Recent Developments & Information
June 19, 2020
Reliable information is the best tool available to protect your family from the pandemic and its shockwaves
“Unless players are essentially in a bubble – insulated from the community and they are tested nearly every day – it would be very hard to see how football is able to be played this fall.”Dr. Fauci
“One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don’t believe science and they don’t believe authority.”Dr. Fauci
“I’m in a high-risk category. Personally, I would not go to a Trump rally. Of course not.”Dr. Fauci
Index of Featured Stories:
Emerging US Hotspots
States with Active or Imminent Outbreaks
New Scientific Findings & Research
Concerns & Unknowns
Back to School!?
Projections & Our (Possible) Future
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A. The Coronavirus As Seen Through Headlines
(In no particular order)
- Two of the highest daily tallies in new global cases were reported this week
- The outbreak is surging, with clusters on several continents
- 23 US states seeing rising case numbers
- In new U.S. coronavirus ‘hotspots,’ hospitals appear poised to meet possible surge in cases
- Doctors Fear Arizona Virus Overload as Hospital Cases Top N.Y.
- Florida “has the makings of the next epicenter”
- Florida positivity rate hits highest level since April
- Florida breaks own record for new coronavirus cases in single day
- The virus hits Florida’s farmworkers hard, just before harvest season
- Texas reports 7th straight record hospitalizations;
- 1/3rd of workers at Orlando International test positive
- Arizona reports record jump in cases
- California sets another record high with 4,233 new cases
- NY Gov. Cuomo ‘considering’ a two-week quarantine on people coming to NY from Florida
- Antibodies to the coronavirus may only last two to three months, especially in people without symptoms, a new study found
- After a new one-day case record, California has mandated face coverings in many public spaces
- California Gov. Newsom signs executive order making mask wearing mandatory
- Governor Abbott Says No To Mayors Who Want To Impose Fines for Not Wearing Masks
- Texas schools to reopen in the fall for in-person classes
- NY reports 29 deaths
- ‘We can’t stay inside forever’: New Yorkers stretch the rules as the city looks to the next phase
- NYC Mayor says city to enter ‘phase 2’ Monday
- Dr. Fauci to testify before Senate later this month
- Dr. Fauci Says Americans Were Initially Misled About Masks – We “Wanted to Make Sure Healthcare Providers” Had Enough.
- Trump says Covid-19 is ‘dying out.’ Experts fear his dismissiveness could prolong the crisis
- Australia Says Border Won’t Reopen Until 2021
- Health-care worker and 15 friends infected after night out at Fla. Bar
- Hundreds of healthcare workers lost their lives battling the coronavirus
- Pakistan report another alarming jump in COVID cases
- Beijing expands lockdowns to nearly 30 residential compounds
- India suffers deadliest day yet
- 13 Texas longhorns football players test positive as Dr. Fauci says 2020 football might not happen
- Italy reports uptick in deaths
- Tokyo reports 41 infections
- Beijing top epidemiologist says outbreak in the city has been contained
- New study shows many infected don’t develop long term antibodies
- India reports record jump in new cases (12,000+)
- Indonesia reports record jump, surpassing Singapore’s case total
- Source of Beijing’s big new COVID-19 outbreak is still a mystery
- ‘We’ve got to be able to move more quickly.’ The pandemic reality of COVID-19 clinical trials
- HIV and TB increase death risk from COVID-19, study finds—but not by much
- Coronavirus forces United States, United Kingdom to cancel Antarctic field research
- Pandemic upends Colombia’s controversial drug war plan to resume aerial spraying
- San Diego’s scientific and medical institutes collaborate on large-scale research program to study spread of COVID-19
- Beijing COVID-19 total grows; Latin America, Mideast face more cases
- COVID-19 continues surge in Sunbelt as mask debate returns
- NYPD told to ignore playground break-ins amid lockdown
- Oxford Experts: “There Is No Scientific Evidence For COVID Two-Meter-Rule”
- Putin Has Three ‘Disinfection Tunnels’ To Shield Him From COVID
- A majority of Americans fear pharma will use Covid-19 as an excuse to raise prices
- NYC to enter Phase 2 reopening Monday with expanded outdoor dining
- Europe Released 122,000 Inmates to Control Coronavirus
- Volunteers Are Lining Up to Be Infected With the Coronavirus
- Chinese manufacturer charged with selling over 140,000 fake ‘KN95’ masks
- Virus infections continue steady rise in S Korea
- German slaughterhouse virus outbreak untenable
- Acting Fast Is the Key to Beating a Second Wave of Covid-19
- Texas announced a plan to reopen schools in the fall with both in-person classes and options for remote instruction
- With college football scheduled to kick off in just over two months, four games have been canceled because of the virus
- NY City Ballet is canceling its fall season and its holiday run of The Nutcracker
- Most States Need More Contact Tracers
- Many summer camps across the U.S. are canceling their programs, but some are remaking the experience with extensive safety measures
- The adult film industry could serve as a model for businesses now trying to keep workers safe
- Trump suggests China allowed coronavirus spread for economic reasons
- New Yorker booted off flight to Trump rally for not wearing face mask
- Early Data Show No Uptick in Covid-19 Transmission From Protests
- Judge denies LI strip club owner’s bid to reopen over coronavirus shutdown
- Florida Keys now requires face masks inside businesses until June 2021
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day. Green highlights indicate a decrease or no change and yellow highlights indicate an increase.
1. Cases & Tests
- Total Cases = 8,570,384 (+1.7%)
- New Cases = 140,528 (-5,583)
- Growth Rate of New Cases (7 day average) = 1.7% (-0.2)
- New Cases (7 day average) = 136,957 (-3,561)
- Although new cases have decreased for last 2 days, the number of new cases is trending higher
US Cases & Testing:
- Total Cases = 2,263,651 (+1.3%)
- New Cases = 27,924 (+1,696)
- Percentage of New Global Cases = 19.9% (+1.5%)
- Growth Rate of New Cases (7 day average) = 1.2% (+0.1%)
- New Cases (7 day average) = 24,805 (+616)
- Total Number of Tests = 26,723,179 (+479,368)
- Percentage of positive tests (7 day average) = 4.6% (+0%)
- Highest number of new cases in last 7 days
- New cases have increased for 4 consecutive days
- Number of new cases have been trending higher since 6/9 (the 7 day average of new cases has increased by 3,540 new cases since 6/9, an increase of 27%)
- Total Deaths = 455,575 (+1.1%)
- New Deaths = 5,123 (-141)
- Growth Rate of New Deaths (7 day average) = 0.5%
- New Deaths (7 day average) = 4,641 (+25)
- New deaths began trending lower on 4/21 through 6/1, after which new deaths have been trending higher (7 day average of new deaths has increased from 3,051 to 4,641 since 6/1, an increase of 52.1%)
- New deaths over the last days have been significantly higher than the 7 day average for new deaths
- Total Deaths = 120,688 (+0.6%)
- New Deaths = 747 (-62)
- Percentage of Global New Deaths = 14.6%
- Growth Rate of New Deaths (7 day average) = -3.3% (-0.4%)
- New Deaths (7 day average) = 665 (-22)
- New deaths have been generally trending down since 4/21 (7 day average of new deaths has decreased from 2,214 to 665 since 4/21, a decrease of 70%)
C. Emerging US Hotspots
1. Active or Imminent Outbreaks
Covid ActNow assigns a Covid Risk Level to All States
- Risk Level 1 = On track to contain COVID
- Risk Level 2 = Controlled Disease Growth
- Risk Level 3 = At Risk
- Risk Level 4 = Active or Imminent Outbreak
Below are the States that have a COVID Risk Level 4 (Active or Imminent Outbreak):
Arizona (COVID Risk Level 4)
- Infection Rate = 1.18 (High)
- Positive Test Rate = 17.3% (High)
- Available ICU Beds = 23% (Critical), High risk of hospital overload
- COVID cases are growing exponentially and/or COVID preparedness is dangerously below international standards
Missouri (COVID Risk Level 4)
- Infection Rate = 1.01 (Medium)
- Positive Test Rate = 4.4% (Medium)
- Available ICU Beds = 87% (Low Risk), Can likely handle a new wave
- COVID cases are growing exponentially and/or COVID preparedness is dangerously below international standards
Alabama (COVID Risk Level 4)
- Infection Rate = 1.11 (High)
- Positive Test Rate = 13.7% (High)
- Available ICU Beds = 68% (Low Risk), Can likely handle a new wave
- COVID cases are growing exponentially and/or COVID preparedness is dangerously below international standards
Georgia (COVID Risk Level 4)
- Infection Rate = 1.02 (Medium)
- Positive Test Rate = 7.3% (Medium)
- Available ICU Beds = 73% (Low Risk), Can likely handle a new wave
2. Spotlight on Florida
- Florida’s confirmed C19 cases Wednesday surged to their highest weekly level, six weeks after the Sunshine State started a phased reopening of its economy.
- Governor Ron DeSantis — who said Tuesday that he has no plans to return to a lockdown — has attributed the jump in part to expanded testing, an argument that’s undermined by the jump in the percentage of tests that come back positive.
- The daily rate of people testing positive for the first time climbed to 10.3% on Tuesday, the highest since at least April, up from 7.4% Monday. The seven-day average rose to 6.3%, nearly twice what it was at the end of May.
- Speaking Tuesday in Tallahasse, DeSantis also said that isolated outbreaks in prisons, long-term care facilities and counties with agriculture communities may be skewing the numbers. He said migrant farmworkers in areas such as Collier, Martin and Alachua counties live and work in close quarters and are testing positive at unusually high rates.
- But even after excluding those factors, Florida’s C19 cases are still surging. In fact, the rate of increase would be up even more if the examples DeSantis cited were excluded — a 50% increase since May 31 versus 47%.
- (The agriculture counties included in the above chart are ones that DeSantis has specifically mentioned as problematic.)
- Asked about the data, Florida Department of Health spokesman Alberto Moscoso said agriculture, prisons and long-term care are “not the only reasons for the rise in the number of positive cases.” And he reiterated the governor’s point that the median age of C19 positive cases dropped to 37 last week — almost half of where it was in early March, meaning the clinical consequences of more cases aren’t likely to be as severe. [Note: the drop in median age is likely due to the protection of the elderly populations]
- Hospitalizations are rising on a seven-day basis, though they are rebounding from recent lows, and the state has ample hospital capacity. [Note: According to the IHME, Florida has more than 20,000 hospital beds available, and there are only 1,000 hospital beds in use for C19 patients. As a result, Florida is well positioned to handle an increase in hospitalizations. Also, even though hospitalizations have been rising recently, the chart shows that Florida has a pattern of alternating between increasing and decreasing numbers of hospitalization, and it is premature to determine whether the recent increase is part of that pattern or an upward trend.]
- Overall, cases rose by 2,610, or 3.3%, to 82,719 on Wednesday, compared with an average of 2.8% in the previous seven days. On a trailing seven-day basis, cases rose by 15,348, the most ever and about triple the rate when Florida began reopening its economy on May 4.
- Deaths continue to be stable, but they can be a trailing indicator. Given that Florida has one of America’s largest 65-and-older populations, it has so far had fewer C19 fatalities than initially feared. [Note: As shown in the chart below, we see a declining trend in C19 deaths.]
3. Hospitalizations Are Best Indicator of a Second Wave
- Are we on the verge of a second wave of coronavirus infections? Is there a spike in infections in states that reopened first?
- The only way to answer that question is to watch as the data roll in. Arguably the best data to look at to see if a second wave is beginning are the hospitalization numbers. The media frequently reports the biggest and most dramatic numbers, often devoid of context. The number of cases has been reported regularly since the early days of the pandemic, and yet we know that the number of cases can be misleading.
- As more people are tested and re-tested for the virus, more results will come back positive, with the current number of confirmed cases exceeding 2 million in the U.S. But if we know anything, it is that increases in the number of confirmed cases do not accurately convey how quickly and widely the virus is spreading. Antibody tests and even the examination of sewage in some cities suggest that the number of infections is likely much higher than the number of confirmed cases.
- But on the other side, some of the confirmed cases are double-counted in some states partly because both antibody and active virus tests are being counted separately but then combined in the total number of cases. While the antibody tests have been criticized for their false positive rate, another criticism has been that the antibody studies can underreport infection rates because they are not sensitive enough to detect a past mild infection.
- Overall, because the bulk of testing is focused on people who are the sickest and who face the greatest exposure, it seems reasonable to conclude that the true number of U.S. infections is substantially higher than the reported figure. But an attempt to estimate the true number of infections would be little better than a guess.
- And this presents a problem with the daily updates. To say that a particular state or city is seeing a “spike” in cases is to say that recently they have had an uptick in positive test results. That could be due to more testing and more ways of testing, or it could be a hint of growth in the infection rate.
Better Data are Available
- Rather than focus on test results, i.e. “cases,” it would make more sense to focus on how the virus affects society and our institutions, particularly the strain the virus puts on health care facilities and health care providers.
- An obvious measure, tracked since the beginning of the pandemic, is the number of deaths, but the number of deaths is hard to interpret without important context.
- The coronavirus is obviously deadly, but how deadly it is seems to depend greatly on how it enters a population and the characteristics of that population. The virus has been far deadlier in New York than it has been in California, and has been most deadly in U.S. long-term care facilities. Among children, the coronavirus is considerably less deadly than seasonal influenza.
- Nonetheless, deaths tell us something important about the virus’s impact on society. They profoundly affect entire social networks and are rightly emphasized in pandemic reporting.
- When it comes to seeing how things are going now, whether the pandemic is growing worse or fading, deaths are a lagging indicator. They do not begin to spike until infections have already been accelerating rapidly for many days, and they do not decline until well after the virus’s spread has slowed.
- The chart below shows that overall, deaths are clearly declining, although there is a weekly cycle where Sundays seem to result in relatively low death counts and Tuesdays and Wednesdays usually have the highest reported numbers. Overall, the past two weeks have had lower death totals than have been seen in the two months prior. But if a second wave were coming soon, we would not see the deaths from it yet.
- Here is another look from the Washington Post.
- In addition to deaths, more attention has shifted to measuring coronavirus-related hospitalizations. Frustratingly, these data tend not to go back as far as numbers on confirmed cases or deaths, but in most states there are hospitalization figures going back over two months. The hospital data are measured two ways, the first being a cumulative measure, similar to the way confirmed cases and deaths are measured.
- The number can only go up as more hospitalizations are added to the total. From that number, the daily number of hospitalizations can be plotted; however that number is very noisy because the numbers are submitted at the state level in a variety of ways and do not seem to reflect the true numbers per day.
- In other words, the hospitalization numbers seem to come in in clumps. They can be reported as weekly totals or weekly averages, as well. But a weakness of the cumulative data is that they do not tell us much about the burden on hospitals and health care workers.
- The total number of coronavirus hospitalizations increased dramatically, from zero to nearly 60,000 in a month nationally, and stayed high for weeks afterward. The chart below shows that the decrease in hospitalization has been fairly steady, and overall there is far less strain on the health care system than there was in mid-April.
- The northeastern U.S. was hit hardest, but most states are either seeing declining or flat trends in hospitalizations, with a few notable exceptions such as North Carolina, Texas, and Arizona. But in those states the number of hospitalizations is still relatively low, a fraction of the totals that New York and New Jersey were seeing in April.
- Claims that Alabama, Georgia, and Florida are emerging “hotspots” are not supported by the hospitalization numbers despite media reports to the contrary.
- There are some parts of the country still in the midst of the first wave of coronavirus infections, states that had very low numbers of hospitalizations and deaths in April, but are now beginning to see the virus spread more quickly. But those states are unlikely to see the kind of spread Northeastern states did, and there is hope the virus can be far less deadly going forward if policies can be implemented to better-protect the elderly and vulnerable, especially those living in long-term care facilities.
D. Potential Treatments
1. Blood plasma is safe for C19 treatment
- A large study of 20,000 hospitalized C19 patients who received transfusions of blood plasma from people who recovered found the treatment was safe and suggests giving it to people early in the disease may be beneficial.
- The treatment, called convalescent plasma, is based on a century-old idea in medicine that has been used against measles, influenza and Ebola. People who recover from an infection have virus-fighting antibodies floating in their blood, and transfusions of their plasma — the clear liquid after blood cells are removed — may give recipients’ immune systems an assist in fighting off the virus.
- The study, published Thursday in Mayo Clinic Proceedings, is the largest analysis yet of an experimental treatment rapidly deployed in the early weeks of the pandemic through a grassroots effort by physicians. What started as a proposal in a medical journal rapidly drew more than 2,000 medical institutions into a collaborative effort to work out the logistics of collecting and deploying the plasma.
- The results are encouraging, showing severe adverse events were rare, in less than 1 percent of patients. But they also highlight the difficulty of conducting conclusive studies in the midst of a global pandemic — and add to a body of inconclusive and sometimes conflicting evidence about the approach.
- “The actionable message here is that this is safe, inexpensive, and the mortality rates in sick patients are quite low,” said Michael Joyner, an anesthesiologist at the Mayo Clinic who led the study.
- But he acknowledged there is a “chicken and egg” conundrum in trying to conclusively determine the effectiveness of the treatment. The patients were given the treatment through an expanded access program created by the Food and Drug Administration, not in a clinical trial in which patients are randomly assigned to receive the treatment or a placebo.
- The data, he pointed out, are consistent with the treatment being beneficial. Among the first 5,000 patients who received a plasma transfusion, the death rate in the week after the transfusion was 12 percent. That first group of patients received transfusions at a time when plasma was often in short supply and was administered to patients late in their illness. In the larger study, the mortality rate fell to less than 9 percent.
- There is no comparison group of patients who did not receive plasma, but the researchers speculate the death rate may have dropped because plasma became more widely available and was given earlier in the disease, which is when doctors say it is more likely to work, based on use in other diseases.
- But other factors could also explain that drop in mortality — as the pandemic went on, physicians might have gotten better at treating C19 patients, or people with less severe illness may have begun to show up at the hospital and receive the treatment.
- “You’d like to have the gold standard [of evidence] in something this important, and I feel like it always ends up here with this approach,” said Jeffrey P. Henderson, an infectious-disease specialist at Washington University in St. Louis who has been working on the effort to use plasma. “It’s pushed into action quickly, because there’s no other option, and there’s a theoretical reason in the moment that it works.”
- While the theory that convalescent plasma could offer a stopgap until better therapeutics are developed has a firm foundation in medical history, the evidence it works has often been inconclusive. In an Ebola outbreak in Guinea, a study found the approach did not have an effect. But studies also found the levels of antibodies can vary widely, and those who saw little effect may have gotten too low of a dose.
- In many cases, convalescent plasma as a C19 treatment took awhile to get off the ground and only got going when the outbreak was on the downturn, which further complicates the data analysis. A study from China, published in the Journal of the American Medical Association, found no effect from plasma, but the study was terminated early and never enrolled enough patients. A small study from researchers at Mount Sinai Health System in New York that compared patients who received plasma with similar patients who did not found a suggestion of a significant benefit — about half as many patients died in the group who received it vs. those who did not.
- Joyner said his team is working to do similar studies comparing patients who received plasma with similar patients who did not. They are also analyzing the level of antibodies that neutralize the virus in the plasma to see if there is evidence that a certain dose was linked to a better outcome. But he noted blood plasma is a complicated biological fluid with many different types of antibodies and at this point, scientists still do not even know what other components of the immune response could play an important role.
- Sean Liu, an assistant professor in the division of infectious diseases at Mount Sinai Health System who led work suggesting beneficial effects among a small group of patients, said that initially, the criteria at his hospital were strict about who could get plasma because the supply was limited. Now, it is far more available because so many patients who have recovered are eager to do their part to help others.
- “Now, anyone who has severe covid and is admitted … we tend to give plasma, because it’s available, and that’s in large part because of the community — the New Yorkers in the area who’ve been donating,” Liu said.
E. New Scientific Findings & Research
1. Infected People May Have Antibodies After C19 Infection — But Not for Long
- It’s a question that has haunted scientists since the pandemic began: Does everyone infected with the virus produce antibodies — and if so, how long do they last?
- Not very long, suggests a new study published Thursday in Nature Medicine. Antibodies — protective proteins made in response to an infection — may last only two to three months, especially in people who never showed symptoms while they were infected.
- The conclusion does not necessarily mean that these people can be infected a second time, several experts cautioned. Even low levels of powerful neutralizing antibodies may still be protective, as are the immune system’s T cells and B cells.
- But the results offer a strong note of caution against the idea of “immunity certificates” for people who have recovered from the illness, the authors suggested.
- Antibodies to other coronaviruses, including those that cause SARS and MERS, are thought to last about a year. Scientists had hoped that antibodies to the new virus might last at least as long.
- Several studies have now shown that most people who are visibly ill with C19 develop antibodies to the virus, although it has been unclear how long those antibodies last. The new study is the first to characterize the immune response in asymptomatic people.
- The researchers compared 37 asymptomatic people to an equal number who had symptoms in the Wanzhou District of China. The investigators found that asymptomatic people mount a weaker response to the virus than those who develop symptoms.
- Antibody levels fell to undetectable levels in 40% of asymptomatic people, compared with just 13% of symptomatic people.
- The sample size is small, however, and the researchers did not take into account protection offered by immune cells that may fight the virus on their own or make new antibodies when the virus invades. A few studies have shown that the coronavirus stimulates a robust and protective cellular immune response.
- “Most people are generally not aware of T cell immunity, and so much of the conversation has focused on antibody levels,” said Angela Rasmussen, a virologist at Columbia University.
- Apart from T cells, which can kill the virus on encounter, people who have been infected make so-called memory B cells, which can rapidly ramp up antibody production when needed.
- “If they find the virus again, they remember and start to make antibodies very, very quickly,” said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, who has led several studies of antibodies to the coronavirus.
- In the new study, antibodies to one viral protein dropped below detectable levels. But a second set of antibodies targeting the so-called spike protein of the coronavirus — needed to neutralize the virus and prevent reinfection — were still present.
- In fact, these antibodies seemed to show a smaller decline in asymptomatic people than in symptomatic people. “The neutralizing antibody is what matters, and that tells a very different story,” Dr. Krammer said.
- A second paper, published on Thursday in the journal Nature, suggests that even low levels of antibodies might be enough to thwart the virus. “It does appear that even low levels of certain antibodies have potent neutralizing capability,” said Dr. Rasmussen, the Columbia University virologist. “Low antibody titers don’t necessarily determine whether a patient will be protected from reinfection.”
- Between 20 and 50% of those infected may never show outward signs of the illness. The new study from China, which tracked people over time to confirm that they never developed symptoms, put that number at 20%.
- About a third of the asymptomatic people had the “ground-glass opacities” characteristic of C19 and abnormalities in the lungs and in cell types, however.
- The study also found that asymptomatic people shed virus when infected, and did so for longer than those who had symptoms. That finding is interesting because “it actually might suggest that these asymptomatic patients are indeed capable of transmitting virus,” Dr. Rasmussen said.
- But she and other experts noted that it’s unclear whether the virus shed by asymptomatic people is capable of infecting others. “It is important to know if they are shedding infectious virus, or just remnants of the virus,” said Akiko Iwasaki, a viral immunologist at Yale University.
- Dr. Iwasaki was more concerned than the other experts about the two new studies.
- “These reports highlight the need to develop strong vaccines, because immunity that develops naturally during infection is suboptimal and short-lived in most people,” she said. “We cannot rely on natural infection to achieve herd immunity.”
2. Super-potent antibodies protect against C19 in animal tests
- A team led by Scripps Research has discovered antibodies in the blood of recovered C19 patients that provide powerful protection against the coronavirus when tested in animals and human cell cultures.
- The research, published in Science, offers a paradigm of swift reaction to an emergent and deadly viral pandemic, and sets the stage for clinical trials and additional tests of the antibodies, which are now being produced as potential treatments and preventives for C19.
- “The discovery of these very potent antibodies represents an extremely rapid response to a totally new pathogen,” says study co-senior author Dennis Burton, PhD, the James and Jessie Minor Chair in Immunology in the Department of Immunology & Microbiology at Scripps Research.
- In principle, injections of such antibodies could be given to patients in the early stage of C19 to reduce the level of virus and protect against severe disease. The antibodies also may be used to provide temporary, vaccine-like protection against C19 infection for healthcare workers, elderly people and others who respond poorly to traditional vaccines or are suspected of a recent exposure to the coronavirus.
- The project was led by groups at Scripps Research; IAVI, a nonprofit scientific research organization dedicated to addressing urgent, unmet global health challenges; and University of California San Diego School of Medicine.
An approach that’s worked for other deadly viruses
- One approach to new viral threats is to identify, in the blood of recovering patients, antibodies that neutralize the virus’s ability to infect cells.
- These antibodies can then be mass-produced, using biotech methods, as a treatment that blocks severe disease and as a vaccine-like preventive that circulates in the blood for several weeks to protect against infection. This approach has already been demonstrated successfully against Ebola virus and the pneumonia-causing respiratory syncytial virus, commonly known as RSV.
Potent patient antibodies block the virus
- For the new project, Rogers and his UC San Diego colleagues took blood samples from patients who had recovered from mild-to-severe C19. In parallel, scientists at Scripps Research and IAVI developed test cells that express ACE2, the receptor that the coronavirus uses to get into human cells. In a set of initial experiments, the team tested whether antibody-containing blood from the patients could bind to the virus and strongly block it from infecting the test cells.
- The scientists were able to isolate more than 1,000 distinct antibody-producing immune cells, called B cells, each of which produced a distinct anti-coronavirus antibody. The team obtained the antibody gene sequences from these B cells so that they could produce the antibodies in the laboratory. By screening these antibodies individually, the team identified several that, even in tiny quantities, could block the virus in test cells, and one that could also protect hamsters against heavy viral exposure.
- All of this work—including the development of the cell and animal infection models, and studies to discover where the antibodies of interest bind the virus—was completed in less than seven weeks.
- “We leveraged our institution’s decades of expertise in antibody isolation and quickly pivoted our focus to the coronavirus to identify these highly potent antibodies,” says study co-author Elise Landais, PhD, an IAVI principal scientist.
- If further safety tests in animals and clinical trials in people go well, then conceivably the antibodies could be used in clinical settings as early as next January, the researchers say.
- “We intend to make them available to those who need them most, including people in low- and middle-income countries,” Landais says.
- In the course of their attempts to isolate anti-coronavirus antibodies from the C19 patients, the researchers found one that can also neutralize SARS-CoV, the related coronavirus that caused the 2002-2004 outbreak of severe acute respiratory syndrome (SARS) in Asia.
- “That discovery gives us hope that we will eventually find broadly neutralizing antibodies that provide at least partial protection against all or most SARS coronaviruses, which should be useful if another one jumps to humans,” Burton says.
3. Certain blood type may limit risk from C10, other type may hurt
- A team of scientists conducting a genetic analysis of coronavirus patients found that having a certain blood type may impact the risk you have of developing the illness, according to a study on Wednesday.
- The study, which appeared in the New England Journal of Medicine, compared the genes of thousands of European patients and found those with Type A blood were more likely to come down with severe illness. Those with Type O blood were less likely.
- The research comes after a similar study out of China published in March found that those with Type O blood may be more resistant to the coronavirus while those with Type A blood might be more at risk.
- “Most of us discounted it because it [the study out of China published in March] was a very crude study,” Dr. Parameswar Hari, a blood specialist at the Medical College of Wisconsin, said of the China report. Following the new study, he declared “now I believe it,” adding “it could be very important.”
- The recent study, which consisted of scientists in Italy, Spain, Denmark, Germany, and other countries, compared 1,980 patients with severe C19 to several thousand other people who were otherwise healthy or had only mild or no symptoms. Researchers tied variations in six genes to the likelihood of severe illness, while also tying blood groups to potential risk.
- Hari said that people with Type O are better at recognizing certain proteins as foreign, which may extend to proteins on virus surfaces. During the SARS outbreak — essentially a genetic cousin of the novel coronavirus — “it was noted that people with O blood type were less likely to get severe disease,” he added.
- Critics did urge caution due to certain factors, including how a limited number of patients were featured in the most recent study.
- In comparison, the genetic testing firm 23andMe released a study that featured 750,000 participants earlier this month after the company used its testing services to help scientists better understand how genetics may play a role in why some people who contract the novel coronavirus develop various levels of severity and symptoms.
- Still, the larger study did find that Type O blood was between 9 and 18% less likely to test positive for C19 when compared to the other blood types, which echoed the most recent European study.
- There are four main blood types — A, B, AB and O — and “it’s determined by proteins on the surface of your red blood cells,” said Dr. Mary Horowitz, scientific chief at the Center for International Blood and Marrow Transplant Research.
- Blood type also has been tied to susceptibility to some other infectious diseases, including cholera, recurrent urinary tract infections from E. coli, and a bug called H. pylori that can cause ulcers and stomach cancer, said Dr. David Valle, director of the Institute of Genetic Medicine at Johns Hopkins University.
4. No symptoms in 37% of C19 nursing home patients
- A study published yesterday in Clinical Infectious Diseases found that more than a quarter of the residents of a Chicago nursing home were infected with C19, 37% of them never had symptoms, 37% were hospitalized, and 28% died.
- University of Illinois at Chicago researchers and public health officials investigating the facility’s outbreak found that 33 of 126 residents tested had confirmed C19, and another 2 who developed symptoms over 30 days of follow-up later tested positive.
- Nineteen (54%) of 35 infected residents had symptoms at testing, 1 (3%) of them developed symptoms later, and 13 (37%) never had symptoms. Three (9%) of 35 residents who initially tested negative later developed symptoms; 2 of 3 residents retested at local hospitals had positive results.
High rates of hospitalization, death
- Ten (28%) of 35 infected patients died, of whom 5 (50%) were symptomatic and hospitalized, 3 (33%) had symptoms but were in hospice and not hospitalized, and 2 (20%) were asymptomatic (had no symptoms) and were not hospitalized. Median time from testing to death was 11.5 days.
- Four (4%) of 91 residents who tested negative and were not retested were hospitalized, while 5 (5%) died, all of whom had end-stage dementia, developed C19 symptoms, and were not hospitalized. Median time from testing to death was 16 days.
- Median age of infected residents was 82 years. Eight of 35 C19 patients (23%) had typical symptoms, 4 (11%) had atypical symptoms, and 10 (29%) had both. The most common symptoms included fever (43%), fatigue (26%), cough (26%), trouble breathing (14%), and loss of appetite (11%).
- Of 42 employees tested, 19 (45%) had confirmed C19, and 11 (58%) of them had no symptoms. The most common symptoms in those who had them were cough (32%), fever (26%), and sore throat (21%).
- The two-floor, 150-bed nursing home employed 112 people and had separate wings for short- and long-term rehabilitation and memory care, most with double-occupancy rooms.
- Seven (20%) of 35 residents with C19 lived in single rooms, while 18 (51%) shared a room with another resident, and 8 (23%) had a roommate who tested negative.
- The outbreak was first identified on Mar 13, when a 67-year-old female resident was hospitalized with fever, cough, low oxygen levels, and trouble breathing tested for SARS-CoV-2, the virus that causes C19. On Mar 15, testing was offered to all residents and 70 employees who worked on the ward where the woman lived, regardless of symptoms.
- The nursing home began screening all visitors and staff for characteristic coronavirus symptoms and fever, prohibited visits, trained staff on infection-control procedures, required all staff and residents to wear masks, monitored residents for symptoms, and moved all C19 patients to a single ward.
Clinical vigilance, adequate PPE and testing
- The authors noted that their results mimic those from an outbreak at a nursing home in Seattle, where over half of infected residents had no symptoms. “Given the increasingly apparent importance of asymptomatic and pre-symptomatic transmission of SARS-CoV-2, testing based on symptom screening alone will likely fail to identify all persons contributing to transmission in these facilities,” they wrote.
- One third of all US C19 deaths by early May were among nursing home residents or employees, and the personal protective equipment (PPE) and testing that allows for cohorting continue to be insufficient, the researchers said.
- They called for prioritization of PPE for nursing homes, monitoring of infection-control protocols, regular testing of asymptomatic residents and staff, and expansion of regional staffing capacity.
- “Enhanced clinical monitoring and extensive, strategic testing will be vital to reduce C19 morbidity and mortality,” they said. “Long-term care facilities are particularly vulnerable given older patients with multiple comorbidities that are cared for in this setting.”
5. C19 emergency measures ‘made a profound difference’
A new study has found that emergency measures introduced in response to the C19 pandemic are likely to have prevented more than 500,000,000 additional infections
- New research on 6 countries has found that introducing emergency measures is likely to have prevented more than 500,000,000 C19 infections.
- The research, which appears in the journal Nature, is the first peer-reviewed analysis of the effects of emergency measures on the number of infections.
- The sudden emergence and rapid spread of C19 forced governments around the world to make quick decisions in response to a virus that could be fatal for a significant number of people — particularly those over the age of 65, with underlying health conditions, or from Black, Asian, and minority ethnic backgrounds.
- Although measures varied from country to country, they typically involved the closing of nonessential businesses, the shutting of schools, the implementation of physical distancing measures, restrictions on traveling, and an emphasis on home isolation.
- However, these measures also come with major economic and social costs, which can themselves have a negative effect on public health.
- When deciding when and how to instigate emergency measures to slow the spread of the virus, governments were dependent on computer modeling and prediction, such as the research that academics at Imperial College London, United Kingdom, produced in an influential study.
- These models, while partially based on data from previous coronaviruses, such as SARS-CoV and MERS-CoV, were best guesses as to what might be the consequences of different responses to the virus.
- As the countries that the pandemic initially affected emerge from the first wave of infections and emergency measures, data are now available to see how effective the measures actually were in slowing the rate of infection.
‘As if the roof was about to fall in’
- The team behind the present paper, based at the Global Policy Laboratory at the University of California, Berkeley, looked at 1,717 policies that authorities implemented between January and April 6 in 5 countries: China, South Korea, Italy, France, and the United States.
- The researchers also initially included Iran, but several factors meant that they were unable to compare these data with those of the other countries.
- The international team had expertise in multiple languages, making it possible to gain a significant amount of information on the various policies implemented in these countries.
The study found that the emergency measures across these countries reduced the number of infections by approximately 530,000,000
- To get this figure, the researchers measured infections not only using the official confirmed cases in each country but also by determining what the number of confirmed cases would have been if everyone had undergone testing.
- According to the lead author of the study, Prof. Solomon Hsiang: “So many have suffered tragic losses already. And yet, April and May would have been even more devastating if we had done nothing, with a toll we probably can’t imagine.”
- “It’s as if the roof was about to fall in, but we caught it before it crushed everyone. It was difficult and exhausting, and we are still holding it up. But by coming together, we did something as a society that nobody could have done alone and which has never been done before.”
- As well as estimating the number of averted infections, the researchers also determined which policy decisions were likely to have been the most effective. To this end, they found that home isolation, the closure of businesses, and lockdowns had the clearest benefits.
- While many behavioral changes took place immediately, it took 3 weeks for them to achieve their full impact.
- Travel restrictions and bans on gatherings were more mixed, with some countries showing benefits and others not.
- School closures did not seem to have significant benefits, although the authors noted that more research is necessary to determine conclusively whether this was the case.
- What is clear from the research is the significant overall reduction in infections that resulted from the implementation of emergency measures.
- As Prof. Hsiang notes, “[t]he last several months have been extraordinarily difficult, but through our individual sacrifices, people everywhere have each contributed to one of humanity’s greatest collective achievements.”
F. Concerns & Unknowns
1. How likely are kids to get C19? Scientists see a ‘huge puzzle’ without easy answers
- In January, when it became clear that a new coronavirus was transmitting with ease among people in central China, one of the top questions scientists who study disease dynamics wanted answered was this: What role are children playing in the spread of the new disease, now known as C19?
- Five months later, they and the rest of us would still like to know.
- There is some evidence that kids are less likely to catch the virus and less likely to spread it, but it’s not clear exactly how strong that evidence is. Much of it was generated at a time when children were caught up in the topsy-turvy world of C19 transmission suppression, with schools closed and families cocooned, limiting their chances of catching or spreading the SARS-CoV-2 virus. In reality, it may take reopening schools and returning children to a closer-to-normal life for the picture to come into clearer focus.
- If we’re lucky, and the hints in the data hold true, a normalizing of children’s lives — and the lives of their parents — could be safely achieved. If we’re not lucky, and the hints were false harbingers, more disruption likely lies ahead.
- “We are going to find out,” said Sean O’Leary, a pediatric infectious diseases specialist at Children’s Hospital of Colorado and vice chair of the infectious diseases committee of the American Academy of Pediatrics.
- With some respiratory illnesses — influenza in particular — young children play an amplifying role. Because of their limited immunological experience, they don’t carry the years’ worth of antibodies that adults have amassed. As a result, they are more susceptible to many of the bugs that cause colds and flu, which circulate more actively as the cold weather sets in.
- Kids get sick, pass the viruses among themselves, and infect the adults in their lives — teachers, day care attendants, parents, and grandparents. It’s not a coincidence that elementary school teachers are often sniffling and sneezing within a month of the start of school, or that flu season often hits in earnest after Thanksgiving or Christmas, when multiple generations share holiday cheer and the occasional germ.
- If children play the same role with the SARS-CoV-2 virus, closing schools and restricting the access of children to each other and the older adults in their lives could be important ways to suppress transmission of the new disease. But if they play a less active role, as studies seem to suggest, then the high cost of these restrictions — interrupted education and socialization, stress as parents juggle working from home with child care, lack of access to school meals — aren’t warranted by the small benefits gained.
- The World Health Organization does not currently see clear answers in the data that have been collected to date.
- “I think the evidence remains weak — and that’s the complexity of answering that question properly,” said Olivier le Polain, an epidemiologist in the Geneva-based agency’s health emergencies program.
- Le Polain said that large serology studies — in which researchers collect blood samples from a cross-section of people to get a better sense of how deeply the virus has penetrated the population of a city, a region, a country — should help shed light on how likely children are to be infected in the first place.
- An early look, from Geneva, suggests when we’re talking about children we need to distinguish between young children on the one hand and tweens and teens on the other. Published last week in the journal the Lancet, the study found very little evidence of prior C19 infection among children ages 5 to 9 years (the youngest included). But children ages 10 to 19 were as likely to have antibodies to the infection as adults ages 20 to 49 — and more likely than adults older than that.
- One thing that is clear is that the disease is generally far less severe for children than it can be for older adults. Deaths among children have been few and the percentage of children who need hospitalization for the illness is substantially lower than it is among adults.
- But teasing out whether kids are as likely to catch the virus and spread it has been exceedingly difficult at a time when children are spending far less time mixing with others than they normally do.
- “There is a huge puzzle over the dynamics in kids and what happens with kids,” said Nick Davies, an epidemiologist and mathematical modeler at the London School of Hygiene and Tropical Medicine.
- “We don’t really have that one great database, piece of evidence, or experiment that has really settled this question,” he said.
- Davies is the lead author of a study published this week that suggested children are less susceptible to the virus than adults. Published in Nature Medicine, it used data from China, Italy, Japan, Singapore, Canada, and South Korea to model whether children contract the virus at the same rate as adults. He and his co-authors concluded the risk of catching C19 for children and teens (under age 20) was half that of people older than 20. They wrote their article in March, based on data collected in the first couple of months of the pandemic.
- Davies said there are confusing differences seen across countries that muddle the picture. A large national serology survey in Spain found that children were less likely to have been infected than adults — but the same was not true in Britain.
- Disparities continue. Denmark reopened schools in mid-April, without serious disruptions. But when classes resumed in Israel in May, infections among children and teachers flared. In China, where a cluster of cases in Beijing has everyone on edge, authorities moved quickly this week to preemptively close schools.
- In the United States, overnight summer camps may help to illuminate the risks of allowing children — albeit generally teens — to resume activities that allow them to congregate together, O’Leary suggested. Colorado is home to a lot of these camps; kids come from across the country to attend. While they aren’t yet open, word has come down they will be allowed to operate starting in July, said O’Leary, who admitted that the idea of the overnight camps makes him nervous, keen as he is to get kids back into school.
- The movement restrictions many countries adopted earlier in the spring didn’t just make it difficult to gauge what role children are playing in the pandemic. The all-at-once layering of multiple actions — closing schools, workplaces and non-essential businesses, issuing shelter-in-place orders — made it challenging to assess the contribution each individual measure had on the tamping down of transmission of the virus.
- “In most places, those interventions have been put into place at pretty much the same time, with maybe one or two weeks in most places,” WHO’s le Polain said.
- The stepwise approach to reopening that many jurisdictions have adopted could afford an opportunity to try to tease out some information on the contributions of the various interventions. Having a good sense of the scope of the benefit of placing restrictions on children would help policy experts as they look to the next school year.
- Marc Lipsitch, an epidemiologist with Harvard’s T.H. Chan School of Public Health, said someone should be studying the issue, though he acknowledged that after the past few brutal months, he doesn’t have the energy to do it.
- But he said the timing of the start of the school year in the United States is so variable that the early start states could provide evidence for those that wait until after Labor Day.
- “The good thing about school opening is that it’s a point change that’s big,” said Lipsitch. “So if there’s an effect, it will be a little bit delayed — but it’s not fuzzy and it’s not subtle.”
1. 12% of Americans may not need vaccine
- A C19 vaccine may not be equally effective for everyone, US officials said on Tuesday.
- But, they added, they expect as many as 40 million Americans to have developed coronavirus antibodies by the end of this year, which would lower the population that would need the treatment that officials hope will end the pandemic.
- “Operation Warp Speed”, an initiative under the auspices of the US Department of Health and Human Services (HHS) in coordination with the Food and Drug Administration, the Defence Department and other federal agencies, has committed nearly US$3 billion to speed development of promising vaccine candidates and build out manufacturing and distribution capacity.
- HHS estimates that as many as 12 per cent of the total US population of about 331 million people will not need the inoculation because of previous exposure to the coronavirus, senior Trump administration officials told reporters.
- “For many reasons we don’t expect to have all Americans vaccinated,” an administration official said on Tuesday. “We fully expect there will be, name the number – 20, 30, 40 million Americans – that probably have strong antibodies to the coronavirus by the end of the year, so they would be a significantly lower priority.”
- “We will not know what the performance, the safety and efficacy, of these vaccines is yet”, he said. “It may be much more applicable to certain demographic categories than others.”
- The official did not specify which groups might not respond as well to the vaccine or why.
- “Our aspiration is very clear that by the height of flu season next year we have enough vaccines, and we have vaccinated those who are vulnerable and desire a vaccine, to protect as much life as possible, and we’re confident that we will hit that objective,” the official said.
- While the officials expressed confidence, one cautioned that there was no way to guarantee the vaccine initiative’s success.
- “There are no sure things in science,” he said. “We cannot promise a 100 per cent chance of success. What we can tell Americans is that we’ve taken every possible step to maximize the probability of success.”
- The administration officials spoke on a briefing call on the condition they not be identified.
1. New C19 antibody test more accurate
A new type of antibody test may reveal whether someone has developed strong immunity to the virus that causes C19,, and may also be much less likely to give false-positive results
- In the weeks after the emergence of the coronavirus many companies rapidly developed tests, or assays, for detecting antibodies to the virus.
- Unlike assays that detect the virus itself, antibody tests are meant to indicate whether someone has already had the infection and developed immunity to it.
- However, there are concerns that a past infection may not necessarily confer strong immunity to future infections.
- In addition, people may test positive as a result of previous encounters with other coronaviruses, such as some of those that cause the common cold.
- Existing tests detect whether a person’s blood contains antibodies that bind to either the whole inactivated virus, a protein from its shell, or the spike protein that gives the coronavirus its characteristic crown-like structure.
- According to a team of researchers — many from the University of North Carolina (UNC), Chapel Hill — there is a strong likelihood that some people with antibodies to other coronaviruses will receive false-positive results from such tests.
- This is because coronaviruses have many features in common, particularly some of the sequences in their spike proteins.
- To resolve this problem of poor specificity, the researchers have developed an antibody test that detects a feature that they believe is unique to SARS coronaviruses.
- They have published their work in the journal Science Immunology. [See The receptor binding domain of the viral spike protein is an immunodominant and highly specific target of antibodies in SARS-CoV-2 patients]
- In the paper, they warn of the dangers of relying on screening tests that have low specificity.
- “Investigators have already encountered problems with the specificity and sensitivity of commercial assays rushed to market,” they write. “Widespread use of inaccurate antibody assays could lead to policies that exacerbate the current coronavirus pandemic instead of containing it.”
- To create a more accurate test, the researchers used part of the viral spike called the receptor binding domain (RBD), which binds to a particular protein on human cells in order to infect them.
- RBDs vary considerably among coronaviruses, and the RBD of SARS-CoV-2 only has relevant similarity to the closely related SARS-CoV-1 virus, which caused the SARS outbreak of 2002–2004.
- To gauge their test’s sensitivity and specificity, the researchers tried it on blood samples from 63 patients with the coronavirus and samples from 71 control participants. The latter samples had been collected and stored before the new coronavirus emerged.
- They also tested blood samples from animals exposed to a wide range of coronaviruses.
- The results suggest that 9 days after the onset of C19 symptoms, the new test would be 98% sensitive, meaning that it would detect 98% of infections.
- Better still, it was 100% specific to antibodies produced to fight SARS coronaviruses.
- While the immune system may generate a range of antibodies that bind to different parts of a virus, only some antibodies are able to neutralize it.
- So the researchers went on to test whether their assay reflected the number of “neutralizing antibodies” in the blood samples from patients.
- This is an important measure of the worth of an antibody test because to assess the concentration of neutralizing antibodies directly takes about 3 days and necessitates working with the live virus in a high-containment facility. This makes the assessment impractical for screening purposes.
- Working with colleagues at the UNC Gillings School of Global Public Health, the team found that the results of the new RBD-based test strongly correlated with levels of neutralizing antibodies in the samples.
- This suggests that the test could be used to screen the blood of people who have recovered from C19 infections to determine whether it is suitable for treating other patients, in what is called convalescent plasma therapy.
- “We observed a robust correlation between levels of RBD-binding antibodies and coronavirus neutralizing antibodies in individual samples,” says Premkumar Lakshmanane, Ph.D., an assistant professor of microbiology and immunology at UNC and co-senior author of the study.
- “This means our assay not only identifies people exposed to coronavirus, but it can also be used to predict levels of neutralizing antibodies and to identify potential donors for plasma therapy.”
- Prof. Lakshmanane says that the team is now attempting to streamline the test so that it takes about 70 minutes to return results rather than the current 4–5 hours.
- The researchers hope that their test will also identify people whose immune systems fought off the virus and who developed few, if any, symptoms. Currently available tests may be insufficiently sensitive to do this.
- “We don’t see our research as a means to replace commercial tests,” says Aravinda de Silva, a professor of microbiology and immunology at UNC and co-senior author of the study.
- “But it’s too early in the pandemic to know if the commercial assays are suitable for identifying people who experienced very mild or no disease after infection, or if the assays tell us anything about protective immunity, as researchers are still learning about this virus.”
- This will be an important factor for deciding whether a population has developed “herd immunity” to the virus, allowing lockdowns to be eased.
More work needed
- However, the scientists acknowledge an important limitation of their study, namely, that all the patients whose blood samples were used were symptomatic, and many were seriously ill.
- Confirming whether people with no or few symptoms of C19 infection have RBD antibodies in their blood will require further research.
- If this is determined, the next step would be to find out whether their levels of RBD antibodies correlate with their ability to neutralize the virus of a future infection.
I. Back to School!
1. From dorms to classes, here’s how college will be different this fall
- Amid the uncertainty of what college will look like this fall, one thing is for sure — it won’t be the typical experience for students.
- There may be in-person classes, online learning only or a hybrid model that combines the two.
- That is just the academic end. There is also life on campus: when and where to don a mask, what type of social activities will be permitted and how dorm living will work.
- “Students who get back to campus are going to find themselves on very different campuses and in a very different environment than they expected,” said Debra Felix, a former director of admissions at New York’s Columbia University who now runs her own firm, Felix Educational Consulting.
- “It won’t be the interactive, busy, fun kind of a place where people are banging ideas around in a dorm room at midnight.”
‘I want the traditional college experience’
- For incoming senior Kassin Reynolds, the wait to find out his school’s fall plans has been frustrating. He lives in Middlesex County, New Jersey, and commutes more than an hour each way to Ramapo College.
- “I like going to school. I like learning. I also like seeing my friends,” he said. “I want the traditional college experience.”
- Ramapo’s website states the school is “actively planning for the Fall 2020 semester” and will announce a decision on July 15.
- “We are very keen to return to campus and are cautiously optimistic about the possibility,” Ramapo President Peter J. Mercer said in an email statement to CNBC. “To this end, we have developed critical action plans for what must occur in order for the College to return to in-person learning, return to on-campus residential/activity operations, and, if needed, adjust to a hybrid learning and/or operational environment.”
- Other schools, like Seton Hall University in South Orange, New Jersey, have already announced plans to reopen. Seton Hall is starting classes Aug. 24 and ending instruction earlier than usual on Nov. 24 in an effort to reduce the risk of spreading the virus during colder months. Review sessions and final exams will be administered remotely after the Thanksgiving break.
- “I’m just hoping that, by then, the numbers will go down and life will flow as usual,” said Seton Hall incoming sophomore Jasmine Cartwright-Atkins.
- “Of course, right now there are still some anxieties about how that will go.”
- According to the Chronicle of Higher Education, which is tracking about 960 colleges across the U.S., 65% of higher-education institutions are planning for in-person classes, 8% are planning for online and 11% are proposing a hybrid model. Additionally, 9% are considering a “range of scenarios” and 6% are waiting to decide.
- While students may want to return to campus, life is going to look and feel very different.
- The CDC is recommending a number of safety measures for colleges, which include closing shared spaces like dining halls, game rooms, gyms and lounges if possible and the use of cloth face masks around campus.
- “The challenge is that we’ve seen very different responses to the current situation, from communities asking everyone to wear masks to other communities only 30 minutes away where very few people wear masks — and all these norms will collide together on campus,” said Jason Dorsey, president and lead researcher at The Center for Generational Kinetics, a global Gen Z and millennial research and strategy firm in Austin, Texas.
- He also predicts large organized activities, like rushing a fraternity or sorority and intramural sports, could be put on hold or severely impacted. The same goes for recreational options in college towns.
- “The impact would be less opportunity for students to socialize, make new friends and have the typical college experience, especially for incoming freshmen,” Dorsey said.
- The CDC also recommends modifying the classroom layouts, so big lecture halls packed with students will be gone. Instead, everyone inside a classroom will be seated 6 feet apart, and seats and rows in lecture halls may be taped off.
- Even while classes may go on, there will also be no hands-on interactive group activities, Felix pointed out.
- And when it comes to taking the online classes, students will “be taking the class in the dorm room by themselves,” she said.
Dorm living or off campus
- So far, colleges have been taking different approaches to address on-campus housing in the age of C19, and many are still deciding what to do, said Von Stange, president of the Association of College and University Housing Officers-International.
- Some schools have gone with single rooms,” said Stange, also assistant vice president for student life and senior director of university housing and dining at the University of Iowa.
- “Others have allowed doubles but have ‘de-densified’ their housing.”
- The bathroom issue will also have to be addressed since those facilities are often shared by 10 or 20 students. The lounge may also be adjusted so that the seating is spread out.
- “Some of the programs that you see for smaller groups may occur at a distance,” Stange noted. “Large things may occur a lot more virtually.”
- “Students who get back to campus are going to find themselves on very different campuses and in a very different environment than they expected.” Debra Felix, Education Consultant
- The changes may lead some students to opt for off-campus housing. Those units are set up differently, generally with three or four bedrooms with a kitchen and living area, as well as a bathroom.
- “If to a degree that you have to ask for social distancing in dorms, that is just going to push more people to the purpose-built off-campus housing,” said Matthew Berger, who co-leads student housing along with Dave Borsos at the National Multifamily Housing Council.
- “The units tend to be much bigger in terms of square foot per student than your traditional on-campus housing.”
- In fact, a number of members of the council who provide off-campus housing said colleges have already started reaching out to them to get more housing space.
- Between that and students possibly moving on their own off-campus, it may put “a bit of a squeeze on the availability for off-campus housing,” Borsos said.
Goodbye to some programs
- Then there are budget cuts likely to come due to the financial blow colleges have taken during the pandemic.
- Already hard hit before the crisis, they had to return room and board fees to students who were sent home in the spring. On top of that, enrollment will likely be down in the fall and there will be an increase in demand for financial aid.
- That could mean some sports, like golf or track, could be eliminated, said education consultant Felix.
- “Luxuries” such as spas, pools, clubs and rock climbing walls could go by the wayside, as could construction and infrastructure development a college had planned, she said. Meals at the dining hall could also be downgraded.
- “They’ll start to hone in on, ‘what educationally do we need to keep’ and if it doesn’t enhance the educational program it might get the ax,” Felix predicted.
- In fact, she believes even education could be impacted if schools reduce or cut out humanities and liberal arts classes in order to save money.
- Some changes may be here to stay, even after the pandemic has passed.
- Gen Z expert Dorsey predicts that distancing learning and online collaboration will become the “go-to resources” for learning, collaboration and engagement.
- “For as much as people complain about video chat and online platforms, the reality is these technologies have brought education, connection, and community to students’ homes around the world,” he said.
- “It likely will be further integrated even when higher education eventually has the option to offer all classes in-person.”
- Felix worries that the changes made due to budget cuts will also stick around.
- “Colleges may be thrilled to finally have an excuse to eliminate their under-enrolled classes, frivolous activities, obscure services, unproductive professors, and least ‘sexy’ departments,” she said.
- “They will justifiably sacrifice them over the altar of C19 austerity measures, do a quiet, ‘Ding Dong, the witch is finally dead’ dance and move on with what’s left.”
J. Projections & Our (Possible) Future
1. What Covid Models Get Wrong
Focus on the burden on hospitals, not on the oft-mistaken forecasts
Opinion, Wall Street Journal
- Here we go again. The University of Washington’s Institute for Health Metrics and Evaluation has issued a new forecast that C19 fatalities would spike over the summer in states that have moved faster to reopen. Cue the media drumbeat for another lockdown. Maybe someone should first explain why the models were wrong about so much the last time.
- Take New York, where Gov. Andrew Cuomo locked down the state in mid-March based on dire warnings. His public health experts projected the state would need as many as 140,000 hospital beds and 40,000 intensive care units—two to three times more regular hospital beds and 10 times more ICU beds than were available. The UW model forecast that 49,000 regular beds and 8,000 ICU beds would be needed at the peak.
- New York was hit hard, but C19 hospital bed utilization in New York peaked at 18,825 and 5,225 for ICUs in mid-April. Even in New York City, hospital utilization never exceeded 85% of capacity and 89% for ICUs. Government-run hospitals in low-income neighborhoods with the most cases were unprepared, but they were ill-managed before the pandemic.
- New York was the country’s frontline in the coronavirus attack, and caution was needed in the early days because so little was known about the virus. The original UW model, which was based on the experiences in Italy and Wuhan, assumed that strict lockdowns would curb infections, reduce hospitalizations and lower deaths faster than they actually did in the Northeast.
- Asked last month about when fatalities and hospitalizations would meet state thresholds for reopening, Mr. Cuomo responded: “All the early national experts, ‘Here’s my projection model.’ . . . They were all wrong. They were all wrong. . . . There are a lot of variables. I understand that. We didn’t know what the social distancing would actually amount to. I get it, but we were all wrong.”
- Hospital utilization by C19 patients in New York City has fallen 94% since the peak, which has allowed some non-essential treatments to resume. New York City has 29% of its hospital beds and 34% of its intensive care units now available. New cases have fallen by about 40% and new hospitalizations by a third in the last two weeks, despite the recent protests.
- Warnings about reopening states are also overblown so far. While Arizona has had an uptick in hospitalizations, about 59% of its emergency beds and 17% of ICU beds are unused. A month ago, 43% of hospitalized patients with Covid were in the ICU. Now only a third are, suggesting that better and earlier treatment is easing disease severity.
- In Texas, hospitalizations have also been climbing, but weekly fatalities are down 40% from a month ago. C19 patients occupy fewer than 5% of all hospital beds, and more than a quarter are available. Even in Houston—which has experienced the biggest increase in hospitalizations—C19 patients occupy only 6% of hospital beds. More than 20% are unused.
- C19 patients take up a small share of ICU beds in most states that have reopened including California (16%), Texas (11%), Georgia (10%), Utah (9%), Wisconsin (8%) and Florida (7%). Nearly all states have ample hospital and ICU capacity.
- California Gov. Gavin Newsom started easing his strict lockdown six weeks ago, and restaurants, hair salons, retail stores and gyms are now allowed open in most counties outside of the Bay Area. While new cases have been rising due to more testing and in some cases from community spread, hospitalizations and fatalities have been flat since early May. In Los Angeles, ICU utilization has fallen by about 15% in the last month.
- “We have to recognize you can’t be in a permanent state where people are locked away—for months and months and months and months on end—to see lives and livelihoods completely destroyed, without considering the health impact of those decisions as well,” Mr. Newsom said Monday.
- Yet national Democrats and the press are still promoting worst-case predictions, almost as if they’re hoping for worse so they can prove Donald Trump wrong. The University of Washington now projects that reopening will cause deaths to triple in California and increase six-fold in Florida and Arizona through September.
- But as Stanford epidemiologist John Ioannidis explains in a new paper, most models have overshot in part by making faulty assumptions about virus reproduction rates and homogenous susceptibility. A Massachusetts General Hospital model predicted more than 23,000 deaths within a month of Georgia reopening but the state had only 896.
- “In the presence of strong groupthink and bandwagon effects, modelers may consciously fit their predictions to what is the dominant thinking and expectations—or they may be forced to do so,” Mr. Ioannidis writes. “Forecasts may be more likely to be published or disseminated, if they are more extreme.”
- A surge of new infections is inevitable as states reopen, and health officials will have to watch for and contain hot spots. But the Covid models aren’t destiny, and the cost of new lockdowns is too great to sustain. We have to live with the virus risks while fortifying the health system and protecting the most vulnerable.
Source: What Covid Models Get Wrong?
2. Rising C19 cases and hospitalizations underscore the long road ahead
- The U.S. is now confronting what public health experts have been warning about but many in the public had not absorbed: the coronavirus pandemic will be with us for many months, and lapses in vigilance will lead to more sickness and death.
- The country as a whole is tacking on about 20,000 new Covid-19 cases to its 2.1 million infection tally each day, a clip that’s been steady for weeks, according to STAT’s Covid-19 Tracker.
- But cases are surging in about half of states, some of which dodged major outbreaks in the spring as the Northeast and other pockets like New Orleans became inundated. The local outbreaks are leading to increasing hospitalizations in Arizona, Texas, Alabama, and the Carolinas — raising concerns about capacity when the original rallying cry of “flatten the curve” was meant to prevent overwhelming health care systems.
- Experts had envisioned localized ups and downs as the U.S. epidemic dragged on. But the new bursts of cases have not galvanized a commitment to rein in the spread and steer those rises into downturns. Instead, there is fading attention in Washington, and many Americans seem inured by the steady stream of 800 daily C19 deaths and desperate to return to work and daily life.
- “I’m worried that people have kind of accepted where we are as a new normal,” said Tom Inglesby, director of the Center for Health Security at Johns Hopkins School of Public Health.
- Much of this was forecast. As states started easing back shelter-in-place restrictions last month, public health experts warned cases would increase. That’s simply the nature of the coronavirus: more people encountering more people provides more chances for the virus to pass from one to another. Plus, unlike in some countries, the U.S. lockdowns were eased at a time when there was still lots of virus circulating, so it was primed to resurge.
- “We should expect to see that the virus will go wherever there are susceptible people,” said Yonatan Grad, an infectious disease expert at Harvard’s Chan School of Public Health.
- But if initial lockdowns were meant to cut off as much transmission as possible and reduce it to manageable levels, they were also supposed to buy health authorities time to design strategies for the long haul, to come up with plans to keep a brake on spread so people could emerge back into life without an explosion of cases. Hospitals were meant to gear up for future spikes of seriously and critically ill patients. Health agencies had to build testing and contact tracing networks, which could keep spread at a simmer and prevent dangerous flare-ups. Authorities had to communicate to the public that some measures — including masks, distancing, and avoiding crowds — had to be maintained for the duration.
- Now, we’re seeing the fruits of those efforts — and the lack thereof.
- The U.S. has not hired enough contact tracers to satisfy expert estimates of what’s needed. Mask wearing has become a political flashpoint, with many people simply refusing or not seeing the purpose. The shortcomings are not limited to states that have so far skirted the worst of the coronavirus; this week, New York Gov. Andrew Cuomo chastised local governments to “do your job” and enforce distancing policies after crowds gathered outside New York City bars.
- In Arizona, local health departments raced during the state’s stay-at-home period to build up contact tracing fleets and prepare for more cases, said Kacey Ernst, an infectious disease epidemiologist at the University of Arizona. But they didn’t have sufficient time to build the capacities that would prove to be necessary once the state reopened.
- “People were using that time, absolutely,” she said. “It wasn’t long enough.”
- Now, the state is regularly reporting more than 1,000 new cases a day, compared to a few hundred in May. Hospitalizations are up. There isn’t enough contact tracing in place to try to get a hold of the outbreak, Ernst said.
- “As cases are going up, you’re just getting further and further behind the curve,” she said. “If you don’t have all of the things in place, the contact tracing folks trained and operating seamlessly, the more cases will ramp up. And you just keep trying to catch up.”
3. Will the Calvary to Arrive by the End of 2020: A Systemic Analysis of the Time to Develop Treatments for C19
- The spread of C19 from Wuhan in China throughout the world has been alarmingly rapid. Epidemiologic techniques succeeded in containing the disease in China, but efforts were not as successful in the rest of the world, particularly the United States where there have been 2,079,592 confirmed cases with 115,484 deaths as of June 15, 2020.
- Projections are for continued new infections and deaths if no effective treatments can be activated over the next six months.
- We performed a systematic review to determine the potential time course for development of treatments and vaccines focusing on availability in the last half of 2020.
- Publications: Our search was performed during the week of June 15, 2020 We reviewed up to date information from several sources to identify potential treatments for C19: We used the Reagan-Udall Expanded Access Navigator C19 Treatment Hub to track the efforts of companies to develop treatments. We then used the results to search for publications identified treatments on pubmed.gov and on medRxiv, the preprint server. We further used a targeted Google search to find announcements of trial results.
- Clinical Trials: We searched for all investigational trials begun in the first quarter of 2020, with cut off on April 1, using several different sources: (A) covid-trials.org, then validated results on (B) clinicaltrials.gov and the (C) World Health Organization’s International Clinical Trials Registry Platform (WHO ICTRP). We focused on trials which were completed or currently recruiting for patients, reasoning that the timeline to arrive at treatments by the end of the year would require completion within the next 6 months. We excluded studies which were clearly observational, with no randomization, control or comparison group. We further set a cutoff of 100 for numbers of subjects since smaller trial size could lack statistical power to establish superiority of the intervention over the control condition.
- Published Data: We found 43 publications reporting findings on 1 classes of agents. There were 12 publications related to hydroxychloroquine (HCQ),11 on tocilizumab, 4 publications related to remdesivir, four on lopanovir/ritonavir (LPV/R), four on interferons, two on favipiravir, two on convalescent plasma, one on meplazumab, one on corticosteroids, one on famotidine, and one on ivermectin. Of these, only 16 were randomized or active control studies; the rest were retrospective observational. Only two publications dealt with outpatient care, the rest all in hospitalized patients.
- Clinical Trials: We found 409 trials meeting our minimum requirement of 100 subjects which were recruiting or completed. The WHO has launched the Solidarity megatrial performed in over 100 countries actively comparing HCQ, lopanovir/ritonavir (LPV/R) alone and in combination with interferon beta-1, and remdesivir. That trial is scheduled to complete enrollment in the first quarter of 2021. In addition, we found 46 trials of HCQ, 11 trials of LPV/R and 8 trials of interferons. There were 18 ongoing trials of antiviral agents, 24 immune modulator trials, 9 vaccine trials, and 62 trials of other agents. We excluded a large number of trials of Chinese traditional medications, reasoning that there was insufficient clinical experience with these agents outside China to offer these treatments to the rest of the world. Forty four trials were hoping to complete enrollment by the end of the second quarter of 2020. Of these, only 9 were conducted on outpatients. A few vaccine trials are hoping to complete Phase 3 enrollment by the end of the third quarter, but a prolonged follow-up of patients will likely be required.
- Remdesivir and tocilizumab have now been granted emergency authorization in many countries for treatment of hospitalized patients. However, the disease is propagated primarily by infected ambulatory individuals.
- There are only a few randomized controlled studies in outpatients which can be expected to yield results in time to impact on the continuing spread of the epidemic in 2020.
- It will be necessary for public health authorities to make hard decisions with limited data. The choices will be hardest in dealing with potential early release of vaccines.