Coronavirus Update

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Coronavirus Update 5-27

Recent Developments & Information 

May 27, 2020

“Now, people can speculate about reopening. People can guess. But I’m out of that business because we all failed at that business. Right? All the early national experts. Here’s my projection model. Here’s my projection model. They were all wrong. They were all wrong.”   New York Governor Cuomo

“I’m not convinced that our strategy was the right decision — we are constantly thinking about this.”  Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency

“I’m a born-and-raised, do-or-die New Yorker because it was always a party, but the party is over.  I’m not getting my city back, so I’m leaving before it gets to the point that I can’t get my mind back.”  Giovanni Cassinelli, soon to be ex-New Yorker

Index Of Featured Stories & Links

Note:  All of stories listed below are included in this Update, but we have included links to the stories upfront so that you can quickly jump to a story if you want

Notes: 

  • You can access all of the updates on our website at https://dailyC19post.com/ and on Facebook at https://www.facebook.com/groups/2467516816834782/group_quality/.  Please share the website and Facebook addresses with anyone you believe might be interested in the updates.  Also, some have asked me to attach a copy of the update to each email, so I will do that going forward.  
  • We are happy to add anyone to the distribution list – just let me know.  And, for those of you that are on social media, feel free to forward or post any or all of our updates or recommendations.  Also, please forward to me any information than you believe should be included in any update, including any precautions that you recommend.  Comments and suggestions are always welcome.  
  • We do not endorse, and may not agree with, any opinion or view included in this Update.  We include a wide spectrum of opinions and views as we believe that it gives perspective on what people are thinking and may give insights into our future.

A. Our World As Seen Through Headlines

B. Key Numbers & Trends

Note: Unless otherwise noted, all changes noted in this Update are the prior day.  Unless otherwise specified, all cases are confirmed cases that have been reported.

Source: https://www.worldometers.info/coronavirus/  

1. Cases & Tests

  • Worldwide:  
    • Total Cases = 5,678,146 (+1.7%)
    • New Cases (7 day avg) = 99,316 (+0.3%) (+325)
  • US: 
    • Total Cases = 1,725,275 (+1.1%)
    • New Cases (7 day avg) = 22,099 (-0.8%) (-177)
    • Total Number of Tests = 15,532,159 (+344,512)

2. Deaths

  • Worldwide Deaths 
    • Total Deaths = 351,661 (+1.2%) 
    • New Deaths (7 day avg) = 3,872 (-1.4%) (-53)
    • New deaths decreased from 4,740 to 4,048 over the last 7 days
  • US Deaths 
  • Total Deaths = 100,579 (+0.8%) 
    • New Deaths (7 day avg) = 1,007 (-9.9%) (-111)
    • New deaths decreased from 1,403 to 774 over the last 7 days, a reduction of approximately 45%
  • 5 Countries with Largest Number of Confirmed Deaths: 
CountryTotal DeathsNew DeathsDeaths Per 1M Population
US100,572744 (+239)304 (+2)
UK37,048134 (+13)546 (+2) 
Italy32,95578 (-14)545 (+1)
France28,53098 (+33)437 (+1)
Spain27,117280580 (+6)
Worldwide351,6454,408 (+3,229)45.1
  • These 5 countries = 64.3% of total deaths and 30.3% of new deaths worldwide, which reflects a decrease in new deaths in these 5 countries as new deaths in the rest of the word are increasing 
  • US total deaths = 28.6% of worldwide deaths, but new US deaths = 16.9% of new worldwide deaths, which signifies a relative decrease in deaths in the US vs. the rest of the world
  • Of these 5 countries, the US has lowest number of deaths per 1 million of population
  • 5 States with Largest Number of Confirmed Deaths: 
StateTotal  DeathsDeaths 7 Day AverageDeaths Per 1M Population
New York29,451115 (-4)1,514 (+7)
New Jersey11,19787 (-14)1,261 (+5)
Massachusetts6,47376 (-3)939 (+8)
Michigan5,26636 (-10)525 (+2)
Pennsylvania5,19463 (-10)406 (+2)
US100,5721,007 (-111)304 (+2)
  • All 5 States are led by Democratic Governors and are reopening slowly 
  • Declining 7 day averages together with a relatively low number of new deaths (less than 1% of total) indicates that all 5 States are well past their peak and moving in positive direction
  • All 5 States have higher deaths per 1 million of population than the national average and per capita deaths in 3 States (NY, NJ & MA) are increasing at a substantially higher rate than the national average even though all 3 States have been under stringent lockdowns for more than 2 months 

3. Countries/States To Watch

  • Sweden is one of the few countries that did not impose a lockdown and has been cited by the WHO as a model for emerging from lockdowns
CountryTotal DeathsDeaths 7 Day AvgDeaths Per 1M Population
Sweden4,12555 (+7)409 (+25)
  • Although per capita deaths in Sweden are substantially less than Spain, Italy and France (among other countries), Sweden’s per capita is much higher than its neighbors such as Norway, Finland and Denmark.  And the increase in 7 day average of deaths, and the substantial increase in per capita deaths, is a troubling sign
  • 5 States that are Reopening:
StateTotal  DeathsDeaths 7 Day AvgDeaths Per 1M Population
Georgia1,89528 (-3)178 (+4)
Florida2,25930 (-6)105 (+0)
Texas1,56323 (-2)54 (+1)
Ohio2,01241 (-7)172 (+1)
Oklahoma3183  (-1)80 (+1)
US100,5721,007 (-111)304 (+2)
  • All 5 States are led by Republican Governors and are reopening rapidly 
  • Declining or stable 7 day averages together with a relatively low number of new deaths (1.1% or less of total) indicate that all 5 States are making good progress with no indication of a second wave
  • All 5 States have substantially lower deaths per 1 million of population than the national average, and new deaths per capita in 4 States (FL, TX, OH & OK) are less than new deaths per capita in US, which show that these States are effectively managing their reopenings.  Although new deaths per capita in GA are greater than the national average, total deaths per capita in GA are well below the national average and the 7 day average of deaths is decreasing, which indicates that GA is also effectively managing its reopening.

C. Vaccines & Testing

1. Merck leaps into C19 vaccine race  

  • Merck, one of the largest vaccine makers in the world, is entering the C19 arena with an announcement on Tuesday it is developing two different vaccines for C19 and is also licensing an oral drug that might treat the virus.
  • Merck is buying Vienna-based Themis, which is developing an experimental C19 vaccine based on a measles vaccine that could begin human studies soon. 
  • Merck is also partnering with the nonprofit IAVI on the development of a vaccine related to Merck’s existing Ebola vaccine that could enter human studies later this year. 
  • And Merck is licensing an experimental drug from a small company called Ridgeback Biotherapeutics.
  • “We are committed to making a contribution to the eradication of C19,” Roger Perlmutter, who heads Merck Research Laboratories, the company’s research and development division, said in an interview.
  • Merck executives see the company’s history of developing vaccines and treatments against infectious diseases as central to its identity, often citing the decision three decades ago to donate a treatment for river blindness as a pivotal moment in the 129-year-old company’s history. But until now, Merck has been conspicuously absent from the efforts to develop a C19 vaccine. It’s not that the company wasn’t working on the problem, Perlmutter said, but that it simply wasn’t ready to speak.
  • In August 2019, Merck inked a deal with Themis, a Viennese company spun out of the Institut Pasteur in Paris. Themis would develop vaccine candidates against an undisclosed disease target and Merck would pay as much as $200 million if the vaccines hit undisclosed sales and development targets. Perlmutter said he was impressed by the company’s approach, which uses a weakened measles virus to slip parts of a new virus into white blood cells, generating an immune response. The most recent Themis vaccine is against Chikungunya, a mosquito-borne viral disease that causes fever and debilitating joint pain.
  • Perlmutter said that the founders of Themis had intended the company to focus on pandemic preparedness, and it will keep that purpose as well as its Vienna home base. The company’s C19 vaccine is finishing up preclinical tests, including studies to see if it can prevent infection in animals. Human studies are planned to begin in France in a matter of weeks, Perlmutter said.
  • The IAVI vaccine could also enter human studies this year. Perlmutter said that Merck began talking about whether vaccines based on the vesicular stomatitis virus, or VSV, that was used in the Ebola vaccine, might work against the coronavirus. According to Perlmutter, Merck researchers reached out to IAVI, which had already begun work on potential vaccines using the virus. Discussions between Merck and IAVI began two-and-a-half months ago.
  • “The fact that regulatory authorities are familiar with this platform is a big asset for our program, as well as for their review,” said Mark Feinberg, the president and CEO of IAVI. “And everyone is doing their best to move forward as quickly as possible while making sure that we generate the appropriate safety data and appropriate characterization of the approach.”
  • From the start, the VSV platform has been seen as one that might be used as a backbone for multiple vaccines.
  • The same factors about both vaccines appealed to Merck. Unlike some other vaccines in development against the coronavirus, the goal in both efforts is to develop a single-dose vaccine, said Perlmutter. “You want to immunize in principle everyone in the world,” he said. “No one’s safe unless we’re all safe.” Having to follow up to give booster shots would make such an effort far more complicated.
  • Based in part on the Ebola experience, a vaccine that used a live but weakened virus instead of a killed virus or a genetically engineered protein fragment would be far more likely to generate the necessary immunity. Equally important is a vaccine that could be manufactured in large amounts. Merck already makes the Ebola vaccine, and the Themis vaccine would be similar to the measles vaccine it makes for use around the world.
  • Merck has done its own work with vaccines based on messenger RNA similar to the ones being developed by Moderna and the team of Pfizer and BioNTech. But, Perlmutter said, in part because of the need to give two doses, he wasn’t sure that was the technology he wanted to pursue.
  • Perlmutter said he worries that a vaccine that is not potent enough could make the effects of the virus worse. He pointed to the experience with the dengue vaccine, in which antibodies were produced that could have made some infections worse, and to preclinical studies on SARS, which is related to the coronavirus, that showed passive administration of an antibody was deleterious. What’s needed, he said, is “a potent immunological stimulus.”
  • “What we’ve learned is that these replicating vectors tend to be more effective,” Perlmutter said, adding that it may take longer than many would like before a vaccine can be ready.
  • “I think the clinical development side is going to take longer than people imagine. And I hate to sound what some people may regard as a sour note, but I don’t want to overpromise.” If a vaccine is sterilizing — meaning that people who get it can’t be infected with the coronavirus at all — studies could finish very quickly. But Perlmutter thinks that won’t be the case. “Most likely, people will still get infected, but it will only very, very rarely progress to severe disease and, we hope, never too critical.”
  • That would mean studies couldn’t just test for the presence of the virus in people’s noses or throats but would need to look at how sick people would become. That would require large studies where thousands and thousands of people, many of whom won’t become very sick, would need to be followed before any develop symptoms. Perlmutter does not, however, think there will be much difficulty finding patients for clinical studies.
  • “We have a global operation, so we’re not limited to the U.S.,” Perlmutter said. “I fear that with the substantial relaxation that is taking place also as we speak, that there will be no shortage, unfortunately, of C19 patients in the United States.”
  • The Ridgeback BioTherapeutics drug, which was invented at Emory University, was recently shown to have efficacy against SARS-CoV-2 in laboratory cultures and to be effective against related viruses in mice. Human safety studies have been conducted, and Phase 2 studies to test the drug’s efficacy should begin this week.

Source: Merck leaps into Covid-19 vaccine race, aiming to test two candidates 

2. Can a Vaccine be Ready by the End of 2020?  

  • The moonshot program to come up with a vaccine against C19 is advancing faster than anyone could have hoped. At least four experimental vaccines have been shown to protect monkeys, and three of those are already being given to brave human volunteers.
  • The aim is a vaccine by January, and money is no object. On May 21, the US said it would throw $1.2 billion behind a vaccine from Oxford University and AstraZeneca, part of what President Donald Trump called “Operation Warp Speed.”
  • It’s all good news, and many scientists believe a vaccine is likely. But the next hurdle is the biggest one: proving that a vaccine candidate actually works.
  • By early summer, expect to see researchers try to launch several huge efficacy studies involving thousands of volunteers. This is going to be the most costly part of testing a vaccine, and also the hardest to speed up. That’s because researchers will have to wait for people in the study to get accidentally infected with the virus, and then check how often those given the vaccine get sick.
  • President Trump along with Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases and Secretary of Health and Human Services Alex Azar in March after returning from the NIH’s vaccine research center.
  • “It’s invariably the most expensive part of vaccine development and the longest of the three phases,” says Stanley Plotkin, former head of vaccines at Sanofi Pasteur. More than anything, he says, the time frame “depends on the incidence of the disease.”
  • The global effort to create a vaccine on such short notice is unprecedented. New technology has led drug makers to move quickly, and regulators have never pushed paper so fast. But with C19 getting beaten back in cities like New York, where new cases have fallen from more than 6,000 a day to less than 600, successful efforts to suppress the disease could perversely make it harder to test a vaccine.
  • Vaccine makers say it’s a concern. Speaking to Wall Street analysts on a conference call this week, Tal Zaks, chief medical officer at Moderna, whose mRNA vaccine was first to enter human studies in March, said: “The challenge is, how do I ensure I have enough cases? If I go and vaccinate a lot of people, it doesn’t matter how many if there is no circulating virus.”
  • The irony is that the process will go faster if the C19 outbreak keeps flaring up. Vaccine researchers are also expected to pick nurses, doctors, and other at-risk groups to join their studies, so there’s a bigger chance of subjects catching it. They will advise people to stay safe, even while hoping some get sick.
  • “You still have to tell people to try not to get infected. You don’t say ‘Stop wearing a mask, or ‘Why don’t you meet people in a closed space.’ How is that for a weird dilemma?” says Arthur Caplan, a bioethicist at NYU Langone Health in New York. “The world is trying to get this under control, which I admire, but it does undermine the ability to study a vaccine.”
Trial design
  • While companies are the ones to decide what a trial looks like, in the US they need approval from the FDA, which has already said it expects to see randomized double-blind trials, the gold standard for proving that a treatment really works.
  • That means in the big studies starting this summer, some people will get the real vaccine and others will likely get a placebo shot. Then researchers will look to see how many in each group get infected or develop C19.
Going faster
  • To run their studies, vaccine companies are likely to look for volunteers among higher-risk populations in big, dense cities, according to Cynthia Dukes, vice president for drug development services at Icon Clinical Research, which is coordinating several covid vaccine and drug trials.
  • Most people to be vaccinated will likely be first responders, health care workers, or members of the National Guard, she says. “It’s a good population to go into and get an answer. We do want them to have a risk of exposure. If they are sitting at home, it’s not going to work.”
  • Dukes says she’s seen draft plans for vaccine trials involving 6,000 to 10,000 volunteers, in which researchers estimated that as many as 3.7% of volunteers would be exposed to the virus. That means they’re expecting about 100 to 150 infections in the placebo arm and fewer, or ideally none, among those who get vaccinated. That would be statistical proof the shot works.
  • During the trials, people will regularly be checked to see if they are infected as well. “In a clinical study, at the first sign of a sniffle you get tested,” says Dukes.
  • According to Dukes, it is possible to speed up the studies by filling them more quickly. She expects that won’t be a problem; volunteers have been calling in by the thousands. Another way to get them done faster is simply to make them larger. That is what the Department of Health and Human Services signaled it planned to do with the AstraZeneca trial, which it said would involve 30,000 people in the US.
  • Like a horse race, Operation Warp Speed could end up backing trials of several vaccine contenders. That means the total number of volunteers needed could soar to more than 150,000, Reuters reported. But it’s far from clear there will be enough C19 around. Adrian Hill, the Oxford University scientist behind the AstraZeneca shot said he thought there was a 50% chance a trial would lead to “no result at all.”
  • “It’s a race against the virus disappearing,” Hill told The Telegraph.
  • The British pharmaceutical company pledged to have 300 million doses ready by October, but some are skeptical that large trials will have delivered answers that soon. “Experts keep saying we’ll have a vaccine in the fall, but we won’t even have any data by then,” says Caplan, who adds that it would be “ethically impossible” to distribute a vaccine before there’s proof it works safely. “People wouldn’t take it. Also, you might be worried about an adverse event that is one in 25,000,” he says. “That’s rare, but if you are vaccinating a billion people, then relatively rare events are going to be more common.”
  • Anthony Fauci, head of the US National Institutes of Allergy and Infectious Diseases, projected that it will take at least four or five months for a big trial to generate enough evidence that a vaccine works. “If we are successful, we hope to know that in the late fall and early winter,” he told a Senate hearing in May.
  • Hermes, the vaccine lawyer, agrees that “you won’t see anything deployed in the general population without proof of efficacy,” but he thinks governments will be likely to permit emergency use of a vaccine in frontline workers even before all the data is in—perhaps within a few months. “If a vaccine has a good safety profile and might possibly work, you could see people on the front line getting it,” he says.
Immunity correlates
  • As clues roll in, the whole world is hanging on any hint a vaccine will end the covid crisis. On May 18, Moderna Therapeutics sent the entire US stock market up nearly 4% after it said volunteers who got its vaccine in a safety trial made antibodies at levels similar to convalescent C19 patients, a hint that its vaccine might be effective.
  • In some volunteers, the antibodies were “neutralizing,” meaning they countered the virus when their plasma was tested in a petri dish.
  • The company was quickly attacked for doing “science by press release,” but Fauci, whose agency is testing the Moderna vaccine, says there is good reason to believe it could work. “It’s definitely not a long shot,” he told Senator Mitt Romney during the Senate hearing. “This is a virus that induces an immune response, and people recover … the very fact that the body is capable of spontaneously clearing the virus tells me that at least from a conceptual standpoint, we can stimulate the body with a vaccine that would induce a similar response.”
  • That’s a very different situation from HIV—where (with rare exceptions) people never naturally defeat the virus, something that may explain why vaccines for AIDS have flopped time and again. With C19, by contrast, about 99 out of 100 people survive and appear to eventually cleared the virus. [Note: Comparing AIDS to C19 isn’t relevant as HIV attacks and actually changes the DNA of the host. C19 does not change the DNA.]
  • The early data from the Moderna trial is an example of what vaccine makers call “correlates of immunity.” A correlate is something they can measure, like antibody levels, and which they can also cause to increase to a certain level with a vaccine. What they need to prove now, in the efficacy trial, is whether or not these factors can predict—or actually cause—real protection against the virus.
  • “There are lots of kinds of immune responses. So which of these are you creating, and which is responsible for protection, if there is protection? That is the question,” says Plotkin. “Neutralizing antibodies are not always sufficient, but it’s a good guess. For many diseases it’s the key to protection, but not always.”
What could go wrong
  • What’s extraordinary now is that C19 vaccines are advancing to big tests even as the parallel scientific effort to understand our immune response to the coronavirus remains in its early stages. Zaks, the chief medical officer of Moderna, compared the process to “flying a plane” while building it.
  • And some voices are rising to warn that Operation Warp Speed could easily crash on takeoff. “Normally, it takes up to 10 years to make a vaccine,” Rick Bright, the former head of the US agency responsible for the vaccine push, told lawmakers on May 14. “A lot of optimism is swirling around a 12-to-18-month time frame, if everything goes perfectly. We’ve never seen everything go perfectly.”
  • So what can go wrong? Dukes, who runs studies on behalf of companies, says that in her experience it’s usually manufacturing. If there’s a problem scaling-up supplies, the process can face a big setback, since everything from animal studies to human studies is supposed to be based on an identical product.
  • For his part, Plotkin says the usual downfall of a vaccine is that researchers pick the wrong part of the virus to include in it or fail to inject enough of the substance. Other times it’s the biology of the virus that’s the problem—as in the case of HIV, a shape-shifter that attacks the immune system.
  • It’s also well known that a perfectly effective vaccine can fail to make a difference for a much more mundane reason: people don’t get vaccinated.
  • That happens more often than you think. Many people don’t bother with flu vaccines, anti-vaccine movements are sowing fear, and there are regions of the world where shots for preventable disease never get delivered.
  • With C19, all those problems remain on the horizon. There’s also the fact that it’s going to be hard to make enough vaccine for everyone. “In the context of a pandemic, we expect demand to far outstrip supply,” Zaks said of his company’s vaccine. During the call with stock analysts, his boss, Stéphane Bancel, the company’s CEO, agreed: “Trust me, it was not part of our business plan to have a billion doses.”

Source: Here’s what we have to do to show a coronavirus vaccine works

3. The Race to Create Rapid C19 Tests  

  • Even as coronavirus testing ramps up around the country, businesses and public-health authorities seeking to safely reopen are hitting a speed-bump: Standard testing techniques still require sophisticated lab equipment and can take hours or even days for results.
  • To stretch beyond the lab, test developers are racing to produce next-stage technologies that could allow for rapid widespread testing as quickly as an at-home pregnancy test.
  • “The truly ideal test is the test that you can do in your house every morning,” said Elizabeth McNally, the director at the Center for Genetic Medicine at Northwestern University.
  • Yet diagnostics experts estimate wide access to quality rapid tests is still months away. Among the challenges is finding noninvasive ways to collect the patient sample while maintaining the sensitivity of current standard tests. The nasalpharyngeal swabs used in most current C19 tests are invasive and difficult to successfully conduct in a home setting.
  • The industry is trying to move quickly, especially before flu season arrives in the fall. That is when public-health experts worry about another surge of C19 cases, and the ability to quickly distinguish between respiratory illnesses would become even more crucial.
  • Mammoth Biosciences is working to develop a hand-held rapid test for Covid-19 using the Crispr system. The technology is best known for enabling gene editing and is now being turned toward detecting the genetic signature of the coronavirus.
  • Sherlock Biosciences in Cambridge, Mass., earlier this month received emergency use authorization from the FDA for a Crispr-based C19 lab test that can provide results in an hour. The test is the first authorized Crispr-based infectious-disease diagnostic, the FDA said, but is still limited to specialized laboratories. The company aims to submit a test that can be used in urgent clinics and doctors’ offices for authorization in the fall, said Sherlock’s chief executive officer, Rahul Dhanda, while the rapid hand-held test is still further off.
  • Mammoth signed a deal this month with GlaxoSmithKline PLC’s GSK Consumer Healthcare to develop its rapid test. A GSK spokesperson said they aim to have a prototype before the end of 2020, and potentially available in clinics by the first quarter of 2021. Over-the-counter availability to consumers would come after that, the spokesperson said.
  • U.S. labs have conducted at least 300,000 daily tests since May 11, according to the Covid Tracking Project, a marked improvement from previous weeks. That daily count is still well below the level that public-health experts say is necessary—along with tracing close contacts and quarantining, among other measures—to stem the spread of the virus.
  • Health officials said “rapid, extensive, and widely available, timely testing is essential” for reopening the country and that the U.S. will be able to perform at least 40 to 50 million tests per month by September.
  • The chief current testing method, the polymerase chain reaction test, is considered the gold standard but has drawbacks. The PCR test relies on a strained supply chain for materials, including protective equipment; samples have to be sent to a lab; and patients sometimes wait days for results.
  • “It’s hard to imagine getting to the numbers that people are talking about without some sort of technical breakthrough, and that’s what everyone’s searching for,” said Gary Samuels, vice president of corporate communications at laboratory-testing giant Quest Diagnostics.
  • Rapid tests at a doctor’s office or urgent-care clinic, called ‘point-of-care’ tests, and tests done in homes, offices and other places without lab access all “allow you to decentralize testing,” said Dr. Chiu.
  • OraSure Technologies Inc., of Bethlehem, Pa., said it has a contract with the Health and Human Services department to develop a rapid C19 antigen test called a lateral flow assay. It uses strips to find viral proteins in oral fluid taken from between the gums and the cheek. The test is based on technology already deployed in the company’s HIV self-test.
  • The lateral flow assay strips, similar to a home pregnancy test, look for viral antigens in saliva or a nose swab and are one of the major technologies companies are exploring. These tests are different, though technologically similar, to rapid antibody tests, which look for signs of past infection in a small sample of blood. Antibody tests, however, can’t diagnose a current infection.
  • Last month, the National Institutes of Health announced a competition meant to speed up development of diagnostic technologies, with the goal of millions of rapid tests a week available by the end of summer, and more by flu season. The Rapid Acceleration of Diagnostics, or RADx, initiative, often compared with the TV show “Shark Tank,” will provide finalists with up to $500 million and technical, business and manufacturing expertise.
  • Over 1,700 groups have registered, more than 280 have applied, and 40 have advanced to a “deep dive” review stage. Bruce Tromberg, director of the National Institute of Biomedical Imaging and Bioengineering at the NIH, which is leading the initiative, says he is expecting five to 10 finalists to emerge.
  • “These advances would normally happen over five years, but we need them now,” Dr. Tromberg said. “We need them in more diverse settings, and we need a diversity of technologies to get us there.”
  • A few point-of-care tests, including Abbott Laboratories ’ ID Now or Cepheid Inc.’s GeneXpert, are on the market though not widely available. Quidel Corp. earlier this month gained FDA authorization for the first point-of-care antigen test.
  • Creating a viable rapid at-home test depends not only on accuracy but also on consumer utility, said Feng Zhang of the Broad Institute of MIT and Harvard and a co-founder of Sherlock Biosciences, one of the Crispr companies. Saliva is easy to collect, but if the person recently ate, drank or chewed gum, that can affect the results. Nasal swabs have to collect sufficient amounts of virus without being invasive. “It has to be super easy to use,” he said.
  • There are no fully at-home diagnostic tests currently authorized by the FDA, though several at-home collection devices, to be sent to a lab for analysis, are on the market.
  • Rapid tests are likely to be less sensitive than laboratory PCR diagnostics and they can process only one or a few samples at a time, while the highly complex laboratory machines can run many more simultaneously.
  • “If you want easy-to-use and low cost, you’re going to sacrifice some performance. That’s just the way it is,” said Ron Chiarello, founder and chief executive of Alveo Technologies Inc., which is developing a point-of-care device with Janssen Pharmaceuticals Inc.
  • OmniVis, in San Francisco, is working on an early-stage rapid test that would attach to a phone. “With these rapid tests, are we trading off some sensitivity? And if we go with these slower tests, are we losing a lot of time?” said Katherine Clayton, co-founder and CEO of the diagnostics company. “You start to see the convergence of all those principles.”
  • A quick test with good-enough sensitivity and a known error rate, paired with the right testing strategy, could pick up most C19 infections, infectious-disease experts say, and be especially useful in a triage situation or absent a nearby lab. Some technologies, such as Crispr, might be able to bridge the gap between speed and sensitivity.
  • Whether the diagnostics industry can ramp up to produce millions of rapid tests a week by the fall remains an open question. The NIH’s Dr. Tromberg and others say it can be done. OraSure said it aims to submit its at-home test for FDA authorization in September, while Alveo Technologies and others anticipate seeking authorization in late 2020 or 2021.
  • NIH director Francis Collins, at a May 7 Senate committee hearing, called the proposed fall target “a stretch goal that goes well beyond what most experts think will be possible.”
  • “The scientific and logistical challenges are truly daunting, but I remain optimistic,” he added.

Source: Race Is On to Create Rapid Covid-19 Tests for the Fall 

D. New Scientific Findings & Research 

1. Genetic mutation increases risk of dementia and severe case of C19  

  • People with a genetic mutation that increases the risk of dementia also have a greater chance of having severe C19, researchers have revealed.
  • The study is the latest to suggest genetics may play a role in why some people are more vulnerable to the coronavirus than others, and could help explain why people with dementia have been hard hit: dementia is one of the most common underlying health conditions among those who have died from C19 in England and Wales.
  • “It is not just age: this is an example of a specific gene variant causing vulnerability in some people,” said David Melzer, a professor of epidemiology and public health at Exeter University and a co-author of the study.
  • Writing in the Journal of Gerontology: Medical Sciences, Melzer and colleagues report how they analyzed data from the UK Biobank, a research endeavor that has collected genetic and health data on 500,000 volunteers aged between 48 and 86.
  • The team focused on a gene called ApoE – this gives rise to proteins involved in carrying fats around the body, and can exist in several forms. One such variant, called “e4”, is known to affect cholesterol levels and processes involved in inflammation, as well as increasing the risk of heart disease and dementia.
  • The researchers found 9,022 of almost 383,000 Biobank participants of European ancestry studied had two copies of the e4 variant, while more than 223,000 had two copies of a variant called “e3”. The former, the team add, have a risk of dementia up to 14-fold higher than the latter.
  • The team then looked at positive tests for C19 between 16 March and 26 April when testing for the coronavirus was largely carried out in hospitals, suggesting the cases were severe.
  • The results reveal 37 people who tested positive for C19 had two copies of the e4 variant of ApoE, while 401 had two copies of the e3 variant. After taking into account various factors, including age and sex, the team say people with two e4 variants had more than double the risk of severe C19 than those with two e3 variants.
  • Melzer said the findings were not down to people with two e4 variants being more likely to be living in a care home – settings that have been hard hit by C19 – since the association remained even when the team excluded participants with a diagnosis of dementia. None of the C19 positive participants with two e4 variants of the ApoE gene had a dementia diagnosis.
  • “It is pretty bulletproof – whatever associated disease we remove, the association is still there. So it looks as if it is the gene variant that is doing it … This association is not driven by people who actually have dementia,” said Melzer.
  • The team say further work is needed to unpick the link.
  • Prof Tara Spires-Jones, an expert in neurodegeneration at the University of Edinburgh who was not involved in the study, said the large number of Biobank participants meant the association between the ApoE genetic variants and C19 risk was robust, but stressed the study did not prove the former caused the latter. Nevertheless, she said, the study was important.
  • “It is possible that the role of ApoE in the immune system is important in the disease and future research may be able to harness this to develop effective treatments,” she said.
  • Fiona Carragher, a director of research and influencing at Alzheimer’s Society, said people with dementia and their families were desperately worried, adding the government must take urgent action to protect people with dementia. But, she said, more research was needed to delve into the possible link between the e4 variant of ApoE and severe C19.
  • “Other factors may contribute, so it is difficult to draw firm conclusions at this stage. But clearly much more in-depth research is urgently needed to fully understand why people with dementia seem to be at a higher risk and to what extent factors like ethnicity and genetics might play a role,” she said.
  • But Prof David Curtis, honorary professor at the UCL Genetics Institute, urged caution. He noted that among the study’s limitations, diagnoses of dementia in recent years are unlikely to be captured, meaning that the link between the e4 variant and severe C19 may still be driven by more people with two e4 variants having dementia than those with two e3 variants.
  • “I’m afraid this study does not really convince me that the ApoE e4 allele [gene variant] is really an independent risk factor for severe C19 infection,” he said. “I would want to see this tested in a sample where dementia could be more confidently excluded, perhaps a younger cohort. I am sure additional data will soon emerge to illuminate this issue.”

Source: Research reveals gene role in both dementia and severe Covid-19 

2. Mild cases of C19 produced antibodies that could prevent reinfection  

  • Almost all doctors and nurses who got mild forms of C19 produced antibodies that could prevent reinfection, according to a study conducted on hospital staff in northeastern France.
  • The study of 160 volunteers shows all but one developed antibodies within 15 days after the start of infection, Institut Pasteur and university hospitals in Strasbourg said in an early version of their findings released before peer review. Almost all of the staff tested had antibodies that were capable of neutralizing the virus within 41 days of developing symptoms.
  • The research addresses a crucial question regarding the new coronavirus: whether people who had C19, and especially those who didn’t get severely ill, develop antibodies capable of protecting them against reinfection. The World Health Organization said on April 24 that there’s no evidence yet that people who have recovered and have antibodies are protected from a second infection.
  • “This finding supports the use of serologic testing for the diagnosis of individuals who have recovered from C19 infection,” Institut Pasteur’s Arnaud Fontanet and colleagues wrote in the paper.
  • More of the hospital staff developed neutralizing antibodies over time, with only 79% of the volunteers exhibiting them within 20 days, compared with 98% detected after 41 days. All of them had their infections confirmed by tests at the time they were ill.

Source: Hospital Staff With Covid-19 Had Protective Antibodies in Study

3. Men with long ring fingers less likely to die from the coronavirus 

  • Men with longer ring fingers may have a lower chance of dying from the coronavirus and could be more likely to face mild symptoms, according to a new study published in the journal Early Human Development.  [Note: A copy of the study can be found here.]
  • The reason? The length of ring fingers is believed to be linked to how much testosterone men are exposed to in utero — the longer the finger, the greater the hormonal exposure. And testosterone is believed to protect against severe coronavirus-related illness because it increases the concentration of angiotensin-converting enzyme 2 (ACE2) in the body.
  • Earlier this month, researchers estimated that men are more than twice as likely to die from C19 than women because of the greater presence of ACE2 found in their blood. ACE2, a receptor and a gatekeeper to cells, binds to the coronavirus, allowing it to cause infection.
  • The risk factors that increase the likelihood of coronavirus hospitalization
  • So while it may not stop them from getting the coronavirus, it could be a sign that the symptoms won’t be as severe. Other studies suggest that even higher levels of ACE2 — thought to create greater entry points for the virus to infect cells — can protect men against lung damage, the Daily Mail notes.
  • With regards to the lungs, the coronavirus is known to lower the number of ACE2 receptors once inside the body. But it appears that men who have higher levels of the enzyme could be better protected from the disease’s wrath than men with a lower count.
  • The Swansea University-led researchers pored over data from 200,000 people across 41 countries where they measured volunteers’ ring fingers in relation to their index fingers to the nearest millimeter. A smaller “digit ratio” means the ring finger is longer, and this trait was found in countries including Malaysia, Russia and Mexico — where the C19 fatality rate was lower. Countries where men have a higher digit ratio, meaning the ring finger is shorter, include the United Kingdom, Spain and Bulgaria — where there’s been a higher fatality rate.
  • On average, men in countries with longer ring fingers have a death rate of 2.7 per 100,000. For the countries where there’s shorter finger length, the average is 4.9 per 100,000.

Source: Men with long ring fingers are less likely to die from the coronavirus: study

4. Boeing and Airbus Study How Coronavirus Behaves During Air Travel  

  • Boeing and Airbus are researching the new coronavirus’s behavior inside jetliners, part of an industry push to curb risks that have brought air traffic to a near standstill.
  • Their work will involve academics, engineers and medical experts who will examine new measures to prevent disease transmission on airplanes, according to the companies and people involved in their discussions.
  • The effort to better understand air-travel risks during the pandemic comes as airlines try to reassure nervous passengers that masks and filtered cabin air provide reliable protection from infection in flight. Global air traffic has plunged as governments closed borders and ordered would-be fliers to stay home.
  • Boeing said it is developing computer models that simulate the cabin environment and could ultimately inform decisions by airlines, health officials and regulators on how to prevent the virus’s spread. “We’re taking steps to better understand any potential risks,” a spokesman said.
  • Airbus said the plane maker is exchanging information with universities in the U.S. and other countries. Airbus engineers are also exploring other methods of reducing the spread of the virus including self-cleaning materials, a disinfectant that can last for five days and touchless devices in lavatories, the company said.
  • The Federal Aviation Administration has been in touch with Boeing, Airbus and experts at the CDC to assess coronavirus risks for fliers and how to mitigate them, people familiar with those discussions said. FAA officials have for years sponsored research on how to measure and reduce the introduction of fuel and oil vapors in cabins, but those efforts haven’t been formally expanded to better understand how the new coronavirus behaves inside planes, one of these people said.
  • The CDC said its experts participated in a call with the FAA and Boeing about recommendations concerning C19 and travel.
  • While much is known about airplane ventilation systems and how some pathogens can spread in flight, researchers said they are still learning how the new coronavirus behaves in various settings.
  • “There are a lot of unknowns right now,” said John Scott Meschke, a microbiologist who teaches at the University of Washington’s school of public health and has fielded questions from Boeing related to curbing the virus’s spread.
  • The issue is becoming more pressing as more passengers start to board planes again. Airlines have said bookings are beginning to pick up after weeks of near-zero demand, and they are adding back flights after slashing their schedules by as much as 90%. On the Friday before the Memorial Day holiday weekend in the U.S., the Transportation Security Administration screened nearly 349,000 people—still 88% below year-ago levels but the most since March.
  • Among the efforts Boeing is weighing are research grants for academics undertaking such work, people familiar with the manufacturer’s internal discussions said. Boeing has said it is researching new technologies to enhance safety, including using ultraviolet light as a disinfectant and antimicrobial coatings for frequently touched surfaces.
  • Boeing has expressed interest in a potential project at the University of Colorado, Boulder, that could determine the dosage of ultraviolet light needed to disinfect airplanes between flights, said Karl Linden, an environmental engineering professor at the university. “They want to move really quickly,” he said.
  • Combating the virus in flight is challenging because of commercial air travel’s incompatibility with social distancing, some experts said. While researchers broadly agree that airplanes’ frequently replaced cabin air and strong filters are effective at removing pathogens, they may not help someone sitting near an infectious passenger who is coughing.
  • “Social distancing is impossible in an airplane,” said Qingyan Chen, a Purdue University engineering professor who recently discussed the topic with Boeing.
  • Studies of previous epidemics, including SARS and avian flu, suggest that airplane passengers who sit near infectious passengers are at the highest risk. Experts said requiring passengers to wear masks should significantly reduce the risk they will spread the virus by sneezing, coughing or talking.
  • “If everyone’s wearing a mask, then there is very little that is getting out into the air,” said Linsey Marr, an engineering professor at Virginia Tech, whom Airbus recently contacted for information on the subject.
  • The CDC has said the virus appears primarily to spread person to person within about 6 feet through droplets excreted by coughing, sneezing or talking. Charles Haas, a professor of environmental engineering at Drexel University, said more research is needed to know whether airborne particles in aircraft or other indoor spaces could spread the virus beyond such a limited area.
  • Airlines have ramped up cleaning efforts—disinfecting bathrooms, tray tables and seats between flights. Some are distributing sanitary wipes to passengers. The CDC has said transmission through touching contaminated surfaces is a possible, though not primary, mode of infection.
  • The International Air Transport Association, a trade group, has collected reports of crew members who have become infected on the job but said that of 18 major carriers it surveyed recently, none reported instances of suspected transmission between passengers. The survey found three episodes of suspected in-flight transmission from passengers to crew members between January and March, and four cases in which pilots might have transmitted the disease to another pilot before, during or between flights.
  • Separately, Canadian public health officials didn’t find evidence of transmission after monitoring the crew and 25 travelers who had sat near an infected passenger on a January flight. Researchers in France suspect one person was infected on a February flight to that country from the Central African Republic. Another recent study tied some cases in China to in-flight transmission.
  • Airline executives said they are working to reduce the risk of infection in flight. U.S. carriers have started requiring masks and reshuffled boarding and deplaning procedures to minimize contact. Carriers including Southwest Airlines and Delta Air Lines are leaving seats empty and capping the number of passengers on a flight. Southwest Chief Executive Gary Kelly said air filters and new cleaning measures have made cabins clean and safe.
  • “It’s never going to be perfect no matter what we do,” Mr. Kelly said in an interview. “But I think for the circumstances, it’s very well done.”

Source: Boeing and Airbus Study How Coronavirus Behaves During Air Travel

E. Updates

1. Remdesivir Offers Limited Benefit  

  • Remdesivir was authorized by the FDA to treat C19 in a group of 1063 adults and children (split into two groups, one receiving placebo instead of remdesivir) who need i) supplemental oxygen, ii) a ventilator or iii) extracorporeal membrane oxygenation (ECMO).
  • According to a pivotal study published in the New England Journal of Medicine late on Friday, May 24, Remdesivir only significantly helped those on supplemental oxygen.
  • The study also found no marked benefit from remdesivir for those who were healthier and didn’t need oxygen or those who were sicker, requiring a ventilator or a heart-lung bypass machine.
  • Another disappointment: the study found that overall “mortality was numerically lower in the remdesivir group than in the placebo group, but the difference was not significant“, in other words the alleged “miracle drug” has largely the same effect as a placebo in terms of overall disease mortality.
  • The study authors also note that the “findings in our trial should be compared with those observed in a randomized trial from China in which 237 patients were enrolled (158 assigned to remdesivir and 79 to placebo)…. That trial failed to complete full enrollment (owing to the end of the outbreak), had lower power than the present trial (owing to the smaller sample size and a 2:1 randomization), and was unable to demonstrate any statistically significant clinical benefits of remdesivir.“
  • Finally, the study found that while mortality was modestly lower for the remdesivir arm, it was not significantly so, at 7.1% at 14 days on drug versus 11.9% on placebo.
  • In conclusion, while the “preliminary findings support the use of remdesivir for patients who are hospitalized with C19 and require supplemental oxygen therapy” the study goes on to warn that “given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient.”

[Note: The full study is available at Remdesivir for the Treatment of Covid-19 — Preliminary Report]

Source: The Remdesivir Study Is Finally Out: Drug Only Helped Those On Oxygen, Finds Mortality Too High For Standalone Treatment

2. Sweden’s Strategy Fails to Achieve Expected Results  

  • Sweden’s controversial approach to fighting the coronavirus pandemic has so far failed to produce the expected results, and there are calls within the country for the government to change its strategy.
  • “We have a very vivid political debate,” Karin Olofsdotter, Sweden’s ambassador to the United States, told NPR. “I don’t think people are protesting on the streets but … there’s a very big debate, if this [strategy] is the right thing to do or not, on Facebook and everywhere.”
  • Unlike its Nordic neighbors, Sweden decided against instituting a strict lockdown. The government has enforced social distancing rules but decided to keep most bars, restaurants, schools and retail shops open. The country’s approach relies on public cooperation to slow the spread and not overwhelm the hospital system.
  • Health officials also hoped that keeping the country open would mean its younger, not-at-risk population would develop immunity against the virus, potentially leading to herd immunity. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency, said in late April that sampling and modeling data indicated that about 20% of Stockholm’s population is already immune to the virus.
  • Olofsdotter told NPR last month that the country’s capital could reach herd immunity by the end of this month. Herd immunity occurs when enough people of a population are immune to an infectious disease, either because they’ve been infected and recovered or they’ve been vaccinated against it. Some researchers have put the threshold for coronavirus herd immunity at 60%.
  • Unfortunately, Stockholm will not reach this milestone in May.
  • “No that will not happen,” Tegnell said Monday in an email to NPR. “Current investigations show different numbers, but [Stockholm’s immunity rate] is likely lower [than 30%]. As you might be aware, there is a problem with measuring immunity for this virus.”
  • Sweden’s Public Health Agency last week released the initial findings of an ongoing antibodies study that showed that 7.3% of people in Stockholm had developed antibodies against C19 by late April. 
  • Tegnell later described the study’s figure as a “bit lower than we’d thought,” adding that the findings represented a snapshot of the situation some weeks ago and he believed that by now “a little more than 20%” of Stockholm’s population should have contracted the virus.
  • It’s the same figure he mentioned in the CNBC interview more than a month ago.
  • The study’s results have provided further fuel for the critics of the Swedish approach. With 39.57 deaths per 100,000, Sweden’s mortality rate is not only higher than that of the U.S. (30.02 deaths per 100,000) but also exponentially higher than those of its neighbors Norway (4.42 per 100,000) and Finland (5.58 per 100,000), which both enacted strict lockdown measures.
  • A protest Sunday against the government’s anti-lockdown strategy at Stockholm’s Sergels Torg attracted a few dozen people. One of the protest signs read, “In memory of everyone who Sweden couldn’t save with its strategy.”
  • The Swedish Embassy in Washington, D.C., said in a statement to NPR that the country’s government as well as its public health agency believe it’s still “far too early to draw any clear conclusions or comparisons connected to the coronavirus pandemic,” but “we are open with that the strategy has failed to protect the elderly living in care homes.”
  • Nearly half of the country’s more than 4,000 C19 deaths have occurred in such care facilities.
  • A majority of Swedes, 63%, according to one recent poll, support the measures Tegnell’s agency has recommended.
  • For some anti-lockdown protesters in the U.S., “Be like Sweden” has become a rallying cry at protests. But given the political, social and cultural differences between the two countries, simply adopting the Swedish model might not work.
  • “Every country and region is different, and every country and region needs do what they think is best for their place,” said Olofsdotter, the Swedish ambassador. “In Sweden, there’s a fairly big trust between the population and the government and its agencies and vice versa. Of course, if we can be an inspiration to others, and they find measures that we have used useful in either a state or region, that’s good, because we are all in this together.”
  • Even without a nationwide lockdown, Sweden’s economy has taken a hit as people continue to follow the government’s guidelines and stay at home. Google records indicated that trips to retail and recreational destinations in Stockholm are down 23%, while passenger numbers on public transit declined 29% between March 28 and May 9.
  • Sweden’s central bank, the Riksbank, provided two potential scenarios for the country’s economic outlook in 2020.
  • “Despite the comprehensive measures both in Sweden and abroad, the economic consequences of the pandemic will be considerable,” the Riksbank said in a statement in April. “The consequences for the economy will vary depending on how long the spread of infection continues and on how long the restrictions implemented to slow it down are in place.”
  • Both scenarios predict a rise in the unemployment rate and a contraction of the country’s gross domestic product. The central bank expects unemployment to rise from 6.8% to 10.1% and GDP to shrink by up to 9.7% this year as result of the pandemic.
  • Earlier this month, Tegnell admitted he is not sure Sweden’s strategy was the right call. “I’m not convinced at all — we are constantly thinking about this,” he told Swedish newspaper Aftonbladet.

Source: Stockholm Won’t Reach Herd Immunity In May, Sweden’s Chief Epidemiologist Says

F. Lockdowns  

1. “Nothing Can Justify This Destruction Of People’s Lives” 

By Yoram Lass, former Director-General of Israel’s Ministry of Health 

  • This is the first epidemic in history which is accompanied by another epidemic – the virus of the social networks. These new media have brainwashed entire populations. What you get is fear and anxiety, and an inability to look at real data. And therefore you have all the ingredients for monstrous hysteria.
  • It is what is known in science as positive feedback or a snowball effect. The government is afraid of its constituents. Therefore, it implements draconian measures. The constituents look at the draconian measures and become even more hysterical. They feed each other and the snowball becomes larger and larger until you reach irrational territory. This is nothing more than a flu epidemic if you care to look at the numbers and the data, but people who are in a state of anxiety are blind. If I were making the decisions, I would try to give people the real numbers. And I would never destroy my country. 
  • Mortality due to coronavirus is an inaccurate number. Those recording deaths simply change the label of many deceased. If patients died from leukemia, from metastatic cancer, from cardiovascular disease or from dementia, they put coronavirus. Also, the number of infected people is inaccurate, because it depends on the number of tests. The more tests you do the more infected people you get.
  • The only real number is the total number of deaths – all causes of death, not just coronavirus. If you look at those numbers, you will see that every winter we get what is called an excess death rate. That is, during the winter more people die compared to the average, due to regular, seasonal flu epidemics, which nobody cares about. If you look at the coronavirus wave on a graph, you will see that it looks like a spike. Coronavirus comes very fast, but it also goes away very fast. The influenza wave is shallow as it takes three months to pass, but coronavirus takes one month. 
  • If you count the number of people who die in terms of excess mortality – which is the area under the curve – you will see that during the coronavirus season, we have had an excess mortality which is about 15% larger than the epidemic of regular flu in 2017.
  • Compared to that rise, the draconian measures are of biblical proportions. Hundreds of millions of people are suffering. In developing countries many will die from starvation. In developed countries many will die from unemployment. 
  • Unemployment is mortality. More people will die from the measures than from the virus. And the people who die from the measures are the breadwinners. They are younger. Among the people who die from coronavirus, the median age is often higher than the life expectancy of the population. What has been done is not proportionate. But people are afraid. People are brainwashed. They do not listen to the data. And that includes governments.
  • Any reasonable expert – that is, anyone but Professor Ferguson from Imperial College who would have locked down everybody when we had swine flu – will tell you that lockdown cannot change the final number of infected people. It can only change the rate of infection. 
  • And people argue that by changing the rate of infection and ‘flattening the curve’, we prevented the collapse of hospitals. I have shown you the costs of lockdown, but this was the argument in favor of it. But look at Sweden. No lockdown and no collapse of hospitals. The argument for the lockdown collapses.
  • For example, you can compare Italy to Israel. In the Middle East, this virus is not really working. There are two reasons. One is that there is a very young population, and the other is that the climate is different. In the latitude of 50 degrees, which is Europe, and 40, which is the north-eastern United States, the virus is much more viable. Italy has the oldest population in the world apart from Japan. Italians are also are heavy smokers and very social people – they keep hugging and kissing. If you look at the numbers, in 2017, 25,000 Italians died from flu complications. Now you have around 30,000 dying from coronavirus. So it is a comparable number. You should not ruin a country for comparable numbers.
  • If you look at the 1950s, we had the Asian flu. In the 1960s, there was the Hong Kong flu. These were worse than this pandemic. Also, look at the story of swine flu in 2009, which began exactly the same as coronavirus. A new virus originated in Mexico. There was no vaccine so it was very frightening. It spread all over the world. It infected one billion people. A quarter of a million people died. But there was no lockdown, no Ferguson, nothing – people were far more interested in the economic crisis that hit a year before in 2008. They did not have time to give attention to this nonsense.
  • The virus, like the influenza virus, is saying farewell to western Europe for sure. The same in the Middle East. In the United States, we do not know yet, so we should talk in a month from now. But nothing can justify this destruction of people’s lives. It is unbelievable.

Source: ‘Nothing can justify this destruction of people’s lives’

2. How Did Japan Beat the Virus Without Lockdowns or Mass Testing?  

  • Yes the curve has been flattened, with deaths well below 1,000, by far the fewest among the Group of Seven developed nations. In Tokyo, its dense center, cases have dropped to single digits on most days. While the possibility of a more severe second wave of infection is ever-present, Japan has entered and is set to leave its emergency in just weeks, with the status lifted already for most of the country and Tokyo and the remaining four other regions set to exit Monday.
  • Analyzing just how Japan defied the odds and contained the virus while disregarding the playbook used by other successful countries has become a national conversation. Only one thing is agreed upon: that there was no silver bullet, no one factor that made the difference.
  • “Just by looking at death numbers, you can say Japan was successful,” said Mikihito Tanaka, a professor at Waseda University specializing in science communication, and a member of a public advisory group of experts on the virus. “But even experts don’t know the reason.”
  • After a peak in early April, new coronavirus cases in Japan have fallen below 50 a day
  • One widely shared list assembled 43 possible reasons cited in media reports, ranging from a culture of mask-wearing and a famously low obesity rate to the relatively early decision to close schools. Among the more fanciful suggestions include a claim Japanese speakers emit fewer potentially virus-laden droplets when talking compared to other languages.
Contact Tracing
  • Experts consulted by Bloomberg News also suggested a myriad of factors that contributed to the outcome, and none could point to a singular policy package that could be replicated in other countries.
  • Nonetheless, these measures still offer long-term lessons for countries in the middle of pandemic that may yet last for years.
  • An early grassroots response to rising infections was crucial. While the central government has been criticized for its slow policy steps, experts praise the role of Japan’s contact tracers, which swung into action after the first infections were found in January. The fast response was enabled by one of Japan’s inbuilt advantages — its public health centers, which in 2018 employed more than half of 50,000 public health nurses who are experienced in infection tracing. In normal times, these nurses would be tracking down more common infections such as influenza and tuberculosis.
  • “It’s very analog — it’s not an app-based system like Singapore,” said Kazuto Suzuki, a professor of public policy at Hokkaido University who has written about Japan’s response. “But nevertheless, it has been very useful.”
  • While countries such as the U.S. and the U.K. are just beginning to hire and train contact tracers as they attempt to reopen their economies, Japan has been tracking the movement of the disease since the first handful of cases were found. These local experts focused on tackling so-called clusters, or groups of infections from a single location such as clubs or hospitals, to contain cases before they got out of control.
  • “Many people say we don’t have a Centers for Disease Control in Japan,” said Yoko Tsukamoto, a professor of infection control at the Health Sciences University of Hokkaido, citing a frequently held complaint about Japan’s infection management. “But the public health center is a kind of local CDC.”
  • The early response was also boosted by an unlikely happening. Japan’s battle with the virus first came to mainstream international attention with its much-criticized response to the Diamond Princess cruise ship in February that led to hundreds of infections. Still, the experience of the ship is credited with providing Japanese experts with invaluable data early in the crisis on how the virus spread, as well as catapulting it into the public consciousness.
  • Other countries still saw the virus as someone else’s problem, said Tanaka. But in Japan, the international scrutiny over the infections onboard and the pace at which the virus raced throughout the ship raised awareness and recognition that the same can happen across the country, he said. “For Japan, it was like having a burning car right outside your house.”
  • Although political leadership was criticized as lacking, that allowed doctors and medical experts to come to the fore — typically seen as a best practice in managing public health emergencies. “You could say that Japan has had an expert-led approach, unlike other countries,” Tanaka said.
  • Experts are also credited with creating an easy-to-understand message of avoiding what are called the “Three C’s” — closed spaces, crowded spaces and close-contact settings — rather than keeping away from others entirely.
  • “Social distancing may work, but it doesn’t really help to continue normal social life,” said Hokkaido University’s Suzuki. “The ‘Three C’s’ are a much more pragmatic approach and very effective, while having a similar effect.”
Different Strain
  • Infectious disease experts also pointed to other determinants, with Shigeru Omi, the deputy head of the expert panel advising the Japanese government and a former chief of the WHO Western Pacific office, citing Japanese people’s health consciousness as possibly the most important factor.
  • The possibility that the virus strain spreading in Japan may have been different, and less dangerous, to that faced by other nations, has also been raised.
  • Researchers at the Los Alamos National Laboratory in the U.S. studied coronavirus variants in a database and found one strain of the virus spreading through Europe that had several mutations distinguishing it from the Asian version, according to a paper put in early May. Although the study has not been peer-reviewed and drawn some criticism, the findings point to a need to more thoroughly study how the virus changes.
  • Large questions still remain over the true extent of the pathogen’s spread. In April, a Tokyo hospital conducted tests on a handful of non-Covid patients and found that around 7% had the coronavirus, showing the danger of missing asymptomatic or mild carriers that can become the source of an outbreak. An antibody test on 500 people in the capital suggested the true outbreak could be nearly 20 times larger than figures have shown. Analog contact tracing breaks down when infection numbers are high, and reports of people unable to get tested or even medical treatment for Covid-like symptoms peppered social media during the height of the outbreak.
  • And the fact remains that Japan’s response was less than perfect. While the overall population is much smaller, Asian neighbors such as Taiwan had just seven confirmed deaths from the virus, while Vietnam had none. 
  • “You can’t say the Japan response was amazing,” said Norio Sugaya, a visiting professor at Keio University’s School of Medicine in Tokyo and a member of a World Health Organization panel advising on pandemic influenza. “If you look at the other Asian countries, they all had a death rate that was about 1/100th of Western countries.”
Buying Time
  • While Japan may have avoided the worst of the health outcomes, the loose lockdown hasn’t protected the country from the economic impact. Its economy, already dealing with the impact of a sales tax hike in October, officially slid into recession in the first three months of the year. Economists have warned the second quarter will be the worst on record, and the specter of deflation, which haunted the economy for decades, once again looms. Tourist numbers plummeted 99.9% in April after the country shut its borders, putting the brakes on a booming industry that had promised to be a growth driver for years. As in other countries, bankruptcies have risen sharply.
  • Even with the state of emergency about to end, authorities are warning that life will not return to normal. When case numbers slowed in early March, there was public optimism that the worst was over — only for cases to spike again and trigger the emergency declaration.
  • If a deadlier second wave does follow, the risk factor in Japan, which has the world’s oldest population, remains high. The country has speedily approved Gilead Sciences Inc.’s remdesivir and is now scrambling to allow the use of still unproven Fujifilm Holdings Corp.’s antiviral Avigan. There are calls for the country to use the time it has bought itself to shore up its testing and learn in the way its neighbors did from SARS and MERS.
  • Officials have begun to speak of a phase in which people “live with the virus,” with a recognition that Japan’s approach has no possibility of wiping out the pathogen.
  • “We have to assume that the second wave could be much worse than the first wave and prepare for it,” said Yoshihito Niki, a professor of infectious diseases at Showa University’s School of Medicine. “If the next explosion of cases is worse, the medical system will break down.”

Source: Did Japan Just Beat the Virus Without Lockdowns or Mass Testing?

G. Projections & Our (Possible) Future 

1. A Second Wave Could Come Sooner Than You Think  

  • It’s generally accepted among scientists and infectious disease experts that large pandemics often come in waves. There’s the first wave, which is the original widespread outbreak, followed by an interval of declining infections, only to see the rate of infection skyrocket months later—the infamous “second wave.”
  • In the case of the 1918-1919 Spanish flu, the first wave lasted between June and July 1918. It was followed by an interval of declining infections for three months. But then the big one hit. The second wave came with a vengeance, lasting from October to December 1918. And whereas the first wave killed a little over 20 of every 1,000 people per week in just one city, New York, at its peak, the second wave killed three times as many people—60 out of every 1,000—per week at its peak.
  • So what everyone wants to know is: Will C19 have a second peak and when will it come?
  • The answer to the first question, virtually every scientist agrees, is yes, C19 will have a second peak. And the answer to the second question is that the second peak will probably come this fall, according to the World Health Organization’s Dr. Mike Ryan. As The Japan Times reports, speaking at an online briefing this week, Ryan said, “When we speak about a second wave, classically what we often mean is there will be a first wave of the disease by itself, and then it recurs months later. And that may be a reality for many countries in a number of months’ time.”
  • However, WHO’s Ryan also warned that a months-long interval of declining infections isn’t a given, and he issued a dire warning about an “immediate second peak” if governments lift lockdown restrictions too quickly and citizens don’t adhere to social distancing and face mask rules during those lifts. As Ryan noted:
    • “But we need also to be cognizant of the fact that the disease can jump up at any time. We cannot make assumptions that just because the disease is on the way down now it is going to keep going down and we are get a number of months to get ready for a second wave. We may get a second peak in this wave.”
  • The warning comes as the U.S. and European countries have begun lifting lockdown restrictions en masse, and it looks like many people are throwing social distancing rules to the wind (or the water). The worry here is that if this leads to a second peak coming sooner than expected, healthcare systems will not have a chance to recuperate, which could see the next round of deaths skyrocket past anything we’ve seen so far.
  • And keep in mind that the second wave, no matter when it arrives, probably won’t be the last wave of C19 we have to deal with.

Source: Will COVID-19 have a second peak? Yes, and WHO warns it could come sooner than you think

2. High Demand for Flu Shots Expected This Fall  

  • U.S. pharmacy chains are preparing a big push for flu vaccinations when the season kicks off in October, hoping to curb tens of thousands of serious cases that could coincide with a second wave of coronavirus infections.
  • CVS Health Corp, one of the largest U.S. pharmacies, said it is working to ensure it has vaccine doses available for an anticipated surge in customers seeking shots to protect against seasonal influenza.
  • Rival chain Rite Aid Corp has ordered 40% more vaccine doses to meet the expected demand. Walmart Inc. and Walgreens Boots Alliance said they also are expecting more Americans to seek these shots.
  • Drugmakers are ramping up to meet the demand. Australian vaccine maker CSL Ltd’s Seqirus said demand from customers has increased by 10 percent. British-based GlaxoSmithKline said it is ready to increase manufacturing as needed.
  • A Reuters/Ipsos poll of 4,428 adults conducted May 13-19 found that about 60 percent of U.S. adults plan to get the flu vaccine in the fall. Typically fewer than half of Americans get vaccinated. The U.S. Centers for Disease Control and Prevention (CDC) recommends the vaccine for everyone over age 6 months.
  • Getting a flu shot does not protect against C19, the respiratory disease caused by the novel coronavirus for which there are no approved vaccines. Public health officials have said vaccination against the flu will be critical to help prevent hospitals from becoming overwhelmed with flu and C19 patients.
  • “We’re in for a double-barreled assault this fall and winter with flu and COVID. Flu is the one you can do something about,“ Vanderbilt University Medical Center infectious disease expert Dr. William Schaffner said.
  • Drugmakers last year produced nearly 170 million doses of influenza vaccine, according to the CDC. There were up to 740,000 hospitalizations and 62,000 deaths in the 2019-2020 flu season that ended last month, the CDC said.
  • While health insurance typically covers the flu shot at a doctor’s office and other groups offer free flu vaccine clinics, the adult vaccine retails for about $40.
  • CDC Director Robert Redfield has said that flu and C19 combined could exact a heavier toll on Americans than the initial coronavirus outbreak that began this winter.
  • Some experts said creative ways must be developed to ensure that people are vaccinated against flu because patients may be less likely to see their doctors in person out of fear of getting infected with the coronavirus in medical offices.
  • Pharmacies, public health clinics and other flu shot providers may need to develop drive-up clinics – popular with C19 diagnostic tests – for flu vaccines, said Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Disease.
  • “My goal is that every single vaccine dose that gets made gets into somebody’s arm to protect them. I don’t want any vaccines left on the shelves or in doctors’ offices,” Messonnier said in an interview.
  • One reason for reluctance among Americans to get the flu shot is that it does not always prevent disease, in part because the flu strains selected as targets of the vaccine months ahead of time are not always a perfect match for the dominant flu strains that actually circulate in any given season. But the shots reliably reduce hospitalizations every year, according to experts.
  • “Even if it protects 35% to 40% of the population, it’s a lot better than zero,” University of Minnesota influenza expert Dr. Michael Osterholm said.
  • In a survey commissioned by CVS Health between January and May, consumers who said they will definitely or are likely to get a flu shot rose from 34% to 65%. They also said they would increasingly go to pharmacies and less often to a doctor’s office or healthcare centers.
  • Rite Aid Chief Pharmacy Officer Jocelyn Konrad said the pharmacy chain, which provided about 2.6 million flu shots last year, upped its order by 40 percent this year.
  • Rite Aid said social distancing policies may cut into workplace flu clinics but that it may offer voucher programs to employers and is considering setting up drive-through clinics. In Australia, where the winter flu season is underway, such sites are already in use.
  • Some U.S. doctors are also considering clinics in parks and community centers and even home visits for vulnerable patients, said David Ross, vice president of commercial operations for North America at Seqirus.
  • “As we look at immunization this coming fall, it will play an enormous role in this battle against C19,” Ross said.

Source: Fears of coronavirus second wave prompt flu push at US pharmacies, drugmakers

H. Practical Tips & Other Useful Information

1. What We Know About Our Chances of Catching the Virus Outdoors  

  • The warmer weather across the country calls to mind carefree summers — picnics in the park, swimming at the beach, fireworks on the Fourth. But nothing feels carefree now.
  • As states move to relax restrictions intended to fight the coronavirus pandemic, even the simplest outdoor activities seem fraught with a thousand questions and calculations.
  • Is it safe to meet friends in the park, as long as they stay six feet away, on the other side of a blanket? What about a burger and beer at an outdoor restaurant? How risky is a trip to the beach or swimming pool with the kids?
  • The good news: Interviews show a growing consensus among experts that, if Americans are going to leave their homes, it’s safer to be outside than in the office or the mall. With fresh air and more space between people, the risk goes down.
  • But experts also expressed particular caution about outdoor dining, using locker rooms at pools and crowds in places like beaches. While going outside can help people cope with quarantine fatigue, there is a risk they will lower their guard or meet people who are not being safe.
  • “I think going outside is important for health,” said Julia L. Marcus, an epidemiologist and assistant professor at Harvard Medical School. “We know that being outdoors is lower risk for coronavirus transmission than being indoors. On a sunny, beautiful weekend, I think going outside is indicated, but I also think there are things to do to reduce our risk.”
  • While many treasured outdoor rites of the season have been closed or canceled, including Disney’s amusement parks, the Coachella festival in California and Free Shakespeare in the Park in New York, governors across the country have been opening golf courses, trails and beaches, hoping to restore some semblance of a normal summer for restless Americans.
  • Some parks, including small urban ones like Ellis Island and vast ones like Joshua Tree National Park, remain closed. But Yellowstone will reopen on a limited basis on Monday, and the Grand Canyon reopened its South Rim entrance on Friday. In Los Angeles County, beaches reopened on Wednesday, but not for sunbathing. Only active pursuits like jogging, swimming and surfing are allowed.
  • Even in the hard-hit New York region, some restrictions will be eased. Connecticut plans to allow outdoor seating at restaurants and outdoor exhibits at zoos on May 20. New Jersey, New York, Delaware and Connecticut will open state beaches on Memorial Day weekend, restricting them to 50 percent capacity. But New York City’s beaches and pools will remain closed.
  • The different approaches have left many Americans bewildered about what is safe behavior outside. Experts have a simple answer: Practice social distancing and wear a mask when that is not possible.
  • Ideally, people should socialize only with people who live in their homes, they say. If you decide to meet friends, you’re increasing your risk, but you can take precautions. 
    • It’s important to keep gatherings small; 
    • Don’t share food, utensils or beverages; keep your hands clean; and 
    • Keep at least six feet from people who don’t live in your home.
  • “I think outdoors is so much better than indoors in almost all cases,” said Linsey Marr, an engineering professor and aerosol scientist at Virginia Tech. “There’s so much dilution that happens outdoors. As long as you’re staying at least six feet apart, I think the risk is very low.”
  • Pandemic life is safer outdoors, in part, because even a light wind will quickly dilute the virus. If a person nearby is sick, the wind will scatter the virus, potentially exposing nearby people but in far smaller quantities, which are less likely to be harmful.
  • “The virus load is important,” said Eugene Chudnovsky, a physicist at Lehman College and the City University of New York’s Graduate Center. “A single virus will not make anyone sick; it will be immediately destroyed by the immune system. The belief is that one needs a few hundred to a few thousand coronavirus particles to overwhelm the immune response.”
  • While the risk of outdoor transmission is low, it can happen. In one study of more than 7,300 cases in China, just one was connected to outdoor transmission. In that case, a 27-year-old man had a conversation outdoors with a traveler who had just returned from Wuhan. Seven days later, he had his first symptoms of C19.
  • “The risk is lower outdoors, but it’s not zero,” said Shan Soe-Lin, a lecturer at the Yale Jackson Institute for Global Affairs. “And I think the risk is higher if you have two people who are stationary next to each other for a long time, like on a beach blanket, rather than people who are walking and passing each other.”
  • One recent study found that just talking can launch thousands of droplets that can remain suspended in the air for eight to 14 minutes. But the risk of inhaling those droplets is lower outdoors.
  • For many Americans who have spent anxious months at home, wide-open parks and trails feel like the safest options these days.
  • Kate Wathall, a Los Angeles television producer and reporter, went for her first hike in weeks last Sunday, one day after local trails reopened. She drove an hour to Trail Canyon Falls in Tujunga, avoiding more popular trails in the city.
  • “It was like being back to normal life,” she said. “Obviously, it’s not. But it’s a day where I forgot what was going on.”
  • In Memorial Park in Maplewood, N.J., on Thursday, Gabriella Gabriel, 22, was exercising with her friend Candace Brodie, also 22, on mats a few feet apart on the grass.
  • “People are spread out and there’s no way for someone to be right on top of me,” Ms. Gabriel said. “But in a pool or beach, everyone is so condensed — too close for comfort.”
  • Experts agreed that the risk of swimming in pools, lakes or the ocean is not from the water, but from exposure to people in and near the water.
  • Although scientists don’t have data on the novel coronavirus specifically, other coronaviruses are not stable in water and are very sensitive to chlorine, said Angela Rasmussen, a virologist at the Columbia University Mailman School of Public Health.
  • “In my opinion, pool water, fresh water in a lake or river, or seawater exposure would be extremely low transmission risk even without dilution (which would reduce risk further),” Dr. Rasmussen said in an email. “Probably the biggest risk for summer water recreation is crowds — a crowded pool locker room, dock or beach, especially if coupled with limited physical distancing or prolonged proximity to others. The most concentrated sources of virus in such an environment will be the people hanging out at the pool, not the pool itself.”
  • Experts say that a person walking, jogging or cycling too close for a few seconds is not a big worry. But they recommend joggers wear a mask or some other form of face covering if they’re going to come close to other people. If someone sets up a picnic blanket within your six-foot perimeter and plans to stay a while, that’s a bigger concern. Try to avoid a confrontation. That only increases your risk of exposure. Such conflicts could spike as more people head outside.
  • “If someone is too close to you and not wearing a mask and you don’t feel safe, instead of yelling at them, just say, ‘I need some space, please,’” Dr. Marcus said.
  • For families with small children, navigating the outdoors can produce a special anxiety.
  • Ms. Gabriel said her brother, who is 6, had wanted to go to the playground, but her mother wouldn’t allow it. She worries about the virus lingering on slides and swings and about a mysterious inflammatory syndrome linked to the virus that has been sickening and killing some children.
  • “It’s hard for a child to understand,” Ms. Gabriel said. “At least we can stay six feet apart. You can’t tell a little kid that.”
  • One challenge in dense cities is finding six feet to call your own on a running path or in a bicycle lane. An open-air cafe may seem safe, until people start walking by on the sidewalk without masks.
  • Some cities, including New York, Boston, Minneapolis and Oakland, have closed streets to traffic, giving people room to spread out. Others have extended sidewalks to make more space for pedestrians and outdoor seating.
  • Even outside, there is a risk of contracting the virus by touching a contaminated surface — a restaurant menu, park bench or lawn chair — and then touching your face. Studies have shown the virus can last three days on hard surfaces like steel and plastic and about 24 hours on cardboard under laboratory conditions. The virus is also more stable in heat and humidity than many other viruses are.
  • According to Dr. Chudnovsky, a sunny day is better than a cloudy day, because there’s more sunlight to kill the virus and more wind to dilute it. If you want to take extreme precautions, position yourself upwind from other people. “This may be especially important at the beach, where people tend to spend a long time at one localized place,” he said.
  • Experts said that although outdoor restaurant patrons can’t wear masks while eating, servers should. The main risk of exposure is if the guests within a few feet at the table aren’t from your household. Sitting and talking for extended periods of time as well as sharing food and common serving utensils are also potential sources of exposure if one of the guests is infected and doesn’t know it.
  • Another worry: Because it can take two weeks for symptoms to appear after a person is infected, there is no way to know if you’re going to the beach or the park in the midst of an invisible local outbreak, experts said. It’s yet another reason to take precautions.
  • “If we now go back to the old normal and don’t follow the social distancing strategy anymore, it’s like a ticking time bomb,” said Peter Jüni, an epidemiologist at the University of Toronto and St. Michael’s Hospital. “You never know where it blows up and when.”

Source: Can You Catch the Virus Outdoors? Here’s What We Know

2. Putting the Risk of C19 in Perspective with Micromorts  

  • How dangerous is it to live in New York City during this pandemic? How much safer is it in other places? Is the risk of dying from C19 comparable to driving to work every day, skydiving or being a soldier in a war?
  • We are awash in statistics about C19: number of deaths, fatality rates, contagion rates. But what does this all mean in terms of personal risk?
  • In 2011, another invisible danger, radiation, sowed fear and confusion in Japan, where I served as the U.S. Ambassador’s science adviser after the nuclear meltdown at Fukushima Daiichi. Then, as now, the news was full of scary numbers. And then, as now, there wasn’t nearly enough context for people to make sense of them, much less act upon them.
  • Fortunately, there are tools for assessing risk that can help us put the daily torrent of numbers in perspective. I found the best way to communicate the level of risk was to put it in terms that allowed easier comparison to other, more familiar, risks. One could then talk, for instance, about how dangerous living in a contaminated city was compared to smoking a pack of cigarettes a day.
  • A useful way to understand risks is by comparing them with what is called a “micromort,” which measures a one-in-a-million chance of dying. Note that we are considering only fatality risks here, not the risk of growing sick from coronavirus, or morbidity. The micromort allows one to easily compare the risk of dying from skydiving, for example (7 micromorts per jump), or going under general anesthesia in the United States (5 micromorts), to that of giving birth in the United States (210 micromorts).
  • The average American endures about one micromort of risk per day, or one in a million chance of dying, from nonnatural causes, such as being electrocuted, dying in a car wreck or being struck by an asteroid (the list is long).
  • Let’s apply this concept to C19.
  • Using data from the Centers for Disease Control and Prevention, New York City experienced approximately 24,000 excess deaths from March 15 to May 9, when the pandemic was peaking. That’s 24,000 more deaths than would have normally occurred during the same time period in previous years, without this pandemic. This statistic is considered a more accurate estimate of the overall mortality risk related to C19 than using the reported number of deaths resulting from confirmed cases, since it captures indirect deaths associated with C19 (because of an overwhelmed health care system, for example) as well as the deaths caused by the virus itself.
  • Converting this to micromort language, an individual living in New York City has experienced roughly 50 additional micromorts of risk per day because of C19. That means you were roughly twice as likely to die as you would have been if you were serving in the U.S. armed forces in Afghanistan throughout 2010, a particularly deadly year.
  • The quality of data varies from state and state, and continues to be updated. But for comparison, using the C.D.C. data, Michigan had approximately 6,200 excess deaths during this same time period. That is roughly the same risk of dying as driving a motorcycle 44 miles every day (11 micromorts per day). Living in Maryland during this time would be roughly as risky as doing one skydiving jump a day for that duration (7 micromorts per jump).
  • Now, if you’re infected with the virus, your odds of dying jump dramatically. Estimates of the fatality rate vary as doctors continue to learn more about this virus and how to care for people sickened by it, but let’s assume it is 1 percent for sake of this discussion. That translates into 10,000 micromorts. That risk is comparable to your chances of dying on a climb in the Himalayas if you go above 26,000 feet, where the tallest peaks, such as Everest and K2, stand (using climbing data taken between 1990 and 2006).
  • But that risk estimate is for the entire population, with an average age of 38. If you happen to be older, the fatality rate can be as much as 10 times higher, which is just slightly less than flying four Royal Air Force bombing missions over Germany during World War II.
  • The acceptability of risk depends, of course, on one’s own attitudes and proclivity to take risks, and whether one has a choice in the matter. Unlike skydiving or hang-gliding, in which the risk is limited to the person making the leap, with C19 the actions of the individual change the risk levels of everyone in the community.
  • So while there are many thrill seekers who happily jump out of planes, they might think twice about forcing their frail grandmothers, or their neighbors, to jump with them.

Source: Putting the Risk of Covid-19 in Perspective

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