“The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse. Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.”Letter from more than 600 Physicians urging President Trump to end the national shutdown
“We still have a long way to go in this pandemic. We are very concerned about rising cases in low- and middle-income countries.”WHO director-general Tedros Adhanom Ghebreyesus
“People are actually out and about trying to get the virus, so attending gatherings, parties trying to maximize their chances of exposure.”Yolanda Enrich, a nurse practitioner at Novant Health Forsyth Medical Center
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- Recent Developments and Headlines
- Numbers and Trends
- Immunity or Not?
- Vaccines & Testing
- New Scientific Findings & Research
- Concerns & Unknowns
- Lockdowns vs. Reopenings
- The Road Back?
- Projections & Our (Possible) Future
- Practical Tips & Other Useful Information
- Questions & Comments From Our Readers
- John Hopkins Daily COVID-19 Update (see Annex I)
A. Recent Developments and Headlines
- All 50 states have started reopening
- Global COVID-19 case total nears 5 million
- WHO reports over 100K new coronavirus cases — the most in a single day
- Trump blames China’s ‘incompetence’ for global coronavirus death toll
- Sweden had most coronavirus deaths per capita in Europe last week
- Coronavirus Forces China to Lock Down over 100 Million People
- China’s Newest COVID-19 Outbreak Shows Virus May Be Mutating
- Head of Japan’s virus advisory committee says 2nd wave possible before winter
- Pakistan Supreme Court Lifts Coronavirus Lockdown
- Brazil reports 3rd record jump in new cases in a week
- California reports most coronavirus deaths in a month
- NY snaps 3 day slowdown in deaths
- Brazil recommends chloroquine to all COVID-19 patients
- Russia outbreak tops 300,000 cases
- Afghanistan passes 8,000 cases
- UN claims Africa largely ‘spared’ by coronavirus
- Germany’s largest state reopens polls
- Spain makes mask wearing in enclosed spaces “compulsory”
- UK still working out quarantine guidelines for travelers
- Fauci conspicuously stops doing TV interviews as White House moves to reopen economy
- ‘We’ve been muzzled’: CDC sources say White House putting politics ahead of science
- Ford Temporarily Shuts Down Two Plants Just Days After Reopening After Workers Test Positive For COVID-19
- Atl. Mayor Bottoms: ‘It Appears That We’re Doing Better’ in GA – Reopening ‘Not as Bad as I Thought’ Yet
- Maine Lawmakers to AG Barr: Gov. Janet Mills ‘Has Exceeded’ Her Authority
- Trump Says He Is Considering Brazil Travel Ban as Coronavirus Cases Spike
- Drive-In Movie Theaters Explode in Florida as Two More Open in Miami
- 70 Percent of Consumers Now Prefer to Watch New Movies at Home
- 94% of Democrats Think A Second Coronavirus Wave Is Coming
- NYU Announces Plan to Reopen Campus
- PA Gov. Tom Wolf Allows Real Estate Agents to Resume Showing Houses
- DOJ to Gavin Newsom: Start Reopening Churches in California
- Coronavirus ‘Fashion Masks’ Set to Become ‘Essential’ Pandemic Accessory in UK
- ‘Hot’ nurse disciplined for wearing bra and panties under see-through PPE gown
- America’s roads have actually been deadlier during coronavirus pandemic
- Study says earlier lockdown measures could have saved thousands of lives
- Covidiots are attending ‘coronavirus parties’ to intentionally get sick
- Most Americans don’t feel safe traveling in anything other than their own car
- Civil dissent is the American answer to outrageous lockdown rules
- End New York City’s lockdown now!
- Direct flights to Greek tourist destinations to begin July 1
- Astrologer who failed to foresee COVID-19 now predicts second wave
- Five leaders of reopened Texas church get coronavirus days after priest’s death
- Good news: New Yorkers can soon get divorced again some counties
- New Zealand PM eyes 4-day workweek to help post-coronavirus economy
- Delta adds more flights to ensure social distancing — despite low demand
- Religious gatherings of up to 10 people can resume Thursday in New York
- Apple, Google debut COVID-19 smartphone technology
- Brazil’s largest city digs mass graves as coronavirus spreads
- Thousands continue to wait in miles-long lines for food in South Africa
- Cancer surgery delays caused by coronavirus may kill thousands
- Most people working from home can’t remember the last time they wore pants
- Social distancing beeper will go off if you’re within 6 feet of someone
- NYC Mayor de Blasio outlines plan to fight coronavirus in NYC nursing homes
- China seizes control of PPE factories, sparking fear of another coronavirus wave
- A mink may have infected a human with coronavirus
- NYC child vaccination rates take ‘troubling’ plunge during pandemic
- Global carbon emissions plummeted 17 percent during coronavirus lockdowns
- Target’s online sales surge 141 percent amid coronavirus panic buying
- Christian high school hosts graduation with hundreds in attendance
- Qantas will offer dirt-cheap flights without social distancing
- New Yorkers leaving NYC cause coronavirus real estate ‘tidal wave’ in Connecticut
- A new high for coronavirus deaths in California as counties push ahead with reopening
- Weekly mortgage applications point to a remarkable recovery in home buying
- People Are Happier Making Big Decisions On A Coin Flip
- Millions of Americans Skip Credit-Card and Car Payments
- Quarantine and a monitoring bracelet for Hong Kong returnees
- Broad Lockdowns Are No Longer Constitutionally Justified
- China imposes a Wuhan-style quarantine in its northeast
- Domestic flights will resume in India next week
- In a Bangkok shopping mall, robots are enforcing social distancing
- Millions of people lost their jobs in hard-hit New England. Many fear their homes could be next.
- Quarantine is endless dirty dishes
B. Numbers & Trends
Note: All changes noted in this Update are since the 5/20 Update
1. Confirmed Total Cases, New Cases and Tests
- Total Cases = 5,082,661 (+2.0%)
- New Cases = 99,724 (+8.7%) (+8,117)
- New Cases (5 day avg) = 92,249 (+0.1%) (+60)
- Total Cases = 1,591,991 (+1.4%)
- New Cases = 21,408 (+5.5%) (+1,119)
- New Cases (5 day avg) = 21,541 (-4.7%) (-1,057)
- Number of Tests = 14,117,870
- Worldwide Deaths = 329,294 (+1.5%)
- New Deaths = 4,740 (+7.2%) (+320)
- New Deaths (5 day avg) = 4,288 (-1.6%) (-66)
- US Deaths = 99,994 (+1.6%)
- New Deaths = 1,461 (-5.9%) (-91)
- New Deaths (5 day avg) = 1,297 (-2.0%) (-27)
- 5 Countries with Largest Number of Confirmed Deaths:
|Country||Total Deaths||New Deaths||Deaths per 1M Pop|
|US||94,994||1461 (-91)||287 (+4)|
|UK||35,704||363 (-182)||521 (+5)|
|Italy||32,330||161 (-1)||535 (+3)|
|Spain||27,888||110 (+41)||596 (+2)|
- 5 States with Largest Number of Confirmed Deaths:
|State||Total Deaths||New Deaths||Deaths (5-day avg)||Deaths per 1M Pop|
|New York||28,816||168 (+0)||248 (+4)||1,481 (+8)|
|New Jersey||10,747||156 (+13)||119 (-10)||1,210 (+18)|
|Massachusetts||6,066||128 (+52)||93 (+2)||880 (+18)|
|Michigan||5,060||43 (-59)||47 (+1)||507 (+5)|
|Pennsylvania||4,822||71 (-12)||79 (-12)||377 (+6)|
|US||94,936||1,403 (-149)||1295 (-27)||287 (+4)|
3. Countries/States To Watch
|Country||Total Deaths||New Deaths||Deaths (5-day avg)||Deaths per 1M Pop|
|Sweden||3,831||88 (+33)||37 (-6)||380 (+9)|
|Europe||165,789||1,224 (+269)||1,063 (-36)|
- Below are 5 of the US States moving quickly to reopen their economies (OK never locked down).
|State||Total Deaths||New Deaths||Deaths |
|Deaths per 1M Pop|
|Georgia||1,697||22 (-4)||22 (-4)||160 (+2)|
|Florida||2,096||44 (-11)||36 (+0)||98 (+2)|
|Texas||1,423||21 (-12)||23 (-6)||49 (+1)|
|Ohio||1,781||57 (-7)||39 (+2)||152 (+5)|
|Oklahoma||299||5 (-1)||3 (+1)||76 (+2)|
|US||94,936||1,403 (-149)||1295 (-27)||287 (+4)|
4. Dr. Birx touts data showing decline in cases, hospitalizations
- Dr. Deborah Birx, the coordinator of the White House’s coronavirus task force, is encouraged by the latest statistics of new coronavirus cases — which she said shows sharp declines in both deaths and hospitalizations in recent weeks.
- Birx said that while certain areas remain at a consistent level, much of the country is seeing significant drops.
- “We are encouraged in reviewing and triangulating clinical data, laboratory data and surveillance data from around the country. It shows that new hospitalizations have dropped by 50% in the last 30 days,” Birx said Tuesday. “All hospitalizations and ICU hospitalizations are both dropping. Fatalities continue to decrease week over week.”
- Birx also pointed to how numbers of cases are going down even as testing is increasing. She said that all states are now seeing less than 20% test positive. In New York, which has been hit harder than any other state, less than 10% test positive, down from more than 45% a month ago.
- “Week over week new cases continue to decline – despite significant increases in testing and more testing focused on contact tracing and proactively searching for asymptomatic cases,” Birx said.
- Birx said she drew three takeaways from the latest data. First off, she said that major metropolitan areas “are starting to improve significantly,” noting that as cities reopen they are expanding testing among vulnerable populations and increasing contact tracing.
- Second, Birx said it is “very reassuring” to see states following her task force’s recommendations by finding cases, testing people, and contact tracing so that they can test additional people who may be asymptomatic, thus helping prevent the further spreading of C19.
- The third takeaway Birx had was that “testing has been expanding at a rate that in several places the governors are saying they need more people to test.” She said the Trump administration is helping governors provide testing in key populations such as nursing homes, prisons, group housing, and “in the most vulnerable and disadvantaged areas of the cities.”
- Birx identified the metropolitan areas of Washington, Chicago, and Los Angeles as locations where the number of new cases have plateaued, and said the task force will be studying them to see which cases are part of community spread and which are from new outbreaks.
- “We study these three metros that are closed and have been closed to understand where precisely the new cases are coming from and how to prevent new infections,” she said.
C. Immunity Or Not?
1. Infection Creates Immunity, But….
- According Dr. Anders Tegnell, Sweden’s chief epidemiologist:
- “Normally you measure immunity by the number of antibodies you can find in the blood. The level of antibodies among different cases seems to vary a lot. So it’s going to be a bit tricky on the individual level to estimate if somebody is immune,” he said.
- “On the other hand, it is quite certain that immunity does exist. And I think there is a lot of proof of that,” he said. “I mean, for all the cases we have had in Sweden, there has not been one single person who had this disease twice. And we have a very strict identification system. So there is no way we would miss a person who had it twice.”
- “I haven’t heard any reports from any countries where there has been a certified case who has actually had this twice. There’s been rumors about it. But in the end, they have been disclaimed. So I think that’s not the problem.
- The problem is to say if an individual will be immune so that you can tell this person, you will never have this disease. And that’s where we still don’t know because we don’t have long enough observation [periods], because we are not quite ready yet to say what level of antibodies is protective. And maybe there are other parts of the immune system that provide protection that antibodies would not do. And for how long this immunity would last. [Our] virologists said at least 3 to 6 months. They would say it’s a minimum, but nobody knows because we haven’t observed this for very long yet.”
- “We think that the now-slowed decline of the number of cases in Stockholm is due to the level of immunity in the population because we do see a drop of cases and we haven’t really changed any measures for the last four or five weeks,” he said.
- “If anything, there is a slight sign that adhering to social distancing and so on is maybe a little bit less now than it used to be a few weeks back. So the one reason we can see for this slow decline of cases, is really that there must be enough immune people in the population to keep the spread down a bit.”
2. Monkeys infected with C19 develop immunity in studies
- Two studies in monkeys published on Wednesday offer some of the first scientific evidence that surviving C19 may result in immunity from reinfection, a positive sign that vaccines under development may succeed, US researchers said on Wednesday.
- Although scientists have assumed that antibodies produced in response to the new coronavirus virus are protective, there has been scant scientifically rigorous evidence to back that up.
- In one of the new studies, researchers infected nine monkeys with C19, the illness caused by the novel coronavirus. After they recovered, the team exposed them to the virus again and the animals did not get sick.
- The findings suggest that they “do develop natural immunity that protects against re-exposure,” said Dr. Dan Barouch, a researcher at the Center for Virology and Vaccine Research at Harvard’s Beth Israel Deaconness Medical Center in Boston, whose studies were published in the journal Science.
- “It’s very good news,” Barouch said.
- Several research teams have released papers – many of them not reviewed by other scientists – suggesting that a vaccine against the virus would be effective in animals.
- In the second study, Barouch and colleagues tested 25 monkeys with six prototype vaccines to see if antibodies produced in response were protective.
- They then exposed these monkeys and 10 control animals to the coronavirus.
- All of the control animals showed high degrees of virus in their noses and lungs, but in the vaccinated animals, “we saw a substantial degree of protection,” Barouch said. Eight of the vaccinated animals were completely protected.
- These studies, which have been peer reviewed, do not prove that humans develop immunity or how long it might last, but they are reassuring.
- “These data will be seen as a welcome scientific advance,” Barouch said.
D. Vaccines & Testing
1. C19 vaccine produces antibodies in mice, guinea pigs
- U.S. immunotherapy company Inovio Pharmaceuticals Inc (INO.O) said on Wednesday its experimental vaccine to prevent coronavirus infection produced protective antibodies and immune system responses in mice and guinea pigs.
- “We saw antibody responses that do many of the things we would want to see in an eventual vaccine,” said Dr. David Weiner, director of the vaccine and immunotherapy center at the Wistar Institute, which has collaborated with Inovio. “We are able to target things that would prevent the virus from having a safe harbor in the body.”
- Inovio began human testing of its vaccine in April. Many other drugmakers including Moderna Inc (MRNA.O), Pfizer Inc (PFE.N), Johnson & Johnson (JNJ.N), Sanofi SANY.PA and AstraZeneca Plc (AZN.L) are also in various stages of vaccine development.
- On Monday, Moderna said its experimental C19 vaccine produced protective antibodies in a small group of healthy volunteers, according to very early data, putting it at the front in the race.
- Inovio said preliminary results from its human trial are expected in June. The 40 healthy participants in the Phase 1 trial are given two shots, four weeks apart, of the vaccine, called INO-4800, and then followed for two weeks.
- “We are already seeing safety data and it has been benign,” Dr. Katherine Broderick, head of research and development at Inovio, told Reuters. “Some people have slight redness of the arm.”
- Both Moderna and Inovio are using newer technology that focuses on specific genes on the outer “spike” portion of the virus.
- Inovio’s vaccine was designed using its DNA medicine platform, while Moderna’s vaccine uses messenger RNA (mRNA) technology. Both companies have no approved drug in the market.
- Once the preliminary data is in, Inovio expects to approach the U.S. Food and Drug Administration for authorization to move into a Phase 2/3 trial, which could happen in July or August.
- Inovio said the latest animal study results, published in the journal Nature Communications, validate its DNA medicines platform.
- It plans to test the vaccine in larger animals including rabbits and monkeys, and undertake “challenge” studies in mice, ferrets and monkeys, Broderick said.
- “Challenge” studies involve intentionally giving the virus to an animal and then seeing if the vaccine prevents infection.
- Inovio’s vaccine efforts are funded by a global coalition and the company has said it can manufacture 1 million doses by the end of the year for additional trials and emergency use.
2. The race is on for a C19 test you can take at home
- You are feeling feverish and have a cough. Is it just a cold, or is it C19? That’s a question that’s going to be hanging over all of us, possibly for several years.
- Right now, getting tested for the coronavirus means going to a doctor or a drive-in clinic and potentially exposing other people, and even then, a test can be hard to obtain. The US Centers for Disease Control is still telling people that if their symptoms are mild, they should simply stay at home.
- That’s why some companies are now trying to develop at-home genetic tests to spot the virus. They include Mammoth Biosciences, a startup in South San Francisco, California, that makes tests using the CRISPR gene-editing technology; the company said today it plans to have a disposable home test kit ready by year’s end.
- The kit will be designed and manufactured by GSK Consumer Healthcare. GSK already sells toothpaste, nicotine gum, and over-the-counter medicines to consumers.
- CRISPR is best known as the gene-editing tool used to modify animals or correct genetic disease. But it can also be employed in diagnostic tests because it is able to zero in on very specific genetic information—like the genetic sequence of a virus—and then trigger a visible signal, similar to the bars that appear on a home pregnancy test.
- The pandemic has added propellant behind the idea of using CRISPR for testing. That’s because the technology has features that make a portable test feasible: it is quick, requires little machinery, and works on raw samples like spit or snot.
- “It’s the ultimate use case for CRISPR,” says Trevor Martin, the CEO of Mammoth. “Our vision is that it would be in the format of a pregnancy test.”
- Right now, the most accurate C19 tests are molecular tests run in central labs, typically employing a technique called PCR, which requires several processing steps. The aim of companies like Mammoth is to skip PCR, making the costly equipment and trained technicians unnecessary.
- “You want to make the type of testing you are doing at home the same level of accuracy as in a lab,” Martin says. “You don’t want a trade-off, and that has not been possible so far.”
- In April, University of California researchers working with Mammoth demonstrated that CRISPR could spot the coronavirus. So did two other diagnostics companies working with the technology, Sherlock Biosciences and Caspr Biotech. “Getting a product to market is not about demonstrating the technology works. That took us a day,” Rahul Dhanda, CEO of Sherlock, said during an interview in March.
- His company later won emergency approval to sell a lab-only version of its CRISPR test, although it’s still not in use.
- It’s unclear how much home tests would really do to control the pandemic or limit new infections. An analysis by Imperial College found that regular C19 screening should be used with high-risk groups—say, to test health-care workers every week. That analysis saw less benefit for testing the population as a whole over just asking people with symptoms to self-quarantine.
- If people test at home, they might not report the results to health authorities, limiting visibility into the spread of the pandemic. Without a doctor involved, they also might not get or follow medical advice about quarantining or alerting contacts.
- “Providing home-based tests to individuals without a component of required reporting means missing potentially critical public health information,” says Donald Thea, a professor of global health at Boston University.
- GSK, which does not currently sell over-the-counter tests, did not answer questions about what benefits it sees for home testing. Martin said Mammoth has not determined the details of how its tests would work, but they could include an app that would record and report anonymized results. “In general, more information is better, especially in a pandemic, and I would trust people to act on it,” he says.
- Drugstores already sell home tests for HIV, cholesterol levels, and allergies, but none of those are genetic tests. Current consumer gene tests, for paternity or ancestry, ask people to mail in a sample of spit or hair.
- In April, the US Food and Drug Administration allowed LabCorpto introduce a mail-in sample collection kit for C19, but it still takes several days to get results.
- In addition to consumer use, a quick and easy C19 test might be in demand by governments and companies like airlines, which want to vouch that people aren’t introducing the infection at ports of entry. Martin calls screening arrivals to a country “a clear use case” and says he’s been in touch with “various government agencies” about the possibility.
- Mammoth was founded by scientists including CRISPR co-discoverer Jennifer Doudna of the University of California, Berkeley, who saw the versatile technology as a potential tool to revolutionize diagnostics. If the C19 pandemic leads to the first at-home gene tests, it’s likely CRISPR could be adapted to the next emerging disease or new consumer uses, like testing for venereal diseases or strep throat.
- “If the technology can be reduced and simplified so it’s easy to use and home-based, theoretically you could use it to find any pathogen with DNA or RNA,” says Thea. “There’s going to be a real revolution in viral diagnostics, [and] coronavirus is really accelerating that. That’s one of the unintended but hopeful consequences of a truly horrible situation.”
E. New Scientific Findings & Research
1. CDC: Coronavirus ‘does not spread easily’ on surfaces
- The US Centers for Disease Control and Prevention now says the coronavirus “does not spread easily” through touching surfaces or objects.
- In early March, the federal health agency was warning that it “may be possible” to pass on the virus from contaminated surfaces, according to Fox News.
- Its guidelines now include a section on ways the virus doesn’t easily spread — including from touching surfaces or objects.
- “It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes,” the CDC webpage states.
- “This is not thought to be the main way the virus spreads, but we are still learning more about this virus.”
- Other ways the virus doesn’t easily spread is from animals to people or people to animals, the CDC’s updated webpage states.
- It’s unclear when the CDC updated its guidance. The agency didn’t immediately respond to The Post’s request for comment.
- The agency continues to note that the virus is thought to mainly spread from person-to-person — even by those not showing symptoms.
- Specifically, it mainly spreads between people who are in close contact, within 6 feet of each other, when someone with the infection coughs, sneezes or talks, causing droplets to land in another persons mouth or nose.
- The Food and Drug Administration said last month there was no evidence to suggest the virus can spread through food, or what it’s wrapped in and that there was no need to wipe down groceries.
- “The biggest issue is that people are picking up COVID-19 from other people,” Marilyn Roberts, a microbiologist and professor at the University of Washington previously told The Post.
- “They’re not picking it up from surfaces.”
2. Antibody found in SARS patients can also block the coronavirus
- The race to find a cure for the novel coronavirus is on, and there are three separate efforts being pursued.
- The simplest one is to use common drugs to treat symptoms and prevent complications. Such drugs include remdesivir, which was proven to reduce the C19 recovery time, and blood thinners, which can prevent clotting-related complications, including strokes, heart attacks, and death.
- One other course of treatment concerns vaccines, which could be ready as early as September, to prevent the infection, though vaccines might not work, and there’s no guarantee they will actually roll out earlier than next year.
- The third option consists of brand new drugs that are being developed to stop the virus from replicating inside the body and improve the patient’s condition. These are antibody drugs that would work just like a plasma transfusion from a patient who survived C19. They could also provide limited immunity, some researchers believe.
- We’ve seen an increasing number of reports detailing the various monoclonal antibody drugs, with several such drugs already in development in China, Korea, and the US. The latest study details an unusual but exciting discovery: An antibody from a patient who survived SARS 17 years ago works against the coronavirus.
- SARS is another coronavirus, and it caused the 2003 outbreak that took the lives of 774 people of a total of 8,098 cases around the world. The novel coronavirus is its successor, which explains the name chosen for the virus that causes C19.
- A person who survived SARS developed an antibody that researchers call S309 in a new study published in Nature magazine (via LiveScience). The study was conducted by doctors from the University of Washington, Pasteur Institute in France, Università della Svizzera Italiana, Switzerland, and Vir Biotechnology. If Vir sounds familiar, that’s because it’s one of the US companies that’s currently looking to develop monoclonal antibodies for C19.
- The S309 antibody, found in the blood of that person, showed a strong ability to bind to the novel coronavirus’s spike protein, which is the key virus component of both SARS and the coronavirus that allows these two viruses to attach themselves to cells and invade them. Without this process, the virus can’t enter the cell to replicate itself, and a patient wouldn’t get C19 even after contracting the virus.
- Lab experiments show that S309 can bind itself to the spike protein, but testing on humans will be required to see whether the antibody is effective and safe. S309 is just one of the 25 SARS monoclonal antibodies found in blood from the patient, including samples taken in 2004 and 2013.
- The researchers identify S309 as the most potent SARS neutralizing antibody that can block the novel coronavirus, but say it may be combined with additional SARS antibodies that had a weaker activity against the coronavirus to form a cocktail that could provide added protection.
- Vir said in a separate announcement that two drugs featuring genetically engineered versions of the S309 antibody will be used in clinical tests in partnership with GlaxoSmithKline. These are known as VIR-7831 and VIR-7832. The first is supposed to have an extended half-life, while the second has an extended half-life and is supposed to function as a T cell vaccine, according to the company.
- “Remarkably, we believe S309 likely covers the entire family of related coronaviruses, which suggests that, even as the coronavirus continues to evolve, it may be quite challenging for it to become resistant to the neutralizing activity of S309,” Vir Chief Scientific Officer Herbert Virgin said in a statement.
- “In addition, S309 exhibits potent effector function in vitro, potentially allowing the antibody to engage and recruit the rest of the immune system to kill off already infected cells. We have seen in animal models of other respiratory infections, such as influenza, that effector function significantly enhances the activity of antibodies that are already potently neutralizing.”
3. Live Coronavirus Found In Feces
- A Research Letter published in Emerging Infectious Diseases reported results from a study that documented the presence of infectious coronavirus in fecal matter.
- The researchers were able to isolate coronavirus from fecal specimens from C19 patients in Guangdong, China, and successfully infect non-human primate cells in vitro using the viral isolates.
- While the study does not necessarily demonstrate that coronavirus transmission in humans is possible via the fecal-oral or fecal-respiratory routes or that fecal transmission is a significant driver of the ongoing C19 pandemic, it does provide evidence that viable coroa virus can be excreted in C19 patients’ feces.
- Further research is necessary to determine the extent to which fecal-oral or fecal-respiratory transmission of coronavirus occurs in humans, but these findings suggest that infection control and prevention measures may be necessary to mitigate exposure to coronavirus via C19 patients’ feces.
F. Concerns & Unknowns
1. China’s New Outbreak Shows Signs the Virus Could Be Changing
- Chinese doctors are seeing the coronavirus manifest differently among patients in its new cluster of cases in the northeast region compared to the original outbreak in Wuhan, suggesting that the pathogen may be changing in unknown ways and complicating efforts to stamp it out.
- Patients found in the northern provinces of Jilin and Heilongjiang appear to carry the virus for a longer period of time and take longer to test negative, Qiu Haibo, one of China’s top critical care doctors, told state television on Tuesday.
- Patients in the northeast also appear to be taking longer than the one to two weeks observed in Wuhan to develop symptoms after infection, and this delayed onset is making it harder for authorities to catch cases before they spread, said Qiu, who is now in the northern region treating patients.
- “The longer period during which infected patients show no symptoms has created clusters of family infections,” said Qiu, who was earlier sent to Wuhan to help in the original outbreak. Some 46 cases have been reported over the past two weeks spread across three cities — Shulan, Jilin city and Shengyang — in two provinces, a resurgence of infection that sparked renewed lockdown measures over a region of 100 million people.
- Scientists still do not fully understand if the virus is changing in significant ways and the differences Chinese doctors are seeing could be due to the fact that they’re able to observe patients more thoroughly and from an earlier stage than in Wuhan. When the outbreak first exploded in the central Chinese city, the local health-care system was so overwhelmed that only the most serious cases were being treated. The northeast cluster is also far smaller than Hubei’s outbreak, which ultimately sickened over 68,000 people.
- Still, the findings suggest that the remaining uncertainty over how the virus manifests will hinder governments’ efforts to curb its spread and re-open their battered economies. China has one of the most comprehensive virus detection and testing regimes globally and yet is still struggling to contain its new cluster.
- Researchers worldwide are trying to ascertain if the virus is mutating in a significant way to become more contagious as it races through the human population, but early research suggesting this possibility has been criticized for being overblown.
- “In theory, some changes in the genetic structure can lead to changes in the virus structure or how the virus behaves,” said Keiji Fukuda, director and clinical professor at the University of Hong Kong’s School of Public Health. “However, many mutations lead to no discernible changes at all.”
- It’s likely that the observations in China don’t have a simple correlation with a mutation and “very clear evidence” is needed before concluding that the virus is mutating, he said.
- Qiu said that doctors have also noticed patients in the northeast cluster seem to have damage mostly in their lungs, whereas patients in Wuhan suffered multi-organ damage across the heart, kidney and gut.
- Officials now believe that the new cluster stemmed from contact with infected arrivals from Russia, which has one of the worst outbreaks in Europe. Genetic sequencing has showed a match between the northeast cases and Russian-linked ones, said Qiu.
- Among the northeast cluster, only 10% have turned critical and 26 are hospitalized.
- China is moving aggressively to stem the spread of the new cluster ahead of its annual political gathering in Beijing scheduled to start this week. As thousands of delegates stream into the capital to endorse the government’s agenda, China’s central leadership is determined to project stability and control.
- The northeast provinces have ordered a return of lockdown measures, halting train services, closing schools and sealing off residential compounds, dismaying residents who had thought the worst was over.
- “People should not assume the peak has passed or let down their guard,” Wu Anhua, a senior infectious disease doctor, said on state television on Tuesday. “It’s totally possible that the epidemic will last for a long time.”
G. Lockdowns vs. Reopenings
1. Infection Rates Decline After Reopening in Vast Majority of Countries and US States
- According to JPMorgan analyst Marko Kolanovic, the “data favors further reopening” in line with what the Trump administration is currently promoting.
- “Despite the conditions for re-opening being mostly met across the US”, Kolanovic observes that this is “not yet happening in the largest economic regions (e.g. CA, NY, etc.)”. Instead, while “the virus risk is abating globally, political/geopolitical fallout is emerging as a new risk.
- Mocking “flawed scientific papers that predicted several million virus deaths in the west”, an outcome which clearly has not happened (with the authors of such papers claiming that this is a result of the measures taken in response to their original forecasts), Kolanovic writes that “in the absence of conclusive data, these lockdowns were justified initially.
- Nonetheless, many of these efforts were inefficient or late” meanwhile more “recent studies indicate that full lockdown policies in some European countries did not produce any change pandemic parameters (such as growth rates R0) and hence might not have yielded additional benefits vs. less restrictive social distancing measures” where the case study of Sweden is most prominent.
- Kolanovic elaborates on this point as follows:
- Figure 2 below show virus spread rates before and after lockdown for different countries around the world, and Figure 1 shows the spread for US states that have re-opened. In particular, regression shows that infection rates declined, not increased, after lockdowns ended (for US states we show most recent R0 vs R0 on the day of lockdown end, and for countries we show infection rates). For example, the data in Figure 2 shows a decrease in infection rates after countries eased national lockdowns with >99% statistical significance. Indeed, virtually everywhere, infection rates have declined after reopening even after allowing for an appropriate measurement lag. This means that the pandemic and C19 likely have its own dynamics unrelated to often inconsistent lockdown measures that were being implemented.
- Further criticizing the continuation of full lockdowns, Kolanovic then writes that “the fact that re-opening did not change the course of pandemic is consistent with mentioned studies showing that initiation of full lockdowns did not alter the course of the pandemic either. These virus dynamics are perhaps driven by the elimination of the most effective spreaders, impact on the most vulnerable populations such as in nursing homes, common sense measures unrelated to full lockdowns (such as washing hands, etc.) and weather patterns in the northern hemisphere, etc.”
- To be sure, the lockdowns remained in place “while our knowledge of the virus and lack of effectiveness of total lockdowns evolved.” However, at the same time, “millions of livelihoods were being destroyed by these lockdowns. Unlike rigorous testing of potential new drugs, lockdowns were administered with little consideration that they might not only cause economic devastation but potentially more deaths than COVID-19 itself.“
- So how can one continue to justify stringent lockdowns in light of the above observations, Kolanovic asks, and then points out that “this question has divided the country” and that “allowed economic activity across the country is now largely following partisan lines.”
2. Doctors raise alarm about health effects of continued shutdown
- More than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the “national shutdown” aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a “mass casualty incident” with “exponentially growing health consequences.”
- The letter outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to “[p]overty and financial uncertainty,” which “is closely linked to poor health.”
- “We are alarmed at what appears to be the lack of consideration for the future health of our patients,” the doctors say in their letter. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.”
- The letter continues: “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.
- “Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.”
- The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable “suffering and death.”
- But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home.
- “The very initial argument … which sounded reasonable three months ago, is that in order to limit the overwhelmed patient flux into hospitals that would prevent adequate care, we needed to spread out the infections and thus the deaths in specific locales that could become hotspots, particularly New York City… It was a valid argument at the beginning based on the models that were given,” McDonald said. “What we’ve seen now over the last three months is that no city — none, zero — outside of New York has even been significantly stressed.”
- McDonald is referring to the misconception that business closures and stay-at-home orders aimed at “flattening the curve” are meant to reduce the total number of people who will fall ill because of the coronavirus. Rather, these curve-flattening measures are meant largely to reduce the number of people who are sick at any given time, thus avoiding a surge in cases that overwhelms the health care system and causes otherwise preventable deaths because not all patients are able to access lifesaving critical care.
- McDonald said that “hospitals are not only not overwhelmed, they’re actually being shut down.” He noted that at one hospital in the Los Angeles area, “the technicians in the ER have been cut by 50 percent.”
- Gold also said the effects of the shutdown are more serious for the vast majority of people than the potential virus spread if it is quickly lifted.
- “When you look at the data of the deaths and the critically ill, they are patients who were very sick to begin with,” she said, “There’s always exceptions. … But when you look at the pure numbers, it’s overwhelmingly patients who are in nursing homes and patients with serious underlying conditions. Meaning, that that’s where our resources should be spent. I think it’s terribly unethical… part of the reason why we let [the virus] fly through the nursing homes is because we’re diverting resources across society at large. We have limited resources we should put them where it’s killed people.”
- People of all ages, of course, have been shown to be able to catch the coronavirus. And there have been reported health complications in children that could potentially be linked to the disease. Fauci also warned about assuming that children are largely protected from the effects of the virus.
- “We don’t know everything about this virus … especially when it comes to children,” Fauci said in a Senate hearing last week. “We ought to be careful and not cavalier.”
- Newport Beach, Calif., concierge doctor Dr. Jeffrey Barke, who led the letter effort with Gold, also put an emphasis on the disparity in who the virus effects.
- “There are thousands of us out there that believe, yes, this virus is deadly, it’s dangerous, and it’s contagious, but only to a select group of Americans,” he said. “The path forward is to allow the young and healthy, the so-called herd, to be exposed and to develop a degree of antibodies that both now is protective to them and also prevents the virus from spreading to the most vulnerable.”
- Dr. Scott Barbour, an orthopedic surgeon in Atlanta, reflected the comments the other doctors made about how the medical system has been able to handle the coronavirus without being overwhelmed, but also noted that the reported mortality rates from the coronavirus might be off.
- “The vast majority of the people that contract this disease are asymptomatic or so minimally symptomatic that they’re not even aware that they’re sick. And so the denominator in our calculation of mortality rate is far greater than we think,” he said. “The risk of dying from COVID is relatively small when we consider these facts.”
H. The Road Back?
1. Don’t count on a vaccine for coronavirus soon
- A top U.S. scientist said on Wednesday that governments should not count on a successful vaccine against C19 being developed anytime soon when deciding whether to ease restrictions imposed to curb the pandemic.
- William Haseltine, a groundbreaking researcher of cancer, HIV/AIDS and human genome projects, said the better approach now is to manage the disease through careful tracing of infections and strict isolation measures whenever it starts spreading.
- While a C19 vaccine could be developed, he said, “I wouldn’t count on it.”
- Vaccines developed previously for other types of coronavirus had failed to protect mucous membranes in the nose where the virus typically enters the body, he said.
- Even without an effective treatment or vaccine, the virus can be controlled by identifying infections, finding people who have been exposed and isolating them, he said. He urged people to wear masks, wash hands, clean surfaces and keep a distance.
- He said China and some other Asian countries used that strategy successfully, while the United States and other countries did not do enough to “forcibly isolate” all who were exposed to the virus.
- China, South Korea and Taiwan have done the best at curbing infections, he said, while the United States, Russia and Brazil have done the worst.
- Tests on animals of experimental C19 vaccines had been able to reduce the viral load in organs like lungs although the infections remained, he said.
- For treatment, patients have been getting antibody-rich plasma donated by people who recovered from C19, and drugmakers are at work producing refined and concentrated versions of that serum.
- Known as hyperimmune globulin, those products are “where the first real treatments are going to be,” he said, predicting success also with research into monoclonal antibodies that home in on and neutralize the ability of the virus to enter human cells.
2. CDC Guidelines on Reopening Schools
- U.S. schools shuttered by the coronavirus should pursue a carefully phased reopening only after public health benchmarks are met, and summer camps should be limited largely only to children from the immediate area, federal guidance recommends.
- The guidelines, released late on Tuesday by the CDC, come from a set of suggestions for specific settings, including restaurants, mass transit systems and employers with workers at high risk.
- President Donald Trump has said the nation needs to move forward with lifting restrictions meant to curb the pandemic in order to limit damage to an economy suffering its worst crisis since the Great Depression of the 1930s.
- Nearly all 50 states have allowed some businesses to reopen, with some moving before meeting federal guidelines. Political fissures have erupted between Americans chafing under restrictions states have put in place and others who argue for pursuing a cautious path toward reopening.
- Schools are poised to become a particular political battleground. Children are less likely to suffer from severe complications from C19, the disease caused by the coronavirus, than older adults, but public health experts say they can spread it to older and frailer family members.
- States have also reported cases of a sometimes fatal inflammatory syndrome in children that is believed to be linked to the coronavirus.
- In its guidelines for kindergarten through 12th grade, the CDC said schools should only reopen after a sustained decrease in newly identified cases, and even then they should implement enhanced social distancing measures – such as closing cafeterias and playgrounds and serving meals in classrooms instead.
- Once new cases drop to nearly zero, schools could move to looser distancing measures, such as staggering school drop-off times, the guidelines suggest.
- American Federation of Teachers President Randi Weingarten said the union welcomed the guidelines but said they shifted responsibility to local health officials and did not provide needed additional support to schools.
- “These guidelines spell out more of what we need to reopen safely, but they come with a necessary cost the administration would rather ignore,” said Weingarten.
3. Banning mass gatherings may be enough to keep pandemic in check
- Some scientists looking for ways to prevent a return to exponential growth in coronavirus infections after lockdowns are lifted are zeroing in on a new approach: focus on avoiding superspreading events.
- The theory is that banning mass public events where hundreds of attendees can infect themselves in the space of a few hours, along with other measures such as wearing face masks, might slow the pace of the new coronavirus’s progression to a manageable level even as shops and factories reopen.
- Researchers believe that the explosive growth of coronavirus infections that overwhelmed hospitals in some countries was primarily driven by such events earlier this year—horse races in Britain, carnival festivities in the U.S. and Germany or a soccer match in Italy.
- The study of superspreading events could help scientists better understand how the virus can propagate in crowded conditions—in offices, schools, churches, gyms and public transportation—and guide governments in regulating such public occasions as weddings, trade conferences and sports games.
- There is little doubt about the mechanisms involved in superspreading events. A study published by the National Academy of Sciences in the U.S. last week found that one minute of loud speech was enough to produce thousands of droplets that remain airborne for about 12 minutes, potentially able to infect anyone in the area. Similar studies have shown that virus-laden aerosols, particles smaller than droplets, can levitate for hours after being released in indoors spaces.
- A more surprising finding is that mass infections tend to be more serious than those contracted in other circumstances, perhaps because of sustained exposure to a larger amount of virus.
- “Most cases globally, and especially most deaths, happened after superspreading events,” said Hendrik Streeck, a virologist with the University Hospital Bonn, Germany, who published the world-wide first study of a coronavirus superspreading event.
- His research into the outbreak in the western county of Heinsberg, which in March became a center of the epidemic in Germany, established that the infection spread across the region like wildfire after around 400 people took part in a traditional carnival party. They drank, sang, kissed and danced for several hours in a large hall on Feb. 15.
- The people who attended not only got infected and then spread the virus across the county, but also showed stronger symptoms and a comparatively severe illness, Dr. Streeck says—possibly because they received a higher load of the virus from close and prolonged exposure. Weeks later, thousands were infected across the region and dozens died.
- Superspreading events exist in many infectious diseases, but with Covid-19 they are especially dangerous because the virus has a longer period of incubation in which patients show no symptoms but can infect others. Sars and MERS, two other deadly coronaviruses that produced smaller global outbreaks in recent years, were also driven by superspreading events, research has shown.
- The Mardi Gras festivities in Louisiana, a choir practice in Skagit County, Washington and a meeting of executives of the Biogen drug company near Boston are among the one-off events scientists think helped give the pandemic a fateful boost.
- U.S. meatpacking plants, where hundreds have become infected, have also emerged as superspreading sites: counties with or near meatpacking plants have been found to have nearly twice as many Covid-19 cases as the national average, according to an analysis by the Environmental Working Group, a nonprofit organization.
- In April, Blaine County in Idaho became one of America’s coronavirus hot spots when hundreds of people tested positive following an apres-ski party. Smaller events like weddings, parties and funerals have also served to turbocharge contagion. In one case, an infected individual visited a funeral and a birthday party within three days in February, spreading the virus to 16 people, three of whom died.
- “It is now pretty clear that large groups of people close together are good opportunities to spread the virus,’’ said Marc Lipsitch, professor of epidemiology at the Harvard T.H. Chan School of Public Health.
- The experience of several European countries seems to confirm the special role played by superspreading events. Over the past four weeks, Germany, Austria, Denmark, Norway and other countries that have exited early from lockdowns have removed most restrictions on public life except those targeting mass gatherings. So far, new infections have remained low and constant. Sweden, which never had a mandatory lockdown, managed to control and then reduce the spread by relying on only one restrictive measure: prohibiting gatherings of over 50 people.
- One remaining question mark regards schools. While no country where schools have reopened has so far reported a sharp increase in infections, some scientists fear schools could act as accelerators for the pandemic.
- Sars, another coronavirus that originated in China and is genetically near-identical to Covid-19, briefly spread world-wide in 2003 after a guest at the Metropole Hotel in Hong Kong infected international visitors who then spread the disease across continents, according to Professor Michael Small, a lecturer in applied mathematics at the University of Western Australia.
- Prof. Small, who holds the Chair in Complex Engineering Systems at CSIRO, the country’s national science agency, studied both coronavirus outbreaks and says the lesson is that authorities must curb all gatherings of more than 100 people.
- “This could well be the end of the open-plan office,” he said. “You can see it clearly from the data in many, many places: superspreading events cause bursts of infection that fuel exponential growth, but that can very quickly be reduced to linear growth if you limit the mass gathering of people.”
- His modeling shows that lockdowns could be replaced by targeted measures with a much smaller economic impact, such as banning mass events, asking a significant number of white-collar workers to work from home and encouraging widespread use of smartphone contact-tracing apps.
- What about crowded subways and commuter trains? Prof. Small is confident that the use of subways during rush-hour is certain to turn into a super-spreading event.
- When London authorities reduced the number of subway trains in March—causing greater crowding than usual—they created superspreading conditions, said Prof. Michael Levitt, a Stanford lecturer and Nobel Prize laureate. He advocates the use of face masks and regular testing of bus drivers, shopkeepers and delivery couriers. Bars should also be regulated, he said, because loud music there forces patrons to speak louder.
- Sports fans are longing to return to the stands, but health experts say stadiums are one of the highest-risk areas for coronavirus transmission.
- In Britain, which has one of the worst Covid-19 death rates in the world, authorities allowed for a series of mass events to take place in March, including large-scale concerts, soccer games and horse races. George Batchelor, director of Edge Health, a data analytics firm that works with Britain’s health-care provider, thinks those gatherings prompted a significant increase in hospitalizations and mortality related to Covid-19 in the respective regions. He studied two soccer matches and a horse race—all of which took place outdoors, preceded and followed by the mass use of public transport and visits to bars and pubs.
- “It would seem very unwise to allow for any such events any time soon,” Mr. Batchelor said.
- Some of the lessons from the research are already being applied. In Germany, choral singing has been banned from religious services and Bundesliga soccer games are taking place without spectators, while churches in Britain are considering a ticket system to avoid crowding.
- Austria will allow cultural events, such as concerts with up to 1,000 visitors, under strict security measures starting from August, while clubs and nightlife venues will remain closed, a government spokesman said, after outbreaks in such establishments in South Korea. A study published this week found that banning mass gatherings had the biggest contribution to bringing the epidemic under control in Germany.
- Superspreading events could even reignite the epidemic when the situation appears under control, said Prof. Cristopher Moore, a physicist with the Santa Fe Institute.
- Dr. Streeck, the German virologist, agrees. While most experts expect a deadly second wave of coronavirus infections in the fall, he thinks a sharper focus on preventing superspreading events and vigilant monitoring could help avoid such a scenario.
- “We are all conducting experiments in our countries—no one knows how to do this right,” he said.
1. C19 Deaths In Context
J. Projections & Our (Possible) Future
1. Penn Wharton model predicts nearly 300,000 deaths by end of July if States fully reopen
- New numbers from the Penn Wharton Budget Model show that reopening States could cause positive coronavirus case numbers to tick as high as 5.4 million by July 24.
- The model explores various scenarios under which States reopen, include continuing lockdowns, and a partial reopening. The model also forecasts those scenarios if social distancing rules continue to be adhered to or are relaxed.
- For the PWBM forecast, the model considers that States reopen on May 18. All totals are cumulative, and include past positive cases and deaths.
- If States fully reopen with no social distancing rules in place, as many as 5.4 million people could test positive for coronavirus. And if States reopen while still practicing measures of social distancing, nearly 4.3 million people are projected to be diagnosed with C19 by the third week of July.
- Partially reopening the States with social distancing rules in place would result in nearly 3.2 million positive cases.
- The forecast represents a large uptick in positive cases in the United States which currently stands at 1.5 million, according to the Johns Hopkins coronavirus tracker.
- And according to the PWBM, the number of deaths would also start to rise as States reopen.
- While previous forecasts from the University of Pennsylvania model had projected a death toll as high as 350,000, the new numbers are lower, though still higher than other models.
- Even with States under a full lockdown, the model has projected a death toll at just over 156,000, a slight increase from its previous forecasts of 117,000.
- The current death toll in the United States stands at nearly 91,000, according to Johns Hopkins.
- But while this scenario is grim, it only serves as the baseline as more and more States reopen and others mull when and how to let business and other normal activities resume.
- With a partial reopening, the model forecasts, the death toll will rise to 173,000 people. A full reopening would result in 231,000 deaths. If all the States reopened without adhering to social distancing guidance, that number leaps to 293,000.
- While these numbers are large, they represent a revision downward from Wharton’s previous forecast of 350,000. They are also much larger than other models.
- According to the University of Washington Institute for Health Metrics and Evaluation (IHME) model, the current projected death toll stands at roughly 144,000 by Aug. 4.
- While the forecasts seem to warn against a full reopening of States, the model does project positive data economically if States reopen.
- Keeping States in lockdown with full social distancing in place will cause U.S. GDP to shrink by 10.8% year over year by July 24, but reopening States would save the U.S. from the severe economic losses.
- Towards the end of July the model forecasts, if States reopen GDP would decline by 7.7% compared to the year prior. And if social distancing is reduced, GDP would decline by 6.6%.
K. Practical Tips & Other Useful Information
1. What is a pulse oximeter, and do you need one?
- Before the coronavirus pandemic, most Americans had heard about pulse oximeters only via TV shows where EMTs shout out a patient’s “pulse ox” — or measure of oxygen in the blood. But when multiple news reports mentioned pulse oximeters as a possible tool in the limited arsenal of weapons against C19, the low-cost medical devices started flying off shelves almost as quickly as toilet paper.
- Typically clipped over a finger (though a toe or ear lobe works, too), a pulse oximeter transmits light from sensors on one side of the device through the body part to sensors on the other side. In about 15 seconds, it calculates how much oxygen is being transported through the person’s bloodstream and displays the results as a percentage (abbreviated SpO₂).
- Doctors consider a SpO₂ reading of 94% and higher to be normal. Low levels of oxygen in the blood (hypoxemia) can lead to low levels of oxygen in the tissue and organs (hypoxia), which can lead to death.
- Pulse oximeters are usually purchased for home use by people who want or need to monitor their oxygen supply, including patients with chronic lung conditions such as COPD, performance athletes or people living at high altitude. Shortly after the pandemic began, however, the easy-to-use devices started being touted as a means to detect serious complications from C19.
- The reason there is such great interest pulse oximeters now is that C19 has a fairly significant effect on the body’s ability to oxygenate, sometimes discordant with how the patient feels,” says Benjamin Seides, director of interventional pulmonology at Northwestern Medicine Central DuPage Hospital in Winfield, Ill., outside Chicago. Though patients aren’t especially short of breath, their low blood oxygen levels may indicate they are headed for a crisis.
- Seides said an idea started to spread: Maybe if physicians told people to watch their blood oxygen levels, they could contact a doctor or go to the emergency room if their saturation levels dramatically dipped. That prompted a run on the devices.
- Sales data provided to The Washington Post from Bloomreach, an e-commerce software firm, shows that U.S. sales of fingertip pulse oximeters increased by 506% over the previous week during the week of Feb. 17 and 168% over that week during the week of Feb. 24. Since that time, demand held fairly steady and then tapered off the first two weeks of April. But in recent weeks, sales again have started to climb, perhaps as consumers prepare for the next phase of living with the pandemic. In mid-May, the devices were still sold out, delayed or on back order in stores such as Walgreens, CVS and Target.
- Medical-grade pulse oximeters cost $200 or more, but consumers can find them for about $50 at pharmacies, big-box stores and online. Even the lower-cost versions are considered a fast and reliable way to measure how well you are oxygenating.
- Correct usage is key to a trustworthy reading, however, which can fluctuate based on a number of factors — what you are doing physically (sitting versus running), proper device placement and the altitude you live at. Artificial nails and nail polish, especially gel-based, can produce inaccurate measurements of SpO₂, as they block the light transmission. Cold hands or poor circulation can also interfere with the light and produce false numbers, because pulse oximeters need a steady flow of blood beneath the sensor.
- Pulmonologist Federico Cerrone, managing physician at Overlook Medical Center in Summit, N.J., says people with chronic health issues may want to get a pulse oximeter at this time because it can be a helpful tool for regularly checking in with a doctor via telemedicine. Patients with C19 who are discharged from a hospital also may be given a pulse oximeter so they can monitor their numbers to see if they are improving or getting worse.
- “It can be a reassurance or a harbinger of issues indicating you may need to return to the hospital,” Cerrone says.
- Unless you have an underlying condition or are recovering from C19, however, you probably don’t need to add one to your collection of home health supplies.
- “It’s a convenience, not a necessity. If you are short of breath or have a cough, you can usually call your physician and have a drive-through check of your oxygenation,” says Cerrone. [Note: This statement assumes that a drive-through check of your oxygenation is available, which may not be the case as we have recently seen. Moreover, as reported in prior Updates, a major concern with hypoxia is that you may not realize how serious your condition is until it is too late. We view a pulse ox as cheap insurance that could become invaluable if anyone in your family becomes infected as it can give an early warning of a potentially serious problem.]
- He also cautions against the use of oximeter apps that purport to tell you various medical readings because their performance has not been validated in scientific studies. A recent University of Oxford study found no evidence that any smartphone technology is accurate for the measurement of blood oxygen saturation. In fact, the study states, “oxygen saturation levels obtained from such technologies should not be trusted.”
- There are potential drawbacks to widespread usage of pulse oximeters. Seides says that some patients who possess them become compulsive and check their saturation levels too often. “In the hands of nervous patients, the device creates anxiety and confusion without much probative value, because even with a small dip in readings they call their physician. It’s important to recognize that a pulse oximeter is a single data point of a complete picture.”
- Another concern is that those who use a pulse oximeter as a C19 litmus test may ignore other troubling signs.
- “I worry that though their saturation numbers look okay, people with other symptoms such a shortness of breath or persistent cough won’t seek medical attention,” says Seides.
- Physicians agree that during this pandemic, the important actions remain physical distancing, washing hands, wearing a mask, listening to public health officials and, if you’re not feeling well, calling your doctor.
2. What the Best Video Chat App?
By Geoffrey A. Fowler and Heather Kelly, Washington Post
- To Zoom, or not to Zoom? That is the question.
- Zoom videoconferencing’s Brady Bunch grid of faces has become synonymous with working, learning and even partying from home during the coronavirus pandemic. But the world’s new favorite app stumbled when hackers figured out how to bust into private conversations. Week after week after week, security and privacy researchers found more holes in Zoom’s protections.
- Now tech’s big guns are trying to replace it. Last week, Facebook rolled out Messenger Rooms, a group video chat service that works across its apps and even for people without accounts on the social network. Google made a free version of Meet, its service built for businesses (and cousin of a similar Google service called Hangouts). And don’t count out Apple’s FaceTime built into iPhones and Macs, Epic Games’ growing Houseparty and Microsoft’s old faithful Skype. There are even more Zoom clones focused on business, gaming and meeting new people.
- For the past week, we’ve been virtual chatty Kathys, giving a half-dozen different group videoconference apps the chance to win our hearts. We looked for the single best video chat app to bridge all aspects of our shelter-in-place existence, rather than work-focused systems (which are probably chosen by somebody else, anyway). We ran all six on problematic WiFi networks, graded clarity with an old-fashioned eye chart, and tested with people who have different tolerances for learning new software. We tried all the virtual backgrounds and special effects options we could find, from scenic caves to jaunty hats. And we studied privacy policies and consulted security experts.
- It’s time to name some winners, which we dubbed the Chatty Awards. Our testing found some apps excelled in particular areas — so we’re giving out awards for technical categories that might matter to you, such as best picture quality, special effects and security.
- Only one gets the top prize. Our big takeaways: The best communication tool is the one that works for the most people. And if you really want to trust software, you have to be willing to pay for it.
Best video quality: Skype
- No video chat app looked great every time, but one had clear video more often than the others: Skype. The app that helped create the idea of video chats with grandparents is still in the game.
- When we held up an eye chart to the camera, Skype made it easiest to read the small type. It’s also what we used to make the video accompanying this column. Just know, its performance demands a lot out of your computer, so you may need to close other apps.
- A close runner-up was Zoom, which uses software smarts to up (or down) scale when needed. For example, it sends over an HD image when someone is looking at you in full screen mode.
- That said, none of the apps could pass our toughest quality test: Making it possible to sing a group rendition of “Happy Birthday.” That slight but ever so annoying delay you notice is called latency, and while it’s also the fault of your device’s Internet connection, we couldn’t find any apps that seemed to improve it significantly.
Best special effects: Facebook Rooms
- Sure, Zoom lets you insert yourself into a virtual background or clear up some wrinkles, but that’s nothing compared to the world of augmented-reality special effects.
- Facebook Rooms come knocking with the best selection of filters that move with your face (a dog that is also a hat, goth makeup), immersive 360-degree backgrounds (fall into a ballpit, or a black hole) and physical games like competitive burger eating, where virtual burgers fly around that you grab with your mouth. Just note, they’re available only on Facebook’s mobile apps, not on the Web version of Rooms.
- The effects are a great time killer with other people, if you can figure out the slightly confusing Rooms setup. For example, the Facebook app asks if you want to invite certain people to your Room … but then also suggests posting to all your friends on Facebook about the existence of your room. Facebook acknowledges its menus might be confusing, and says only the friends you’ve invited will see your post. But we’ve seen enough shenanigans like this from Facebook before.
- Good news if you want to have fun without also feeding data to Mark Zuckerberg: The Snap Camera desktop app, made by the same company as Snapchat, is filled with special effects and works with apps that allow it. (Zoom recently stopped working with Snap Camera but is slowly adding it back.) Our favorite filter is one that makes you look like a potato.
Best privacy and security: Apple FaceTime
- Membership in the Apple cult — we mean, club — has its privileges. Most of the security pros we spoke with said FaceTime was their go-to of our mainstream options. The problem is, of course, it only works if everyone you need to speak with also has Apple devices.
- Group video calls of up to 32 people using FaceTime meet the gold standard of security with end-to-end encryption. That means they can’t be seen or heard by anyone else who might try to intercept them.
- There’s no way to add an extra password onto a chat, but the chance of random people crashing into your call is also low. You start a group FaceTime by sending an Apple Message to all the other people you want to talk to, and then tapping on their face icons at the top and looking for the FaceTime button. Then everyone can hop in and out of the call.
- FaceTime is also the natural (if rather unexciting) choice for families with kids. It is one of the few apps that actually allows kids under 13 to set up special accounts. There are also parental controls to limit whom they can call and how long they can talk.
- An alternative that works on different kinds of mobile devices is WhatsApp. While it’s owned by Facebook, its video calls are fully encrypted (which Facebook Rooms is not). But WhatsApp group calls don’t work well on PCs and Macs and are limited to just eight participants.
Best for a party: Houseparty
- It says it right there in the name. Houseparty, which Fortnite maker Epic Games bought last year, is a funky little video chatting app made for having fun and maybe a drink with other people. There’s a desktop computer app, but the mobile version is where the real good times happen, with built-in games to fill in awkward silences, and the option to meet new people and split off into separate rooms if you find like-minded friends.
- By far the most social of the video chat contenders, Houseparty invited celebrity guests to film segments any group could watch together, such as Idina Menzel flubbing the words to “Frozen” or Zooey Deschanel being Zooey Deschanel.
- There’s no apologizing for forgetting to mute or sharing a PowerPoint presentation in this house, but there also isn’t much in the way of fun backgrounds or filters. This is a come as you are kind of party.
- Honorable mention: Third-party tools are making it easier than ever to turn your video chat app of choice into a party. Jackbox.tv games, which include fun group competitions like creating funny T-shirts, work with any app that allows screensharing, like Skype, Zoom and Meet.
Best overall video chat app: Zoom
- Yep, we’re sticking with Zoom, even after all those security problems — and in part, because of how it responded to them.
- Zoom defines much of what we need from a group video conference. It gives you the simplest way to get up to 49 people together on one screen in happy rows of boxes, regardless of whether they have an account or whether they want to use an iPhone, Windows PC, or even an old-fashioned landline. Usually, everyone just has to click one link to get in.
- Zoom’s features win the Goldilocks principle, sitting somewhere in between a work app (you can share screens) and a social one (you can turn your background into a Malibu dreamhouse). While it could still do better when participants have poor connections, Zoom’s call quality is good enough across a shockingly wide array of devices. Google’s Meet, a Zoom clone in many respects, never met our threshold for video quality and is utterly bereft of any fun features at all.
- Then there’s simplicity. Our families and friends all know how to Zoom. Even after a week, we still can’t quite figure out — or trust — the sharing mechanisms of Facebook’s Rooms. Skype recently added a one-link-to-join option like Zoom, but you can’t use it for a scheduled meeting or put it behind a passcode. Houseparty is fun but requires too much coordination when you actually want to meet someone at a particular time. Apple’s FaceTime needs a rethink for the pandemic era where you can’t expect everyone you need to interact with owns an Apple device.
- What about Zoom’s security problems? We won’t know for a few months until they’ve stopped making changes — and until good (and bad) hackers have had a chance to thoroughly poke at it. But security experts we spoke with at the Electronic Frontier Foundation, Consumer Reports and privacy software maker Disconnect agree it is moving in the right direction. Zoom already has changed some default settings to address “Zoom bombing” — when someone uninvited figures out the code to enter a meeting. (Now people joining calls by default go into a virtual waiting room.) It apologized for and fixed problems like routing some traffic through China. Some organizations that had banned Zoom, such as New York City Schools, have resumed using the app.
- Many researchers we spoke with noted security and privacy issues are not unique to Zoom, and Consumer Reports has called out others using unclear language in privacy policies. But Zoom has been the quickest to respond and hire respected security and privacy leaders. Zoom calls are still not end-to-end encrypted, the gold standard for keeping snooping eyes out, but it has a timeline to move that way, at least for paying customers.
- Most importantly: Zoom’s main business is selling video chat software. It’s the only service we tested that you have to pay for after a limited window — $15 per month for calls lasting longer than 40 minutes.
- But we actually find that reassuring compared to some of its rivals mainly in the advertising and gadget-selling business. We know we sound like a broken record, but remember: If the product is free, that means you’re the product.
L. Comments & Questions From Our Readers
- I just wanted to make a comment on the second story in the 5/20 Update, “Six feet not far enough to stop virus transmission in light winds”. As far as I can tell from this article, this research has been done by physicists, not epidemiologists. In other words, it shows that particles can travel in light winds at these more lengthy distances, but does not prove that you can contract COVID (or anything else) at these distances. My understanding is that a specific viral load is needed to cause infection, and it still needs to be proven at what distance that may occur. The other variable is exposure time, or how long must someone be in this situation in order for infection to occur. The research from China that examined people in a restaurant contracting COVID due to AC vents blowing particles across the room was telling—the longer you are in the environment to catch it, and the closer you are to the air pattern than can distribute the particles, the better the chance you have of becoming ill. I just think a caveat needs to be included on this topic.
- Another bit of research in this same category was done by physicists in Belgium some time ago (see link below), regarding cyclists in each others slipstream—it also shows similar travel of particles, even further with the slipstream effect (I’m a cyclist, and this had crossed my mind before the research came out). This is be true of runners as well, just over a shorter distance than cyclists considering slower speeds. It was criticized by epidemiologists for the same reason—it doesn’t show infection, just possibility of particle travel. See Outdoor activities require stricter social distancing, Belgian study suggests
- Ariadne, those are all really good points. We have previously included stories on all of those issues. As you noted, a certain viral load is needed to become infected. One article estimated as few as 1,000 viral particles can cause infection. According to the article, the factors contributing to infection are exposure and time. The article reduces it to a formula (infection = exposure x time). The article can be found at COVID-19: Transmission Scenarios Explained.
- If it is possible for the viral particles to reach you, then you can become exposed and then infected. The issue becomes how many particles reach you over the time you are exposed. Unfortunately, 1,000 viral particles is a very small number of particles. A single sneeze or cough could be more than enough to infect someone (or a bunch of people), as could simply talking for a longer period of time. If it is possible to become infected by someone while outside even if you are 6 feet or more apart as claimed by this research, it would be a mistake for anyone to think that they are immune to infection while outside, even if they are 6 feet apart from everyone. This is likely more of a concern when next to people for a prolonged period of time while outside as would be the case when eating outside with someone. The restaurant example you referenced shows that people can be infected by viral particles moved by air conditioning, which is not much different than a light breeze.
- Having said that, I believe that the risk of infection is much greater inside than outside. There have been very few reports of infections that have occurred outside, which supports a conclusion that the risk of infection is much less outside (although lack of reported cases of outdoor infection is by itself obviously not proof). For that reason, I rarely wear a mask outside when walking (or biking) because there are not many people around and I am only momentarily exposed while passing people, and I do keep some distance from people in front of me to reduce any risk of being exposed by their slip stream).
- So, it all comes down to individual choices based on the risk each of us is willing to assume. As there are still many unknowns about this virus, my goal is to provide people with as much reliable and up-to-date information as I can so that their choices can be as well informed as possible. I believe data showing that the virus can travel more than 6 feet outside in a slight breeze is relevant to evaluating risk. As I believe the risk of infection outside is low , I don’t worry about it much, but others may have a lower risk threshold than me (or you) and make a different decision.
Best regards, Pat
Annex I. John Hopkins Daily C19 Updates
May 20, 2020
EPI UPDATE The WHO COVID-19 Situation Report for May 19 reports 4.73 million confirmed cases (112,637 new) and 316,169 deaths (4,322 new). This is the second time in the past 3 days that the WHO has reported more than 100,000 new cases, and the global total incidence could reach 5 million cases by Friday’s Situation Report.
Brazil reported 17,408 new cases, its highest daily incidence to date. Brazil is now #3 globally in terms of total incidence—behind only the United States and Russia—and its daily per capita incidence is now nearly identical to the United States—60.35 new cases per million population in Brazil, compared to 61.11 for the United States. While the daily incidence in the United States has been decreasing for several weeks, Brazil’s is rapidly increasing.
Russia reported 8,764 new cases, slightly fewer than its recent trend of elevated incidence. India reported 5,611 new cases, continuing its recent trend of elevated and increasing daily incidence. The state of Tamil Nadu, where a large outbreak has been linked to one of Asia’s largest markets, reported 688 new cases.
Singapore reported 570 new cases, including 562 (98.6%) among residents of migrant worker dormitories. Outbreaks in migrant worker dormitories continue to drive Singapore’s growing COVID-19 epidemic. Singapore estimates that the cases confirmed so far represent 8.39% of the total population across all migrant worker dormitories, compared to only 0.03% of the general public population. Of the total confirmed cases reported in Singapore, 92.3% are among residents of migrant worker dormitories.
The US CDC reported 1.50 million total cases (24,481 new) and 90,340 deaths (933 new). Daily COVID-19 deaths in the United States are on the decline, but the total could potentially reach 100,000 deaths in the next 7-10 days. In total, 10 states (1 new) 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 New York Times continues to track state-level COVID-19 incidence, with a focus on state social distancing policies. This tracker now differentiates between states that have relaxed social distancing measures statewide and those that have done so on a regional basis.
New York state and New York City have reported steadily increasing tests since late March and steadily decreasing incidence since mid-to-late April, an encouraging sign from the hardest-hit area of the country.
Alabama continues to exhibit increasing daily incidence after beginning to relax social distancing measures on May 1. Following a brief period of relatively level or decreasing incidence in mid-to-late April (approximately April 9-28), Alabama’s reported incidence has increased substantially over the past several weeks. The 14-day average increased from fewer than 200 new cases per day on April 29 to more than 300 yesterday, and the states 399 new cases yesterday, its highest daily incidence to date. Alabama’s COVID-19 hospitalizations are also increasing, up from 515 patients on April 6 to a high of 706 on May 18. Notably, Alabama’s test positivity increased from 6.6% for the week of March 28 to 9.8-9.9% through most of April before falling to 7.0% for the week of May 9. According to the Johns Hopkins COVID-19 Testing Insights Initiative, which utilizes data compiled by the COVID Tracking Project, Alabama appears to have increased testing since March, which would likely contribute to increasing reported incidence. Alabama ranks #27 among states with respect to per capita testing—3,215 tests performed per 100,000 population.
The Johns Hopkins CSSE dashboard is reporting 1.53 million US cases and 92,149 deaths as of 12:30pm on May 20.
RE-POSITIVE TESTS The Korean Centers for Disease Control and Prevention (Korean CDC) reported findings from a study of recovered COVID-19 patients who tested positive for SARS-CoV-2 after their recovery. The study aimed to determine whether the positive test results after recovery—as long as 37 days after discharge from isolation—were artifacts of testing or due to reinfection or reactivation of the virus. The study concluded that the re-positive test results were not due to reinfection or reactivation, but rather, were a result of the PCR diagnostic tests detecting non-viable viral particles as the infection is slowly cleared from the body. These results indicate that individuals who have recovered from acute illness can no longer infect others. As such, the Korean CDC updated its guidance regarding the management of “re-positive cases,” including the removal of a mandatory 14-day self isolation period after being discharged from isolation and the requirement for subsequent PCR testing if symptoms present after a patient is discharged from isolation.
LIVE SARS-CoV-2 IN FECES A Research Letter published in Emerging Infectious Diseases reported results from a study that documented the presence of infectious SARS-CoV-2 virus in fecal matter. The researchers were able to isolate SARS-CoV-2 from fecal specimens from COVID-19 patients in Guangdong, China, and successfully infect non-human primate cells in vitro using the viral isolates. While the study does not necessarily demonstrate that SARS-CoV-2 transmission in humans is possible via the fecal-oral or fecal-respiratory routes or that fecal transmission is a significant driver of the ongoing COVID-19 pandemic, it does provide evidence that viable SARS-CoV-2 virus can be excreted in COVID-19 patients’ feces. Further research is necessary to determine the extent to which fecal-oral or fecal-respiratory transmission of SARS-CoV-2 occurs in humans, but these findings suggest that infection control and prevention measures may be necessary to mitigate exposure to SARS-CoV-2 via COVID-19 patients’ feces.
CHILE PROTESTS In Santiago, Chile, protesters gathered to call attention to a lack of food and government aid during the recently implemented COVID-19 “lockdown” in Chile’s capital city. Following the protest, Chilean President Sebastián Piñera reportedly committed to increasing aid to the affected population, with a focus on supporting the most vulnerable among them. Chilean citizens have protested the national government in recent years, demanding political and social reforms to policies and legislation enacted under former dictator Augusto Pinochet. A referendum on constitutional changes was originally scheduled for the end of April, but it has been delayed until at least October due the country’s COVID-19 epidemic.
BRAZIL HEALTH MINISTER RESIGNS Brazil’s Minister of Health, Nelson Teich, resigned from his position after only several weeks in office. Dr. Teich and his predecessor were reportedly pressured by Brazilian President Jair Bolsonaro to promote the use of hydroxychloroquine and to work with the state governors to lift social distancing restrictions, which may have contributed to their respective decisions to resign. President Bolsonaro reportedly instructed Dr. Teich to issue federal guidance that would increase the early use of hydroxychloroquine, despite concerns regarding the drug’s efficacy and risk of severe adverse effects. President Bolsonaro has also clashed with state governors, some of whom are resisting orders to relax social distancing measures. Brazil has been reporting increasing COVID-19 incidence and deaths, including reporting its record high daily COVID-19 incidence and deaths yesterday, and the health system in São Paulo is reportedly on the brink of collapse.
IN-PERSON COLLEGE CLASSES Some US colleges and universities are making plans to reopen their institutions for in-person classes this fall. While universities face difficult choices regarding when and how to resume classes, they are also developing creative options in an attempt to support the health and safety of their students, faculty, and staff while still providing a valuable education experience. The University of Notre Dame, for example, plans on beginning classes August 10 and intends to end the semester before Thanksgiving, which would avoid students dispersing across the country for the holiday and then returning for the final weeks of classes and exams between Thanksgiving and Christmas. New York University (NYU) is offering a “Go Local” option, which will allow students to attend the NYU campus closest to where they live. This could allow some students in other countries to resume classes without needing return to New York, one of the hardest-hit areas in the United States. The University of Kentucky is considering several options to resume classes, including one that will allow only freshmen and sophomores to return to campus, while juniors and seniors will take classes online in order to reduce the number of students on campus.
DOWNSTREAM EFFECTS As we have covered previously, the ongoing US COVID-19 epidemic is impacting hospital and health system operations far beyond COVID-19 patient surge. “Stay at home” orders and recommendations to avoid emergency departments unless absolutely necessary have resulted in substantial decreases in non-COVID patient volumes at many hospitals across the country. While a substantial portion of the decrease can be attributed to fewer trauma patients—eg, due to fewer automobile accidents—patients with other emergent conditions, including heart attacks and strokes, have decreased as well. Patients may avoid or delay seeking care for truly emergent health conditions due to concern about exposure to SARS-CoV-2 in the hospital, which can result in death if treatment is not received in time. Some estimates indicate that normal emergency department patient volume decreased by 50%, or possibly more, compared to last year. Additionally, “elective procedures” (eg, scheduled surgeries) have been prohibited in many states, which can include surgeries and other treatments for cancer. Some conditions may not pose an immediate risk of death, but lengthy delays to treatment can allow these conditions to worsen, which can ultimately increase the risk of death. The effect of the COVID-19 epidemic is similar to what has been observed in areas affected by hurricanes or other major disasters; however, the COVID-19 impact is persisting for a prolonged period of time.
JILIN PROVINCE, CHINA Health officials in Jilin Province, China, have implemented “lockdown” measures, reminiscent of those implemented in Wuhan, following a recent cluster of COVID-19 cases that began on May 7. We have not been able to definitively determine the exact incidence in Jilin prior to the current outbreak, but it appears as though approximately 100 cases had been reported prior to May 7. At least 34 new cases have been reported in Jilin City and Shulan since that date [Note: Shulan appears to be under the jurisdiction of Jilin City]. Shulan was designated as a high-risk area on May 10, “the only such area in China” at that time, and several other districts in Jilin City have been designated as medium- or high-risk areas since then. On May 13, the Jilin City rail station was closed, allowing trains to pass through but not permitting them to stop for passengers. Lockdowns have been initiated in Shulan and Jilin City, potentially affecting approximately 1.5 million local residents. Additionally, medical response teams have been deployed from other cities in Jilin Province to support the response, and several hospitals have been designated to treat COVID-19 patients. Jilin Province had nearly 4.5 million visitors for its May Day celebration from May 1-5, just 2 days before the onset of the current outbreak, which could potentially pose risk of broader spread to other parts of China. Multiple media outlets are reporting that more than 100 million people across Jilin Province are under lockdown, but we have not identified any official sources to confirm that lockdowns are in place in Jilin Province outside Jilin City.
Also of note, China’s National Health Commission recently announced that face masks are no longer mandatory across China. Masks are no longer required in outdoor spaces in areas of low infection risk, where social distancing can be properly maintained. Individuals should still wear masks indoors or in crowded areas.
HOW TO GET REOPENING RIGHT The Johns Hopkins University Bloomberg School of Public Health is hosting a webcast to discuss various metrics and criteria, challenges, and recommendations as states continue to relax social distancing measures, including protective measures individuals can take to mitigate their infection risk. The event, How to Get Reopening Right, will take place tomorrow—Thursday, May 21—from 2:30-3:15pm EDT. The panelists will be Dr. Tom Inglesby and Dr. Crystal Watson from the Johns Hopkins Center for Health Security and Beth Blauer from the Johns Hopkins University Centers for Civic Impact, and it will be moderated by Stephanie Desmon, co-host of the Johns Hopkins Bloomberg School of Public Health’s Public Health on Call podcast.
MASKS MANDATORY IN SPAIN Spain’s Ministry of Health issued an order requiring all persons aged 6 years and older to wear a mask in public spaces where it is not possible to maintain social distancing. The order extends to both indoor and outdoor settings, and it includes exceptions for individuals who have health conditions (eg, difficulty breathing) that would not allow them to wear a mask. The order also recommends mask use for children between the ages of 3-5 years, but is not mandatory. Spain was subject to one of the worst national COVID-19 epidemics, which necessitated implementing some of the most restrictive social distancing measures in Europe, including not allowing children outside for more than 6 weeks. In addition to the new mask order, Spanish Prime Minister Pedro Sanchez requested that the national parliament extend emergency authorities for an additional 2 weeks, which would allow Spain to slow its process of relaxing social distancing measures. Protests are ongoing in some parts of the country, calling for “lockdown” measures to be removed.
CDC SOCIAL DISTANCING GUIDANCE The US CDC published new guidance to support states’ efforts to relax social distancing measures implemented in response to COVID-19. The guidance—CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again—includes both “gating criteria” and recommendations for each of 3 phases. The gating criteria address daily COVID-19 incidence; health system capacity, including emergency department (ED) and outpatient volume for COVID- and influenza-like illnesses as well as inpatient and intensive care unit (ICU) capacity; and SARS-CoV-2 testing, including capacity and test positivity. The CDC also includes a variety of metrics, tools, and guidance to support states’ efforts to properly collect and analyze data needed to evaluate trends and thresholds related to these criteria. Additionally, the document provides “setting specific guidance” for schools and child care, high-risk individuals in the workplace, restaurants and bars, and public transit, which appears to provide more detailed information to supplement similar guidance published last week.
This most recent guidance is dated May 2020, but it is unclear exactly when the CDC published it. Multiple media outlets began reporting on its release late yesterday evening, but the CDC does not appear to have made a formal announcement coinciding with its release. We have not identified any archived versions of the document before today. The new guidance comes at a time when all 50 states have already started to relax social distancing measures, a number of which do not appear to have met the recommended gating criteria outlined in the document.LINGERING QUESTIONS FOR CANDIDATE VACCINE In a recent press release, Moderna, Inc., revealed preliminary information from the Phase 1 trial for its mRNA vaccine candidate against SARS-CoV-2. The press release claimed that several of the Phase 1 study participants developed antibodies against SARS-CoV-2 consistent with the levels found in COVID-19 patients. While this information seems promising, scientists quickly called for a more cautious evaluation of the results. Experts pointed out that Moderna has not released enough data for efficacy to be properly evaluated, including the levels of antibodies present in the specimens or the values against which they were compared. The actual biological and statistical data from the trial has yet to be released, which is critical to understanding the vaccine’s effects on the body’s immune response. Additionally, the claim in Moderna’s press release is based on a very small sample size, only 8 of 45 total study participants, and it is unclear whether the remaining participants had comparable levels of neutralizing antibodies. The information presented in the press release is encouraging, but considerable data and analysis are needed to better understand the vaccine candidate’s effects.