Coronavirus Update

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Coronavirus Update 5-28

Recent Developments & Information 

May 28, 2020

“Vaccines should be tested in very large clinical trials that take several months if not years to complete.  You want to make sure that when you put a vaccine into millions if not billions of people, it is safe.”  Ken Frazier, Chairman and CEO of Merck

“Remdesivir doesn’t work at all, as far as I can tell, or has only a minor effect.   It is comparable to Tamiflu and maybe not even as good.”  William Haseltine, a scientist who has spent decades studying viruses and helped lead the U.S. government response to the HIV/AIDS epidemic

“The cover-up that the Chinese government did of the virus is going to go down in history, along with Chernobyl.”   Robert O’Brien, White House national security advisor

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

  • New Scientific Findings & Research

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

  • Report Shows 43% of Coronavirus Deaths Are in Nursing Homes
  • Dow Up More Than 500 Points on Economic Confidence
  • Disney World to Reopen in July, SeaWorld Orlando to Reopen in June
  • Democrat Governors: Wearing Masks Is ‘Cool’ and ‘Signifies Strength’
  • Mexico Breaks Daily Coronavirus Death Record
  • Brazil reports more daily deaths than US
  • UK Health Secretary Matt Hancock unveils “test & trace”
  • New York reports approx. 100 deaths
  • Italy reports another 117 deaths
  • Disney to reopen “the Magic Kingdom”
  • Dr. Fauci says images of Memorial Day Weekend partiers are ‘troubling’
  • Germany returns chloroquine donated by Bayer
  • India cases top 150,000
  • France discontinues use of hydroxychloroquine
  • Wuhan finds 200 ‘asymptomatic’ cases after testing millions
  • ECB’s Lagarde said eurozone economy could take 12% hit due to virus
  • WHO reiterates warnings about premature reopening
  • Amtrak Seeks Billion Dollar Bailout, Prepares To Slash 20% Of Workforce As Ridership Crashes
  • Health officials nervously eye emerging hotspots
  • A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds
  • Virus apps expose tension between privacy and need for data
  • Some Fort Worth Students To Return To Elementary Schools Next Week
  • Fauci Warns About Hydroxychloroquine and In-Person Party Conventions
  • Even In Well-To-Do Glen Ellyn, Food Pantries See Surge In Demand As Pandemic Hammers Economy
  • Salaries Get Chopped for Many Americans Who Manage to Keep Jobs
  • Disney World to reopen in July with ‘high-energy squads’ roaming park to make sure people wear masks
  • New Zealand sees no new cases for five days in row, no patients in hospital
  • NYC Mayor de Blasio pushes back on Trump’s insistence at reopening churches, calls the move ‘dangerous’
  • India backs hydroxychloroquine for virus prevention
  • Reopen it: 74% small firms will be ‘back to business as usual’ in six months
  • More than 1,350 coronavirus lawsuits filed since start of pandemic
  • President Trump Gives North Carolina a Week to Decide If They’ll Allow Republican National Convention at Full Capacity 
  • Two-thirds of laid-off workers may temporarily be receiving more money in unemployment benefits than they did from their jobs
  • The world sacrificed its elderly in the race to protect hospitals. The result was a catastrophe in care homes  
  • China Drafts Sovereign Immunity Bill to Fight Global Coronavirus Lawsuits

B. Key Numbers & Trends

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

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

1. Cases & Tests

  • Worldwide:  
    • Total Cases = 5,784,603 (+1.9%)
    • New Cases (7 day average) = 100,227 (+1.0%) (+962)
  • US: 
    • Total Cases = 1,754,803 (+1.2%)
    • New Cases (7 day average) = 21,973 (-0.6%) (-126)
    • Total Number of Tests = 15,875,473 (+343,314)
    • Note: 7 day average of new cases is decreasing while testing is significantly increasing, which is positive trend

2. Deaths

  • Worldwide Deaths 
    • Total Deaths = 356,937 (+1.5%) 
    • New Deaths (7 day average) = 3,949 (+2.0%) (+77)
  • US Deaths 
    • Total Deaths = 102,107 (+1.5%) 
    • New Deaths (7 day average) = 1,024 (+1.7%) (+17)

5 Countries with Largest Number of Confirmed Deaths: 

CountryTotal DeathsNew DeathsDeaths Per 1M Population
US102,1071,528 (+754)309 (+5)
UK37,460412 (+278)552 (+6) 
Italy33,072117 (+39)547 (+2)
France28,59666 (-32)438 (+1)
Spain27,1181 (-279)580 (+0)
Worldwide356,9375,276 (+1,228)45.8
  • Deaths in these 5 countries = 64% of total worldwide deaths (-0.4%), and 40.3% of new worldwide deaths (+10%).  Although a 10% increase in new deaths is noteworthy, changes in deaths from day to day are not particularly meaningful.  As a result, we will begin reporting on the 7 day average for these countries next week, which we believe is a more meaningful measure as it smooths out day-to-day changes.
  • US deaths = 28.6% of total worldwide deaths (+0%), and 29.0% of new worldwide deaths (+12.1%)  [Note: 1,528 new US deaths is the largest number of new deaths since May 20 (1,552 deaths).  However, the 7 day average of US deaths has only increased by 17 (1.7%).]
  • 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  DeathsNew Deaths 7 Day AvgDeaths Per 1M Population
NY29,553105 (-10)1,519  (+5)
NJ11,34185 (-2)1,277 (+16)
MA6,54790 (+2)950 (+11)
MI5,33439 (+3)534 (+9)
PA5,32271 (+8)416  (+10)
US102,1071,024 (+17)309 (+5)
  • All 5 States are led by Democratic Governors and are reopening slowly 
  • 7 day average of new deaths for NY and MA continue to decline, while 7 day average of new deaths in MA, MI and PA has increased (more than 10% in PA).  It is too early to tell if increases in the 7 day average of new deaths is the result of a short term spike or a trend.
  • The deaths per million of population of all 5 States exceed the national average, and the increases in NJ, MA, MI and PA are very high, which reflect significant increases in the number of deaths in those States since yesterday.  
  • We are not aware of any hospitals that are currently under stress or overwhelmed in any of these States.

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 DeathsNew Deaths 7 Day AvgDeaths Per 1M Population
Sweden4,22056 (+1)418 (+9)
  • 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 Nordic neighbors.  Although the 7 day average of US deaths increased slightly, the average decreased by 6 since yesterday.  Although a positive development, it is too early to determine if the recent increase in deaths is a short term spike or a trend.  
  • The increase in the number of deaths per 1 million of population is very high, which reflects a high number of deaths for the population.  
  • 5 States that Are Reopening Rapidly:
StateTotal  DeathsNew Deaths 7 Day AvgDeaths Per 1M Population
GA1,93334 (+3)182 (+4)
FL2,32032 (+2)108 (+3)
TX1,60226 (+3)55 (+1)
OH2,05339 (-2)176 (+4)
OK3183  (+0)81 (+1)
US102,1071,024 (+17)309 (+5)
  • All 5 States are led by a Republican Governor
  • 7 day averages in new deaths in OH and OK continue to decline or are stable.  Although the 7 day averages for GA, FL and TX have increased slightly, it is too early to tell whether the increases are the result of a short term spike or reflect a trend.  
  • All 5 States have substantially lower deaths per 1 million of population than the national average, and new deaths per capita in all 5 States are less than new deaths per capita in US, which show that these States are effectively managing their reopenings.  

C. New Scientific Findings & Research 

1. The Invisible Brick Wall: Does Cross-Immunity Protect Most People From Infection?  

  • Could nearly half the population not already infected with the coronavirus be immune to it from having already contracted other forms of coronavirus in recent years?
  • That is one implication of a major study conducted by over a dozen researchers from several microbiology and immunology institutions in the U.S. (you can read the study https://www.cell.com/cell/pdf/S0092-8674(20)30610-3.pdf).
  • The study is built upon the principle that T cells play a central role in destroying viruses and providing immunity. Not only were these cells discovered in all the blood samples of confirmed recovered C19 patients, but they were also found in 6 of the 11 blood samples from 2015-2018, before those individual donors could possibly have contracted the virus.
  • Until now, the assumption was that only those with IgG or IgM antibodies can be immune because they are the ones who have already contracted the disease. However, this study examined the cellular defenses that are created in the body and have been proven to serve as a defense against the coronavirus, then discovered them among 40%-60% of their samples not infected with the coronavirus.
  • In order to prove the efficacy of these T cells developed in the recovered population, the researchers exposed immune cells from 10 recovered patients to the virus. They found those cells effectively fight the virus. 100% of the samples of 20 donors contained “helper” T cells, known as CD4+, and 70 percent contained killer T cells, known as CD8+, which directly kill the viral cells. Then they discovered “SARS-CoV-2−reactive CD4+ T cells in ∼40-60% of unexposed individuals, suggesting cross-reactive T cell recognition between circulating ‘common cold’ coronaviruses and the coronavirus.”
  • The hypothesis is that numerous common colds are forms of coronavirus and that a significant percentage of the population that has already contracted those forms of coronavirus have cross-immunity to C19. It’s unclear to what degree these people are immune, but it might help explain why some people in certain areas react so violently to C19, whereas so many others are asymptomatic. In other words, it’s possible that people with cross-immunity could still catch the virus, but their reaction to it will either never present symptoms or present very mildly due to the pre-existing T cells working for them.
  • The authors note that more time and cell numbers are needed to study identification of the cross-reactive chains of cells.
  • A similar T cell study published April 22 by German immunologist Andreas Thiel found that 34% of 68 blood samples from people not infected with coronavirus hosted helper T cells that nevertheless recognized the novel coronavirus.
  • The authors of the newer study posit that the concept of “crossreactive memory T cell responses might have been one factor contributing to the lesser severity of the H1N1 flu pandemic.” There is still no way of proving whether those T cells discovered in non-infected individuals are definitively effective in warding off the virus or blunting its symptoms, but the theory might explain some enigmatic behaviors of this virus.
  • On the one hand, this virus seems to be extremely contagious and transmissible. But, it appears to have been around for a while, possibly in December, and didn’t kill too many people until super-spreading events in March.
  • On the one hand, the virus seems to kill a lot of vulnerable people for several weeks. But then it peaks after six weeks or so and nearly disappears a month or so later. We’ve seen the same curve in every country, almost as if it hits a brick wall and then runs out of steam.
  • But why is that the case? Most antibody tests show no more than 10%-15% of the population contain antibodies in a given area – 25% in the most extreme case of New York City. Why would the virus not continue cutting through the population like butter, as it did the first number of people who contracted the virus? The theory of a more ubiquitous cross-immunity from other coronaviruses would answer those questions and explain that invisible brick wall.
  • A theory of partial immunity, at least from helper T cells (if not killer T cells) could also explain why, on the one hand, once the virus gets into prisons, most test positive for it, but on the other hand, nearly all of them seem asymptomatic. The outcome of prisons as a fully confined and defined population could be a harbinger of what would theoretically happen if the entire world were exposed to the virus after it had already targeted the most vulnerable population. It’s possible that upwards of 95% would be asymptomatic, just like we are seeing in prisons.
  • Perhaps, it could also explain why there appears to be a massive gap in severity of the virus in Asia vs. Western countries. Asian countries are regularly exposed to coronaviruses.
  • Professor Karol Sikora, founder of University of Buckingham Medical Schools, has a short video explaining in layman’s terms the significance of this T cell study and cross-immunity.
  • Sunetra Gupta, professor of theoretical epidemiology at the University of Oxford, is also a strong believer in the likelihood of cross-immunity. “We may also be able to fend off the virus with pre-existing responses against other coronaviruses, which I think is very likely to play a role in protection, specifically against severity of the disease,” said Professor Gupta in a recent interview with a British media outlet.
  • “In almost every context we’ve seen the epidemic grow, turn around and die away — almost like clockwork. Different countries have had different lockdown policies, and yet what we’ve observed is almost a uniform pattern of behavior which is highly consistent with the SIR model. To me that suggests that much of the driving force here was due to the build-up of immunity.”
  • Stanford professor of epidemiology John P.A. Ioannidis has also posited the existence of cross-immunity and the idea that many people’s bodies are using innate cellular immunity to ward off the virus.
  • This theory might also explain why Sweden believes it reached herd immunity with just 20% infected and why some studies suggest a similar ratio could be achieved elsewhere.
  • To be clear, these are all unproven theories at this point. But if our government and media were willing to run with unproven theories of doom and gloom even as the facts on the ground refuted them, shouldn’t they at least examine some good news when the fact pattern of the virus itself seems to harmonize with the theory?

Source: Horowitz: Bombshell study: Could half the uninfected population already be partially immune?

2. Up to 81% of infected people may be asymptomatic  

  • In mid-March, a cruise ship departed from Ushuaia, Argentina, and set sail towards Antarctica following explorer Ernest Shackleton’s 1915 route. The passengers and crew aboard didn’t know their ship would become a floating Petri dish of C19.
  • Eight days after embarking, the first passenger got a fever and the cruise ship instituted isolation and testing measures. Almost two weeks later, 59% of the 217 passengers and crew tested positive for C19. Out of that group, more than eight out of 10 had no symptoms.
  • In a study released Thursday in the journal Thorax, scientists report that these findings suggest ‘silent’ symptomless C19 infections — the sort experienced by asymptomatic carriers — may be far more common than previously thought.
  • The cruise offered a unique testing ground for study co-authors Alvin Ing and Christine Cocks, scientists who were on board as passengers, and co-author Jeffrey Green, the expedition physician. They witnessed C19 unfold in the unique, isolated environment in real-time, and began their study before they could disembark.
  • Their report is another example of the fact that C19 can spread like wildfire on cruises, which often have semi-crowded public spaces, close quarters, and older travelers. The findings can also be extrapolated to other scenarios such as aged care facilities and migrant camps, the study’s authors tell Inverse.
  • “The high rate of asymptomatic C19 patients may mean there may be higher rates of immunity to C19 in the general population than we currently are aware of,” Ing, a respiratory and cardiovascular medicine researcher at Macquarie University, tells Inverse. At this point, scientists don’t know yet how much protection C19 infection creates against future reinfection.
  • “Being free of symptoms does not equal being free of infection,” Alan Smyth, joint editor-in-chief of the journal Thorax and researcher at the University of Nottingham, tells Inverse. He was not involved directly in the study but published a related commentary.
  • The researchers documented how C19 spread among cruise passengers and crew and charted the enforced isolation measures put in place.
  • On day 20 of the cruise, all passengers and crew were tested for C19. Ultimately, 128 out of 217 people tested positive.
  • Just 24 positive patients actually showed symptoms. 16 had fevers and mild symptoms, while four required intubation and ventilation. One person died due to C19 complications.
  • Overall, 81% of those who tested positive for C19 were asymptomatic. This doesn’t quite jibe with what we know about asymptomatic patients so far: The CDC reports 35% of infected people may be asymptomatic. Meanwhile, another cruise ship study, this one focused on the infamous Diamond Princess, suggests 18% of infected people were asymptomatic — but not all passengers and crew were tested. This study quadruples that number.
  • While the “population” on the cruise ship was small, every single member of this population was tested. This makes this cruise a unique “natural experiment” that can’t be repeated elsewhere, Smyth says.
  • “There is no reason why the passengers and crew on the ship are any more likely than the general population to be infected with C19 but have no symptoms,” he adds.
  • “It is therefore very plausible that the rate of 81% infected but symptom-free might apply to the general population. This means that many more people may be potentially immune than was first thought.”
  • Currently, testing hasn’t fully captured how many asymptomatic C19 positive people are out there. But this study suggests the number may be higher than anticipated, and testing only symptomatic people may be missing a huge proportion of infected people.
  • “Testing just symptomatic subjects in such an at-risk environment is likely to miss a significant population with C19, and may thus promote community transmission if untested or unmonitored,” Ing says.
  • “If we are serious about preventing a second wave of C19 infection, then it is vital that we have widespread accessible community testing, and the ability to rapidly trace and isolate contacts.”

Source: Cruise ship study exemplifies the danger of asymptomatic patients 

3. Antibody testing finds more people had C19 than expected  

  • Early testing for C19 antibodies in several Utah communities reveals a rate that is well above the statewide C19 infection rate.
  • That likely means more people have had the virus than testing for C19 shows.
  • More than 500 people paid $70 for an appointment today at Galena Hills Park in Draper to find out if they had C19 and never knew it.
  • The cities of Draper, Bluffdale, Riverton and Vineyard are sponsoring C19 antibody testing for residents through a private company based in Layton, RapidScreen Solutions.
  • It’s information the cities and the residents want to make important decisions.
  • “Once we get the data collated and can figure out what it means, I think we can start to understand how widespread it has been,” said Troy Walker, mayor of Draper.
  • Statewide, among those who have been tested for C19, 4.3% tested positive.
  • However, the rate for those who test positive C19 antibodies in two communities, after two days of testing, is more than twice that rate at 11%.
  • “When I see an 11% number after our first two days, that really surprised me. It’s a lot more people than I thought,” said Dr. Paul Benson, Rapid Screen Solutions Owner and Clinical Director.
  • He said one reason the antibody test rate is higher than the statewide infection rate, is because all of the people getting antibody tests so far chose to get tested because they thought they might have been sick.

Source: Antibody testing shows many Utahns had COVID-19 but did not know it; results higher because of self-selection

4. Coronavirus uses same strategy as HIV to avoid immune system  

  • The coronavirus uses the same strategy to evade attack from the human immune system as HIV, according to a new study by Chinese scientists.
  • Both viruses remove marker molecules on the surface of an infected cell that are used by the immune system to identify invaders, the researchers said in a non-peer reviewed paper posted on preprint website bioRxiv.org on Sunday. 
  • They warned that this commonality could mean that the coronavirus could be around for some time, like HIV.
  • Virologist Zhang Hui and a team from Sun Yat-sen University in Guangzhou also said their discovery added weight to clinical observations that the coronavirus was showing “some characteristics of viruses causing chronic infection”.
  • Their research involved collecting killer T cells from five patients who had recently recovered from C19, the disease caused by the virus. Those immune cells are generated by people after they are infected with the coronavirus – their job is to find and destroy the virus.
  • But the killer T cells used in the study were not effective at eliminating the virus in infected cells. When the scientists took a closer look they found that a molecule known as major histocompatibility complex, or MHC, was missing.
  • The molecule is an identification tag usually present in the membrane of a healthy cell, or in sick cells infected by other coronaviruses such as severe acute respiratory syndrome, or Sars. It changes with infections, alerting the immune system whether a cell is healthy or infected by a virus.
  • HIV uses the same strategy – MHC molecules are also absent in cells infected with that virus.
  • “In contrast, Sars does not make use of this function,” Zhang said.
  • The coronavirus removes these markers by producing a protein known as ORF8, which binds with MHC molecules, then pulls them inside the infected cell and destroys them, the researchers said.
  • ORF8 is known to play an important role in viral replication, and most commercial test kits target this gene to detect viral loads in nose or oral swabs.
  • While drugs being used to treat C19 patients mainly targeted enzymes or structural proteins needed for viral replication, Zhang and his team suggested compounds be developed “specifically targeting the impairment of MHC by ORF8, and therefore enhancing immune surveillance for coronavirus infection”.
  • Earlier studies have found the spike protein of the new coronavirus had a structure that allowed it to enter many types of human cells and bind with them. The same structure was also found in HIV, but not in other coronaviruses found in animals such as bats and pangolins.
  • Another study by researchers in New York and Shanghai also found that the coronavirus could kill T cells. The discovery came after autopsies in China found immune system destruction similar to that caused by AIDS.
  • Four decades after HIV – a virus that attacks the immune system – emerged, it has killed about 32 million people globally, according to the World Health Organization, and there is still no vaccine or drug that can completely cure the disease.
  • Zhang Shuye, principal investigator with the Shanghai Public Health Clinical Centre at Fudan University, said the findings of the Guangzhou study were “not entirely a surprise”, and unrelated viruses could take on similar traits as they came under similar selective pressure.
  • Suppression of MHC molecules had also happened in other viruses such as some herpes viruses, said Zhang, who was not involved in the study.
  • He noted that the new coronavirus was not hijacking T cells and turning them into a means to reproduce, as HIV did, adding that the new virus was mutating at a much slower pace and the death rate was “much, much lower than for AIDS”.
  • He said the body’s immune system had various ways to fight back. “What we need to bear in mind through this pandemic is that, though the virus may have some traits that are new or unexpected, the majority of patients recover,” Zhang said. “This should give us some confidence.”

Source: Coronavirus uses same strategy as HIV to dodge immune response: study

5. Best Advance Indicator of a Second Wave 

  • As public health officials and investors search for reliable leading indicators for the ‘second wave’ of infections that Dr. Fauci and the WHO insist is right around the corner, one team of researchers has determined that the answers might be found under the ground…
  • To wit, a team of researchers from Yale University in New Haven, Conn. published a paper earlier this month on their studies of coronavirus concentrations in the sewage in the Greater New Haven area. 
  • In the abstract of their report, the team determined that “when adjusted for the time lag, the virus RNA concentrations were highly correlated with the C19 epidemiological curve (R2 =0.99) and local hospital admissions (R2 =0.99). 
  • Coronavirus RNA concentrations were a 7-day leading indicator ahead of compiled C19 testing data and led local hospital admissions data by three days.”
  • The search for a reliable leading indicator is critical for developing an effective policy response, since the most closely watched data (reports on the number of newly diagnosed cases) is a lagging indicator, since tests typically aren’t run on an individual until symptoms of the virus have already started to appear.
  • Scientists have already proven that coronavirus RNA is present in the human waste of C19 patients. That then seeps into the wastewater in a given community’s collection system. An analysis of RNA concentrations in waste can, according to the researchers, “provide information on the prevalence and dynamics of infection for entire populations.”
  • By analyzing wastewater from a sewage plant that serves a four-municipality area (pop ~200,000 residents), the researchers applied several data processing techniques to smooth the data and allow for fair comparisons between the sewage data and data collected by the local hospital system in New Haven.
  • Like many other scientific specialties, the field of wastewater epidemiology existed before the pandemic. But the global outbreak has allowed scientists to expand on these methods in real time in the hope that it can help predict outbreaks before they overwhelm hospital systems.
    • New Haven C19 epidemic suggest that these data may provide useful epidemiological insights. Coronavirus RNA sludge concentrations were quantitatively compared with data that are commonly used to track the community progression of C19 including hospital admissions and C19 compiled testing data for the four municipalities (New Haven, East Haven, Hamden, and Woodbridge, CT) served by the ESWPAF.  
    • All three measures traced the initial wave of the coronavirus outbreak in the New Haven metropolitan area. Applying Locally Weighted Scatterplot Smoothing (LOWESS) to the data and rescaling enables comparison. 
    • The virus RNA time course peaked 3 days earlier than hospital admissions (April 9 versus April 12) and a cross correlation analysis revealed a correlation coefficient (R=0.996) between smoothed RNA and hospital data when the latter was shifted 3 days forward.
  • The team found that the “peak” level of virus RNA arrived 3 days before hospitals reported their ‘peak’ number of patients.
https://zh-prod-1cc738ca-7d3b-4a72-b792-20bd8d8fa069.storage.googleapis.com/s3fs-public/inline-images/EY6Z_9MU8AI-X5G.jpeg
  • “Normally when I tell people I work with poo, they’re not super-interested,” Stephanie Loeb, a postdoctoral researcher at Stanford University, told NPR. But “there’s really a lot of information in our waste.”

Source:  Best Advance Indicator of a Second Wave

6. Coronavirus antibody tests could be wrong up to half the time 

  • Antibody tests for C19 — used to determine if people have been infected in the past with the deadly illness — might be wrong up to half the time, the Centers for Disease Control and Prevention announced.
  • The antibody tests, often called serologic tests, look for evidence of an immune response to infection, but are not accurate enough to use in making important policy decisions, the CDC said in new guidance.
  • “Serologic test results should not be used to make decisions about grouping persons residing in or being admitted to congregate settings, such as schools, dormitories, or correctional facilities,” the federal agency said.
  • “Serologic test results should not be used to make decisions about returning persons to the workplace,” it added.
  • The tests “can play an important role in understanding the virus’s epidemiology in the general population and identifying groups at higher risk for infection,” the CDC said.
  • The tests “do not typically replace direct detection methods as the primary tool for diagnosing an active coronavirus infection, but they do have several important applications in monitoring and responding to the C19 pandemic,” it continued.
  • “Although serologic tests should not be used at this time to determine if an individual is immune, these tests can help determine the proportion of a population previously infected with coronavirus and provide information about populations that may be immune and potentially protected.”
  • Health officials or health care providers who use the tests must use the most accurate ones they can find and may need to test people twice, the CDC said.
  • “In most of the country, including areas that have been heavily impacted, the prevalence of coronavirus antibody is expected to be low, ranging from less than 5% to 25%, so that testing at this point might result in relatively more false positive results and fewer false-negative results,” it added.

Source: Coronavirus antibody tests could be wrong half the time: CDC

D. Your Immunity Passport is Suspended Until Further Notice

1. Jury is very much out on whether antibodies provide immunity  

  • It remains unclear whether people who have been infected with the coronavirus are at risk of becoming infected again, the World Health Organization said Wednesday. 
  • “The jury is still very much out on that,” Dr. Mike Ryan, executive director of the WHO’s emergencies program, said during a press conference at the agency’s Geneva headquarters. 
  • Scientists are still learning about key aspects of the virus, including how immune systems respond once a person is exposed.
  • Researchers from the Korean Centers for Disease Control and Prevention published a report last week that studied patients who tested positive for C19 again after recovering and getting discharged from isolation.
  • They found that re-positive cases carried the antibodies that would protect them from falling ill again and few healthy people who were exposed to the reinfected patients contracted C19 themselves. That led researchers to conclude the reinfected people were “re-detected” and not a threat if released from isolation. That should be good news for those who have recovered and wish to head back to work, but it’s not definitive proof yet.  
  • Ryan said Wednesday that there is some evidence that former C19 patients with virus-killing T cells may be able to mount a more “rapid response” against the virus. But there is no empirical evidence that previous coronavirus infections protect patients from re-infection, he said. 
  • He said some studies suggest patients produce a broad-based immune response to the virus, which he said may be helpful as scientists work to develop a vaccine for C19.
  • Last month, WHO said scientists still don’t know whether coronavirus antibodies give a person immunity or reduce the risk of reinfection, even as some nations consider issuing passports or certificates that indicate whether someone has had the virus.

Source: WHO says ‘jury is still very much out’ on whether coronavirus antibodies provide immunity

E. Potential Treatment?

1. No cure, but Chinese herb capsule shortens fever, fatigue and coughing  

  • A Chinese herb combination can help ease the symptoms of C19, say some of China’s top scientists after conducting a multi-center trial.
  • According to a previous diagnosis and treatment protocol by the National Health Commission, Lianhuaqingwen (LH) capsules are recognized for treating symptoms of C19, such as fatigue and fever, but not C19 itself. There is not yet a confirmed cure for the disease.
  • The scientific paper was published on Phytomedicine journal on May 16 and the research team includes Li Lanjuan, director of the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Zhang Boli, president of Tianjin University of Traditional Chinese Medicine, and Zhong Nanshan, China’s “Sars hero” and veteran infectious disease expert.
  • Lianhuaqingwen is a compounded Chinese herbal medicine comprising several plant products, including Japanese honeysuckle and golden-bell.
  • The researchers recruited 284 C19 patients in February from 23 hospitals in 9 Chinese provinces for the study.
  • They found that treatment with LH capsules for 14 days markedly improved the rate of symptom recovery (57.7% at day 5, 80.3% at day 10 and 91.5% at day 14).
  • The time to symptom recovery was also significantly shorter in the LH treatment group. For example, the capsules shortened the duration of fever by one day and the symptoms of fatigue and coughing by three days for each compared to the control group and improved chest CT images, the study found. But the degree of virus reduction did not reach statistical significance.
  • “In light of the efficacy and safety profiles, LH capsules could be considered for the treatment of C19,” the study concluded.
  • The urgency of the outbreak means no “blinding” – in which researchers and subjects do not know whether who is receiving a placebo and who is receiving possible treatment – was implemented. The researchers acknowledged this was a limitation of the study. Instead of blinding, patients were randomized to either receive the usual treatment alone or in combination with LH capsules (four capsules, three times a day) for 14 days.
  • The researchers said further study was needed to determine whether a longer period of Lianhuaqingwen treatment would be more efficacious. And an extended study would be needed to thoroughly explore the effects of LH capsules on viral shedding and the resolution of all symptoms.
  • Previously, Zhong has publicly recommended LH capsules to treat C19 patients. In early May, in a public video chat with overseas Chinese students, he said that if they showed fever symptoms, they should take medicine such as LH capsules.
  • The herbal medicine has met with resistance in the West, however. In early May, Canadian doctors warned against the Beijing-touted health supplement as the Chinese embassy distributed LH capsules to students there, according to CBC News.
  • On Tuesday, United States Customs and Border Protection officers seized three postal packages of a total of 28,800 LH capsules, citing that they violated the Federal Food, Drug and Cosmetic Act, which prohibits any food, drug, device, tobacco product, or cosmetic that is adulterated or misbranded.
  • Border officials said the dangers of the pills were “catastrophic” as they gave “consumers a false sense of security”.

Source: Herb capsule shortens Covid-19 fever, fatigue and coughing: research

F. Concerns & Unknowns

1. Questions, But Few Answers  

Can you catch the coronavirus twice?

  • It’s unclear. A key question is whether antibodies produced by the body following an infection with the coronavirus provide some level of immunity, and if so, for how long.
  • But we do have some clues. “We know from ‘normal’ coronavirus studies done in the past you can infect people after about a year following an initial infection,” said Dr Ben Killingley, consultant in acute medicine and infectious diseases at University College London hospital.
  • Dr Joshua Schiffer, an expert in infectious diseases at Fred Hutchinson Cancer Research Center in the US, added that any signs of reinfection would require detailed scrutiny.
  • “I have yet to see a definitive case of reinfection reported in the scientific literature [to date]. To truly prove reinfection, and discriminate from prolonged viral shedding related to the first infection, would require sequencing of both the first and second viruses and demonstration that the two viruses are genetically different,” he said, adding it will also be important to look at symptoms and how long reinfection lasts.
  • “It is also important to recognize that documentation of one or a handful of reinfections does not prove that this is a common, epidemiologically important event.”
  • What happened in South Korea, where patients tested positive after having recovered from C19?
  • This initially caused concerns, as experts feared the results might suggest patients had been reinfected. However, the World Health Organization has since said the results were actually false positives, a result of the test picking up particles of the virus within dead lung cells – but this is not active virus. That’s because the PCR (or “have-you-got-it”) test is based on detecting genetic material from the virus – on its own it does not reveal whether that virus is active, and infectious, or not.

Why do some people have long-lasting symptoms?

  • “In some cases, people begin to feel well again and signs and symptoms including fever decrease, but some then go on to develop respiratory distress and must be provided oxygen in hospital,” said David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. “It appears to be a delayed immune response that is more serious in some persons and that reacts to remaining virus in various organs.”
  • Even some people who have had a mild experience of C19 have reported experiencing symptoms for several weeks or even months, although experts say only time and testing will tell what the long-term implications are and how common this is.
  • Killingley said it was unclear what was behind such ongoing symptoms, but there are a range of possibilities – including inflammation caused by the virus – although the mechanisms and risks are, as yet, unclear.
  • Immunology professor Daniel Altmann, of Imperial College London, said such cases are important to study.
  • “[We are] at the beginning of describing what may be a complex picture of chronic disease that may ensue from the initial infection – coming and going in relapsing waves, sometimes almost like a kind of chronic fatigue syndrome,” he said. “[These cases] may reflect examples of virus not fully cleared, or alternatively, some kind of damaging post-hoc disturbance to immune or inflammatory function,” he said.
  • Schiffer agreed such cases are cause for concern. “In the case of the coronavirus, my colleagues and I are particularly worried about the possibility of prolonged periods of lung inflammation and/or scarring,” he said.

Could the coronavirus lie dormant in the body, and then reactivate?

  • Experts say it is unlikely. “I know some have discussed ‘reactivation’ of virus, but this seems unhelpful and unsupported to me,” said Altmann. “It’s a term that’s borrowed from other viruses, especially the herpes virus family, that can hide in the body in a latent state to reactivate years later. [There is] no evidence of that at all for coronaviruses.”

How long are people with C19 infectious for?

  • A recent study of 60 coronavirus patients in China showed 10 patients tested positive for C19 after discharge from hospital. However, once again, experts say this could be down to the test picking up genetic material from inactive virus, with other studies, including work in South Korea, suggesting those who test positive with C19 after recovering from the disease are not infectious.
  • “It’s not uncommon to find virus in the nose or throat for up to four weeks after initial infection, but tests to establish whether this is live infectious virus – as opposed to just genetic material detection – are not normally positive for much longer than a week,” said Killingley, adding: “I haven’t come across relapse cases whereby the initial infection acquired weeks ago reignites itself into an infectious case.”
  • Schiffer had doubts: “In my view, the presence of Sars CoV-2 RNA many weeks after initial infection may represent ongoing viral replication in cells, which also implies the persistence of small amounts of “active” virus,” he said. “However, quantities are tiny and may represent the dying embers of infection in the body.”
  • Altmann said that, asymptomatic cases aside, infectiousness correlates strongly with acute symptoms, which typically last for up to 12 days, with a tailout to 28 days. “My sense is that in the people who are feeling unwell long after this, it may not be virus, but some kind of immune or inflammatory perturbation,” he said.

[Note:  As reported in our 5/26 Update, a recent study from Singapore indicated that people remained infectious for only 11 days.]

Source: Can you catch coronavirus twice? What we know about Covid-19 so far

G. The Road Back?  

1. Mitigating airborne transmission should be at the forefront of our disease-control strategies for C19  

Opinion by Joseph Allen, who is director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health and co-author of “Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.”

  • If you’ve been following advice about C19 from the Centers for Disease Control and Prevention or the World Health Organization, chances are you’ve heard a lot about how the coronavirus can travel through large droplets via coughing and sneezes. You’ve also probably heard about the virus being transmitted through surfaces. But you probably haven’t heard anything about airborne transmission, which many organizations have largely ignored.
  • That’s a mistake. Airborne transmission — caused by small particles that can linger in the air for extended periods of time, unlike droplets from coughs, which settle quickly — is key to understanding why this disease spreads so rapidly in certain circumstances. It’s also key to figuring out how best to reopen our country.
  • I’ve been warning about airborne transmission of C19 since early February. The explosive transmission on the Diamond Princess cruise ship, as well as other coronavirus outbreaks, constituted telltale signs that airborne transmission was happening. Close contact transmission was likely happening on that cruise ship, but the disease had spread far more quickly than non-airborne diseases typically spread.
  • Since then, evidence has continuously pointed to airborne transmission of C19, as my colleague Linsey Marr and I outline in a recent paper. Scientists have detected the virus in places that can be reached only by air, such as ductwork; asymptomatic transmission is occurring, meaning people are spreading this without coughing or sneezing large droplets; and basic aerosol physics shows that people shed an entire continuum of particles when they cough, sneeze or talk, including large particles that settle out quickly and smaller ones that stay afloat for hours.
  • Why is airborne transmission so important? One reason: super-spreader events. C19 does not spread from one person to the next equally. Some infected with the virus may not spread it to anyone, while others may spread it to dozens or more. In fact, one recent paper found that 10% of cases led to about 80% of the spread.
  • Such super-spreader events appear to be happening exclusively indoors, where airborne transmission is more likely. Consider the infamous March 10 choir practice in Skagit County, Wash., where one member of the choir infected 52 of 60 other members, leading to two deaths. Local public health departments did an investigation and concluded that all three modes of transmission were likely involved in the outbreak. 
  • But this likely under-emphasizes the role that airborne transmission played. Neither surface nor droplet transmission is likely to have infected so many people in one event. But we do know that when people sing, they emit as many aerosol particles as they do when they’re coughing. The practice also happened from 6:30 to 9 p.m., when most buildings turn off their ventilation systems. (Local investigators don’t mention building ventilation in their report, so we are left to infer.)
  • The evidence suggests that mitigating airborne transmission should be at the front of our disease-control strategies for C19. In some ways, that only bolsters public health measures already in place, such as avoiding groups and wearing masks in public. But it also requires that we minimize exposure to airborne pathogens, especially indoors.
  • To do that, we need to do two things. First, maintain physical distancing. Six feet is good, but 10 feet is better. 
  • Second, we must deploy healthy building strategies, such as refreshing stale indoor air. We do this by opening windows in our homes and cars and by increasing the outdoor air ventilation rate in buildings with HVAC systems. Any recirculated air needs to pass through a high-efficiency filter so an infected person in one room doesn’t contaminate people in an adjacent room (as happened with the first SARS outbreak). 
  • We also have to make sure places such as bathrooms and rooms with infected patients have enough exhaust, and are negatively pressurized relative to common areas, so any airborne virus is confined to limited areas. This isn’t rocket science; as far back as 1860, Florence Nightingale said, “Cleanliness and fresh air from open windows, with unremitting attention to the patient are the only defense a true nurse either asks or needs.”
  • We also need to recognize that some groups are more vulnerable to the ravages of this virus. Just looking at these next few statistics will tell you everything you need to know about where we need to target our intervention efforts. One in 3 deaths nationally are workers or residents of senior homes; nine of the top 10 clusters in the United States occur in meatpacking plants and prisons; the death rate in hot spots is 10-fold higher in areas with lower incomes; and communities of color have nearly five times the odds of infection. 
  • If we are to get a handle on this pandemic, it is imperative that we continue to identify those at most risk and provide them precision support.
  • It’s past time we put the pieces together and acknowledge the scientific record on airborne transmission of C19. Only once we do this can we take control of the super-spreading events that are driving the epidemic.

Source: Opinion | We cannot keep ignoring the possibility of airborne transmission. Here’s how to address it.

2. 5 ways to prevent another 100,000 coronavirus deaths in the US (and beyond)  

  • The corona virus is likely to kill more than 1 million people worldwide by the end of this year, and 60 million people will die this year from other, often preventable causes, as they do every year. As we confront the most devastating infectious disease threat the world has faced in a century, unless we are more careful, there will be many more avoidable deaths, not just from C19 but also from the disruption it causes.
  • To save as many lives as possible, both from the coronavirus and other causes, public health specialists must guide and political leaders must fully support five things at the core of public health.
1. Fix the glaring gaps in data about deaths
  • Although deaths are not an early indicator of the spread of the coronavirus and other health trends, tracking death rates is crucial to understanding and counteracting the impact of the pandemic. Tracking deaths identifies increases from the virus missed by testing and tracking systems and provides an early warning if deaths from other conditions increase.
  • What gets measured can be managed, and so every US state and every country must report all-cause mortality every week. Many higher-income countries can start weekly reporting by age group compared with historical levels, as Switzerland and others have done.
  • Even in the United States, this information isn’t readily available, and in places ranging from New York City to Georgia, public health leaders have had to resist pressure from political leaders to hide this key data.
  • We need to change the expectation so that we learn the death rates every week, in every community — both deaths caused by the coronavirus and all deaths. In lower-income countries where basic vital registration systems are often weak or lacking, this will require training, supporting, and paying community health workers and hospital registrars and also improving the capacity to collect, analyze, and disseminate real-time data. Last week, our organization, Resolve to Save Lives, joined the World Health Organization and others in releasing practical guidance on how countries can do just that.
  • In the US, this increase in deaths from other conditions, which results from the pandemic’s disruption, could come in the form of more heart disease deaths among those who didn’t seek care during the pandemic. At the height of the pandemic, a colleague in a New York City emergency department commented to me, “We’re seeing no angina.” It’s likely that patients with heart attacks avoided care for fear of contracting the coronavirus.
  • In Africa, meanwhile, falling immunization and malaria treatment rates could cause millions of preventable deaths. These trends can be found early — and further deterioration prevented — with rapid mortality surveillance.
2. Protect our health care workers to keep our health care systems functioning so they can prevent both coronavirus and non-coronavirus deaths
  • It is appalling that more than 100,000 health care workers have been infected with the coronavirus. The health and economic consequences of losing health care workers and overwhelming health care facilities are catastrophic.
  • This does not have to be. I began my public health career documenting and stopping the spread of multidrug-resistant tuberculosis in hospitals; it is possible to make health care much safer.
  • Singapore has had few if any health care workers infected by the virus at work — not thanks to high-technology interventions, but due to sensible, meticulous attention to protocols. Protective equipment is important, but comprehensive and well-implemented infection prevention programs are the most effective ways to protect health care workers and patients.
  • Only if health care workers are and are known to be safe will we be able to prevent avoidable deaths from people infected with the coronavirus and also prevent increases in mortality from other conditions that result from overwhelmed health care systems.
3. Preserve non-coronavirus health care
  • In New York City, between mid-March and mid-May, there were more than 4,000 “excess” deaths — deaths that may have been but are not known to have been related to the coronavirus. It’s likely that many people died from non-coronavirus causes because they did not seek care, for example for heart disease, which is the leading cause of death in the US.
  • Avoiding an increase in non-coronavirus deaths is a particularly urgent priority in Africa. If we don’t take steps to preserve care, over the coming years more than 10 million people in Africa could die from malaria, tuberculosis, HIV, vaccine-preventable diseases, and other causes due to the pandemic’s disruption of health care systems. Yet the age structure — only 4% of Africans are over age 65 — means that the proportion of coronavirus infections that are fatal will be far below 1%: closer to the seasonal flu than to the devastation seen in other parts of the world.
  • If we fail to preserve the programs that address preventable killers, the number of people who die from the coronavirus directly might be a small fraction of those killed by other diseases because of the disruption the pandemic causes. Donor agencies, international organizations, and governments themselves must keep non-coronavirus health care going, with telemedicine, longer-term prescription refills, safer facilities, and bolstered primary and preventive care.
4. Protect the most vulnerable
  • One-third of the US coronavirus deaths have occurred in nursing homes, revealing that facilities for the elderly will be coronavirus death traps until we drastically improve efforts to keep the virus out, find it fast when the first staff or residents become infected, and stop outbreaks from spreading.
  • The US Centers for Medicare and Medicaid Services (CMS) has made a good start requiring an end to nonessential visitors, but regulators, payors, and nursing home administrators will all need to keep the virus out with strict policies. These include universal wearing of masks, limited visitors, and extensive testing. 
  • Nursing homes need to find the virus fast with rapid and repeated testing, and they need to stop outbreaks before they spread widely with rapid-response teams and test-based strategies. 
  • We need to identify and protect the highest-risk facilities — not just nursing homes, but also prisons, homeless shelters, and factories, and the highest-risk individuals, including the elderly and those with underlying conditions.
5. Balance saving lives with preserving livelihoods
  • Health versus the economy is a false dichotomy. Poverty increases ill health, and until people are confident, they will not resume economic activities.
  • Yogi Berra asked, “If people don’t want to come to the ballpark, how are you going to stop them?” Unless people feel safer working, dining, or shopping, they won’t venture out for those activities.
  • The coronavirus will cause the first increase in global poverty in more than two decades. In a recent survey in Africa, half of respondents estimated they would run out of money and food in a week or less.
  • Every country needs to find the balance, and this may mean allowing economically important activities to begin even before all of the ideal disease control systems are in place. 
  • This can only happen if we better protect health care workers, shield the most vulnerable, and redesign to reduce risk. In most places, most economic disruption from the pandemic isn’t from lockdowns, but from fear — much of it rational — that everyday activities could kill us or our loved ones.
  • It’s not a “guns or butter” dilemma. We can save the most lives and protect our economy most effectively by urgently strengthening public health and emerging as soon and as safely as possible, focusing on the most important societal activities first. This means widespread use of face masks, hand-washing, staggered shifts, telework, and prompt contact tracing to prevent cases from becoming clusters, clusters from becoming outbreaks, and outbreaks from forcing another retreat into our homes.
  • The British epidemiologist William Farr wrote, “The death rate is a fact; anything beyond this is an inference.” Weekly mortality tracking can guide a response that rapidly identifies and prevents further increases in coronavirus and non-coronavirus deaths. Only focused and intensive action will prevent another 100,000 deaths in our nursing homes alone.
  • As future waves of the virus hit, we need to be ready to adapt rapidly to reduce spread, stop outbreaks, and protect the vulnerable. In every step we take, we must first remember: Illness and economic damage are reversible. Death is not.

Source: Coronavirus deaths: The 5 things we must do to save the most lives in the pandemic

H. Projections & Our (Possible) Future

1. The coronavirus pandemic is still getting worse in 24 US States 

  • The coronavirus pandemic has been raging in the United States for months now, but not every state has been impacted in the same way. Some states have likely seen the worst of the first wave of infections, while others are only now grappling with sharp increases in the number of cases they’re seeing.
  • A new study from an international group of scientists and researchers at the Imperial College uses existing data and predictive modeling to forecast when the disease will peak (or has peaked) in each individual state. Unsurprisingly, around half of the states in the country have yet to see a peak and case numbers continue to grow.  [Note: The study can be found at https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-05-21-COVID19-Report-23.pdf]
  • Based on the numbers, the researchers are confident that half the states have reached their peak. The states that the researchers believe may not yet have reached their peak are listed below, in order of most confident (that a peak is still coming) to least confident:
  1. Texas
  2. Arizona
  3. Illinois
  4. Colorado
  5. Ohio
  6. Minnesota
  7. Indiana
  8. Iowa
  9. Alabama
  10. Wisconsin
  11. Mississippi
  12. Tennessee
  13. Florida
  14. Virginia
  15. New Mexico
  16. Missouri
  17. Delaware
  18. South Carolina
  19. Massachusetts
  20. North Carolina
  21. California
  22. Pennsylvania
  23. Louisiana
  24. Maryland
  • If you see your state on this list, that doesn’t necessarily mean that you’re in store for more widespread infections and skyrocketing fatalities. It just means that, based on the data, it doesn’t look like your state has the pandemic under control.
  • Likewise, if you don’t see your state on this list, it doesn’t mean you can run out and start pretending life is back to normal. It’s not. Even in some states that have peaked, the loosening of restrictions and stay-at-home orders has already resulted in a secondary increase in positive cases.
  • The list is a good resource insofar as it shows us that, as a country, the United States is not out of the woods yet. With half the country yet to experience a peak in coronavirus cases, we still can’t even begin to estimate what the final death toll will be by the time it’s all over. But when will it really be over?
  • Right now we’re biding our time until a vaccine is developed. Scientists are working hard on that front and several companies have promising trials in the works. Still, vaccine development takes time, even when it’s being fast-tracked and we shouldn’t expect a vaccine to be available until 2021 at the earliest.
  • In the meantime, it’s important that we practice the things we’ve been practicing all along, like social distancing, wearing protective masks when in public and avoiding gathering in large numbers.

Source: The coronavirus pandemic is still getting worse in these 24 US states

I. Updates

1. CDC Confuses and then Clarifies Its View On Whether C19 Can be Spread by Touching a Surface or Object  

  • The CDC says recent edits to its website with guidance on how coronavirus is spread on surfaces created confusion and was not based on new science. The change drew attention because it indicated that the virus “does not spread easily” through touching surfaces or objects.
  • The agency issued a statement saying it has updated the page again. The new edits have not changed the information but reorganized it.
  • When the first change was noticed this week, it said that person-to-person contact was the most likely way to transmit C19. After that, the page had a subsection that explained ways the virus “does not spread easily.” That subsection stated that transmission was less likely through touching surfaces or objects, or by human-to-animal or animal-to-human transmission.
  • “This change was intended to make it easier to read, and was not a result of any new science,” the CDC said in a statement Friday night. “After media reports appeared that suggested a change in CDC’s view on transmissibility, it became clear that these edits were confusing. Therefore, we have once again edited the page to provide clarity.”
  • The transmission page is now divided into new subsections. It again says person-to-person is how the virus spreads most easily.
  • But a new sub-headline is titled, “The virus may be spread in other ways.” Beneath that, the CDC says it may be possible to get C19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.
  • “This is not thought to be the main way the virus spreads, but we are still learning more about how this virus spreads,” the page says.
  • To be clear, the information about touching a surface then touching one’s face was on the version of the page that the CDC says led to the confusion. It was just presented differently.

Source: CDC: COVID-19 surface spread guidance wasn’t from new science

J. Practical Tips & Other Useful Information

1. Steps to take if you’ve tested positive for coronavirus or have C19 symptoms 

  • The Centers for Disease Control and Prevention released a clear roadmap this week outlining what those who have tested positive for the coronavirus — whether or not they are showing symptoms — need to do in order to refrain from spreading it to other people. 
  • [Find more information on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html]
  • The organization says that those who “think or know they have C19 and have symptoms” must wait 10 days after symptoms appear to see people, including three days without fever. Those who test positive but are showing no symptoms should also wait 10 days until after the positive test. Those with weakened immune systems, it notes, may need to wait longer.
  • Yahoo Life Medical Contributor Dr. Dara Kass clarifies what the advice means. “This is saying if you are symptomatic, regardless of when you’re tested, you should stay away from other people from the first day of symptoms until 10 days,” Kass tells Yahoo Life. “But you have to have three days of no fever. So if you have a fever until day 9, you have to stay until day 12.”
  • Although 10 days may seem arbitrary, Willam Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, says there is likely a reason for it. “What the CDC is basically saying is that they think the data are pretty secure that after 10 days you’re no longer infectious,” Schaffner tells Yahoo Life. “There’s probably not live virus anymore.”
  • More research is needed to confirm exactly how long individuals are contagious, but in a separate memo released this May, the CDC cited two studies that show the level of infectious virus “approaches zero by 10 days.” One of the studies, published by Nature in April, found that the peak of infectiousness for patients with C19 occurred in the first five days and that once individuals reached the 10-day mark they were likely no longer shedding the virus actively.
  • Schaffner says the concept is particularly important given reports of recovered patients testing positive for the coronavirus again. He says given current research, this should not necessarily be cause for alarm. “I think the CDC has come to the conclusion that [another positive test] is not reinfection or a relapsing infection, it’s just the remnants of an infection,” says Schaffner. “So those are [likely] just viral fragments that are being detected with a positive test.”
  • The guidance does note that anyone who has knowingly been in “close contact” with someone who had a confirmed case of C19 should isolate at home for a full 14 days. Dr. Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security, says the longer length of this is likely due to questions about the delayed onset of symptoms. “Fourteen days is probably because they’re waiting out the longer duration of the incubation period because they might become symptomatic,” says Adalja. “That’s a different scenario than someone who has just recovered.”
  • While most people with C19 should be able to see others after 10 days, the guidance does note that those with weakened immune systems may need to wait longer, and should talk to their doctor. “If testing is available in your community, it may be recommended by your healthcare provider,” it reads. “You can be with others after you receive two negative test results in a row, at least 24 hours apart.” Schaffner says that infections can linger longer in those who are immunocompromised, which is probably the reason for more caution.
  • Overall, all three experts feel the CDC’s advice is valuable as the country moves toward reopening. “I think these guidelines give people a basis for how to modify their behavior after they’ve recovered or been in contact with some individuals,” says Adalja. “It’s also important because employers look at it as well because they want to have people come back to work and then they’re nervous if there’s not an official guidance document to help with that decision.”
  • Kass agrees, but cautions that — like many things in this crisis — the advice may change. “I think it’s important for people to continue to get guidance for how to act,” she says. “We still don’t have the right answers across the board, so a lot of it we’re still trying to figure out the answer. It’s evolving evidence but this is where we are and let’s continue to figure it out.”

Source: CDC advises on steps to take if you’ve tested positive for coronavirus or have COVID-19 symptoms

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