Coronavirus Update

Reliable information to protect your family from the pandemic and its shockwaves

Coronavirus Update 6-2

Recent Developments & Information

June 2, 2020

“The swabs performed over the last 10 days showed a viral load in quantitative terms that was infinitesimal compared to the ones carried out a month or two ago.  In reality, the virus clinically no longer exists in Italy.”  

Alberto Zangrillo, head of San Raffaele Hospital in Milan, which has borne the brunt of Italy’s coronavirus contagion

“I probably took many of the [lockdown] decisions out of fear.”

Norway’s prime minister Erna Solberg

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.

Correction: One of our readers noted that Louisiana is led by a Democratic Governor and not a Republican Governor as reported in our 6/1 Update.  Our apologies to the great State of Louisiana and the GOP.  

A. Our World As Seen Through Headlines

(In No Particular Order)

B. Key Numbers & Trends

Note: Unless otherwise noted, all numbers in this Update are as of 5/31 and changes are since the prior day.  Unless otherwise specified, all cases/deaths are confirmed cases/deaths that have been reported.  Please note that the reporting of cases/deaths for a state/country may be delayed (which often occurs over weekends and holidays), and the number of cases/deaths for a state/country can be revised, which can result in some unusual short-term changes in numbers. 

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

1. Cases & Tests

  • Worldwide:  
    • Total Cases = 6,362,148 (+1.6%)
    • New Cases (7 day average) = 111,126 (+1.7%) (+1,870)
  • US: 
    • Total Cases = 1,859,323 (+1.2%)
    • New Cases (7 day average) = 21,871 (+1.6%) (+338)
    • Total Number of Tests = 18,150,053 (+441,283)
    • Positive Test Rate (7 day average) = 5.3% (+0%)
    • Note: 7 day average of new cases has increased slightly while testing is occurring in significant (and increasing) numbers, which is a positive trend.  The percentage of positive tests remains stable, which is also a positive trend.

2. Deaths

  • Worldwide Deaths 
    • Total Deaths = 377,152 (+0.9%) 
    • New Deaths (7 day average) = 4,220 (+8.4%) (+325)
  • US Deaths 
    • Total Deaths = 106,925 (+0.7%) 
    • New Deaths (7 day average) = 1,017 (+3.3%) (+32)
    • Note: Although the 7 day average increased more than 3% due to higher number of deaths earlier in the 7 day period, the number of US deaths are trending down overall (the number of deaths on 6/1 was 730, which was well below (28.2%) the 7 day average)
  • 5 Countries with Largest Number of Confirmed Deaths: 
CountryTotal DeathsNew Deaths 7 Day AvgDeaths Per 1M Pop
US106,9251,017 (+32)323 (+2) 
UK39,045304 (+79)575 (+8) 
Italy33,47585 (+7)554 (+1)
France28,88357 (+4)442 (+1)
Spain27,12741 (+0)580 (+0)
Worldwide377,1524,220 (+325)48.4
  • While the 7 day average of US, UK, Italy and France increased, their respective daily number of deaths have generally been trending down (although the number of deaths in UK spiked today, it is unclear if that is an anomaly or a trend).  Although Spain’s 7 day average has stabilized, the number of its daily deaths have been less than 4 deaths per day during the last 6 days. 
  • Deaths in these 5 countries = 62.4% of total worldwide deaths (-0.5%), and 35.6% of worldwide 7 day average of new deaths.  
  • US deaths = 28.4% of total worldwide deaths (+0%), and 24.1% of  worldwide 7 day average of new deaths.
  • Per Capita Deaths of Most Populous States: 
StatePer Capita Deaths(per 1,000,000)Increase in Per Capita DeathsCompared to National Avg.
California108N/A0.33 Nat’l Avg
Texas59+10.18 Nat’l Avg
Florida115+10.36 Nat’l Avg
New York1542+44.77 Nat’l Avg
Pennsylvania437+11.35 Nat’l Avg
Illinois427+31.32 Nat’l Avg
Ohio189+40.59 Nat’l Avg
Georgia197+40.61 Nat’l Avg
North Carolina90N/A1.71 Nat’l Avg
Michigan552+21.35 Nat’l Avg
United States323+2
  • Of the 10 most populous States, the per capita deaths of all of them are less than the national average, other than NY, MI, PA and IL.   NY has the highest number of deaths and per capita deaths in the country, by significant margins.  
  • Increases in per capita deaths for all States are less than or the same as the national average, other than NY, OH, GA and IL.  Although per capita deaths in OH and GA are well below the national average, their growth rates in per capita deaths is 2x the national average, which could be an early warning signal. 

C. Is The Virus Weakening?

1. New coronavirus losing potency  

  • The new coronavirus is losing its potency and has become much less lethal, a senior Italian doctor said on Sunday.
  • “In reality, the virus clinically no longer exists in Italy,” said Alberto Zangrillo, the head of the San Raffaele Hospital in Milan in the northern region of Lombardy, which has borne the brunt of Italy’s coronavirus contagion.
  • “The swabs that were performed over the last 10 days showed a viral load in quantitative terms that was absolutely infinitesimal compared to the ones carried out a month or two months ago,” he told RAI television.
  • Italy has the third highest death toll in the world from C19, with 33,415 people dying since the outbreak came to light on Feb. 21. It has the sixth highest global tally of cases at 233,019.
  • However new infections and fatalities have fallen steadily in May and the country is unwinding some of the most rigid lockdown restrictions introduced anywhere on the continent.
  • Zangrillo said some experts were too alarmist about the prospect of a second wave of infections and politicians needed to take into account the new reality.
  • “We’ve got to get back to being a normal country,” he said. “Someone has to take responsibility for terrorizing the country.”
  • The government urged caution, saying it was far too soon to claim victory.
  • “Pending scientific evidence to support the thesis that the virus has disappeared … I would invite those who say they are sure of it not to confuse Italians,” Sandra Zampa, an undersecretary at the health ministry, said in a statement.
  • “We should instead invite Italians to maintain the maximum caution, maintain physical distancing, avoid large groups, to frequently wash their hands and to wear masks.”
  • A second doctor from northern Italy told the national ANSA news agency that he was also seeing the coronavirus weaken.
  • “The strength the virus had two months ago is not the same strength it has today,” said Matteo Bassetti, head of the infectious diseases clinic at the San Martino hospital in the city of Genoa.
  • “It is clear that today the C19 disease is different.”

Source: New coronavirus losing potency, top Italian doctor says

2. WHO: The Coronavirus is still a killer 

  • The World Health Organization cautioned world leaders Monday about reports that the coronavirus is “losing potency,” saying “this is still a killer virus” and thousands of people are still dying daily.
  • “We need to be exceptionally careful that we are not creating a sense that all of a sudden the virus has decided to be less pathogenic. That is not the case at all,” Dr. Mike Ryan, executive director of the WHO’s emergencies program, said during a press conference at the agency’s headquarters in Geneva. 
  • WHO officials were asked about comments made by a doctor in Italy who said the coronavirus is losing potency and has become less lethal. 
  • Alberto Zangrillo told an Italian public broadcasting company that “swabs that were performed over the last 10 days showed a viral load in quantitative terms that was absolutely infinitesimal compared to the ones carried out a month or two months ago,” according to a Reuters report. 
  • Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, said Monday that she had not seen the report but added there are measures governments can take to reduce and suppress transmission of the virus. That includes finding, testing and isolating C19 patients, she said.
  • “But if we let the virus go, it will transmit. If we let the virus go, it will infect people and it will cause severe illness in about 20% of people,” she added.
  • The virus can also impact people differently, she said, adding it causes a range of illnesses consistently across the globe. It has a so-called R naught above 2, meaning the virus will “take off” if we allow it to, she said. 
  • “The important message is that there are things we can do to suppress transmission and to save lives,” she said.
  • The epicenter of the global C19 pandemic has shifted to South America, WHO officials said last month, as cases in Rio de Janeiro and Sao Paulo explode.
  • Last week, the WHO warned that countries with declining coronavirus infections could still face an “immediate second peak” if they let up too soon on measures to halt the outbreak. 

[Note: While WHO understandably does not want people to drop their guard as the virus can obviously still permanently injure or kill people, scary statistics about C19 does not address the findings that the virus is weakening in Italy.  If the virus is weakening, that is profoundly important and deserves further study.  Moreover, statements by the WHO deserve some scrutiny.  For example, the comment that 20% of infected people will become severely ill is based on confirmed cases.  But, we know that some infected people are asymptomatic, perhaps a lot.  The CDC has estimated that 35% of infected people are asymptomatic, and other studies have indicated that up to 81% of infected people could be asymptomatic, which would reduce the percentage of people that will have severe symptoms from 20% to between 3.8% and 13%.  Also, there have been studies that forecast that the infection rate will decrease over a short period of time, and there is some evidence to support those forecasts (although the evidence is far from conclusive and may only reflect a short term trend, it is worth tracking).]  

Source: WHO says coronavirus isn’t losing potency: ‘This is still a killer virus’

D. New Scientific Findings & Research 

1. Are Statins and ACE Inhibitors the Antiviral We’ve Been Looking For?  

  • In April, blood clots emerged as one of the many mysterious symptoms attributed to C19, a disease that had initially been thought to largely affect the lungs in the form of pneumonia. Quickly after came reports of young people dying due to coronavirus-related strokes. Next it was Covid toes — painful red or purple digits.
  • What do all of these symptoms have in common? An impairment in blood circulation. Add in the fact that 40% of deaths from C19 are related to cardiovascular complications, and the disease starts to look like a vascular infection instead of a purely respiratory one.
  • Months into the pandemic, there is now a growing body of evidence to support the theory that the coronavirus can infect blood vessels, which could explain not only the high prevalence of blood clots, strokes, and heart attacks, but also provide an answer for the diverse set of head-to-toe symptoms that have emerged.
  • “All these Covid-associated complications were a mystery. We see blood clotting, we see kidney damage, we see inflammation of the heart, we see stroke, we see encephalitis [swelling of the brain],” says William Li, MD, president of the Angiogenesis Foundation. “A whole myriad of seemingly unconnected phenomena that you do not normally see with SARS or H1N1 or, frankly, most infectious diseases.”
  • “If you start to put all of the data together that’s emerging, it turns out that this virus is probably a vasculotropic virus, meaning that it affects the [blood vessels],” says Mandeep Mehra, MD, medical director of the Brigham and Women’s Hospital Heart and Vascular Center.
  • In a paper published in April in the scientific journal The Lancet, Mehra and a team of scientists discovered that the SARS-CoV-2 virus can infect the endothelial cells that line the inside of blood vessels. Endothelial cells protect the cardiovascular system, and they release proteins that influence everything from blood clotting to the immune response. In the paper, the scientists showed damage to endothelial cells in the lungs, heart, kidneys, liver, and intestines in people with C19.
  • “The concept that’s emerging is that this is not a respiratory illness alone, this is a respiratory illness to start with, but it is actually a vascular illness that kills people through its involvement of the vasculature,” says Mehra.
A one-of-a-kind respiratory virus
  • The coronavirus is thought to enter the body through ACE2 receptors present on the surface of cells that line the respiratory tract in the nose and throat. Once in the lungs, the virus appears to move from the alveoli, the air sacs in the lung, into the blood vessels, which are also rich in ACE2 receptors.
  • “[The virus] enters the lung, it destroys the lung tissue, and people start coughing. The destruction of the lung tissue breaks open some blood vessels,” Mehra explains. “Then it starts to infect endothelial cell after endothelial cell, creates a local immune response, and inflames the endothelium.”
  • A respiratory virus infecting blood cells and circulating through the body is virtually unheard of. Influenza viruses like H1N1 are not known to do this, and the original SARS virus, a sister coronavirus to the current infection, did not spread past the lung. Other types of viruses, such as Ebola or Dengue, can damage endothelial cells, but they are very different from viruses that typically infect the lungs.
  • Benhur Lee, MD, a professor of microbiology at the Icahn School of Medicine at Mount Sinai, says the difference between SARS and the coronavirus likely stems from an extra protein each of the viruses requires to activate and spread. Although both viruses dock onto cells through ACE2 receptors, another protein is needed to crack open the virus so its genetic material can get into the infected cell. The additional protein the original SARS virus requires is only present in lung tissue, but the protein for the coronaviru to activate is present in all cells, especially endothelial cells.
  • “In SARS1, the protein that’s required to cleave it is likely present only in the lung environment, so that’s where it can replicate. To my knowledge, it doesn’t really go systemic,” Lee says. “[the coronavirus] is cleaved by a protein called furin, and that’s a big danger because furin is present in all our cells, it’s ubiquitous.”
Endothelial damage could explain the virus’ weird symptoms
  • An infection of the blood vessels would explain many of the weird tendencies of the coronavirus, like the high rates of blood clots. Endothelial cells help regulate clot formation by sending out proteins that turn the coagulation system on or off. The cells also help ensure that blood flows smoothly and doesn’t get caught on any rough edges on the blood vessel walls.
  • “The endothelial cell layer is in part responsible for [clot] regulation, it inhibits clot formation through a variety of ways,” says Sanjum Sethi, MD, MPH, an interventional cardiologist at Columbia University Irving Medical Center. “If that’s disrupted, you could see why that may potentially promote clot formation.”
  • Endothelial damage might account for the high rates of cardiovascular damage and seemingly spontaneous heart attacks in people with C19, too. Damage to endothelial cells causes inflammation in the blood vessels, and that can cause any plaque that’s accumulated to rupture, causing a heart attack. This means anyone who has plaque in their blood vessels that might normally have remained stable or been controlled with medication is suddenly at a much higher risk for a heart attack.
  • “Inflammation and endothelial dysfunction promote plaque rupture,” Sethi says. “Endothelial dysfunction is linked towards worse heart outcomes, in particular myocardial infarction or heart attack.”
  • Blood vessel damage could also explain why people with pre-existing conditions like high blood pressure, high cholesterol, diabetes, and heart disease are at a higher risk for severe complications from a virus that’s supposed to just infect the lungs. All of those diseases cause endothelial cell dysfunction, and the additional damage and inflammation in the blood vessels caused by the infection could push them over the edge and cause serious problems.
  • The theory could even solve the mystery of why ventilation often isn’t enough to help many C19 patients breathe better. Moving air into the lungs, which ventilators help with, is only one part of the equation. The exchange of oxygen and carbon dioxide in the blood is just as important to provide the rest of the body with oxygen, and that process relies on functioning blood vessels in the lungs.
  • “If you have blood clots within the blood vessels that are required for complete oxygen exchange, even if you’re moving air in and out of the airways, [if] the circulation is blocked, the full benefits of mechanical ventilatory support are somewhat thwarted,” says Li.
  • A new paper published last week in the New England Journal of Medicine, on which Li is a co-author, found widespread evidence of blood clots and infection in the endothelial cells in the lungs of people who died from C19. This was in stark contrast to people who died from H1N1, who had nine times fewer blood clots in the lungs. Even the structure of the blood vessels was different in the C19 lungs, with many more new branches that likely formed after the original blood vessels were damaged.
  • “We saw blood clots everywhere,” Li says. “We were observing virus particles filling up the endothelial cell like filling up a gumball machine. The endothelial cell swells and the cell membrane starts to break down, and now you have a layer of injured endothelium.”
  • Finally, infection of the blood vessels may be how the virus travels through the body and infects other organs — something that’s atypical of respiratory infections.
  • “Endothelial cells connect the entire circulation [system], 60,000 miles worth of blood vessels throughout our body,” says Li. “Is this one way that C19 can impact the brain, the heart, the Covid toe? Does the coronavirus traffic itself through the endothelial cells or get into the bloodstream this way? We don’t know the answer to that.”
  • IF C19 IS A VASCULAR DISEASE, THE BEST ANTIVIRAL THERAPY MIGHT NOT BE ANTIVIRAL THERAPY.
  • An alternative theory is that the blood clotting and symptoms in other organs are caused by inflammation in the body due to an over-reactive immune response — the so-called cytokine storm. This inflammatory reaction can occur in other respiratory illnesses and severe cases of pneumonia, which is why the initial reports of blood clots, heart complications, and neurological symptoms didn’t sound the alarm bells. However, the magnitude of the problems seen with C19 appear to go beyond the inflammation experienced in other respiratory infections.
  • “There is some increased propensity, we think, of clotting happening with these [other] viruses. I think inflammation in general promotes that,” Sethi says. “Is this over and above or unique for the coronavirus, or is that just because [the infection] is just that much more severe? I think those are all really good questions that unfortunately we don’t have the answer to yet.”
  • Anecdotally, Sethi says the number of requests he received as the director of the pulmonary embolism response team, which deals with blood clots in the lungs, in April 2020 was two to three times the number in April 2019. The question he’s now trying to answer is whether that’s because there were simply more patients at the hospital during that month, the peak of the pandemic, or if C19 patients really do have a higher risk for blood clots.
  • “I suspect from what we see and what our preliminary data show is that this virus has an additional risk factor for blood clots, but I can’t prove that yet,” Sethi says.
  • THE GOOD NEWS IS THAT IF COVID-19 IS A VASCULAR DISEASE, THERE ARE EXISTING DRUGS THAT CAN HELP PROTECT AGAINST ENDOTHELIAL CELL DAMAGE. 
  • In another New England Journal of Medicine paper that looked at nearly 9,000 people with C19, Mehra showed that the use of statins and ACE inhibitors were linked to higher rates of survival. Statins reduce the risk of heart attacks not only by lowering cholesterol or preventing plaque, they also stabilize existing plaque, meaning they’re less likely to rupture if someone is on the drugs.
  • “It turns out that both statins and ACE inhibitors are extremely protective on vascular dysfunction,” Mehra says. “Most of their benefit in the continuum of cardiovascular illness — be it high blood pressure, be it stroke, be it heart attack, be it arrhythmia, be it heart failure — in any situation the mechanism by which they protect the cardiovascular system starts with their ability to stabilize the endothelial cells.”
  • Mehra continues, “What we’re saying is that maybe the best antiviral therapy is not actually an antiviral therapy. The best therapy might actually be a drug that stabilizes the vascular endothelial. We’re building a drastically different concept.”

Source:  Coronavirus May Be a Blood Vessel Disease, Which Explains Everything

2. Danger Ahead: C19 Increases Risk of Surgery  

Note: Below is an overview of study on “Mortality and Pulmonary complications in patients undergoing surgery with COVID-19 infection.”    
Background
  • The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the C19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative C19 infection.
Methods
  • This international, multicenter, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation.
Findings
  • This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 
  • 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 82·6% (219 of 265) of all deaths. 
  • In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047).
Interpretation
  • Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. 
  • Thresholds for surgery during the C19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. 
  • Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.

Source: Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study 

3. C19 could be seasonal illness that returns as humidity decreases  

  • A study conducted in Australia during the early stage of the coronavirus pandemic has found an association between lower humidity and an increase in locally acquired positive cases.
  • The study, which is the first peer-reviewed study of a relationship between climate and C19 in the southern hemisphere and was published today in Transboundary and Emerging Diseases, FOUND A 1% DECREASE IN HUMIDITY COULD INCREASE THE NUMBER OF C19 CASES BY 6%.
  • “C19 is likely to be a seasonal disease that recurs in periods of lower humidity. We need to be thinking if it’s winter time, it could be C19 time,” said Michael Ward, an epidemiologist in the Sydney School of Veterinary Science at the University of Sydney who led the research, in a statement.
  • Since the C19 pandemic developed in China, Europe and North America during those regions’ winter, researchers were curious to see if there was a unique association between the virus and Australia’s late summer and early autumn.
  • “When it comes to climate, we found that lower humidity is the main driver here, rather than colder temperatures,” Ward explained. 
  • “It means we may see an increased risk in winter here, when we have a drop in humidity. But in the northern hemisphere, in areas with lower humidity or during periods when humidity drops, there might be a risk even during the summer months. So vigilance must be maintained.”
  • According to Ward, there are also biological reasons why humidity can impact the transmission of airborne viruses.
  • “When the humidity is lower, the air is drier and it makes the aerosols smaller,” he said. 
  • “When you sneeze and cough those smaller infectious aerosols can stay suspended in the air for longer. That increases the exposure for other people. When the air is humid and the aerosols are larger and heavier, they fall and hit surfaces quicker.”
  • Scientists believe that more studies, including during the winter in the southern hemisphere, are needed to confirm how this relationship works in more detail.

Source: COVID-19 could be seasonal illness that returns as humidity decreases, new Australia study reveals

4. Most Comprehensive Study to Date: Optimal Physical Distancing, Face Masks, and Eye Protection to Prevent Spread of C19

  • First review of all available evidence including 172 observational studies looking at how physical distancing, face masks, and eye protection affect the spread of C19, SARS, and MERS in both community and healthcare settings across 16 countries
What Protects against COVID-19 Infection or Transmission?
  • Physical distancing of at least 1 meter lowers risk of C19 transmission, but distances of 2 meters could be more effective.
  • Keeping at least one meter from other people as well as wearing face coverings and eye protection, in and outside of health-care settings, could be the best way to reduce the chance of viral infection or transmission of C19, according to a systematic review and meta-analysis synthesizing all the available evidence from the scientific literature, published in The Lancet.
  • However, none of these interventions, even when properly used and combined, give complete protection from infection, and the authors note that some of the findings, particularly around face masks and eye protection, are supported by low-certainty evidence, with no completed randomized trials addressing C19 for these interventions.
  • The study, conducted to inform WHO guidance documents, is the first time researchers have systematically examined the optimum use of these protective measures in both community and healthcare settings for C19. The authors say it has immediate and important implications for curtailing the current C19 pandemic and future waves by informing disease models, and standardizing the definition of who has been ‘potentially exposed’ (ie, within 2 meters) for contact tracing.
  • Many countries and regions have issued conflicting advice about physical distancing to reduce transmission of C19, based on limited information. In addition, the questions of whether masks and eye coverings might reduce transmission of C19 in the general population, and what the optimum use of masks in healthcare settings is, have been debated during the pandemic.
  • “Our findings are the first to synthesize all direct information on C19, SARS, and MERS, and provide the currently best available evidence on the optimum use of these common and simple interventions to help “flatten the curve” and inform pandemic response efforts in the community,” says Professor Holger Schünemann from McMaster University in Canada, who co-led the research. “Governments and the public health community can use our results to give clear advice for community settings and healthcare workers on these protective measures to reduce infection risk.”
  • The currently best available evidence suggests that C19 is most commonly spread by respiratory droplets, especially when people cough and sneeze, entering through the eyes, nose, and mouth, either directly or by touching a contaminated surface. At the moment, although there is consensus that SARS-CoV-2 mainly spreads through large droplets and contact, debate continues about the role of aerosol spreading.
  • For the current analysis, an international team of researchers did a systematic review of 172 observational studies assessing distance measures, face masks, and eye protection to prevent transmission between patients with confirmed or probable C19, SARS, or MERS infection and individuals close to them (eg, caregivers, family, healthcare workers), up to May 3, 2020.
  • Pooled estimates from 44 comparative studies involving 25,697 participants were included in the meta-analysis. Of these, 7 studies focused on C19 (6,674 participants), 26 on SARS (15,928), and 11 on MERS (3,095).
  • The C19 studies included in the analysis consistently reported a benefit for the three interventions and had similar findings to studies of SARS and MERS.
  • For healthcare workers, N95 and other respirator-type masks might be associated with a greater protection from viral transmission than surgical masks or similar (eg, reusable 12-16 layer cotton or gauze masks). For the general public, face masks are also probably associated with protection, even in non-health-care settings, with either disposable surgical masks or reusable 12-16 layer cotton ones. However, the authors note that there are concerns that mass face mask use risks diverting supplies from health-care workers and other caregivers at highest risk for infection.
  • People must be clear that wearing a mask is not an alternative to physical distancing, eye protection or basic measures such as hand hygiene, but might add an extra layer of protection.
  • According to co-author Karla Solo from McMaster University in Canada: “While our results provide moderate and low certainty evidence, this is the first study to synthesize all direct information from C19 and, therefore, provides the currently best available evidence to inform optimum use of these common and simple interventions.”
  • Despite these important findings, the review has some limitations including that few studies assessed the effect of interventions in non-healthcare settings, and most evidence came from studies of SARS and MERS. Finally, the effect of duration of exposure on risk for transmission was not specifically examined.
  • Writing in a linked Comment, lead author Professor Raina MacIntyre (who was not involved in the study) from the Kirby Institute, University of New South Wales in Australia, describes the study as “an important milestone,” and writes, “For healthcare workers on C19 wards, a respirator should be the minimum standard of care. This study by Chu and colleagues should prompt a review of all guidelines that recommend a medical mask for health workers caring for C19 patients. Although medical masks do protect, the occupational health and safety of health workers should be the highest priority and the precautionary principle applied.”
  • She continues, “[They] also report that respirators and multilayer masks are more protective than are single layer masks. This finding is vital to inform the proliferation of homemade cloth mask designs, many of which are singlelayered. 
  • A well designed cloth mask should have water resistant fabric, multiple layers, and good facial fit.  
  • Universal face mask use might enable safe lifting of restrictions in communities seeking to resume normal activities and could protect people in crowded public settings and within households.”

Note: The full study can be found at Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a syste

Source: Most Comprehensive Study to Date: Optimal Physical Distancing, Face Masks, and Eye Protection to Prevent Spread of COVID-19

5. Wastewater Testing: Canary in the C19 Coal Mine

  • What only a month ago had been merely an intriguing laboratory finding about analyzing wastewater to detect the virus that causes C19 has quickly leapt to the threshold of real-world use.
  • With swab tests still plagued by capacity issues, inaccuracy, and slow turnaround, testing wastewater for the coronavirus’ genetic signature could give communities a faster way to spot a rebound in cases — as soon as this fall.
  • “There is real hope that this can be a sensitive, early warning” if, as officials ease social distancing measures, C19 begins to spread again, said Peter Grevatt, CEO of the nonprofit Water Research Foundation. “Several labs have achieved a proof-of-concept in terms of demonstrating the ability to detect the RNA [genetic material] of the virus in wastewater.” Studies in the U.S. and the Netherlands, among others, have shown you can pick up a signal about a week before the first clinical case.
  • Grevatt and his colleagues briefed congressional staffers last week on the potential for wastewater analysis to be the canary in the C19 coal mine, and on Wednesday the National Academies’ Water Science and Technology Board hosted a panel discussion on how to build a surveillance network and what additional research is needed to make it work. 
  • Water utilities from southeastern Virginia to Portland, Ore., are already conducting the analysis on their own. And by next week, Grevatt’s group will have identified the labs that will participate in a quality control test deemed crucial for rolling out a nationwide effort to analyze wastewater for coronavirus: The foundation will send wastewater samples gathered by several utilities to all participating labs and have them run the analysis, compare results, and agree on best practices.
  • “We hope to have results of this lab-to-lab comparison by the end of the summer,” Grevatt said.
  • Countries are not waiting for every scientific question to be answered. Finland, Germany, and the Netherlands have already launched national wastewater surveillance programs to catch any resurgence of C19. 
  • “People are already starting to scale this up,” environmental engineer David Sedlak of the University of California, Berkeley, told the Academies’ panel.

Source: Wastewater testing gains support as early warning for Covid-19 – STAT

E. Potential Treatments

1. Russians claim to have an effective treatment for the coronavirus  

  • Russia has approved an anti-influenza drug, Aviifavir, to treat C19 and will start delivering it to hospitals this month, according to Russia’s sovereign wealth fund.
  • The fund, RDIF, has provided money for Russia’s development and production of the drug which is based on favipiravir, an anti-influenza drug developed in Japan under the name Avigan, in a 50-50 joint venture with Russian pharmaceutical firm ChemRar. 
  • Preliminary trials appeared to show that it could shorten recovery times for patients with C19. The final stage of Avifavir clinical trials involving 330 patients are ongoing, RDIF and ChemRar said Monday, but Russia’s Ministry of Health on Saturday already temporarily approved the use of the drug as a coronavirus treatment. 
  • “It’s a major, major step forward,” RDIF CEO Kirill Dmitriev told CNBC on Monday. 
  • “We believe there are now only two antiviral drugs against the virus that are really effective, those are remdesivir, done by the U.S., and this favipiravir, which also has significant promise,” he told CNBC’s “Squawk Box Europe.”
  • RDIF and the ChemRar Group said Monday they will deliver 60,000 courses of Avifavir to Russian hospitals in June, promoting it as among the world’s first coronavirus treatments to be approved.
  • “Avifavir is Russia’s first C19 drug and has shown high efficacy in treating patients with coronavirus during clinical trials. Avifavir has received a registration certificate from the Ministry of Health of the Russian Federation. Thus, Avifavir has become the first Favipiravir-based drug in the world approved for the treatment of C19,” they said in the statement.
  • According to data received from an earlier clinical trial of the drug, 65% of the 40 patients tested negative for coronavirus after five days of treatment, which was two times higher than in the standard therapy group, RDIF and ChemRar said last month.

Source: Russia approves drug to treat Covid-19, hospitals to use in June

F. Vaccines

1. Newly Developed Vaccines Protect Against C19 in Macaques Study  

  • “The global C19 pandemic has made the development of a vaccine a top biomedical priority, but very little is currently known about protective immunity to the SARS-CoV-2 virus,” said senior author Dan H. Barouch, MD, PhD, Director of the Center for Virology and Vaccine Research at BIDMC. “In these two studies, we demonstrate in rhesus macaques that prototype vaccines protected against SARS-CoV-2 infection and that SARS-CoV-2 infection protected against re-exposure.”
  • In the first study, the team demonstrated that six candidate DNA vaccines induced neutralizing antibody responses and protected against SARS-CoV-2 in rhesus macaques. Barouch and colleagues — who began working toward a C19 vaccine in mid-January when Chinese scientists release the viral genome — developed a series of candidate DNA vaccines expressing variants of the Spike protein, a key antibody target of the novel coronavirus. The vaccines are designed to train the body’s immune system to recognize and respond quickly to the virus upon exposure.
  • To assess the efficacy of the vaccines, the researchers immunized 25 adult rhesus macaques with the investigational vaccines, and 10 animals received a sham control. Vaccinated animals developed neutralizing antibodies against the virus. Three weeks after a boost vaccination, all 35 animals were exposed to the virus. Follow-up testing revealed dramatically lower viral loads in vaccinated animals compared to the control group. 
  • Eight of the 25 vaccinated animals demonstrated no detectable virus at any point following exposure to the virus, and the other animals showed low levels of virus. 
  • Moreover, higher antibody levels were linked to lower viral loads, suggesting that neutralizing antibodies may serve as a correlate of protection and may prove useful as a benchmark in clinical testing SARS-CoV-2 vaccines.
  • In the second study, the team demonstrated that macaques that recovered from C19 developed natural protective immunity against re-infection. 
  • “Individuals who recover from many viral infections typically develop antibodies that provide protection against re-exposure, but not all viruses generate this natural protective immunity,” said Barouch, who is also Professor of Medicine at Harvard Medical School and a member of the Ragon Institute of MGH, MIT, and Harvard.
  • After exposing nine adult macaques to the SARS-CoV-2 virus, the researchers monitored viral levels as the animals recovered. All nine animals recovered and developed antibodies against the virus. 
  • More than a month after initial infection, the team re-exposed the rhesus macaques to the virus. Upon second exposure, the animals demonstrated near-complete protection against the virus. These data suggest natural protective immunity against C19 in this model.
  • “Our findings increase optimism that the development of C19 vaccines will be possible,” said Barouch. “Further research will be needed to address the important questions about the length of protection, as well as the optimal vaccine platforms for a SARS-CoV-2 vaccines for humans.”

Source: Newly Developed Vaccines Protect Against COVID-19 in Macaques Study

2. GSK to manufacture 1 billion doses of vaccine adjuvant system   

  • GlaxoSmithKline (GSK) said it will manufacture 1 billion doses of its pandemic vaccine adjuvant system in 2021 to support the development of multiple adjuvanted C19 vaccine candidates.
  • The pharmaceutical company says its pandemic adjuvant technology could make a significant contribution against C19.  GSK’s pandemic adjuvant can reduce the amount of vaccine protein required per dose. This allows more vaccine doses to be produced, which can lead to protecting more people. Further, an adjuvant can enhance the immune response.
  • GSK has formed several collaborations, including with scientific partners in North America, Europe, and China, to develop vaccines. Discussions with potential partners on further collaborations are ongoing. The company will manufacture the adjuvant for use in C19 vaccines at sites in the U.K., U.S., Canada, and Europe.
  • “We believe that more than one vaccine will be needed to address this global pandemic, and we are working with partners around the world to do so,” Roger Connor, president, GSK Global Vaccines, said. “We believe that our innovative pandemic adjuvant technology has the potential to help improve the efficacy and scale-up of multiple C19 vaccines. With this significant expansion in our manufacturing capacity, we can help deliver up to 1 billion doses of adjuvanted vaccines through 2021, helping protect many more people and support the global effort to fight C19.”
  • GSK is committed to making its adjuvant available through fair access to people across the world, including the world’s poorest countries. GSK does not expect to profit from sales of its portfolio of collaborations for C19 vaccines made during this pandemic phase, as profit generated will be invested in support of coronavirus related research and long-term pandemic preparedness.

Source: GSK to manufacture 1 billion doses of pandemic vaccine adjuvant system

G. Updates

1. Remdesivir Has Only Small Benefit in Large Trial  

  • Gilead Sciences Inc.’s drug remdesivir showed only a limited benefit in a large trial of more moderate patients with Covid-19, a result that may shift perceptions of the therapy already cleared for use in severe cases of the disease.
  • In the phase 3 trial, a group of moderately ill, hospitalized patients getting the drug for five days showed a modest improvement compared to those getting the standard of care, the company said in a statement. But another group getting the drug for 10 days didn’t show a statistically significant improvement, which is likely to raise questions about why a longer course doesn’t help more. Severely ill patients weren’t included in the trial.
  • Gilead’s drug has become a symbol of efforts to reopen the economy and effectively treat patients stricken with the coronavirus. A working therapy would help reduce the risk for people who become sick, providing greater certainty to efforts to reopen economies around the globe.
  • The clinical trial looked at hospitalized Covid-19 patients who had more moderate disease, with pneumonia but who didn’t have reduced oxygen levels at the beginning of the study. Patients were randomly assigned to get five days of remdesivir, 10 days of remdesivir, or the standard of care, and then evaluated on a 7-point scale.
  • Overall, the differences were quite modest. The patients who received five days of remdesivir did best, with 76% improving by at least one point by day 11, compared to 66% who received standard of care.
  • But confusingly, patients who stayed on remdesivir for 10 days did slightly worse than those who received five days of remdesivir, with only 70% of them improving at day 11. That difference wasn’t statistically significant compared to the standard of care group.
  • “There seems to be growing evidence five-day treatment is as good or better than 10-day — somewhat curious given no clear side-effect liabilities and may seem counter-intuitive to the typical ‘more is better’ expectation,” said Brian Abrahams, an analyst with RBC Capital Markets. He said the difference could be caused by a less burdensome administration of the drug.
  • The U.S. Food and Drug Administration cleared remdesivir under an emergency authorization on May 1, which has allowed hospitalized patients with severe cases of Covid-19 to begin using the therapy. The emergency approval followed early results from a large, placebo-controlled study run by the U.S. government that showed that patients getting remdesivir recovered faster than those that got a placebo.
  • In the new trial, Gilead said there were no new safety risks identified across either treatment group. The company plans to submit the full data for publication in a peer-reviewed medical journal in coming weeks.

Source: Gilead’s Covid-19 Drug Remdesivir Modest Benefit in Large Trial 

2. CDC Updates

H. Reopenings

1. The Road to Recovery: Which Economies are Reopening?  

  • C19 has brought the world to a halt—but after months of uncertainty, it seems that the situation is slowly taking a turn for the better.
  • The chart below measures the extent to which 41 major economies are reopening, by plotting two metrics for each country: the mobility rate and the C19 recovery rate:
  • The Mobility Index refers to the change in activity around workplaces, subtracting activity around residences, measured as a percentage deviation from the baseline.
  • C19 Recovery Rate: The number of recovered cases in a country is measured as the percentage of total cases.
  • Data for the first measure comes from Google’s C19 Community Mobility Reports, which relies on aggregated, anonymous location history data from individuals. Note that China does not show up in the graphic as the government bans Google services.
  • C19 recovery rates rely on values from CoronaTracker, using aggregated information from multiple global and governmental databases such as WHO and CDC.
  • In general, the higher the mobility rate, the more economic activity this signifies. In most cases, mobility rate also correlates with a higher rate of recovered people in the population.
  • In the main scatterplot visualization shown below, we’ve taken things a step further, assigning these countries into four distinct quadrants:
1. High Mobility, High Recovery
  • High recovery rates are resulting in lifted restrictions for countries in this quadrant, and people are steadily returning to work.
  • New Zealand has earned praise for its early and effective pandemic response, allowing it to curtail the total number of cases. This has resulted in a 98% recovery rate, the highest of all countries. After almost 50 days of lockdown, the government is recommending a flexible four-day work week to boost the economy back up.
2. High Mobility, Low Recovery
  • Despite low C19 related recoveries, mobility rates of countries in this quadrant remain higher than average. Some countries have loosened lockdown measures, while others did not have strict measures in place to begin with.
  • Brazil is an interesting case study to consider here. After deferring lockdown decisions to state and local levels, the country is now averaging the highest number of daily cases out of any country. On May 28th, for example, the country had 24,151 new cases and 1,067 new deaths.
3. Low Mobility, High Recovery
  • Countries in this quadrant are playing it safe, and holding off on reopening their economies until the population has fully recovered.
  • Italy, the once-epicenter for the crisis in Europe is understandably wary of cases rising back up to critical levels. As a result, it has opted to keep its activity to a minimum to try and boost the 65% recovery rate, even as it slowly emerges from over 10 weeks of lockdown.
4. Low Mobility, Low Recovery
  • Last but not least, people in these countries are cautiously remaining indoors as their governments continue to work on crisis response.
  • With a low 0.05% recovery rate, the United Kingdom has no immediate plans to reopen. A two-week lag time in reporting discharged patients from NHS services may also be contributing to this low number. Although new cases are leveling off, the country has the highest coronavirus-caused death toll across Europe.
  • The U.S. also sits in this quadrant with over 1.7 million cases and counting. Recently, some states have opted to ease restrictions on social and business activity, which could potentially result in case numbers climbing back up.
  • Over in Sweden, a controversial herd immunity strategy meant that the country continued business as usual amid the rest of Europe’s heightened regulations. Sweden’s C19 recovery rate sits at only 13.9%, and the country’s -93% mobility rate implies that people have been taking their own precautions.

Source: The Road to Recovery: Which Economies are Reopening?

2. State Reopenings

I. Lockdowns:  Sweden v. Norway

1. It’s Not Looking Good In Sweden Right Now  

  • Unlike most nations, including its Scandinavian counterparts, Sweden did not shut down its economy or schools. Instead, the country’s leaders asked its people to take responsibility for social distancing themselves and banned only gatherings larger than 50 people, allowing schools and businesses, including bars and restaurants, to stay open. (Officials advised people to work from home when possible and avoid nonessential travel, and on March 31, the country issued a ban on visits to elder care homes.)
  • On Monday it was reported that Sweden tallied zero coronavirus-related deaths in the past 24 hours for the first time since March 13. Only the week before the country reported the highest number of C19 deaths in Europe per capita over a seven-day period.
Be careful of assumptions
  • Sweden’s approach relied on several assumptions, some more overt than others. 
  • One was that the country’s entire population would and could, without punishment or incentive, maintain the social distancing needed to protect themselves and each other from disease transmission. 
  • Another assumption was that infection with the coronavirus eventually leads to protection — both from repeat infection and onward transmission to others — and that its high transmissibility meant many people would quickly become infected and thus protected. 
  • And a third was that the country’s relatively low population density would be protective for everyone.
  • The goal of Sweden’s strategy was to avoid the financial collapse facing countries whose near-universal shutdowns have led to severe economic contractions, while simultaneously slowing disease transmission to avoid health care system overload. 
  • But the strategy seems to be resulting in more deaths: Sweden’s per capita C19 mortality rate, already high in late April, is currently higher than any other European country—and an order of magnitude higher than that of its neighbors Finland and Norway.  [Note:  While unquestionably high, Sweden’s per capital mortality rate is not higher than all other countries in Europe.  UK, Italy, Spain and France are all have higher per capita deaths.]
  • Despite the country’s ban on care home visits, C19 ravaged the largely older populations living in these homes: Nearly half of the country’s deaths from the virus occurred in care home residents. This pattern suggests that even in a country with low population density, “once the virus gets into congregate living facilities, it’s extremely hard to control,” says Eric Schneider, senior vice president for policy and research at the Commonwealth Fund, an independent health care research organization. Sweden’s liberal approach invited this problem “because you’re allowing a certain level of cases in the community — and eventually, through workers, usually, or visitors, or other mechanisms, the virus will make it into those residential facilities,” he says.
Widespread infections means more death
  • Additionally, the assumption that Sweden’s population would achieve broad protection as a consequence of infection, often called herd immunity by public health specialists, did not play out. Sweden’s leaders did not specifically identify herd immunity as a goal — and they have denied that it’s part of the country’s strategy — but in early May, the epidemiologist who formulated the country’s no-lockdown strategy estimated that 40% of Stockholm’s population would be immune to the virus by the end of the month. Recently published antibody survey results, however, suggest that only 7% of the city’s residents had been exposed to the virus by late April, and the question of how much protection antibodies confer is still a very murky one. In Sweden — as in the rest of the world — population-level protection as a consequence of infection is still a mirage.
  • Some Swedes did voluntarily stay home when advised by their government to do so, but not nearly as many as in the rest of Scandinavia. According to Google mobility reports, retail and transit activity are down 16% to 17% in Sweden, while similar activity took deeper and more sustained dives in Norway, Finland, and Denmark.
  • To Schneider, the Swedish model is an intriguing experiment in relying on the voluntary efforts of citizens to change their behaviors without severe mandates — and it is not going well. 
  • Things might have turned out differently if the country had taken special steps to protect older residents in facilities, he says, but it’s hard to know. In any case, the most instructive phase of Sweden’s approach may lie ahead: “It will be interesting to find out whether they can respond now, or whether they’re going to keep going with a strategy that seems like it’s not working,” he says.

Source: The Good and Bad Lessons From Sweden

2. Norway wonders if it should have been more like Sweden   

Cost of lockdown sees prime minister raise questions about strategy
  • On Wednesday night, Norway’s prime minister Erna Solberg went on Norwegian television to make a startling admission: she had panicked. 
  • Some, even most, of the tough measures imposed in Norway’s lockdown now looked like steps too far. “Was it necessary to close schools?” she mused. “Perhaps not.”
  • It was a preemptive step only a leader with Solberg’s folksy, down-to-earth style could get away with. “I probably took many of the decisions out of fear,” she admitted, reminding viewers of the terrifying images then flooding their screens from Italy.
  • She is not the first in Norway to conclude that closing schools and kindergartens, making everyone work from home, or limiting gatherings to a maximum of five people might have been excessive.
  • As far back as May 5, the Norwegian Institute of Public Health (NIPH) published a briefing note reporting that at the time the lockdown was imposed on March 12, Norway’s reproduction number – the number of people each infected person on average infects – had already fallen to 1.1. It slipped under 1 on March 19.  
  • “Our assessment now….is that we could possibly have achieved the same effects and avoided some of the unfortunate impacts by not locking down, but by instead keeping open but with infection control measures,” Camilla Stoltenberg, NIPH’s Director General (and the sister of Nato head Jens Stoltenberg) said in a TV interview earlier this month.
  • No one doubts Norway’s success in bringing the pandemic under control. On Friday, there were just 30 people in hospital with coronavirus and five on a ventilator. Only one person had died all week. The per capita death toll is now 44 per million people, just over a tenth of that seen in neighbouring Sweden, where 4,971 people have died.
  • But this success has come at a prohibitive social and economic cost. An expert committee charged with carrying out a cost-benefit analysis into the lockdown measures in April estimated that they had together cost Norway 27bn kroner (£2.3) every month. With only 0.7 per cent of Norwegians infected, according to NIPH estimates, there is almost no immunity in the population.
  • The expert committee concluded last Friday that the country should avoid lockdown if there is a second wave of infections.
  • “We recommend a much lighter approach,” the committee’s head, Steinar Holden, an Oslo University economics professor, told the Sunday Telegraph.  “We should start with measures at an individual level — which is what we have now — and if there’s a second wave, we should have measures in the local area where this occurs, and avoid measures at a national level if that is possible.”
  • Norway’s current strategy — using testing, contact tracing, and home isolation to keep the level of infections down without heavy restrictions — would be best, the report concluded. But if this ‘keep down’ strategy fails to prevent a surge in cases, a ‘brake strategy’ which aims to suppress the rate of transmission but not bring it below 1, would be preferable to a lockdown.
  • “If it’s necessary to have very strict restrictions for a long time, then the costs are higher than letting the infection go through the population,” Holden told the Telegraph. “Because that would be immensely costly.”
  • According to the report, a brake strategy would cost as much as 234bn kroner (£20bn) less than an “unstable keep-down” scenario, if you assume that those infected gain immunity and that no vaccine is developed until 2023. But it would also lead to a little over 3,000 additional deaths.  
  • One measure that no one thinks should be reimposed is school closures.
  • Holden’s committee estimated in April that the measure had cost 6.7 bn kroner (£520m) a month, while at best having “little impact” on the spread of infection. NIPH has gone further, and suggested that school closures may have even increased the spread.
  • Margrethe Greve-Isdahl, the doctor who is NIPH’s expert on infections in schools, told the Telegraph that if schools hadn’t been closed, they could have played a role in informing people in immigrant communities – which were hit disproportionately hard by the epidemic – of hygiene and social distancing rules.
  • “They can learn these measures in school and teach their parents and grandparents, so at least for some of these hard-to-reach minorities, there might be a positive effect from keeping kids in school.”
  • There were also fears in late March and April that adolescents were spreading the virus more out of schools than they would have been in them. “There were large groups of adolescents that were hanging out together and not necessarily following any preventive measures,” Greve-Isdahl said.  
  • But perhaps the main reason Norway is unlikely to close schools again, whatever happens in future waves of infection, is the recognition of the impact on the most vulnerable pupils.  
  • “There’s now a lot of information available on how it has impacted negatively on the economy and on vulnerable children. Their whole care system has kind of collapsed,” Greve-Isdahl says. “I think there would be it would be difficult to impose heavy restrictions again.”
  • Norway, it seems, has already decided a second lockdown is not the way to go, however much the infection flares up again. But that does not mean its prime minister has any regrets.
  • “I think it was the right to do at the time,” she said. “Based on the information we had, we took a precautionary strategy.”
  • It will probably never be possible to know, she added, which of the lockdown measures Norway imposed caused the number of infections to drop away so sharply, if any.

Source: Coronavirus: Norway wonders if it should have been more like Sweden

J. The Road Back?

1. Science says: ‘Open the schools’  

BY DR. SCOTT W. ATLAS AND PAUL E. PETERSON 
  • To stop C19 dead in its tracks, many governors, mayors and superintendents are threatening to keep schools closed this fall, failing to consider the greater harm that comes from refusing to open them.
  • “We have to make sure kids are safe, family members are safe, educators are safe, staff is safe,” says New York City Mayor Bill de Blasio. “If for any reason we are not confident of that, then you can just stick with the pure online learning.” Similarly, teacher unions insist that comprehensive testing, tracing and distancing are essential if reopening is to be done safely.
  • The irony in such language is that children are safe at school already. The CDC states that of the first 68,998 U.S. deaths from C19, only 12 have been in children under age 14 — less than 0.02 percent. Nor is coronavirus killing teenagers. At last count, the fatality total among children under 18 without an underlying condition is one; only ten of the 16,469 confirmed coronavirus deaths in New York City were among those under the age of 18. That’s similar to the fatality rate for those under 20 in France, estimated at 0.001 percent, and in Spain.
  • The death of even one child is tragic, of course. Yet, it must be kept in mind that as many as 600 children in the United States died from seasonal influenza in 2017-18, according to CDC estimates, while the CDC’s estimate for C19 fatalities number just 12. A just-released JAMA Pediatrics study flatly states: “Our data indicate that children are at far greater risk of critical illness from influenza than from C19.” If the C19 hazard sets the new standard for health safety, the country will need to close its schools each year from November until April to guard against influenza.
  • What about the new threat similar to Kawasaki disease, recently sensationalized as a C19 association? In fact, the association is extremely low, and the incidence of the disorder is itself rare, affecting only 3,000 to 5,000 children in the United States each year. Importantly, the syndrome is typically treatable and never has been regarded previously as a risk so serious that schools must be shuttered.
  • While public attention is focused on exceptional rarities, learning is in free-fall. In Boston, only half of students are showing up for online instruction on any given day; 20 percent of them have never logged on to the designated website. “This situation is going to be like what is often called the summer slide [in student achievement], but on steroids,” says Virginia’s state school superintendent. 
  • Low-income students are suffering the most. Many lack WiFi, computer tablets, software and other paraphernalia of the affluent. Nor are they as likely to have access to equivalent mentors at home as those with better educated parents. Robin Lake at the Center for Reinventing Public Education says that “elementary students [in urban districts] may have lost 30 percent of their reading skills.”
  • Closure will endanger the health of our children, too. Already, more than half of America’s children are not receiving needed vaccinations. Further, schools are the place where many learn that they need glasses or a hearing aid, or, if seriously ill, are guided by the school nurse to the doctor’s office for prompt medical attention.
  • In addition, children are being denied opportunities for social and emotional development that come with play, exercise, sports and socialization. Reports already indicate that suicide rates among the young are on the increase. More certain is the loss in human capital that lasts a lifetime: Closing schools this past spring translates into a 3 percent or more cut in lifetime earnings for those whose education is being sidelined. Clearly, closing schools does not benefit those whom schools are supposed to serve. 
  • But what about the adults — the teachers, guidance counsellors, bus drivers and kitchen staff? No one wants to endanger the health of educators but, fortunately, risks to adults in schools are much less than those encountered in grocery stores, pharmacies and other essential businesses. As is shown across the world, including Switzerland, Canada, the Netherlands, France, Iceland, the UK, Australia and now Ireland, children seldom if ever transmit the disease to adults, even to their parents. Several epidemiologists recently denounced the widely cited April publication that erroneously concluded that children can transmit C19 just as readily as adults. Its author, German virologist Christian Drosten, previously had been featured as a C19 hero, abetting the panic to close schools.
  • No less important, C19 mainly targets the elderly and those with underlying conditions. For people under 60, C19 fatality rates are so low that they are less than or equal to those associated with the seasonal flu, according to data from France, Spain and the Netherlands, as well as the CDC. Certainly, adults at high risk or who are fearful should take precautions, and by now they understand how to social-distance for their own protection. But teaching is a young person’s occupation. Teachers’ median age is 41; more than 80 percent are under the age of 55, the age at which most become eligible for a retirement pension.  
If opening day should come sooner, how should schools open? 
  • Unfortunately, it is rapidly becoming conventional wisdom that students should be asked to attend half-days, wear masks, skip recess, spread themselves six feet apart and spend half their time in front of a computer — all in the name of social distancing. But how can classrooms hold students spread apart by six feet? How can you practice phonics with your mouth covered? How can you learn if it is time to return home just as you have settled into your seat? How can you develop socially and emotionally if you must remain distant from friends at recess? How can teachers instruct with masks on their faces? 
  • All of this borders on the absurd, when we now know that social distancing and face coverings for children are completely unnecessary. 
  • Never have schools subjected children to such an unhealthy, uncomfortable and anti-educational environment, so science cannot precisely define the total harm it will cause. But science does tell us that risks from C19 are too minimal to sacrifice the educational, social, emotional and physical well-being – to say nothing of the very health – of our young people.   
  • Scott W. Atlas, MD, is a physician and the David and Joan Traitel Senior Fellow at Stanford University’s Hoover Institution. Paul E. Peterson is a professor of government and director of the Program on Education Policy and Governance at Harvard University, and a senior fellow at the Hoover Institution, Stanford University.

Source: Science says: ‘Open the schools’

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