Coronavirus Update

Without reliable information, we rely on fear or luck.

Coronavirus Update 5-20

“Until either a proven vaccine is in our midst, or proven therapeutics are widely available, we cannot firmly enter the ‘new normal’ which eventually awaits us when life will once again return to all our workplaces, downtowns and main streets.”

New Jersey Governor Murphy

“I’m not sure why the governors of Maryland and New Jersey have opened their beaches, but they have.  I wouldn’t go. There are people there who aren’t wearing masks and you’re putting yourself at risk.” 

Pennsylvania Governor Wolf

“How many workers should give their lives to increase the GDP or the Dow by 1,000 points?”  

US Senator Sherrod Brown

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 5/19 Update

Sources: Worldometers

1. Confirmed Total Cases, New Cases and Tests

  • Worldwide:  
    • Total Cases = 4,982,937 (+1.9%)
    • New Cases = 91,607 (-0.5%) (-457)
    • New Cases (5 day avg) = 92,190 (-1.0%) (-945)
  • US: 
    • Total Cases = 1,570,583 (+1.3%)
    • New Cases = 20,289 (-10.3%) (-2,341)
    • New Cases (5 day avg) = 22,598 (-5.8%) (-1,391)
    • Number of Tests = 12,645,473 (+344,729)

2. Deaths

  • Worldwide Deaths = 324,554 (+1.4%) 
    • New Deaths = 4,420 (+22.3%) (+806)
    • New Deaths (5 day avg) = 4,474 (-7.1%) (-340)
  • US Deaths = 93,533 (+1.7%) 
    • New Deaths = 1,552 (+54.7%) (+549)
    • New Deaths (5 day avg) = 1,324 (-2.4%) (-33)
    • 5 Countries with Largest Number of Confirmed Deaths: 
CountryTotal DeathsDeaths per 1M Pop
US93,553 (+1,552)283 (+5) 
UK35,341 (+545)521 (+8)
Italy32,169 (+162)532 (+3)
France28,022 429
Spain27,778 (+69)594 (+1)
Worldwide324,554 (+4,589)41.6
  • 5 Countries = 66.8% of Worldwide Total Confirmed Deaths (-0.3%)
  • US = 28.8% of Worldwide Total Confirmed Deaths (+0%)
  • 5 States with Largest Number of Confirmed Deaths: 
StateTotal DeathsNew Deaths
(5-day avg)		Deaths per 1M Pop
New York28,648 (+168)244 (+6)1,473 (+9)
New Jersey10,591 (+143)129 (-15)1,192 (+16)
Massachusetts5,938 (+76)91 (-18)862  (+12)
Michigan5,017 (+102)46 (+6)502 (+10)
Pennsylvania4,751 (+83)91 (-13)371 (+6)
US93,533 (+1,552) 283 (+5)
  • 5 States = 58.7% of US Total Confirmed Deaths (-3.2%)
  • NY = 30.6% 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 = 30,799 (+422)
    • Deaths = 3,743 (+45)
    • New Deaths (5 day avg) = 43 (-10.1%) (-5)
    • Deaths per 1M population = 371 (+6) 
  • Below are 5 of the States moving quickly to reopen their economies (OK never locked down).   
StateTotal CasesTotal DeathsNew Deaths (5-day avg)Deaths per 1M Pop
Georgia38,855 (+572)1,675 (+26)26 (+0)158 (+3)
Florida46,944 (+502)2,052 (+55)35 (+1)96 (+3)
Texas50,672 (+988)1,402 (+33)29 (-1)48 (+1)
Ohio28,991 (+506)1,724 (+64)37 (+2)147 (+5)
Oklahoma5,489 (+91)294 (+6)2 (+0)74 (+1)
US1,570,583 (+20,289)93,533 (+1,552) 283 (+5)
  • 5 States = 10.9% of US Total Confirmed Cases (+0%)
  • 5 States = 7.6% of US Total Confirmed Deaths (+0.1%)

C. Vaccines

1. Why Do Vaccines Take So Long?  

  • Early news about medical treatments — like yesterday’s announcement that a coronavirus vaccine has shown positive results in eight people — can feel both exciting and frustrating.
  • The frustrating part is the timing. Even if all continues to go well with the research into this vaccine, it won’t be available until late this year or early next year. Between now and then, the vaccine will have to endure two more research trials, one involving hundreds of people and the other involving thousands.
  • Given the virus’s terrible toll, that long process can seem strangely lacking in urgency. But scientists insist that it isn’t. Here are the key reasons they say that there are no easy or fast routes to a vaccine:
  • Early results don’t always stand. In 2015, the French drug company Sanofi began selling the first vaccine for dengue. The drug had made it through multiple research trials — although some researchers believed Sanofi had ignored worrisome signs. Sure enough, as children in the Philippines began using it, some contracted an even worse form of dengue. Today, use of the vaccine is highly restricted.
  • In recent testimony, Dr. Anthony Fauci, the nation’s top infectious-disease expert, noted that a coronavirus vaccine could suffer from the same problem.
  • The larger point is that drugs that look good in small, initial studies often look less good when they’re tested in more people.
  • Side effects matter. A vaccine doesn’t merely need to work, as Katie Thomas, a Times reporter covering pharmaceuticals, explained to me. It needs not to have side effects that cause more damage than the virus itself.
  • This coronavirus seems to kill only a small percentage of people who get it. The side effects have the potential to do more damage, because any coronavirus vaccine will be given to billions of people, including many with underlying health problems.
  • Politics matter, too. Vaccines are the subject of frequent conspiracy theories and falsehoods. Given this skepticism, a coronavirus vaccine that did more harm than good could cause much broader damage.
  • It could lead people around the world to stop taking vaccines that actually work. That’s what happened in the Philippines after the dengue scandal.
  • All of which is a reminder that promising early results — like yesterday’s — often prove fleeting. Only about 10% of drugs that clear the first research phase ultimately make it to market.

Source: Why vaccines are so slow

D. New Scientific Findings & Research  

1. Coronavirus particles spread by talking can remain in the air for up to 14 minutes  

  • A recent study by researchers at the National Institutes of Health has found that particles of the coronavirus released by talking can remain in the air for 8 to 14 minutes, a warning sign that airborne transmission may be even more widespread than previously thought.  [Note: The study is entitled “The airborne lifetime of small speech droplets and their potential importance in coronavirus transmission”.]
  • While it’s been long accepted that coughing and sneezing can transmit respiratory viruses through droplets, it’s less known that just regular talking produces thousands of oral fluid droplets, the scientists behind the study said.
  • “There is a substantial probability that normal speaking causes airborne virus transmission in confined environments,” the research, published in last week’s edition of the peer-reviewed Proceedings of the National Academy of Sciences, concluded. 
  • “Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus are increasingly considered to be a likely mode of disease transmission,” the study found. 
  • And loud talkers present a bigger risk: “Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second,” it said.
  • While C19 is less deadly than SARS, it is far more easily transmitted, and scientists are still working to understand the extent to which it can be spread and how long it can survive. That data has huge ramifications for how we interact with one another and what kinds of spaces and activities are considered safe. 
  • The researchers used a closed, stagnant-air environment, and found that the droplets stop being visible after 8 minutes to 14 minutes, which they say “corresponds to droplet nuclei of ca. 4um (micrometers) diameter, or 12um to 21um droplets prior to dehydration.” One um, or micrometer, equals one millionth of a meter. The coronavirus is even tinier than that — a mind-bendingly small 0.125 um.
  • The velocity and length of time droplets stay in the air are also dependent on a range of factors, including the volume at which the speaker is talking, their age, and how dry their mouth is. 
  • Public transport and rooms with poor ventilation are considered high-risk areas for this kind of transmission. Scientific studies continue to produce new and sometimes varying findings on the fast-spreading coronavirus — scientists at Princeton University, UCLA and the National Institutes of Health reported in the New England Journal of Medicine that the virus could survive for up to three hours in the air “post aerosolization.”
  • And a team of researchers at the Academy of Military Medical Sciences in Beijing found that droplets can travel as far as 13 feet, meaning that many governments’ social-distancing recommendations of six feet may not be enough. Numerous variables can affect this, including air temperature and humidity.
  • States are grappling with this information as they try to balance reopening their economies after months of lockdown with ensuring the safety of their populations. The respiratory virus has infected more than 4.8 million people worldwide and killed more than 300,000.
  • Funding for the National Institutes of Health is primarily provided by the the annual Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act.

Source: Coronavirus spread by talking can remain in air, NIH researchers find

2. Six feet not far enough to stop virus transmission in light winds  

  • Airborne transmission of viruses, like the virus causing C19, is not well understood, but a good baseline for study is a deeper understanding of how particles travel through the air when people cough.
  • In a paper published in Physics of Fluids, Talib Dbouk and Dimitris Drikakis discovered that with even a slight breeze of 4 kph, saliva travels 18 feet in 5 seconds.
  • “The droplet cloud will affect both adults and children of different heights,” Drikakis said. “Shorter adults and children could be at higher risk if they are located within the trajectory of the traveling saliva droplets.”
  • Saliva is a complex fluid, and it travels suspended in a bulk of surrounding air released by a cough. Many factors affect how saliva droplets travel, including the size and number of droplets, how they interact with one another and the surrounding air as they disperse and evaporate, how heat and mass are transferred, and the humidity and temperature of the surrounding air.
  • To study how saliva moves through air, Dbouk and Drikakis created a computational fluid dynamics simulation that examines the state of every saliva droplet moving through the air in front of a coughing person. Their simulation considered the effects of humidity, dispersion force, interactions of molecules of saliva and air, and how the droplets change from liquid to vapor and evaporate.
  • The computational domain in the simulation is a grid representing the space in front of a coughing person. The analysis involved running partial differential equations on 1,008 saliva droplets and solving approximately 3.7 million equations in total.
  • “Each cell holds information about variables like pressure, fluid velocity, temperature, droplet mass, droplet position, etc.,” Dbouk said. “The purpose of the mathematical modeling and simulation is to take into account all the real coupling or interaction mechanisms that may take place between the main bulk fluid flow and the saliva droplets, and between the saliva droplets themselves.”
  • Further studies are needed to determine the effect of ground surface temperature on the behavior of saliva in air and to examine indoor environments, where air conditioning significantly affects the particle movement through air.
  • “This work is vital, because it concerns health and safety distance guidelines, advances the understanding of spreading and transmission of airborne diseases, and helps form precautionary measures based on scientific results,” said Drikakis.

Source: Six feet not far enough to stop virus transmission in light winds: study

3. C19 Patients Testing Positive After Recovery Aren’t Infectious  

  • Researchers are finding evidence that patients who test positive for the coronavirus after recovering aren’t capable of transmitting the infection, and could have the antibodies that prevent them from falling sick again.
  • Scientists from the Korean Centers for Disease Control and Prevention studied 285 C19 survivors who had tested positive for the coronavirus after their illness had apparently resolved, as indicated by a previous negative test result. The so-called re-positive patients weren’t found to have spread any lingering infection, and virus samples collected from them couldn’t be grown in culture, indicating the patients were shedding non-infectious or dead virus particles.
  • The findings, reported late Monday, are a positive sign for regions looking to open up as more patients recover from the pandemic that has sickened at least 4.8 million people. The emerging evidence from South Korea suggests those who have recovered from C19 present no risk of spreading the coronavirus when physical distancing measures are relaxed.
  • The results mean health authorities in South Korea will no longer consider people infectious after recovering from the illness. Research last month showed that so-called PCR tests for the coronavirus’s nucleic acid can’t distinguish between dead and viable virus particles, potentially giving the wrong impression that someone who tests positive for the virus remains infectious.
  • The research may also aid in the debate over antibody tests, which look for markers in the blood that indicate exposure to the novel coronavirus. Experts believe antibodies probably convey some level of protection against the virus, but they don’t have any solid proof yet. Nor do they know how long any immunity may last.
  • A recent study in Singapore showed that recovered patients from severe acute respiratory syndrome, or SARS, are found to have “significant levels of neutralizing antibodies” nine to 17 years after initial infection, according to researchers including Danielle E. Anderson of Duke-NUS Medical School.
  • Other scientists have found higher levels of IgM, an antibody that appears in response to exposure to an antigen, in children, according to an article published on medRxiv. That suggests younger populations have the potential to produce a more potent defense against C19. The study has not been certified by peer review.
  • “Under the new protocols, no additional tests are required for cases that have been discharged from isolation,” the Korean CDC said in a report. The agency said it will now refer to “re-positive” cases as “PCR re-detected after discharge from isolation.”
  • Some coronavirus patients have tested positive again for the virus up to 82 days after becoming infected. Almost all of the cases for which blood tests were taken had antibodies against the virus.

Source: Covid Patients Testing Positive After Recovery Aren’t Infectious, Study Shows

E. Technology Takes on the Coronavirus

1. Cell Phones May Be Able to Detect Coronavirus Within 60 Seconds 

  • Coronavirus could soon be detected by sneezing or coughing onto a phone, using a tiny sensor that will produce results within 60 seconds, according to reports.
  • University of Utah engineering professor Massood Tabib-Azar said he’s leading a team of researchers to develop a quarter-size device that can be plugged into the phone’s charging port and test saliva particles for the virus, Metro UK reported.
  • “If someone breathes, coughs, sneezes or blows on the sensor, it would be able to tell if they had C19,” Tabib-Azar told the outlet.
  • If the virus is present, there are DNA strands in the sensor that would bind to the virus proteins, which would trigger electrical resistance that signals a positive result, Tabib-Azar said.
  • “The sensor would change color or visually indicate the presence of C19 so it can be viewed with the naked eye,” Tabib-Azar said.
  • Tabib-Azir said the gadget could be available within three months since he already created a prototype of the sensor a year ago to help detect the mosquito-borne Zika virus.
  • “The plan is to program it to identify C19 instead,” said Tabib-Azir, who was awarded a $200,000 National Science Foundation Rapid Response grant to develop the new device, according to news station KTVX.
  • Tabib-Azir noted that the gadget could be produced inexpensively and would also be a less invasive way to test for the virus.
  • People are currently tested through a nasal swab where mucous is collected from the back of the nose and throat.
  • “I think it will help a lot with opening the country and giving people peace of mind that they are in a safe environment,” he told news station KSL-TV.

Source: Coronavirus could soon be detected by sneezing onto phone

F. Lockdowns vs. Reopenings

1. Viruses vs. Lockdowns: It’s Not About Tradeoffs  

By Michel Accad

Lockdowns should be opposed—not because of tradeoffs—but because they are antithetical to the economy, that is, to the good of society.

  • It is tempting to oppose the harmful effects of COVID-related lockdowns with arguments couched in terms of tradeoffs. 
  • We may contend that when public authorities promote the benefits of “flattening the curve,” they fail to properly take into account the actual costs of imposing business closures and of forced social distancing: the coming economic depression will lead to mass unemployment, rising poverty, suicides, domestic abuse, alcoholism, and myriad other potential causes of death and suffering which could be considerably worse than the harms of the pandemic itself, especially if we consider the spontaneous mitigation that people normally apply under the circumstances.
  • While I have no doubt that lockdown policies can and will have serious deleterious consequences, I believe that the emphasis on tradeoffs is misguided and counterproductive. It immediately invites a utilitarian calculus: How many deaths and how much suffering will be caused by lockdowns? How many deaths and how much suffering would occur without the lockdowns? How exactly are we to measure the total harm? What time frame should we consider when we ponder the costs of one option versus the other?
  • It’s easy to see that no one can have any firm answers to those questions. No one can convincingly make the case that one policy is better than the other on utilitarian grounds, which is what tradeoff language encourages us to do. That is especially true if we consider that lockdown policies are invariably modified in response to changing circumstances and aim toward ever shifting goalposts. 
  • This goes to the heart of Ludwig von Mises’s criticism of the empiricists and behaviorists of his day: they could only conceive of social phenomena in mechanical terms and failed to see that human action makes the planning of human affairs irreducible to predictive calculus. Things have not changed. Ludicrous presumptions hide behind mathematical wizardry and statistical modeling continues to rule. 
It’s All About The Economy
  • On what grounds, then, should we oppose lockdowns if not by calling attention to the great harms that will ensue?
  • It seems to me that lockdowns should be opposed not by arguing in terms of “quantity of harm,” but by pointing out that the only role for government—whether in pandemic times or not—is actually to promote the economy.
  • But we need to understand what the economy is to begin with.
  • In its broader, original meaning, the economy is not simply a sum total of exchanges of material goods and services among consumers, businesses, and governments, to be measured as a “GDP.” That is the concept that the utilitarians are accustomed to, and it’s how mainstream political philosophy conceives of the economy. Originally, however, the Greek term Oîkonomia meant “household affairs” and came to refer, by extension, to the entire life of the community as such. 
  • The reason to consider the life of the community as such is that the human being is, by nature, a social animal who depends essentially on the division of labor that takes place within an integrated and wholly interconnected society. We depend on the division of labor from the moment we are born: we need parents who can feed us, and our parents themselves need the specialized work of others to survive—specialized work that invariably crosses different generations. The division of labor forms a more or less tight-knit “political” community that promotes and defends the interests of its own members. That community may be a small primitive tribe or a huge nation-state, it is nevertheless one community engaged in the division of labor in its own unique way.
  • The division of labor, then, is not a matter of personal choice. Being connected to a community is not an option that one can choose to either engage in or refrain from. No one can live as an outcast. Even the hermit depends on others, and therefore on society. True ostracism is a death sentence, and involuntary partial ostracism (imprisonment) is a most severe punishment. The economy is as necessary to human life as oxygen or water are.
  • For that reason, the famous evolutionary sociobiologist E.O. Wilson has changed his perspective on the human race. He has taken the position that human beings are a “eusocial species,” whose members are totally dependent on a complex, intergenerational division of labor in much the same way that bees are dependent on other bees. Man is indeed a very social animal.
The True Common Good
  • The broad division of labor on which we all essentially depend amounts to far more than the accounting transactions that occupy the attention of professional econometricians. It includes the myriad ways in which we depend on others, ways which may be at once measurable yet uncountable, self-interested yet gratuitous. Understood properly, the economy points to the true common good, the good that unites us as the eusocial animals that we are. That true common good does not distinguish between “essential” and “nonessential” worker or activity. 
  • That understanding of the common good is a far cry from the perverted notion of it that dominates modern political thought: a stock of material goods or services to be taken from some and redistributed to others by the government according to “shared interests” and “rights.” We should be especially fearful of that notion given that the same government determines what those shared interests and rights are based on mechanistic, utilitarian norms—norms that invariably garner votes.
  • If the government’s role is to safeguard the true common good, then it should do so primarily by safeguarding the integrity of the society, in which the division of labor naturally takes place. Government acts properly when that integrity is threatened, either from within (by criminal activity) or from without (by outside invaders or aggressors). Its role is to deter or defend from those threats when private efforts cannot prevail. The role of government is not to defend or promote the particular goods of certain individuals. That’s an abomination! 
  • Even individual lives are not for the government to “save,” because efforts by the government to save the lives of some invariably infringe on the goods and sometimes on the lives of others. The saving of individual lives cannot possibly be a promotion of the true common good.
  • But does not the saving of lives help safeguard the integrity of society? 
  • Not really. To see this we must distinguish secondary effects from primary ones. For example, imagine that the police successfully intervene to stop Smith from murdering Jones. Did they act because the police has a mission to save Jones’s life? No. The primary effect of the police action is to protect the integrity of the community by putting Smith and his sociopathic behavior out of commission. It is not, per se, to save Jones’ life—even if he should be so lucky.
  • Likewise, when soldiers are deployed against an invading army, the primary aim is to defend the integrity of society. Military defense is not carried out primarily to save individual lives or reduce individual suffering: more lives might conceivably be lost and more individual suffering occasioned in the process of defending the country than if the country were to capitulate and allow the invader to take over.
Beware of Metaphors
  • Might one argue that a pandemic threatens the integrity of society precisely as a foreign invader would? Doesn’t the C19, then, warrant government action for that very reason?
  • I don’t believe so. Such an argument falls into the metaphorical trap of considering the C19 virus in martial terms. The virus is not an invader. It has no intention of destroying or taking over society. In fact, as Jörg Guido Hüllsman recently pointed out, it has no intention whatsoever. It is not even alive! To be sure, the coronavirus is a very dangerous and transmissible pollutant that can cause much harm and many deaths. But it is not, as such, a threat to the integrity of society.
  • It is the true economy and the integrity of society that the government should protect or promote. Lockdowns do the exact opposite. They fracture us, harm us, and weaken us all. If maintained long enough, they will disintegrate us. In the meantime, they undoubtedly obstruct our efforts to find the best way to respond to pandemics. They should be opposed—not because of tradeoffs—but because they are antithetical to the economy, that is, to the good of society.

Source: Viruses versus Lockdowns: It’s Not about Tradeoffs | Michel Accad

G. The Road Back?

1. Scientists propose a rolling cycle of 50 days on, 30 days off coronavirus lockdown strategies  

  • In an EU-backed study published on Wednesday, a cohort of researchers from nine countries simulated how various lockdown strategies would impact the spread of the coronavirus.
  • Many governments have imposed some form of lockdown to mitigate transmission of the virus. But policymakers around the world are now calculating ways to gradually lift those measures as the pandemic weighs heavily on economic activity.
  • Scientists suggested in the new report that an alternative, more effective approach to indefinite or milder lockdowns could be alternating stricter measures with intervals of relaxed social distancing. Effective testing, contact tracing and isolation strategies, as well as efforts to shield society’s most vulnerable, would be consistently kept in place.
  • They modeled several different scenarios on 16 countries, including Australia, Mexico, Belgium, South Africa and Nigeria.
  • In the first scenario, no mitigation or social-distancing measures were imposed. In every single country, this led to the number of patients requiring treatment in intensive care units (ICUs) quickly and significantly exceeding available capacity. Ultimately, this would result in 7.8 million deaths across the countries included in the analysis, researchers said, and the duration of the epidemic would be almost 200 days in the majority of those nations.
  • The second scenario modeled a rolling cycle of 50-day “mitigation measures” followed by a 30-day period where those measures were relaxed. Analysts defined mitigation measures as strategies that gradually reduced the number of new infections, such as social distancing, hygiene rules, isolating individuals with the virus, school closures and restricting large public events. These measures did not include a total lockdown.
  • This scenario was likely to reduce the R number — the reproduction rate of the virus — to 0.8 in all countries, the study showed. However, while it proved effective for the first three months, after the first relaxation period scientists found the number of patients requiring ICU care would exceed hospital capacities. This would lead to 3.5 million deaths across the 16 countries used in the simulation, with the pandemic lasting around 12 months in high income countries and at least 18 months in other nations.
  • Researchers also modeled a third scenario, which involved a rolling cycle of stricter “suppression measures” for 50 days followed by a 30-day relaxation period. Suppression measures were defined as those that led to a faster reduction in the number of new infections, achieved by applying strict lockdown measures on top of other mitigation measures.
  • In the third, most stringent scenario, the R number would be reduced to 0.5 and keep ICU demand within national capacity across all countries, scientists concluded. As more people would remain susceptible to catching the virus at the end of each cycle, however, the pandemic would be prolonged and last for more than 18 months in all countries.
  • But the C19 death toll during the pandemic would be significantly reduced in this scenario, with just over 130,000 deaths expected across the 16 countries included the analysis.
  • Researchers noted that individual countries would need to define for themselves how long the durations of the intervals would last to suit their domestic needs and facilities.
  • A continuous, three-month strategy of strict suppression measures would be the fastest way to end the pandemic, with most countries able to reduce new cases to near zero in this scenario, scientists said.
  • Meanwhile, if looser mitigation strategies were continuously applied, it would take just over six months for new cases to fall close to zero.
  • Rajiv Chowdhury, a global health epidemiologist at the University of Cambridge and the report’s lead author, said the third scenario — rotating strict suppression measures with relaxation periods — may allow populations to “breathe” at intervals.
  • “That might make this solution more sustainable, especially in resource-poor regions,” he said.
  • Oscar Franco, director of the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, added that the research provided a strategic option for countries to better control C19.
  • “There’s no simple answer to the question of which strategy to choose,” he said. “Countries — particularly low-income countries — will have to weigh up the dilemma of preventing C19 related deaths and public health system failure with the long-term economic collapse and hardship.”
  • The IMF has warned that the world is on course for the deepest recession since the 1930s thanks to the coronavirus pandemic, predicting that the global economy will contract by 3% this year.

Source: Study proposes 50 days on, 30 days off coronavirus lockdown strategy 

2. New online course trains thousands of C19 contact tracers  

  • The Association of State and Territorial Health Officials (ASTHO) and National Coalition of STD Directors (NCSD) said the agencies have trained over 10,000 individuals nationwide in C19 contact tracing.
  • The effort seeks to support ongoing state and local public health agencies in preparing new contact tracers in identifying C19 positive cases and those with whom they have been in close contact. ASTHO and NCSD have joined other national public health agencies in encouraging an immediate hire of at least 100,000 contact tracers and 10,000 Disease Intervention Specialists to meet the C19 contact tracing need while also rebuilding the American workforce.
  • “We are thrilled by the overwhelming response from so many individuals across the country who want to be part of the C19 contact tracing efforts happening in their communities,” Michael Fraser, CEO of ASTHO, said. “Contact tracing is critical to our nation’s C19 response, and we know that this course will continue to supplement the efforts underway in cities and states to quickly on-board new contact tracers and help meaningfully bend the curve of C19 infection.”
  • NCSD Executive Director David C. Harvey said the program is preparing thousands of new contact tracers to go out into communities to fight the spread of C19 and break the chain of infection.
  • “Contact tracing has been used for decades to combat infectious disease outbreaks in the U.S. and around the world,” Harvey said. “No matter your professional background, you can be trained to do this work.”

Source: New online course trains thousands of COVID-19 contact tracers

3. MTA rolling out 230 virus-killing UV lamps on NYC Subways and Buses  

  • The MTA is rolling out a new weapon in its battle to keep the city’s buses and trains clean during the C19 pandemic — coronavirus-killing ultraviolet lamps.
  • The agency will roll out 230 far ultraviolet-C lamps next week on select trains, buses and agency facilities, MTA Chairman Pat Foye said Tuesday.
  • “These UV lights that we have on site today efficiently kill the virus that causes C19,” Foye said before a demo at the Corona yard in Queens.
  • “We believe this is a big deal for the MTA — for our customers and employees, and the future of our system.”
  • The lamps will be used out of view of straphangers — in yards and depots and during overnight station closures, the MTA said.
  • Foye said the decision to advance the pilot comes after months of tests by the MTA and Dr. David Brenner, a professor of radiation biophysics and director of the Center for Radiological Research at Columbia University.
  • Manhattan’s popular Magnolia Bakery is also working with Columbia to test out the tech, known as “far-UVC” for short, its owners told The Post Monday.
  • While normal ultraviolet light is harmful to humans, the gentler far-UVC is not, according to Brenner.
  • Brenner and his team have tested the tech on lab rats for eight months and found no detrimental impact, he said earlier this week.
  • Special type of ultraviolet light could kill flu virus in public places
  • The cash-strapped agency is paying PURO Lighting $1 million for the lamps.
  • If the MTA decides to expand the program system-wide, PURO will have to bid against other companies for a long-term contract, Foye said.
  • He emphasized that the lamps are just one piece of a large virus-fighting strategy.
  • Earlier this month, the MTA instituted a nightly shutdown to allow for frequent cleaning. And Foye has suggested straphangers may even need to pre-book trips via a Ticketmaster-style service to keep crowds down in the future.
  • “I don’t want to mislead everybody into thinking this is a cure-all. There is significant work to be done,” Foye told reporters.

Source: MTA rolling out virus-killing UV lamps on NYC subways and buses

H. Updates

1. FDA warns Abbott ID NOW test for C19 may give inaccurate results  

  • Another C19 test is being investigated for faults, resulting in the FDA to warn people that the Abbott ID NOW point-of-care test may return inaccurate, false negative results.
  • The warning stems from some scientific studies that have identified accuracy issues in the test. The FDA is examining whether this is due to the types of swabs used or the type of material used to transport patients’ specimens. 
  • The FDA acknowledged that no diagnostic test would be 100% accurate. However, the studies raising alarms have a variety of limitations themselves, including small sample sizes, potential design biases, or tests that may not have been executed according to the manufacturer’s instructions for use.
  • “We are still evaluating the information about inaccurate results and are in direct communications with Abbott about this important issue,” Dr. Tim Stenzel, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health, said. “We will continue to study the data available and are working with the company to create additional mechanisms for studying the test. This test can still be used and can correctly identify many positive cases in minutes. Negative results may need to be confirmed with a high-sensitivity authorized molecular test.”
  • In its examinations, the FDA is working with Abbott to analyze the information gathered. Abbott is currently working on a customer notification letter to alert users that their negative test results may not be consistent with their symptoms, signs, or actual health — and may need to be confirmed with another test. To ensure the test’s accuracy, the FDA will weigh sources and chart potential patterns or significant issues. Whatever it finds, Abbott has agreed to conduct post-market studies for its ID NOW device with at least 150 C19 positive patients in various clinical settings.
  • Total, the FDA has so far received 15 adverse reports regarding the Abbott ID NOW device.

Source:  FDA warns Abbott ID NOW test for COVID-19 may give inaccurate results

2. Were Results of Moderna’s Vaccine Overhyped?  

  • Heavy hearts soared Monday with news that Moderna’s C19 vaccine candidate — the frontrunner in the American market — seemed to be generating an immune response in Phase 1 trial subjects. The company’s stock valuation also surged, hitting $29 billion, an astonishing feat for a company that currently sells zero products.
  • But was there a good reason for so much enthusiasm? Several vaccine experts asked by STAT concluded that, based on the information made available by the Cambridge, Mass.-based company, there’s really no way to know how impressive — or not — the vaccine may be.
  • While Moderna blitzed the media, it revealed very little information — and most of what it did disclose were words, not data. That’s important: If you ask scientists to read a journal article, they will scour data tables, not corporate statements. With science, numbers speak much louder than words.
  • Even the figures the company did release don’t mean much on their own, because critical information — effectively the key to interpreting them — was withheld.
  • Experts suggest we ought to take the early readout with a big grain of salt. Here are a few reasons why.
The silence of the NIAID
  • The National Institute for Allergy and Infectious Diseases has partnered with Moderna on this vaccine. Scientists at NIAID made the vaccine’s construct, or prototype, and the agency is running the Phase 1 trial. This week’s Moderna readout came from the earliest of data from the NIAID-led Phase 1.
  • NIAID doesn’t hide its light under a bushel. The institute generally trumpets its findings, often offering director Anthony Fauci — who, fair enough, is pretty busy these days — or other senior personnel for interviews.
  • But NIAID did not put out a press release Monday and declined to provide comment on Moderna’s announcement.
The n = 8 thing
  • The company’s statement led with the fact that all 45 subjects (in this analysis) who received doses of 25 micrograms (two doses each), 100 micrograms (two doses each), or 250 micrograms (one dose) developed binding antibodies.
  • Later, the statement indicated that eight volunteers — four each from the 25-microgram and 100-microgram arms — developed neutralizing antibodies. Of the two types, these are the ones you’d really want to see.
  • We don’t know results from the other 37 trial participants. This doesn’t mean that they didn’t develop neutralizing antibodies. Testing for neutralizing antibodies is more time-consuming than other antibody tests and must be done in a biosecurity level 3 laboratory. Moderna disclosed the findings from eight subjects because that’s all it had at that point. Still, it’s a reason for caution.
  • Separately, while the Phase 1 trial included healthy volunteers ages 18 to 55 years, the exact ages of these eight people are unknown. If, by chance, they mostly clustered around the younger end of the age spectrum, you might expect a better response to the vaccine than if they were mostly from the senior end of it. And given who is at highest risk from the coronavirus, protecting older adults is what C19 vaccines need to do.
There’s no way to know how durable the response will be
  • The report of neutralizing antibodies in subjects who were vaccinated comes from blood drawn two weeks after they received their second dose of vaccine.
  • Two weeks.
  • “That’s very early. We don’t know if those antibodies are durable,” said Anna Durbin, a vaccine researcher at Johns Hopkins University.
There’s no real way to contextualize the findings
  • Moderna stated that the antibody levels seen were on a par with — or greater than, in the case of the 100-microgram dose — those seen in people who have recovered from C19 infection.
  • But studies have shown antibody levels among people who have recovered from the illness vary enormously; the range that may be influenced by the severity of a person’s disease. John “Jack” Rose, a vaccine researcher from Yale University, pointed STAT to a study from China that showed that, among 175 recovered C19 patients studied, 10 had no detectable neutralizing antibodies. Recovered patients at the other end of the spectrum had really high antibody levels.
  • So though the company said the antibody levels induced by vaccine were as good as those generated by infection, there’s no real way to know what that comparison means.
  • STAT asked Moderna for information on the antibody levels it used as a comparator. The response: That will be disclosed in an eventual journal article from NIAID, which is part of the National Institutes of Health.
  • “The convalescent sera levels are not being detailed in our data readout, but would be expected in a downstream full data exposition with NIH and its academic collaborators,” Colleen Hussey, the company’s senior manager for corporate communications, said in an email.
  • Durbin was struck by the wording of the company’s statement, pointing to this sentence: “The levels of neutralizing antibodies at day 43 were at or above levels generally seen in convalescent sera.”
  • “I thought: Generally? What does that mean?” Durbin said. Her question, for the time being, can’t be answered.
  • Rose said the company should disclose the information. “When a company like Moderna with such incredibly vast resources says they have generated SARS-2 neutralizing antibodies in a human trial, I would really like to see numbers from whatever assay they are using,” he said.
Moderna’s approach to disclosure
  • The company has not yet brought a vaccine to market, but it has a variety of vaccines for infectious diseases in its pipeline. It doesn’t publish on its work in scientific journals. What is known has been disclosed through press releases. That’s not enough to generate confidence within the scientific community.
  • “My guess is that their numbers are marginal or they would say more,” Rose said about the company’s SARS-2 vaccine, echoing a suspicion that others have about some of the company’s other work.
  • “I do think it’s a bit of a concern that they haven’t published the results of any of their ongoing trials that they mention in their press release. They have not published any of that,” Durbin noted.
  • Still, she characterized herself as “cautiously optimistic” based on what the company has said so far.
  • “I would like to see the data to make my own interpretation of the data. But I think it is at least encouraging that we’ve seen immune responses with this RNA vaccine that we haven’t seen with previous RNA vaccines for other pathogens. Whether it’s going to be enough, we don’t know,” Durbin said.
  • Moderna has been more forthcoming with data on at least one of its other vaccine candidates. In a statement issued in January about a Phase 1 trial for its cytomegalovirus (CMV) vaccine, it quantified how far over baseline measures antibody levels rose in vaccines.

Source: Vaccine experts say Moderna didn’t produce data critical to assessing Covid-19 vaccine 

I. Reopenings: Progress & Setbacks

1. Georgia’s C19 hospitalizations drop by a third  

  • In Georgia, current statewide hospitalizations for C19 dropped by about a third in the last two weeks, according to an Atlanta Journal-Constitution analysis of data published by the Georgia Emergency Management & Homeland Security Agency. [Note: Gov. Kemp began reopening the state on April 24, which was 25 days ago.]
Source: GA Department of Health; GEMA — GA Situation Report COVID-19
  • [NOTE: According to the IHME predictive model, current hospitalization usage was predicted to be 978 beds and the actual usage was 986. Also, according to IHME, the total number of beds available in GA are expected to be 8,323. After 25 days of reopening the state, current hospitalizations are only 11.75% of capacity]
  • The decline is significant, but it does not mean that infections are down since Georgia began to re-open at the end of April. There is about a two week lag between when a person is infected, shows symptoms, is admitted to the hospital, gets tested and receives the results. 
  • A press release from Gov. Brian Kemp said there were 986 patients currently hospitalized as of 1 p.m. Tuesday, which was an important milestone for the state. It was the lowest number of patients hospitalized since hospitals started reporting data to GEMA on April 8, it said.
  • “We’ve got to keep our foot on the gas. What we’re doing is working,” Kemp said on The Erick Erickson Show on WSB Atlanta’s News & Talk.
  • An AJC analysis found hospitalizations for the novel coronavirus stood at just above 1,025 as of 7 p.m. Monday, according to GEMA’s latest daily situation report. It was 1,500 as of May 2, the date that GEMA first reported the measure publicly. 
  • Prior to that, the agency was publishing daily cumulative hospitalization figures. The AJC is now tracking current hospitalizations on its C19 data dashboard to give readers a clearer picture of coronavirus in Georgia. The tracker uses GEMA’s daily figures, which are based on 7 p.m. reports. [NOTE: The current GEMA Georgia Situation Report C19 can be found here: https://gema.georgia.gov/emergencies-0/coronavirus] 
  • Kemp downplayed criticisms in recent weeks that confusing or incorrect coronavirus data published by the Georgia Department of Public Health have harmed the public’s trust in the information the state is releasing.
  • “It’s really not a big issue. People trust the data. I certainly do,” Kemp said. GEMA began to publish current COVID hospitalizations on its daily situation report to give the public a better idea of the availability of hospital resources, a spokesperson for the agency said. It gets its figures from DPH. It does not include those hospitalized who are being investigated for suspected novel coronavirus infections. Experts agree that Georgia’s April lockdown slowed the spread of the virus successfully. They also expect cases and deaths to rise in the coming weeks now that the state’s shelter-in-place order has been lifted and more people are venturing from the safety of their homes.

Source: Georgia’s COVID-19 hospitalizations drop by a third, state’s data shows

K. Projections & Our (Possible) Future

1. 9 ways C19 may forever upend the U.S. health care industry  

  • In the U.S. alone, C19 has claimed nearly 100,000 lives and 30 million jobs. Beyond grinding day-to-day life to a halt, the pandemic has prompted a reckoning throughout the country’s health care infrastructure, shattering decades-old assumptions about how Americans conceive of medicine, and the doctors, hospitals, insurance companies, and pharmaceutical manufacturers they pay to provide it.
  • Already, the coronavirus has led to sweeping changes in who can receive care and how they access it. Millions of Americans, newly out of work, are also newly uninsured. Millions more who still have insurance have been forced to delay necessary but noncritical treatments. At the same time, doctors across the country have been granted broad flexibility to treat patients remotely, using telemedicine, instantly reshaping services ranging from routine checkups to addiction treatment.
  • STAT surveyed a host of prominent health policy experts — top health advisers to both Republican and Democratic presidents, lawmakers, executives, physicians, and top lobbyists  — who forecast a new status quo that they say will upend what American health care looks like for decades.
  • Among their predictions: The pandemic could help bring about an end to the American tradition of tying health insurance to employment status. It could prompt a reckoning about why Black people and other historically marginalized populations have long suffered so disproportionately — not just from C19, but from nearly every common health condition. And it could represent the beginning of the end for the very concept of nursing homes and assisted living facilities.
  • Below, STAT lays out nine ways in which the coronavirus pandemic is likely to forever change health care, the policies that guide it.
#1. How C19 has accelerated telemedicine ‘by a decade’:
  • Health care providers in the U.S. have been inching toward making more services available via telehealth for years. But health care leaders across the ideological spectrum agree: C19 has pushed the inevitable telemedicine revolution forward by a decade, if not more, according to health care leaders.
  • Chris Jennings, policy consultant and former health care adviser to the Obama and Clinton administrations: “There’s the assumption in primary care that you always had to have in-person contact, and that telemedicine would be unsatisfactory, or wouldn’t fill the void. That’s been exposed — actually, it’s safer, it’s quicker, and it’s easier. If I just have a quick question, I want to see someone and engage them and see their focus is on me. But do I have to be in that office? And for a physician, can I get more things done, be more efficient, and protect myself, as well as my patients? People are now seeing this model, which we thought would take years and years to develop. And it’s probably been accelerated by a decade.”
  • While the changes are most broadly relevant to primary care, other experts said the same trend is increasingly applicable to specialists. From addiction doctors prescribing drugs to treat opioid dependency after video chat visits to podiatrists using cameras to treat patients with diabetes, thanks to C19 physicians across the country are providing care that, until now, was thought to only be feasible in person.
  • Karen Ignagni, president of the nonprofit health plan EmblemHealth and former CEO of the insurance lobbying group AHIP: “The convenience factor of being able to talk to your clinician via video conference, or even text, is something that we haven’t internalized as a country until recently. I can speak from the perspective of the specialists in our medical group: Podiatrists are learning, for routine maintenance of checking the feet of diabetics, to ask our diabetic patients to put the camera near their feet, so they can properly space their toes, so they can properly look at their feet. One could suggest it’s not as great as being there in person. But in the past, people would likely not have had that option at all.”
#2. Another step away from traditional employer-based health insurance
  • In a floundering economy, employers will be under more pressure than ever to reduce costs. Some conservative thinkers see it as a chance to bolster the prominence of health reimbursement arrangements, or HRAs, in which employers reimburse employees for medical expenses and in some cases, insurance premiums — in place of  providing insurance to employees as a company. Proponents say HRAs offer employees more flexibility, but detractors caution that they often offer employees less help with their medical costs than under traditional employer-based insurance.
  • Brian Blase, former Trump administration health care adviser and health policy consultant: “Employers are going to look to HRAs as a potential way to get more certainty over their costs, and basically say: All right, we can afford $4,000 per employee for health insurance in a year, so we’re going to give employees $4,000 for health insurance and let them go shop for coverage that works best for them. I see HRAs as politically viable — it’s the only big thing I worked on when I was in the administration that didn’t get sued by attorneys general or by liberal groups, and there’s no love for traditional employer coverage.”
  • Many progressives, of course, see things differently. But there’s agreement across the ideological spectrum — 30 million newly unemployed Americans, and scores of others who worry they’ll lose their job and their health care with it — have made traditional models of employer-based health insurance less relevant than ever.
  • Don Berwick, former administrator Centers for Medicare and Medicaid Services during the Obama administration: “You notice the number of band-aids that Congress is having to apply to help people who have lost their jobs. It’s interesting to me: Amid C19, the only people in America who don’t have to worry about their health insurance are people on Medicare, or people covered by the Department of Veterans Affairs or the Military Health System. What we have now is a whole series of band-aids and special measures. What if instead, we just had universal health insurance?”
#3. Out with nursing homes and assisted living facilities — and in with home health aides
  • In most states, deaths in nursing homes and other long-term care facilities have accounted for over one-third of C19 fatalities. It’s a disturbing statistic that some experts say could finally flip modern-day thinking about long-term care on its head. While assisted living or nursing facilities can provide consolidated services and around-the-clock medical care, the idea that society’s most vulnerable should be housed in such close quarters may have forever lost its appeal.
  • Grace-Marie Turner, president of the Galen Institute, a conservative health policy research group: “I served on the Medicaid Commission 10 years ago. It was so obvious that the last place that anybody wants to go is a nursing home — and this was before the coronavirus. People want their own independent life. Now, they don’t want to be in what’s basically a nursing-home prison, as some have called it, because they’re locked up, they can’t leave, and nobody can come see them — it might as well be a jail. There are going to be major changes, particularly with an aging baby boom, with so many tens of millions of people who are going to need longer-term care and do not want to go to a nursing home. So how’s the private sector going to respond?”
  • Such a shift, however, could lead to a staggering increase in demand for home health aides, house calls, and in-person medical services delivered to elderly Americans with significant needs but who, understandably, have little interest in living in such close quarters with dozens or hundreds of others.
  • Billy Tauzin, former Republican congressman from Louisiana and former president of PhRMA: “I think there’s going to be a major shift in terms of support for the nursing care industry in America, and toward home care. The notion that seniors would prefer to be in their homes has always been around. We used to raise our grandparents in our homes — I remember my grandparents used to live right next to me, and we took care of them. We even had a buzzer system in our home when our grandparents needed help.”
#4. An inflection point on racial disparities
  • Black people represent 6% of Wisconsin’s population — but account for nearly half of the state’s coronavirus deaths. Black people, similarly, account for two-thirds of Chicago’s deaths despite constituting only one-third of its population. Across the country, the story is the same: C19 is killing people of color, particularly Black people, at staggeringly disproportionate rates.
  • To longtime observers of the U.S.’s health care system, the numbers are hardly surprising. But there’s hope among some experts that the tragedy could prompt a long-overdue reckoning about health disparities and the social determinants of health. The differences in coronavirus death rates between white and Black people in the U.S., many argued, are too dramatic, and too immediate, to ignore.
  • Risa Lavizzo-Mourey, former president, Robert Wood Johnson Foundation and professor of health policy at the University of Pennsylvania: “The stark disparities in C19 infection rates and outcomes among different populations and different parts of the country has been hard to ignore. While there’s a rich body of work that has demonstrated this in the past, it’s a unique moment where it’s happening all at once, and you can see it in real time. I think that the moment is one that hopefully will sort of force us to address some of the potential policy solutions.”
  • Berwick: “Anyone who’s been studying equity and justice in health care knows that the vulnerabilities have been there — this has always been true. But C19 has kind of underlined it, made it more visible. My feeling is: For Pete’s sake, can’t this country finally get serious about closing racial and socioeconomic gaps in access to health care and health status and being able to lead a good life?”
  • Georges Benjamin, executive director for the American Public Health Association: “We have to recognize that inequities still exist. Why do we think it’s going to be any different when we get a vaccine or antiviral agent? We need a plan now to make sure that those existing disparities are not exacerbated by inadequate access to treatment or access to vaccines. We have to pay attention to that now, and make sure we plan.”
#5. Yet another reckoning on drug affordability, with a chance for pharma to rehab its reputation
  • For years, politicians ranging from Sen. Bernie Sanders (I-Vt.) to President Trump have blasted major pharmaceutical companies as profiteers. But C19 has flipped the script: Never before has the public placed such pressure on drug companies to develop, at a breakneck pace, treatments and vaccines to guard against the novel coronavirus. Already, two major U.S. drug companies have made strides toward approvals for a therapeutic and a vaccine: Gilead Sciences and Moderna, respectively. Some experts see the pandemic as a chance for the pharmaceutical industry to rehab its reputation in Washington, and for drug companies to showcase their vast research and development capabilities.
  • In addition to those questions about pharma’s reputation, experts said the pandemic would also raise new questions about how the U.S. prices drugs. Some Democratic lawmakers have advocated for NIH to reexamine its mandate to license potential drug candidates to companies that will make them available on “reasonable terms” — and to interpret “reasonableness” more narrowly. They say the C19 pandemic could provide unprecedented leverage for the government to finally exercise negotiating power.
  • But NIH and its director Francis Collins have long said the agency isn’t in a position to enact drug pricing constraints.
  • Tauzin: “People love [pharma] when they produce a product that takes care of their problem. When we get a cure for hepatitis C, we love the idea that we can now cure — not just treat, but cure — hepatitis C. We hate the idea that it costs so damn much. That’s always going to be the equation.”
  • More broadly, with millions of Americans newly out of work, high drug prices could pose a bigger barrier to care than ever before — even if the public gives the pharmaceutical industry some credit for scrambling to develop cures and vaccines.
  • Sheila Burke, former chief of staff to onetime Senate majority leader Bob Dole (R-Kan.) and former executive dean of Harvard’s Kennedy School of Government: “It’s been interesting to see issues at the top of the list six or eight months ago, like drug pricing and surprise billing, disappear in the coronavirus discussions. I think drug pricing will continue to be an issue even after the pandemic subsides, particularly with people now under more economic strain and essentially having to foot the bill. Will there be some forgiveness on prices because of the moves to scale up production of a vaccine, or whatever it might be? Yes, but there will still be growing sensitivity and concern, and real desire to resolve this question of what should be the right structure of the pricing mechanism.”
#6. American drugs, made once again in American factories
  • Janet Woodcock, a top official at the Food and Drug Administration, has already pointed to C19’s potential to “revitalize drug manufacturing in the U.S.” — a step Democrats and Republicans alike have called for amid concerns that, as China entered a national lockdown in early 2020, its shuttered factories could cause shortages for drugs and other critical medical supplies in North America.
  • Rep. Donna Shalala, Democratic congresswoman from Florida and former Clinton administration health secretary: “In the 1990s, I was so worried about the possibility of a flu pandemic, and that we weren’t making the flu shots, the vaccines, in the United States. I actually moved the vaccine production to the U.S. and did a huge contract with a company in Pennsylvania. … We have to look, fundamentally, at the supply chain. It doesn’t mean that we don’t believe in a global market, but it does mean that we have to be able to ramp up production here quickly, and do some of the manufacturing here so that we can ramp up production.”
  • It’s a school of thought that, since the start of the C19 pandemic, has become surprisingly bipartisan — Republicans and Democrats have historically differed both on free-trade issues, and GOP figures have been far more aggressive in blaming China for the initial coronavirus outbreak more broadly. Similarly, many Republicans have used far harsher words than Shalala to characterize the U.S. biomedical supply chain’s reliance on China. Sens. Marsha Blackburn (R-Tenn.) and Bob Menendez (D-N.J.) introduced legislation advocating for the U.S. to become less reliant on both China and India for pharmaceutical manufacturing capacity.
  • Turner: “You’re going to see that more companies will do what Pfizer already has done, and that’s bring more of their manufacturing capability into the United States — or at least diversify it away from China. That’s almost inevitable. I think people should be looking at all those Harvard MBAs who, for the last 20 years, have been saying, ‘Oh, move all your manufacturing to China, it’s a lot cheaper,’ and maybe had to rethink that.”
#7. A new era of health care preparedness
  • C19 has already prompted calls for a dramatic scaling up of the country’s disaster readiness workforce. By consensus, America’s health care infrastructure wasn’t ready for the pandemic — at first incapable of conducting testing and later short on the workforce required to carry out the Herculean task of contact-tracing tens of thousands of new C19 cases per day.
  • There are several proposals to increase the health care workforce in times of emergency. A bill from House Democrats would fund a $75 billion contact-tracing workforce through which hundreds of thousands of Americans use shoe-leather epidemiology to track C19’s spread. Other ideas have focused on creating networks of retired doctors, once-trained practitioners who no longer work in medicine, and even advanced medical students participate in the medical equivalent of a National Guard.
  • Shalala: “The federal government needs to have real plans for how they can find health personnel to augment during an infectious disease disaster. And one way of doing that is for the federal government to develop a reserve corps in every part of the United States that’s ready and able to come back in emergencies. They can be a wide variety of people, including the possibility of taking a look at foreign medical graduates, and maybe upgrade their training so they could be brought back under doctor’s supervision.”
  • Burke: “I don’t think the U.S. Public Health Service Commissioned Corps, which is spectacular, will ever be adequate. Contact tracing is a perfect example: You’re going to have to scale up extraordinarily large numbers of people. And these aren’t necessarily people who are MDs or nurse practitioners or physicians’ assistants. They are classic public health workers who can do that basic kind of work. Much like the last time we went through this extraordinary economic disaster, we found things for people to do — instead of building bridges, maybe they do contact tracing.”
#8. Allowing non-physicians, like nurses, nurse practitioners, and physician assistants to play a bigger role in care
  • The coronavirus pandemic has placed immense pressure on emergency rooms and intensive care units, highlighting the immense role of nurses, nurse practitioners, and physician assistants.
  • The phenomenon is compounded by a reality that predates C19 by decades: Rural hospitals across America are struggling to stay afloat, and many practices could provide care at lower cost to more patients by leaning more heavily on the nondoctor medical practitioners already on their payrolls — if Congress, state legislatures, and state medical boards, which have varying powers over scope-of-practice rules, let them.
  • Shalala: “Frankly, 70% of primary care could be handled by advanced practice nurses.”
  • Tauzin: “You’re going to see a shift toward more authority for skilled nurse training and skilled nurse activities in health care, as family doctors become more scarce and hospitals in parts of our country are shutting down. That’s going to be a major shift to decentralize health care, and toward preventive care and home care.”
#9. Who makes money in health care — and how they make it
  • While there’s immense demand for coronavirus treatment, there’s almost no demand for any other health service — meaning that many doctors’ and hospitals’ revenue streams have taken a nosedive. Hospitals and physician practices across the country have laid off support staff and cut wages or benefits for their staff doctors.
  • That dynamic could eventually upend the traditional American model of paying for health care services in individual line items, known as fee-for-service medicine, the experts said. Other payment structures — under which a hospital might be paid a lump sum for caring for an entire group of patients, or compensated for keeping a patient healthy and avoiding an unnecessary readmission, for example — had previously been met with mixed interest, since they forced providers to accept some responsibility for keeping costs down.
  • Jennings: “We’ve seen physician offices that live off fee-for-service just get freakin’ killed, because you can’t bill for services you’re not providing. What physicians are also noticing is that for those few practices that had per capita contracts, and had guaranteed payment structures, they’re surviving and thriving. They’re learning that the risk factor they’re so worried about goes both ways. There are benefits to that guaranteed, per capita contract, and that’s never been really understood — but now it is. Now the question is whether enough practices see it and digest it, and whether it will have applications.”

Source: 9 ways Covid-19 may forever upend the US health care industry 

Annex I: John Hopkins Daily C19 Updates

May 19, 2020

EPI UPDATE The WHO C19 Situation Report for May 18 reports 4.62 million confirmed cases (93,324 new) and 311,847 deaths (4,452 new).

Brazil continues its accelerating trend, reporting 13,140 new cases, its fourth highest daily incidence to date. Brazil is currently reporting the second most new cases daily, following only the United States, and it has reported its 5 highest daily totals over the past 6 days. Nearly a quarter of Brazil’s cases are in the state of São Paulo, more than double the total from any other state, but the state also represents 22% of Brazil’s total population. Brazil’s daily per capita incidence (56.5 new cases per million population) has almost reached that of the United States (65.7), and it is exhibiting an overall increasing trend, whereas the United States appears to be on the decline.

Russia reported 9,263 new cases, continuing its recent trend of elevated incidence, and it will surpass 300,000 cases in its next update. India reported 5,970 new cases, posting its 3 highest daily totals over the past 3 days. The state of Tamil Nadu, where a large outbreak has been linked to one of Asia’s largest markets, reported 536 new cases.

Singapore reported 451 new cases, including 450 (99.8%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing C19 epidemic. Singapore estimates that the cases confirmed so far represent 8.22% of the total population across all migrant worker dormitories, compared to only 0.03% of the general public population. Of the 28,794 total C19 cases reported in Singapore, 26,541 (92.2%) are among residents of migrant worker dormitories.

UNITED STATES

The US CDC reported 1.48 million total cases (13,284 new) and 88,709 deaths (698 new). A day after reporting its highest daily incidence since April 25, the CDC reported the lowest daily total since March 24. Monday and Tuesday updates are typically low due to reporting delays over the weekend, but yesterday was the fourth consecutive Monday with decreasing incidence compared to the previous week. After such a low incidence reported yesterday, the United States may not reach 1.5 million cases until Wednesday’s update. In total, 9 states (no change) reported more than 40,000 cases, including New York with more than 325,000; New Jersey with more than 125,000; and California, Illinois, and Massachusetts with more than 75,000. The CDC removed information about the degree of transmission reported in each state from its C19 data website.

The New York Times continues to track state-level C19 incidence, with a focus on state policies regarding social distancing. This tracker has been updated to differentiate between states that have relaxed social distancing measures statewide and those that have done so on a regional basis. After holding relatively steady for several weeks—approximately April 7-26—Texas has reported increasing incidence over the past 3 weeks, including a record high daily incidence (1,801 new cases) on May 16. Texas’ “stay at home” order expired on April 30, and non-essential businesses, including restaurants, barber shops/salons, retail stores, gyms, and movie theaters were permitted to reopen. Texas’s C19 incidence was beginning to increase when the statewide order expired, and it has continued that trend in the weeks since. Texas also reported its 2 highest daily death totals on May 14 and 15—58 and 56 new deaths, respectively. Notably, Texas’ testing capacity has increased as well, more than doubling since the “stay at home” order expired. The positivity ratio decreased over that time, from approximately 6% to 4.5%. 

The Johns Hopkins CSSE dashboard is reporting 1.52 million US cases and 90,994 deaths as of 1:30pm on May 19.

LOS ANGELES SEROLOGICAL STUDY A research letter published in The Journal of the American Medical Association (JAMA) describes a study that evaluated the seroprevalence of SARS-CoV-2-specific antibodies adults in April 2020. Based on tests performed on 865 individuals, the researchers estimate that approximately 4.65% of the Los Angeles population would have antibodies against SARS-CoV-2, which would total approximately 367,000 individuals. At the time of the study, Los Angeles had reported a total of 8,430 confirmed cases, which suggests that there could potentially be more than 40 unidentified infections in Los Angeles for every confirmed case.

PRESIDENT TRUMP TAKING HYDROXYCHLOROQUINE US President Donald Trump shared yesterday that he has been taking a daily dose of hydroxychloroquine for the past few weeks. President Trump’s physician issued a statement that suggests that he prescribed the treatment course, citing its “potential benefit,” but it does not explicitly state that the President has been prescribed or is taking the drug. especially in light of recent news about potential SARS-CoV-2 exposures within White House staff. The announcement prompted a response from health experts across the country warning that the drug has not yet demonstrated an effect in treating or preventing C19 and emphasizing that its use is associated with potentially severe adverse effects.

A report published yesterday by STAT News describes how widespread use of hydroxychloroquine in Utah necessitated drastic changes in state policy following high rates of adverse events. After initially placing large a order in order to establish a stockpile of the drug, the state “abandoned its plans to make the drugs available without prescriptions and canceled its order.” Based on its own investigation, STAT News outlines the timeline for these decisions and conflict between health experts and elected officials regarding hydroxychloroquine and its potential use in C19 patients.

US SOCIAL DISTANCING Many US states are beginning to relax social distancing measures in an attempt to return to modified forms of business. California Governor Gavin Newsom announced an update to California’s plan that could potentially allow counties to move more quickly in their efforts to relax social distancing. Perhaps the most substantial change lies in updated epidemiological criteria for moving into State 2. Previously, counties were required to report “no more than 1 C19 case per 10,000” population over the previous 2 weeks and no C19 deaths over that same period. The updated requirements shift away from C19 incidence and focus more on the impacts to healthcare systems. The new criteria require counties to have “stable/decreasing” C19 hospitalizations—ie, less than a 5% daily increase—or no more than 20 total hospitalized C19 patients over the previous 2 weeks. Additionally, counties must report fewer than 25 new cases per 100,000 population over a 2-week period or testing positivity below 8% over 1 week.

In Texas, which has also moved into its second phase of relaxing social distancing, some parts of the state, including El Paso, will reportedly face a delayed timeline. Texas Governor Greg Abbott announced that the delay was in response to an elevated burden on local health systems that did not provide sufficient surge capacity in the event of increased SARS-CoV-2 transmission. Currently, these counties are scheduled to enter Phase 2 on May 29, a week behind the original timeline. The announcement was reportedly a result of a request by local officials to be temporarily exempted from the statewide changes.

While businesses in many parts of the country are reopening as social distancing measures are relaxed, some consumers may not be quite ready to return. Perceived risk of C19 is still high in many communities, and consumers—and potentially workers as well—may not yet feel it is safe enough to resume normal activities, even with some social distancing measures remaining in place. The economic recovery may proceed more slowly rather than simply switching on as businesses reopen. 

SARS-CoV-2 VACCINE HESITANCY Looking ahead to the availability of a SARS-CoV-2 vaccine—hopefully, sooner than later—concerns about individuals’ willingness to be vaccinated could potentially limit the effect of national and global vaccination campaigns. Vaccine hesitancy and anti-vaccine sentiment have grown worldwide in recent years, and proactive effort between now and when the vaccine is available could mitigate their effects on vaccine acceptance. A commentary published in JAMA outlines potential barriers to vaccine acceptance and emphasizes the importance of initiating appropriate engagement efforts now. Vaccine hesitancy or anti-vaccine sentiment broadly stem from concerns about the need for or value of vaccines, vaccine safety, and freedom of choice. Leveraging demand for the vaccine once it becomes available, ensuring transparency regarding vaccine efficacy and safety, and engaging trusted community and cultural leaders can help shape the conversation to promote vaccine acceptance. Additionally, it will be critical to counter mis- and disinformation around the vaccine and vaccination campaigns and ensure fair and equitable access to the vaccine, particularly for high-risk populations.

NAVAJO NATION The Navajo Nation (US) has surpassed New York and New Jersey in terms of per capita C19 incidence. With 4,278 reported cases, the Navajo have an incidence of nearly 2,500 cases per 100,000 population, compared to approximately 1,670 and 1,800 cases per 100,000 in New Jersey and New York, respectively. Native American tribes face a number of barriers that can put them at elevated risk for C19 and other diseases. In this case, multiple generations of family members often live together, which can facilitate transmission in the home, and limited options for groceries and other supplies can increase the number of people at certain stores such as supermarkets. The Navajo Nation has implemented a robust testing program that has reached more than 10% of the population already, which could be contributing to the elevated C19 incidence; however, the test positivity is approximately 16%, which indicates that increased testing may be needed to better capture ongoing community transmission. Racial and ethnic minority populations have been disproportionately affected by the US C19 epidemic, and additional effort is needed to provide essential services and support, including access to testing and health care, to mitigate the increased risk in these populations.

PRESIDENT TRUMP & THE WHO US President Donald Trump published a letter addressed to WHO Director-General Tedros Adhanom Ghebreyesus in which he threatens to terminate the United States’ membership in the WHO. The letter outlines findings from a US government investigation into the WHO response to C19 and asserts that the WHO is unable to remain independent from China’s influence. The letter highlights a series of “missteps” made by the WHO and notes that the WHO “repeatedly made claims about the coronavirus that were either grossly inaccurate or misleading.” A number of the “missteps” address the WHO’s praise for China’s response and transparency, contradicting evidence suggesting that Chinese officials attempted to conceal or misrepresent relevant information regarding the emerging pandemic, and delays in the WHO declaring a Public Health Emergency of International Concern (PHEIC) and pandemic. President Trump previously ordered a temporary hold on WHO funding, and he stated that he intends to make this permanent and consider withdrawing from the WHO if “substantive improvements” are not made within 30 days.

In the letter, President Trump cited content published in The Lancet in December 2019 or earlier as evidence that the extent of transmission in China was known to the WHO at that time. The Lancet published a response this morning to correct the “factually inaccurate” statement, noting that the journal did not publish anything on the initial outbreak prior to January 24, 2020. Additionally, the journal emphasized the risk that President Trump’s statements pose to critical international cooperation as well as the importance of conducting “factually accurate” reviews of the global response. 

INDIA & BANGLADESH EVACUATE MILLIONS In advance of an impending “super cyclone,” India and Bangladesh are evacuating millions of residents living in the storm’s projected path. Cyclone Amphan—currently the equivalent of a Category 4 hurricane (Atlantic) or “super typhoon” (Pacific)— is forecasted to reach land in the next several days, and Bangladesh officials reportedly indicated that it is expected to be the worst storm since 2007. Much like the recent typhoon response and recovery efforts in the Philippines, evacuations and housing are complicated by the C19 pandemic. Additional shelters are being opened, and masks are being distributed to mitigate the risk of transmission in densely populated evacuation shelters; however, some emergency shelters are currently being utilized to support the C19 response and are not available for evacuees.

Both India and Bangladesh are exhibiting increasing C19 incidence, and a major natural disaster could further increase the risk of transmission in affected areas. Additionally, Bangladesh recently reported its first confirmed C19 cases in and around Rohingya refugee camps, which raised concerns about a future humanitarian crisis if an outbreak is seeded in the camps. The storm is projected to make landfall on Bangladesh’s Eastern border, on the opposite side of the country from the camps in Cox’s Bazar, but the storm could cause heavy rain and dangerous seas hundreds of miles away.C19 CASES IN FRENCH SCHOOLS Many students in France have returned to school, and in the week since classes resumed, France has reported 70 cases associated with the schools—potentially including teachers and students. French Minister of Education Jean-Michel Blanquer reportedly commented that the timeline suggests that the cases were likely infected prior to resuming classes, but this illustrates the potential risk of exposure as schools reopen. Additional schools in France’s “green zones” began reopening yesterday. France reported its first death in a child that appeared to be a result of a “syndrome related to Kawasaki disease” in a 9-year-old child on May 15, which is thought to be potentially associated with C19 in children. Some countries are resuming classes, and others, including many parts of the United States, are evaluating plans to reopen schools, including the protective measures needed to mitigate transmission risk. It is important to monitor data in areas where schools are reopening to better characterize the role of children in community transmission and, more specifically, the effect of opening schools on the epidemic’s trajectory.

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