Coronavirus Update

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Coronavirus Update 6-10

Recent Developments & Information

June 10, 2020

“Asymptomatic spread of the coronavirus is a really complex question and much is still unknown. “We don’t actually have that answer yet.” 

Dr. Maria Van Kerkhove, head of the WHO’s emerging diseases and zoonosis unit, 24 hours after saying that asymptomatic transmission is “very rare”

“Covid-19 is the disease that I always said would be my worst nightmare — a new, highly contagious respiratory infection that causes a significant amount of illness and death.  In a period of four months, it has devastated the whole world.  And it isn’t over yet.” 

Dr. Fauci

Index Of Featured Stories & Links

Note:  All of the 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: 

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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.

A. Our World As Seen Through Headlines

(In No Particular Order)

B. Key Numbers & Trends

Notes: Unless otherwise noted, all cases/deaths are confirmed cases/deaths that have been reported.  All numbers reported in this Update are as of the end of the most recent reporting period (reporting periods end each day at 11:59 pm Greenwich Time, or 7:59 pm NYC Time), and all changes reflect changes since the day preceding the end of the most recent reporting period.  Green highlights indicate a decrease or no change and yellow highlights indicate an increase.

Sources: https://www.worldometers.info/coronavirus/ and https://covidtracking.com/

1. Cases & Tests

  • Worldwide Cases:  
    • Total Cases = 7,312,198 (+1.7%)
    • New Cases = 122,330 (+15,060)
    • Growth Rate of New Cases (7 day average) = 1.8% (+0%)
    • New Cases (7 day average) = 121,910 (+946)
  • US Cases & Testing: 
    • Total Cases = 2,045,549 (+0.9%)
    • New Cases = 19,056 (+12)
    • Growth Rate of New Cases (7 day average) = 1.1% (+0%)
    • New Cases (7 day average) = 21,264 (-457)
    • Total Number of Tests = 22,140,676 (+415,612)
    • Percentage of positive tests (7 day average) = 4.4% (-0.2%)
  • Observations:
    • The 7 day average growth rate of new cases in the US declined slightly, a positive (and continuing) trend.
    • The 7 day average number of new cases in the US has decreased by 457 (-2.1%), a positive trend, particularly in light of large number of daily tests
    • The 7 day average percentage of positive tests in the US decreased from 4.6% to 4.4%, which is also a positive trend and perhaps the best indicator that the virus is not spreading on a large scale (although there are some states and hotspots where the virus is spreading significantly as reflected in the increase in new cases)

2. Deaths

  • Worldwide Deaths: 
    • Total Deaths = 413,003 (+1.2%) 
    • New Deaths = 4,763 (+1,604)
    • Growth Rate of Deaths (7 day average) = 1.1% (+0%)
    • New Deaths (7 day average) = 4,449 (+8)
  • US Deaths: 
    • Total Deaths = 114,148 (+1.0%)
    • New Deaths = 1,093 (+507) 
    • Growth Rate of Deaths (7 day average) = 0.8% (+0%)
    • New Deaths (7 day average) = 870 (-6)
  • Observations:
    • Although the new deaths increased by 507 (+86.5%) to over 1,000 since yesterday, the 7 day average has decreased slightly, which reflects a continuation of a downward trend  
    • The 7 day average growth rate of new deaths remains stable.  

3. Red State v Blue States – Comparisons & Observations

  • In general, Red States (voted for Trump) decided to end shelter in place conditions earlier than the Blue States (voted against Trump). We decided to analyze statistics based on how states voted in the 2016 election. 
  • Overall, the Deaths per 1 Million of Population are higher in the Blue States than the Red States — 7 out of the top 10 death rates are in States that voted against President Trump.  And, the three Red States with the highest per capita deaths (LA, MI and PA) are led by Democratic governors, which means that the 10 States with the highest deaths per capita are all led by Democratic governors.  
  • Positivity Rates (Positive Tests as a % of Total Cases) show that the 7 day average for 15 Red States (including MI and PA) exceeds 5% whereas only 4 Blue States exceed 5% (the US average is 4.4%).
  • After lockdowns that lasted into early June, several Blue States have seen positive test % fall well below 2%. New York’s positivity rate has fallen to 1.5%.
  • We believe that the percentage of positive cases is an early warning system for States, which could indicate potential problems in States with high percentages of positive tests.  For example, Arizona has a positive rate of 12.7% (highest in the country), and its hospitals just enacted emergency plans to prepare for a potential spike in hospitalizations.

C. WHO Said What?!

1. “Never mind” — WHO walks back comments on asymptomatic coronavirus spread, says much is still unknown

  • A top World Health Organization official clarified on Tuesday that scientists have not determined yet how frequently people with asymptomatic cases of C19 pass the disease on to others, a day after suggesting that such spread is “very rare.”
  • The clarification comes after the WHO’s original comments incited strong pushback from outside public health experts, who suggested the agency had erred, or at least miscommunicated, when it said people who didn’t show symptoms were unlikely to spread the virus.
  • Maria Van Kerkhove, the WHO’s technical lead on the C19 pandemic, made it very clear Tuesday that the actual rates of asymptomatic transmission aren’t yet known.
  • “The majority of transmission that we know about is that people who have symptoms transmit the virus to other people through infectious droplets,” Van Kerkhove said. “But there are a subset of people who don’t develop symptoms, and to truly understand how many people don’t have symptoms, we don’t actually have that answer yet.”
  • Van Kerkhove’s remarks on Tuesday came at a WHO question-and-answer session aimed at explaining what was known and unknown about how the virus spreads.
  • Some of the confusion boiled down to the details of what an asymptomatic infection actually is, and the different ways the term is used. While some cases of C19 are fully asymptomatic, sometimes the word is also used to describe people who haven’t started showing symptoms yet, when they are presymptomatic. Research has shown that people become infectious before they start feeling sick, during that presymptomatic period.
  • At one of the WHO’s thrice-weekly press briefings Monday, Van Kerkhove noted that when health officials review cases that are initially reported to be asymptomatic, “we find out that many have really mild disease.” There are some infected people who are “truly asymptomatic,” she said, but countries that are doing detailed contact tracing are “not finding secondary transmission onward” from those cases. “It’s very rare,” she said.
  • She added: “We are constantly looking at this data and we’re trying to get more information from countries to truly answer this question.”
  • To some, it came across as if the WHO was suggesting that people without symptoms weren’t driving spread. 
  • Some studies, however, have estimated that people without symptoms (whether truly asymptomatic or presymptomatic) could be responsible for up to half of the spread, which is why the virus has been so difficult to contain. Isolating people who are sick, for example, does not prevent the possibility they already passed the virus on to others. Some modeling studies have assumed quite widespread asymptomatic transmission.
  • “The WHO created confusion yesterday when it reported that asymptomatic patients rarely spread the disease,” an email from the Harvard Global Health Institute said Tuesday. “All of the best evidence suggests that people without symptoms can and do readily spread the coronavirus. In fact, some evidence suggests that people may be most infectious in the days before they become symptomatic — that is, in the presymptomatic phase when they feel well, have no symptoms, but may be shedding substantial amounts of virus.”
  • Their point: People not showing symptoms can spread the virus, whether they ultimately feel sick or not. That’s why wearing masks and keeping distance are so important to limiting transmission.
  • Van Kerkhove acknowledged Tuesday that her use of the phrase “very rare” had been a miscommunication. She said she had based that phrasing on findings from a small number of studies that followed asymptomatic cases and tracked how many of their contacts became infected. She said she did not mean to imply that “asymptomatic transmission globally” was happening rarely, because that has not been determined yet.
  • Determining which routes of transmission are driving most of the spread of the virus is crucial so health experts can develop the right strategies to combat the virus. At the WHO event Tuesday, officials stressed that even as scientists are still learning more about the virus and how it spreads, countries have demonstrated that the best tactics to address the pandemic include isolating cases, contact tracing, and quarantining contacts — as well as hand hygiene and respiratory etiquette.
  • With those measures, “We won’t stop all transmission, but what we do is, we suppress transmission,” Mike Ryan, the head of WHO’s emergencies program, said Tuesday.
  • Other unknowns the WHO experts raised Tuesday include how asymptomatic or presymptomatic people are spreading the virus if they are not coughing — it could be that they still expel infectious droplets through singing, yelling, or even talking — as well as the percentage of all C19 cases that are asymptomatic.  One recent paper estimated that 40 to 45% of cases might be asymptomatic, though others have pegged that figure at closer to 20% or even lower.  [See at Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review: Annals of Internal Medicine: Vol 0, No 0]
  • Based on what’s been seen so far, asymptomatic people tend to be younger and not have other health issues, Van Kerkhove said Tuesday, though she cautioned she didn’t want to generalize.
  • In addition to the studies about asymptomatic transmission that Van Kerkhove referred to, the WHO has also received data from member countries that “suggests that asymptomatically-infected individuals are much less likely to transmit the virus than those who develop symptoms,” according to WHO’s interim guidance on masks issued last week.
  • Outside experts have called on the WHO to release that data. Both outside experts and WHO officials have acknowledged that detecting asymptomatic spread would be really difficult, and just because scientists haven’t seen something occurring often doesn’t mean it’s not happening.
  • “Every question we answer, we have 10 more,” Van Kerkhove said Tuesday.

Source:  WHO clarifies comments on asymptomatic spread of Covid-19

2. In the WHO’s Coronavirus Stumbles, Some Scientists See a Pattern  

  • Even as the World Health Organization leads the worldwide response to the coronavirus pandemic, the agency is failing to take stock of rapidly evolving research findings and to communicate clearly about them, several scientists warned on Tuesday.
  • In a news briefing on Monday, a W.H.O. official asserted that transmission of the coronavirus by people without symptoms is “very rare.” Following concerted pushback from researchers, officials on Tuesday walked back the claim, saying it was a “misunderstanding.”
  • But it is not the first time the W.H.O.’s assessment has seemed to lag behind scientific opinion.
  • The agency delayed endorsing masks for the general public until Friday, claiming there was too little evidence that they prevented transmission of the virus. Virtually all scientists and governments have been recommending masks for months.
  • The W.H.O. has said repeatedly that small airborne droplets, or aerosols, are not a significant factor in the pandemic’s spread, although a growing body of evidence suggests that they may be.
  • “The W.H.O. has been out of step with most of the world on the issue of droplets and aerosols,” said Michael Osterholm, an infectious disease expert at the University of Minnesota.
  • These scientific disagreements have wide policy implications. Many countries, including the United States, adopted lockdown strategies because they recognized that isolating only people who were sick might not be enough to contain the epidemic.
  • If the virus is transmitted by small airborne droplets, people will need to continue to avoid congregating in poorly ventilated spaces, even if they practice rigorous hand hygiene.
  • The W.H.O. traditionally has taken a cautious approach to evaluating scientific evidence. But the pace of research has changed: Now scientists are rushing to publish preliminary research, even before their results can be thoroughly vetted by other experts.
  • The avalanche of findings may bring advances — like a vaccine — in record time. But the onslaught also has led to confusion, even retractions of high-profile results.
  • “On the one hand, I do want to cut the W.H.O. some slack, because it is hard to do this in an evolving pandemic,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “At the same time, we do rely on the W.H.O. to give us the best scientific data and evidence.”
  • The W.H.O.’s thinking on asymptomatic transmission does not appear to have changed much since February, when the W.H.O. China Joint Mission reported that “the proportion of truly asymptomatic infections is unclear, but appears to be relatively rare and does not appear to be a major driver of transmission.”
  • Studies later estimated this number could be as high as 40%; the current best estimate from the Centers for Disease Control and Prevention is 35%. The research prompted many countries, including the United States, to endorse use of masks by everyone.
  • But on Monday, Dr. Maria Van Kerkhove, the W.H.O.’s technical lead for coronavirus response, said that “it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual.”
  • Her statement provoked an immediate backlash from scientists, who noted that study after study had shown transmission of the virus from people before they ever felt symptoms.
  • The reaction prompted the W.H.O. to clarify its position in a live session hosted on Facebook and Twitter. Dr. Van Kerkhove said her comment had been based on only two or three studies.
  • “I was just responding to a question, I wasn’t stating a policy of W.H.O. or anything like that,” she said. Dr. Van Kerkhove said her statement was also based on unpublished evidence that some countries have shared with the W.H.O.
  • But critics, including its own officials, said the organization should be transparent about its sources. “W.H.O.’s first and foremost responsibility is to be the science leader,” said Lawrence Gostin, director of the W.H.O. Collaborating Center on National and Global Health Law.
  • “And when they come out with things that are clearly contradicted by the scientific establishment without any justification or citing studies, it significantly reduces their credibility.”
  • A key point of confusion is the difference between people who are “pre-symptomatic” and will go on to develop symptoms, and those who are “asymptomatic” and never feel sick. Dr. Van Kerkhove suggested that her comments were about people who are truly asymptomatic.
  • A widely cited paper published in April suggested that people are most infectious up to two days before the onset of symptoms, and estimated that 44% of new infections were a result of transmission from people who were not yet showing symptoms.
  • W.H.O. refers to such people as pre-symptomatic. “OK, technically fine,” Dr. Jha said. “But for all intents and purposes, they are asymptomatic — they are without symptoms.”
  • Dr. Van Kerkhove said that by using the two terms, W.H.O. officials are in fact trying to be very clear about the group of people they are referring to.
  • “Unfortunately, that’s not how everybody uses it,” she said. “I didn’t intend that to make things more complicated.”
  • The W.H.O. continues to maintain that large respiratory droplets expelled by sneezing or coughing are the main route of transmission and to downplay a possible role for aerosols, smaller particles that may linger in the air.
  • But evidence is piling up that aerosols may be an important route.
  • “What they haven’t recognized is that activities like coughing and talking, even breathing in some cases, are also aerosol-producing procedures,” said Linsey Marr, who studies airborne transmission of viruses at Virginia Tech.
  • W.H.O. officials said they were aware that breathing and talking might result in aerosols, but questioned their importance in spreading the virus.
  • “To date, there has been no demonstration of transmission by this type of aerosol route,” said Dr. Benedetta Allegranzi, the W.H.O.’s technical lead on the coronavirus.
  • But the W.H.O. defines airborne transmission too narrowly, some scientists said. Airborne transmission also includes the possibility that the virus is aloft for shorter distances, then inhaled.
  • “The W.H.O. has a very early 20th century, very unsophisticated view of what aerosols and airborne transmission are,” said Dr. Don Milton, an expert on public health aerobiology at the University of Maryland.
  • Up until the 1950s, Dr. Milton said, tuberculosis was thought to be spread by prolonged close contact. “We now know that it’s only transmitted by aerosols,” he said.
  • Some scientists are suspicious that W.H.O.’s stance on masks and aerosols may stem less from scientific research than from a concern over supplies of personal protective equipment for medical workers.
  • The organization currently recommends respirator masks that would block aerosols only for health care workers doing medical procedures that produce aerosols.
  • Dr. Van Kerkhove said that the W.H.O.’s guidance was based only on science and not on any considerations of supply. While a shortage of P.P.E. is a problem, she said, “it doesn’t change what we recommend.”
  • All of the experts said it was not that the W.H.O. is wrong on all counts, but that given the implications of its statements, it should be more cautious in concluding that transmission by air or by people without symptoms is not significant.
  • “We don’t know,” Dr. Milton said. “But they also don’t know.”
  • Some experts said that when the W.H.O. uses the phrase “there is no evidence” to indicate uncertainty, it is in fact conveying certainty about the absence of a phenomenon.
  • Dr. Van Kerkhove conceded that point.
  • “That’s a fair statement,” she said. “There’s a lot of research that needs to be done to really understand this, and we are open to the fact that there is new research every day.”

Source: In the WHO’s Coronavirus Stumbles, Some Scientists See a Pattern

D. Potential Treatments

1. Animal Study Shows Early Use of Remdesivir Prevents Progression of Pneumonia  

[Abstract of a study published in Nature]

  • While many investigational, approved, and repurposed drugs have been suggested, preclinical data from animal models can guide the search for effective treatments by ruling out treatments without in vivo efficacy. 
  • Remdesivir (GS-5734) is a nucleotide analog prodrug with broad antiviral activity, that is currently investigated in C19 clinical trials and recently received Emergency Use Authorization from the FDA. 
  • In animal models, remdesivir treatment was effective against MERS and SARS. In vitro, remdesivir inhibited replication of the coronavirus. 
  • Here, we investigated the efficacy of remdesivir treatment in a rhesus macaque model of coronavirus infection. 
  • In contrast to vehicle-treated animals, animals treated with remdesivir did not show signs of respiratory disease and had reduced pulmonary infiltrates on radiographs and reduced virus titers in bronchoalveolar lavages 12 hours after the first treatment administration. 
  • Virus shedding from the upper respiratory tract was not reduced by remdesivir treatment. At necropsy, lung viral loads of remdesivir-treated animals were lower and there was a reduction in damage to the lungs. 
  • Thus, therapeutic remdesivir treatment initiated early during infection had a clinical benefit in coronavirus-infected rhesus macaques. 
  • Although the rhesus macaque model does not represent the severe disease observed in a proportion of C19 patients, our data support early remdesivir treatment initiation in C19 patients to prevent progression to pneumonia.

Source: Clinical benefit of remdesivir in rhesus macaques infected with SARS-CoV-2

E. New Scientific Findings & Other Research

1. More Humidity, Less Spread of Virus; But More Sunshine, More Spread  

  • An international team of researchers led by McMaster University has found that while higher heat and humidity can slow the spread of C19, longer hours of sunlight are associated with a higher incidence of the disease, in a sign that sunny days can tempt more people out even if this means a higher risk of infection.
  • The findings, published online the journal Geographical Analysis, inform the widespread scientific debate over how seasonal changes, specifically warmer weather, might shape the spread of C19.
  • While research has shown that pathogens such as influenza and SARS thrive in lower temperatures and humidity, little is known about the coronavirus.
  • “There is a lot of pressure to reopen the economy, and many people want to know if it will be safer to do so in the summer months,” says Antonio Páez, a professor and researcher in McMaster’s School of Geography & Earth Sciences who is lead author of the study.
  • “Restrictions in movement, which have begun to ease around the world, hinge in part on how the coronavirus will be affected by a change in season,” he says.
  • Páez and colleagues from Spain’s Universidad Politecnica de Cartegena and Brazil’s Universidade Federal de Pernambuco investigated climate factors in the spread of C19 in several provinces in Spain, one of the countries hardest hit by the pandemic, with more than 270,000 cases.
  • They combined and analyzed data on reported cases of the disease and meteorological information over a period of 30 days that began immediately before a state-of-emergency was declared.
  • At higher levels of heat and humidity, researchers found that for every percentage increase, there was a 3 percent decline in the incidence of C19, possibly because warmer temperatures curtail the viability of the virus.
  • The opposite was true for hours of sunshine: more sun meant greater spread. The researchers speculate the increase may be related to human behavior since compliance with lockdown measures breaks down in sunnier days.
  • They were also surprised to find rates of transmission dropped among more dense populations and in areas with more older adults, suggesting those populations regard themselves as being at greater risk, and so are more likely to adhere to lockdown guidance.
  • While older adults are more vulnerable to the disease, researchers believe they are less likely overall to contribute to the spread of the disease because they are more apt to be isolated from others because of health or mobility issues.
  • Páez stresses that models such as the one he helped develop show that contagion of C19 declines as a lockdown progresses, possibly to the vanishing point — an argument for maintaining discipline despite the approach of pleasant weather.
  • “We will likely see a decrease in the incidence of C19 as the weather warms up, which is an argument for relaxing social distancing to take advantage of the lower incidence associated with higher temperatures” he says. “But a more conservative approach would be to use the months of summer to continue to follow strict orders to remain in place and to crush this pandemic.”

Source: Battle for Influence Over the Spread of COVID-19: Heat and Humidity vs. Sunshine

2. Lab-grown mini-lungs could reveal why C19 kills  

  • Inside the biosafety level 4 lab at the National Emerging Infectious Diseases Laboratories (NEIDL) in Boston, researchers wear three sets of gloves and breathe air piped into moon suits through snaking tubes. Before them, under a plastic shield, are human lung-sac cells grown from organoids, blobs of cells that mimic organs.
  • Now it’s time to infect them with the coronavirus.
  • What happens next could shed light on the strange and deadly effects of C19—because it’s not just the virus that matters, but the body’s reaction to it. People are dying from that reaction, and organoids could help zero in on where the damage is worst. Accurate cell models are already pinpointing how the virus gets into the body, where it causes the most harm, and will help in the search for treatments.
  • Many virologists work with computer data, or with surrogate viruses into which they plug parts of the C19 germ, or sometimes by infecting supplies of monkey cells that viruses like to grow in. But these surrogates can’t tell you what the actual virus does to specific human cell types. “If you work with the real thing, you get real results,” says Elke Mühlberger, a microbiologist at NEIDL, which is operated by Boston University. “If you are interested in the host response, then substitutes are of no use.”
  • One area where research on lab-made human lung tissue could pay off is in testing C19 drugs. Before trying any potential antiviral drug on people, researchers test their potency at blocking the virus in the lab. But after years of adaptation to a petri dish, standard laboratory cells are far from normal. “They’ve lost their ability to act as a lung or liver, they don’t respond to interferon—they are very different from the real thing,” Mühlberger says. “They don’t do much other than get infected.”
  • Cells from organoids are different.
Tiny organs
  • Organoids are complex mini-tissues created from stem cells. These master cells are allowed to multiply and self-organize until they end up creating tiny clumps that can have the basic cellular makeup—and functions—of a real organ. There are mini-guts with delicate wrinkles, brain blobs that emit EEG waves, and structures that look surprisingly like real embryos.
  • Human lung cells grow as three-dimensional organoids. Cells from these “alveolospheres” are being infected with the virus that causes C19 to help researchers understand how it kills.
  • Organoids had their debut as a virus-solver during the Zika outbreak, when infecting tiny lab brains showed that the virus had a preference for young, developing neurons. That offered an explanation for why the mosquito-borne germ was causing a birth defect, microcephaly, in some Brazilian newborns.
  • Organoids may also help researchers study animal viruses they haven’t had a good look at yet because they have proved difficult to grow in a laboratory setting. In May, scientists in Hong Kong cultivated mini-guts from horseshoe bats, the very species eyed as the root of the C19 outbreak, which harbor thousands of viruses about which we yet know little.
Lung cells
  • The research in Boston uses lung tissues being created at several area laboratories, including some that match parts of the alveoli, the puffy air sacs that exchange oxygen in the lung and that get overwhelmed in severe cases of C19.
  • Finn Hawkins, who runs one of the organoid labs, is a lung doctor who just finished a stint in an ICU caring for C19 patients. “I have never seen anything like it,” he says. “To me, the striking thing is the degree to which it causes severe lung damage in some patients. It’s not like Ebola, where everyone gets sick.”
  • The serious cases struggle with the same mysterious symptoms. Patients on ventilators are supposed to get weaned off. Instead, some are seized by a “cytokine storm,” an out-of-control inflammatory response, matched with a fever that won’t break. What’s killing most C19 patients is they come to the point where they can’t breathe at all. “Their markers go up; they need oxygen. The sudden worsening—that is something I have never seen before and now see over and over again,” says Hawkins. “You start to wonder what is going on, what’s driving the worsening.”
  • Hawkins says supplies of specific airway and lung cells could answer two questions: first, which cells let the virus into the body, and second, which are key to the devastating effects. Combine stem-cell-derived lung cells with the ability to sequence and track molecules inside individual cells and the result is “unbelievable resolution,” he says. “You can get information that is otherwise impossible to get.”
  • To see which cells are most susceptible, for instance, a team in North Carolina used sheets of human airway cells to form layers growing between liquid and air. They determined that ciliated cells—whose fuzzy hairs, waving like fronds on a sea anemone, move phlegm up and out—had the high levels of ACE-2, the human cell receptor the virus seizes on. Their findings pointed to the nose as the most likely place the virus gets in.
  • That’s information scientists may be able to use to come up with viral defenses. One video on YouTube suggested fashioning an anti-coronavirus nose closer out of a paper clip. If the virus is entering the nose, it’s not an entirely crazy idea. “If you can understand which types are getting infected and how, then you can find strategies to block or attenuate that,” says Hawkins.
  • The next question for the lung models will be to determine how particular cell types react to infection. “We suspect the virus is triggering something. What we are really interested in seeing is: when a virus gets in a cell, what are the downstream consequences?” says Hawkins. Some doctors think it’s damage to the lungs’ gas-exchange system, the alveoli, that leads to death. The air sac cells that exchange oxygen are big and thin, almost like the sails on a yacht. But the real problem could lie with “type 2” cells whose job is to make surfactant, a substance that reduces surface tension to let the air sacs stay open.
  • “If you look at the autopsies, the type 2 cells are very badly damaged. We know they are infected by the virus. That is the key cell type to understand what is killing these patients,” says Hawkins. “You get completely closed alveoli, and that’s what causes issues with oxygenation. When the patient ends up on the ventilators, it’s very challenging to deliver the right pressure and rescue these sick lungs that are leaky.”
Watching cells die
  • While Hawkins tends to patients on the wards, Jessie Huang, a postdoc at the Boston University lab of Darrell Kotton, has been manufacturing type 2 cells using organoids and sending them around the nation and the world. Alveolar cells from patients aren’t easy to grow, but the Boston labs have figured out how to generate  them, and they can make a type of organoid called an alveolosphere.
  • Those cells are being transported to the secure labs across town. “Our part is super simple. We just add the virus,” says Mühlberger.
  • So what happens after giving lung cells C19? Mühlberger says she adds fluid with “a tiny amount of virus” to make the infection take hold. Within a few days the cells’ nuclei look fragmented, and some detach and float away. “You see the cells don’t do so well,” she says. “We think the virus kills the cells directly, but we don’t actually know.” It could be the overproduction of cytokines and chemokines, types of inflammation molecules.
  • Mühlberger believes organoids may also give a better idea of what drugs will work to block the virus from copying itself. One compound that stopped the virus in monkey cells didn’t help the lung cells at all, she says. She adds, “We think organoids have totally different responses to viruses, and the drugs might act differently too.”

Source: Lab-grown mini-lungs could reveal why covid-19 kills 

F. Concerns & Unknowns

1. The Kawasaki-like syndrome found in children with C19 is a new, different condition  

  • New research suggests that the severe inflammatory syndrome observed in children during the C19 pandemic is new and distinct from Kawasaki disease.
  • Led by researchers from Imperial College Academic Health Science Centre (AHSC) along with Great Ormond Street Hospital (GOSH) and the Evelina London Children’s Hospital, UK, and the Kawasaki Disease Research Center at the University of California San Diego, the new study looked at 58 children admitted to 8 hospitals in England who exhibited symptoms of the new syndrome.
  • The condition was first observed in April, when children in the UK and other European countries with high numbers of C19 cases showed symptoms of a new inflammatory syndrome, similar to Kawasaki disease. Kawasaki disease is a rare syndrome that affects young children and which damages the coronary artery so that as the child grows, the artery doesn’t grow with them, reducing the amount of blood that can reach the heart.
  • After observing the children in their study, the researchers identified the main symptoms and markers of the condition, which they have named Pediatric Inflammatory Multisystem Syndrome Temporally associated with the coronavirus (PIMS-TS), a different condition to Kawasaki disease.
  • The researchers, who have detailed their findings in the Journal of the American Medical Association, say that PIMS-TS appears to affect older children — on average nine years old — than Kawasaki disease, which affects those around four years old. It also appears to affect a higher proportion of Black and Asian patients.
  • They also found that symptoms of PIMS-TS are more likely to include abdominal pains and diarrhea than Kawasaki disease, and that the results of the blood tests also showed differences to Kawasaki disease, with the PIMS-TS patients showing more markers of inflammation and cardiac enzymes, which suggest the heart is under strain.
  • The researchers found that 45 of the 58 children had evidence of current or past C19 infection, so they cannot be sure that PIMS-TS is caused by C19. However, they say it is unlikely to be a coincidence that a new condition has appeared during a pandemic, they say. 
  • The condition is thought to be extremely rare — less than 200 cases reported in England and most children have already recovered. However, there are worries that the condition could cause long-lasting coronary damage. 
  • “The new condition, PIMS-TS, is extremely rare but it can make a child very ill, so it’s important to characterize the disease properly so we can provide close monitoring and the best treatment,” said lead author Dr. Elizabeth Whittaker.
  • “For any parents worried about their children, I would urge them to follow their usual instincts — whatever would normally prompt you to visit your GP or A&E with your child still applies here.”
  • “Our analysis has shown that this is indeed a new condition. Untreated, there is a risk of severe complications in very unwell children, but with early identification and treatment the outcome is excellent, with the children we are reviewing after discharge completely well,” added researcher Dr. Julia Kenny.

Source: The Kawasaki-like syndrome found in children with COVID-19 is a new, different condition says study

2. Crowded Homes Increase Risk; Quarantine Outside of Home Significantly Reduces Risk  

  • Communities are reopening after months-long lockdown orders managed to slow the spread of C19 in some places. But the lockdowns have done little to thwart the virus’s transmission within packed households. 
  • Outside of institutional settings like assisted-living facilities, large, multigenerational homes have emerged as one of the most dangerous places to be during the outbreak—a weak spot in the country’s public health response especially in the event of another wave of infections in the fall, as some experts fear.
  • A Wall Street Journal analysis found that, across the country, the virus has spread more widely in places with the most crowded households, not necessarily places with the largest or densest populations. 
  • Remote, rural hamlets where extended families live under the same roof have turned deadlier than some of the densest blocks of Manhattan or Chicago, the analysis found. 
  • In both contexts, the virus has zeroed in on crowded homes, sometimes wiping out generations in a matter of days.
  • Housing analysts and some government agencies consider a home with more than one resident per room to be crowded. Nationwide—4 million homes, or about 3%—fall into this category, according to census data.
  • As states reopen, stopping transmission of the virus within households will be key to preventing a second wave of infections, said Dr. Ashish Jha, a health-policy professor at the Harvard T.H. Chan School of Public Health.
  • San Francisco, Kansas and the Navajo Nation in the Southwest are among the places that have encouraged sick people to leave their homes and stay in alternative housing sites and hotels that have been converted into quarantine facilities. Yet, persuading people to do so has been difficult, health workers say, and there is little appetite among public officials to make the sick leave their families.
  • “I’m 110% opposed to anything forcible on this,” said Dr. Jha. But if the U.S. can’t find a way to control intra-household infections, he said, “that will lead to more community transmission.”
  • A study from New York University’s Furman Center found that in New York City, the areas hit hardest by the disease weren’t those with the densest population; they were the ones with the greatest household crowding among renters.
  • The Journal analysis found that in Chicago, ZIP Codes where crowded households are most common accounted for a disproportionate share of the city’s coronavirus cases. The Humboldt Park neighborhood on Chicago’s West Side, for example, has a household crowding rate more than eight times as high as the Evergreen Park area, on the city’s outskirts. Its infection rate is twice as high.
  • Household crowding frequently overlaps with other risk factors, studies show. It is more common in poorer neighborhoods, where residents are more likely to have underlying health conditions and to still be working outside the house during the outbreak.
  • C19 has disproportionately hit African-Americans and Latinos, several studies have shown. Black and Latino households are almost twice as likely to be multigenerational as white households, according to the Pew Research Center.
  • In California, the three counties with the highest coronavirus rates—Kings County, Imperial County and Los Angeles County—are majority Latino and Black and have among the highest rates of household crowding in the country.
  • A study from the Public Policy Institute of California found that essential workers are at higher risk of contracting C19—and more likely to live in crowded homes.
  • Recognizing that simply staying at home won’t stop transmission of the virus, countries in Asia have adopted more drastic measures. Singapore and South Korea required all people who test positive for C19 to move into isolation or medical facilities; Vietnam and Hong Kong extended mandatory out-of-home quarantining to contacts of the sick as well.
  • In Italy, where multigenerational households are common and most people with C19 remain at home, the country’s National Health Institute found that one in five people who have tested positive in April and early May were likely infected by family members, the second-highest source of infection after nursing homes.
  • A study from the London School of Hygiene & Tropical Medicine found that in a city of four million people, home-based isolation would result in a 20% reduction in coronavirus cases, while isolation in quarantine centers would cut cases by 59%.
  • In the U.S., quarantine centers have been used sparingly. Because testing hasn’t been as widespread as in some other countries, many people have passed the virus to loved ones before even realizing they are sick.
  • Kansas officials have set up quarantine centers in six counties across the state, including Ford County, where outbreaks at two meatpacking plants have sickened workers and their family members. The county of 33,600 people has more than 1,800 confirmed cases, the highest total in the state. According to census data, 18% of households in Ford County have five or more people and 7.1% are crowded, both well above the national average.
  • As of Saturday, only 8 Covid-positive people were checked into the quarantine center in Ford County, state health officials said. Statewide, just 12 of more than 300 available rooms for infected residents were occupied. Public-health officials and immigrant advocates said some workers in the county, who may be undocumented, are wary of using the facilities. A Ford County official said the quarantine centers were working well.
  • San Francisco has contracted with hotels to provide more than 1,000 rooms where people who get sick can isolate and are provided with three meals a day. But convincing the sick to leave their families can be difficult, said Trent Rhorer, director of San Francisco’s Human Services Agency.
  • “Often, the family bond is strong—you have multigenerational households and they all rely on each other for income, or to cook, or to clean,” Mr. Rhorer said.

Source: Covid-19 Stalks Large Families in Rural America 

G. Updates

1. Three big studies dim hopes that hydroxychloroquine can treat or prevent C19

  • Through the fog of alleged misconduct, hope, hype, and politicization that surrounds hydroxychloroquine, the malaria drug touted as a C19 treatment, a scientific picture is now emerging.
  • Praised by presidents as a potential miracle cure and dismissed by others as a deadly distraction, hydroxychloroquine was spared a seeming death blow last week. On 4 June, after critics challenged the data, The Lancet suddenly retracted a paper that had suggested the drug increased the death rate in C19 patients, a finding that had stopped many clinical trials in their tracks. 
  • But now three large studies, two in people exposed to the virus and at risk of infection and the other in severely ill patients, show no benefit from the drug. Coming on top of earlier smaller trials with disappointing findings, the new results mean it’s time to move on, some scientists say, and end most of the trials still in progress.
  • “It just seems like we are ignoring signal after signal,” says Eric Topol, director of the Scripps Translational Science Institute. U.S. President Donald Trump’s promotion of it led to a scientific “obsession” with hydroxychloroquine despite thin evidence for its promise, he says. 
  • “We’d be better off shifting our attention to drugs that might actually work.” Peter Kremsner of the University of Tübingen agrees hydroxychloroquine “certainly isn’t a wonder drug.” The new results left him “wrestling” with the question of whether to proceed with two hydroxychloroquine trials, one in hospitals and the other in patients with milder illness at home.
  • Hydroxychloroquine and its sister drug chloroquine have been used against malaria and other diseases for decades. The first evidence that they might work against the coronavirus came from test tube data. Since then, hundreds of trials have been launched around the globe. Scientists are trying the drugs in low doses and high doses; alone or combined with the antibiotic azithromycin, the antiviral compound favipiravir, or other drugs; and in patients with mild or severe disease, health care workers, pregnant women, and people living with HIV.
  • On 5 June, researchers in the United Kingdom announced the results from the largest trial yet, Recovery. I n a group of 1542 hospitalized patients treated with hydroxychloroquine, 25.7% had died after 28 days, compared with 23.5% in a group of 3132 patients who had only received standard care. “These data convincingly rule out any meaningful mortality benefit,” wrote the investigators, who ended the study early and promised to publish the full results as soon as possible.
  • The results are persuading some doctors to stop using the drug for C19. “The Recovery trial, in addition to the signals from other studies we have received so far, are enough to convince me to not offer hydroxychloroquine to hospitalized patients,” Nahid Bhadelia, a physician at Boston Medical Center, wrote in an email. Martin Landray of the University of Oxford, one of Recovery’s principal investigators, agrees: “If you, your spouse, your mother gets admitted to hospital and is offered hydroxychloroquine, don’t take it,” he says.
  • But some scientists say they want to see the full data before making up their minds. About one in four patients died in both arms of the study, Kremsner notes—a very high rate, suggesting they were gravely ill when treatment started. Nicholas White of Mahidol University in Bangkok, who also studies hydroxychloroquine, agrees the full data need evaluation. “But overall, it’s very unlikely, in my view right now sitting here, that anything’s going to change,” he says.
  • Another hope for hydroxychloroquine, that it might prevent people exposed to the virus from getting sick, also faded last week when David Boulware of the University of Minnesota, Twin Cities, and colleagues published the results of the largest study to date of this strategy, called postexposure prophylaxis (PEP). The researchers sent either hydroxychloroquine or a placebo by mail to 821 people who had been in close contact with a C19 patient for more than 10 minutes without proper protection. They reported in The New England Journal of Medicine that 12% of the people who took the drug went on to develop C19 symptoms, versus 14% in a placebo group, a difference that was not statistically significant.
  • A second large PEP trial has come up empty as well, its leader tells Science. Carried out in Barcelona, Spain, that study randomized more than 2300 people exposed to the virus to either hydroxychloroquine or the usual care. There was no significant difference between the number of people in each group who developed C19, says Oriol Mitjà of the Germans Trias i Pujol University Hospital. Mitjà says he has submitted the results for publication.
  • The data are important because they come from large randomized trials. So far, most data came from small trials or case series. A meta-analysis of 24 such studies published in the Annals of Internal Medicine concluded there was “insufficient and often conflicting evidence on the benefits and harms of using hydroxychloroquine or chloroquine to treat C19.”
  • The new findings raise questions about whether to stop other trials. Most are much smaller than Recovery, and thus less powerful; their outcomes are unlikely to change many minds. 
  • And continuing the trials may prevent researchers from testing drugs with a better chance of working and robs patients of the chance to try those. Landray says the World Health Organization (WHO) is now likely to end the hydroxychloroquine arm of its large C19 treatment trial, named Solidarity. “I think the decision is pretty obvious,” he says. WHO says it is considering the issue.
  • There is one exception. Many researchers agree that a good case can be made for continuing to test whether hydroxychloroquine can prevent infection if given to people just in case they get exposed to the virus, for instance on the job at a hospital—a strategy called pre-exposure prophylaxis (PrEP). 
  • “You have a much better chance of preventing something with a weak drug than you have of curing a fully established infection,” says White, who runs one of the largest PrEP trials. He notes that doxycycline, an antibiotic, has long been used in malaria prophylaxis. “We would never treat anybody with it, it’s too weak. But it’s a very good prophylactic.”
  • Landray, however, is on the fence about continuing prophylaxis trials: “I suspect it’s one of these decisions where there isn’t a right or wrong.” 
  • It’s an important question, Bhadelia says, because an effective PrEP drug could have a major impact on the pandemic. Hydroxychloroquine, a cheap and widely available drug, is one of the few compounds that could fit the bill.
  • But the Lancet paper, despite its retraction, will make it more difficult to continue current trials, White laments. Published on 22 May, the study claimed, supposedly based on data from 96,000 patients around the world, that hydroxychloroquine and chloroquine, whether given alone or in combination with another drug, caused a steep increase in deaths. That led many regulatory agencies to ask scientists to halt their trials and make sure they were not harming their patients. Recovery and Solidarity were temporarily halted but resumed after a safety committee took a look at the data.
  • Many other trials are still on pause. U.K. regulators, for instance, have asked for a raft of additional safeguards, says Joseph Cheriyan, a clinical pharmacologist at Cambridge University Hospital and principal investigator of a PrEP trial in health care workers. That study already excluded patients who take any one of several dozens of drugs, but Cheriyan says regulators have asked for more changes, which will set the trial back weeks. And despite the Lancet retraction, the alarming headlines about the drug’s risks have made it much more difficult to convince people to participate in a trial, White says. “I just think these trials have been really badly damaged and some of them may never restart.”
  • The problem for scientists is that there’s such a rush to find treatments for the rapidly spreading virus, Mitjà says: “The pressure is immense.” 
  • Yet that shouldn’t stop researchers from properly analyzing data and making carefully considered decisions, White says. “We don’t always have to act today,” he says. “Let’s not panic.”

Source: Three big studies dim hopes that hydroxychloroquine can treat or prev…

2. The Mysterious Missing Link – Hydroxychloroquine (HCQ) & Zinc  

  • Zinc, available as an over-the-counter supplement, has long been seen as an immune-system booster that helps develop immune cells, or antibodies, and can strengthen the body’s response to a virus.
  • American infectious disease specialist Joseph Rahimian explained that, in relation to C19, zinc ‘does the heavy lifting and is the primary substance attacking the pathogen’. HCQ is said to work as a delivery system for zinc in fighting coronavirus.
  • A study by the New York University Grossman School of Medicine found that those receiving the triple-drug combination (HCQ, with azithromycin and, crucially, zinc) ‘were 44% less likely to die, compared with the double-drug combination (i.e. without zinc)’.
  • As the study notes: ‘This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for C19.’  [The study at Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients]

[Observations: Although conflicting (and, in some cases, what appear to be fraudulent) reports and political axe-grinding have certainly  thickened the fog of war on the efficacy of hydroxychloroquine, recent clinical trials show that hydroxychloroquine does not help severely ill patients.  However, it does seem further research is warranted to determine whether hydroxychloroquine can reduce the severity of symptoms if treatment begins early, and whether zinc makes a major contribution to positive outcomes.]   

Source: The Mysterious Missing Link – Anti-Malaria Drug & Zinc

H. The Road Back?  

1. A devastating second wave is possible, but there are ways to avert it    

  • Summer beckons, and the coronavirus pandemic is still running strong in the United States. Fortunately, there is more clarity now about how to fight it than in the terrible early weeks. A devastating second wave is possible — but can be averted.
  • All available evidence points in one direction — that people and governments should be as relentless as the virus. Wear masks; wash hands; avoid crowded, confined spaces; and set up adequate testing and contact tracing.
  • This appears to be helping improve the situation in Europe. In hard-hit Italy and across much of the continent, countries have restarted their economies and resumed socializing to some extent without experiencing the dire consequences of a second wave. 
  • The Post’s correspondents report that virologists have become more optimistic that, even absent a vaccine or drug therapy, Europe can manage the pandemic at least through the summer with nothing more than localized and containable hot spots. 
  • Europeans are hand-washing and mask-wearing, and it helps. Also, Europe’s opening is still gradual, with a ban on large events; international flights and tourism have been on hold, while some countries have not restarted schools. 
  • And Europe also shows what can go wrong. Closed environments can become incubators for disease. Poland reacted quickly to the pandemic and thus didn’t suffer a nationwide toll like Spain or Italy, but now the coal mines of Silesia are the scene of a continuing outbreak and thousands of infections.
  • In the United States, New York City, an early epicenter, is taking the first steps toward reopening, and a decline in the New York region is a welcome sign after so many weeks of sickness and death. Another positive sign is that the intensive care unit capacity in the United States is not overstretched, as had been feared. 
  • But the nation is not beyond danger. A host of states are seeing a jump in new cases, including California, Arizona, Utah, Texas, North Carolina, Michigan, Florida and Arkansas. In Houston, which initially saw a decline, the case count has swung sharply upward in recent days, almost to levels of mid-April. In South Carolina, cases on Saturday reached the highest count for a day since the pandemic began.
  • These worrisome signs suggest that some places should neither ease up on physical distancing nor return to business as usual. Also concerning is whether the protests over police brutality might have seeded outbreaks that will appear two weeks or so from now.
  • Ultimately, the battle against the coronavirus depends on choices we make. For individuals, this means a commitment to wearing face masks, washing hands and avoiding crowded enclosures. 
  • For states and cities — delegated the task by an irresponsible president who turned his back on it — the key is building a robust testing, contact tracing and isolating regimen as soon as possible. 
  • So far, the record is quite uneven. This won’t be a carefree summer, but all the effort is worth it if a second wave can be avoided or ameliorated.

Source: Opinion | A devastating second wave is possible. But there are ways to avert it.

I. A Risk of Reopening

1. Arizona hospitals activate emergency plans as coronavirus cases spike 

  • The Arizona Department of Health Services urged the state’s hospitals to “fully activate” their emergency plans — as the state has seen a spike in coronavirus cases since reopening last month, according to new reports.
  • The letter, dated Saturday and signed by health services director Cara Christ, urged hospitals to prepare surge beds, cross-train staff and “reduce or suspend elective surgeries to ensure adequate bed capacity” for COVID and non-COVID patients alike.
  • The letter includes many of the same recommendations outlined in another memo sent to hospitals in March — except the new letter comes weeks after Gov. Doug Ducey’s stay-at-home order expired May 15. Statewide coronavirus cases have more than doubled since then.
  • Ducey attributed the rise last week to an increase in testing.  [Note: at 12.7%, the positive test rate in Arizona is the highest in the country, which is almost 3x the national average.]
  • “In recent days, we’ve seen some hospitals come out with concerns related to a surge in patients,” health services assistant director Jessica Rigler told KTAR News 92.3 FM. “So we wanted to make sure that we provided some additional guidance to those facilities about steps that they could be taking and remind them of some of the requirements that were … recommended in the previous letter.”
  • Hospitals must also identify additional ICU and inpatient beds to meet the 50% additional bed increase, the letter outlines.
  • They must also determine whether to shift their facilities from conventional care to contingency care, and prepare for crisis care.
  • The letter was dated the same day Christ told ABC 15 that her department’s staff had made errors and reported incorrect hospitalization numbers since April on the department’s coronavirus dashboard.
  • The state miscalculated the number of hospital beds currently available and in use in Arizona, because of staff members’ confusion over the number of beds the facilities are allowed to have in operation, and their surge capacities, according to the report.
  • Arizona has tallied a total of 28,296 coronavirus cases and 1,070 deaths.
  • That includes 618 new cases and 23 additional deaths reported Tuesday morning.

Source:  Arizona hospitals activate emergency plans as coronavirus cases spike

J. Practical Tips & Other Useful Information

1. When Will Epidemiologists Be Comfortable Flying, Eating at Restaurants, and Riding Public Transportation?  

  • The New York Times surveyed 511 infectious disease specialists and epidemiologists and asked their opinions as to when they personally will resume 20 routine activities.
  • The respondents’ replies assume “that the pandemic and the public health response to it unfold as they expect. Plus, “Their answers are not guidelines for the public, and incorporate respondents’ individual life circumstances, risk tolerance and expectations about when there will be widespread testing, contact tracing, treatment and vaccination for C19. They said it’s these things that will determine their actions, because the virus sets the timeline.”
Flying & Mass Transportation
  • Only 20% said they expect to fly this summer. Meanwhile, 44% are cool with taking to the skies sometime between fall and next summer. Thirty-seven percent (37%), though, think it’ll be at least a year from now before flying again.
  • The figures are roughly the same for riding a subway or a bus.
  • More than half (56%) are OK dining in a restaurant during the fall 2020 to summer 2021 range.
  • So that’s at least some good news, right?
Concerts, Plays, Sports Events, Weddings, Funerals
  • Many of us travel to experience concerts, take in major theatre productions, see our favorite sports teams play, enjoy weddings, and bid farewell to loved ones.
  • Unfortunately, the survey participants weren’t as gung-ho about these activities.
  • Sixty-four percent (64%) are going to wait until mid-2021 — at the earliest — to attend a sporting event, a concert, or a play. Half that number will risk it before then.
  • Weddings and funerals also aren’t high on their to-do lists. Forty-two percent (42%) will wait a year before chancing it; about the same number (41%) see themselves attending one sometime between summer and fall.
What About Face Coverings?
  • If you follow the experts’ advice, you’re going to wear a mask for a while.
  • Only 7% said they’ll stop routinely wearing one this summer. Forty-percent (40%) might bare some face sometime between this fall and next summer. But 52% said they’ll cover up for at least another year.

Source: Here’s When Several Hundred Epidemiologists are Comfortable Flying, Eating at Restaurants, and Riding Public Transportation 

2. 5 Rules to Live By During a Pandemic  

  • While it might feel as if the coronavirus crisis is over, it’s not. The virus is still out there.
  • But some things have changed. To start, lockdowns are ending because cases are low or falling in some areas or because state leaders have decided to move ahead despite the risk. Testing has increased, giving us more indicators of community health. Plus we know a lot more about how the virus behaves and what activities pose the highest risk.
  • And because life on permanent lockdown isn’t sustainable, public health experts are beginning to embrace a “harm reduction” approach, giving people alternatives to strict quarantine. 
  • These options — like forming a “bubble” with another household or moving social activities outdoors — don’t eliminate risk, but they minimize it as people try to return to daily life.
  • Nobody knows exactly what will happen as communities open up. The most likely scenario is that virus cases will continue to surge and fall around the globe for the foreseeable future.
  • “It’s hard to imagine how we will avoid another surge in infections, which is why these harm reduction approaches that keep people away from much higher risk situations are so important,” said Julia Marcus, an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School. “If someone expanding their bubble keeps them from having crowded dinner parties or going to bars, then that is a success.”
  • While we’ve learned to live with masks and social distancing, as well as new rituals of hand-washing after handling packages and touching surfaces, we need some basic rules to minimize risk and still have a life going forward. We’ve consulted with several public health experts and scientists to give you the tools you need to make your own decisions, whether it’s dining at a restaurant, going to church or simply getting a haircut.
1. Check the health of your state and community
  • To gauge your risk of coming into contact with an infected person, pay attention to two important indicators of C19 in your area: the percentage of tests that are positive, and the trend in overall case rates.
  • Start by learning the percentage of positive C19 tests in your state, which tells you if testing and contact tracing are finding mild and asymptomatic cases. When positive test rates stay at 5% or lower for two weeks, that suggests there’s adequate testing in your state to get virus transmission under control, and you’re less likely to cross paths with the virus. The closer the number is to 2 percent, the better.
  • “It doesn’t mean you have total freedom,” warns Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. “It means there’s enough testing going on there that you can feel confident that your interactions in society are going to be of much lower risk.”
  • If the percentage of positive tests starts to rise, you should take more precautions.
  • To find out whether your state is meeting the testing criteria, go to your state health department website. Or you can use this chart from Johns Hopkins University. The website Covid Act Now allows you to see positive test rates by county.
  • Next, use our maps and case count pages to stay informed of the C19 trends in your area. When the number of overall cases is low or falling, you should feel safer, but you still need to be vigilant. Be more cautious when case counts start rising.
2. Limit the number of your close contacts
  • You’re safest with members of your household, but if you want to widen your circle to extended family or friends, keep the number of close contacts as low and as consistent as possible. 
  • One way to do this is to form a “corona bubble,” which happens when two households form an exclusive social circle, agreeing on safety guidelines and to see only each other. The arrangement allows people to visit each other’s homes and lead a somewhat normal, if limited, social life. It may be particularly helpful for families with similar structures — such as those with young children longing for playmates or teenagers seeking in-person contact.
  • The arrangement requires a high level of trust. How does each family define reasonable precautions? Count the number of potential “leaks” for each member of the bubble — such as trips to the store or office, play dates, children and teens who see friends, or housekeepers and nannies who may visit multiple homes.
  • Keep communication open and without judgment, so people feel comfortable disclosing new exposure risks and potential “leaks” in the bubble.
  • “People’s activities are going to change every day — schools may reopen, someone may decide to go to protest,” said Dr. Marcus. “This is not just a one-time agreement. The communication about risk needs to be ongoing and open.”
3. Manage your exposure budget
  • Risk is cumulative. Going forward, you’ll need to make trade-offs, choosing activities that are most important to you (like seeing an aging parent) and skipping things that might matter less (an office going-away party). Think about managing virus risk just as you might manage a diet: If you want dessert, eat a little less for dinner.
  • During a pandemic, every member of the household should manage their own exposure budget. (Think Weight Watchers points for virus risk.) You spend very few budget points for low-risk choices like a once-a-week grocery trip or exercising outdoors. You spend more budget points when you attend an indoor dinner party, get a haircut or go to the office. You blow your budget completely if you spend time in a crowd.
  • “Moving into a long-term management phase, we have to start thinking like this,” says Johannes Eichstaedt, a computational social scientist and psychology professor at Stanford University. “Don’t take risks where it’s not needed, and make trade-offs that are congruent with your larger health needs and priorities. If seeing my grandchild in the park means, to balance this, I can only go to the supermarket every other week, maybe that’s a trade-off I’m willing to make for my mental health and well-being.”
  • Unfortunately, there’s no magic number to determine your personal exposure budget and the exposure “costs” of different actions. But think about your overall exposure budget when you make decisions to spend time with other people, particularly older people and those with high-risk conditions.
4. Keep higher risk activities as short as possible
  • Every time you make plans, ask yourself, “If an infected person happens to be nearby, how much time could I be spending with them?” It takes an extended period of close contact with an infected person, or extended time in a poorly ventilated room with an infected person, to have a substantial risk of catching the virus through the air, said Linsey Marr, an aerosol scientist at Virginia Tech.
  • When making decisions, keep indoor events brief and move social events outdoors. Wear a mask and practice social distancing. Here’s some guidance about time of exposure.
    • Brief exposure:  Brief encounters, particularly those outside — like passing someone on the sidewalk or a runner who huffs and puffs past your picnic — are unlikely to make you sick.
    • Face-to-face contact: Wear a mask, and keep close conversations short. We don’t know the level of exposure required to make you sick, but estimates range from a few hundred to 1,000 copies of the virus. In theory, you might reach the higher estimate after just five minutes of close conversation, given that a person might expel 200 viral particles a minute through speech. When health officials perform contact tracing, they typically look for people with whom you’ve spent at least 15 minutes in close contact.
    • Indoor exposure: In an enclosed space, like an office, at a birthday party, in a restaurant or in a church, you can still become infected from a person across the room if you share the same air for an extended period of time. There’s no proven time limit that is safest, but based on contact tracing guidelines and the average rate at which we expel viral particles — through breathing, speaking and coughing — it’s best to keep indoor activities, like shopping or haircuts, to less than an hour. Even shorter is better.
  • As you make decisions, Dr. Bromage suggests you consider the volume of air space (open space is safer than a small meeting room), the number of people in the space (fewer is better) and how much time everyone is together (keep it brief). To learn more about timing and risk, read Dr. Bromage’s blog post on the topic, which has been viewed more than 18 million times.  [See Dr. Bromage’s blog post at The Risks – Know Them – Avoid Them]
5. Keep taking pandemic precautions
  • Already some people in many communities have stopped wearing masks, suspended social distancing and returned to their pre-pandemic socializing. Time will tell if case counts start to rise as a result, but in the coming months you would be wise to adopt the following habits:
    • Keep a mask handy. Wear a mask in enclosed spaces, when you shop or go to the office and anytime you are in close contact with people outside your household.
    • Practice social distancing — staying six feet apart — when you are with people who live outside your household. Keep social activities outdoors.
    • Wash hands frequently, and be mindful about touching public surfaces (elevator buttons, hand rails, subway poles, and other high-touch areas)
    • Adopt stricter quarantine practices if you or someone in your circle is at higher risk.

Source: 5 Rules to Live By During a Pandemic

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