy denouncing the pandemic as a hoax cooked up by Bill Gates, the Democratic National Committee, or some other imaginary supervillain.
  • The resistance to masks and other public health measures, while noisy, is still a small minority. A poll released by the Washington Post and the University of Maryland last week found that only 11% of Americans think the anti-pandemic measures have been too severe, including only 32% of Republicans.
  • Still, “it doesn’t take much noncompliance to create problems,” Humphreys pointed out.
  • Smart public health planners are already thinking about making the next stage work, including how much to ask of those who may have been exposed to the virus.
  • “I don’t think you necessarily want to ask people to quarantine for 14 days,” Ashish Jha, director of Harvard’s Global Health Institute, told me.
  • “I could see a system that asks people to self-isolate for three to five days, gives them a couple of tests, and if both are negative tell them they are OK as long as they avoid large gatherings,” he added. “Is that the ideal scientific outcome? No. But we can live with it.”
  • Bottom line: We’ll never see 100% compliance, but we don’t need it. If doctors can get 60% or 70% to cooperate, the contagion can still be contained — just more slowly.
  • That means a long, uneven slog toward reducing the danger, with some states imposing tougher measures than others — a crazy quilt of slightly different approaches.
  • That creates problems too. People are still largely free to travel from one state to another, which gives the virus more ways to spread. As Humphreys put it, “it’s like building a no-peeing section in the swimming pool.”
  • And all this is merely awaiting an effective vaccine to protect people from the virus. Did I mention that the anti-vaccine movement has roared back to life, denouncing Trump’s call for a crash program to develop, test and deploy 300 million doses by January as another dangerous plot?
  • Thanks to the anti-vaxxers, even an effective vaccine is unlikely to eradicate C19 completely because some Americans will choose to remain vulnerable to it. In that respect, it will be something like the measles — a threat that came back because some families refused the vaccinations.
  • We’ll still contend with the coronavirus years from now — and still argue about the appropriate public health measures to employ.
  • We’re not like South Korea or Taiwan. We’re not even like Canada or Germany, countries where people trust government more than we do.
  • We’re America, and we’re going to do it our way — no matter how long it takes and how many mistakes we choose to make.

Source: Column: We won’t end COVID-19 with ‘test and trace’

2. CDC Needs to Cut Through the Fog of Coronavirus War  

By Dr. Scott Gottlieb, former commissioner of the FDA, 2017-19
  • The Centers for Disease Control and Prevention made its first definitive statement last week describing a rare but disturbing condition in children related to C19. Doctors in the U.K. first reported in April a spike in previously healthy children presenting with features similar to another rare condition, Kawasaki disease, whose symptoms include rash and fever and, later in its progression, inflammation of blood vessels.
  • This is a reminder of how much we don’t know about C19. We’ve learned a lot over the past two months as C19 became an epidemic, with 1.5 million Americans diagnosed and more than 90,000 dead. New insights have translated into improved care. This knowledge is saving lives and will be especially useful if infections flare up again.
  • Yet such data on patients isn’t being streamlined and shared with the public quickly. There are shortcomings in our ability to access the electronic systems designed to help glean facts from clinical data. CDC hasn’t been filling its traditional role of promptly publishing medical findings that may help doctors care for patients. Instead, a lot of this information is being passed around social media, by email or even through word of mouth. It’s trial and error on a global scale.
  • To take one example, the latest evidence is that blood clots are a frequent complication of Covid. The disease seems to activate platelets in ways that doctors are only beginning to untangle. It’s likely that some patients who seemed to need ventilators to breathe instead developed big clots in their lungs. This finding is supported by autopsy data that emerged this month. Studies from the Netherlands and France suggest that clots arise in 20% to 30% of critically ill Covid patients. For weeks, American doctors have been experimenting with blood thinners to stave off these complications.
  • Another insight: Patients can appear to be starved for oxygen—say, a pulse oximeter reading in the 80s when a reading below 94% might normally suggest trouble—even though their organs are in fact well supplied with air. Doctors have become more conservative in putting patients on breathing machines and are trying novel ways of providing ventilator support, such as prone positioning. The traditional way providers have used respirators can damage lungs that are inflamed from infection.
  • What’s more, some of the severe organ damage from Covid may be the result of the body’s immune response to the infection. Finding ways to arrest the dangerous parts of that natural defense while preserving its beneficial elements has driven providers to try different drugs that may fine-tune the immune reaction.
  • These findings have come in the setting of an epidemic that has overwhelmed health-care systems. Doctors who usually conduct careful clinical research are battling to preserve lives while risking their own health. Much of the information has been passed along in short research notes, or even on Twitter. A little of it has flowed from the CDC. But to date there’s been no systematic reporting from CDC on collected clinical experience, even with hundreds of thousands of American patients hospitalized, tens of thousands of dead, and many more suffering.
  • Some serious efforts are under way. The Food and Drug Administration is trying to use electronic health-reporting systems and real-world evidence to derive insights on experience with patients and how different drug interventions may be helping or hurting. FDA is using innovative methods to allow clinicians to analyze their own records and merge the results to try to answer questions about, say, the right moment to intubate a patient or give a drug.
  • But CDC and its highly capable career experts must be elevated to play their role in reporting on these findings in real time, so medical practice can be quickly informed of the latest information about Covid patients. Whatever the reasons, CDC has spoken infrequently and with more reticence than is customary in public-health crises. Policy makers may worry that prescriptive guidance and descriptive clinical findings will fuel public fears or constrain a reopening.
  • The opposite is true. The more information about how to reduce the risk of spread and the severity of sickness, the more lives that can be saved, and the more comfortable Americans will feel about starting to resume normal life.

Source: Opinion | Cut Through the Fog of Coronavirus War

F. Updates

1. False Start: Oxford Vaccine Candidate Overhyped  

  • The day after data appeared from the vaccine maker Sinovac showed complete protection of rhesus monkeys by their vaccine candidate (whole inactivated coronavirus particles), scientists from the Jenner Institute in Oxford issued a press release announcing that their vaccine (an adenovirus vector based vaccine that carried the coronavirus spike protein) worked to protect rhesus monkeys and that they were moving forward with large scale human safety trials. At the time, the substantiating data was not available. Now it is, in the form of a May 13 BioRxiv preprint. Does the data support the claim?
  • Not really. All of the vaccinated monkeys treated with the Oxford vaccine became infected when challenged, as judged by recovery of virus genomic RNA from nasal secretions. There was no difference in the amount of viral RNA detected from this site in the vaccinated monkeys as compared to the unvaccinated animals. Which is to say, all vaccinated animals were infected. This observation is in marked contrast to the results reported from Sinovac trial. At the highest dose studied, no virus was recovered from vaccinated monkeys from the throat, lung, or rectum of the vaccinated animals. 
  • There is a second troubling result of the Oxford paper. The titer of neutralizing antibody, as judged by inhibition of virus replication by successive serum dilutions as reported is extremely low. Typically, neutralizing antibodies in effective vaccines can be diluted by more than a thousand fold and retain activity. In these experiments the serum could be diluted only by 4 to 40 fold before neutralizing activity was lost. Again, by contrast the titer of neutralizing antibodies in the serum of those vaccinated with whole inactivated coronavirus was high. 
  • What then is the argument for pressing forward with the adenovirus vector coronavirus spike protein vaccine?
  • The authors present evidence to the effect that, although the vaccine did not protect the animals from infection, it did moderate the disease. 
  • The vaccinated and control animals were followed for clinical signs of infection for 7 days post infection. One clinical sign of infection in rhesus monkeys is breathing rate. Monkeys ill from coronavirus infection breathe more rapidly than normal. By this measure 3 of the 6 vaccinated monkeys were clinically ill, the remaining three were not clinically distinguishable from the unvaccinated animals.
  • A second test is measurement of the amount of virus in the lungs (bronchial lavage). Viral RNA was detected in the bronchial lavage of 2 of the 6 vaccinated animals and in all three unvaccinated animals, again suggesting only partial protection.
  • At day 7 post challenge the animals were euthanized and examined for lung damage. Two of the three unvaccinated animals “developed some degree of interstitial pneumonia” as judged by pathological examination of the lungs. No such damage was observed in any of the vaccinated animals. 
  • It is encouraging that no evidence of vaccine induced disease enhancement was observed in either the Sinovac vaccine nor the Oxford trials. However, experience with other vaccines tells us that is not a firm guarantee that such will be the case for humans.
  • What to make of this data? It is crystal clear that the vaccine did not provide immunity to the virus, the gold standard for any vaccine. It may provide partial protection. 
  • The question then becomes: Will partial protection be enough to control the C19 pandemic? That is an open question. For an answer we can look to other diseases for which only partially effective vaccines exist—HIV, tuberculosis, and malaria. The answers are not encouraging, except perhaps for the protection of childhood malaria. 
  • What are the potential implications for other vaccine trials? We know adenovirus is a good vector for eliciting protective responses for protein coding genes of other viruses, in fact better than many others. This then raises the question of whether vaccine strategies based on the delivery of viral antigens by nucleic acids, be it DNA or RNA, will suffice. From the published data the nucleic acid of select viral genes and proteins delivery technology seems inferior to a whole killed virus vaccine approach. 
  • What then are the choices for the Oxford group? Steam ahead with a vaccine known to be partially effective at best, one which we already know elicits poor neutralizing responses? Work to improve the immunogenicity of the current vaccine? Attempt trials with combinations of two or more vaccines, a prime boost strategy? 
  • These questions are all the more fraught by what we already know about the complexities of antibody reposes to natural infections. For example, we know in the case of SARS and other coronavirus infections that even high titers of neutralizing antibodies fade quickly over time. How long can we expect weakly neutralizing antibodies to protect?
  • We know what the public response is of the Oxford group and their collaborators. Proceed with full speed to human safety then efficacy trials. Time will tell if this is the best approach. I wouldn’t bet on it.

Source: Forbes article here. 

G. Can the Numbers Be Trusted?  

1. State and Federal Data on C19 Testing Don’t Match Up  

  • How many coronavirus tests have been conducted in the United States? For the first time since February, the federal government has an answer. The CDC now says that 10,847,778 coronavirus tests have been conducted nationwide. These tests have found about 1.4 million positive cases.
  • These figures come from a new CDC website that appeared online last week with little fanfare. [Note: you can find the website here]. It marks an important but much belated development for the nation’s premier public-health agency, which has struggled to manage a pandemic that has killed more than 90,000 Americans and plunged the U.S. economy into a recession. Not since February 29, when the nationwide death toll stood at five, has the CDC published anything close to a comprehensive daily count of tests.
  • For the past 11 weeks, the COVID Tracking Project at The Atlantic has been the country’s only reliable source for national testing data. (The tracker compiles the number of tests reported by each U.S. state and territory daily.) While the CDC has provided only occasional and rudimentary tallies of total tests, data from the COVID Tracking Project have been used by Johns Hopkins University, governors and members of Congress, and the White House.
  • With the new CDC site, the federal government is providing regular testing data again, and for the first time ever, it is doing so on a state-by-state level. But an initial analysis of the CDC’s state-level data finds major discrepancies between what many states are reporting and what the federal government is reporting about them. 
  • In Florida, for example, the disparity is enormous. The state government reported on Friday that about 700,000 coronavirus tests have been conducted statewide since the beginning of the outbreak. This count should be authoritative: Governor Ron DeSantis has ordered hospitals and doctors to report their test results to the Florida Department of Health. Yet the CDC reported more than 919,000 tests in the state in that same period. That’s 31% more tests than Florida itself seems to think it has conducted. (Because the CDC says it does not update its data on the weekends, we have, throughout this article, compared its figures against the numbers reported by each state on Friday.) When we asked the CDC to explain the discrepancy in Florida, the agency declined to comment on the record.
  • “If this is what they’re getting, the CDC should pick up the phone and call the state of Florida and say, ‘What’s happening?’” Ashish Jha, the K.T. Li Professor of Global Health at Harvard, told us.
  • Given the complexity and the multisource nature of the data, some variations should certainly be anticipated. But the inconsistencies we found suggest that Florida is not an outlier. Using the state numbers that match the CDC’s output most closely, in 22 states, the CDC’s reported number of tests diverges from the number reported by the state government by more than 10%. In 13 states, it diverges by more than 25%. In some cases, the CDC’s tallies are much higher than what states are reporting; in others, much lower.
  • Curiously, the CDC’s state and national totals for cases and deaths match up well with what we’ve gathered from states at the COVID Tracking Project. So do its national testing totals. Only when you dig into the state-level testing data—where discrepancies skew in both directions—do things begin to go awry.
  • The data sets have one known major difference: Some states report the total number of people tested, while the CDC reports every test, even if a single person is tested more than once. A spokesperson for Indiana’s public health department pointed to this difference to explain the state’s test gap. But our analysis suggests this—or any other methodological factor—does not fully explain the widespread discrepancies. 
  • Caitlin Rivers, an epidemiologist at the Johns Hopkins University Center for Health Security, told us that one possible explanation is that the CDC could be overreporting testing totals in some states if it is including antibody-test results, which don’t track real-time infections, and underreporting in other states because of delays in paperwork. But the differences seem to be so widespread that they are unlikely to arise from a single discrepancy in how certain kinds of tests are reported. At their current rate of growth, Florida’s state-reported testing numbers would not match the CDC’s current totals for another two weeks.
  • “This is more evidence of the dysfunction of the CDC,” Jha said. “There is not supposed to be a lot of daylight between the CDC and the states.” Jha has previously criticized the CDC for being “inexplicably absent” during the coronavirus pandemic.
  • Some of the mismatch between states and the CDC could be explained by the federal government’s unusual manner of collecting testing data. Generally, disease-surveillance data flow from local public-health departments to state governments, and then on to the federal government. But in April, Vice President Mike Pence asked hospitals to start reporting their C19 testing data directly to the federal government. In an email, a CDC spokesperson confirmed that the new website reflected test data from more sources than just states, saying it came from hospitals, private medical-testing companies, and state and local public-health labs.
  • The data that Pence requested fed into a piece of software called HHS Protect, which was meant to serve as a clearinghouse of coronavirus data for the Trump administration, according to a spokesperson for the Department of Health and Human Services. HHS Protect was developed by the defense contractor Palantir. The company declined to comment on the record.
  • It’s unclear exactly when the CDC site first appeared. A CDC spokesperson told us that it went live on May 7, but the first Internet Archive cache of the page is dated May 9. The CDC did not announce the existence of the page in any statement, social-media post, or press conference.
  • In many of the counts the CDC did provide over the past several months, it missed the large majority of tests. In early May, the CDC reported that only about 5 tests had been conducted in the U.S. But the COVID Tracking Project had tallied the results of more than 7.5 million tests reported by states by then. In late April, the White House used the COVID Tracking Project’s data in a major report on national testing strategy. It cited the data again earlier this week in a press conference.
  • The CDC should provide the country with a single, trustworthy data source on the state of C19 testing. But the fact that its data is still in such disagreement with the state-reported totals means that the CDC’s latest efforts are not of much use to politicians and the public. For now, the agency that should be a respected source of truth in this crisis is only adding to the national confusion.

Source: How Many Americans Have Been Tested for the Coronavirus? 

H. Stories From The Homefront

1. Parenting in Quarantine: ‘I’ve Given Up’  

  • What does parenting burnout look like during a pandemic? After a column by Farhad Manjoo on the subject, thousands of readers told us about their “new normal.” For many, excessive screen time was the least of their worries.
  • “Our goal is to survive: no divorce, no getting fired and no children running away from home. If we can do that, I’ll consider us a success story,” wrote Marie LaRiviere, a reader in Fremont, Calif. “We have lowered our expectations in every way possible.”
  • A selection of their stories, edited for length and clarity, is below, accompanied by images from Alice Proujansky’s series of photographs, “Six Feet Apart,” which focuses on her experience sheltering in place with her children, January and William, in New York.
There’s Nothing Normal About the New Normal
  • I don’t even feel like I’m parenting at the moment. We’re all just alive and in the same room. I had twin boys in December and I thought that this would be a great extended maternity leave. But with their need for constant attention, I have just broken down and let my 3-year-old do whatever she wants. My husband and I were splitting shifts to take care of the twins and now my daughter has moved into his side of the bed so I have a near-constant shadow. From the time I wake up until the time I go to sleep, that child is with me. I cannot get away and yet I allow it, because it’s easier than fighting. — Elizabeth Kelley, Columbus, Ohio
‘I blink and it’s time to feed these rascals again’
  • My wife and I love each other, but this is just a lot. Frankly, we are kind of spiraling. Our house is a disaster and it is driving us all crazy but I can’t get it together enough to pick up. I blink and it’s time to feed these rascals again. Our older children (10 and 12) are OK, they can entertain themselves with books, music and chatting with friends on devices. But our 6-year-old is struggling. We finally broke down and allowed him to watch educational television (fishing shows or Nova) or play Prodigy (a math game) on the computer. No tablet, no YouTube (those things makes him insane). At night we build fires in the fire pit and let the kids feed twigs into it one by one. It’s cathartic and feels ancient in a weird way. — Justin Taylor, Schaumburg, Ill.
‘I’ve cried more in front of my boys than my father ever did in front of me’
  • We’ve had to make decisions we never dreamed we would have to make. I missed our daughter’s birth so as not to not risk exposure and to keep something constant in my sons’ lives. We missed Passover with my mother-in-law, who flew in to help with the birth and still has not held her granddaughter. We named our daughter on a Zoom chat with family and friends, rather than in a synagogue with a celebration. My wife and I have lost our tempers more in the last month than in our entire seven years of marriage. I’ve cried more in front of my boys than my father ever did in front of me, and that’s OK because the boys have tremendous amounts of empathy and they give out hugs as much as we give out treats. We have learned amazing things as a family about each other and our faith. — Aharon Hyman, Jerusalem
‘I was fighting with everyone to be quiet’
  • My day starts at 4 a.m. and ends at 9 p.m. I work as a chart analyst for the Hospital for Special Surgery and have to go into the office at least a few days a week. My husband is also an essential worker, a night shift cleaning supervisor in the food industry. He sleeps during the day so my Mom, who lives with us, takes care of our son, who is 6. But my son waits for me to get home before starting his school work. At first I was fighting with everyone to be quiet so that we could concentrate. He’d run around the house crying and whining that he didn’t want to do it. There were a lot of assignments — I counted 14 one day — and I had to speak to the teacher. I tell everyone I have two jobs and the second one, of course, is teaching. — Beatriz Ramirez, Queens, N.Y.
‘He doesn’t understand why his world changed on a dime’
  • We have a 25-year-old nonverbal son with Down syndrome and autism. He needs 100% assistance in everything from showering to making sure he doesn’t choke while eating. He attended an adult day program until it closed on March 12. It was hard before this pandemic, now it’s exhausting because we have no relief, no caregivers, not even visits from his siblings or extended family. He doesn’t understand why his world changed on a dime and he looks for his lunchbox every day. We go on walks and take him for aimless car rides. My husband and I take turns losing our minds. — Cheryl Carbonell, Connecticut
‘I am scrambling to try and save my job’
  • We are failing miserably with our 3-year-old and 8-month-old, cooped up in a New York City apartment. My billable hours at work have suffered to a point where I am scrambling to try and save my job (compared to last year when I got a big promotion). I’m not sure when things are going to explode, but the end is nigh. The threat of the virus seems minuscule compared to our mental and physical exhaustion. My husband has resorted to increased alcohol consumption to cope (I can’t drink because I am breastfeeding). I haven’t washed my hair in over a week. At the start of the lockdown I told my husband that we will come out of this either planning a second honeymoon or putting a divorce lawyer on speed dial. — Avy Pitamber, Manhattan
‘We haven’t touched school work in days’
  • I’m a single Mom and a teacher. I started this with the expectation that I would personally teach my oldest child (in kindergarten), keep in contact with my students and keep up with housework. I also have a 1-year-old who gets therapy for his developmental delays. As time has gone on, I find that I’m frustrated, depressed and can’t finish anything I start. We haven’t touched school work in days. The kids are stressed and it’s undone all their sleep training. I feel overwhelmed and ashamed that as a professional I can’t do this. My house is in shambles. When I have to do work meetings I point the camera to the highest point possible to hide the chaos on the floor. — Sarah Nicklas, Harrisonburg, Va.
‘The Mom guilt is out of control’
  • I’m not expected to put in a full eight hours a day when my children are with me, but I have split custody so I put a lot of pressure on myself to overachieve or work overtime the days I don’t have them. When I do have them, the Mom guilt is out of control as my boys (2 and 5) begin their fourth or fifth hour of television. My 5-year-old has been potty trained for more than two years but has started to regress. My soon to be ex and I signed divorce papers the weekend before everything started to shut down in Utah. Is it terrible to say that I’m so thankful I have somewhere to send my children so I don’t have to be with them 24/7? — Michelle Sayers, Salt Lake City
‘The kids are in charge of themselves’
  • I have given up, and for the better. The kids (8, 10 and 12) are in charge of themselves and their schooling. I go to work in health care every day and don’t have the bandwidth. I trust them, and if there are issues, I ask the teachers to email me. They’re learning little aside from school work sheets, how to fold laundry, sweep, mop and fix their own meals. My bar is very low but there is much to be said for kids learning self-sufficiency. If that is the most they learn these long months, so be it. — Alexandra Leigh, Louisiana
‘I’ve been outspoken at my company from day one about this new reality’
  • This has been one of the hardest things we have done as working parents. I’m a high-achiever type personality, and not only am I not doing well, I’m barely keeping things afloat some days. I’ve been outspoken at my company from day one about this new reality and how those of us with young children in particular are bearing a burden that makes work impossible to sustain at normal capacity. The constant feeling of never crossing items off a to-do list is incredibly tough for my mental well-being. Thankfully, my employer has been supportive. But this marathon with no finish line has shifted our standards. — Katherine Lehmann, Roswell, Ga.
‘That level of unhappiness was unsustainable’
  • The first two weeks that we stuck to the school-provided schedule were miserable. The kids (3 and 6) missed their friends, going to playgrounds, and my husband and I were high strung, trying to do exemplary work to avoid being laid off in addition to full-time home schooling. We realized that level of unhappiness was unsustainable. Our new normal involves going for long walks, watching lots of movies, making Lego creations, gardening and reorganizing Pokemon cards a thousand times over, in between fits of hyper-focus on work. Homeschool is relegated to no more than an hour a day, if that. Our pediatrician told us that boredom is good for kids and to stop worrying about entertaining them all the time. — Eleanor T. Chung, Baltimore County, Md.
‘A mediocre parent and subpar employee’
  • As a deputy general counsel of a large company and a single Mom who is home schooling a kindergartner in a language I don’t speak (he attends a French bilingual school), the whole thing has been frustrating and tear-inducing. But now in week six, I’ve reached a plateau and gotten comfortable with being a mediocre parent and subpar employee. Sleep is super important, as is riding bikes or hiking in a large park every day. Co-parenting seems like a dream. Someone else to take the kid for an hour so I could go for a run or hit the store? Not happening. — Laura Altieri, Berkeley, Calif.
I thank God I’m co-parenting with someone who isn’t a panicker’
  • I work at a Trader Joe’s, so I’m on the proverbial front lines. My ex-wife is working from home with the children, and I still get them on my days off. In both households, they do very little of the school work assigned. It’s too much of a battle. And we’ve largely stopped fighting it. When I’m with the kids, we try to do a lot of creative play — both sports in the driveway and elaborate family rituals with dolls. It’s exhausting but it keeps them amused — and then I feel less guilty about giving them screen time. I thank God I’m co-parenting with someone who isn’t a panicker and is fairly relaxed about letting the children go out to the taco truck or ride their bikes around the neighborhood. I know other divorced couples at each other’s throats because they have different danger thresholds. — Hugo Schwyzer, Hawthorne, Calif.
‘Space Attack!’
  • I was home-schooled in a fundamental evangelical household so I knew how much work this would be from the beginning. It’s all my worst nightmares at once. I’ve decided to tune out all the advice from my elders about how they kept their toddlers busy — when were their toddlers at home during a global pandemic? I’m just doing what makes sense to me right now. So I bought the kids a trampoline. We also created a code word: “Space Attack!” Whenever one of us says it, we all have to scatter so we don’t lose our tempers at each other. — Liz Ivkovich, Salt Lake City
‘Think like a team’
  • The first two weeks seemed easy, then everyone’s emotions became bigger, more sporadic, harder to manage. So we created space to just be with the feelings; more hugs, more new strategies, more self-care, more gratitude. We use prayers to motivate our kids (6 and 8) to reflect and be thankful. And a daily nap for both kids and grown-ups was a game changer! Think like a team. Help each other up like a team would. I’ve never been more thankful for my husband and our differences than right now. — Alison Elliott, Ontario, Canada
‘We don’t talk about the future’
  • Initially, I thought we could give our 7-year-old a more entertaining, well-rounded and meaningful education than he was getting at school, and that it would be fun. I am an idiot. Now we do the bare minimum and are thankful for distance learning. My younger son, 5, has a rare genetic disorder that makes him immune-compromised. This epidemic has been a frightening and perilous journey. We have seen him nearly die of respiratory infections at least three times in his life. If he gets Covid-19 there is no question in our minds that he will not survive. Playing games — Monopoly, Uno, Poker — helps us forget for a time that we’re huddling indoors, afraid.
  • And, for me, quiet intimacy with my wife after the kids are asleep, having more time to share thoughts, helps. We cook and drink expensive wines. We don’t talk about the future. Everything is so immediate these days, so moment to moment. But there is a freedom in that as well. — O. Gabriel Avila-Mooney, Seattle

Source: Opinion | Parenting During the Coronavirus: ‘I Have Given Up’

I. Practical Tips & Other Useful Information

1. WHO: That’s A Bad Idea  

  • Spraying disinfectant on the streets, as practiced in some countries, does not eliminate the new coronavirus and even poses a health risk, the World Health Organization warned on Saturday.
  • In a document on cleaning and disinfecting surfaces as part of the response to the virus, the WHO says spraying can be ineffective.
  • “Spraying or fumigation of outdoor spaces, such as streets or marketplaces, is … not recommended to kill the coronavirus or other pathogens because disinfectant is inactivated by dirt and debris,” explains the WHO.
  • “Even in the absence of organic matter, chemical spraying is unlikely to adequately cover all surfaces for the duration of the required contact time needed to inactivate pathogens.”
  • The WHO said that streets and pavements are not considered as “reservoirs of infection” of C19, adding that spraying disinfectants, even outside, can be “dangerous for human health.”
  • The document also stresses that spraying individuals with disinfectants is “not recommended under any circumstances.”
  • “This could be physically and psychologically harmful and would not reduce an infected person’s ability to spread the virus through droplets or contact,” said the document.
  • Spraying chlorine or other toxic chemicals on people can cause eye and skin irritation, bronchospasm and gastrointestinal effects, it adds.
  • The organization is also warning against the systematic spraying and fumigating of disinfectants on to surfaces in indoor spaces, citing a study that has shown it to be ineffective outside direct spraying areas.
  • “If disinfectants are to be applied, this should be done with a cloth or wipe that has been soaked in disinfectant,” it says.
  • However, no precise information is currently available for the period during which the viruses remain infectious on the various surfaces.
  • Studies have shown that the virus can stay on several types of surfaces for several days. However, these maximum durations are only theoretical because they are recorded under laboratory conditions and should be “interpreted with caution” in the real-world environment.

Source: Japan Times here

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