Recent Developments & Information
June 15, 2020
Index Of Featured Stories & Links
Note: All of the stories listed below are included in this Update, but we embedded links in the title of the stories upfront so that you can quickly jump to a story if you want (except for original content, which has no link).
- Warning: Danger Ahead
- Beyond the Headlines: A Closer Look at Emerging US Hotspots
- Potential Treatments
- SARS Antibodies Block C19 Infections
- Polio vaccine could protect against C19
- Regeneron to begin trials for C19 antibody cocktail
- New Scientific Findings & Research
- T-Cells Primed For Battle: Some People’s Immune Systems Are Ready to Fight The Coronavirus
- Why children avoid the worst coronavirus complications might lie in their arteries
- Dominant form of virus may be ‘10 times’ more infectious than original strain
- Mandatory face masks may dramatically slow coronavirus spread
- Evaluating C19 treatments in kids
- FDA Authorizes First Next Generation Sequence Test for Diagnosing C19
- Moderna Plans To Start Phase 3 Testing of its C19 Vaccine Candidate in July
- Sinovac’s Vaccine Trial Data Suggest Potential in Virus Defense
- Concerns & Unknowns
- Long Haulers: Some Mildly Symptomatic C19 Patients Endure Serious Long-Term Effects
- Immunity to the coronavirus remains a mystery
- Where reopening is working
- Johns Hopkins COVID-19 Update (see Annex I)
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A. Our World As Seen Through Headlines
(In No Particular Order)
- COVID-19 activity escalating in Africa, Middle East
- The CDC projects 124,000 to 140,000 deaths in the U.S. by July 4
- Texas, Florida and California recently reported records for their daily tallies of new cases — a troubling sign as states reopen
- Utah and Oregon put reopening on hold amid spikes in cases, but Texas, Arkansas and Arizona press on despite warning signs
- Singapore May Re-Open Practically Entire Economy This Month
- Houston on ‘Precipice of Disaster’ With Virus Cases Spreading
- Oregon pauses its reopening plans for one week after coronavirus cases hit new high
- North Carolina breaks record for new coronavirus cases in a single day
- India records biggest single-day jump in coronavirus cases
- NYC Remains Mostly Shuttered Even as NY Has Lowest COVID Transmission Rate in US
- New York Governor Threatens Reopening Rollback over Street Drinking
- 20 year old Covid-19 Patient Gets Double Lung Transplant, Offering Hope for Others
- Beijing closes food market, locks down district after new coronavirus outbreak
- Latin America and Its Global Partners Toil to Procure Medical Supplies as COVID-19 Pushes the Region to Its Limit
- The next COVID-19 challenge: Convincing people to get flu shots
- Study finds 12% of patients with COVID-19 have gastrointestinal symptoms, including diarrhea, nausea, and vomiting
- Iran Daily Virus Deaths Exceed 100 for First Time in 2 Months
- Top Health Official: Israel Battling Second Coronavirus Wave
- Did the coronavirus crisis give you FOGO, the fear of going out?
- Fleeing NYC amid coronavirus leaves defectors with ‘survivor’s guilt’
- Don’t Mask, Don’t Tell: NYPD blows off concerns over cops ditching masks during coronavirus
- Local officials can decide when pools, playgrounds reopen: Gov. Cuomo
- No new cases among 140 clients served by coronavirus-stricken hairstylists
- The coronavirus case count in Africa has doubled in the last 18 days, growing to more than 200,000, the World Health Organization said
- Concerned about the economic impact, the European Union is recommending that all member countries in the bloc open their borders to one another
- As schools in U.S. prepare to welcome back more than 50 million students in the fall, they plan to procure millions of masks, flood schools with nurses, and stagger schedules to minimize class size
- 5 regions of NY can begin Phase 3 of reopening, allowing indoor restaurant dining and nail salons and massage parlors to operate, with restrictions
- Singapore May Re-Open Practically Entire Economy This Month
- Houston on ‘Precipice of Disaster’ With Virus Cases Spreading
- England’s Contact Tracers Come Up Short
- Formula One Cancels Singapore, Japan and Azerbaijan Races Due To Pandemic
- Jewish kids take over Brooklyn streets to demand reopening of sleepaway camps
- Face masks no longer required in California’s Orange County
- Worst to best: Gov. Cuomo says New York now has slowest coronavirus spread in US
- The Federal Reserve predicted a rapidly contracting G.D.P. in a grim report to Congress
- Russia’s annual day of military parades for June 24 was meant to signal a return to normalcy, but at least a dozen major cities will skip the festivities
- European have accelerated investments on biking infrastructure to help get workers moving again
- Puerto Rico will welcome tourists again starting July 15, and beaches will be fully open next week.
- Across the U.S., recently reopened salons and barbershops are booked solid with customers clamoring to tame shaggy manes.
- In Australia, which has eliminated the virus in much of the country, stadiums will be allowed to host up to 10,000 people beginning next month.
- A summer for hitting the road
- Africa Turns to Home Care With Virus Cases Inundating Hospitals
- Stores in England Are Back in Business After Economy Slumps
- Resurgence Puts Governors Back in Hot Seat
- UK Prime Minister says 2 meter social distance rule is being reviewed
- AstraZeneca Reaches Vaccine Supply Deal With Four EU Nations
- Even Record High Florida Cases Can’t Keep Miami’s Beaches Empty
- Greece Beat the Coronavirus. Can Tourists Now Save Its Economy?
- Health experts warn of coronavirus risks at Trump’s upcoming rally
- Contact tracing is ‘best’ tool we have until there’s a vaccine, health experts say
- Study finds mask-wearing ‘most effective means to prevent interhuman transmission’ of the coronavirus
- MLB union cuts off talks as hopes for an agreement reach an apparent end
- CDC urges organizers of large gatherings to ‘strongly encourage’ use of face masks
- Western states are entering an active wildfire season just as coronavirus cases spike
- Christopher Nolan’s ‘Tenet’ and ‘Wonder Woman 1984’ are pushed, endangering hopes for a Hollywood summer
- Secret Service drops more than $30K for convention hand sanitizer
- Dr. Fauci is fan of controversial NBA restart plan
- Zoos are experiencing a baby boom amid coronavirus lockdowns
- Gov. Cuomo blasts cops who refuse to wear face masks: ‘It is the law’
- Hundreds pack St. Marks Place to drink, party despite coronavirus
- Surgeon General says wearing masks will give Americans ‘more freedom’
- Dr. Fauci says ‘real normality’ in the US unlikely until next year
- Indian holy man who offered ‘COVID exorcisms’ gets infected and dies
- CDC warns of second coronavirus wave as states lift lockdowns
- COVID-19 risks ranked: Grocery stores among least-likely places to contract virus
- Indian Women Worship Coronavirus ‘Goddess’
- New York bans summer sleepaway camps to contain coronavirus pandemic
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 = 7,984,307 (+1.6%)
- New Cases = 123,807 (-9,461)
- Growth Rate of New Cases (7 day average) = 1.7% (-0.1%)
- New Cases (7 day average) = 128,816 (+1,367)
- US Cases & Testing:
- Total Cases = 2,162,144 (+0.9%)
- New Cases = 19,920 (-5,382)
- Growth Rate of New Cases (7 day average) = 1.1% (+0%)
- New Cases (7 day average) = 22,099 (+145)
- Total Number of Tests = 24,790,931
- Percentage of positive tests (7 day average) = 4.6% (+0.2%)
- Worldwide Deaths:
- Total Deaths = 435,176 (+0.8%)
- New Deaths = 3,258 (-971)
- Growth Rate of Deaths (7 day average) = 1.0% (-0.1%)
- New Deaths (7 day average) = 4,299 (-18)
- US Deaths:
- Total Deaths = 117,853 (+0.3%)
- New Deaths = 326 (-376)
- Growth Rate of Deaths (7 day average) = 0.7% (-0.1%)
- New Deaths (7 day average) = 769 (-7)
- Deaths have been trending down since April 21 (although there have been significant ups and downs)
- June 14 is the lowest US death total since March 25
C. Warning: Danger Ahead
1. Beyond The Headlines: A Closer Look at Emerging US Hotspots
Key Takeaway: TX, CA and FL are well positioned to handle a new wave of C19 infections, but AZ is at risk of its healthcare system being overwhelmed without the addition of substantial surge capacity
- Over the past week, several states were in the news as the number of their new cases hit highs.
- Texas and Florida—two of the first states to reopen—both hit daily highs for new cases last week.
- California also hit a record daily high for new cases last week, though one official attributed the spike to increased testing (Florida’s governor has also attributed his state’s spike to more testing). See our charts below.
- Arkansas, Alabama, North Carolina, South Carolina, Utah and Alaska have also seen surging case numbers over the last week.
- On Friday, the CDC released new forecasts that singled out six states—Arizona, Arkansas, Hawaii, North Carolina, Utah and Vermont—where the coronavirus death toll is expected to rise over the next month as a result of an increase in new cases.
- Some states and cities have walked back reopening measures in response to surging cases: Oregon’s governor put the reopening process on pause on Friday after the state saw its highest level of new cases since the start of the pandemic; Utah’s governor issued a similar order, as did the mayor of Nashville, Tennessee.
- While an increase in the number of new cases can indicate a problem, we feel that the positivity rate (the number of daily positive tests as a % of total daily tests) is a better indicator of viral spread and potential risk. We also prefer to use the 7-day moving average to smooth out any reporting lags.
- Below is a more detail look at the Covid Risk Level of Arizona, Texas, California and Florida.
- The number of new cases in Arizona on June 13 was 1,606, which is slightly less than the record high of 1,642 new cases on June 12. The 7 day average of new cases have been increasing rapidly since May 26, which had new cases of 222. Between May 26 and June 13, the number of new cases has increased by 7.2x.
- Arizona’s percentage of positive test has also increased substantially. Since ending it’s shelter in place on May 15th, Arizona’s percentage of tests that were positive (based on a 7-day moving average) has more than doubled to 14.3% from 6.5%. Arizona’s positive test percentage is more than 3x the national average of 4.6% (Arizona’s positive test percentage has been increasing while the national average has been trending downward).
- Arizona had 3 new deaths on 6/14 and has had total C19 deaths of 1,186. Per capita deaths in Arizona is 163 per million, which is substantially below the national average of 356 per million (Arizona per capita deaths is 45.8% of the national average). The number of new deaths was 33 on June 13, which is 3 more than the number of new deaths on May 15. So, while cases (and, as discussed below, ICU hospitalizations) have increased significantly, the number of new deaths is only 11.1% more than on May 15.
- Hospitalizations have increased 75% to 1,457 from 808 on May 15th. The State health department has urged hospitals to prepare for a crisis situation. Hospitals have been urged to “fully activate” emergency plans. Hospitals are being reminded to prepare for crisis care and to suspend elective surgeries if they are experiencing a shortage of staff or bed capacity, according to the June 6 letter from Dr. Cara Christ, director of the Arizona Department of Health Services.
- Covid ActNow estimates that 63% of the ICU bed capacity in Arizona available for C19 patients is currently occupied. Covid ActNow concluded this suggests Arizona’s hospitals may not be well positioned to absorb a wave of new C19 infections without substantial surge capacity.
- Covid ActNow rates Arizona’s Covid Risk Level as CRITICAL (Level 4 of 4).
- Although the number of new cases in Texas spiked to a high of 2,437 on June 10, the cases have been trending downward since then, with 1,339 new cases reported on June 14. The 7 day average of new cases has been rapidly increasing since May 26.
- When Governor Abbott ended the shelter in place on May 1st, Texas’s percentage of tests that were positive (based on a 7-day moving average) was 6.1%. Over the next four weeks, the positivity rate continued to decline and hit the lowest rate on May 26th at 3.8%. Since then, the rate has increased more than 130% to 8.8%, which is 1.9x more than the national average.
- Texas had 13 new deaths on 6/13 and has had total C19 deaths of 1,995. Per capita deaths in Texas is 69 per million, which is substantially below the national average of 356 per million (Texas per capita deaths is 19.4% of the national average). The 7 day average of deaths in Texas has been trending downward since May 16.
- Hospitalizations have increased 29% to 2,287 from 1,776 on May 1st. Covid ActNow estimates that only 17% of the ICU bed capacity in Texas available for C19 patients is currently occupied. Covid ActNow concluded that it is likely Texas has enough hospital capacity to absorb a new wave of C19 infections.
- Covid ActNow rates Texas’ Covid Risk Level as low medium (Level 2 of 4).
- While California has been in the news as a potential hotspot, on June 12 counties around the state were able to move to Stage 3 of 4 of the reopening road map.
- The number of new cases in California hit a record high of 3,593 on June 5. Although the 7 day average of new cases has been increasing at a moderate rate since then, the number of new cases on June 13 had dropped to 3,149.
- The 7 day average of California’s positive test percentage is 4.7%, which is slightly more than the national average.
- California had 73 new deaths on 6/13 and has had total C19 deaths of 5,089. Per capita deaths in California is 129 per million, which is substantially below the national average of 356 per million (California per capita deaths is 36.2% of the national average). The 7 day average of deaths in California has been trending downward since May 21.
- The number of hospitalizations in California has been relatively stable since May 3. Covid ActNow estimates that 27% of the ICU bed capacity available for C19 patients is currently occupied. Covid ActNow concluded that it is likely California has enough capacity to absorb a wave of new C19 infections.
- Covid ActNow rates CA’s Covid Risk Level as low medium (Level 2 of 4).
- The 7 day average of new cases in Florida has been increasing rapidly since May 28, when the number of new cases was 651 cases. On June 13, the number of new cases in Florida spiked a record high of 2,581, which was 4x more than the number of new cases on May 28.
- When Governor DeSantis ended the shelter in place on May 3th, Florida’s percentage of tests that were positive (based on a 7-day moving average) was 5.5%. Over the next three weeks, the positivity rate continued to decline and hit the lowest rate on May 23th at 2.7%. Since then, the rate has more than doubled to 5.6%, which is higher than the national average of 4.6%.
- Florida had 48 new deaths on 6/13 and has had total C19 deaths of 2,930. Per capita deaths in Florida is 137 per million, which is substantially below the national average of 356 per million (Florida per capita deaths is 38.5% of the national average). The 7 day average of deaths in Florida has been trending downward since May 8.
- Florida does not provide data on hospitalizations. Covid ActNow estimates that 10% of the ICU bed capacity available for C19 patients in Florida is currently occupied. Covid ActNow concluded that it is likely Florida has enough hospital capacity to absorb a wave of new C19 infections.
- Covid ActNow rates Florida’s Covid Risk Level as low medium (Level 2 of 4).
Source: Covid Tracking Project (www.covidtracking.com/data)
D. Potential Treatments
1. SARS Antibodies Block C19 Infections
- Antibodies from people who recovered from SARS — a deadly respiratory disease caused by a coronavirus that emerged nearly 20 years ago — may be critical to fighting C19, according to a study in the journal Nature.
- The peer-reviewed paper reveals how an antibody discovered in a person infected by the severe acute respiratory syndrome virus in 2003 acted as a potent blocker against SARS-CoV-2, the closely related coronavirus that causes C19.
- A team of international researchers, including scientists from San Francisco’s Vir Biotechnology and the University of Washington, conducted the study, which was published in May.
- Their finding is part of a ballooning area of inquiry by researchers, universities and drug companies around the world, and in the Bay Area, to develop antibody treatments for C19, and to prevent people from getting sick in the first place.
- Vir Biotechnology, whose stock shot up after the paper was published, plans to start clinical trials this summer on two treatments related to the SARS antibody discovery.
- The immune system forms antibodies, which are y-shaped proteins, to disable specific pathogens it encounters. Vaccines spur the immune system into producing these antibodies without causing a person to become sick.
- Antibody therapies for viruses are mostly made by finding antibodies in people who were previously infected. These antibodies are then generally used to treat disease early in infection by preventing more cells from becoming infected or destroying those that already are.
- In February, the team of scientists from Vir Biotechnology and the University of Washington began to look for SARS coronavirus antibodies that could work against the new coronavirus because antibodies to that virus weren’t readily available for study. Since the two viruses are closely related — akin to viral cousins — it made sense to search for antibodies that would work for both, said David Veesler, a senior author on the paper and a virologist at the University of Washington who had been studying SARS.
- Still, it was a long shot. So scientists were surprised by the strength of the antibody they discovered, which blocked not only the SARS and C19 coronaviruses in the lab, but a third coronavirus found in bats.
- “Looking for effective antibodies is like looking for a needle in a haystack,” Veesler said. “So this was very, very exciting because this antibody has the potential to have a high public health impact.”
- Viruses are snippets of genetic code wrapped in protein. The genetic material is an instruction manual for manufacturing more viruses. But a virus must first infect and then hijack the protein-making assembly lines of a living cell — be it in a tomato plant, a bat or a human being — before it can start building more viruses.
- “Wherever you find life, you find viruses,” Veesler said.
- As with any parasite, gaining entry into a host is the most crucial step. The new coronavirus does this through the spiky proteins on its surface that give the virus its eponymous crown-like appearance. The spike protein acts like a key that fits snugly into a specific protein on a human cell and lets the virus in.
- Antibodies are just one component of a person’s immune response. But some antibodies that glom onto the spike protein appear to thwart this cellular invasion.
- These so-called virus “neutralizing” antibodies were what Veesler and his team went looking for in old blood samples from the person infected with the SARS coronavirus. Following infection, the immune system stores the blueprints for various antibodies in memory B cells, the body’s equivalent of a storage locker full of weapons it has previously forged to help fight pathogens.
- In this locker, Veesler’s team unearthed the antibody S309. The lab results were stark: Whenever S309 was added, the coronavirus couldn’t enter cells and replicate. It also appeared to effectively obstruct the SARS coronavirus and the related bat coronavirus from entering cells. But how?
- The group of scientists used molecular imaging technology to visualize what was happening at the atomic level. What they discovered was both surprising and helped explain why this particular antibody appeared so effective.
- Not only did it bind to the spike protein, but also to carbohydrates on the spike that the virus uses to try to “trick” the immune system into thinking it’s just a normal human molecule, Veesler said.
- If the virus is the wolf, then the carbohydrates are the sheep’s clothing.
- “But this antibody saw right through that,” Veesler said.
- The team is still researching exactly how that interaction blocks the virus from entering cells. Perhaps even more intriguing, however, is that the antibody binds to a specific area of the spike protein that is almost identical among the SARS virus, the new coronavirus (SARS-CoV-2), and related coronaviruses.
- “To hit a spot like that was fairly fortuitous,” said Anthony Fehr, a virologist and coronavirus expert at the University of Kansas, who is researching other therapies for the new virus. “This probably won’t be the last time that a SARS-like virus is going to emerge in the human population. So having something like this could be a really useful tool.”
- Unlike drugs made of chemical compounds, antibody therapeutics are quicker to develop, test and get approved, said National Institutes of Health Director Dr. Francis Collins in a recent blog post. They also can be used to target vaccine development.
- “Because of these and other factors, many experts think antibody-based therapies may offer one of the best near-term options for developing safe, effective treatments for C19,” he said.
- The gold standard for viruses, however, is still a vaccine. Although antibodies are used to lessen the severity of symptoms after exposure to viruses like rabies and hepatitis B, they have generated disappointing results with other diseases. In addition, any prophylactic antibody therapy for people in high-risk settings like nursing homes would have to be taken regularly, an expensive and less efficient method than using a vaccine to prompt a person’s immune system into building its own antibodies.
- “It is not a substitute for a vaccine,” Fehr said. “Antibody therapy is more transient in nature. It is not a permanent fix.”
2. Polio vaccine could protect against C19
- While scientists around the world race to develop a vaccine for the novel coronavirus, some suggest that existing polio vaccines could be used as an effective and affordable means of protecting against the pandemic, according to a report in Science magazine.
- The team of researchers – including Konstantin Chumakov, associate director for research at the FDA’s vaccine division, and Dr. Robert Gallo, a researcher from the Institute of Human Virology at the University of Maryland School of Medicine, who helped discover HIV – discussed existing live attenuated vaccines that could, according to some experts, induce protection against unrelated diseases – specifying the oral poliovirus vaccine (OPV) in particular as a possibility.
- The vaccine was developed in the 1950s by Albert Sabin, offering protection against polio. However, according to earlier clinical studies, the vaccine may have also protected patients against other conditions. For instance, the paper cites observations made in Bangladesh where OPV was shown to reduce the effects of bacterial diarrheal disease in infants. Another study in Finland showed that using OPV resulted in fewer doctor-diagnosed middle ear infections, and a retrospective study from Denmark showed that OPVs were associated with reduced hospital visits by children with respiratory infections.
- The vaccine has a proven track record, and has already succeeded in nearly eliminating polio worldwide.
- But the OPV has other advantages over other existing live vaccines. For example, like the coronavirus, poliovirus is a positive-strand RNA virus. As a result, the researchers say it is more likely that OPV could induce common innate immunity mechanisms for the coronavirus.
- Other advantages for OPV are its safety record, its relatively affordable cost, its easy administration method and its widespread availability. While it is no longer licensed or available in the US, over 1 billion OPV doses are produced yearly and are used in over 140 countries worldwide.
- The team added that the risk of complications from OPV is very low. While it is possible that it could cause complications similar to polio, this would only happen in about one in every 3 million doses, and even then, it largely only occurs in immunocomproised children.
- In addition, the researchers even go so far as to say that a nonspecific vaccine like OPV would be preferable not only to other live vaccines but to a coronavirus-specific vaccine, as it could help prevent the spread of the virus even if it undergoes a mutation similar to the seasonal flu, which necessitates new vaccines yearly.
3. Regeneron to begin trials for C19 antibody cocktail
- Biotechnology company Regeneron Pharmaceuticals said that it is launching a series of clinical trials to test the safety and efficacy of an investigational antibody cocktail (REGH-COV2) for the treatment and prevention of C19.
- REGN-COV2 consists of two virus-neutralizing antibodies that bind non-competitively to the critical receptor binding domain of the spike protein that the coronavirus uses to enter cells.
- The antibodies were selected from thousands of antibodies produced by mice that have been genetically engineered by the company to have a human-like immune system, and from patients who have recovered from C19.
- The hope is that the cocktail of antibodies, which mimic the type of antibodies the human immune system produces if exposed to coronavirus or a vaccine, can both prevent and treat coronavirus infections.
- The company also says preclinical studies indicated that REGN-COV2 may reduce the potential for viral escape, which occurs when a virus mutates to evade the body’s immune response.
- “We have created a unique anti-viral antibody cocktail with the potential both to prevent and treat infection, and also to preempt viral ‘escape,’ a critical precaution in the midst of an ongoing global pandemic,” said Regeneron president and chief scientific officer George Yancopoulos, MD, PhD. “REGN-COV2 could have a major impact on public health by slowing spread of the virus and providing a needed treatment for those already sick—and could be available much sooner than a vaccine.”
- The results of the preclinical studies will be published in Science next week.
- The cocktail is similar to REGN-EB3, a triple-antibody drug developed by Regeneron for treating Ebola. The FDA granted priority review for REGN-EB3 in April after trials conducted in Ebola treatment centers in the Democratic Republic of the Congo found the drug was one of two that proved more effective than other options.
- Regeneron received funding from the Biomedical Advanced Research and Development Authority to develop REGN-COV2.
E. New Scientific Findings & Research
1. T-Cells Primed For Battle: Some People’s Immune Systems Are Ready to Fight The Coronavirus
- Researchers piecing together how the body’s immune system responds to the virus that causes C19 are exploring a tantalizing effect: Some people who have never encountered the pathogen before appear to be able to mobilize parts of their immune system to ward it off.
- That response suggests that infection with other coronaviruses, such as those responsible for severe acute respiratory syndrome, or SARS, and even the common cold, may aid the body’s fight against the new invader. Harnessing the biological processes at play could aid the search for a new vaccine, researchers say.
- A team of scientists at the La Jolla Institute for Immunology in California looked at blood samples from 20 people who came down with C19 and subsequently recovered. Most had only mild symptoms.
- The team found that when they reintroduced synthesized bits of the virus to the subjects’ blood they mobilized white blood cells known as helper T-cells that coordinate a broad immune response to the infection.
- A second type of T-cell that seeks out and destroys cells hijacked by the virus was detected in most subjects, the authors wrote in a peer-reviewed paper published in the scientific journal Cell last month.
- The finding dispels some of the worries people had that the virus that causes C19 wasn’t capable of triggering a forceful immune response, said Alessandro Sette, a professor of infectious disease and vaccine research at La Jolla and one of the study’s lead authors. The virus has infected at least seven million people world-wide and killed more than 400,000, according to data compiled by Johns Hopkins University.
- The team also tested the blood drawn from 20 volunteers between 2015 and 2018, long before the coronavirus responsible for C19 appeared, and found a similar immune reaction in around half of those subjects when their blood was exposed to the virus.
- It isn’t just the team at La Jolla who have noticed this effect. Scientists in Singapore found that some people who came down more than a decade ago with SARS, caused by a closely related coronavirus, were able to muster their T-cells to fight the C19 attacker. Researchers in Germany have also noted the presence of T-cells able to combat the virus in healthy donors, possibly a result of getting a cold.
- The emerging theory: Exposure to other coronaviruses earlier in life helps some individuals fight the new invader.
- “It’s a consistent finding that some people have reactivity even though they’ve never seen the virus,” said Dr. Sette. “This is a hypothesis and our labs are working hard to try and produce a smoking gun, to really show that this is true.”
- The theory has myriad implications. It may suggest there is a degree of inbuilt human resistance to the bug that lowers the threshold for herd immunity, when the virus can no longer find enough susceptible hosts to keep spreading.
- It may also offer clues as to why some places have been hit harder by C19 than others, or why some people end up on ventilators and others barely notice they are infected.
- Dr. Sette and other scientists involved in researching C19 say, however, that these findings are preliminary and further work is needed to fully understand how the virus interacts with its human hosts. It isn’t clear, for example, if such an immune reaction affords a degree of protection against infection or onward transmission of the virus, or whether it affects how severe an infected person’s symptoms are. An outside possibility is that the reaction might even worsen the illness, perhaps by tricking the body into thinking the new coronavirus was a harmless cold.
- “Just because you’ve got a few T-cells that cross-react doesn’t mean you are protected,” said Gary McLean, professor of molecular immunology at London Metropolitan University. “This is the one thing we need to figure out—what is the correlation with protection?”
- Babak Javid, professor at Tsinghua University School of Medicine, Beijing, and a consultant in infectious diseases at Cambridge University Hospitals, said an important next step will be to track people displaying these immune responses over time to determine what effect they have.
- “We need to know how important they are in terms of modulating the disease,” he said.
- Still, scientists say the findings do offer several hopeful notes for vaccine development. More than 100 vaccines are currently in development across the world, with 10 already in human trials.
- The most advanced vaccine candidates are designed to stop infection by teaching the body to produce invader-fighting antibodies that recognize the spike protein the virus uses to force its way into cells. But it wasn’t clear if the two types of T-cell could also spot the virus and join the fray, potentially allowing for a more forceful immune response after vaccination. The research shows they can.
- The body’s T-cells can also identify other telltale signs of the virus’s presence, experiments show, giving researchers extra targets to optimize their attack, Dr. Sette said. “That opens the door to maybe fortifying the existing vaccines,” he said.
- One nagging uncertainty surrounding C19 has been whether people can be reinfected and fall ill repeatedly, which would dampen expectations that vaccination would confer lasting immunity. That T-cells can recognize similar viruses years after infection suggests long-lasting immunity might be possible, said Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene & Tropical Medicine.
2. Why children avoid the worst coronavirus complications might lie in their arteries
- Since the coronavirus outbreak began, scientists have been trying to work out why children are much less likely than adults to experience severe complications from the infection. Now research suggests that the answer might lie in children’s healthy blood vessels.
- Children make up only a small proportion of those infected by the coronavirus. A large survey by the CDC found that children aged 17 and under, who make up 22% of the US population, account for fewer than 2% of confirmed C19 infections across the United States. And, of 2,572 children included in the survey, only 5.7% went to hospital and only three died.
- Several theories have been proposed to explain why children aren’t getting so ill. These include the possibility that they have a stronger and more effective initial immune response to the virus than adults do, and that they might have some immunity from recent exposure to similar viruses. But a growing number of researchers think that the difference between adults and children might be the condition of their blood vessels.
- Many adults with serious C19 experience clotting in their blood vessels, which leads to heart attacks or strokes. The clotting seems to be linked to a malfunctioning endothelium, the smooth tissue that lines blood vessels and normally prevents clotting, says Frank Ruschitzka, a cardiologist at the University Hospital Zurich in Switzerland. Normally, blood clots form only to stop bleeding from an injury, but if the endothelium is damaged, clots can also form.
- Ruschitzka and colleagues have found that the coronavirus can infect endothelial cells, which are found throughout the body. In a study of three people with C19, two of whom died, Ruschitzka’s team found that the coronavirus had infected the patient’s endothelium and caused inflammation and signs of clotting. The study was small so such complications will need to be investigated further, but problems with the endothelium seem to be involved in most cases of C19 that progress to severe or fatal disease in adults, he says.
- This theory could also explain why people with conditions that compromise the endothelium, such as diabetes and hypertension, are at a greater risk of serious C19, says Marcel Levi, a haematologist at University College Hospital in London.
- Endothelium is typically in much better condition in children than adults. “A kid’s endothelium is set up perfectly and then just deteriorates with age,” says Paul Monagle, a paediatric haematologist at the Melbourne Children’s Campus.
- Monagle and others think that children’s blood vessels are able to withstand a viral attack more than adults. Further support for this theory is the observation that few children with C19 present with excessive clotting and damaged vessels, he says.
- Monagle is trying to understand what happens when the virus enters endothelial cells. He thinks the coronavirus likely disrupts communication between the cells, the platelets and plasma components involved in clotting, and that this communication breakdown leads to excess clots forming.
- He has launched two experiments to try to better understand this mechanism and see whether there is something protective about kids’ blood vessels that makes them less likely to produce excess clots in response to viral infection.
- In the first experiment, his team will try to recreate conditions inside the blood vessels of children and adults in the lab. They will take cultured endothelial cells infected with the coronavirus and bathe them in plasma from three sources — children, healthy adults, and adults with vascular disease. By comparing how the infected cells interact with the three different types of plasma, they should be able to see what makes the signalling in the vessels go awry.
- Monagle hopes that studying samples from children will offer clues about what’s going wrong in some adults. “If we understand what happens to children, we could tweak adults to make them more child-like,” he says.
- In a second experiment, the team will analyze plasma from children and adults with C19, which contains proteins released by damaged endothelial cells, to identify possible markers of disease.
3. Dominant form of virus may be ‘10 times’ more infectious than original strain
Researchers say mutation in Wuhan virus gave it sturdier spikes to latch onto cells, with lab tests showing it is far more contagious; but some scientists urge caution
- A form of the novel coronavirus which has become the dominant type in much of the world may have done so thanks to a mutation that allows it to better latch onto human hosts’ cells, new research indicates.
- Lab tests performed by US-based Scripps Research, in a study which has not yet been peer-reviewed, showed that this isolate of the coronavirus was much more infectious than others when introduced to cell cultures.
- Researchers said the Spike D614G mutation, which has proliferated around the world, has sturdier spikes — the projections on the virus’s body through which it attaches to cells and which give the virus its “crown,” or “corona” — than the original Wuhan strain.
- Virus particles with the mutation thus tended to have 4 to 5 times the number of functional spikes, enabling them to more easily bind to cells.
- “Viruses with this mutation were much more infectious than those without the mutation in the cell culture system we used,” Scripps Research virologist Hyeryun Choe, who led the study, said.
- Specifically, they were “nearly 10 times more infectious in the cell culture system that we used.”
- The D614G mutation has been the most widely-observed form in North America and Europe. Study co-author Michael Farzan said the form first appeared in a global database in February, and by May was present in 70% of uploaded samples.
- “Over time, it has figured out how to hold on better and not fall apart until it needs to,” Farzan says. “The virus has, under selection pressure, made itself more stable.”
- While potentially more infectious, there is no evidence that the virus is more aggressive or causes more hospitalizations and fatalities than other strains.
- It is also worth noting that a higher infection rate in lab conditions does not necessarily mean the same applies when the virus acts inside a host.
- All viruses mutate over time, though scientists have said coronavirus appears to be relatively stable, mutating at a slower rate than seasonal flu. This could be important in developing an effective vaccine.
- The Spike D614G mutation first gained attention in April when the Los Alamos National Laboratory said it was “of urgent concern” due to its proliferation, “increasing in frequency at an alarming rate, indicating a fitness advantage relative to the original Wuhan strain that enables more rapid spread.”
- Many scientists have urged caution in jumping to conclusions regarding the infectiousness of the strain, pointing to other factors that may have contributed to its spread: for example the strain may have, by chance, stumbled upon a particularly susceptible population, such as the elderly in Italy, allowing it to greatly increase its spread.
- The Scripps lab results boost the viability of the claim, but will need to be replicated by other studies.
- Kristian Andersen, another Scripps geneticist, noted to The New York Times that other analyses of virus variants in labs had not found significant differences in infection rates.
- “That’s the main reason that I’m so hesitant at the moment,” Andersen said. “Because if one really was able to spread significantly better than the other, then we would expect to see a difference here, and we don’t.”
- In late May researchers in University College London said their studies of the genomes of more than 15,000 samples had not shown one strain being more infectious than others.
- Scientists will likely seek to test D614G in animals to check whether it shows higher infection rates when working inside hosts’ bodies.
4. Mandatory face masks may dramatically slow coronavirus spread
- The compulsory use of face masks could slow the spread of the coronavirus by as much as 40%, according to a new report.
- Scientists from Johannes Gutenberg University Mainz and the University of Southern Denmark studied the German city of Jena, which became the first in Germany to make wearing the face coverings mandatory for citizens riding trains, buses and going into stores on April 6.
- The number of new C19 infections recorded in the city then fell by 23% over the next 20 days, the study found.
- When collating data from the other regions, the researchers said they found a strong curve-flattening effect, concluding that wearing face masks reduces the daily growth rate of reported coronavirus infections by around 40%.
- “This is a sizeable effect. Wearing facemasks apparently helped considerably in reducing the spread of C19,” they wrote in a discussion paper, published for the Institute of Labour Economics.
- “The most convincing argument stresses that Jena introduced face masks before any other region did so,” the paper went on.
- “It announced face masks as the first region in Germany while in our post-treatment period no other public health measures were introduced or eased. Hence, it provides the most clear-cut experiment of its effects.”
- Jeremy Howard, a research scientist at the University of San Francisco who was not involved in the research, told The London Times that the results were significant.
- “You can see the dramatic and sudden divergence between Jena, and the average of other regions that had previously had similar results,” he said.
- But Antonio Lazzarino, from University College London, said he is skeptical.
- “This is a non-experimental study, so causal inference cannot be claimed,” he told The Times.
- There are “too many assumptions,” he said.
5. Evaluating C19 treatments in kids
- The National Institutes of Health (NIH) said researchers will begin evaluating in infants, children, and adolescents antiviral and anti-inflammatory drugs currently being used to treat C19.
- The study, which is part of a larger clinical trial evaluating the pharmacokinetics of understudied drugs administered to children, will analyze blood samples to better understand how drugs used to treat C19 move through the bodies of children, and to collect information on outcomes and potential side effects. Many of the drugs have not been tested specifically for use in children.
- “As we search for safe and effective therapies for C19, we want to make sure that we do not overlook the needs of our youngest patients who may respond differently to these drugs, compared to adults,” Diana Bianchi, MD, director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which oversees the project, said in a news release.
- The NIH says the aim of the study is to gather information to refine dosing and improve safety, and not to evaluate the best treatment.
F. FDA Authorizes First Next Generation Sequence Test for Diagnosing C19
- The FDA issued an emergency use authorization (EUA) to Illumina, Inc. for the first C19 diagnostic test utilizing next generation sequence technology.
- The FDA authorized the Illumina COVIDSeq Test for the qualitative detection of coronavirus RNA from respiratory specimens collected from individuals suspected of C19 by their healthcare provider. Using next generation sequencing means that the test can generate information about the genomic sequence of the virus present in a sample, which can be also used for research purposes.
- “Throughout the C19 pandemic, we have seen the ingenuity that results from the FDA working in partnership with the private sector. Having a next generation sequencing diagnostic tool available will continue to expand our testing capabilities. Additionally, genetic sequencing information will help us monitor if and how the virus mutates, which will be crucial to our efforts to continue to learn and fight this virus,” said FDA Commissioner Dr. Stephen Hahn, M.D.
- Next generation sequencing is a type of diagnostic technology that can determine, among other things, the genetic sequence of a virus. Comparing sequencing results over time can help scientists understand if and how viruses mutate.
1. Moderna Plans To Start Phase 3 Testing of its C19 Vaccine Candidate in July
- On June 11, biotech company Moderna announced it had finalized plans for phase 3 testing of its C19 vaccine candidate. The late-stage trial will include 30,000 participants and is expected to begin in July.
- The trial will test just one dose level of the vaccine, 100 micrograms, given in two shots. In the earlier phase 1 study involving 45 healthy volunteers, the company explored lower and higher doses, but preliminary results revealed by the company from this trial suggested that 100 micrograms provided the desired immune response safely.
- According to the company, the vaccine produced antibodies against the C19 virus in those who were vaccinated, and in tests involving a handful of participants, those antibodies were able to neutralize the virus in the lab. The full details of that study aren’t available yet; that will soon be published by Moderna’s collaborators, a team of scientists at the National Institute of Allergy and Infectious Diseases.
- The phase 2 study is ongoing, and is enrolling 600 healthy people who will be followed for a year after their injections. This stage will continue to look at the vaccine’s safety as well as collect further data on its effectiveness. This study will include more people who might be a high risk of exposure to C19, such as health care workers and residents in long-term care facilities.
- In June, Moderna became one of five vaccine developers chosen to be part of President Trump’s Operation Warp Speed program to speed development of a C19 vaccine. The selection qualifies Moderna to receive federal government funding to continue development of vaccine, conduct tests, as well as scale up manufacturing to meet the goal of beginning to inoculate 300 million people beginning early next year. Moderna said it plans to deliver 500 million to 1 billion doses a year beginning in 2021.
2. Sinovac’s Vaccine Trial Data Suggest Potential in Virus Defense
- Sinovac Biotech Ltd. said its coronavirus shot is safe and capable of eliciting an immune response from human trials, suggesting the shot’s potential in defending against infection of the novel coronavirus.
- The Beijing-based company’s vaccine, called CoronaVac, hasn’t caused severe side effects and more than 90% of people administered with the shot on a 14-day interval have induced neutralizing antibodies two weeks after inoculation, Sinovac said in a press release on Sunday.
- The preliminary findings come from phase I and II trials in China. A total of 743 healthy people ages 18 to 59 either received shots on two schedules or a placebo. More data will be uncovered from another group in the trial that received shots on a 28-day interval. Sinovac plans to publish its results in academic journals, according to a company spokesman.
- Using a killed version of the coronavirus, Sinovac’s vaccine is among five Chinese experimental shots that have reached the crucial final stage of human testing before they can be approved for public use. The company announced a partnership this month with Instituto Butantan to conduct its phase III trial in Brazil, where the novel pathogen has caused the second-largest outbreak in a global pandemic that so far infected more than 7.7 million people and killed over 428,000.
- Since lockdowns and social-distancing measures have helped to keep infection rates low in many countries, some of the world’s leading vaccine efforts are seeking to conduct phase III trial in active outbreaks to evaluate the effectiveness of their shots.
- Authorities in Brazil have approved the vaccine co-developed by the University of Oxford and AstraZeneca Plc to carry out late stage trials there, while Cambridge, Massachusetts-based Moderna Inc. is set to go into phase III trials in the U.S.
H. Concerns & Unknowns
1. Long-Haulers: Some Mildly Symptomatic C19 Patients Endure Serious Long-Term Effects
- The existence of C19 and the coronavirus has been known for less than half a year. And so it stands to reason that the precise pathogenesis hasn’t been fully characterized.
- What’s also unclear at this point are reasons for the differential impact the disease has on those who test positive for the novel coronavirus. A neat breakdown into the three categories asymptomatic, mild, and severe cases is far too simplistic.
- A Dutch study released this week confirms, for example, that some patients in the “mildly symptomatic” category turn out to be substantially burdened by C19 for long periods of time, sometimes months.
- From the outset of the pandemic, conventional wisdom has indicated that a minority of infected people, who are typically elderly or have pre-existing health conditions, get seriously ill. They often require hospitalization and, in some cases, intensive care.
- And over 80% of cases, according to the World Health Organization, are mild or asymptomatic. These patients typically recover after two weeks.
- However, the rapid recovery has not been the experience of thousands – perhaps tens of thousands – of patients worldwide who’ve been classified as mild cases.
- Many struggle for months with lingering C19 symptoms that can be debilitating. They exhibit shortness of breath, extreme fatigue, intermittent fevers, cough, concentration issues, chest pressure, headaches, and heart palpitations, among other symptoms. The literature has a name for them: “long-haulers.”
- In the Netherlands, the Lung Foundation, together with the University of Maastricht and the CIRO group, surveyed 1,622 C19 patients who had reported a number of long-term effects from their illness. 91% of the patients were not hospitalized, which indicates that the vast majority of the surveyed patients would fall under the category “mildly symptomatic.” The average age of the patients surveyed was 53.
- Nearly 88% of patients reported persistent intense fatigue, while almost 75% had continued shortness of breath. Other enduring symptoms included, among other things, chest pressure (45% of patients), headache and muscle ache (40% and 36%, respectively), elevated pulse (30%), and dizziness (29%). Perhaps the most startling finding was that 85% of the surveyed patients considered themselves healthy prior to getting C19. One or more months after getting the disease, only 6% consider themselves healthy.
- Just as the exact biological mechanism(s) that leads to the manifestation of C19 disease symptoms is unknown, it’s uncertain why some patients exhibit very long-term effects. A number of clinicians posit that a reactivation may occur in a number of patients in which the coronavirus, which could lie dormant or latent in a patient’s body for a period of time, “awakens” to an active phase and causes recurring symptoms. Essentially, this hypothesis suggests that some patients harbor the virus somewhere in their body, and they either still test positive for the virus or it is missed by conventional coronavirus tests that use nasal swabs. What is perhaps a more likely scenario, according to immunologists, is that the virus no longer resides in the body but the immune system continues to be in perpetual overdrive.
- Regardless of the possible reasons for some “mildly” ill patients being symptomatic long-term, the Dutch study confirms what has been known anecdotally about long-haulers. For this group, recovery is a grueling process. Globally, as the number of people infected with the novel coronavirus increases, so will the number of people with (temporary) disabilities, in spite of their “mildly symptomatic” status.
1. Immunity to the coronavirus remains a mystery
- Scientists stress that just because someone has recovered from C19 and produced antibodies to the coronavirus does not mean they are protected from contracting it a second time. No one’s yet proven that.
- That, then, leaves open the question: What does immunity look like?
- Experts anticipate an initial coronavirus infection will lend people some level of immunity for some amount of time. But they still don’t know what potpourri of antibodies, cells, and other markers in a person’s blood will signify that protection. And determining those “correlates of protection” is crucial both so individuals can know if they are again at risk, and so researchers can understand how well potential vaccines work, how long they last, and how to accelerate their development.
- “What you would like is to have some blood measure that serves as a correlate of that protective efficacy or immunity,” said Sarah Fortune, the chair of immunology and infectious diseases at Harvard’s T.H. Chan School of Public Health. “Which sounds like it’s simple, but it’s much more complicated than you’d think.”
- Knowing the correlates of protection is different from knowing the mechanism of protection. Immunity is a Rube Goldberg machine, a choreography of different proteins and cells that results in the body fending off a pathogen before it can gain a toehold. The scheme varies from pathogen to pathogen.
- Correlates of protection, rather, are signals that someone is protected, the way glancing at a formidable offensive line makes clear that it can hold off the pass rush. They could include the presence of — as well as the levels of — certain types of antibodies, immune cells, or proteins that act like messengers in the immune system.
- Scientists don’t need to fully understand the correlates to make progress on vaccines. Already, researchers have launched a number of clinical trials for vaccine candidates to test whether they are safe and effective against C19, the disease caused by the coronavirus. But scientists are relying on clues from how our bodies protect themselves from other viruses, including the other disease-causing coronaviruses, to guide what kind of immune response vaccines should aim to induce.
- “We don’t formally need to know” the correlates of protection, said John Mascola, the director of the National Institutes of Health’s Vaccine Research Center. “One can make the vaccine somewhat empirically, which means make it and test it, and in the old days that’s how all the vaccines were made.”
- Now, vaccine research and determining the correlates of protection often take place at the same time, Mascola said. And with the coronavirus, vaccine developers “are taking advantage of the fact that we think we know what kind of antibody response to generate, and that’s what the designs are based on.”
- After clinical trials confirm one vaccine’s effectiveness, other immunizations that produce the same immune responses could be accelerated into use, Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, recently told STAT.
- “If one vaccine proves efficacy in a clinical trial and another vaccine is behind it but it’s getting the same correlate of immunity, you could bridge data and facilitate the approval of the second and the third one based on the efficacy of the first one,” Fauci said.
- Experts stress that it’s still key to test vaccines in large-scale clinical trials, and not solely approve them based on correlates of protection. Only clinical trials demonstrate whether a vaccine lowers the risk of infection in people or makes them less likely to get severely ill.
- To study the correlates of protection, scientists are now peering into the blood of people who have recovered from C19 to map the defenses the immune system put up when the virus attacked. In recent weeks, they’ve described the type of antibodies produced, finding that they can have powerful effects against one of the virus’ key proteins, and that almost all patients who had the disease, even those who had mild infections, generated antibodies. Those are positive signs, given that a type of antibody, called a neutralizing antibody, is, in sufficient quantities, expected to offer some amount of protection for at least some amount of time. Scientists have also reported the rallying of immune cells, which can be involved in recognizing a virus and stopping it.
- The thought is that the defenses the body mounted to vanquish the virus the first time provide clues to what is required to fend off a second attack.
- To confirm that people who recover from C19 are protected and to determine how long that lasts, scientists have to track people and see what happens to them if they encounter the virus again. That research often focuses on health care workers who are more likely to be exposed repeatedly. (Scientists can’t ethically expose people to the virus again intentionally.)
- But with animals, researchers can “challenge” those that are vaccinated or have had an initial infection to see if they can ward the virus off — which is what recent studies in monkeys demonstrated. Scientists found that the animals generated neutralizing antibodies after they first contracted the virus or when they were given experimental vaccines, and that the higher the level of the antibodies the monkeys had (the higher the “titer,” in scientific parlance), the more protected they were against the pathogen when scientists sprayed a second dose into their noses.
- “That is a suggestion that neutralizing antibodies to the virus can protect” against reinfection, said Dan Barouch, the director of Beth Israel Deaconess Medical Center’s Center for Virology and Vaccine Research, who steered that research.
- If that finding extends to people, “we will start to be able to use that as a predictor of success,” Barouch said. That is, in experiments with vaccine candidates, researchers can start to see what levels of neutralizing antibodies they are producing, and prioritize those that seem to generate more promising responses.
- With some diseases, researchers also run “human challenge trials” of vaccines — in which volunteers are given an experimental vaccine and then exposed to the virus — in an attempt to speed up the process of testing them. Scientists are divided over the ethics of such trials for the coronavirus, but those who are supportive say one benefit could be establishing the correlates of protection, indicating which parts of the immune system need to be active to insulate someone from the virus.
- Scientists often home in on neutralizing antibodies as correlates, but there can be other markers as well. They include other types of antibodies, like binding antibodies; immune cells like T cells and B cells; and cytokines — small proteins released by immune cells that serve as messengers. In the monkey study, for example, Barouch and colleagues also found an association between protection and the level of another type of antibody, though it wasn’t as strong as the correlation between protection and neutralizing antibodies.
- “There are a whole bunch of other things that people look at for correlates of protection,” said virologist Angela Rasmussen of Columbia University.
- One challenge is that people respond differently to infections; some studies, for example, have found people who recovered from C19 actually generated low levels of antibodies. But because the immune system is so complex, having low levels of antibodies does not necessarily mean that a person won’t be safeguarded. All that can make it harder to define exactly what immunity looks like.
- “Some people who’ve had this have not had high antibody titers or have had low antibody titers,” said Anna Durbin, a vaccine researcher at Johns Hopkins University. “We still don’t know what’s going to happen to them if they’re re-exposed.”
- Durbin also noted that what’s happening with immune cells and antibodies in someone’s blood may not mean the cells in the upper airway — which the coronavirus targets — are similarly defended. Certain antibodies in the blood might stave off severe illness, but they won’t necessarily be able to fully prevent the virus from reinfecting cells in the nose and throat.
- Because of the difficulties of stopping upper respiratory infections, scientists are already anticipating that C19 vaccines may not provide complete protection — called sterilizing immunity — but will rather reduce the risk of contracting the virus and of getting critically sick.
- “I am not convinced we’re going to have a singular, absolute correlate of protection,” Durbin said.
- With C19, immunity — whether from an infection or a vaccine — is expected to wane over perhaps a few years; that is what happens with the four human coronaviruses that cause colds. If that pattern extends to this virus, people will gradually become more susceptible to the virus after some amount of time (though they may be less likely to get a severe case). Tracking the levels of the different correlates could provide clues to how long immunity lasts, and when a person becomes vulnerable again. It could also indicate when people might need another dose of the vaccine.
- “When we’re trying to evaluate an immune response, we don’t only want to see we engage the proper immune responses for protection,” said Scott Hale, a University of Utah immunologist. “We also want to make sure there’s some form of long-lasting immunity in case you’re exposed to the pathogen in a year or five years or 10 years.”
1. Where reopening is working
New York Times
- We journalists don’t always pay enough attention to good news. So I want to highlight some this morning: Across much of the United States and Europe, the coronavirus has been spreading less rapidly than many people feared.
- Yes, the caseload is growing in some places, and they’re rightly getting a lot of attention. But the full story is more complex. Over the past six weeks — as communities have started to reopen, Americans have flocked to beaches and lakes and European schools have reopened — the number of new cases has continued falling in many places.
- Across the Northeast and Midwest of the U.S., they’re down more than 50%, and often much more, since May 1.
- Nationwide, weekly deaths have fallen for six weeks in a row. And Europe “seems to have turned a corner,” Caitlin Rivers of Johns Hopkins University says.
- How could this be? I put that question to public health experts, and they gave two main answers.
- One, the virus spreads much less easily outdoors than indoors. “Summer — being outside, warmer weather, humidity — seems to help, and we may have underestimated how much it’s helped,” Ashish Jha, the incoming dean of Brown University School of Public Health, told me.
- Two, many people are taking more precautions than they were in February and March. They’re wearing masks, remaining six feet apart and being careful about what they touch. “Even absent top-down health interventions” — like lockdowns — “people want to keep themselves safe,” Rivers said.
- The combination appears to have eliminated most “superspreader events,” like parties, concerts and restaurant meals, where multiple people get sick. Such events may account for 80 percent of all transmissions, research suggests.
- I recognize that this is a somewhat dangerous message. Transmission rates in the U.S. are higher than they need to be, and they have begun rising again in parts of the South and West. In Arizona, where the governor has played down the virus and hospitals are filling up, the situation looks especially bad. But many other places are showing what a responsible and effective reopening looks like.
- One crucial caveat is that the virus will outlast the summer — everywhere. During the 1918-19 flu, transmission rates fell in the warmer months, only to soar again in the fall. “People thought it was over,” as Apoorva Mandavilli, a science reporter at The Times, said, “and stopped taking precautions.”
- Where the news is worse: A few big countries where cases are still rising — India, Mexico, Russia, Iran and Pakistan — are nevertheless ending their lockdowns, citing economic reasons.
Johns Hopkins COVID-19 Update
June 12, 2020
EPI UPDATE The WHO COVID-19 Situation Report for June 11 reports 7.27 million confirmed cases (128,419 new) and 413,372 deaths (5,347 new).
Following a week of reporting slightly fewer than 10,000 new cases per day, India’s daily incidence jumped today to 10,956 new cases. India remains #3 globally in terms of daily incidence. Pakistan has exhibited increasing daily incidence over the past several weeks, reporting its highest daily total yesterday (6,397 new cases). Pakistan’s daily incidence has more than doubled since late May, and it is now #5 globally in terms of daily incidence. Bangladesh also reported its highest daily total yesterday, with 3,471 new cases. Bangladesh remains #10 globally in terms of daily incidence.
Iran reported 2,369 new cases. While the national incidence is down from more than 3,500 new daily cases last week, this represents an increase from earlier in the week. Iran is #12 globally in terms of daily incidence. Russia is now reporting more than 500,000 cumulative cases, with nearly half (49.0%) in Moscow and the Moscow Region. Russia remains #3 globally in terms of cumulative incidence and #4 in daily incidence.
Brazil reported more than 30,000 new cases for the third consecutive day—and the sixth time in the past 2 weeks. Brazil remains #1 globally in terms of daily incidence. Broadly, the Central and South American regions are still 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 Peru (#6), Chile (#7), and Mexico (#8)—and per capita daily incidence—Chile (#3), Peru (#5), Brazil (#8), and Panama (#9).
The Eastern Mediterranean Region also remains an emerging hotspot, particularly in terms of per capita incidence. The region represents 5 of the top 11 countries in terms of per capita incidence: Qatar (#1), Bahrain (#2), Oman (#4), Kuwait (#7), and Saudi Arabia (#11). Additionally, nearby Armenia is #6. Several Eastern Mediterranean countries are also exhibiting high total daily incidence. Saudi Arabia ranks #11 globally, and Qatar is #13, despite ranking #139 by total population. Bahrain and Saudi Arabia both reported their highest daily incidence, and Saudi Arabia’s daily incidence has doubled since early June.
The US CDC reported 1.99 million total cases (20,486 new) and 112,967 deaths (834 new). The United States will likely surpass 2 million cases in today’s update. 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 New York Times, ProPublica, Johns Hopkins University, and others continue to track state- and local-level COVID-19 incidence in a variety of forms. A number of states began to relax social distancing measures—including resuming operations at restaurants, retail stores, and barbershops/salons—at the end of April/early May. Increased social interaction as well as mass gatherings associated with the Memorial Day holiday weekend and ongoing large-scale protests against racial injustice could potentially contribute to community transmission. We will continue monitoring these trends over the coming weeks.
As we have noted recently, a number of US states are exhibiting increasing COVID-19 incidence and hospitalizations, several weeks after initiating efforts to relax social distancing restrictions. We have covered several of these states already this week, including Arizona, California, and Texas (hospitalizations and testing). Other states of note include Alabama, Alaska, Florida, North Carolina, South Carolina, and Vermont. A number of these states reported their highest daily incidence and/or highest current COVID-19 hospitalizations over the past several days. While Alaska still has relatively few cumulative reported cases, its daily incidence has returned to a similar level as its “first wave” of cases, and modeling indicates that its epidemic is currently exhibiting exponential growth. In addition to increasing incidence, several of these states are also reporting increasing COVID-19 hospitalizations or increasing or elevated test positivity, which suggests that increased testing may not wholly account for the increased incidence. Increased incidence is not necessarily distributed evenly across these states. Multiple outbreaks in different locations—including congregate settings such as nursing homes, meat packing facilities, and prisons or jails—are contributing substantially to these totals in numerous states. Many of these states were not hit particularly hard early in the US COVID-19 epidemic, but they are now exhibiting increasing incidence that corresponds temporally with decisions several weeks ago to relax social distancing and permit increased social interaction. It is still a little early to identify any increased transmission related to Memorial Day holiday gatherings or protests against racial and social injustice in the United States or other countries.
The Johns Hopkins CSSE dashboard reported 2.03 million US cases and 113,924 deaths as of 12:30pm on June 12.
LUNG TRANSPLANT FOR COVID-19 PATIENT A COVID-19 survivor in the United States is the recipient of the first reported lung transplant on a former COVID-19 patient. The patient, a young and otherwise relatively healthy woman, had severe lung damage as a result of COVID-19, which caused other complications such as secondary bacterial infections and the onset of other organ failure due to lack of oxygen. The surgery was especially challenging, as the inflammation and lung damage nearly fused the lung tissue to the patient’s chest wall, according to surgeon Dr. Ankit Bharat. Her physicians expect her long-term prognosis to be good. The United States is experiencing a shortage of available organs for transplant and a growing waiting list of patients, even prior to the emergence of SARS-CoV-2. As we have covered previously, this situation is being exacerbated by the ongoing COVID-19 epidemic, due to a variety of factors.
SARS-CoV-2 IMMUNITY Scientists and vaccine developers are working to understand how the human immune system responds to SARS-CoV-2 and the lasting immunological profile of infection. While evidence is emerging that recovering from COVID-19 does confer some protective immunity, the degree and duration of protection remain uncertain. There are a wide variety of cells and proteins that contribute to the immune response, including antibodies, T cells, and innate immune cells. Considerable attention is currently focused on the neutralizing antibody response, but more research is beginning to address the role of T cells in fighting SARS-CoV-2. Understanding these correlates of immunity is important vaccine development, as these products must elicit an appropriate and protective immune response. There is also great variability in the magnitude of the immune response from person to person, and vaccine developers must take these variations into account when developing a widely protective vaccine.
MASK USE Following the recent statement and clarification by the WHO regarding recommendations regarding the use of face masks and coverings to mitigate SARS-CoV-2 transmission risk, a study was published that suggests that widespread mask use by the general public can provide significant benefit in terms of curbing transmission. The study, a modeling effort by researchers in the United Kingdom, found that universal mask use by the public could be sufficient to contain a COVID-19 epidemic, in some cases, even without associated “lockdown” restrictions. The researchers modeled a variety of scenarios, utilizing both individual- and population-level transmission dynamics, to characterize the conditions, including mask filtering efficiency, under which mask use could be beneficial. In addition to modeling reduced transmission due to mask use, the researchers also factored in potential increased transmission risk resulting from improper mask use or self-contamination due to individuals touching their face and mask.
The study found that mask use, with or without “lockdown” restrictions could effectively reduce transmission risk. Under some conditions, mask use by the public could be sufficient to contain transmission by itself, and in others, it substantially reduced transmission. The largest effect was achieved for scenarios in which mask use was universal, including for asymptomatic individuals. The lead author, Dr. Richard Stutt, stated that the “analyses support the immediate and universal adoption of face masks by the public,” including both symptomatic and asymptomatic individuals. As with any modeling study, there are inevitable limitations and assumptions that will impact the results. Even if the magnitude of the effect is lower than this model indicates, however, it provides additional support for widespread mask use, including by those not currently exhibiting symptoms.
The UN High Commission for Refugees (UNHCR) is supporting efforts to produce and distribute face masks in Turkey. The effort is led by 12 Afghan refugees currently living in Turkey, who are coordinating with local volunteers to provide 1,000 masks per day, as well as soap and other supplies. The project ultimately aims to produce 30,000 masks over the course of a month. The group said that they wanted to find a way to thank Turkey for welcoming them and other Afghan refugees and to actively contribute to the COVID-19 response rather than “just rely[ing] on assistance.”
AFRICA COVID-19 PREPARATIONS Initially, many public health experts were concerned about the potential for COVID-19 to devastate the African continent, where many struggle with inadequate public health and healthcare infrastructure. Additionally, many African countries face a high prevalence of underlying health conditions—including HIV/AIDS, malaria, and tuberculosis—which place individuals at elevated risk for severe disease and death. To date, however, most countries in Africa have reported an unexpectedly slow rise of cases and relatively low mortality.
While some countries, like Nigeria, are beginning to experience an exponential increase in cases, some public health experts remain cautiously optimistic that strict control measures implemented early in the pandemic may have made a meaningful difference in many countries. When reports of imported cases first appeared in Egypt and Nigeria, many sub-Saharan African countries quickly moved to impose strict “lockdowns” and other restrictive physical distancing measures, although a number of countries are beginning to relax these policies. Another possible explanation for Africa’s relative success against COVID-19 is the overall “younger demographic age structure” in many countries. For example, 23% of Italy’s population is over the age of 65, compared to only 3% of the sub-Saharan African population, which could account for some of the reduced mortality observed so far in Africa. Climate could also potentially play a role, but further investigation is needed to better characterize any seasonality or impact from temperature or humidity. While Africa’s COVID-19 reporting appears to indicate relative success compared to other parts of the world, some experts remain concerned that the low incidence may be a function of limited testing capacity rather than an indication that countries are effectively containing their national epidemics. Experts recommend continued vigilance, support, and surveillance in the coming weeks and months in order to stay abreast of the COVID-19 pandemic’s effect on African nations.
SOUTH KOREA South Korea has been praised for the successful containment of its COVID-19 epidemic, but a recent increase in incidence, particularly in and around Seoul, is raising concern that South Korea could be on the precipice of a second “wave” of cases. Following substantial transmission among the members of a large religious group that fueled early SARS-CoV-2 transmission in South Korea, the country was largely able to bring COVID-19 under control. In fact, South Korea reported 10 or fewer cases on most days between mid-April and early May. As a result of successfully reducing transmission, South Korea relaxed a number of social distancing measures nationwide and permitted resumed operations at many businesses. Despite ongoing encouragement by government officials to continue practicing social distancing and refraining from unnecessary activity and gatherings, credit card and cell phone location data indicate that public activity has essentially returned to pre-pandemic levels.
South Korea has reported increased COVID-19 incidence since early May. While the total number of daily cases, now approximately 40-60 new cases per day, is nowhere near the incidence observed in many other countries, the fact that transmission has been linked to numerous exposures in and around South Korea’s most populous city gives cause for concern. As transmission has increased, South Korean health officials have reportedly struggled to keep up through contact tracing. The combination of social distancing and contact tracing has been touted as the key to South Korea’s early success, but if this capacity is unable to stay ahead of the epidemic and identify COVID-19 cases before they can infect others, an outbreak in Seoul could pose major challenges for the COVID-19 response. The Korean CDC emphasized that transmission is occurring at a variety of settings in Seoul, particularly those that involve prolonged close contact, such as nightclubs and bars, entertainment venues, and places of worship. Additionally, South Korea has reported dozens of cases associated with a logistics company warehouse. South Korea has not re-instituted nationwide or large-scale social distancing restrictions, but some cities are reacting to the increased transmission by implementing their own policies. Seoul, for example, reportedly closed nightclubs, bars, and entertainment venues to mitigate transmission risk.
US ECONOMY & EMPLOYEE SAFETY The US Department of Labor published its weekly report on unemployment claims, which yielded mixed results. On the positive side, the number of new unemployment claims fell last week, down more than 350,000 compared to the previous week. Additionally, the total number of active unemployment claims decreased by 339,000 compared to the previous week, and the national unemployment rate decreased from 14.4% to 14.2%. These figures indicate that some Americans are beginning to return to work. That being said, Americans still filed more than 1.5 million new unemployment claims last week, and 20.9 million unemployment claims remained active nationwide, indicating that many Americans continue to struggle with employment, even as states relax social distancing and economic activity increases. Additionally, the US Federal Reserve announced that it intends to keep interest rates low, potentially through 2021, in order to promote economic recovery, and it forecast a 6.5% decline in the national gross domestic product by the end of 2020.
As US states continue to relax social distancing and resume business, government, transportation, and other activities, workers are returning to a myriad of new policies and protective measures. Despite changes designed to ensure workers’ health and safety, many remain concerned that the protections are not sufficient to effectively mitigate the COVID-19 risk. One of the major challenges lies in the guidance issued by federal agencies, including the US CDC, much of which is voluntary, as opposed to mandatory and enforceable. While some industries have been more severely affected than others, such as meat processing, many aspects of the economy—including restaurants, barbershops and salons, and retail stores—are resuming activity across the country. Many businesses (or individual employees) are developing and implementing their own plans without the aid of government-mandated requirements, which could result in inconsistencies, within and between communities, in how federal guidance is operationalized.
The combination of the unemployment report, economic forecasts, and reports of increasing COVID-19 incidence and hospitalizations in numerous states appears to have made a major impact on the stock market. US stocks fell yesterday by their largest daily total since March, including a 6.9% drop in the Dow Jones Industrial Average. Responding to these economic and epidemic trends, US Secretary of the Treasury Steven Mnuchin commented that the United States could not afford to shut down the economy again in response to increased COVID-19 transmission, citing both economic impact and downstream effects, including on health.
BRAZILIAN FAVELAS RESPOND TO COVID-19 As Brazil’s COVID-19 incidence continues to increase dramatically, some of the country’s most vulnerable populations have been provided limited support or resources by the government to protect themselves or maintain financial security. Those living in Brazil’s favelas, densely populated and low-income areas, are at elevated risk from COVID-19. Like many countries, lower-income and racial and ethnic minorities are at higher risk of infection as well as severe disease and death. In São Paulo, Brazil, individuals living in lower-income parts of the city are reportedly up to 10 times as likely to die from COVID-19 than those living in wealthier areas, and Black residents are 62% more likely to die from COVID-19 than White residents.
Without adequate government support, favelas have been forced to become more self-reliant, particularly as gang violence, systemic racism, and other factors have limited access to vital resources. In response, local communities formed their own systems for services like mail, sanitation, and even internet access. Similarly, these communities are now mounting their own COVID-19 response. Local community organizations and leaders, including “street presidents” who represent smaller groups of neighbors among the favela communities, are coordinating efforts to deliver supplies like masks and hand sanitizer, distribute food, conduct disease surveillance, and dispel misinformation. Additionally, community organizations have hired ambulances for use in their neighborhoods and created funding support for those who are unemployed and in need of financial assistance.
STAFFING SHORTAGES AT NURSING HOMES Nursing homes and long-term care facilities are among the highest-risk settings in the US COVID-19 epidemic. Prolonged close contact among residents and staff and the presence of high-risk older residents with underlying health conditions have resulted in numerous outbreaks across the country, accounting for a disproportionate fraction of US COVID-19 cases and deaths. The Kaiser Family Foundation estimates that approximately 15% of COVID-19 cases and 45% of deaths (across 41 states with available data) are among residents of long-term care facilities.In addition to the elevated risk, chronic staffing shortages and management problems at these facilities are reportedly being exacerbated by the COVID-19 epidemic, which poses additional challenges in caring for patients and controlling SARS-CoV-2 transmission. These facilities have experienced long-standing staffing and management limitations, but the COVID-19 epidemic has highlighted the magnitude of these challenges and the associated dangers. Staffing standards vary by state, and according to analysis conducted by Reuters, approximately 40% of nursing home facilities nationwide would fail to meet the strictest staffing standards, which are implemented in California. The federal government has been criticized by advocacy groups during the COVID-19 response for not providing sufficient coordination and guidance to nursing home facilities in order to protect the most vulnerable populations. For example, the US government recommends that states test all residents and staff at long-term care facilities, but it is not mandatory and compliance with this guidance reportedly varies by state and local jurisdiction. US Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma stated that CMS would cover the cost of testing for residents if there is a suspected outbreak; however, individual facilities or states are responsible for the cost of testing staff.