Recent Developments & Information
June 23, 2020
Reliable information is the best tool available to protect your family from the pandemic and its shockwaves
“Americans should not be thinking about new waves but rather about one continuous forest fire.”Michael Osterholm, epidemiologist at University of Minnesota
“To state the obvious, COVID-19 is now spreading at an unacceptable rate in Texas. Our goal is to keep Texans out of hospitals and to reduce the number of Texans who test positive…COVID hasn’t simply gone away. We don’t have to choose between jobs and health. We can have both.”Texas Governor Greg Abbott
“I haven’t set any strict conditions or other directions for the football league. They have come to me and asked me from a medical standpoint a bunch of questions about risks. They are a very competent group of people, and they will make up their own minds.”Dr. Fauci
A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
C. Emerging US Hotspots
D. Potential Treatments
E. New Scientific Findings & Research
F. Concerns & Unknowns
G. Back to School!?
H. Projections & Our (Possible) Future
I. Pandemic Economy
J. The Road Back?
K. Practical Tips & Other Useful Information
L. Johns Hopkins COVID-19 Update
M. Links to Other Interesting Stories
A. The Pandemic As Seen Through Headlines
(In no particular order)
- The FDA is warning that 9 hand sanitizer products made in Mexico may contain methanol, which can be toxic when absorbed through the skin
- Virus cases top 9 million as WHO says pandemic ‘accelerating’
- New virus cases worldwide reached a record on June 19, fueled by a surge in Latin America
- Over 1,000,000 new cases being reported each week
- Virus surge threatens developing nations exiting lockdown
- EU Health Chief Aims for Virus Vaccine Within 18 Months
- Covid-19 Accelerates in Latin America
- South Africa cases exceed 100,000
- Saudi Arabia imposes strict limits on this year’s hajj, dashing the hopes of many pilgrims
- New cases in the U.S. account for 20% of new global cases as the pandemic surges around the world
- Clusters around the U.S. have been increasingly linked with social and religious gathering places
- More than two dozen states report coronavirus surges as Trump administration prepares for possible second wave
- U.S. Coronavirus Deaths Remain on Downward Trajectory as Cases Rise
- More Young People Are Testing Positive Across the South
- NY Gov. Cuomo: We Had High Number of Nursing Home Deaths Because Feds Didn’t Tell Us Virus Was Coming from Europe (!)
- Miami-Area Mayors Mandate Masks
- San Francisco Speeds Up Some Reopenings
- More Toronto Businesses to Reopen
- California Cases Climb; LAX to Scan for Fevers
- U.S. Preps for Flu Hitting as Covid Remains
- Louisiana extends ‘Phase 2’ for another four weeks
- Texas Gov. says virus spreading at “unacceptable” rate
- WHO warns minks have spread virus to humans
- Boston Fed chief says reopening to early threatens the economic recovery
- Florida passes 100,000 cases
- NYC enters ‘phase 2’ reopening
- More evidence emerges showing virus hit earlier than previously thought
- The UN General Assembly will conduct its annual meeting virtually for the first time this September (….a small silver lining)
- Indian hospitals begin to buckle
- Cases are on the rise in Arizona, but residents are divided over whether they should comply with rules requiring face masks
- Sweden’s lax approach to the virus has prompted its Scandinavian neighbors to close their borders to Swedes
- Belarus has reported 58,000 cases, compared with 32,000 in neighboring Poland, which has four times as many people.
- In Australia, the state of Victoria, has brought back tighter restrictions on gatherings after 6 days of double-digit case increases
- Spain welcomes back tourists
- UK Prime Minister Johnson to Set Out Lockdown Easing Plans as Virus Cases Fall
- Delta Air Lines resumed flights to China
- Germany’s infection rate rose for a third day, lifted by local outbreaks including many at a slaughterhouse
- Florida’s new infections rose to another high on June 19
- Texas hospitalizations rose the most in two and a half weeks
- Texas governor warns state may face new limits if virus spread worsens
- As Texas cases double, governor says closing businesses again would ‘always be the last option’
- Dr. Fauci Says He’s No Obstacle to NFL Season
- Illinois Expands Reopening
- Portugal to Tighten Restrictions in Lisbon Suburbs
- NJ Gov. Murphy Expects Some ‘Spiking’ in N.J.
- Scotland May Take Company Stakes to Prevent Collapse
- Netherlands Reports First Day With No Deaths Since March
- Israel Weighs Renewal of Controversial Tracking Tool
- Hong Kong Cases Increase Most Since April 3
- WHO Director Warns World Leaders Not to ‘Politicize’ Coronavirus
- As Coronavirus Cases Rise in Arizona, New Mask Rules Spark a Fight
- Gilead Sciences will soon start trials of an inhalable version of remdesivir, an antiviral drug that has shown some preliminary promise as a virus treatment
- Nursing homes across the country are kicking out old and disabled residents and sending them to homeless shelters and rundown motels to make room for Covid-19 patients who can generate more revenue
- The psychological fallout from the pandemic has yet to fully show itself, but some experts have forecast a torrent of new disorders
- Right Now There Is A “Mad Rush” To Get Out Of The Cities
- US New Home Sales Plunge To 10 Year Low As Exodus From Cities Accelerates
- Americans are considering moving to less populated areas to avoid coronavirus
- South Korea battling second wave of coronavirus: health official
- Gov. Phil Murphy says New Jersey casinos can open in July
- NY Gov. Cuomo talking to NJ, Connecticut about quarantine guidelines for Floridians
- New Yorkers flood barbershops, hair salons as Phase 2 reopening begins
- Coronavirus outbreak could spin ‘out of control’ in South Sudan
- Saudi Arabia lifts three-month coronavirus curfew
- Over 3,000 NYC eateries approved for outdoor dining as Phase 2 starts
- New Yorkers need to stay in ‘pandemic social bubble’ as city reopens
- 30% Of Americans Didn’t Make Their Housing Payment In June
- Miami mayor blames coronavirus spike on restaurants
- Women’s soccer team pulls out of restart due to multiple coronavirus cases
- Dr. Fauci: If coronavirus resurges ‘doesn’t mean you shouldn’t have a World Series’
- Coronavirus outbreak at German slaughterhouse infects more than 1,000 employees
- Nursing Homes & Assisted Living Facilities Account for 43% of COVID-19 Deaths
- April Pot Sales Grew Like A Weed During Lockdowns
- Apple will now let you put a face mask on your memoji
- Hot-yoga domes could be the new social-distancing fitness craze
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 = 9,180,744 (+1.6%)
- New Cases = 141,935 (+31,496)
- Growth Rate of New Cases (7 day average) = 1.6% (+1.0%)
- New Cases (7 day average) = 148,652 (+2,329)
- Although new cases have declined over the last 3 days from an all-time high of 181,581 new cases on 6/19, the number of new cases has generally been increasing since 4/21
- The 7 day average for new cases increased from 79,340 on 4/21 to 148,621 on 6/22, and increase of 87.3% over the last 60 days
US Cases & Testing:
- Total Cases = 2,388,153 (+1.1%)
- New Cases = 31,496 (+5,417)
- Percentage of New Global Cases = 22.2% (+2.2%)
- Growth Rate of New Cases (7 day average) = 5.5% (+2.3%)
- New Cases (7 day average) = 29,180 (+1,517)
- Total Number of Tests = 29,013,182 (+521,192)
- Percentage of positive tests (7 day average) = 5.4% (+0.2%)
- New cases have generally been increasing since 6/9 as new cases in hotspots have been increasing rapidly
- The 7 day average of new cases has increased from 21,265 on 6/9 to 29,180 on 6/22, an increase of 37.2% (the peak 7 day average of new cases was 32,425 on 4/10)
- The 7 day average of positive test rates has increased from 4.6% to 5.4% over the last 7 days, an increase of 17.4% in one week, which indicates that the virus is spreading at a rapidly increasing rate.
- Daily testing now exceeding 500,000
- Total Deaths = 473,482 (+0.8%)
- New Deaths = 3,878 (+540)
- Growth Rate of New Deaths (7 day average) = 1.4% (+1.2%)
- New Deaths (7 day average) = 4,818 (+65)
- The number of new deaths have been rising since May 26. Although the 7 day average of new deaths has generally been declining since June 16, it is too early to tell if the recent decreases in new deaths are a trend or a temporary decline.
- The 7 day average for new deaths increased from 4,079 on 5/26 to 4,818 on 6/22, an increase of 18.1%. During the same period, the 7 day average for new cases increased from 93,494 to 148,621, an increase of 59%.
- Currently, the 7 day average of new cases is increasing much faster rate (3.26x) than the increase in the 7 day average of new deaths.
- The 7 day average ratio of new deaths to new cases has decreased from 1 new death per 11.6 new cases on 4/21 to 1 new death per 30.9 new cases, or a decrease in fatality per reported new case of 62.5%.
- Although deaths is a lagging indicator, the divergence in increasing new cases and decreasing new deaths nonetheless suggests that the fatality rate may be decreasing.
- Total Deaths = 122,610 (+0.3%)
- New Deaths = 363 (+96)
- Percentage of Global New Deaths = 9.4% (+1.4%)
- Growth Rate of New Deaths (7 day average) = -1.5% (-0.2%)
- New Deaths (7 day average) = 618 (-10)
- New deaths have been generally trending down since 4/21 (7 day average of new deaths has decreased from 2,214 on 4/21 to 619 on 6/22, a decrease of 72%).
- Although the number of new cases have increased by 37.2% since 6/9, the number of new deaths have decreased by 26%.
- The 7 day average ratio of new deaths to new cases has decreased from 1 new death per 13.1 new cases on 4/21 to 1 new death per 47.1 new cases, or a decrease in fatality per reported new case of 72.1%.
- Although deaths is a lagging indicator, the divergence in increasing new cases and decreasing new deaths nonetheless suggests that the fatality rate may be decreasing.
- The fatality rate per reported case in the US since 4/21 is 36.2% less than the global rate during the same period.
C. Emerging US Hotspots
1. This is a ‘pivotal week’ for Texas, Florida, other states with coronavirus spikes
- Florida, Texas, Arizona and other states seeing major spikes in new coronavirus cases are heading into a “pivotal week” that might determine whether “they’re tipping over into exponential growth or not,” former Food and Drug Administration Commissioner Dr. Scott Gottlieb told CNBC on Monday.
- A number of states, mostly across the American South and West, have seen a dramatic rise in cases over the past couple of weeks as more people move about in increasingly reopened areas and the virus spreads to new communities.
- “I think this week’s going to really be a pivotal week for us to get a picture of where things are heading in states like Florida and Arizona and Texas, whether or not they’re tipping over into exponential growth or not,” Gottlieb said on CNBC’s “Squawk Box.” “The problem is with exponential growth everything looks sort of OK until all of a sudden it doesn’t.”
- Officials in some states, including Florida, initially pointed to increased testing as a driver of the spike in new confirmed cases. However, Florida Gov. Ron DeSantis acknowledged that the share of people who test positive is accelerating faster than the number of tests being run. The percentage of people testing positive for the virus in Florida has risen from about 4.2% on June 7 to more than 8% on June 14, the most recent data available, according to the Florida Department of Health.
- The positivity rate has similarly risen in Arizona, which has been reporting more than 2,000 new cases per day for about a week. The statistics to watch this week will be the doubling rate of the outbreaks in such states, Gottlieb said.
- “That’s going to be a curve that’s starting to look like exponential growth, the doubling time coming down to something about a week or less,” he said. “Right now, the doubling time is about 10 days in some of these places, so it’s been coming down.”
- The number of deaths due to C19 does not appear to be rising along with the number of confirmed cases, Gottlieb said. However, that could be due to the lag in time it takes for infected people to fall ill, become hospitalized and then die. Gottlieb said he doesn’t think the death rate will rise drastically, as doctors have become better at treating patients and more people who get infected are younger and not as vulnerable as the elderly or those with underlying health conditions.
- Nonetheless, if such states fail to bring down the rate of spread and contain the virus, Gottlieb said, it will find its way to at-risk communities. The longer officials in these states allow the virus to spread, he said, the more difficult it will be to bring it under control.
- “They’re having major outbreaks underway. There’s no question about it,” he said. “They might be past the point that they can control this just with simple interventions like trying to get more people to wear masks and people being mindful of their social interactions.”
- States with the worst outbreaks might have to start closing businesses down again, Gottlieb said, adding that it would be best if officials could target establishments where they know people are congregating and getting infected. DeSantis of Florida and Texas Gov. Greg Abbott have both attributed part of the rise in cases to young people disregarding precautions, especially at bars.
- “They’re guessing it’s the bars because a lot of young people are getting the illness, but I don’t think they’ve really traced it back to those locations effectively,” Gottlieb said, “because they don’t have the tracking and tracing in place that other states, including New York, New Jersey and Connecticut, had as they reopened.”
- Tracing occurs when health officials contact infected people to try to understand how they might have become infected and who they might have exposed to the virus before they were diagnosed. It’s an age-old, proven public health strategy that’s used to combat infectious diseases like measles and tuberculosis.
- Establishing strong contact tracing infrastructure was part of the White House’s reopening guidelines, though it was not required nationally in order to ease restrictions and reopen businesses. And rather than taking a leadership role, the Centers for Disease Control and Prevention has instead sought largely to support local health departments as they try to ramp up tracing systems.
- “They might have to start closing some establishments where people are congregating indoors and they know the virus is spreading,” Gottlieb said of cities with major spikes. “The problem is they don’t know what those establishments are.”
- The Northeast, especially the New York City metro area, was once the epicenter of the U.S. outbreak, but has since seen cases drop sharply as other states continue to report record spikes. New York City is moving Monday into its next phase of reopening, which will allow for hair salons, outdoor dining and more.
- “We’ll see an increase in cases, but we’re reopening against a much different backdrop,” Gottlieb said. “So I wouldn’t expect to see the big increases that they’re seeing in the Southeast and the South here when we reopen.”
- New York, New Jersey and Connecticut all drove daily new infections way down before reopening at all, Gottlieb said, noting that states now seeing a spike reopened early while they still had considerable spread in some communities. He added that people in the Northeast, many of whom saw some of the worst of the outbreak, are more likely to adhere to public health guidance like mask wearing and social distancing.
- He added that because the virus infected so many people in the Northeast, a greater portion of the population likely has some degree of immunity or resistance to infection.
- “New York probably 30% of the population’s been infected. In New Jersey and Connecticut, probably around 10% if you did seroprevalence studies, maybe higher than that,” he said. “There’s been more infection here, so the transmission rate is going to be a little bit less because of that.”
D. Potential Treatments
1. C19 Patient With Acute Respiratory Distress Cured by Cancer Drug
- Although the coronavirus usually causes only mild respiratory symptoms, the C19 disease progresses so severely in around 5% of those affected that acute respiratory distress can occur. “The mortality rate in these cases is high,” says Dr. Thomas Wiesmann, who attended the patient along with the intensive care team in the Department of Anesthesia and Intensive Care at Marburg University Hospital.
- The patient is a 65-year-old woman without pre-existing conditions who was admitted to the hospital for progressive shortness of breath and fever. Her shortness of breath worsened so rapidly that she had to be intubated to receive artificial ventilation 3 hours after admission. A standard molecular genetic test confirmed she was infected with the coronavirus. The patient’s overall prognosis was assessed as very poor due to extensive organ damage.
- “We knew from Chinese publications that patients with a severe and even fatal course of the disease are characterized by a so-called cytokine storm,” Neubauer says. “During a cytokine storm, the body is flooded with substances that stimulate the immune system.” This overreaction of the body’s own defense system damages the tissue — making it all the easier for the invading virus to spread.
- Neubauer suspected that the patient might respond to ruxolitinib, a drug originally used in cancer treatment. It inhibits enzymes in the body involved in excessive inflammatory reactions. “We suggested to our colleagues who were treating the patients that the cancer drug might be able to prevent the life-threatening effects brought on by the inflammatory damage to lung tissue,” Neubauer says.
- “We were faced with a difficult decision,” adds Professor Dr. Hinnerk Wulf, Director of the Department of Anesthesia and Intensive Care. “It was uncertain whether the theory would also work in practice; after all, the experimental treatment was also associated with a risk.” In fact, the condition of the Marburg University Medicine patient did improve after she received ruxolitinib. The treatment team noted clinical stabilization as well as rapid improvement in respiration and heart function.
- “This course of treatment was remarkable compared to that in other patients,” Wiesmann emphasizes. The patient was gradually weaned from the ventilator starting on the tenth day of her hospital stay. Virus replication was also reduced during the administration of the cancer drug.
- Apparently, the success of the treatment was not an isolated case. The team in Marburg also administered the cancer drug to several other patients to control a severe course of the disease. “It turned out well in the end for all patients who received the cancer drug for longer than one week,” Neubauer explains. A team lead by Professor Dr. Paul Graf La Rosée at Schwarzwald-Baar Hospital has also reported the successful use of the immune inhibitor, although in less severe cases.
- “The time between onset of ruxolitinib administration and improvement of health is so short that it is reasonable to assume that the drug ruxolitinib contributed to the favorable clinical course,” Neubauer explains.
- Based on the success of the treatment, the German Federal Institute for Drugs and Medical Devices has approved a clinical trial that will test the effect of the administration of ruxolitinib in additional C19 patients.
E. New Scientific Findings & Research
1. High levels of stress hormone could be killing C19 patients
- Could stress from the C19 pandemic be making cases more severe for some patients? New research suggests that high levels of the stress hormone, cortisol, are associated with a greater risk of death in coronavirus patients.
- Cortisol is a hormone produced by the adrenal glands. Best known for its role in regulating our body’s fight-or-flight response in stressful situations, it’s also important for controlling other bodily functions. Those include metabolism, blood pressure, salt and water balance, and the body’s immune system response. Too little and too much cortisol are both dangerous. High levels are particularly dangerous because they can alter immune system function and increase the risk of infection and serious illness.
- In the study, scientists collected blood samples from 535 hospital patients and examined the amount of cortisol in their blood. Of the sample, 403 of them had C19. When scientists compared cortisol levels between patients with and without C19, they found that patients with the virus have significantly higher cortisol levels.
Does cortisol play a role in survival?
- The study also shows that C19 patients with baseline cortisol levels less than or equal to 744 nm/L survive for an average of 36 days. In contrast, C19 patients with baseline cortisol levels over 744 nm/L survive for an average of only 15 days. For reference, cortisol levels in healthy people at rest are between 100 to 200 nm/L.
- These findings are important because they provide a way for doctors to identify which patients require the most urgent medical care.
- “Three months ago when we started seeing this wave of C19 patients here in London hospitals, we had very little information about how to best triage people. Now, when people arrive at hospital, we potentially have another simple marker to use alongside oxygen saturation levels to help us identify which patients need to be admitted immediately, and which may not,” says lead author Waljit Dhillo in a media release.
- “Having an early indicator of which patients may deteriorate more quickly will help us with providing the best level of care as quickly as possible, as well as helping manage the pressure on the NHS. In addition, we can also take cortisol levels into account when we are working out how best to treat our patients.”
- The study is published in The Lancet Diabetes & Endocrinology and can be read here
2. Median infection fatality rate of coronavirus for those under 70 is just 0.04%
- A scientist known for his contrarian takes to dire C19 predictions has released a paper claiming that antibody evidence suggests the median coronavirus infection fatality rate for those under 70 is just 0.04%. [Note: 0.04% is less than half of the risk of the flu]
- The estimate throws into sharp relief the lopsided mortality figures for the disease, which has claimed an inordinate number of elderly people across the planet while leaving younger individuals mostly unscathed.
- John Ioannidis, a professor of epidemiology and population health at Stanford University, argues in a paper published earlier this month that C19 “seroprevalence studies,” which measure infection rates using the presence of antibodies in blood samples, “typically show a much lower fatality than initially speculated in the earlier days of the pandemic.”
- “It should be appreciated,” he writes in the paper, “that [the fatality rate] is not a fixed physical constant and it can vary substantially across locations, depending on the population structure, the case-mix of infected and deceased individuals and other, local factors.”
- In the paper, which has not yet been peer-reviewed, Ioannidis surveyed 23 different seroprevalence studies and found that “among people <70 years old, infection fatality rates ranged from … 0.00-0.23% with median of 0.04%.”
- The median fatality rate of all cases, he writes, is 0.26%, significantly lower than some earlier estimates that suggested rates as high as over 3%.
- In the paper, Ioannidis acknowledges that “while C19 is a formidable threat,” the apparently low fatality rate compared to earlier estimates “is a welcome piece of evidence.”
- “Decision-makers can use measures that will try to avert having the virus infect people and settings who are at high risk of severe outcomes,” he writes. “
- These measures may be possible to be far more precise and tailored to specific high- risk individuals and settings than blind lockdown of the entire society.”
- Many epidemiologists believe that the initial C19 infection rate was undercounted due to testing issues, asymptomatic and alternatively symptomatic individuals, and a failure to identify early cases.
- Now, a new study from Penn State estimates that the number of early C19 cases in the U.S. may have been more than 80 times greater and doubled nearly twice as fast as originally believed.
- In a paper published today (June 22) in the journal Science Translational Medicine, researchers estimated the detection rate of symptomatic C19 cases using the CDC’s influenza-like illnesses (ILI) surveillance data over a three week period in March 2020.
- “We analyzed each state’s ILI cases to estimate the number that could not be attributed to influenza and were in excess of seasonal baseline levels,” said Justin Silverman, assistant professor in Penn State’s College of Information Sciences and Technology and Department of Medicine. “When you subtract these out, you’re left with what we’re calling excess ILI – cases that can’t be explained by either influenza or the typical seasonal variation of respiratory pathogens.”
- The researchers found that the excess ILI showed a nearly perfect correlation with the spread of C19 around the country.
- Said Silverman, “This suggests that ILI data is capturing COVID cases, and there appears to be a much greater undiagnosed population than originally thought.”
- Remarkably, the size of the observed surge of excess ILI corresponds to more than 8.7 million new cases during the last three weeks of March, compared to the roughly 100,000 cases of C19 that were officially reported during the same time period.
- “At first, I couldn’t believe our estimates were correct,” said Silverman. “But we realized that deaths across the U.S. had been doubling every three days and that our estimate of the infection rate was consistent with three-day doubling since the first observed case was reported in Washington state on Jan. 15.”
- The researchers also used this process to estimate infection rates for each state, noting that states showing higher per capita rates of infection also had higher per capita rates of a surge in excess ILI. Their estimates showed rates much higher than initially reported but closer to those found once states began completing antibody testing.
- In New York, for example, the researchers’ model suggested that at least 9% of the state’s entire population was infected by the end of March. After the state conducted antibody testing on 3,000 residents, they found a 13.9% infection rate, or 2.7 million New Yorkers.
- Excess ILI appears to have peaked in mid-March as, the researchers suggest, fewer patients with mild symptoms sought care and states implemented interventions which led to lower transmission rates. Nearly half of the states in the country were under stay-at-home orders by March 28.
- The findings suggest an alternative way of thinking about the C19 pandemic.
- “Our results suggest that the overwhelming effects of C19 may have less to do with the virus’ lethality and more to do with how quickly it was able to spread through communities initially,” Silverman explained.
- “A lower fatality rate coupled with a higher prevalence of disease and rapid growth of regional epidemics provides an alternative explanation to the large number of deaths and overcrowding of hospitals we have seen in certain areas of the world.”
4. Risk of C19 Infection is Lower than We Might Think
- Months into the new coronavirus pandemic, researchers are grappling with an urgent question: How much risk do we have of catching C19 — or dying from it — from our chance encounters?
- The debate has flared as authorities find themselves alternately accused of moving too fast or not fast enough in easing restrictions so more business and activity can resume.
- Overall, it’s probably less now than many likely believe, given the daily drumbeat of new cases, hospitalizations and deaths, according to new research this month by a pair of medical scientists at Stanford University and UCLA.
- “Across the country, current probabilities of infection transmission, hospitalization, and death from C19 vary substantially, yet severe outcomes are still rare events,” the study said. “Individuals may be overestimating their risks of hospitalization and death and a moderate number and frequency of community contacts is unlikely to overwhelm hospital capacity in most U.S. settings.”
- But like other research challenging assumptions about the disease’s danger, the new findings — yet to be certified through peer review — also raised concerns from other researchers and officials who argue it underplays the virus’s threat.
- The risk study by Dr. Rajiv Bhatia, clinical assistant professor of primary care and population health at Stanford, and Dr. Jeffrey Klauser, adjunct professor of epidemiology at UCLA, looked at publicly available case incidence data for the week ending May 30 in the 100 largest U.S. counties as states began to reopen.
- “The thing we are looking for is to start a discussion of risk,” Bhatia said. “We’re bombarded with data on death and cases.”
- The study found a person in a typical medium to large U.S. county who has a single random contact with another person has, on average, a 1 in 3,836 chance of being infected without social distancing, hand-washing or mask-wearing.
- If that sounds like a tolerable risk, consider the odds of being hospitalized. The study found a 50-to-64-year-old person who has a single random contact has, on average, a 1 in 852,000 chance of being hospitalized or a 1 in 19.1 million chance of dying based on rates as of the last week of May.
- “We were surprised how low the relative risk was,” Klausner said.
- The study assumes the same risk for every individual, even though it is known to be higher in certain regions, occupations and residential settings where there have been repeated outbreaks — meat-packing plants, nursing homes, health care jobs, jails and prisons. The study also did not account for a person’s pre-existing health conditions.
- And the report did not attempt to compare the risk levels for infection, hospitalization and death from C19 to other infectious diseases or potential dangers such as automobile accidents, which the authors acknowledged is a more difficult exercise. A 2017 report from the National Safety Council calculated the odds of a person dying in a motor vehicle crash at 1-in-114 and dying from a lightning strike at 1-in-161,856. But that’s over a lifetime, not just a single week.
- A. Marm Kilpatrick, an infectious disease researcher at UC Santa Cruz, questioned underlying assumptions in the research after reading the paper and said it is “badly flawed.” He was among scientists who also took issue with a Stanford study in April suggesting the virus is more widespread and less lethal than authorities have assumed.
- Santa Clara County Executive Jeff Smith, whose administration led the Bay Area in a regional shelter-in-place order and has taken some criticism for its slow pace of reopening, said after reviewing the study its conclusions are “misleading and not helpful.” He noted that the more than 116,000 U.S. fatalities from C19 are on par with the country’s military losses in World War I, which he called “unacceptable.”
- Bhatia doesn’t dispute that cumulative C19 deaths have been significant but said the study was an assessment only of average risks based on current infection reports, which after months of lockdown are lower than they were in March. The estimated risks represent a single point in the epidemic in late May and will increase if the infection rates increase.
- Epidemiologists say the nature of the new coronavirus that can spread invisibly through people who don’t feel ill makes it hard for people to assess their own risk. Tulane University epidemiologist Susan E. Hassig said that unlike say, HIV, which is spread through sex or drug needles, it’s often a mystery how a person was infected with the new coronavirus. Was it talking to a friend at the park or lunch with a co-worker?
- And people don’t have a long history with this new coronavirus from which to develop a sense of risk.
- “It’s not like the risk of being struck by lightning,” Hassig said. “We tally that over years, sometimes decades. We’ve been doing the coronavirus for four months, so we’re in a really challenging position where it seems like there’s lots of information but it’s not like it’s data that’s usable to estimate risk.”
- Bhatia, deputy health officer for San Francisco from 1998 to 2014, and Klausner have asked the California Department of Public Health to make more C19 case report data available so researchers can refine the risks much more closely for settings and occupations, allowing people to better protect themselves.
5. Scientists Discovered Why C19 Can Cause Loss of Smell
- From the first reports coming out of Wuhan, Iran and later Italy, we knew that losing your sense of smell (anosmia) was a significant symptom of the disease. Now, after months of reports, both anecdotal and more rigorous clinical findings, we think we have a model for how this virus may cause smell loss.
- One of the most common causes of smell loss is a viral infection, such as the common cold, sinus or other upper respiratory tract infections. Those coronaviruses that don’t cause deadly diseases, such as C19, SARS and MERS, are one of the causes of the common cold and have been known to cause smell loss.
- In most of these cases, sense of smell returns when symptoms clear, as smell loss is simply the result of a blocked nose, which prevents aroma molecules reaching olfactory receptors in the nose. In some cases, smell loss can persist for months and years.
- For the novel coronavirus (SARS-CoV-2), however, the pattern of smell loss is different. Many people with C19 reported a sudden loss of sense of smell and then a sudden and full return to a normal sense of smell in a week or two.
- Interestingly, many of these people said their nose was clear, so smell loss cannot be attributed to a blocked nose. For others, smell loss was prolonged and several weeks later they still had no sense of smell. Any theory of anosmia in C19 has to account for both of these patterns.
- This sudden return of a normal sense of smell suggests an obstructive smell loss in which the aroma molecules cannot reach the receptors in the nose (the same type of loss one gets with a clothes peg on the nose).
- Now that we have CT scans of the noses and sinuses of people with C19 smell loss, we can see that the part of the nose that does the smelling, the olfactory cleft, is blocked with swollen soft tissue and mucus – known as a cleft syndrome. The rest of the nose and sinuses look normal and patients have no problem breathing through their nose.
- We know that the way the coronavirus infects the body is by attaching to ACE2 receptors on the surface of cells that line the upper respiratory tract. A protein called TMPRSS2 then helps the virus invade the cell.
- Once inside the cell, the virus can replicate, triggering the immune system’s inflammatory response. This is the starting point for the havoc and destruction that this virus causes once in the body.
- Initially, we thought that the virus might be infecting and destroying the olfactory neurons. These are the cells that transmit the signal from the aroma molecule in your nose to the area in the brain where these signals get interpreted as “smell”.
- However, an international collaboration showed recently that the ACE2 proteins the virus needs to invade the cells were not found on the olfactory neurons. But they were found on cells called “sustentacular cells”, which support the olfactory neurons.
- We expect that these support cells are likely to be the ones that are damaged by the virus, and the immune response would cause swelling of the area but leave the olfactory neurons intact. When the immune system has dealt with the virus, the swelling subsides and the aroma molecules have a clear route to their undamaged receptors and the sense of smell returns to normal.
- So why does smell not return in some cases? This is more theoretical but follows from what we know about inflammation in other systems. Inflammation is the body’s response to damage and results in the release of chemicals that destroy the tissues involved.
- When this inflammation is severe, other nearby cells start to be damaged or destroyed by this “splash damage”. We believe that accounts for the second stage, where the olfactory neurons are damaged.
- Recovery of smell is much slower because the olfactory neurons need time to regenerate from the supply of stem cells within the lining of the nose.
- Initial recovery is often associated with distortion of the sense of smell known as parosmia, where things don’t smell like they used to. For many parosmics, for instance, the smell of coffee is often described as burnt, chemical, dirty and reminiscent of sewage.
Physiotherapy for the nose
- Olfaction has been called the Cinderella of the senses because of its neglect by scientific research. But it has come to the forefront in this pandemic. The silver lining is that we will learn a lot about how viruses are involved in smell loss from this. But what hope is there for people with a loss of smell now?
- The good news is that the olfactory neurons can regenerate. They’re regrowing in almost all of us, all of the time. We can harness that regeneration and guide it with “physiotherapy for the nose”: smell training.
- There is solid evidence that many forms of smell loss are helped by this repeated, mindful exposure to a fixed set of odorants every day and no reason to think it won’t work in C19 smell loss.
6. Recovered Chinese patients may be defenseless against foreign mutation
- Recovered C19 patients in China may still be vulnerable to a mutant form of the pathogen spreading overseas, a new study says.
- According to Professor Huang Ailong from Chongqing Medical University, there is an urgent need to determine what threat the mutation, known as D614G, poses to people who have recovered from a different form of the virus.
- D614G began spreading in Europe in early February and by May was the dominant strain around the world, presenting in 70% of sequenced samples in Europe and North America.
- Antibodies found in patients who had been infected with earlier forms of the pathogen failed to neutralize the mutant strain, the scientists said in paper published on Biorxiv.org, a preprint website, which means it has not been peer-reviewed.
- Since the latest coronavirus outbreak was reported at the Xinfadi wholesale food market in Beijing, 227 new infections have been confirmed and more than 2.3 million residents have been tested for C19 in a bid to contain the spread.
- Health authorities identified the infection in a number of locations at the market, including inside the mouths of imported salmon. The whole genome sequencing data of samples from the first three patients have been released and they all contained the D614G mutation.
- Huang and his team selected a strain of the virus that had previously circulated in China and then manipulated it to create a man-made version containing the mutation.
- They then extracted antibodies from 41 blood samples collected from recovered patients and pitched them against the mutant.
- According to a report published last week by Scripps Research, a medical research facility in San Diego, the D614G mutation has the potential to increase the number of spike proteins on the coronavirus and boost its ability to infect human cells by a factor of 10.
- However, that estimate was mostly based on computer modelling so questions remained over the possible increase in binding efficiency.
- In the Chongqing study, the antibodies generated by three patients failed to suppress the mutated strain, with one sample showing almost zero effect.
- The researchers then tried to infect host cells with the mutant and normal strains. The mutant’s entry efficiency was 2.4 times higher.
- “This seemingly small increase in entry activity could cause a large difference in viral infectivity in the human body,” they said.
- One of the concerns now is that the prevalence of D614G will have a detrimental impact on vaccine development.
- Several Chinese vaccine candidates have entered the final phase of clinical trials, but they are based – like those under development in the United States and Europe – on the earliest strains of the coronavirus detected and sequenced in Wuhan.
- A study by IBM’s AI medical team in April warned that the D614G mutation could reduce the effectiveness of vaccine programmes that target the virus’ spike protein. A separate study by a team of researchers in Serbia last month came to a similar conclusion.
- “Given the evolving nature of the coronavirus RNA genome, antibody treatment and vaccine design might require further consideration to accommodate the D614G and other mutations that may affect the immunogenicity of the virus,” Huang said.
- About 10% of the people infected by the new outbreak in Beijing are in a critical condition, according to the city’s health authorities, and medical teams from across the country have been flown into to help with the aid effort.
- The Chinese government and the World Health Organization have both said the genetic information of the virus points to a source outside China, but whether it arrived via a refrigerated food chain or a human visitor has yet to be determined.
7. Open Source All-Atom Models of Full-Length C19 ‘S’ Protein Produced by Scientists
- The “spike” or S protein of the coronavirus facilitates viral entry into host cells.
- Now a group of researchers from Lehigh, Seoul National University in South Korea and the University of Cambridge in the UK has worked together to produce the first open-source all-atom models of a full-length S protein.
- The researchers say this is of particular importance because the S protein plays a central role in viral entry into cells, making it a main target for vaccine and antiviral drug development.
- “Our models are the first fully-glycosylated full-length coronavirus spike (S) protein models that are available to other scientists,” says Im. “I was fortunate to collaborate with Dr. Chaok Seok from Seoul National University in Korea and Dr. Tristan Croll from University of Cambridge in the U.K. Our team spent days and nights to build these models very carefully from the known cryo-EM structure portions. Modeling was very challenging because there were many regions where simple modeling failed to provide high-quality models.”
- Scientists can use the models to conduct innovative and novel simulation research for the prevention and treatment of C19, according to Im.
F. Concerns & Unknowns
1. Critically Ill C19 Patients 10x More Likely to Develop Cardiac Arrhythmias
- Patients with C19 who were admitted to an intensive care unit were 10 times more likely than other hospitalized C19 patients to suffer cardiac arrest or heart rhythm disorders, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania.
- Researchers say the results suggest that cardiac arrests and arrhythmias suffered by some patients with C19 are likely triggered by a severe, systemic form of the disease and are and not the sole consequence of the viral infection. The findings — which differ significantly from early reports that showed a high incidence of arrhythmias among all C19 patients — provide more clarity about the role of the coronavirus and C19 in the development of arrhythmias, including irregular heart rate (atrial fibrillation), slow heart rhythms (bradyarrhythmia) or rapid heart rate that stops by itself within 30 seconds (non-sustained ventricular tachycardia).
- The study was published today (June 22, 2020) in the journal Heart Rhythm — the official journal of the Heart Rhythm Society.
- “In order to best protect and treat patients who develop C19, it’s critical for us to improve our understanding of how the disease affects various organs and pathways within our body — including our heart rhythm abnormalities,” said the study’s senior and corresponding author Rajat Deo, MD, MTR, a cardiac electrophysiologist and an associate professor of Cardiovascular Medicine at Penn. “Our findings suggest that non-cardiac causes such as systemic infection, inflammation and illness are likely to contribute more to the occurrence of cardiac arrest and arrhythmias than damaged or infected heart cells due to the viral infection.”
- Recent studies from China have suggested that C19 is associated with a high incidence of cardiac arrhythmias, particularly among critically ill patients — early reports showed 44% of patients admitted to the ICU suffered arrhythmias. Heart rhythm problems occur when electrical impulses that coordinate your heartbeats don’t work properly, causing your heart to beat too fast, too slow, or irregularly. If left untreated, cardiac arrhythmias can lead to serious medical conditions, including stroke and cardiac arrest — the abrupt loss of heart function.
- To evaluate the risk and incidence of cardiac arrest and arrhythmias among hospitalized patients with C19, the Penn team evaluated 700 patients with C19 who were admitted to the Hospital of the University of Pennsylvania between early March and mid-May. Researchers evaluated cardiac telemetry and clinical records for patient demographics and medical comorbidities — such as heart disease, diabetes and chronic kidney disease — and recorded patient vitals, test results and treatment.
- The cohort of patients had a mean age of 50 years, with Black patients accounting for more than 70 percent of the population. Researchers identified a total of 53 arrhythmic events: nine patients who suffered cardiac arrest, 25 patients with atrial fibrillation who required treatment, nine patients with clinically significant bradyarrhythmias and 10 non-sustained ventricular tachycardia events. The team did not identify any cases of heart block, sustained ventricular tachycardia or ventricular fibrillation.
- Of the 700 patients hospitalized, about 11% were admitted to the ICU. None of the other hospitalized patients suffered a cardiac arrest. After controlling for underlying demographic and clinical factors, researchers found cardiac arrest and arrhythmias were more likely to occur among patients in an ICU compared to the other hospitalized patients.
- Researchers noted that the study has several limitations, including that the analysis was conducted from a single center serving a large urban population.
- “More research is needed to assess whether the presence of cardiac arrhythmias have long-term health effects on patients who were hospitalized for C19,” Deo said. “In the meantime, it’s important that we launch studies to evaluate the most effective and safest strategies for long-term anticoagulation and rhythm management in this population.”
2. Can Vaccines Protect Elderly?
- Health experts are worried about whether coronavirus vaccines under development will adequately protect the elderly, sparking efforts to make sure there are shots that can help the vulnerable group.
- Older adults are especially susceptible to infection by the virus, and at higher risk of falling critically ill and dying, at least partly because their immune systems have lost strength with age. Public-health officials and scientists are concerned that a weakened immune system could also limit the effectiveness of a coronavirus vaccine, just as it has sapped the power of other shots in older people.
- “It would not be particularly encouraging if we have a vaccine that’s capable of protecting 20-year-olds who probably have a pretty low risk anyway of getting sick, and doesn’t work at all for people over 65,” Francis Collins, director of the National Institutes of Health, said in an interview.
- To find a vaccine that works safely in older adults, researchers at Pfizer and other companies are exploring possible options such as increasing the doses or adding a booster to the shot. At least one vaccine specifically for the elderly is in development. And Pfizer, the University of Oxford and others have started testing their coronavirus vaccine candidates in older adults.
- Some of the experimental vaccines “may turn out to be better for older individuals, and that’ll be a big issue in terms of how we then end up deploying these,” Dr. Collins said.
- Older adults have been especially hard hit by the new coronavirus. Between March and mid-June, Americans over the age of 65 had the highest rate of hospitalization among all age groups, about double the rate for people 50 to 64 years old and five times the rate for 18- to 49-year-olds, according to the Centers for Disease Control and Prevention.
- Vaccines will be crucial, public-health experts say, to stopping the spread of the virus. More than 100 are in development and more than a dozen are in human testing, according to the World Health Organization.
- The shots work by tricking the body into thinking it has been infected with a virus, prompting the immune system to make antibodies to fight the pathogen. Yet antibody production weakens over time, part of a process known as immunosenescence. Researchers aren’t sure why, aside from the fact that the body generally weakens with age.
- The loss of immune system strength makes older adults more susceptible to bacterial and viral infections such as influenza. Some 90% of flu deaths in the U.S. each year are of people over the age of 65.
- And flu vaccines tend not to protect older adults as well as they defend younger people. Research shows the vaccines protect between 70% and 90% of children and younger adults, but 30% to 50% of adults over 65.
- “We’re just starting to understand some of the ways to overcome those immune responses,” said Dr. Kawsar Talaat, deputy director of clinical research for the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, who is slated to help coronavirus vaccine developers test their shots in older adults. “We hadn’t been designing vaccines for the elderly for a long time.”
- The FDA is working with companies to make it easier for experimental vaccines to be tested in older adults earlier during clinical trials, and alongside younger subjects, an agency spokesman said. Moderna is among the companies already testing its experimental shot in adults older than 55, while Johnson & Johnson plans to after it begins testing next month.
- Pfizer, which is also testing its potential coronavirus vaccines in older people, is studying whether increasing the dosage could protect the elderly better. Higher doses have helped make flu vaccines more effective in the elderly.
- Researchers at the New York drugmaker are also curious whether their gene-based technology might prove more effective in elderly people than shots based on older, different technologies, said Kathrin Jansen, Pfizer’s head of vaccine research and development.
- The unproven technology uses messenger RNA, or mRNA, programmed to tell cells to make proteins that can protect against the coronavirus. Pfizer wants to see whether the synthesized mRNA spurs both a broad immune response, which may not be as strong in older adults, as well as a targeted response that makes up for the gap, Dr. Jansen said.
- The more powerful punch could “help overcome the difference between younger adults’ responses and that of an older adult,” Dr. Jansen said in an interview.
- Some companies are considering the use of a booster, or adjuvant, to strengthen a vaccine’s effect on the immune systems of older adults. An adjuvant in Shingrix, a shingles vaccine from GlaxoSmithKline, helps the shot safely reduce the risk of contracting the disease by more than 90% in older people, almost twice the percentage of the other shingles vaccine in the U.S., according to the CDC.
- Glaxo provided one of its adjuvants to Sanofi and six other drugmakers working on coronavirus vaccines, said Dr. Thomas Breuer, chief medical officer of GSK vaccines. Glaxo had used that adjuvant in an H1N1 vaccine.
- Meantime, researchers at Boston Children’s Hospital are trying to develop a vaccine specifically for older adults. The researchers are screening vaccine candidates against white blood cells donated by older people to see whether any of the shots would work better in the elderly, said Ofer Levy, director of the hospital’s vaccines program.
- The hospital researchers have narrowed the search to about seven different vaccine candidates, and are also evaluating about 50 potential adjuvants that could be added, Dr. Levy said. They hope to begin testing a vaccine in people ages 65 and older next year, he said.
G. Back to School!?
1. In person, online classes or a mix: Colleges pursue different approaches for reopening this fall
- Michigan State University President Samuel Stanley says he knows the coronavirus will spread if students come back to campus in the fall.
- While safety is “paramount,” managing the risk is a chance worth taking for MSU, he said.
- “The one thing that’s going to be really important, then, is confidence in our students, faculty and staff and their willingness to abide by a number of the things we’re going to be asking them to do on campus,” Stanley said.
- Like Stanley, most college administrators are mulling over how to restart their programs with no end in sight for the public health crisis.
- According to the Chronicle of Higher Education, which is tracking more than 860 institutions’ plans, two-thirds of colleges are planning to welcome back students in person, while only 7% are planning to hold classes only online. Many other colleges have yet to make a decision.
- Their approaches are as diverse as the roughly 3,000 four-year colleges and universities that span the United States.
Back to campus – with masks, one-way hallways
- Stanley is among a majority of university presidents who aspire to welcome students back to campus in the fall. He said many students had difficulties with remote learning in the spring. Some lacked the resources at home to complete courses online.
- But Michigan State still plans to hold about half of its classes entirely online. Others will be taught via a hybrid format, with students doing some course sessions online and some in person, or in larger classrooms on campus. The school plans to accommodate students who cannot return in person by giving them an online curriculum.
- Stanley said university affiliates will need to commit to a new way of life on the East Lansing campus: always wearing masks in public spaces, respecting “directional flow” for certain hallways, and committing to self-isolation if exposed to the virus.
- To decrease density in residential facilities and minimize unnecessary social contact, college administrators are lowering dormitory occupancy and requiring changes to life in residence halls.
- Duke University, for example, is offering extra housing in local hotels and apartments, with most students promised a single room.
- At historically Black Florida A&M University, the proposed plan for reopening this fall places a strong focus on health precautions. Black Americans have already been disproportionately affected by the C19 pandemic.
- Class sizes at FAMU will be limited, and students will be required to shower at scheduled times. Students are “strongly encouraged” to get tested for C19 when they arrive on campus, and at least 2% of faculty and staff will be tested every month.
- The University of Colorado-Boulder plans to house first-year students in “social cohort groups” tied to the courses they’re registered to take.
- “In a regular semester, (students) may have 40 or 50 different students that they would be interacting with rather than just 10. And we believe that by reducing that population density, we’ll certainly help to mitigate some of the problems with the virus,” Chancellor Philip DiStefano told CNN.
- Boston University’s students are invited back to campus, but they will have a choice between in-person classes or remote classes for their fall semester.
- “It protects the health and safety of everyone, students and faculty, and provides the kind of flexibility that students need in these difficult times,” Sue Kennedy, BU’s interim associate provost for undergraduate affairs, wrote in a news release.
- Why all the effort to reopen campuses? Many colleges – especially smaller, residential schools – need students on campus to stay afloat. Refunds for room and board when classes went online in March created budget crises at many institutions.
- What’s more, students said they might not return to college if classes were online again in the fall. In lawsuits and social media posts, they spent much of the spring saying it wasn’t fair they had to pay full tuition rates to learn online.
Online classes throughout California
- Still, some colleges have decided the risk of a community outbreak is too great.
- California State University – the nation’s largest public university system – and many universities in the University of California system plan to offer most of their fall semester coursework online.
- CSU Chancellor Timothy White said he was skeptical of college administrators who say they can bring their students back, noting forecasts of a second wave of the coronavirus that could severely disrupt campus activities.
- “If you started in person and then had to flip back to virtual halfway through – that kind of yo-yo, you know – is that good for students and for the learning experience, or is it better to have a consistent space, the virtual space?” White said.
- For academic programs that depend on specialized equipment – such as kilns for pottery workshops and laboratories for chemistry experiments – CSU plans to move forward with a limited number of on-campus offerings, according to White. Each of the system’s 23 campuses might teach anywhere from 2% to 12% of its classes in person.
- White said he is confident virtual courses will be more compelling than they were in the spring and hopes students will “stay with it” instead of taking a gap year.
- “That’s actually sort of field training for the future workforce, because when they graduate, chances are going to be increasing every day that they will be working in a virtual space in the future,” White said.
- At the University of California-Los Angeles, administrators have said no more than 20% of classes will be taught in-person.
- Low-density housing will be provided based on financial need and for students taking courses or participating in other activities offered in-person, according to a statement from Provost Emily Carter.
Shifting class schedules
- Some universities are opening their campuses but reimagining their academic calendars or approaches to minimize transmission of the virus.
- Syracuse University plans to move to an alternating in-person schedule for the fall term. Half of all students will attend a class in-person one day, with the other half following along virtually. The students will swap spots on alternate days.
- Stanford University plans to start its fall term earlier and allow only half of undergraduates back to campus each quarter.
- And, like universities such as Rice, Notre Dame and Purdue, Stanford will end its term before Thanksgiving to avoid the expected reemergence of the coronavirus in late fall. Such universities want to reduce the chances that students become exposed to the virus at home and bring it back to campus.
- A few smaller colleges are experimenting with block scheduling. Centre College in Kentucky plans to divide the normal academic term of 13 weeks and four courses into two blocks of two courses, each six weeks plus two days long. That way, the argument goes, fewer classes at a time will be disrupted by a potential outbreak. Centre administrators say they hope to decide by midsummer whether classes will be online or in-person.
Still considering options
- Many colleges, like Centre, are still weighing avenues for return.
- While planning to keep classes online, Harvard University is considering three options for undergraduate living for the fall semester: keeping the campus population at its low-density level, with most undergraduates at home; housing about half of its undergrads; and welcoming back all students.
- Harvard officials say they expect to make a decision by July.
- In states that have lifted public health restrictions, potentially paving the way for universities to resume their operations, some colleges have created their own reopening phases.
- At the University of Alabama, officials are implementing four phases of reopening as they assess C19 mitigation efforts.
- For now, the college says, students will be tested for C19 before or immediately after returning to campus, and the university is considering limiting in-semester holidays and breaks as well as ending in-person instruction by Thanksgiving.
- [Note: Noticeably absent from plans so far are frequent testing of teachers and students as well as contract tracing. These techniques are often cited as ways to safely reopen the economy.]
H. Projections & Our (Possible) Future
1. Talk of Second Wave is Premature
- About 120,000 Americans have died of C19, and daily counts of new cases in the U.S. are the highest they’ve been in more than a month, driven by recent increases in the South and Southwest.
- The alarming trend has spurred talk of a “second wave” of coronavirus infections in the U.S. But health experts agree that “second wave” is probably the wrong term to describe what’s happening.
- “When you have 20,000-plus infections per day, how can you talk about a second wave?” said Dr. Anthony Fauci , director of the National Institute of Allergy and Infectious Diseases. “We’re in the first wave. Let’s get out of the first wave before you have a second wave.”
- Clearly there was an initial infection peak in April as cases exploded in New York City. After schools and businesses were closed across the country, the rate of new cases dropped somewhat.
- But “it’s more of a plateau, or a mesa,” not the trough after a wave, said Caitlin Rivers, a disease researcher at Johns Hopkins University’s Center for Health Security.
- Scientists generally agree the nation is still in its first wave of coronavirus infections, albeit one that’s dipping in some parts of the country while rising in others.
- “This virus is spreading around the United States and hitting different places with different intensity at different times,” said Dr. Richard Besser, chief executive of the Robert Wood Johnson Foundation who was acting director of the federal Centers for Disease Control and Prevention when the H1N1 flu pandemic hit the U.S. in 2009.
- Dr. Arnold Monto, a flu expert at the University of Michigan, echoed that sentiment.
- “What I would call this is continued transmission with flare-ups,” he said.
- Flu seasons sometimes feature a second wave of infections. But in those cases, the second wave is a distinct new surge in cases from a strain of flu that is different than the strain that caused earlier illnesses.
- That’s not the case in the coronavirus epidemic.
- Monto doesn’t think “second wave” really describes what’s happening now, calling it “totally semantics.”
- “Second waves are basically in the eye of the beholder,” he said.
- But Besser said semantics matter, because implying that a first wave has passed may give people a false sense that the worst is over.
- Some worry a large wave of coronavirus might occur this fall or winter — after schools reopen, the weather turns colder and less humid, and people huddle inside more. That would follow seasonal patterns seen with flu and other respiratory viruses. And such a fall wave could be very bad, given that there’s no vaccine and most Americans still won’t have any immunity to the virus.
- But the new coronavirus so far has been spreading more episodically and sporadically than flu, and it may not follow the same playbook.
- “It’s very difficult to make a prediction,” Rivers said. “We don’t know the degree to which this virus is seasonal, if at all.”
I. The Road Back?
1. People asking friends to take C19 tests before hanging out
- As more locations around the U.S. re-open, people are starting to plan social events again.
- But for some, these gatherings include new precautions to reduce the risk of spreading C19.
- In Los Angeles, Jay Prasad and his roommate Dennis Yun, who is a physician, recently hosted a Memorial Day barbecue. Before guests could enter, Yun administered a C19 antibody finger-prick test, then made them wait ten minutes for the results. Antibody tests typically register positive if a person has been exposed to the disease, even if they didn’t show symptoms.
- Prasad and Yun also used an infrared forehead thermometer to check if any guests had a fever, a common symptom of C19. Although no guests tested positive for antibodies or showed signs of a fever, Prasad said he and his roommates were prepared to turn people away if they had.
- “That’s just the smart thing to do, and I don’t think we know anybody who would have objected to it,” Prasad said.
- Additionally, Prasad handed out face masks from NxtStop, a direct-to-consumer clothing brand that he invested in. Although the barbecue was a mostly outdoor event, guests were asked to wear the masks while inside.
- “We got some sense of return to normalcy,” Prasad said. “At least this was a path toward how that might happen.”
New standards of etiquette
- From requiring C19 tests to wearing masks indoors, people are creating new standards of social etiquette suited for the “new normal” of life amid the coronavirus.
- For the Fourth of July, Ivan Malina of Brooklyn is planning a trip with friends to Lake George, New York. The group of 10 is renting a large home where they can keep their distance from one another, and they have all agreed to use masks while inside. Additionally, the group is planning to use disposable plates and utensils throughout the gathering.
- Most importantly, everyone has to take a C19 test prior to the trip, Malina said.
- “We’re going into another community. It would be really bad if we went up there and someone had it and spread it,” Malina said. “A lot of stuff with Covid is less about protecting yourself and protecting others.”
- Malina is asking his friends to take the test within a week before the trip, then refrain from any risky activities where they could become infected before the gathering. If anyone tests positive, Malina said, the group will refund that friend for their portion of the vacation rental.
- “This is unprecedented,” Malina said. “Paying a little bit more because your friend got sick, I don’t think that’s going to bother anyone.”
- In San Francisco, Sara Broyles moved into a new apartment just before the city enacted its shelter-in-place order in March. The lockdown scuttled her plans for a housewarming party.
- Recently, she decided to try again. She reached out to her close friends to ask how they would feel about that type of hangout, and collectively, the group decided that they would love to get together — as long as everyone took a C19 test before the event.
- “I do want to make sure that everyone does feel comfortable being in close quarters together,” Broyles said. “If we do this the right way, I feel like it will be OK to do.”
- For Broyles, who had never lived alone before, hosting friends at her place for the first time will be a milestone.
- “We’ve all spoken on the phone and FaceTimed and Zoomed a bunch, and that’s all great,” she said. “But of course, we miss spending time together.”
J. Pandemic Economy
1. A Tale of Two US Economies
Job gains are much greater in states that have reopened faster
- The Labor Department on Friday reported jobless rates in May for the 50 states, and the news is the greater than usual variation. Some state economies are recovering much faster than others, and the worst performing tend to be those that have imposed the most severe lockdowns.
- The national jobless rate was 13.3% in May, but 10 states still have unemployment rates above 15%. From highest down, they are: Nevada (25.3%), Hawaii (22.6%), Michigan (21.2%), California, Rhode Island and Massachusetts (16.3%), Delaware (15.8%), Illinois and New Jersey (15.2%), and Washington state (15.1%).
- The Nevada and Hawaii economies rely heavily on tourism that has been walloped by the pandemic. But all of these 10 states have had some of the strictest lockdowns. The Michigan rate is especially striking compared to the lower rates in Wisconsin (12%) and Indiana (12.3%, down from 17.5% in a month). New York, the state hit hardest by the virus, had a jobless rate of 14.5% in May, down somewhat from 15.3% a month earlier.
- Nine of the 10 states with the highest jobless rate are run by Democrats, who have tended to demand that the economy should stay locked down and in some cases are still resisting opening.
- One exception is Colorado, where Democratic Gov. Jared Polis was one of the first to reopen. His decision is paying off as Colorado’s jobless rate in May fell to 10.2% from 12.2% in April.
- Other states well below the national rate include Georgia (9.7%), Arkansas (9.5%), Arizona (8.9%), Utah (8.5%), and Nebraska (the lowest rate in the country at 5.2%). These tend to be states that resisted total lockdowns or reopened sooner.
- Some of this variation may be related to statistical noise from rapid labor shifts that are hard to track. Over time the rates should tend to converge closer to the national average.
- But so far these numbers suggest a tale of two U.S. economies.
- States that are reopening faster are recovering faster and easing more economic suffering. The states that put a premium on trying to reduce the spread beyond the original purpose of protecting hospitals and the health-care system are lagging.
- It isn’t clear that those shutdowns reduced the rates of infection and fatalities from the coronavirus compared to other states even as they continue to do more economic harm.
- All of this offers lessons for the months ahead as candidates debate which policies will best spur the most rapid recovery. The most important decision is letting people return to the business of life and commerce.
Source: A Tale of Two US Economies
K. Practical Tips & Other Useful Information
1. Air conditioners can help prevent coronavirus spread
- They’re no cure, but when used properly air conditioners can help mitigate the spread of the coronavirus.
- As the US emerges from quarantine and heads into summer, air conditioners are turning on across the country — and, experts say, the machines are not only safe but potentially helpful in preventing further spread of the disease.
- The standard air conditioner works by recirculating and filtering air inside a space and mixing it with outside air. Just by bringing more outside air into interior spaces, air conditioners are helping combat the virus in a small way, as outside air reduces the risk of coronavirus transmission compared with confined spaces.
- High-efficiency particulate air (HEPA) filters, considered the gold standard of AC filters, are also capable of capturing small particles, including viruses, Bloomberg reports.
- “Changes to building operations, including the operation of heating, ventilating, and air conditioning systems, can reduce airborne exposures,” says the American Society of Heating, Refrigerating and Air-Conditioning Engineers’ (ASHRAE) official statement. “Air conditioning systems can reduce the airborne concentration of the coronavirus and thus the risk of transmission through the air.”
- The exception, however, is in spaces with poor ventilation.
- “When we see reports of super-spreading events that apparently involve air conditioning, it usually means there’s little or no ventilation in the space,” Pennsylvania State University architectural engineering professor William Bahnfleth tells Bloomberg. “You can have one drink and you’re fine, but if you drink a whole bottle of hard liquor, you may die. With pathogens, it’s similar. It takes a certain number of them to have a high probability of getting an infection. If you can reduce the concentration in the air, then the rate at which you can be exposed drops.”
- So, in the case of a poorly ventilated space, simply opening the windows is a better solution than recirculating musty air.
- While in some instances air conditioners are not helpful in virus prevention, ASHRAE stands by the fact that air conditioners do more good than bad in context. “In general, disabling of heating, ventilating and air conditioning systems is not a recommended measure to reduce the transmission of the virus,” reads their statement.
L. Johns Hopkins COVID-19 Update
June 22, 2020
1. Cases & Trends
- The WHO C19 Situation Report for June 21 reports 8.71 million confirmed cases (183,020 new) and 461,715 deaths (4,743 new). This exceeds the record daily incidence set on June 18 (which included more than 30,000 cases not previously reported by Chile). It appears that Brazil may be the key driver of this elevated incidence, reporting more than 54,000 new cases. However, Brazil reported an unexpectedly low incidence the previous day, so this may be the result of a reporting anomaly. Nonetheless, the global daily incidence continues to increase, and the pandemic continues to accelerate. Not considering the 2% recent spikes, the WHO is reporting approximately 1 million new cases per week.
India, Pakistan & Bangladesh
- India has reported its 5 highest daily incidence over the past 5 days, including more than 15,000 new cases yesterday. India’s C19 epidemic continues to accelerate, doubling since May 29. India is currently #3 in terms of daily incidence. Pakistan reported its second highest daily incidence to date (6,604 new cases), but all other days since June 14 have been fewer than 6,000 new cases. It appears that Pakistan may be reaching a peak or plateau, but additional data is required to understand the longer-term trend. Pakistan remains #6 globally in terms of daily incidence. Bangladesh reported its fourth and fifth highest daily incidence over the past 2 days (3,531 and 3,480 new cases, respectively). Notably, Bangladesh’s test positivity is holding steady at approximately 20%, which is considerably higher than the WHO’s 5% benchmark for relaxing social distancing measures. Bangladesh is currently #11 globally in terms of daily incidence.
- Brazil reported its highest and third highest daily incidence over the weekend, including 54,771 new cases on June 19, a 57% increase above the previous high. However, Brazil reported an uncharacteristically low incidence on June 18, so the elevated incidence on June 19 could be a result of reporting issues, covering cases that would have normally been reported the previous day. Brazil remains #1 globally in terms of daily incidence.
Central & South America
- Broadly, the Central and South American regions are still a major C19 hotspot. The region represents 6 of the top 14 countries globally in terms of daily incidence, including:
- Iran reported 2,573 new cases. While still lower than the peaks in late March and early June, Iran’s current daily incidence remains elevated compared to most of April and May. Iran is currently #13 globally in terms of daily incidence.
Eastern Mediterranean Region
- Overall, the Eastern Mediterranean Region remains an emerging hotspot, representing 5 of the top 9 countries in terms of per capita incidence: Qatar (#1), Bahrain (#3), Oman (#6), Kuwait (#8), and Saudi Arabia (#9). Additionally, nearby Armenia is #4. In addition to Iran and Pakistan, Saudi Arabia is #9, Iraq is #15, and Turkey is #18. Nearby Egypt is #16.
- Beijing’s C19 outbreak continues, now reporting more than 200 associated cases since June 11, including 9 new cases today. One major component of China’s response includes large-scale SARS-CoV-2 testing. As part of this effort, China’s National Health Commission reported that Beijing more than doubled its testing capacity, up to 230,000 tests, although the report does not specify over what period. Another report by the Beijing government indicates that the city has the capacity to perform 500,000 tests per day, rapidly scaled up from 8,000 prior to the outbreak. In order to increase testing capacity, China constructed temporary testing sites at local facilities, including sports arenas. Additionally, the NHC reported that it has shared data from the identified C19 cases linked to the Beijing outbreak with the WHO and international partners. An investigation continues to determine the source of the outbreak. While the initial cases have been linked to the Xinfadi Market, it remains unclear how and when the virus was introduced.
- Several cases of COIVID-19 were reported among construction workers at 2 construction sites in Beijing. Health officials conducted screening and testing at 435 ongoing construction projects across the city, including more than 1,600 tests for individuals who had recent contact with someone who visited the market.
- The US CDC reported 2.25 million total cases (32,411 new) and 119,615 deaths (560 new). Additionally, the CDC reported 32,218 new cases the previous day. These represent the 2 highest daily totals for the United States since April 25 and the sixth and seventh highest daily incidence to date. In total, 18 states (no change) and New York City reported more than 40,000 total cases, including New York City with more than 200,000; New York state with more than 175,000; California and New Jersey with more than 150,000; and Illinois with more than 125,000. Following an overall decrease in daily incidence from mid-April through the end of May, the United States’ national C19 burden has increased since early June, approximately several weeks after states began to relax social distancing measures.
- The Johns Hopkins CSSE dashboard reported 2.29 million US cases and 120,044 deaths as of 12:30pm on June 22.
2. Contamination of Early US Test Kits
- The US Department of Health and Human Services completed an internal investigation regarding delays in scaling up US SARS-CoV-2 testing capacity. The final report, obtained by multiple media outlets, was published on Friday. The investigation concluded that initial batches of critical reagents were “likely” contaminated at some point during the manufacturing process. CNN reported that representatives from the US FDA indicated that the tests were not manufactured in the traditional fashion. Specifically, the testing material was produced in a CDC laboratory rather than a manufacturing facility. A variety of factors, including “time pressure” to make the test kits available quickly, could have impacted the implementation of production protocols and resulted in inadvertent contamination of test kit materials or disrupted quality control checks that could have identified the contamination prior to shipping the test kits. The HHS report indicates that the tests are extremely sensitive and that even seemingly minor breaches of protocol could have resulted in the contamination. It notes that “a single person walking through an area with positive control material and then later entering an area where tests reagents were being manipulated” could have contaminated the reagents.
3. US Mandatory Mask Orders
- As numerous states report continued increases in C19 incidence, some state and local officials are moving to require citizens to wear masks. Washington Governor Jay Inslee announced over the weekend that he intends to issue a proclamation mandating mask use in public in Yakima County, which is experiencing increased community transmission, making the current local order enforceable. According to The Seattle Times, more than 20% of Washington’s cases and 22% of its C19-related hospitalizations can be attributed to Yakima County, despite it only accounting for only 4% of the state’s total population. Similar situations are occurring in other states as well. Oregon Governor Kate Brown announced last Wednesday mandatory mask use would be implemented in 7 counties that make up the majority of Oregon’s C19 burden. Additionally, other counties could opt in to the mandate. In North Carolina, multiple local jurisdictions have implemented mandatory mask use, and Governor Roy Cooper announced that a prospective proposal this week could mandate mask use statewide.
- Not all states, however, are enforcing mask use. Notably, Florida Governor Ron DeSantis—despite acknowledging that increased community transmission, and not increased testing, is driving the state’s increased C19 incidence—continues to refrain from mandating mask use. According to CNN, at least 15 states have put statewide mask requirements in places as of Friday evening. A report by CNN indicates that the CDC may issue updated mask guidance in the near future; however, it is unclear what the update would include or when it would be released.
4. Coronavirus & Wastewater
- According to a press release, the Italian National Institute of Health detected SARS-CoV-2 in wastewater samples from Milan and Turin that were collected in December 2019, nearly 2 months prior to Italy’s first reported case of C19. The investigation tested 40 sewage samples from northern Italy that were collected between October 2019 and February 2020. The researchers note that discovery of virus in wastewater samples does not necessarily indicate that Italy’s epidemic originated with these early cases. A publication with the full data set is expected this week. This new evidence, along with the detection of SARS-CoV-2 in wastewater in other European countries and Australia, suggests that SARS-CoV-2 may have been circulating outside of China in late 2019, prior to when initial C19 cases were reported.
- In the United States, Clemson University and the city of Clemson, South Carolina, reported elevated SARS-CoV-2 levels in wastewater, which coincides with increased C19 incidence statewide. Similarly, Cape Canaveral, Florida, detected SARS-CoV-2 in wastewater specimens from the week of May 26. Local officials believe that the concentration of the virus in the specimens could be equivalent to approximately 85 cases of C19. Those involved in the testing note that the results may not match the city’s low official C19 incidence at the time, as a number of travelers visited Cape Canaveral for Memorial Day as well as a SpaceX launch around the same time.
- Systematic wastewater testing could have the potential to provide advance warning of circulating pathogens prior to initial detection and reporting of early cases. Reports of SARS-CoV-2 detected in wastewater, particularly prior to detected C19 suggests that this kind of system could be developed, but additional research is required in order to establish this capability.
5. Inhaled Remdesivir
- Gilead Sciences announced today that it received authorization from the US FDA to commence a Phase 1 clinical trial to evaluate an inhaled formulation of remdesivir, an antiviral that has demonstrated efficacy in treating C19 in clinical trials. The new version could be administered using a nebulizer, and it could potentially enable administration outside of hospitals, including at earlier stages of the disease. Gilead will also pursue other investigations with remdesivir to expand its use, including testing intravenous infusions for outpatient cases as well as the combination of remdesivir with other therapeutics, particularly anti-inflammatory drugs such as dexamethasone. Studies to test the use of remdesivir in vulnerable populations such as children and pregnant women are also underway or being planned. Currently, remdesivir is currently allowed to be used for certain hospitalized patients under the US FDA Emergency Use Authorization that was issued at the beginning of May.
6. UK Social Distancing
- The United kingdom announced today that its national policies regarding “shielding” highly vulnerable individuals will begin to relax on July 6. Previously, shielded individuals, based on pre-existing health conditions that put them at particularly elevated risk for severe C19 disease and death, were instructed to fully isolate themselves. These conditions included organ transplant recipients, individuals undergoing chemotherapy, pregnant women with health conditions, and those with severe respiratory diseases. Because these individuals faced more restrictive social and physical isolation than others, the UK government instituted broad support for affected individuals—including volunteer assistance with delivering food and medications, transportation to medical appointments, and regular social contact via phone or other form of communication—which will continue through the end of July. Starting on July 6, shielded individuals will be permitted to create a “support bubble” with one other household, and beginning August 1, shielding guidance will be relaxed completely. The announcement emphasizes that individuals at elevated risk of severe disease and death should continue to practice “strict social distancing” as they resume some of their routine activities, including shopping and returning to work. The Shielded Patient List includes approximately 2.2 million people across the United Kingdom.