Recent Developments & Information
June 11, 2020
Note: Next Scheduled Update is Monday, June 14. Have a nice weekend!
“I’m afraid of bringing it home to my family. I often drive around town at 3:30 am after a shift to just think and to be. At night the city looks no different during Covid than it did pre-Covid. Empty streets, street lights. It’s peaceful.”Missy Arruda, emergency room nurse
“The fact that I cannot hug my family after a long shift has got to be the worst part. Afraid that I might pass something on to them, I refrain…because I worry, can couldn’t possibly live with myself if I harmed them in any way.”Veronica Medieros, emergency room nurse
“I haven’t seen my family in months, and I worry that if I do go around them, I will get them sick. The only people that I have spent time with outside of work are my co-workers, who are the only people that understand the stress we deal with at work. This has become our new normal.”Lauren Beardsley, emergency room nurse
“The fear is always there.”Alex Potter, emergency room nurse
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.
Warning: Danger Ahead
New Scientific Findings
Lessons From Abroad
The Road Back?
Practical Tips & Useful Information
Johns Hopkins COVID-19 Update (see Annex I)
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A. Our World As Seen Through Headlines
(In No Particular Order)
- E.U. issues its most forceful criticism of China’s false information
- Cases surpass 2 million in the U.S., with new hot spots emerging
- Lockdowns are ending in many developing countries, even as cases rise
- Dr. Fauci says protests could cause an increase in cases
- International Labor Organization says more than 1 billion workers globally at high risk of pay cuts or job losses because of coronavirus
- OECD Warns Of Deepest Global Downturn In Century, Second Virus Wave
- UN warns ‘food systems are failing’ amid coronavirus pandemic
- The Federal Reserve says unemployment will remain high as it leaves interest rates near zero
- WHO Now Says Role of Silent Virus Spreaders Remains Unclear
- Dr. Fauci slams WHO over coronavirus transmission claim
- Texas reports another record jump in new cases
- Arkansas to enter phase 2 next week
- Rhode Island Gov. says students will return to schools on Aug. 31
- Bloomberg warns signs of second wave building for CA, TX, FL and AZ
- Mumbai surpasses case total from Wuhan as Indian outbreak worsens
- Bangladesh, Jakarta reports record jump in new cases
- Germany expands warning on international travel to non-European countries
- National guardsmen deployed in Washington DC test positive
- Former FDA Commissioner Scott Gottlieb warns Texas on the brink of losing control of the outbreak
- Greater New York area continues to bend the curve down
- Brazil’s favelas, neglected by the government, organize their own coronavirus fight
- South Korea rolls out smartphone tracing to fight new infections
- Federal Reserve Chair Powell Sees Fed Keeping Foot on Gas Until Jobs Come Back
- Africa’s Debt Bill Consumes Funds Needed for Post-Virus Recovery
- Asymptomatic threat has made nations wary of opening economies
- Red Cross Warns of a ‘Staggering’ Drop in Blood Supplies
- 14 states and Puerto Rico hit highest seven-day average of new coronavirus infections
- ‘Flying blind’: Doctors race to understand what Covid-19 means for people with HIV
- Farm workers’ coronavirus cases spike
- Brazil to consider leaving World Health Organization
- Orange County health official resigns amid pushback (death threats) over face mask order
- New Yorkers now consider waiting in line a joyful pandemic pastime (nothing better to do)
- Italy could be nearing ‘herd immunity’ from coronavirus
- Veterans Administration says it lacks adequate medical gear for another coronavirus wave
- Coronavirus leaves diamond miners with stockpiles worth billions
- AMC Theaters, the world’s largest cineplex operator, said “almost all” of its locations in the U.S. and Britain would reopen in July
- As people in New York City slowly return to the subway, they’re finding a changed system — scented with lemon
- Indonesia worried about a wave of unplanned births, after 10 million married couples stopped using contraception because of limited access to clinics
- For some economists, the dental industry is the perfect barometer for gauging the U.S. recovery from the pandemic
- Moscow Relaxes Lockdown Measures Despite High Number of Cases
- Brazil Announces Proposal to Reform W.H.O. for ‘Lack of Transparency, Coherence’
- Bipartisan Majorities Move to Override PA Gov. Tom Wolf and End Lockdowns
- “Triple Threat”: COVID-19, Ebola, Measles Outbreak In Congo
- UK Forecast To Suffer Worst COVID-Driven GDP Hit Of All Nations Worldwide
- Researchers Find At Least 7 Different Strains Of Coronavirus Circulated In California
- American Cities Becoming ‘A Big Toilet’ For Lack Of Public Restrooms Amid COVID-19
- Four Workers At Tesla Tested Positive For COVID-19 Yesterday
- Disney to begin reopening California resort in July after coronavirus
- Belgian prince got coronavirus after breaking quarantine to party in Spain
- New York has another great day versus coronavirus, de Blasio, Cuomo say
- Study Claims COVID-19 Lockdowns Saved 3 Million Lives Across Europe
- Burundi’s president may be first world leader to die of COVID-19
- Dubai Airport debuts pandemic-friendly concierge shopping service
- UK company creates cardboard box for the post-coronavirus office
- Second wave of coronavirus could cripple economic recovery, group warns
- Starbucks to fast-track pickup-only stores amid $3.2 billion loss
- Coachella and Stagecoach are canceled over fear of virus resurgence
- Faced with huge needs, leading foundations will borrow in order to increase their philanthropy
- Pandemic-stricken schools tell the Senate they need help to reopen
- Journalists in Latin America say they’re facing grave risks to cover the pandemic
- Can We Survive Our Collective Stupidity?
- Sexit almost over: UK partially ending boinking ban
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.
1. Cases & Tests
- Worldwide Cases:
- Total Cases = 7,446,229 (+1.8%)
- New Cases = 134,031 (+11,701)
- Record High Number of New Cases
- Growth Rate of New Cases (7 day average) = 1.8% (+0%)
- New Cases (7 day average) = 123,844 (+1,934)
- US Cases & Testing:
- Total Cases = 2,066,401 (+1.0%)
- New Cases = 20,852 (+1,796)
- Growth Rate of New Cases (7 day average) = 1.1% (+0%)
- New Cases (7 day average) = 21,284 (+19)
- Total Number of Tests = 22,625,758 (+485,082)
- Percentage of positive tests (7 day average) = 4.4% (+0%)
- Worldwide Deaths:
- Total Deaths = 418,137 (+1.2%)
- New Deaths = 5,134 (+371)
- Growth Rate of Deaths (7 day average) = 1.1% (+0%)
- New Deaths (7 day average) = 4,478 (+29)
- US Deaths:
- Total Deaths = 115,130 (+0.9%)
- New Deaths = 982 (-111)
- Growth Rate of Deaths (7 day average) = 0.8% (+0%)
- New Deaths (7 day average) = 855 (-15)
C. Warning: Danger Ahead
1. Some Experts See a Second Wave Emerging
Increase in C19 cases in Arizona, Florida, California raise alarms
Experts say that surges can’t be linked directly to reopenings
Texas on Wednesday reported 2,504 new coronavirus cases, the highest one-day total since the pandemic emerged.
A month into its reopening, Florida this week reported 8,553 new cases — the most of any seven-day period.
California’s hospitalizations are at their highest since May 13 and have risen in nine of the past 10 days.
A fresh onslaught of the novel coronavirus is bringing challenges for residents and the economy in pockets across the U.S. The localized surges have raised alarms among experts even as they’re masked by the nation’s overall case count, which early this week rose just under 1%, the smallest increase since March.
“There is a new wave coming in parts of the country,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “It’s small and it’s distant so far, but it’s coming.”
Though the outbreaks come weeks into state reopenings, it’s not clear that they’re linked to increased economic activity. And health experts say it’s still too soon to tell whether the massive protests against police brutality that have erupted in the past two weeks have led to more infections.
In Georgia, where hair salons, tattoo parlors and gyms have been operating for a month and a half, case numbers have plateaued, flummoxing experts.
Puzzling differences show up even within states. In California, which imposed a stay-at-home order in late March, San Francisco saw zero cases for three consecutive days this week, while Los Angeles County reported well over half of the state’s new cases. The White House Coronavirus Task Force has yet to see any relationship between reopening and increased cases of C19, FDA Commissioner Stephen Hahn said on a podcast.
But in some states, rising numbers outpace increases in testing, raising concerns about whether the virus can be controlled. It will take a couple of weeks to know, Toner said, but by then “it’s going to be pretty late” to respond.
Since the pandemic initially swept the U.S. starting early this year, almost 2 million people have been infected and more than 110,000 have died.
After a national shutdown that arrested the spread, rising illness had been expected as restrictions loosened. The trend has been observed across 22 states in recent weeks, though many increases are steady but slow.
In New York, the state hardest hit by C19, Governor Andrew Cuomo only recently started reopening by region. New York City, the epicenter, began the first of four phases Monday.
“We know as a fact that reopening other states, we’re seeing significant problems,” Cuomo said Tuesday. “Just because you reopen does not mean you will have a spike, but if you are not smart, you can have a spike.”
Experts see evidence of a second wave building in Arizona, Texas, Florida and California. Arizona “sticks out like a sore thumb in terms of a major problem,” said Jeffrey Morris, director of the division of biostatistics at University of Pennsylvania’s Perelman School of Medicine.
Arizona’s daily tally of new cases has abruptly spiked in the last two weeks, hitting an all-time high of 1,187 on June 2.
This week, Arizona’s Department of Health Services urged hospitals to activate emergency plans. Director Cara Christ, told a Phoenix television station that she was concerned about the rising case count and percentage of people tested who are found to be positive.
Valleywise Health, the public hospital system in Phoenix, has seen an increase in C19 cases during the past two weeks. It’s expanded its intensive-care capacity and those beds are 87% full, about half with Covid patients, according to Michael White, the chief medical officer.
White said Valleywise has adequate protective gear for staff, but hospitals aren’t getting their entire orders. A surge in Covid cases could put that supply under stress, he said.
The increase in transmission follows steps to resume business and public life.
“Within Phoenix, we’ve been more relaxed than I’ve seen in some of the other parts of the country,” White said, with some people disregarding advice to wear masks and maintain six feet of distance from others. “People are coming together in environments where social distancing is challenging.”
Texas on Wednesday reported a 4.7% jump in hospitalizations to 2,153, the fourth consecutive daily increase. The latest figures showing an escalation came as Governor Greg Abbott tweeted a public service announcement featuring baseball legend Nolan Ryan urging Texans to wash their hands and to not be “a knucklehead.”
Abbott was criticized for an aggressive reopening last month. Mobile-phone data show activity by residents is rebounding toward pre-Covid levels, according to the Children’s Hospital of Philadelphia’s PolicyLab.
That could reflect a perception that the virus wasn’t “ever a big threat,” said Morris, who recently moved to Philadelphia after 20 years in Houston.
Florida’s health department said in a statement that it attributes the increase in cases to “greatly expanded efforts in testing,” and noted that overall positivity rates remain low, at about 5.5%.
Bucking the trend is Georgia, which was the first U.S. state to reopen. Covid cases there have plateaued. Despite local outbreaks in the state, “their sea levels did not rise,” said David Rubin, director of the PolicyLab, which has been modeling the virus’ spread. “They’ve kind of held this fragile equilibrium.”
California was the earliest state to shut down its economy over the coronavirus, after one of the nation’s first outbreaks in the San Francisco Bay Area. It has been slower than most to reopen.
Even so, California has also seen the number of people hospitalized with C19 rebound in the past two weeks, as commerce accelerates. Case counts are climbing too, although officials attribute that to increased testing and say it’s a sign of preparation.
In part, rising numbers represent the virus spreading into places that largely avoided the first round of infections, including rural Imperial County in California’s southeastern desert. Yet the contagion remains present in places that bore the brunt of the first wave, including Los Angeles County. Hospitalizations there are lower than at the start of May, but deaths remain stubbornly high, with 500 in the past week alone.
Barbara Ferrer, Los Angeles County public health director, said the region has likely not seen the end of the first wave. And despite concerns about infections coming out of mass demonstrations in the sprawling city, she thinks the reopening of the economy will have a bigger impact.
“We’re not at the tail end of anything,” Ferrer said. “We never had a huge peak. We’ve kind of been within this band. We’re not in decline, we’re kind of holding our own in ways that protect the health-care system.” But, she added, “go to Venice and see the crowds, and you’ll understand why I have concerns.”
The U.S. has long been bracing for another wave, but future outbreaks are likely to take a different shape.
Social distancing and mask-wearing, as well as careful behavior by individuals, are likely to have staying power even as economies reopen.
Experts are steeling for autumn, when changes in weather and back-to-school plans could have damaging repercussions.
“The second wave isn’t going to mirror the first wave exactly,” said Lance Waller, a professor at Emory University’s Rollins School of Public Health in Atlanta. “It’s not snapping back to exactly the same thing as before, because we’re not exactly the way we were before.”
Daniel Lucey, a fellow at the Infectious Diseases Society of America, compared the virus’ new paradigm with a day at the beach: The U.S. has been bracing for another “high tide” like the one that engulfed New York City. Today is a low tide, but “the waves are always coming in.”
2. Coronavirus hospitalizations rise sharply in at least 9 States
As the number of coronavirus cases continues to increase worldwide, and more than a dozen states and Puerto Rico are recording their highest averages of new cases since the pandemic began, hospitalizations in at least nine states have been on the rise since Memorial Day.
In Texas, North and South Carolina, California, Oregon, Arkansas, Mississippi, Utah and Arizona, there are an increasing number of patients under supervised care since the holiday weekend because of coronavirus infections. The spikes generally began in the past couple weeks and in most states are trending higher.
Data from states that are reporting some of their highest seven-day averages of new cases is disproving the notion that the country is seeing such a spike in cases solely because of the continued increase in testing, according to data tracked by The Washington Post.
Many of these states that have experienced an increase in cases have also had an increase in hospitalizations, with a handful of states also nearing bed capacity. Hospitalizations nationwide are difficult to track, with states reporting hospitalization numbers in varying ways, or not at all. Even states that do report hospitalization numbers may not have always received complete data from every hospital in the state at the time of their reports.
Texas has reported 75,616 cases since the pandemic began, and in 10 of the past 15 days, the state’s seven-day average of new cases has increased.
As of Tuesday, Texas has reported two consecutive days of record-breaking coronavirus hospitalizations. The state has seen a 36% increase in new cases since Memorial Day, with a record 2,056 current hospitalizations as of early Tuesday afternoon. It was up from a high of 1,935 hospitalizations on Monday.
Texas was one of the first states to relax their stay-at-home order. Businesses started to open up in early May. According to the state’s health department, Texas has 28.14% of available hospital beds open, and 1,723 available intensive care unit beds.
In Arizona, 28,296 cases have been reported as of Tuesday, and in 13 of the past 15 days the state’s seven-day average of new cases has increased. There have been a record number of hospitalizations in Arizona over the past few days. As of Tuesday, Arizona reported 1,243 current hospitalizations, a 49% increase since Memorial Day, when there were 833 hospitalizations.
Arizona has also been struggling with its bed capacity. On Friday, Banner Health, one of the largest health-care systems in the country, confirmed that ICUs in Arizona were nearing capacity. Roughly 50% of all those hospitalized are in Banner Health facilities. As of Monday, 76% of all ICU beds in Arizona were in use, according to data from the state health department.
Arkansas has reported 10,080 cases, and in 11 of the past 15 days the state’s seven-day average of new cases has increased. Arkansas has had an 88% increase in hospitalizations since Memorial Day. Arkansas had 173 hospitalizations reported on Tuesday, compared with 92 on May 25.
According to local reports, hospitals statewide remained below capacity on Monday, and none of the new coronavirus cases had been linked to recent protests in the state.
The Carolinas have also seen a rise in hospitalizations, with North Carolina experiencing the second-largest spike in the nation behind Texas. North Carolina’s upward trend began after Memorial Day. On May 26, the state reported 621 hospitalizations but two weeks later, that number has climbed to 774.
In South Carolina, hospitalizations sharply increased Monday. In that 24-hour span, there were 30 new hospitalizations, or a 6 percent jump, for a total of 507 covid-19 patients. With the current spike, 12 counties in South Carolina have reached 75 percent of hospital capacity or greater, according to the state’s health department.
Mississippi has reported 18,109 cases since the pandemic begin. On Tuesday, it recorded 671 hospitalizations, a new daily high. It has seen an 17% increase in hospitalizations since Memorial Day, with 573 reported on May 25.
In Utah, new C19 cases are on the rise and as a result, so are hospitalizations. Utah’s coronavirus task force tweeted that the state has seen a spike in coronavirus cases, and it wasn’t because of testing or a lone outbreak.
Similar to other regions, Utah’s numbers have climbed steadily since Memorial Day, as the seven-day average of new cases has increased 12 of the past 15 days. Over that two-week span, Utah’s current hospitalizations more than doubled, and as of Tuesday afternoon, 230 patients were hospitalized with C19.
Arizona tourist sites were packed for Memorial Day weekend. Lake Havasu, a popular vacation destination, was full, according to local officials. In South Carolina, a host of entertainment venues, including zoos, aquariums and water parks, were allowed to open the weekend ahead of Memorial Day.
In North Carolina, restaurants were allowed to open at reduced capacity and public pools at 50% capacity during Memorial Day weekend.
Also see: US COVID-19 INCIDENCE in Johns Hopkins COVID-19 Update (Annex I to this Update)
D. Potential Treatments
1. Cat drug shows promise against coronavirus
● A drug used to treat an infectious disease in cats effectively stopped the replication of the pandemic coronavirus in laboratory tests, according to Chinese researchers.
● The findings come just weeks after the American developer of the feline medicine announced that it had applied to the FDA for emergency approval to start clinical trials of the drug on humans.
● In a non-peer-review paper posted on the preprint server bioRxiv on Sunday, researchers led by Professor Zhang Shuyang at the Chinese Academy of Medical Sciences said that computer modelling and laboratory experiments suggested that the medication called GC376 was “a relatively effective and safe drug candidate”.
● The drug binds to an important enzyme of the coronavirus, according to the study. The enzyme, called Mpro, breaks down big proteins into amino acids and the virus uses these amino acids as building blocks. Without Mpro, the virus cannot make copies of itself.
● The Chinese scientists found that the drug could easily enter cells infected by the novel coronavirus and inhibit viral production. It required only a dose of very low concentration to achieve maximum effect, “showing an excellent safety profile”, the researchers said.
● GC376 was developed by Anivive Lifesciences, a biotech company based in Long Beach, California, and has been used to treat kittens suffering the feline infectious peritonitis, a fetal disease that is caused by a coronavirus that does not infect humans.
● Anivive filed a pre-investigational new drug request with the FDA for GC376 based on its own research over the past few months, the company said late last month.
● Anivive said it would receive guidance from the FDA to set up clinical study protocols. It was unclear when the drugs would be tested on C19 patients.
● “We look forward to our discussions with the FDA and advancing toward a clinical trial,” company founder Dylan Balsz was quoted as saying.
● There were numerous reports of cats being infected in the global pandemic. At the Bronx Zoo in New York, five tigers and three lions developed symptoms including a cough and tested positive for the new coronavirus.
● A study in April led by Professor Chen Hualan, at the Harbin Veterinary Research Institute, found that Sars-CoV-2 was particularly bad for cats. The virus replicated poorly in dogs, pigs, chickens and ducks, but thrived in the airway and intestines of cats.
● The Chinese scientists warned in a paper published in Science magazine that cats could become a hidden reservoir or intermediate host that passed the virus to humans.
● Guo Xiaofeng, professor of veterinary with the South China Agricultural University in Guangzhou, said some diseases infected both humans and animals, and their medical treatments could be similar. The rabies virus, for instance, could jump from dogs to humans through a bite, and the rabies vaccines for dogs and humans were technically identical.
● “The difference, if any, may be quality,” Guo said. “If a drug works on cats, there is a reasonable hope it will work on humans as well. But there is no guarantee.
2. Common Enzyme May Protect Lungs
● When a person is infected with the novel coronavirus, the deadliest symptoms often show up in the lungs.
● The reason is now well-understood: The virus enters through ACE2, an enzyme that is commonly found on the surface of lung cells and that, ordinarily, helps tamp down inflammation. When it’s interrupted, inflammatory forces run amok.
● But ACE2 is far more than just an entryway for infection, and scientists say the enzyme could point the way to a much-needed treatment for C19. Constant Therapeutics, a privately held Boston biotech company with a small staff and a threadbare website, hopes it might have just the drug to address that need.
● ACE2 operates like a referee in what’s called the renin-angiotensin system, which regulates blood pressure. When angiotensin II, a peptide that constricts blood vessels, gets too high, ACE2 steps in and converts it to angiotensin-(1-7), a Gallant to its Goofus that relaxes vessels and reduces inflammation.
● “The system seems to operate on a balance in which angiotensin-(1-7) is protective and angiotensin II is the bad guy,” said Salvador Moncada, a professor of clinical pharmacology at the University of Manchester who specializes in inflammatory disease.
● For Concepción Peiró, a professor of pharmacology at the Autonomous University of Madrid, reading that the novel coronavirus attacked ACE2 brought angiotensin-(1-7) immediately to mind. Beyond its effects on inflammation, angiotensin-(1-7) has proved to protect against blood clots, oxidation, and premature cell death.
● So she called Moncada, a longtime colleague, to confer, and the two wrote a letter to the journal Circulation, hypothesizing that boosting angiotensin-(1-7) could protect the lungs from C19’s worst symptoms while the immune system did its work on the virus.
● Their work appeared online April 4. On April 5, Moncada got an email from Rick Franklin, CEO of Constant Therapeutics. The company’s intravenous drug, TXA127, is a pharmaceutical version of the naturally occurring peptide angiotensin-(1-7), and the company had spent years developing it as a treatment for diseases in which the renin-angiotensin system was out of kilter.
● When C19 came, Franklin saw TXA127 as a potential missing puzzle piece. The industry’s focus had been on antivirals, which would fight infection, and vaccines, which would prevent it in the first place. But TXA127 could be a treatment for the host, not the virus, buying patients time by replicating the effects of ACE2 until the natural enzyme got out from under coronavirus.
● “It wasn’t any genius on our part to piece this story together,” Franklin said. “It’s just that we had been looking at it for such a long time that it became obvious to us.”
● The Circulation letter lent weight to Franklin’s argument, and Constant began hearing from academic centers around the world hoping to study the drug in C19.
● The first trial, sponsored by Columbia University, is slated to start this month, enrolling 100 patients with moderate C19 and comparing a daily dose of TXA127 to placebo. The primary goals are safety and prevention of lung failure, with secondary measures of survival, inflammation, and the need for respiratory assistance.
● Constant is mapping out a Phase 2 trial of its own, one that would involve about seven sites and enroll more than 200 patients who have C19 but don’t yet require intensive care. It will likely take a few months to get up and running, Franklin said, meaning it would be recruiting by the fall, in time for what could be a second wave of C19 cases in the U.S.
● The company’s approach sounds promising, said Ankit Patel, a nephrologist at Brigham and Women’s Hospital in Boston. But ACE2 does more than just create angiotensin-(1-7), and replicating its beneficial effects may require more than just infusing more of the peptide, he said.
● “It definitely seems that there’s this unopposed angiotensin II in C19, and trying to reverse that seems like a good technique to address some of the lung pathology that we see,” Patel said. “But it’s going to be a fine balance, and the devil’s really in the details in terms of how these different trials are going to be set up.”
● While TXA127 makes biological sense as a C19 treatment, proving its benefit in clinical trials could be an arduous process, said Moncada, of the University of Manchester. A significant percentage of people who get the disease recover without developing serious lung symptoms. That means, in order to demonstrate the potential of TXA127, Constant will either need to enroll a large number of patients or figure out how to screen for the C19 cases most likely benefit from the drug, Moncada said.
● Franklin is confident his company can thread the needle. Constant is considering a trial design that would recruit C19 patients who need oxygen but aren’t yet in the ICU, betting TXA127 can differentiate itself from placebo when it comes to preventing lung damage.
● The role of ACE2 in C19 is widely accepted, and the potential of angiotensin-(1-7) is clear to experts around the world, Franklin said. Constant’s task ahead is the blocking and tackling of running a clinical trial, something he believes the company is well-prepared for.
● “I’d love to say that a year from now there’s no need for this drug because we’re all immune, but that’s not going to happen,” Franklin said. “I think we can provide an enormous benefit to people and to the health care system if this drug works. And my gut says that it’s going to.”
1. Antibody Tests Are Not As Reliable As You Think
● After a rocky rollout, higher-quality coronavirus antibody tests have emerged that, among other uses, are beginning to give a clearer picture of the pathogen’s spread.
● But for people who are simply curious about whether they’ve unknowingly been infected, some doctors and public-health authorities are still hesitant to recommend antibody tests. The reliability of these tests for any one person, they say, comes down to a matter of probability: As with most other medical tests, that depends not only on a test’s quality but also on a disease’s prevalence within a community.
● A positive result is more likely to be accurate in places where the infection rate is high—and less likely in places where the infection rate is low. That is because in an area with low prevalence, many more people without the disease are getting screened compared with those who are infected, so false positives make up a higher proportion of positive results.
● “It’s a probability nightmare if the prevalence is low,” said Anthony Lemmo, chief executive of BioDot, a diagnostics manufacturing company. “That is really difficult for people to wrap their head around.”
● If you tested positive, there is a 16.0% chance it was a false positive and you actually do not have antibodies
How reliable are antibody test results?
● All antibody tests are not created equal, and the reliability of their results depends on the test’s sensitivity and specificity and the prevalence of the virus in the population (not taking into account past symptoms or exposure). Explore how changes in those metrics can dramatically affect the accuracy of your results [Go to the WSJ article to enter your test information: Tested Positive for Coronavirus Antibodies? Don’t Let Your Guard Down]
● Antibody tests search the blood for disease-fighting proteins that signify past infection. Testing surveys within communities, also called seroprevalence studies, are starting to confirm that the continuing pandemic has spread unevenly in the U.S.
● In New York City, roughly 22.7% of adults are estimated to have been infected through March 29, according to a non-peer-reviewed report from the New York State Department of Health. The prevalence is likely much lower in other parts of the country, according to infectious-disease experts, though it could be higher in specific settings that have seen outbreaks, such as nursing homes or meatpacking plants.
● “In New York City, or in Detroit, New Orleans, Seattle—these areas that have had high prevalence—I think [a positive result is] more likely to be a true positive,” said John Williams, chief of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh. He added, “I really worry a false sense of security from a false positive test will allow people to let down their guard.”
● In May, the U.S. Food and Drug Administration enacted stricter regulations on antibody tests to crack down on many early offerings that proved unreliable. Antibody test makers are now required to seek an emergency use authorization from the FDA to market their tests. The agency has authorized at least 17 antibody tests for C19, and there are more than 100 additional tests on the market awaiting review.
● To get authorization, tests now have to be 90% “sensitive,” or able to detect antibodies, and 95% “specific,” or able to identify their absence. Yet even with tests that hit that benchmark, the chance for false positives can still be higher than true positives if the prevalence of disease is too low.
● For example, for a survey of 2,000 people in a community where the actual infection rate is 5%, or 100 people, a test that is 90% sensitive would pick up 90 true positives and 10 false negatives. And if the test is 95% specific, it would identify 1,805 true negatives and 95 false positives. False positives outnumber true positives, even though the results were accurate for the majority of people tested.
● “95%—that sounds like a high number,” Angela Caliendo, secretary for the Infectious Diseases Society of America and professor at Brown University, said at a media briefing last month. But even with that high specificity, she said, “you’re going to have as many false positives as you have true positives” if the community infection rate is low.
● Concerns over high proportions of false positives aren’t unique to antibody testing. Oncologists have debated the benefits and harms of widespread cancer screenings for years, and false positives have posed a problem in newborn screening programs as well.
● For C19 antibody testing, public-health experts are concerned that a false positive result would cause a person to change their behavior and become less cautious, because they think they have some level of immunity to the virus.
● While immunologists say antibodies probably do provide some protection against the coronavirus, they don’t yet know what levels are required to be protective, or how long such protection might last.
● Even a true positive test result shouldn’t change a person’s behavior, experts say, at least for now. The CDC recently said antibody tests shouldn’t be used to make decisions about returning to work.
● In its testing guidelines for doctors, labs and health officials, the CDC recommends choosing tests with a specificity above 99.5% if possible, or focusing tests on people who are more likely to test positive—such as those who have had symptoms associated with the virus. It also recommends potentially retesting, using a different test, to reduce the chances of false positives.
● Researchers can adjust results from large surveys to account for imperfect accuracy and better understand the disease’s prevalence. But determining whether an individual test result is accurate is more difficult, public-health experts say.
● The reliability of an individual positive test result is called “positive predictive value,” a number the FDA posts for authorized tests.
● For some of the most accurate tests—those with greater than 99.5% specificity, like the ones developed by Roche Holding AG and Mount Sinai Hospital in New York—the positive predictive value is still above 90% at 5% prevalence, so false positives are rarer.
● For a handful of tests, though, the positive predictive value drops to around 50%.
● For those reasons, an individual test result is most valuable when it is part of a broader clinical picture, medical experts say. Clinical clues such as past symptoms, travel history and known exposure help doctors interpret a positive test result, Nandini Sethuraman, a clinical microbiologist at Apollo Hospitals in India, said. “It all boils down to your pretest probability,” she said, or how likely it is that someone had the disease in the first place.
● “We try to be selective in our testing to make it more reliable,” UPMC’s Dr. Williams said. “If somebody had an exposure to sick people, or they’re a health-care worker, that’s more likely to be a true positive.
● If we just start testing the population at large, most of the positives are going to be false positives.”
F. New Scientific Findings & Research
1. Widespread mask-wearing could prevent second waves
● Population-wide face mask use could push C19 transmission down to controllable levels for national epidemics, and could prevent further waves of the pandemic disease when combined with lockdowns, according to a British study on Wednesday.
● The research, led by scientists at the Britain’s Cambridge and Greenwich Universities, suggests lockdowns alone will not stop the resurgence of the new SARS-CoV-2 coronavirus, but that even homemade masks can dramatically reduce transmission rates if enough people wear them in public.
● “Our analyses support the immediate and universal adoption of face masks by the public,” said Richard Stutt, who co-led the study at Cambridge.
● He said combining widespread mask use with social distancing and some lockdown measures, could be “an acceptable way of managing the pandemic and re-opening economic activity” before the development of an effective vaccine against C19, the respiratory illness caused by the coronavirus.
● The study’s findings were published in the “Proceedings of the Royal Society A” scientific journal.
● At the onset of the pandemic, scientific evidence on the effectiveness of face masks in slowing transmission of respiratory diseases was limited, and there was no data on C19 since it was a previously unknown disease.
● But, prompted by some new research in recent weeks, the World Health Organization said on Friday it now recommends that everyone wear fabric face masks in public to try to reduce disease spread.
● In this study, researchers linked the dynamics of spread between people with population-level models to assess the effect on the disease’s reproduction rate, or R value, of different scenarios of mask adoption combined with periods of lockdown.
● The R value measures the average number of people that one infected person will pass the disease on to. An R value above 1 can lead to exponential growth.
● The study found that if people wear masks whenever they are in public it is twice as effective at reducing the R value than if masks are only worn after symptoms appear.
● In all scenarios the study looked at, routine face mask use by 50% or more of the population reduced C19 spread to an R of less than 1.0, flattening future disease waves and allowing for less stringent lockdowns.
● Experts not directly involved in the latest British study were divided over its conclusions.
● Brooks Pollock, a Bristol University infectious disease modelling expert, said the likely impact of masks could be much smaller than predicted. Trish Greenhalgh, an Oxford University professor, said the findings were encouraging and suggested masks “are likely to be an effective population measure”.
2. Speech Superemitters: The Language and Volume We Speak Can Affect Transmission of the Virus
● During the 2003 SARS outbreak, almost all of the suspected cases in the United States were people who had recently traveled to parts of the world where SARS was spreading, like China. In July of that year, Sakae Inouye, a researcher at Otsuma Women’s University in Tokyo, brought up a puzzling fact: There had been more Japanese tourists in China than Americans, and yet Japan had somehow escaped SARS—with zero officially reported cases.
● Inouye’s guess as to why, which he wrote about in a letter to the medical journal The Lancet, was that SARS might be more easily transmitted in certain languages, namely Chinese and English, because of how much breathing in and out is needed to produce those language’s common sounds.
● In Chinese, “the consonants p, t, k, q, ch, and c, when placed in front of vowels, are pronounced with a strong breath,” he wrote. In English, p, t, and k are also pronounced by exhaling breath—but not in Japanese. He also noted that the “p” sound isn’t used as frequently in Japanese.
● He suggested that a Chinese person would mostly speak English to an American traveler—“I believe American tourists would, hence, be exposed to the infectious droplets to a greater extent than would Japanese tourists.”
● This idea—that disease transmission could change based on language—has been raised again during our current global pandemic with the coronavirus .
● On May 14, Japan began to lift its state of emergency, about two weeks earlier than it had planned to. Their new C19 cases have dropped near .5 per 100,000 people, and they accomplished this without strict social distancing or widespread testing seen in other countries. “Did Japan Just Beat the Virus Without Lockdowns or Mass Testing?” a recent headline at Bloomberg wondered. Even in Tokyo, the most populated city in the world, case numbers have fallen to single digits.
● There have been speculations circulating online as to why Japan got off so easy. Hitoshi Oshitani, a virologist and public health expert at Tohoku University, told Science magazine that they identified clusters of infections to stop them from spreading and urged people to avoid “the ‘three Cs’—closed spaces, crowds, and close-contact settings in which people are talking face-to-face.” Other factors may have led to Japan’s success: An already existing mask-wearing culture and rapid response from contact tracers.
● But the question of language has reemerged: Maybe something about speaking the Japanese language produces less viral particles to pass onto others. In May, a clip from Japanese television started circulating on Twitter, garnering over 40,000 likes. It shows a woman saying, “This is a pen,” first in Japanese, and then in English, with a white cloth hanging in front of her face. When the woman speaks English, the phrase causes the cloth to flap in the wind emitted from her mouth; when she speaks Japanese, it stays nearly entirely still.
● One of the ways the coronavirus is thought to be transmitted between people through respiratory droplets, which can fall and land on surfaces, and then be brought to people’s faces by touch. Coughing and sneezing are the poster children of transmitting these disease-containing particles, which are often large enough for the eye to see.
● But normal speech can also produce smaller particles that we can’t see, yet are big enough to carry pathogenic viruses. The question of how well C19 can spread through the air on these small particles, or aerosols, has been up for debate. Case reports of transmission at choir practices, restaurants, and call centers suggest that it is possible for SARS-CoV-2 to hitch a ride on aerosol particles and stay suspended in the air.
● Two recent studies have found that normal talking can emit thousands of small particles that can linger in the air for over 10 minutes. And other recent work has found that different speech sounds produce more of these particles than others. For example, more particles are emitted by saying phrases that have a lot of vowels.
● “Saying eee releases more than saying ahhh,” said William Ristenpart, a chemical engineer and an expert in transport phenomena at The University of California Davis. In a study by Ristenpart and his colleagues from January, they found that saying the phrase “The rainbow is a division of white,” produces many more particles than “A sign from the gods to foretell war.”
● Still, we’re not yet able to pinpoint a particular language as being more or less risky for transmission. Ristenpart said that the volume at which a person speaks might overpower any individual differences of language. He and others found that some people, despite their language or volume, seem to emit much more particles than others while they talk. Taken altogether, the variations of different kinds of talking, breathing, and singing need to be paid closer attention to and investigated, multiple experts have said, especially as public health recommendations are made around mask-wearing, how far apart and where people can gather (and talk), and what kinds of speaking or singing activities can be done indoors—no matter what the language.
● More recently, a study in the Journal of Aerosol Science found that counting from 1 to 100 releases six times as many particles as one cough. In 2009, a study found that coughing continuously for 30 seconds released half as many particles as saying “aah” for 30 seconds.
● These particles are thought to come from the mucosal layer coating the respiratory tract, and they are very small: about 1 micron in diameter (a micron is a millionth of a meter; about .00004 inches). We know these minuscule particles can carry other pathogens. Research from 2016 and 2018 found infectious influenza in particles emitted by influenza-infected people who weren’t coughing or sneezing, but just breathing naturally.
● These particles could be an even higher risk for infection, because they linger in the air longer (since they’re so light) and could penetrate further into the respiratory tract. And since speech is more common than coughing or sneezing, it has more of a chance to release particles.
● A study from May in The Proceedings of the National Academy of Sciences found that talking can propel thousands of tiny aerosol droplets into the air, which can evade gravity and stay floating in the air for 8 to 14 minutes.
● The researchers asked people to say the phrase “stay healthy” while measuring the droplets they emitted. There were around 2,600 small droplets produced per second. Though the subjects in the study weren’t sick themselves, using information from past work, they estimated that one minute of loud talking could make 1,000 virus-containing droplets.
● “For asymptomatic people, saliva droplets created from simple speech – not sneezing or coughing – likely account for the majority of droplets a person expels, but more research is needed to determine the number of virus particles that are present in speech-generated droplets,” said Lisa Yuan, a spokesperson on behalf of the study’s authors at the National Institute of Diabetes and Digestive and Kidney Diseases.
● Pathogen spread might be slightly influenced by language, but more by certain people who just produce more particles when they talk. Research from 2019 also found that a small number of people were “speech superemitters,” who regularly produced much more particles than the others, despite what language they were using or how loud they were talking.
● “We called that the loud-mouth hypothesis,” Ristenpart said. “Some people speak pretty loud, pretty often, and they’re going to emit more. And then some people, for reasons we don’t understand, emit a heck of a lot more than others.”
● There could be some unknown physiological reasons that makes someone a speech superemitter, and we need more research to find out if that contributes to make someone a “super spreader”—individuals that infect many others.
● “It would be wise to avoid extended face-to-face conversations with other people unless you are far apart and in a well-ventilated space, including outdoors.”
● Still, Ristenpart thinks that language—what sounds are made as well as the volume at which they’re spoken—should be an epidemiological consideration that’s factored in, especially when considering why or why not a certain country has high or low infection rates.
● In a recent editorial in Science, scientists from National Sun Yat-sen University in Taiwan and University of California San Diego wrote that they believed a large proportion of the spread of C19 “appears to be occurring through airborne transmission of aerosols produced by asymptomatic individuals during breathing and speaking.”
● Ristenpart has one idea, though: “One possible, very easy, public health measure would be just to recommend everybody to use their library voices.”
3. Dogs Can Be Trained to Sniff Out C19
● In the future, getting checked for C19 might involve a visit with a dog rather than a doctor.
● Canines may be able to detect the disease, reports a new study, possibly even before people start showing symptoms.
● In a new proof of concept paper, French researchers present evidence for dogs being able to detect C19 by sniffing sweat from humans’ armpits. After a training period, eight dogs — which had previously been trained to detect explosives and colon cancer — were able to detect the disease either most or all of the time, researchers report.
● This finding was published on June 5 on the preprint server bioRxiv. It has not yet been peer-reviewed.
● The dogs completed 368 trials, sniffing hospital-provided sweat samples of people who either tested positive or negative for C19. The main question the researchers needed the dogs to answer was whether SWEAT SMELLS DIFFERENT in people who have the disease.
● “If the answer had been no, we would have stopped — poof, finito,” lead study author Dominique Grandjean tells Inverse.
● But on the first day of training, it became clear within just a few hours that the dogs’ expert noses picked up something different in the C19 sweat samples. It was “so damn easy” to get the dogs to detect the disease, Grandjean says.
● To train the dogs, the researchers placed four sweat samples, gathered on gauze cylinders swabbed on human armpits, in a line. The dogs were trained to sit after they identified a C19-positive sample.
● PRE-SCREENING FOR C19? — Grandjean is a veterinarian and professor at the National Veterinary School of Alfort, just outside Paris, France. In addition to conducting medical research with dogs sniffing for diseases like colon cancer and Parkinson’s disease, he works with firefighters to train search-and-rescue dogs.
● In the new study, most of the dogs used were Belgian Malinois Shepherds, a common work dog in France. But the study authors point out that many dog breeds can develop similar skills.
● It may even be the case that dogs can detect C19 before humans show symptoms. Grandjean explains that one pair of cases, from a couple that provided sweat samples, puzzled him: The humans had tested negative for C19, but every dog in the study flagged the sweat sample as C19-positive.
● Grandjean didn’t know what the problem was. A week later, the chief medical officer at the hospital gave him a call: The patients were back in the hospital, with C19 symptoms and a positive diagnosis.
● “It’s just amazing,” Grandjean says.
● Researchers in Finland are currently looking at whether dogs can detect the novel coronavirus in humans’ urine. In the United Kingdom, researchers are having dogs sniff worn masks and nylon socks. And in the United States, trials are underway to look at dogs sniffing both urine and saliva.
● Grandjean chose to focus on sweat because the evidence so far suggests that sweat is unlikely to transmit C19. This detail could protect both dogs and humans coming into contact with the sweat: Several cases of dogs with the disease have been reported, though all animals have been expected to recover. Researchers don’t believe dog transmission is a significant risk to humans.
● Sniffing pit sweat offers another benefit, too, Grandjean says: practicality. Down the road, it’s possible that some kind of disease detection would be useful at public places like airports. In that case, sniffing sweat is a more viable approach than, say, detecting the disease through urine.
● “Are you going to ask the people to pee when they arrive at the airport?” he asks. “I don’t think it’s a good option.”
● Sniffing sweat also helps to avoid the risk of a dog contracting the disease through human saliva, Grandjean says.
● Looking ahead, Grandjean is continuing to study dog detection of C19. Now that he’s completed the proof of concept, he hopes the next round of study can include at least 100 dogs, to gain better numbers on how accurately dogs can sniff out the disease.
1. Pivotal Vaccine Testing to Start This Summer
● The federal government plans to fund and conduct the decisive studies of three experimental coronavirus vaccines starting this summer, according to a lead government vaccine researcher.
● These phase 3 trials are expected to involve tens of thousands of subjects at dozens of sites around the U.S., John Mascola, director of the vaccine research center at the National Institute of Allergy and Infectious Diseases, said. Meant to determine a vaccine’s safety and effectiveness, they would mark the final stage of testing.
● Moderna Inc.’s vaccine is set to be first, starting in July, followed in August by one co-developed by Oxford University and AstraZeneca and in September by Johnson & Johnson’s, he said.
● The timetable suggests researchers are making relatively rapid progress advancing their vaccines through earlier stages of testing—focused on whether they are safe and induce the desired immune response—to at least merit the planning.
● “We will want to use the investigative resources of the country as best we can to optimize us getting an answer as quickly as possible,” said Larry Corey, a vaccine and infectious-disease specialist at the Fred Hutchinson Cancer Research Center in Seattle and member of a committee advising the National Institutes of Health on the design of the coronavirus-vaccine trials.
● A Moderna spokesman confirmed the plan for the NIH-funded trial of its vaccine. An AstraZeneca spokeswoman on Tuesday evening said the company’s recent contract with a U.S. health agency would support a large study but couldn’t confirm the start date. A J&J spokesman declined to comment.
● Separately, Pfizer Inc., which with partner BioNTech SE has one of the more advanced vaccine candidates, could begin its phase 3 trial as early as July, said a person familiar with the matter. Pfizer isn’t participating in the NIH testing program.
● Many vaccine candidates fail to make it through the trials.
● “There’s a lot of optimism in our community that a vaccine should be possible, but we are very focused on the fact that that has to be proven in clinical trials,” Dr. Mascola said in an online video discussion hosted by the Fred Hutchinson Cancer Research Center on Friday.
● There aren’t any vaccines proven to work against the coronavirus. Public-health authorities say one or more will be needed before life can fully return to normal, because unlike drugs, vaccines could prevent infections or at least prevent or limit the severity of C19, the disease caused by the coronavirus.
● An existing network of researchers who have run HIV vaccine studies, which Dr. Corey leads, will help to conduct the large coronavirus vaccine studies.
● The studies will be designed, Dr. Corey said, to show more definitively whether the vaccines safely prevent disease. Researchers would start the phase 3, NIH-funded studies only once they have sufficient evidence from the earlier testing that the vaccines are safe and elicit certain immune responses in people, Dr. Corey said. The studies are also subject to clearance by regulators.
● Each vaccine study is expected to include roughly 30,000 people, some receiving the experimental shots and others placebo shots, though the final number of participants could vary, Dr. Mascola said. Each study will be conducted at more than 50 sites, primarily in the U.S. but possibly including other countries, Dr. Corey said.
● Researchers will track whether people who receive the vaccines are infected with the virus and develop C19 at lower rates than those who get placebo. The studies will be conducted in locations where the virus continues to spread, Dr. Corey said.
● The government may plan similarly large trials for additional coronavirus vaccines in development, such as those being developed by Sanofi SA and Merck & Co. Dr. Corey said testing plans for other vaccines haven’t been completed.
● Last month, Moderna said its vaccine, co-designed with NIH researchers, was generally safe and induced immune responses in a small, early-stage study. The second phase of testing just began.
● Human testing of the vaccine from AstraZeneca and Oxford’s Jenner Institute has started, but results haven’t been released. J&J said previously it would start human testing by September.
● Researchers hope the trials will yield answers within six to eight months of their starts, Dr. Corey said. Some vaccine developers have said their shots could become available for emergency use on a shorter timeline, possibly as soon as the fall.
● Though each vaccine will be tested in a separate trial, the companies are coordinating certain aspects, such as using the same independent committee to monitor safety, according to Dr. Corey. This will allow researchers to better compare how the vaccines perform, and whether certain shots are better suited to certain subpopulations, he said.
2. Is it realistic to expect a vaccine soon?
Scientists around the world are working on more than 135 vaccines for the virus. But producing one in just 12 to 18 months, the oft-cited timeline, would be an unprecedented feat.
To understand the enormity of the challenge and what the future may hold, The Times assembled a virtual round table with five experts. Here are some of their key points.
How could researchers come up with a vaccine in less time than the years (or decades) it has historically taken?
“For C19, developers are talking about performing as many steps in parallel as possible, as opposed to sequentially. For example, multiple vaccine manufacturers are willing to take enormous financial risks — planning for large-scale manufacturing upfront, even before knowing whether the vaccine works or not.” — Dan Barouch, virologist and professor at Harvard Medical School
The process could be sped up even further, but doing so would likely be dangerous.
“One ethically fraught possibility that some experts have floated is the use of so-called challenge trials, in which young, healthy people are given a vaccine and then deliberately exposed to the virus.” — Siddhartha Mukherjee, associate professor of medicine at Columbia University
The panelists were hopeful after seeing the scientific community unite against the virus.
“There’s been more openness and sharing than I’ve seen in past crises like Ebola or Zika or H1N1. Regulatory authorities around the world are coming together in ways that are very, very important to reduce barriers and to make sure that they’re bringing the best possible science to bear on decision making.” — Margaret Hamburg, foreign secretary of the National Academy of Medicine
For full story, see: Is it realistic to expect a vaccine soon?
Also, the New York Times has created a new tracker that will that will follow the status of every vaccine that has reached human trials, as well as some promising ones still being tested in cells or animals., which can be found at Coronavirus Tracker
H. Lessons From Abroad
1. Architect of Japan’s Virus Strategy Sees Flaws in West’s Approach
One of the key architects of Japan’s coronavirus strategy has hailed the country’s response to the pandemic, saying its approach was more effective than those implemented by Western nations.
“Data clearly indicates that the measures taken by Japan have been more effective than those taken in Western countries,” Hitoshi Oshitani, a professor of virology at Tohoku University and a member of the expert panel advising the government, said in an interview with Diplomacy, a journal published by the country’s Foreign Ministry.
Western countries became involved in a “war of attrition” of tracking down each individual case of the virus to thoroughly eliminate them, Oshitani said.
Japan, on the other hand, allowed some degree of transmission of the virus and focused instead on identifying clusters of infection. This avoided exhausting the testing and medical system but was effective in eliminating large-scale transmission, he said in the interview, which was released in Japanese earlier this month.
Oshitani’s remarks come despite domestic dissatisfaction with the handling of the outbreak, and as Tokyo is yet to fully reopen its economy after ending the state of emergency. While cases and deaths in Japan are lower than Group of Seven peers, its performance still trails that of several other Asia Pacific nations — including neighbor Taiwan, which saw just seven deaths from the disease, and New Zealand, which on Tuesday declared the virus eliminated. Japan had 17,210 cases and 916 deaths as of Tuesday, according to data from the Health Ministry.
Noting the success other Asian countries have had with varying strategies, a “one-size fits all” approach where Western countries create guidelines on infectious diseases for lower-income countries — with the WHO acting as the intermediary — no longer makes sense, according to Oshitani.
Japan allowed a second wave of infections to develop by letting in an estimated 1,000 to 2,000 carriers of the virus from Europe, the U.S. and elsewhere before travel restrictions were implemented at the end of March, Oshitani said. The delay was “regrettable,” he said, despite having quashed the first wave of the disease which stemmed from China. Oshitani acknowledged Japan failed to meet a target of keeping deaths below 100, and said it is now focusing on keeping them below 1,000.
Prime Minister Shinzo Abe touted what he called a “Japan model” to tackling the coronavirus when he declared an end to the state of emergency in May. Citizens and businesses are slowly trying to resume a sense of normality, with new cases of the virus dropping to zero in many parts of the country. A warning that was triggered in Tokyo following an uptick of cases last week may soon be lifted after cases began to fall again.
Japan took a controversial approach to the call from the World Health Organization to “test, test, test,” — its total testing rate remains one of the lowest in the world. This has met with criticism both domestically, from those who couldn’t get checked for the disease, and from other countries, with the German embassy in Tokyo at one point warning its citizens that Japan didn’t know the true scale of the infection due to its testing approach.
But Oshitani defended the country’s stance, saying that deliberately limiting access to PCR tests was a key reason for success. During the H1N1 influenza pandemic in 2009, a rush of people cramming into clinics to get tested created breeding grounds for the virus to circulate in waiting rooms. Oshitani questioned the quality of PCR test kits used in the U.S. that were “prematurely” approved, and PCR primer reported by China had low accuracy, he said.
In the wide-ranging interview, Oshitani also dismissed the concept of herd immunity as “nonsense,” said it was “impossible” to completely eliminate the virus and called for Japan to change how society works to avoid a resurgence of the pandemic.
The next threat would be from another influenza pandemic for which no one has immunity, with infectivity no match to the coronavirus — a reality that could occur “at any moment.”
Oshitani also cast doubt on the future of a globalized world.
“An efficient world that prioritizes economic efficiency, is extremely vulnerable to infectious diseases,” he said. “We are now being challenged whether we want to return to such a vulnerable world even after Covid-19.”
I. The Road Back?
1. Will Immunity Create An Epidemiological Hierarchy?
● Scrolling through Airbnbs in Brooklyn, one listing stands out. “IMMUNE HOST,” claims the heading in caps. Among photos of rooftop sunsets and interiors, lies something else unexpected – a picture of a positive antibody test.
● Host Martin Eaton says he got tested in March a few weeks after getting sick with what he suspected was C19. When the results came back positive, he decided to include it in his profile to attract reservations.
● “If I was having to travel to New York I’d prefer staying with somebody who had the antibodies versus somebody who didn’t,” says the 48-year-old writer. So far, he adds, “it’s proved pretty successful”.
● In the absence of a vaccine, immunity is emerging as a potential key to resuming normal life after the pandemic – leading some to believe that testing positive may not be such a bad thing. Providing they survive, they will at least – they hope – be immune. But as states and countries slowly reopen businesses to the public, how important will it be?
● Questions remain over the accuracy of C19 antibody tests and the World Health Organization has warned that there is no evidence that people who have recovered from the virus and have antibodies are protected from getting it a second time.
● But experts predict that if survivors are found to be immune, they could perform a range of jobs and services – such as volunteering in hospitals and nursing homes, caring for coronavirus patients and working in shops and food processing plants – risk-free. And, depending on how authorities, business and society at large respond, they could also be entitled to greater freedoms.
● In Chile, the government is issuing “release certificates” (but they will not confirm immunity) to people who complete quarantine after testing positive. In China, “health code” apps are being used to determine who can travel where.
● Dr Anthony Fauci, director of America’s National Institute of Allergy and Infectious Diseases, has said immunity certificates are “possible” in the US and that they “might actually have some merit under certain circumstances”.
● Providing there is a way to certify that people have had the test, that it was effective and that the antibodies last, Dr Ezekiel J Emanuel, chairman of the department of medical ethics and health policy at the University of Pennsylvania, says immunity passports could have “real positives” for both the patient and the wider community.
● He also believes it will become necessary for travel – even after a vaccine – to prove immunity and as a means to skip quarantine. “Showing that you’ve been infected and are immune and can’t transmit the virus is a really powerful mechanism.”
● The concept is already being adopted by the private sector. The hotel booking app Sidehide and verification company Onfido are developing an immunity passport for hotels – set to launch in Miami this month.
● Such are the perceived benefits of immunity that some people are intentionally trying to get the potentially deadly virus.
● Dr Jerome Williams Jr, cardiologist and senior vice-president of consumer engagement at Novant Health, says they have had multiple people test positive in Winston-Salem, North Carolina, after attending “coronavirus parties” – gathering unprotected with positive people – in the hope of getting infected.
● Without knowing exactly how immunity works, the parties are, he says, “a bad idea all round”.
● Despite the perceived advantages of immunity, creating a system that publicly identifies people with antibodies opens safety and privacy issues.
● The ACLU has warned against immunity passports, which it fears could incentivise poor people to risk their lives to intentionally get sick so they can work, exacerbate racial and economic disparities, encourage health surveillance and endanger privacy rights.
● Eric Klinenberg, sociologist and director of the Institute for Public Knowledge at New York University, says immunity is not “the new golden ticket” it is perceived to be.
● “That just opens up a Pandora’s box of questions about how we determine who’s immune, about how we record and register who’s immune, about how we track people and what happens to people who are not?” he says. “So I can very easily see it becoming yet another source of controversy in an already divided country.”
● During the 19th century in the American south, yellow fever – which had a 50% death rate – created an “epidemiological hierarchy” of those who had and had not had it, says Kathryn Olivarius, assistant professor of history at Stanford University.
● This, she adds, created “immunocapital” that affected newly arrived white people’s ability to get jobs, homes and insurance policies, which meant they had little option but to try to get infected.
● Olivarius fears a similar situation could be created today if employers start hiring only people with antibodies. “I’m worried we’ll develop this system, the haves of immunity, the have-nots, it sounds science fictional almost.”
● Immune status could also result in discrimination. Last month, it was revealed that the US military was considering banning people who had been hospitalized by coronavirus from enlisting – guidance it has since walked back.
● There is, Olivarius warns, “a fine line between privilege and stigma”. “Even if there are benefits to being immune potentially, like being able to work, maybe later immunity could turn into a kind of stigmatized status.”
● But according to Cathy O’Neil, mathematician and author of Weapons of Math Destruction, it is unlikely that immunity will grant people much power, considering brown and black people are the ones hardest hit by the virus and therefore the most likely to be immune.
● “Most powerful people in this country will not have immunity and they will not set up a system that excludes them from things that they like to do.”
● It’s possible that, given regional differences in infection rate and its distribution in the population, only a very small number of people in some areas would actually be eligible for an immunity certificate. And the concept may be most compelling now, as the public anxiously awaits a vaccine.
● But once one is developed, O’Neil predicts the advantages of any immunity certificates will fade. The infrastructure set up to track it, however, would probably live on.
● “I do worry that it’s like we’re welcoming our algorithmic overlords to our lives in order to deal with this public health menace,” she says. “And then we’ll be stuck with them.”
J. Practical Tips & Other Useful Information
1. NYC Health Officials Offer Advice On Sex During a Pandemic
[Note: Highlights Omitted As We Have No Idea What May Interest You]
- City health officials suggest New Yorkers kiss boring bedroom behavior goodbye — but not each other — in an updated guide on how to practice extra-safe sex during the coronavirus pandemic.
- But before getting frisky, everyone should slip on a different type of protection — a face mask.
- “During the pandemic wearing a face covering that covers your nose and mouth is a good way to add a layer of protection during sex,” according to the agency, which this week announced free home delivery of condoms, lube and HIV self-test kits. “Maybe it’s your thing, maybe it’s not.”
- And while the agency does not outright recommend casual sex, for those who live a more adventurous lifestyle the advisory says, “Make it a little kinky. Be creative with sexual positions and physical barriers, like walls, that allow sexual contact while preventing close face to face contact.”
- The advisory, issued Monday, is an expansion of one released in March, which warned against in-person dates and locking lips in lockdown.
- The March guide urged New Yorkers to emphasize the “self” in self-isolation — encouraging masturbation as the safest type of sex.
- That’s still the case, with officials suggesting heading online to get off.
- “Video dates, sexting, subscription-based fan platforms, sexy ‘Zoom parties’ or chat rooms may be options for you,” according to the guide.
- For those who find social distancing a turnoff, officials advise choosing large, open and “well-ventilated spaces” for group sex, and bringing along alcohol-based hand sanitizer — probably sound advice even pre-pandemic.
- In the March guidance, the agency called out “rim jobs” as particularly dangerous — and swiftly became the butt of Twitter jokes.
- Health officials continue to pooh-pooh the practice.
- The new guide also includes a warning about testing positive for coronavirus antibodies — as well as advice on preventing sexually transmitted infections, HIV and unplanned pregnancy.
- “Be cautious in using these tests to make decisions about who you have sex with and what kind of sex you have since antibody test results are not definite proof of immunity,” according to the advisory.
- While traces of C19 have been found in semen and feces, it remains unclear if it can be transmitted sexually, the Health Department said, while noting that other strains of coronavirus can’t easily spread in bed.
- Despite its three-page list of dos and don’ts — many of them decidedly libido-killing — the Health Department stressed that the plague in the streets shouldn’t keep New Yorkers from having fun in the sheets.
- “Decisions about sex and sexuality need to be balanced with personal and public health,” the advisory read. “During this extended public health emergency, people will and should have sex.
Johns Hopkins COVID-19 Update
June 10, 2020
EPI UPDATE The WHO COVID-19 Situation Report for June 9 reports 7.04 million confirmed cases (108,918 new) and 404,396 deaths (3,539 new). The global totals surpassed 7 million cases in yesterday’s Situation Report and 400,000 deaths on June 8.
India continues to report elevated daily incidence, holding steady at slightly fewer than 10,000 new cases per day for the past several days. Pakistan has exhibited increasing daily incidence over the past several weeks, reporting its highest daily total yesterday (5,385 new cases). Pakistan’s daily incidence has doubled since late May, and it is now #5 globally in terms of daily incidence. Bangladesh’s COVID-19 epidemic is also accelerating. Bangladesh reported 3,190 new cases, its highest daily incidence to date, and it is now #10 globally in terms of daily incidence.
Following 2 days with fewer than 20,000 new cases, Brazil reported 32,091 new cases, its second highest daily incidence to date. Brazil updated its COVID-19 dashboard again, restoring cumulative values for cases and deaths as well as figures displaying various epidemiological trends and maps. These trends indicate that Brazil’s COVID-19 epidemic continues to accelerate; however, the growth in reported deaths appears to be slowing and could potentially reach a peak or plateau in the next several weeks. Brazil is once again #1 globally in terms of daily incidence. Broadly, Central and South America remain a major COVID-19 hot spot. In total, the region represents 4 of the top 10 countries globally both in terms of daily incidence—including Mexico (#6), Peru (#7), and Chile (#8)—and per capita daily incidence—Chile (#3), Peru (#7), Brazil (#8), and Panama (#9).
The US CDC reported 1.96 million total cases (17,598 new) and 110,925 deaths (550 new). The United States could potentially surpass 2 million cases in the next 2-3 days. In total, 14 states (no change) and New York City reported more than 40,000 total cases, including New York City with more than 200,000; New Jersey and New York state with more than 150,000; and California and Illinois with more than 125,000.
The Johns Hopkins CSSE dashboard reported 1.88 million US cases and 108,334 deaths as of 11:30am on June 5.
WHO CLARIFIES COMMENTS ON ASYMPTOMATIC TRANSMISSION At the June 8 COVID-19 media briefing, Dr. Maria Van Kerkhove, Technical Lead for the WHO COVID-19 response, commented in response to a journalist’s question that current evidence suggests that asymptomatic transmission is possible but “very rare,” based on data from available studies. The comment garnered significant attention, including uncertainty about how to interpret the statement in the context of the ongoing pandemic response, which prompted the WHO to clarify the statement to provide additional detail and put the statement in the proper context.
In a live-streamed question and answer session on June 9, Dr. Van Kerkhove clarified her initial statement. In her explanation, Dr. Van Kerkhove noted that she was addressing a limited subset of studies that followed truly asymptomatic individuals to identify transmission to others, which found limited transmission by these individuals. However, there is a key difference between truly asymptomatic infections (i.e., that never develop any symptoms) and presymptomatic cases (i.e., that are not currently exhibiting symptoms but will develop them in the future). Dr. Van Kerkhove emphasized that when the WHO uses the term “asymptomatic,” they are exclusively referring to those individuals who never develop symptoms. The difference in transmission risk for asymptomatic and presymptomatic individuals is unclear at this time. Data indicate that viral load peaks in COVID-19 patients shortly before symptoms present, but this does not necessarily correlate with viral shedding or transmissibility.
At the session, Dr. Mike Ryan, Executive Director of the WHO Health Emergencies Programme, emphasized that transmission by individuals not exhibiting symptoms is occurring, but the extent remains unknown. Strategies implemented to date, including large-scale social distancing and “lockdown,” have been effective at limiting contact and exposures in the community, which has impacted both symptomatic and asymptomatic transmission. As social distancing measures are relaxed and public health focuses on identifying and isolating symptomatic cases (e.g., via contact tracing), further efforts are needed to characterize the role of asymptomatic transmission and implement mechanisms that will enable health officials to better identify and isolate asymptomatic and presymptomatic infections in order to mitigate their risk of transmitting the virus to others.
Dr. Anthony Fauci commented that the existing evidence indicates that the severity of COVID-19 can range from truly asymptomatic infections to very mild symptoms to severe and deadly disease, and that patients across the spectrum of disease pose transmission risk.
INTERNATIONAL COVID-19 INCIDENCE While many of the countries that were severely affected early in the pandemic are now reporting decreasing COVID-19 incidence and subsequently relaxing some of their social distancing measures, incidence is climbing in other parts of the world. Countries like China, South Korea, the United States, and numerous European countries are reporting declining or lower levels of transmission as their epidemics come under control. Countries in Africa, Asia (excluding China), and South America are representing increasing proportions of the global COVID-19 incidence; WHO Director-General Dr. Tedros Adhanom Ghebreyesus noted that the pandemic is shifting geographically. The WHO reported more than 136,000 new cases on June 7, the highest daily global total to date, and the majority of cases were reported by countries in the Americas and South Asia. Multiple WHO officials emphasized the importance of maintaining vigilance and continuing to implement effective social distancing and epidemic control measures.
Following efforts to lift “lockdown” measures in May, Pakistan is stepping up enforcement of existing social distancing policies in response to recent increases in COVID-19 incidence. One report indicates that the WHO is urging Pakistan to re-institute more restrictive social distancing in order to slow transmission, noting that Pakistan does not currently meet the recommended gating metrics to begin relaxing social distancing. Pakistan has increased testing; however, the test positivity has increased—up from 10-15% in early May to more than 20% now—which suggests that the increase in reported incidence is not entirely due to increased testing.
Despte increasing incidence, some countries are moving ahead with efforts to relax social distancing. South Africa, for example, reopened schools this week. The plan to reopen was reportedly delayed by a week in order to provide additional training for teachers and staff. South Africa continues to report the highest daily incidence on the continent (#2 in terms of per capita daily incidence). South Africa has reported decreased daily incidence in the past several days, but overall, the daily incidence has exhibited a substantial increase over the past several weeks, more than doubling between May 29 and June 7.
US COVID-19 INCIDENCE Several weeks after US states began to relax social distancing measures and “stay at home” orders as well as celebrations over the Memorial Day holiday weekend, a number of states are reporting increasing COVID-19 incidence. Analysis published by NPR identifies 23 US states and Puerto Rico with increasing COVID-19 incidence over the past 2 weeks, including 5 states with more than double the daily incidence compared to 2 weeks ago. Additionally, analysis published by The Washington Post found that 13 states and Puerto Rico recently reported their highest 14-day average incidence. Reported incidence does not necessarily represent the full impact, and other analysis indicates that the number of COVID-19 hospitalizations is increasing as well. Increased hospitalizations suggest that growing case counts in many states is not entirely a result of more testing. Much like trends on the international scale, areas hit the hardest early in the US epidemic are largely exhibiting decreasing COVID-19 incidence, whereas areas not previously affected are experiencing increasing community transmission.
Arizona has reported significant increases in daily incidence over the past 2 weeks, and now state health officials are directing health systems to anticipate a surge in COVID-19 patients. On June 6, the Director of Arizona’s Department of Health Services, Dr. Cara Christ, reportedly distributed a letter to hospitals across the state that urged them to “fully activate” their emergency response plans. This would likely include activating hospital incident command systems, preparing to implement crisis standards of care, suspending elective medical procedures, and expanding intensive care unit (ICU) bed capacity. The number of hospital, emergency department (ED), and ICU beds in use statewide has increased steadily since mid-April, and the number of mechanical ventilators in use has increased since at least late March. Dr. Christ emphasized that “COVID-19 is widespread and still circulating” in Arizona, even though the state is relaxing social distancing and resuming normal activities.
Texas reported record numbers for COVID-19 hospitalizations this week, as efforts continue to relax social distancing. In addition to elevated daily incidence, Texas reported 5 of its 6 highest daily totals for COVID-19 hospitalizations over the past 5 days, including its first day with more than 2,000 hospitalized COVID-19 patients. Texas’ test positivity is also increasing, up from a low of 4.27% on May 26 to 7.55% on June 6 (currently 6.66%). On June 3, Texas Governor Greg Abbott announced that the state would move into Phase 3 of its recovery plan, which allows businesses to increase to 50% of their normal capacity. In the announcement, Governor Abbott stated that the increased transmission was a “result of isolated hot spots in nursing homes, jails, and meat packing plants” rather than broader increases in community transmission. Governor Abbott also stated that 1,457 COVID-19 patients were hospitalized at that time, but this comment is inconsistent with data reported by the Texas Department of State Health Services, which indicates nearly 1,800 hospitalizations on that date.
AMERICAN COVID-19 POLL A poll released today indicates that Americans are still divided on their perceptions of returning to normal activity and the US government’s response. The poll, conducted by SSRS on behalf of CNN, included responses from 1,259 people across the country compiled June 2-5. Overall, 49% of respondents indicated that they were comfortable resuming normal activities, up from 41% in the previous poll (May 7-10). Those who identified as Republicans reported increased comfort (73%) compared to Democrats (23%), although both parties (and Independents) showed increases from the previous poll. Notably, those who indicated that they are uncomfortable with resuming normal activity, 17% believe they will resume their normal routine by the end of the year, compared to 32% who think it will be after the start of 2021. Even as states continue to relax social distancing and permit businesses to resume operations, 36% of the respondents believe the economy is continuing to worsen, compared to 23% that believe that it is beginning to recover. Perceptions on the economy are also divided by political party, with Republicans more likely to believe the economy is recovering (40%) than Democrats (12%). Notably, 47% of respondents believe that the worst of the pandemic is still ahead, compared to 46% who believe that it is already behind us. Participants who identified as Democrat (64%), Black (68%), and Latino (55%) were more likely to believe the worst is yet to come, compared to those who identified as Republican (22%) and White (40%).
EVALUATING COVID-19 THERAPEUTICS IN CHILDREN COVID-19 incidence data indicate that children represent both a smaller proportion of infections and deaths. In the United States, for example, children aged 0-17 years represent only 0.4% of reported COVID-19 cases nationwide according to the CDC. Despite the overall trend, there are reports of severe COVID-19 disease and other potentially associated conditions such as Multisystem Inflammatory Syndrome in Children (MIS-C). Clinical trials are being rapidly implemented globally to evaluate therapeutic candidates for COVID-19, but unfortunately, the majority of these trials exclude children. A Viewpoint published in The Journal of the American Medical Association: Pediatrics (JAMA Pediatrics) discusses the implications of excluding children from these trials. The authors, from the Harvard Medical School and Boston Children’s Hospital, argue that excluding children will hinder our ability to understand the drugs’ efficacy in children, which still represent a large number of cases, and would require off-label prescription by clinicians or emergency authorization by regulatory authorities. Without adequate data from pediatric patients, future patients could be subject to treatment with an ineffective or potentially dangerous product. Legislation and regulatory policies exist that direct the conduct of pediatric clinical trials, including the Best Pharmaceuticals for Children Act in the United States, which could be leveraged to expand clinical trial access for pediatric patients.In response to the gap in research evaluating therapeutics in children, the US National Institutes of Health is funding the Pharmacokinetics of Understudied Drugs Administered in Children Per Standard of Care, a 40-site study conducted through the Pediatric Trials Network. Rather than evaluating new or candidate drugs in pediatric patients, this study aims to evaluate how children’s bodies and immune system process drugs they are already receiving, including antiviral and antiinflammatory drugs. Additionally, the study “also aims to analyze drug dosage and safety for special populations, including premature infants, critically ill children, children with Down syndrome and obese children.”