Recent Developments & Information
June 3, 2020
“Google how to do a haircut.”Michigan Governor Whitmer’s advice to people that want hair salons to be reopened
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
- Effective Neutralizing Antibodies Found – Major Milestone in the Fight Against C19
- Proteins in C19 patients’ blood could predict severity of illness
- Potential Treatments
- Heart Drugs Show Promise With C19 Complications
- Gilead developing inhaled remdesivir usable outside of hospitals
- Is The Virus Weakening?
- Experts dispute reports that coronavirus is becoming less lethal
- Concerns & Unknowns
- Patients Lose Taste, Smell—and Haven’t Gotten Them Back
- The Growing Evidence Linking Obesity to C19 Deaths
- Injuries Found in Placentas From C19-Positive Pregnant Women Suggests Abnormal Blood Flow Between Mothers, Babies
- Asymptomatic Transmission Called Into Question
- At-Home Testing Arrives
- No Lockdown, Same Health Outcome
- Collateral Damage
- Old Scourges Revived in Africa as the Pandemic Drains Resources
- Practical Tips & Other Useful Information
- How to Safely Travel on Mass Transit During Coronavirus
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- 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)
- China reportedly delayed releasing critical coronavirus data to WHO
- W.H.O. Feared China Would Attack Its Scientists if Criticized on Coronavirus
- More than 25,000 nursing home residents and 400 staff have died during pandemic, federal report shows
- Medical Workers Should Use Respirator Masks, Not Surgical Masks
- Immigration detention centers become Malaysia coronavirus hotspot
- Mexico’s President Touts Reopening With The Country Mostly In Coronavirus Red Zone
- 7 in 10 Americans would be likely to get a coronavirus vaccine, Post-ABC poll finds
- Bangladesh reported approx. 3,000 new cases, in largest daily jump
- India cases top 200,000
- China finds 300 asymptomatic cases after testing all 10 million people in Wuhan
- Tokyo reports another jump in cases
- Hong Kong extends some restrictions by 2 weeks after finding new cluster
- Singapore plans to roll back strict lockdown
- Brazil’s C19 deaths most in world
- India, Russia, Brazil report thousands of new cases
- Spain Reports No Virus Deaths for First Time Since March
- UK records lowest daily virus death toll since start of lockdown
- Pfizer projects October release date for coronavirus vaccine
- Israeli disinfectant tunnel may lead way to safer public events during pandemic
- Handheld UV Light Devices that Kill Coronavirus, Other Viruses May Soon Be as Common as Phone, Keys
- Flyers May Soon See Iris Scans, Socially Distanced Searches
- Bar employs humanoid robot waiter to serve and take orders during Covid-19 pandemic
- Gravediggers in Brazil cannot keep up with Covid-19 deaths as virus spreads in favelas
- As Iran Lifts Its Lockdown, Coronavirus Cases Return to Peak Level
- My rabbit for your detergent? Cubans turn to barter as shortages worsen
- New Zealand expected to lift coronavirus restrictions next week after 11 days without new cases
- WHO pushes back against Italy’s top viral expert
- France has allowed cafes and restaurants to open their outdoor terraces, lifted domestic travel restrictions and permitted sunbathing on beaches.
- Louisiana will start easing restrictions on Friday, allowing churches, malls, bars, theaters and other venues to increase capacity to 50 percent, but New Orleans will not follow the state’s lead.
- The British Parliament has returned to pre-pandemic rules that require in-person voting, leading lawmakers to wait in a socially distanced line about a half-mile long.
- Indonesia, which has the largest Muslim population in the world, will not allow its citizens to travel to Mecca for the hajj this year
- It’s curtains for the Met
- Box office could see 50% drop in ticket sales this year
- Gov. Whitmer to Michigan Residents: ‘Google How to Do a Haircut’
- Already-Obese Average Americans Have Drunk & Eaten Their Way To An Extra 5lbs During Lockdown
- Maine Governor Blocks Restaurant Openings, Advises Selling Food to Prisons
- Post-Lockdown Paris Begins to Partially Open Cafes and Restaurants
- Anger over Coronavirus Lockdowns Grows Throughout Italy
- Two Hour Lines In The UK At McDonald’s As Drive-Thrus Reopen
- Minnesota To Test All 7,000 National Guardsmen Deployed To Quell Riots As First Tests Positive
- Overdose Deaths Skyrocketed In Chicago As COVID Lockdowns Continued
- SAT drops plans for home exam amid internet access concerns
- People rent RVs in droves for fun, safe adventures amid chaos
- NYPD cops ignore directive, abandon masks during clashes with protesters
- Greek tourism minister says all foreign visitors welcome
- Coronavirus ‘deaths of despair’ could reach 150,000, new study suggests
- Primary elections being held Tuesday amid protests, coronavirus pandemic
- Some US salons, gyms, offices requiring coronavirus waivers before entry
- Coronavirus cases increased in Israel after public transportation restrictions were loosened
- Coronavirus mask rules could spur spike in bank robberies: regulator
- Coronavirus pandemic has caused shortage for antidepressant (Zoloft)
- New Yorkers fleeing coronavirus shamed, shunned by ‘pissed-off’ locals
- Pandemic, Economic Crash, Social Unrest, And Now Four Asteroids?
- Hollywood reopen plan stops short of sacrificing ‘intimate scenes’
- Couples should wear face masks during sex, new study insists
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.
1. Cases & Tests
- Total Cases = 6,479,177 (+1.8%)
- New Cases (7 day average) = 114,433 (+3.0%) (+3,307)
- Note: Daily new cases have exceeded 100,000 for the last 7 days and are generally trending higher
- Total Cases = 1,881,205 (+1.2%)
- New Cases (7 day average) = 22,276 (+1.9%) (+405)
- Total Number of Tests = 18,603,174 (+453,121)
- Positive Test Rate (7 day average) = 5.3% (+0%)
- Note: Although the 7 day average of new cases has increased almost 2%, the number of new cases is generally trending down. While testing is occurring in significant (and increasing) numbers, the percentage of positive tests remains stable, which is also a positive trend.
- Worldwide Deaths
- Total Deaths = 381,859 (+1.3%)
- New Deaths (7 day average) = 4,314 (+2.2%) (+94)
- US Deaths
- Total Deaths = 108,059 (+1.1%)
- New Deaths (7 day average) = 1,069 (+5.1%) (+51)
- Note: 7 day average increased more than 5%, which is a significant increase over the last 2 days. The primary reason for the increase was 1,134 deaths on 6/2 (+404)
- 5 Countries with Largest Number of Confirmed Deaths:
|Country||Total Deaths||New Deaths 7 Day Avg||Deaths Per 1M Pop|
|US||108,059||1,069 (+51)||326 (+3)|
|UK||39,369||332 (+27)||580 (+5)|
|Italy||33,530||82 (-3)||555 (+1)|
|France||28,940||59 (+2)||443 (+1)|
|Spain||27,127||1 (-40)||580 (+0)|
- Spain has had no deaths for the last 2 days, and is averaging less than 2 deaths per day for the last week. The US and UK continue to have high numbers of death as reflected in the increases in their per capita deaths.
- Deaths in these 5 countries = 62.1% of total worldwide deaths (-0.3%), and 35.8% of worldwide 7 day average of new deaths (+0.2%).
- US deaths = 28.3% of total worldwide deaths (-0.1%), and 24.8% of worldwide 7 day average of new deaths (+0.7%).
- States with Largest Single Day Increases in Per Capita Deaths:
|State||Per Capita Deaths(per 1,000,000)||Increase in Per Capita Deaths||Compared to National Avg.|
|Rhode Island||691||+11||2.12 Nat’l Avg|
|Mississippi||258||+10||0.79 Nat’l Avg|
|Illinois||436||+9||1.34 Nat’l Avg|
|Louisiana||611||+8||1.87 Nat’l Avg|
|Pennsylvania||445||+8||1.35 Nat’l Avg|
|Maryland||430||+8||1.32 Nat’l Avg|
|Massachusetts||1,028||+7||3.15 Nat’l Avg|
|New Jersey||1,327||+6||4.07 Nat’l Avg|
|Delaware||383||+5||1.17 Nat’l Avg|
|New York||1,546||+4||4.74 Nat’l Avg|
|Michigan||556||+4||1.70 Nat’l Avg|
C. New Scientific Findings & Research
1. Effective Neutralizing Antibodies Found – Major Milestone in the Fight Against C19
- A joint research team led by Sunney Xie, Director of Beijing Advanced Innovation Center for Genomics (ICG) at Peking University (PKU) has successfully identified multiple highly potent neutralizing antibodies against the novel coronavirus SARS-CoV-2 from convalescent plasma by high-throughput single-cell sequencing.
- Generated by the human immune system, neutralizing antibodies can effectively prevent viruses from infecting cells.
- New results from animal studies showed that their neutralizing antibody provides a potential cure for C19 as well as means for short-term prevention. This marks a major milestone in the fight against the pandemic.
- This study has been published online in Cell, titled “Potent neutralizing antibodies against SARS-CoV-2 identified by high-throughput single-cell sequencing of convalescent patients’ B cells.” [Note: The article can be found at Potent Neutralizing Antibodies against SARS-CoV-2 Identified by High-Throughput Single-Cell Sequencing of Convalescent Patients&]
Testing on the therapeutic and prophylactic efficacy of neutralizing antibodies on mice models (A) Therapeutic group (green), injected with BD-368-2 two hours after infection (n=3); prophylactic group (red), injected with BD-368-2 one day before infection (n=3); control group (blue) injected with non-relevant antibody two hours after infection. (B) The rate of weight loss of therapeutic and prophylactic groups was significantly lower than that of the control group. (C) After 5 days, the viral load of therapeutic group decreased by ~ 2400 times; no viral load was detected in the prophylactic group. Credit: Beijing Advanced Innovation Center for Genomics, Biomedical Pioneering Innovation Center, Peking University.
- There has been an urgent need for highly effective drugs to cure C19. Repurposed small-molecule drugs lack in specificity thus efficacy is compromised. Although plasma therapy has exhibited certain efficacy, it’s limited by convalescent plasma supply. The active component of plasma therapy is the target-specific neutralizing antibody.
- Antibody drugs as a kind of biologics have been successfully applied to treat viruses like AIDS, Ebola, and MERS. However, it is often time-consuming to develop neutralizing antibodies suitable for clinical use, taking months or even years.
- By using their expertise in single-cell genomics, Sunney Xie’s team collected blood samples from over 60 convalescent patients, among which 14 highly potent neutralizing antibodies were selected from 8,558 antigen-binding IgG1+ clonotypes. Their most potent antibody, BD-368-2, exhibited an IC50 of 8pM and 100pM against pseudotyped and authentic SARS-CoV-2. Experiments on the authentic virus were completed in the P3 laboratory of the Academy of Military Medical Sciences.
- The in vivo antiviral experiment of neutralizing antibodies has recently been completed, using hACE2 transgenic mice model developed by Dr. Chuan Qin’s lab at ILAS. The results showed that BD-368-2 antibody could provide strong therapeutic efficacy and prophylactic protection against SARS-CoV-2: When the BD-368-2 antibody was injected into infected mice, virus load was decreased by ~ 2400 times; when uninfected mice were injected with BD-368-2, they were protected from the virus infection.
- In addition, structural biologists obtained the 3.8Å Cryo-EM structure of a neutralizing antibody in complex with the Spike-ectodomain trimer. It revealed the antibody’s epitope overlaps with the ACE2 binding-site, which provides the structural basis of neutralization.
- Moreover, they showed that SARS-CoV-2 neutralizing antibodies could be selected with high efficiency based on similarities of their predicted structures to those of SARS-CoV neutralizing antibodies, hence greatly expediting the screening process.
- The potent neutralizing antibody could be used to develop drugs for both therapeutic intervention and prophylactic protection against SARS-CoV-2. Clinical trials are underway, and the research team have strong confidence in finding a cure.
- “If the C19 epidemic reappears in the winter,” remarked Sunney Xie, “Our neutralizing antibody might be available by that time.”
2. Proteins in C19 patients’ blood could predict severity of illness
- Scientists have found 27 key proteins in the blood of people infected with C19 which they say could act as predictive biomarkers for how ill a patient could become with the disease.
- In research published in the journal Cell Systems on Tuesday, scientists at Britain’s Francis Crick Institute and Germany’s Charite Universitaetsmedizin Berlin found the proteins are present in different levels in C19 patients, depending on the severity of their symptoms.
- The markers could lead to the development of a test that would help doctors predict how ill a patient might get when infected with the coronavirus, they said, and could also provide new targets for the development of potential treatments for the disease.
- Doctors and scientists say those infected with the coronavirus, respond differently – with some developing no symptoms at all, while others need to be hospitalized and others suffer fatal infection.
- “A test to help doctors predict whether a C19 patient is likely to become critical or not would be invaluable,” said Christoph Messner, an expert in molecular biology at the Crick Institute who co-led the research.
- He said such tests would help doctors decide how best manage the disease for each patient, as well as identify those most at risk of needing hospital treatment or intensive care.
- Messner’s team used a method called mass spectrometry to rapidly test for the presence and quantity of various proteins in blood plasma from 31 C19 patients at Berlin’s Charite hospital. They then validated their results in 17 other patients with C19 at the same hospital, and in 15 healthy people who acted as controls.
- Three of the key proteins identified were linked with interleukin IL-6, a protein known to cause inflammation and also a known marker for severe C19 symptoms.
D. Potential Treatments
1. Heart Drugs Show Promise with C19 Complications
- Spurred by promising early findings, researchers are investigating whether drugs currently approved to treat heart disease can also prevent or reduce complications from C19 and help hospitalized patients recover sooner.
- Treatments being evaluated include blood-pressure drugs, blood thinners, statins, antiplatelets and a drug to lower triglycerides. Results from the studies, some of which could come as early as this summer, could offer doctors a new array of drugs to treat patients infected with the coronavirus.
- As many as 20% of C19 patients have been severely or critically ill, according to several studies. Many of them developed cardiovascular complications, such as inflammation of the heart, heart rhythm disorders or blood clots that choke blood flow.
- These complications and others have led some researchers to conclude that C19 is both a vascular and a lung disease.
- Researchers hope cardiovascular drugs can save patients by reducing inflammation—a bodily response to the virus—and potentially by attacking the virus itself. There are no approved drugs or vaccines for the coronavirus, although researchers and companies are racing to advance hundreds of efforts in the laboratory.
- Some recent studies have found that two classes of widely prescribed blood-pressure medicines—angiotensin-converting enzyme, or ACE inhibitors, and angiotensin-receptor blockers, or ARBS—don’t raise patients’ risk of infection, serious illness or death from C19.
How Heart Drugs Could Help C19 Patients
- Researchers are studying whether blood pressure drugs such as losartan could prevent lung injury in C19 patients.
- The studies were conducted after some research had suggested the drugs might have had a role in high death rates of C19 patients with hypertension. Researchers had hypothesized the blood-pressure drugs were giving the coronavirus more opportunity to infect by increasing levels of the ACE2 receptor in the lungs and other tissues.
- Now, however, efforts are under way to find whether these drugs in fact have a protective effect.
- Several trials are testing losartan, a common treatment for high blood pressure. The drug may help prevent lung injury in C19 patients by blocking the angiotensin receptor, which is tied to high blood pressure and can cause inflammation and fluid in the lungs, said Michael Puskarich, associate professor in the department of emergency medicine at the University of Minnesota, which is enrolling patients in two losartan trials.
- Some breathing difficulties in C19 patients may be caused by constricting blood vessels in the lungs, which losartan could help prevent by blocking the angiotensin receptor, he said.
- A 200-person study, funded by the Bill and Melinda Gates Foundation, is testing whether the drug can prevent hospitalized C19 patients with pneumonia from getting worse. Results could come by the end of the summer. A 580-person study, funded by a collaboration between the University of Minnesota and Mayo Clinic, is testing whether losartan can prevent C19 patients from being hospitalized.
- Dr. Puskarich said he and a colleague began the trials after a team in China published research suggesting losartan could help C19 patients. Animal research involving the SARS and avian-flu viruses showed losartan can help prevent serious lung injury and death, Dr. Puskarich and researchers running similar trials said.
- “We’re trying to intervene early and prevent the development of all those lung problems down the line,” Dr. Puskarich said.
- Researchers at the University of Hawaii at Manoa are planning a clinical trial of 40 patients to test whether telmisartan, another angiotensin-receptor blocker, reduces the severity of pulmonary and cardiovascular complications from C19.
- The hope is that the drug can counteract imbalances in the angiotensin-renin system that cause inflammation and fibrosis, or tissue damage, said Cecilia Shikuma, a professor of medicine at the university who is leading the study. The angiotensin-renin hormone system regulates blood volume and blood flow. The researchers are interested in telmisartan in particular because it might have some antiviral effects against the coronavirus, according to Dr. Shikuma.
- Studies of other cardiovascular drugs include Amarin Corp. ’s plans to test whether its fish oil-derived drug, Vascepa, can prevent or treat C19 infection and reduce the risk of cardiovascular problems in patients who sustained heart damage during their illness. It also wants to test whether the drug, first approved in 2012 to treat adults with very high levels of triglycerides, has antiviral effects.
- Amarin says Vascepa may help prevent or treat inflammation caused when the coronavirus attacks the endothelium, the layer of cells lining blood vessels and the inner walls of the heart chambers. Vascepa is a high-purity prescription form of eicosapentaenoic acid, or EPA, which has been shown to reduce a marker of inflammation, C-reactive protein.
- “It quiets down inflammation,” said Deepak Bhatt, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital and an investigator in a pilot study Amarin announced recently to test Vascepa as a treatment on hospitalized C19 patients at the University of Toronto.
- Amarin is planning studies elsewhere on health-care workers, people with underlying cardiovascular issues and other types of patients.
- Statins, the cholesterol-lowering drugs taken by millions of Americans, have also shown promise as protective agents against serious C19 complications.
- Two large studies across several continents have suggested individuals with heart disease who were already taking statins were more likely to survive C19 than those who weren’t taking the medicines, though the drugs’ potential effect hasn’t been directly tested yet.
- In a 154-person analysis by researchers in Belgium, elderly patients taking statins were three times as likely to be free of C19 symptoms. The observational study, published last month on a so-called preprint server, hasn’t been peer-reviewed.
- Some trials are also studying the effect on C19 patients of antiplatelet drugs, which prevent the formation of blood clots by keeping blood platelets from staying together, and of blood thinners, which are now routinely given at therapeutic doses to C19 patients to prevent blood clots.
- New York University’s Langone Hospital aims to enroll 1,000 patients to assess whether blood thinners are more effective at preventing blood clots or death when given at high doses rather than low doses. While doctors accept that low-dose blood thinners help C19 patients, it isn’t clear whether high doses might be more effective, said Jeffrey Berger, director of the Center for the Prevention of Cardiovascular Disease at New York University Grossman School of Medicine.
- Dr. Berger also cited the high frequency of C19 patients who have developed blood clots in areas like the leg and the lungs, including patients who don’t have underlying heart disease or other risk factors.
- “While it is less common, it is not infrequent,” he said. “That is what is so concerning with this disease.”
2. Gilead developing inhaled remdesivir usable outside of hospitals
- Gilead Sciences is developing easier-to-administer versions of its antiviral treatment remdesivir for C19 that could be used outside of hospitals, including ones that can be inhaled, after trials showed moderate effectiveness for the drug given by infusion.
- Remdesivir is the only drug so far that has been shown to help patients with C19, but Gilead and other companies are looking for ways to make it work better.
- For critically ill patients, Roche and Eli Lilly are testing drugs in combination with remdesivir.
- Gilead is also seeking to treat the virus earlier. Other antivirals, like influenza pill Tamiflu, work best when given as early as possible after someone becomes infected.
- Gilead in a statement on Monday said it is looking at ways to use remdesivir earlier in the course of disease, including via alternate formulations. The company confirmed in an e-mail that it is researching an inhaled version, but declined further comment.
- In the longer term, the company is exploring a subcutaneous injection formulation of remdesivir, as well as dry powder versions to be inhaled. Remdesivir cannot be given as a pill because it has a chemical makeup that would degrade in the liver, and the intravenous formulation is only used by hospitals.
- In the short term, Gilead is studying how its existing IV formulation of remdesivir can be diluted for use with a nebulizer — a drug delivery device used to administer medication in the form of a mist inhaled into the lungs.
- The idea is that a nebulizer would make remdesivir more directly available to upper airway and lung tissue as the coronavirus is known to attack the lungs. It would also allow for early treatment of coronavirus patients who are not hospitalized.
- “People look forward to an inhaled formulation in time,” but development is in the very early stages, said Jefferies analyst Michael Yee, adding that demand may be limited as many people infected with the virus require minimal treatment.
- He said Gilead is building up its capacity to supply remdesivir and has begun talking to governments around the world about commercial pricing.
- Gilead on Monday reported trial results showing that IV remdesivir provided a modest benefit for hospitalized patients with moderate C19 compared to standard care.
E. Is The Virus Weakening?
1. Experts dispute reports that coronavirus is becoming less lethal
- Has the coronavirus in Italy changed in some significant way? That was the suggestion of a top doctor in northern Italy who reports that patients to his hospital have been showing up with lower levels of the virus in their upper respiratory tracts compared with those two months ago.
- Alberto Zangrillo, head of San Raffaele Hospital in Milan, roiled the global public health community on Sunday when he told RAI, the national TV station, that “the virus clinically no longer exists in Italy,” with patients showing minute amounts of virus in nasal swabs. Zangrillo theorized in a follow-up interview with The Washington Post that something different may be occurring “in the interaction between the virus and the human airway receptors.”
- He added, “We cannot demonstrate that the virus has mutated, but we cannot ignore that our clinical findings have dramatically improved.”
- The comments, which received widespread attention following a Reuters report, prompted vigorous pushback from Michael Ryan, a top official with the World Health Organization, who said on Monday during an online news conference that “we need to be exceptionally careful not to create a sense that all of a sudden the virus by its own volition has now decided to be less pathogenic. That is not the case at all.”
- The consensus among other experts interviewed Monday is that the clinical findings in Italy likely do not reflect any change in the virus itself.
- Zangrillo’s clinical observations are more likely a reflection of the fact that with the peak of the outbreak long past, there is less virus in circulation, and people may be less likely to be exposed to high doses of it. In addition, only severely sick people were likely to be tested early on, compared with the situation now when even those with mild symptoms are more likely to get swabbed, experts said.
- The pandemic is evolving rapidly, with the rate of new cases declining in some hard-hit areas of the world, including northern Italy and New York City, while rising dramatically in Brazil, Peru and India.
- The virus, however, is mutating at a slow rate, experts say.
- Some strains of the virus have become more dominant, but there is no firm evidence yet that any of them are more contagious or deadly, according to scientists who have reviewed recent genetic studies.
- Vaughn Cooper, an infectious-disease expert at the University of Pittsburgh School of Medicine, said the new coronavirus mutates slowly compared with influenza and other microbes, and its genetic changes appear to be “mostly inconsequential.”
- “I believe it’s safe to say that the differences that doctors are reporting in Italy are entirely due to changes to medical treatment and in human behavior, which limit transmission and numbers of new infections initiated by large inocula — a larger dose of virus appears to be worse — rather than changes in the virus itself,” he said.
- All viruses evolve over time, and many infectious-disease experts think the novel coronavirus will eventually become less lethal to human beings, joining four other coronaviruses in causing common colds. But there is no solid evidence so far that it has changed significantly in the five months since it was first recognized among patients in Wuhan, China.
- “The virus hasn’t lost function on the time scale of two months,” said Andrew Noymer, an epidemiologist at the University of California at Irvine. “Loss of function is something I expect over a time scale of years.”
- In the United States, the pandemic has taken on a patchwork pattern, with much of the Northeast seeing marked improvement. But some places in the South — Alabama, Texas and Virginia, for example — as well as Wisconsin, California and Washington state are showing increases in confirmed cases, according to the coronavirus tracker of Johns Hopkins University.
- “Every place has a different epidemic, and it’s not because of the virus,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security.
- Slight tweaks in the microbe’s genetic makeup appear in different places on the planet. Epidemiologists use those mutations to track the virus’s spread. Those changes are akin to stickers slapped on a well-traveled suitcase — markers of where the luggage has gone that don’t impart any functional change.
- Researchers Harm van Bakel, Emilia Sordillo and Viviana Simon at the Icahn School of Medicine at Mount Sinai, who have been focusing on the genetics of the novel coronavirus, said in an interview that they had not seen a dip in viral load among patients in that hospital system since March, nor have they detected any major genetic changes in the virus in New York City.
F. Concerns & Unknowns
1. Patients Lose Taste, Smell—and Haven’t Gotten Them Back
- Matt Newey was overcome with emotion clearing his deceased grandmother’s home in late April: He reached for her perfume, but he couldn’t smell a thing.
- “I loved her so much. I wanted to remember what she smelled like one last time,” said the 23-year-old, who recovered from C19 in March. “It felt like I was losing that memory. It hurt.”
- Clinicians racing to understand the novel disease are starting to discern an unusual trend: one common symptom—the loss of smell and taste—can linger months after recovery. Doctors say it is possible some survivors may never taste or smell again.
- Out of 417 patients who suffered mild to moderate forms of C19 in Europe, 88% and 86% reported taste and smell dysfunctions, respectively, according to a study published in April in the European Archives of Oto-Rhino-Laryngology.
- Most patients said they couldn’t taste or smell even after other symptoms were gone. Preliminary data showed at least a quarter of people regained their ability to taste and smell within two weeks of other symptoms dissipating. The study said long-term data are needed to assess how long this can last in people who didn’t report an improvement.
- The loss is altering survivors’ relationships with people, food and the environment, complicating the path to recovery.
- Mr. Newey, who hasn’t regained his taste or smell after suffering a mild form of the illness, reports losing more than 15 pounds because eating has become a chore. “I was a pretty skinny guy already,” said Mr. Newey, who at 5 feet 10 inches is 135 pounds.
- “I’ve gone a day-and-a-half without eating anything,” he adds, “because my stomach isn’t communicating anymore. It’s been like that for a while now.” Sometimes, he spends up to two hours finishing a meal. Certain foods like bananas make him gag, because he has grown “hypersensitive to texture.”
- Another source of anxiety is his inability to detect danger. Mr. Newey’s sister burned pancakes several weeks ago, and “I couldn’t smell a thing,” he said. It then occurred to him that he wouldn’t know if there was a gas leak or fire at home.
- Taste and smell disorders can occur with age or as a result of other conditions. The flu can temporarily numb those senses, for example, while acute respiratory illnesses might disable them for life.
- Almost one out of four Americans over the age of 40 report some alteration in their sense of smell, according to the National Institute of Deafness and Other Communication Disorders. Nearly one in five Americans over that age report some alteration in taste.
- In a study involving people with taste and smell disorders, researchers at the University of East Anglia in Norwich, England, found that participants reported emotions such as anxiety, depression, isolation and an erosion of self-esteem.
- Some people said their disability impaired social relationships—a mother found it difficult to bond with a baby she couldn’t smell, for example. Some lost interest in preparing food for friends; others reported losing or gaining weight, which negatively affected their health and sexual intimacy. The findings were published in the journal Clinical Otolaryngology in December.
- Taste and smell are intertwined because they combine at the back of the throat and collectively shape perceptions of flavor. People with olfactory, or smell-related, disorders alone may believe their taste is impaired even though their taste buds function fine.
- The olfactory system “rises above our conscious awareness and appreciation,” said Pamela Dalton, a Philadelphia-based chemosensory scientist. “That’s the shock when it’s gone. We’ve scooped out a whole piece of our consciousness that we didn’t even realize we were using everyday.”
- Dr. Dalton believes biology plays a role in triggering negative emotions, too. When people are robbed of the ability to enjoy the food they love, or smell a loved one, it leads to less serotonin—the feel-good molecules—flowing to the brain. “So, what they’re feeling is not just psychological,” she said.
- Anyone who has had the sniffles knows a stuffy nose impedes smell and taste; the novel coronavirus’s ability to break down smell receptors is puzzling because it occurs without nasal congestion. One theory is that the “olfactory receptors that go to the brain—that are essentially like a highway to the brain—commit suicide so they can’t carry the virus to the brain,” said Danielle Reed, associate director of the Monell Chemical Senses Center.
2. The Growing Evidence Linking Obesity to C19 Deaths
- Based on the patterns we saw with H1N1 and obesity a decade ago, many physicians worried that obesity would prove to be a prevalent risk factor for mortality among C19 patients. In recent weeks, that fear has been confirmed as a harsh reality — perhaps even harsher than we imagined it would be.
- In study after study, obesity has been found to be a leading risk factor for mortality and morbidity from C19 across the globe.
- In a study out of NYU, severe obesity (BMI >40) was a greater risk factor for hospitalization among C19 patients than heart failure, smoking status, diabetes, or chronic kidney disease.
- In China, in a small case series of critically ill C19 patients, 88.24% of patients who died had obesity versus an obesity rate of 18.95% in survivors. In France, patients with a BMI greater than 35 were seven times more likely to require mechanical ventilation than patients with a BMI below 25.
- The data on the repercussions of obesity in the setting of this global pandemic cannot be ignored. Nearly half of the U.S. population is expected to have obesity by 2030. This statistic was alarming when it was released prior to the global spread of C19. In the context of the pandemic, given what we now know about the increased mortality risk among people with obesity, this statistic is downright terrifying.
3. Injuries Found in Placentas From C19-Positive Pregnant Women Suggests Abnormal Blood Flow Between Mothers, Babies
- The placentas from 16 women who tested positive for C19 while pregnant showed evidence of injury, according to pathological exams completed directly following birth, reports a new Northwestern Medicine study.
- The type of injury seen in the placentas shows abnormal blood flow between the mothers and their babies in utero, pointing to a new complication of C19. The findings, though early, could help inform how pregnant women should be clinically monitored during the pandemic.
- The study was published today (May 22, 2020) in the journal American Journal of Clinical Pathology. It is the largest study to examine the health of placentas in women who tested positive for C19.
- “Most of these babies were delivered full-term after otherwise normal pregnancies, so you wouldn’t expect to find anything wrong with the placentas, but this virus appears to be inducing some injury in the placenta,” said senior author Dr. Jeffrey Goldstein, assistant professor of pathology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine pathologist.
- “It doesn’t appear to be inducing negative outcomes in live-born infants, based on our limited data, but it does validate the idea that women with COVID should be monitored more closely.”
1. Asymptomatic Transmission Called Into Question
- A paper published on 30 January in The New England Journal of Medicine (NEJM) about the first four people in Germany infected with a novel coronavirus made many headlines because it seemed to confirm what public health experts feared: that someone who has no symptoms from infection with the coronavirus can still transmit it to others. That might make controlling the virus much harder.
- This story has been cited widely on social media to argue against the use of face masks and shelter-in-place policies. This is based on a misreading of the article.
- The fact that the NEJM paper had a flaw does not mean asymptomatic transmission (by people who have absolutely no symptoms) does not exist; this is still under discussion. But it is now well-established that people with very mild symptoms—so mild they are unlikely to recognize them as C19—can infect others and even spark large outbreaks of disease.
- The letter in NEJM described a cluster of infections that began after a businesswoman from Shanghai visited a company near Munich on 20 and 21 January, where she had a meeting with the first of four people who later fell ill. Crucially, she wasn’t sick at the time: “During her stay, she had been well with no sign or symptoms of infection but had become ill on her flight back to China,” the authors wrote. “The fact that asymptomatic persons are potential sources of C19 infection may warrant a reassessment of transmission dynamics of the current outbreak.”
- But the researchers didn’t actually speak to the woman before they published the paper.
- “I feel bad about how this went, but I don’t think anybody is at fault here,” says virologist Christian Drosten of the Charité University Hospital in Berlin, who did the lab work for the study and is one of its authors. “Apparently the woman could not be reached at first and people felt this had to be communicated quickly.”
- Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, says calling a case asymptomatic without talking to the person is problematic. “In retrospect, it sounds like this was a poor choice,” he says. However, “In an emergency setting, it’s often not possible to talk to all the people,” he adds. “I’m assuming that this was an overstretched group trying to get out their best idea of what the truth was quickly rather than somebody trying to be careless.”
- The Public Health Agency of Sweden reacted less charitably. “The sources that claimed that the coronavirus would infect during the incubation period lack scientific support for this analysis in their articles,” says a document with frequently asked questions the agency posted on its website yesterday. “This applies, among other things, to an article in [NEJM] that has subsequently proven to contain major flaws and errors.” Even if the patient’s symptoms were unspecific, it wasn’t an asymptomatic infection, says Isaac Bogoch, an infectious disease specialist at the University of Toronto. “Asymptomatic means no symptoms, zero. It means you feel fine. We have to be careful with our words.”
- Hoelscher agrees that the paper should have been clearer about the origin of the information about the woman’s health. “If I was writing this today, I would phrase that differently,” he says. The need to share information as fast as possible, along with NEJM’s push to publish early, created a lot of pressure, he says.
- Given how fast data are coming out amid the growing global crisis, it’s good to read even peer-reviewed papers with some extra caution at the moment, Lipsitch says: “I think peer review is lighter in the middle of an epidemic than it is at normal speed, and also the quality of the data going into the papers is necessarily more uncertain.”
- The fact that the paper got it wrong doesn’t mean transmission from asymptomatic people doesn’t occur. Fauci, for one, still believes it does. “This evening I telephoned one of my colleagues in China who is a highly respected infectious diseases scientist and health official,” he says. “He said that he is convinced that there is asymptomatic infection and that some asymptomatic people are transmitting infection.”
- But even if they do, asymptomatic transmission likely plays a minor role in the epidemic overall, WHO says. People who cough or sneeze are more likely to spread the virus, the agency wrote in a situation report on Saturday. “More data may come out soon. We will just have to wait,” Lipsitch says.
- The German cluster does reveal another interesting aspect about the new virus, Drosten says. So far most attention has gone to patients who get seriously ill, but all four cases in Germany had a very mild infection. That may be true for many more patients, Drosten says, which may help the virus spread. “There is increasingly the sense that patients may just experience mild cold symptoms, while already shedding the virus,” he says. “Those are not symptoms that lead people to stay at home.”
1. At-Home Testing Arrives
- Companies are starting to roll out tests that can diagnose coronavirus infections at home, offering people who are seeking to return to work a potentially safer, more accessible option to check their health.
- Yet experts worry about the accuracy of the results generated by the at-home tests, costs that insurers often don’t cover and other factors that could limit use.
- At-home tests are the next wave of coronavirus diagnostics, following tests given by doctors at offices and hospitals. Some of the newest ones use a person’s saliva to detect an infection. All of the tests, whether done at home or not, must be sent to a lab for analysis.
- The FDA has authorized the emergency use of six coronavirus at-home collection kits, with the first at-home test greenlighted April 20.
- The tests promise to expand diagnoses to people with disabilities, compromised immune systems or limited access to transportation who have struggled to leave their homes, health experts and industry officials say. Overall, they will add to the number of desperately needed tests available in the U.S.
- The market for the tests is large, analysts say. The kits will also appeal to companies looking to test their workers before reopening, as well as colleges and universities that want to test faculty and students, said Brian Tanquilut, health-care services analyst at Jefferies LLC.
- “With more than 20 million college students in the country, that’s a fairly sizable number of tests,” Mr. Tanquilut said. “It could be a really big market for that reason.”
- Sales of at-home Covid-19 diagnostic tests could reach as high as $816 million this year, estimates Frost & Sullivan analyst Amartya Bose.
- So far, the at-home tests take three different forms. Some rely on samples collected at people’s homes by health workers such as nurses using swabs in the nose and throat, while other tests let people use swabs inside a nostril or spit collected in a test tube.
- Saliva tests are appealing as an at-home test, partly because it is easier to spit into a test tube than inserting a swab up the nose, said Andrew Brooks, chief operating officer and director of technology development at Rutgers University’s RUCDR Infinite Biologics, a laboratory that developed a saliva test that won emergency-use authorization May 7.
- While the technology behind at-home kits is similar to what other Covid-19 diagnostic tests use, where and when the sample is collected can affect accuracy, said Alan Wells, professor of pathology at the University of Pittsburgh and medical director at UPMC Clinical Laboratories.
- A sample taken from saliva or a nose swab could return a false negative, Dr. Wells said, if the disease has moved onto the lungs, as it often does.
- For this reason, sampling from the nostril or saliva increases the rate of false negatives by 10% to 20%, he said. “I would trust a positive [test result] as being positive,” he added. “If you get a negative, it doesn’t mean it truly is negative.”
- Mistakes taking samples can also affect accuracy, said Anne Wyllie, an associate research scientist at Yale School of Public Health. She led a study comparing samples taken from different places in the same patient, and found the coronavirus was detected at different rates depending on the site of the sample.
- The virus was detected in nasopharyngeal swabs, the samples taken from deep down the throat that is considered the best place to test, but not in saliva from the same patient 8% of the time, according to the report published online April 22 on the preprint server medRxiv. The virus was detected in saliva but not nasopharyngeal swabs 21% of the time.
- The study didn’t look at nasal swabs. Other studies have shown that “saliva is a much more consistent sample type,” Dr. Wyllie said.
- The FDA considers nasopharyngeal swabs to be most accurate, but authorized use of nasal tests because they have relatively comparable performance, an agency spokesman said. The FDA has seen variable performance with tests using saliva, and has issued specific recommendations for labs looking to validate tests with that sample type, he said.
- To address the collection concerns, some test makers are sending trained nurses and other health workers to people’s homes to take throat, or nasopharyngeal swabs. Such measures,however, are one limitation on the number of at-home tests available.
- Microdrop LLC sends nurses to the homes of Houston residents who are elderly, disabled or don’t have access to mass transit, said Jani Tuomi, co-founder of the at-home testing company. The nurses wear masks, gloves and other protective gear.
- The Houston city government is paying for the tests, which list for $135, said Mr. Tuomi. The test maker, which can process more than 10,000 swab tests a week, plans to give the tests in Texas and select other areas later, he said.
- “I think our focus should be in our own backyard,” Mr. Tuomi said.
- Also limiting at-home testing is the capacity of labs to analyze results. Rutgers University’s RUCDR Infinite Biologics can process 30,000 tests a day. Given the constraints and FDA concerns about detecting infections in asymptomatic people, the lab’s marketing partners are restricting sales to those with symptoms, Dr. Brooks said.
- One partner, Hims Inc., asks potential customers to fill out an online assessment asking questions including whether they have come into contact with any confirmed cases and if they are experiencing any symptoms associated with Covid-19 like dry cough or shortness of breath.
- “The FDA is trying to prioritize those that are symptomatic, so, if you do not have any symptoms at all, physicians won’t be able to prescribe the test at this time,” Hims Chief Executive Andrew Dudum said.
- Another constraint on access is price. The Rutgers tests cost about $150 out-of-pocket, while a test from Everlywell Inc. costs $109 and a test from PrivaPath Diagnostics Inc. is priced at $129. Mr. Dudum said the company is talking to insurance companies to get the full costs of the test covered, but currently patients have received only partial reimbursement.
- Health insurers will pay upfront for a nasal-swab test from Laboratory Corp. of America Holdings, which charges $119 to consumers buying the test directly, a company spokeswoman said. For the uninsured, the company will seek government reimbursement, she said.
- Mikey Smith, a restaurant manager from Kingwood, Texas, said he wouldn’t have ordered the LabCorp test last month if it wasn’t covered by his insurance, even though he wanted to make sure it was safe to spend time with family over the recent Memorial Day weekend after interacting with strangers.
- “$119—I don’t have that to blow every week,” said Mr. Smith, 41 years old, whose test came back negative.
Also see: FDA Takes Steps to Streamline Development of Tests With At-Home Sample Collection at Coronavirus (COVID-19) Update: FDA Takes Steps to Streamline Development of Tests With At-Home Sample Collection
1. No Lockdown, Same Health Outcome
- On Tuesday, Professor Neil Ferguson, of Imperial College London, whose bleak projections of future deaths from C19 influenced governments around the world to institute massive lockdowns, admitted of Sweden, which did not institute harsh lockdowns, “It is interesting that adopting a policy which is short of a full lockdown – they have closed secondary schools and universities and there is a significant amount of social distancing, but it’s not a full lockdown – they have got quite a long way to the same effect.”
- Speaking before a House of Lords Science and Technology Committee, the man who half a million Britons could die from C19 spoke of Sweden, whose 436 people per million mortality rate from the coronavirus is significantly lower than the UK’s 575 people per million. The Daily Mail noted, “As well as fewer deaths, Sweden’s GDP actually grew in the first quarter of 2020, suggesting it might avoid the worst of the economic fallout from the crisis.”
- Ferguson admitted, “’There are differences in how science has influenced policies in different countries. I have the greatest respect for scientists there [in Sweden]. They came to a different policy conclusion but based really on quite similar science.” Asked why 4,000 people had died in Sweden instead of the 90,000 that had been forecast, he answered, “I think it’s an interesting question. It’s clear there have been significant social distancing in Sweden. Our best estimate is that that has led to a reduction in the reproduction number to around 1.” He cautioned, “It’s clear that when you look at their mortality, they are not seeing the rate of decline most European countries are seeing.”
- He admitted, “But nevertheless it is interesting that adopting a policy which is short of a full lockdown… they’ve gone quite a long way to [achieving] the same effect,” while adding, “’Although there is no evidence of a rapid decline in the same way in other European countries. That is something we’re looking at very closely.” Then he acknowledged, “Lockdown is a very crude policy and what we’d like to do is have a much more targeted approach that does not have the same economic impacts.”
- Ferguson added, “I suspect though, under any scenario that levels of transmission and numbers of cases will remain relatively flat between now and September, short of very big policy changes or behavior changes in the community. The real uncertainty then is if there are larger policy changes in September, of course we move into time of year when respiratory viruses tend to transmit slightly better, what will happen then. And that remains very unclear.”
- The Imperial College London model headed by Ferguson surmised as many as 2.2 million Americans could have died from the virus if no action were taken. It also suggested 510,000 people would die in the U.K. without a lockdown and 250,000 if mitigating steps were taken.
- Business Insider noted, “In 2009, one of Ferguson’s models predicted 65,000 people could die from the Swine Flu outbreak in the UK — the final figure was below 500.” Business Insider also noted, “Michael Thrusfield, a professor of veterinary epidemiology at Edinburgh University, told the paper he had ‘déjà vu’ after reading the Imperial paper, saying Ferguson was responsible for excessive animal culling during the 2001 Foot and Mouth outbreak. Ferguson warned the government that 150,000 people could die. Six million animals were slaughtered as a precaution, costing the country billions in farming revenue. In the end, 200 people died.”
J. Collateral Damage
1. Old Scourges Revived in Africa as the Pandemic Drains Resources
- Children in the Democratic Republic of Congo haven’t been vaccinated against measles this year. Polio is making a comeback in Nigeria. In Cameroon, where malaria is rampant, a state-run program switched to phone consultations after half of its staff was deployed to help C19 patients. In southern Africa, where millions live with tuberculosis and HIV, treatment centers have been converted into C19 wards.
- A quiet and deadly health catastrophe is brewing in Africa. Not from the coronavirus, but from age-old diseases that have overnight taken a back seat to the pandemic. As scarce resources are diverted to cap C19 cases and the fear of infection deters people from visiting medical facilities, diseases that health organizations have been trying for decades to eradicate — from malaria to yellow fever and HIV to tuberculosis — are set to surge.
- “We are deeply concerned about the potential impact on HIV, TB and malaria,” said Peter Sands, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which spends more than $4 billion a year in over 100 countries. “The indirect cost in terms of lives could be greater than the direct cost from Covid.”
- Africa, which has less than 1% of the world’s financial resources, carries more than 22% of the global disease burden, according to the World Health Organization. Even before the coronavirus pandemic struck, about a million people died every year across the continent from malaria and tuberculosis alone.
- The continent has done relatively well in keeping the march of the coronavirus in check. Most African nations responded quickly, imposing lockdowns to allow their health systems to prepare for the outbreak.
- In the west and center, health experts were well aware of the dangers of a pandemic after dealing with the Ebola virus that’s killed more than 13,000 people from Sierra Leone to Congo in the last decade. Nigeria built isolation wards in stadiums; in Ghana, residents of the biggest cities were immediately confined to their homes.
- The number of deaths recorded in Africa since the first person tested positive in February remains low, at just over 4,228 — tiny set against the almost 375,000 global fatalities.
- As with the rest of the world, the pandemic has had a huge economic impact in Africa. According to the World Bank, sub-Saharan Africa will suffer its first recession in 25 years after economies were brought to a halt and global trade was disrupted.
- But the human cost is becoming evident as African nations are forced to divert health workers and supplies away from a range of other diseases.
- In South Africa, which has the world’s largest HIV epidemic and 300,000 people with tuberculosis, fear of the coronavirus has emptied hospitals. Although clinics remain open, the number tested for TB has dropped by half, and HIV testing is down a quarter since a national lockdown began on March 27, said Francois Venter, the deputy director of the Wits Reproductive Health & HIV Institute in Johannesburg.
- “People’s health-seeking behavior has changed, they are scared of Covid, quarantine,” he said. “There is a devastation of programs. It’s an absolute catastrophe. We are going see a wave of secondary diseases, fatalities and morbidity.”
- Regular health services are being affected, too. Zambia, for instance, reconfigured its main TB center to fight C19, using staff from one of its biggest hospitals. All elective surgeries were suspended, pharmacies are running out of stock and the number of people coming for treatment of other ailments has dropped sharply, said Naeem Dalal, a doctor in the capital, Lusaka.
- “A lot of people haven’t been able to work and don’t have the money to come to the hospital,” said Dalal. “In normal times, in my department, we are four doctors and see 60 to 100 people per week. That number has dropped to between 20 to 30. The question is: where do these people go when they are unwell?”
- Travel restrictions mean that awareness and treatment campaigns have been halted in some countries and vaccination drives postponed in others.
- Vaccination campaigns that would have prevented some 21 million children from getting measles were canceled in five African countries, including some of the world’s poorest — the Democratic Republic of Congo, Central African Republic and South Sudan.
- Another 11 countries have postponed preventive measles campaigns while authorities in South Sudan, Ethiopia and Uganda are afraid of conducting mass vaccination campaigns against yellow fever while the coronavirus is spreading, according to Richard Mihigo, who runs the immunization and vaccines program for the WHO at its Africa regional office in Brazzaville, the Republic of Congo.
- “Modeling data shows there will be an upsurge in measles outbreaks if vaccination is not resumed,” Mihigo said. “There is a serious risk of rolling back progress. There will be life after C19, and we don’t want to see ourselves in the position where other health issues are unmanageable.”
- Polio was almost on the verge of being eradicated, with the wild polio virus last seen in Nigeria more than three years ago. Cases have now emerged of so-called vaccine derived polio, where the attenuated virus can occasionally mutate and spread, causing paralysis, Mihigo said. Normally, widespread vaccination keeps it in check.
- “We will lose all the achievements in communicable diseases we have had since 2010,” said Lucica Ditiu, director of Stop TB, an organization that’s trying to eliminate the disease worldwide. “When you are climbing Everest, this is an avalanche that puts you back to the start of the mountain.”
K. Practical Tips & Other Useful Information
1. How to Safely Travel on Mass Transit During Coronavirus
- As lockdowns start to ease, trains, buses and planes are becoming an even greater focus of anxiety, with larger numbers of people considering when and how to resume travel. Larger crowds could pose a greater risk to both essential workers who may have been using transit all along, and the others who may start to join them. What factors most affect your risk of catching Covid-19 while using mass transit? CityLab talked to several experts about both the dangers and necessary precautions.
Keep your distance – and watch your mouth
- When it comes to staying safe on mass transit, one piece of advice outweighs any other: Do whatever you can to stay at a safe distance from other people. The same six-feet rule applies as elsewhere, and the safest form of transit is always the one that makes this easiest. Dr. Simon Clark, associate professor of microbiology at the University of Reading, cautions against focusing too narrowly on balancing one mode against another.
- “Let’s face it,” he says. “With public transport, it’s an aluminum can that people are packed into, whatever the mode. The key question is: How densely are people packed in together? That’s basically it. The longer they are exposed to one another, the greater the risk. The more densely packed in they are, the greater the risk. It doesn’t particularly matter if you are in a bus or a train.”
- These are also the key considerations for airplanes, says Dr. Julian Tang, a professor in the Department of Respiratory Sciences at the University of Leicester, where it is distance rather than air cleaning that is the key issue:
- “Airplanes have good ventilation systems but if you’re sitting side-by-side next to a stranger within talking distance, then that may not leave time for the ventilation in the roof and the walls of the plane to change the air between you. That means local airborne transmission will not necessarily be prevented.”
- “If you talk, you produce aerosol. If you talk louder, you produce more, so the loud-talking guys on the train are possibly the worst spreaders of the virus.”
- In keeping your distance, it isn’t just evidently ill-looking people you need to be wary of. The contagion risk from sitting or standing too close to people goes beyond the simple danger of being coughed on, says Tang. “If you talk, you produce aerosol. If you talk louder, you produce more, so the loud-talking guys on the train are possibly the worst spreaders of the virus. Because when you cough or sneeze you usually look away or cough into your sleeve.”
- Wearing masks can do much to mitigate the risk of this kind of proximity, says Tang. “Masks are better at containing virus exhaled by the wearer. If everyone wears masks, protection is two-way, containing your own virus and protecting you from others’ exhaled virus. If there is little or no ventilation present, the masks are even more effective, as virus will start to build up in the air, so distancing alone is not effective if the virus is distributed throughout the carriage.”
Ventilation could matter — but maybe not how you think
- If proximity is still the overwhelming issue, how much does the ventilation on a train or bus matter? It depends on the type of ventilation you’re talking about: Being in a vehicle with poor ventilation that doesn’t adequately circulate infected air probably makes a difference. But the idea that a ventilation system could play a perverse role by spreading the virus has far less support.
- Worries about spread through ventilation systems were sparked by a study tracing an outbreak of Covid-19 in a restaurant in Guangzhou, China, that suggested that air conditioning could have played a role in spreading contagion. While the study concluded that infection in the restaurant did indeed follow the direction of the air conditioning’s flow, experts have suggested that this single reported case is a freak outlier and that the actual cause was more likely the proximity of the people in the room.
- “This virus is not like TB, where people could get ill in two separate places if they have a ventilation link,” says Dr. Lena Ciric, a microbiologist at University College London. “Hospitals, which are the places most on top of this at the moment, are not so worried about ventilation systems.” Ciric notes that while there have been traces of the virus found in hospital ventilation systems, they are not necessarily able to cause infection.
- But while the likelihood of a vehicle’s ventilation system actively spreading the virus seems low-to-nonexistent, the risk of poor ventilation is considered higher. This is the reason why the outdoors is considered safer than indoors, and why confined spaces are considered higher-risk areas.
- “Basically, the packed subways of Tokyo, London and New York are in the worst possible situation for both aerosol and close contact transmission,” Tang says. “The London Underground is old, the trains are very narrow and the carriages are closed at each end so that you can’t walk through. That reduces the volume [of air in the space] in there that can reduce the concentration of airborne contaminants.” Other transit systems, however, perform better.
- “If you look at the Hong Kong and Singapore systems, they have fantastic air conditioning,” adds Tang. “They have vents going to the outside so they have fresh air coming in cool, and inside air filtered, hopefully allowing greater removal of contaminants, including viruses.”
- While these comments might alarm transit users, Tang nonetheless underlines that being in close proximity with someone is the key risk, a risk that no ventilation system can eradicate.
- “[Fully preventative] ventilation would need to be so powerful, that it pulls away the air straight away when it comes out of your mouth. You might get these conditions outside on a very windy day when you’re trying to talk to your neighbor, and you’ll feel it because you can’t hear anything. There’s no ventilation system like that in an indoor area. You can’t maintain it because it’s too powerful and impractical.”
- Clark agrees, conceding an advantage for vehicles that are partially open air.
- “Certainly, if you’re in a tightly packed trolley that is fully open, there would be a lower risk — concern about ventilation is not a red herring — but otherwise it is difficult to make broad statements about a particular mode of transport because there are so many different systems at play.”
- In other words, while good ventilation, and larger, more open carriages might moderate the risk of becoming infected by someone standing close to you, no indoor air conditioning can ever be as effective at protecting you as taking a step or two back.
It’s prudent to be careful of surfaces, too
- What you touch during travel may also be important, although exactly how important is not a matter of consensus among the experts CityLab talked to. Tang notes that there is a lack of evidence proving coronavirus transmission from people touching their faces with virus-contaminated hands, while Clark and Ciric emphasized that it is nonetheless a very good idea to take precautions given the high-exposure surfaces like turnstiles and subway poles in transit systems. They advise regularly using hand sanitizer, considering wearing gloves and avoiding unnecessary contact with surfaces.
The best precautions
- The potential areas of risk outlined here are by no means limited to mass transit. People occupying any kind of crowded, or ill-ventilated spaces, especially for longer periods of time, would be just as vulnerable to infection — meaning that trains or buses are not inherently less safe than, say, offices or stores.
- The primary difference with mass transit is that you may face a greater challenge maintaining enough distance from others. Even if you get on a relatively empty train, you may find that a crowd enters at a subsequent stop. So what can you do if you still have to ride? The advice here will sound familiar: Wear a mask, keep your distance and don’t touch your face.
- Tang recommends staying in a place that offers good air flow: “If I have to take a train,” he says, “I personally choose to sit in a place close to the door, as there is a more regular exchange of air there.” Ciric, meanwhile, advises wearing some protective gear, and avoiding unnecessary trips altogether. And if there is a portion of your trip that you can take outside by walking or biking, Ciric suggests doing that rather than getting on multiple trains or buses in the course of your journey.
- “If I had to get into London by public transport right now, I’d probably avoid getting the bus [the short distance] to my local station. Once there, I’d definitely wait for a train that’s less busy, and I’d think about changing hours to miss the rush. I’d wear a mask and maybe wear gloves while on the train, and when I got to my destination, I’d give my hands a really good clean.”
- Depending where you live, some of these precautions may be partially baked into city policies. Milan, for example, plans to stagger the times of some functions like schools and stores in the hope of reducing rush-hour crowds. Many places are adding more bike lanes and closing streets to cars so more people have the option to walk. And New York has ordered rider capacity limits on trains to reduce crowding. Many transit authorities are also giving passengers visual guidelines to maintain social distancing, requiring masks, and reducing contact between passengers and drivers by making public transit free.
- And while only a few airlines — notably Air India for repatriation flights — have gone as far as leaving middle seats empty to facilitate social distancing, Airbus is now recommending that airplanes start their ventilation systems before passengers board, so that air exchange is already up and running by the time they enter the craft.
- It’s sensible to make yourself as aware as possible of the safety measures adopted by your transit provider — safety measures that may still change in the near future, as transit authorities introduce new measures. And if you can avoid traveling at peak times, you’ll not only be helping yourself. You could be making more space for essential workers, who don’t have the luxury of opting for a less-crowded time.