Coronavirus Update

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Coronavirus Update 6-25

Recent Developments & Information 

June 25, 2020

Reliable information is the best tool available to protect your family from the pandemic and its shockwaves

“The global economy will shrink this year by 4.9% percent, worse than the 3% percent decline predicted in April.   The darker forecast reflects the effects of social distancing; scarring to global production capacity from the lockdown of activity; and the productivity cost of new safety and hygiene rules.”  

International Monetary Fund

“A second wave of infections is almost inevitable if residents do not abide by social-distancing rules. It will come. And once it comes, it’s too late.”  

NY Governor Cuomo

“States experiencing growing novel coronavirus outbreaks may need to pause or roll back their reopening stages without necessarily reimposing an absolute shutdown.” 

Dr. Anthony Fauci

Index

A. The Pandemic As Seen Through Headlines

B. Numbers & Trends

C. Emerging US Hotspots

Positive Test Rates in Hotspots

Alarming spike in coronavirus sparks fears California is ‘starting to lose this battle’  

D. Risk of Airborne Transmission

Airborne Coronavirus may be more infectious than previously thought 

Air Conditioning and the Transmission of C19  

E. New Scientific Findings & Research

Herd immunity threshold could be much lower than originally thought  

Early Stage Antiviral Could Reduce Transmission of C19 and Save Lives 

Asymptomatic patients may shed virus for longer than others  

School Children Don’t Spread Coronavirus  

Summer sun can kill coronavirus in 34 minutes  

BLM protests have not led to a spike in coronavirus cases  

F. Vaccines

Coronavirus vaccine may be stronger through nasal spray 

G. Concerns & Unknowns

U.S. Preps for ‘Tremendous Burden’ of Flu, Covid Hit at Once  

H. Lockdowns

‘World Went Mad’ With Lockdowns  

I. Back to School!? 

What Are the Ivy League’s Plans for the Fall?

Reopening Schools:  What We Can Learn From Child Care Centers That Stayed Open During Lockdowns  

It’s Ridiculous to Treat Schools Like Covid Hot Zones  

J. Projections & Our (Possible) Future

‘A new and dangerous phase’: WHO issues a dire warning as cases grow in 81 countries  

K. Pandemic Economy

IMF says global economic collapse will be worse than feared  

L. Johns Hopkins C19 Update M. Links to Other Interesting Stories

A. The Pandemic As Seen Through Headlines

(In no particular order)

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. 

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

1. Cases & Tests

Worldwide Cases:  
  • Total Cases = 9,520,199 (+1.9%)
  • New Cases = 174,630 (+9,805)
  • Growth Rate of New Cases (7 day average) = 2.7% (+1.6%)
  • New Cases (7 day average) = 155,763 (+4,074)
Observations:
  • Although fluctuating from day to day, new cases have generally been rising since the beginning of the pandemic
  • More than one million cases are now being reported each week
  • New cases on 6/23 was second highest number of reported cases
US Cases & Testing: 
  • Total Cases = 2,463,271 (+1.6%)
  • New Cases = 39,103 (+3,088)
  • Percentage of New Global Cases = 22.4% (+0.2%)
  • Growth Rate of New Cases (7 day average) = 5.5% (+2.3%) 
  • New Cases (7 day average) = 32,506 (+1,839)
  • Total Number of Tests = 30,059,864 (+523,341)
  • Percentage of positive tests (7 day average) = 6.0% (+0.4%)
Observations:
  • Second highest number of new cases reported on 6/24 
  • The 7 day average of new cases have been increasing steadily since 6/9 
  • The 7 day average of new cases has increased from 21,265 on 6/9 to 32,404 on 6/24, an increase of 52.4% (the highest 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 6.0% over the last 7 days, an increase of 30.4% in one week, which indicates that the virus is spreading at a rapidly increasing rate.  
  • Daily testing now exceeding 500,000

2. Deaths

Worldwide Deaths: 
  • Total Deaths = 483,959 (+1.1%) 
  • New Deaths = 5,010 (-457)
  • Growth Rate of New Deaths (7 day average) = -0.8% (-0.3%) 
  • New Deaths (7 day average) = 4,619 (-37)
Observations:
  • The number of new deaths has been fluctuating between 3,000 and 6,800 since April 26
  • The 7 day average of new deaths declined from 6,989 on 4/18 to 4,709 on 5/16, a decrease of 67.4%
  • The 7 day average for new deaths increased from 4,079 on 5/26 to 4,267 on 6/24, an increase of 4.6%
  • The 7 day average of new deaths on 6/24 is 41.7% less than peak on 4/18.  During the same period of time, the 7 day average of new cases increased from 77,998 to 155,468, an increase of 99.3%  
US Deaths: 
  • Total Deaths = 124,281 (+0.7%)
  • New Deaths = 808 (-55) 
  • Percentage of Global New Deaths = 9.4% (+1.4%)
  • Growth Rate of New Deaths (7 day average) = +0% (+1.3%)
  • New Deaths (7 day average) = 620 (+0)
Observations:
  • New deaths have spiked during the last 2 days, with the 3 day average increasing from 401 to 678, up 69%.  It is too early to determine whether the increase is normal variance or arising from the increase in cases since 6/9
  • Despite the recent spike, 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 620 on 6/24, a decrease of 72%)
  • Although the number of 7 day average of new cases has increased by 37.2% since 6/9, the number of new deaths have decreased by 26%.

3. Growth of Worldwide Cases   

C. Emerging US Hotspots

1. Positive Test Rates in Hotspots

  • Since May 3, a total of 17 states have shown an increase in positivity rates
  • 6 States have positive test rates in excess of 10%: Alabama, Arizona, Florida, South Carolina, Texas and Utah 
  • Significant increases in positive test rates indicate the virus spread is accelerating 
Chart

2. Alarming spike in coronavirus sparks fears California is ‘starting to lose this battle’  

  • Coronavirus cases in California continued a troubling spike this week, but it remains unclear how much worse conditions must get before officials move to slow the rapid reopening of the economy.
  • For the second consecutive day, California shattered a daily record for new cases Tuesday. More than 6,600 infections were reported — the largest single-day count in the state since the pandemic hit the U.S.
  • Hospitalizations from C19 are also beginning to rise in some parts of the state, another troubling sign. Officials in Silicon Valley warned that progress against the coronavirus was eroding. Santa Clara County on Tuesday recorded its largest daily total of new cases — 121 — much worse than any single day in March or April.
  • “Now, we’re going back up at a pattern similar to the rest of the state,” said Santa Clara County Executive Dr. Jeffrey Smith. “We’re at our highest peak at this point.”
  • Dr. Sara Cody, the health officer for Santa Clara County, said the increase in cases was worrisome.
  • “This increase may be accelerating,” Cody said. “This increase reflects both widespread testing — we’re finding more of the cases that do exist — but it also reflects an increase in cases because the virus continues to spread. It’s a bit early to tell if this will translate to a significant increase in hospitalizations and deaths going forward.”
  • In Ventura County, there was an average of 85 people hospitalized daily with confirmed or suspected coronavirus infections last week, a 67% increase from six weeks ago.
  • “We’re showing the first signs of starting to lose this battle against C19 in our county,” Dr. Robert Levin, the Ventura County health officer, told the Board of Supervisors. There are increased cases statewide as well. “It worries me. And it should worry you,” he said.
  • In Los Angeles County, officials Tuesday reported more than 2,000 new cases for the fourth time in the last week, bringing the infection total to more than 88,500. Officials also reported 34 additional deaths, increasing the toll to 3,171 — the bulk of the state’s total.
  • In San Diego County, officials reported more than 300 new cases on Monday for the second day in a row after breaking a record with more than 310 cases Sunday. An additional 198 cases were reported Tuesday.
  • The case count is only one metric in tracking the spread of the virus. Although increased testing capacity may account for part of the increase, officials have said the surge cannot be pegged to greater testing alone.
  • Officials have repeatedly warned that they expect transmission rates to increase as more businesses reopen and people resume normal activities after months-long stay-at-home orders.
  • L.A. County Public Health Director Barbara Ferrer has said that although it is impossible to track the origin of spread in a public setting, it is “highly likely” that the overall increase is related to mass protests that erupted over the death of George Floyd, as well as clusters of social gatherings at restaurants and private parties.
  • Across the state, the positivity rate among those tested for coronavirus over the previous 14 days increased from 4.5% to 4.8% in the last week, and the number of hospitalizations of patients with confirmed infections jumped by 16% over the past two weeks.
  • In L.A. County, the daily positivity rate over a seven-day average jumped to 8.8%. Officials reported Tuesday there were 1,515 people hospitalized with confirmed coronavirus infections, 27% of them in intensive care. Although that number is a far cry from the highs of 1,900 patients in April, it is higher than the daily hospitalization counts of 1,350 to 1,450 in the past few weeks.
  • Despite the uptick in cases, more cities and counties are continuing to expand their reopening plans.
  • In San Francisco, Mayor London Breed and Health Director Dr. Grant Colfax announced this week that the city would move up its next phase of reopening from mid-July to June 29. Hair and nail salons, barbershops, museums, zoos, tattoo parlors, massage establishments and outdoor bars will be able to reopen, provided they follow safety protocols.
  • “Thanks to San Franciscans’ efforts to follow health requirements, wear face coverings and practice social distancing, our C19 health indicators are in a good place, and we can continue reopening our city,” Breed said. “We know a lot of businesses and residents are struggling financially, and this next step will help get more San Franciscans back to work while still balancing safety.”
  • Gov. Gavin Newsom said state health officials were keeping a close eye on the numbers. He added that he felt confident the state would be able to respond to the virus in the weeks and months ahead.
  • “We’ve always walked into this with our eyes wide open. We’ve always prepared for a surge,” he said. “I feel like we anticipated the likelihood as we’ve reopened, of the numbers increasing, and they have.”

Source: Alarming California coronavirus spike sparks new fears 

D. Risk of Airborne Transmission

1. Airborne Coronavirus may be more infectious than previously thought 

Abstract
  • We aerosolized severe acute respiratory syndrome coronavirus 2 and determined that its dynamic aerosol efficiency surpassed those of severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome. 
  • Although we performed experiment only once across several laboratories, our findings suggest retained infectivity and virion integrity for up to 16 hours in respirable-sized aerosols.
Conclusions:
  • The comparison of short-term aerosol efficiencies of 3 coronaviruses showed SARS-CoV-2 approximates or exceeds the efficiency estimates of SARS-CoV and MERS-CoV. Some efficiency determinations for SARS-CoV-2 ranged to −5.5log10, a full log difference from MERS-CoV. The higher efficiencies across independent laboratories strengthens this observation. 
  • These data suggest that SARS-CoV-2 generally maintains infectivity at a respirable particle size over short distances, in contrast to either betacoronavirus. 
  • Aerosol suspension results suggest that SARS-CoV-2 persists longer than would be expected when generated as this size particle (2-µm mass median aerodynamic diameter). 
  • This finding is notable because decay and loss in the infectious fraction of airborne virus would be expected on the basis of prior susceptibility studies with other environmentally hardy viruses, such as monkeypox virus. A recent study showing only a slight reduction of infectivity in aerosol suspensions with approximately similar particle sizes also suggested minimal effects on SARS-CoV-2 airborne degradation.
  • Collectively, these preliminary data suggest that SARS-CoV-2 is resilient in aerosol form and agree with conclusions reached in earlier studies of aerosol fitness. 
  • Aerosol transmission of SARS-CoV-2 may be a more important exposure transmission pathway than previously considered. 
  • Our approach of quantitative measurement of infectivity of viral airborne efficiency augmented by assessment of virion morphology suggests that SARS-CoV-2 may be viable as an airborne pathogen. 
  • Humans produce aerosols continuously through normal respiration. Aerosol production increases during respiratory illnesses and during louder-than-normal oration. A fraction of naturally generated aerosols falls within the size distribution used in our experimental studies (<5 μm), which leads us to conclude that SARS-CoV-2–infected persons may produce viral bioaerosols that remain infectious for long periods after production through human shedding and airborne transport. 
  • Accordingly, our study results provide a preliminary basis for broader recognition of the unique aerobiology of SARS-CoV-2, which might lead to tractable solutions and prevention interventions.

Source:  Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions (the full study may be found at this address)

2. Air Conditioning and the Transmission of C19  

  • As summer heats up, many people are blasting the air conditioning units that fill their homes. Meanwhile, recently reopened restaurants, buildings, and offices are weighing how to cool public spaces without heightening the risk of C19 transmission.
  • As people search for the safest way to cool off, experts say air conditioning systems and ventilation play a pivotal role in how people contract and spread C19.
  • Air conditioning systems partially filter coronavirus-containing viral particles, alter airflow patterns, and often, recirculate indoor air — all shifts that can influence C19 transmission.
  • A.C. also increases ventilation within a stagnant room or building, which can disperse coronavirus-containing viral droplets, and lower the chance of infection.
  • Based on current evidence, concern about C19 and air conditioning hinges on the airflow patterns, not the air itself, Qingyan Chen tells Inverse. Chen is a mechanical engineer at Purdue University who studies how airflow influences viral transmission.
  • “The virus is not brought in by the air conditioning system, but the system will enhance recirculation in the room,” Chen explains. Recirculating indoor air can cause problems transmission-wise, by exposing people to viral particles.
  • If you have the choice between firing up the A.C. or opening a window, choose the latter, Chen says.
  • “Just open a window because natural ventilation is much more effective than air conditioning systems,” he advises.
  • BREATHE IN, BREATHE OUT — When people sneeze, speak, or cough, they’re also spewing hundreds — even thousands — of droplets into their immediate vicinity. C19 mainly spreads through these respiratory droplets, the Centers for Disease Control explains, primarily through close contact with infected individuals and sometimes, contaminated surfaces. Masks help cut off the source and spread of C19 by providing a physical block between people and these viral particles.
  • Emerging evidence suggests that while many coronavirus-containing viral droplets drop to the ground or dissolve quickly, some can spread by air. Studies show small droplets can become airborne and linger for longer than 8 minutes in stagnant air. In some cases, small droplets can stick around for hours.
  • Air conditioning and ventilation methods can influence C19’s aerodynamics — altering how and where viral droplets spread through an area.
How does air conditioning work?
  • Air conditioning systems function by filtering, cooling, and circulating air (often a mixture of outdoor and indoor air) through a complicated chemical and mechanical process.
  • “Almost all air conditioning systems use filters,” Chen says. “However, lots of filters are not high-efficiency filters.”
  • Typical air conditioning systems filter 20-30 percent of viral droplets (mainly large particles) that could infect people with C19, Chen adds.
  • It’s unlikely that buildings with central air conditioning systems, like commercial office buildings, would spread C19 droplets from one space to another and infect office workers. But it is possible.
  • Even low doses of C19 exposure over a long duration, like a typical eight-hour workday, could make someone sick, Chen says. If possible, people should work remotely as long as C19 is with us or until there is an effective treatment, Chen says.
  • “When we talk about going back to office buildings in the future, you will stay there at least eight hours per day. And then there will be risks,” Chen says. Jane Khomi
  • To keep people healthy and limit spread, scientists, including Chen, advise maximizing ventilation and minimizing the recirculation of indoor air.
  • In public spaces, cooling systems should be set to maximum airflow, Chen says, which can dilute viral particles and maximize filtration rates. If financially feasible, Chen suggests replacing low-efficiency filters with HEPA filters, like the ones used on airplanes and in hospitals.
  • “Changing to 100 percent outside air is much more important than anything else,” Chen says. “That will ensure the air sent into different spaces is very clean.”
  • Luckily, making this change is often as easy as flipping a switch, he adds. Most air conditioning units are designed with this feature in mind, although it may take more energy to rely on outdoor air than recirculated air.
  • “It will cost a little bit more energy, but you can easily calculate the trade-off between energy saving and health risk,” Chen says. “During the pandemic season, we should take health more importantly than saving a couple of dollars in energy.”
  • On especially hot days, air conditioning units may have trouble cooling off spaces with outside air alone, than with recirculated air. But Chen adds that it’s worth it to put up with temperature swings — at least for now, as we wait for an effective C19 vaccine and widely accessible treatment.
  • It’s even easier to open a window. Natural ventilation keeps air cleaner than air conditioning systems.
What does the research say about air conditioning and C19?
  • A research letter published by the Centers for Disease Control suggests air conditioning systems can shape the direction of airflow, and potentially heighten C19 transmission. In the letter, researchers describe how strong airflow from air conditioners propelled viral droplets table-to-table in a restaurant in Guangzhou, China, fueling an outbreak of 10 people. To prevent the spread of the virus in restaurants, the letter’s authors recommend increasing the distance between tables and improving ventilation.
  • Another study, which analyzed the level of aerosol coronavirus present in two hospitals in Wuhan China, found that levels of airborne SARS-CoV-2 RNA (C19 viral particles) in most public areas was undetectable, except in two areas that were prone to crowding. Levels were higher in the toilet areas used by patients. Based on the findings, the team concludes room ventilation, open space, and disinfection of toilet areas can help contain C19’s aerosol spread.
  • To date, large scale aerosol studies haven’t been conducted, so the full scope and scale of airborne C19 isn’t clear yet.
What’s Next? 
  • At this point in the pandemic, some researchers say existing evidence is “sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors.”
  • Engineer controls, on top of social distancing, isolation measures, and hand hygiene, would be important measures globally to manage C19, the researchers add.
  • This means building managers and business owners should ensure sufficient and effective ventilation. They should also consider employing particle filtration and air disinfection, as well as avoid air recirculation and overcrowding, the team writes. These controls are crucial for places like hospitals, offices, schools, libraries, cruise ships, public transport, and restaurants.
  • “We don’t know how long C19 will last,” Chen says. “So if we don’t have a vaccine and then, C19 will be with us for a few years, I recommend that we should change air conditioning systems in such a way that we do not try to mix air in indoor spaces.”

Source: Air conditioning and Covid-19: The scientific factors you should know 

E. New Scientific Findings & Research

1. Herd immunity threshold could be much lower than originally thought  

  • Herd immunity to C19 could be achieved with less people being infected than previously estimated according to new research.
  • Mathematicians from the University of Nottingham and University of Stockholm devised a simple model categorizing people into groups reflecting age and social activity level. When differences in age and social activity are incorporated in the model, the herd immunity level reduces from 60% to 43%. The figure of 43% should be interpreted as an illustration rather than an exact value or even a best estimate. The research has been published today in Science.
  • Herd immunity happens when so many people in a community become immune to an infectious disease that it stops the disease from spreading. This happens by people contracting the disease and building up natural immunity and by people receiving a vaccine. When a large percentage of the population becomes immune to a disease, the spread of that disease slows down or stops and the chain of transmission is broken.
  • This research takes a new mathematical approach to estimating the herd immunity figure for a population to an infectious disease, such as the current C19 pandemic. The herd immunity level is defined as the fraction of the population that must become immune for disease spreading to decline and stop when all preventive measures, such as social distancing, are lifted. For C19 it is often stated that this is around 60%, a figure derived from the fraction of the population that must be vaccinated (in advance of an epidemic) to prevent a large outbreak.
  • The figure of 60% assumes that each individual in the population is equally likely to be vaccinated, and hence immune. However, that is not the case if immunity arises as a result of disease spreading in a population consisting of people with many different behaviors.
  • Professor Frank Ball from the University of Nottingham participated in the research and explains: “By taking this new mathematical approach to estimating the level for herd immunity to be achieved we found it could potentially be reduced to 43% and that this reduction is mainly due to activity level rather than age structure. 
  • The more socially active individuals are then the more likely they are to get infected than less socially active ones, and they are also more likely to infect people if they become infected. Consequently, the herd immunity level is lower when immunity is caused by disease spreading than when immunity comes from vaccination.
  • Our findings have potential consequences for the current C19 pandemic and the release of lockdown and suggests that individual variation (e.g. in activity level) is an important feature to include in models that guide policy.”

Source: Herd immunity threshold could be lower according to new study

2. Early Stage Antiviral Could Reduce Transmission of C19 and Save Lives 

  • A new study from researchers at The University of Texas at Austin has found that some antivirals are useful for more than helping sick people get better — they also can prevent thousands of deaths and hundreds of thousands of virus cases if used in the early stages of infection.
  • The study, published this month in the journal Nature Communications, focused on influenza and has implications for the coronavirus that causes C19. By modeling the impact of a pair of leading flu drugs, the team found significant differences in effects between oseltamivir, an older antiviral treatment for flu that patients know by the name Tamiflu, and a newer one, baloxavir, which is sold under the brand name Xofluza.
  • The researchers found that the newer treatment — by effectively and rapidly stopping virus replication — dramatically reduced the length of time that an infected person is contagious and, therefore, better limited the spread of flu.
  • “We found that treating even 10% of infected patients with baloxavir shortly after the onset of their symptoms can indirectly prevent millions of infections and save thousands of lives during a typical influenza season,” said Robert Krug, a professor emeritus of molecular biosciences, writing for a blog that accompanied the paper.
  • Early basic research discoveries by Krug informed the development of baloxavir.
  • Krug and a team of epidemiological modelers headed by Lauren Ancel Meyers, a professor of integrative biology, concluded from the study that having a similarly effective antiviral treatment for the coronavirus would help to prevent thousands of infections and deaths. Creating such an antiviral would take time and new strategies in public health planning, but the benefits for patients, communities and health care settings could be profound.
  • “Imagine a drug that quashes viral load within a day and thus radically shortens the contagious period,” said Meyers, who models the spread of viruses including the virus that causes C19. “Basically, we could isolate C19 cases pharmaceutically rather than physically and disrupt chains of transmission.”
  • To date, most C19 drug research efforts have prioritized existing antivirals that can be deployed quickly to treat the most seriously ill patients coping with life-threatening symptoms. The scientists acknowledge it would represent a shift to develop a new antiviral for the coronavirus, to be used early in an infection with the aim of curtailing viral replication, just as baloxavir does for flu.
  • “It may seem counterintuitive to focus on treatments, not for the critically ill patient in need of a life-saving intervention, but rather for the seemingly healthy patient shortly after a C19 positive test,” Krug said. “Nonetheless, our analysis shows that the right early-stage antiviral treatment can block transmission to others and, in the long run, may well save more lives.”

Source: COVID-19 Drug Development Could Benefit From Approach Used Against Flu

3. Asymptomatic patients may shed virus for longer than others  

  • Asymptomatic coronavirus patients could shed the virus for longer than those with symptoms, according to a new study in southwest China.
  • “The emergence of these silent spreaders … has caused difficulties in the control of the epidemic,” the researchers led by Huang Ailong, from Chongqing Medical University, wrote in a peer-reviewed paper in Nature Medicine on Thursday.
  • Huang’s team found that the median duration of viral shedding among the 37 asymptomatic patients in the Chongqing study was 19 days – a third longer than the patients with mild symptoms.
  • In one case, an asymptomatic patient shed the virus for 45 days.
  • Viral shedding refers to its release in the environment – including in the air and on surfaces. But Huang said it did not necessarily lead to infection of others, and that more research was needed to find out if the coronavirus could replicate in human cells.
  • The study also found that asymptomatic patients had lower antibody levels than those with symptoms. All of the patients had antibodies, which are generated by the immune system to stop the virus from infecting cells. But the asymptomatic patients had them at just 15 per cent of the level found in those with symptoms.
  • Several recent studies have suggested patients might not be able to build up long-term immunity against the virus, and some have been found to lose antibodies after they recover.
  • But this appeared to happen much faster in asymptomatic patients, according to Huang’s study. It found that more than 40 per cent of asymptomatic patients no longer had antibodies even before they were discharged from hospital.
  • “Asymptomatic individuals had a weaker immune response,” the researchers said.
  • Their findings “indicate the risks of using C19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups, and widespread testing”, they added.
  • In the Chongqing study, asymptomatic patients comprised more than 20 per cent of the 180 patients, who were all from the Wanzhou district. Those patients did not show any sign of illness from the time they tested positive to the time they were cleared of the disease.
  • But the study authors noted that the proportion of asymptomatic carriers might not be accurate due to the small sample size, saying the actual figure “might be even higher”.
  • A challenge of research on asymptomatic transmission is that some patients could be pre-symptomatic – meaning they are infected and do not have symptoms but go on to develop them later. These patients could have an exceptionally long incubation period, and some could be highly infectious days before the onset of symptoms, according to some studies.
  • Monica Gandhi, a professor of medicine with the University of California, San Francisco, said existing systems to control the spread of infectious disease relied heavily on symptoms, and many countries only tested patients who reported being ill.
  • “Asymptomatic transmission of the coronvirus is the Achilles’ heel of C19 pandemic control,” Gandhi said, using the clinical name for the new coronavirus, in an editorial published in the New England Journal of Medicine in May.
  • Some researchers suspect there could be a huge number of asymptomatic patients. On an Antarctic cruise ship in March, more than 80 per cent of those infected had no symptoms, according to a study by a team from Macquarie University in Sydney.
  • Meanwhile, the United States has seen a recent uptick of cases, and Florida health authorities on Sunday linked a spike in infections in the state to asymptomatic patients.
  • It is still not certain whether asymptomatic patients can infect others – the World Health Organisation said early this month that it remained “a big open question”.

Source: Asymptomatic patients may shed virus for longer than others, study says

4. School Children Don’t Spread Coronavirus  

  • School kids don’t appear to transmit the new coronavirus to peers or teachers, a French study found, weighing in on the crucial topic of children’s role in propagating C19.
  • Scientists at Institut Pasteur studied 1,340 people in Crepy-en-Valois, a town northeast of Paris that suffered an outbreak in February and March, including 510 students from six primary schools. They found three probable cases among kids that didn’t lead to more infections among other pupils or teachers.
  • The study confirms that children appear to show fewer telltale symptoms than adults and be less contagious, providing a justification for school reopenings in countries from Denmark to Switzerland. The researchers found that 61% of the parents of infected kids had the coronavirus, compared with about 7% of parents of healthy ones, suggesting it was the parents who had infected their offspring rather than the other way around.
  • Understanding the pandemic and the new virus’s transmission patterns is key to determining which parts of society can reopen — or should be shuttered again in the event of a resurgence — and mitigate the outbreak’s impact on the economy. The data on kids has been contradictory so far, with some reports corroborating the Pasteur findings and at least one pointing the other way.
  • Epidemiologist Arnaud Fontanet and colleagues said more studies on schools were needed because of the small number of cases they were able to study. They found that an estimated 41% of the children infected showed no symptoms, compared with about 10% of adults.

Source: School Children Don’t Spread Coronavirus, French Study Shows

5. Summer sun can kill coronavirus in 34 minutes  

  • The strong summer sun is capable of wiping out 90% or more of coronavirus living on surfaces in just 34 minutes, a new study has found.
  • Scientists suggest that “midday sunlight in most US and world cities during summer” is extremely effective in inactivating the virus that causes C19 when it’s been coughed or sneezed onto a surface, according to the study published earlier this month.
  • It found the virus is most infectious from December until March — when it can live on surfaces for up to a day or more “with risk of re-aerosolization and transmission in most of these cities.”
  • The study, which appeared in the journal Photochemistry and Photobiology, was authored by Jose-Luis Sagripanti and David Lytle — scientists who are retired from the US Army and FDA, respectively.
  • The pair examined how well UVB in sunlight was in destroying the virus in various cities across the globe during different times of the year. They used a model that’s previously estimated solar inactivation of viruses like Ebola and Lassa.
  • The study also suggests that the mandatory stay-at-home orders issued in hopes of stopping the spread of coronavirus may have been more harmful than good.
  • “In contrast, healthy people outdoors receiving sunlight could have been exposed to lower viral dose with more chances for mounting an efficient immune response,” the study said.
  • Past research has shown that during the Spanish flu outbreak of 1918-’19, patients who were exposed to fresh air and sunshine in “open-air hospitals” may have had a better chance at survival.
  • The study can be found at Estimated Inactivation of Coronaviruses by Solar Radiation With Special Reference to COVID-19 

Source: New study says summer sun can kill coronavirus in 34 minutes

6. BLM protests have not led to a spike in coronavirus cases  

  • Black Lives Matter protests haven’t seen coronavirus cases surge in cities since the massive demonstrations began, a study says.
  • The new research, which was published by the National Bureau of Economic Research, found no evidence that coronavirus cases jumped in 315 cities in the weeks following the first protests.
  • Researchers determined that protests may have been offset by an increase in social distancing among those who decided not to march.
  • Using cellphone data, the study determined that more people opted to stay home “perhaps due to fear of violence from police clashes or general unrest.”
  • “While it is almost certain that the protests caused a decrease in social distancing behavior among protest attendees, we demonstrate that the effect of the protests on the social distancing behavior of the entire population residing in counties with large urban protests was positive,” the report reads.
  • Researchers said they observed no jump in cases in the more than three weeks after the first protests, possibly due to a “net effect.”
  • “While it is possible that the protests caused an increase in the spread of C19 among those who attended the protests, we demonstrate that the protests had little effect on the spread of C19 for the entire population of the counties with protests during the more than three weeks following protest onset,” researchers said.
  • The full study can be found at here. 

Source: BLM protests have not led to a spike in coronavirus cases: study 

F. Vaccines

1. Coronavirus vaccine may be stronger through nasal spray 

  • As the global race to find a vaccine for the coronavirus heats up, British researchers say immunizations may be more effective if delivered through a nasal spray as opposed to an injection.
  • Scientists from Oxford University and Imperial College London — who are currently undergoing human trials of C19 vaccines administered through an injection — are planning to launch a second wave of studies looking into “mucosal immunization.”  
  • “At the moment most of the vaccines are being delivered by conventional intramuscular injection… The reason is that’s the easiest and fastest to get off the starting blocks and into studies. But a number of us [are] interested in looking at mucosal immunization, as well,” Professor Robin Shattock, an immunologist at Imperial, told the UK House of Commons Science and Technology Committee.
  • “And certainly [Oxford’s] Professor Gilbert and myself are already in discussion as to how we might be able to move that as a second wave of clinical study.”
  • Sarah Gilbert, a professor of vaccinology at Oxford, added vaccines delivered orally or nasally “would have much stronger mucosal response,” which is “probably really important in the protection against respiratory pathogens.”
  • However, Gilbert said it’s “very difficult to study and we’re not yet very good at measuring it.”
  • “But, as Professor Shattock said, we’re very interested in looking at delivery to the respiratory tract, either intranasal delivery [via a nasal spray] or aerosol delivery [using an inhaler],” Gilbert said, according to the Daily Mail.
  • “This takes the vaccine itself right down into the lungs where it can access the same tissue that would be reached by the virus infection.”
  • In addition, elderly people, who are most at risk from dying of C19, don’t respond to traditional vaccines as well as younger, healthier people do but could respond better with a mucosal immunization because it directly protects the lungs.
  • Currently, Oxford is leading the charge for a C19 cure and their vaccine is currently being tested on more than 10,000 people in Britain, Brazil and South Africa, the outlet reported.

Source: Coronavirus vaccine may be stronger through nasal spray 

G. Concerns & Unknowns

1. U.S. Preps for ‘Tremendous Burden’ of Flu, Covid Hit at Once  

  • U.S. health agencies are preparing for a flu season that will be complicated by the coronavirus pandemic, which they don’t expect to be mitigated by a vaccine anytime soon.
  • Covid activity is expected to “continue for some time” and “could place a tremendous burden” on an already stretched health-care system if coupled with the influenza season that comes each fall, top officials including Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, will tell House lawmakers on Tuesday, according to prepared testimony.
  • The testimony contrasts with recent rhetoric from President Donald Trump, who has pushed to move on from the virus despite almost 120,000 American deaths from C19 and large rises in cases in some states as they re-open. 
  • According to their written testimony, CDC Director Robert Redfield, Fauci and FDA Commissioner Stephen Hahn will tell Congress that the duration of the pandemic is unknown and that a vaccine that can be distributed widely isn’t imminent, despite Trump’s push for one by the end of the year.
  • “The rigorous clinical testing required to establish vaccine safety and efficacy means that it might take some time for a licensed coronavirus vaccine to be available to the general public,” according to prepared testimony by NIAID. “The C19 response currently is focused on the proven public health practices of containment and mitigation.”
  • Part of that mitigation is anticipating the burdens of handling 19 and influenza at the same time.
Dual Test
  • The CDC developed a test that can check for both viruses at the same time and requested emergency authorization from the FDA last week.
  • “This will save public health laboratories both time and resources, including testing materials that are in short supply,” the officials said.
  • “Current efforts are focused on further scaling up testing capabilities to guarantee that each state has the testing supplies and capabilities they need to reopen according to their own individual state plans,” according to the testimony.
  • The CDC gave $140 million earlier this month to 64 jurisdictions throughout the country to help states prepare for the flu season through an existing immunization agreement. The goal is to increase flu vaccinations for vulnerable populations and increase access for uninsured, high-risk people.

Source:  Sales of Previously Owned U.S. Homes Fall to Lowest Since 2010

H. Lockdowns

1. ‘World Went Mad’ With Lockdowns  

  • The man behind Sweden’s controversial C19 strategy has characterized lockdowns imposed across much of the globe as a form of “madness” that flies in the face of what is known about handling viral outbreaks.
  • Anders Tegnell, Sweden’s state epidemiologist, said he advised against such restrictions on movement because of the detrimental side effects they often entail.
  • “It was as if the world had gone mad, and everything we had discussed was forgotten,” Tegnell said in a podcast with Swedish Radio on Wednesday. “The cases became too many and the political pressure got too strong. And then Sweden stood there rather alone.”
  • Tegnell admits he misjudged the deadly potential of the coronavirus in its early stages, but has refused to consider abandoning his strategy. He says restricting movement to the radical extent seen across much of the globe can create other problems, including increased domestic abuse, loneliness and mass unemployment.
  • “In the same way that all drugs have side effects, measures against a pandemic also have negative effects,” he said. “At an authority like ours, which works with a broad spectrum of public health issues, it is natural to take these aspects into account.”
  • But Sweden now has one of the world’s highest C19 mortality rates, with more deaths per 100,000 than the U.S., according to Johns Hopkins University data. Polls suggest Swedes have started to lose faith in their country’s response to the pandemic.
  • Instead of shuttering schools, shops and restaurants, Sweden left pretty much everything open. Citizens were encouraged to observe social distancing guidelines, but the strategy assumed Swedes would voluntarily alter their behavior without the need for laws.
  • Tegnell also advised against using face masks, arguing there’s little scientific evidence they work. And he says it’s clear that closing down schools was an unnecessary response to the pandemic, a notion that’s actually supported in a recent French study.
  • Tegnell’s underlying argument is that C19 isn’t going away any time soon, meaning sudden, severe lockdowns will ultimately prove ineffective in addressing the longer-term threat. Meanwhile, the virus has recently resurfaced in a number of places where authorities thought they’d brought it under control, including Beijing.
  • “I’m looking forward to a more serious evaluation of our work than has been made so far,” Tegnell said. “There is no way of knowing how this ends.”
  • Sweden’s parliament has agreed to have a commission probe the government’s response to the Covid crisis. The results of the investigation are due to be published in early 2022, before the next general election. Recent polls show that Prime Minister Stefan Lofven, who heads a minority center-left coalition, has seen his voter approval ratings slump amid concerns about the country’s Covid policy.

Source: Sweden’s Covid Expert Says ‘World Went Mad’ With Lockdowns

I. Back to School!?

1. What Are the Ivy League’s Plans for the Fall?

  • Although a work in progress, below are the current plans of Ivy League colleges for the return of students this summer and fall.
  • Notably, there is little information of the testing and other procedures that Ivy League colleges will offer or require for those returning to school
University NameTotal StudentsPlan for Fall ReturnPlan for Resuming ResearchOther
Brown University10,250Considering range of scenarios including splitting up student body among 3 semesters or entirely virtualSummer 20202020 commencement delayed to May 2021
Columbia University31,000Considering range of scenarios, primarily splitting up students among 3 semestersJune 2020
Cornell University23,600Decision expected June 30th following conclusion of reopening committee discussionsN/A
Dartmouth College6,500Decision expected in July, however considering completely remote semesterN/A
Harvard University31,500Announced June 9th planning for completely remote semesterN/A
Princeton University8,400No decision, although considering postponing courses until Spring 2021N/AActively spending 5% endowment annually and early signaling of financial issues
University of Pennsylvania25,900Evaluating several options including ending semester at Thanksgiving, or being completely remoteN/AAnnounced there will be widespread testing, but no indication of who will receive testing or how often testing will be done
Yale University13,400No decision on upcoming semesterJune 2020 including undergraduate research

2. Reopening Schools:  What We Can Learn From Child Care Centers That Stayed Open During Lockdowns  

  • Throughout the pandemic, many child care centers have stayed open for the children of front-line workers — everyone from doctors to grocery store clerks. YMCA of the USA and New York City’s Department of Education have been caring for, collectively, tens of thousands of children since March, and both tell NPR they have no reports of coronavirus clusters or outbreaks. As school districts sweat over reopening plans, and with just over half of parents telling pollsters they’re comfortable with in-person school this fall, public health and policy experts say education leaders should be discussing and drawing on these real-world child care experiences.
  • The Y says that during the lockdowns it cared for up to 40,000 children between the ages of 1 and 14 at 1,100 separate sites, often in partnership with local and state governments. And NYC’s Department of Education reports that it cared for more than 10,000 children at 170 sites.
  • Working in early days, and on very short notice, these two organizations followed safety guidance that closely resembles what’s now been officially put out by the CDC. The Y says a few staff members and parents at sites around the country did test positive, but there are no records of having more than one case at a site. This, among a population of essential workers.
  • In a separate, unscientific survey of child care centers, Brown University economist Emily Oster found that, as of Tuesday afternoon, among 916 centers serving more than 20,000 children, just over 1% of staff and 0.16% of children were confirmed infected with the coronavirus.
  • The Y emphasized to NPR that its data is not comprehensive, and the availability of testing has varied across the country. But experts say it’s worth taking these low numbers into account.
  • “There are almost no recorded cases of child-to-adult transmission of C19,” says Elliot Haspel, an education policy expert and child care advocate who wrote an op-ed arguing for reopening full-time child care and schools as soon as possible. “It’s not zero risk, [but] we’re acting with a March 2020 understanding of C19 and kids, and not with a June 2020 understanding of C19 and kids.”
Pods and “airplane arms”
  • In March, the CDC had yet to issue its official guidance about how to safely operate schools or group child care. And yet, the protocols that the Y and New York City came up with were strikingly similar to the CDC’s May recommendations, as well as guidelines now being considered by states and districts.
  • In order to slow the spread of illness, local YMCAs and New York City grouped “pods” of no more than 9 children with each adult. Heidi Brasher of the YMCA of the USA says this often meant using spaces such as basketball courts or even boardrooms, taking advantage of buildings that were otherwise closed. “They were very creative in the way they utilized space,” Brasher says.
  • Pods didn’t mix, but social distancing and use of masks weren’t necessarily observed within each pod, especially with very young children — the Y cares for children as young as 1 year old.
  • Brasher says her organization consulted with the CDC to create a “quick start” guide for each location around the country to get up and running with emergency child care, going over everything from morning check-in procedures to food prep. 
  • They did temperature checks and symptom screenings on each child coming in each day, with staff members wearing masks, gloves and gowns where available. Children with symptoms were urged to stay home.
  • Staff came up with creative ways to reinforce frequent and thorough hand-washing. Libby Corral is chief operating officer of the Valley of the Sun YMCA, which operated nine emergency child care sites across Arizona (this month they expanded to regular camp programming). She says that at the beginning of each 30-minute activity, such as sports or craft time, children get a stamp or marker doodle on their hands, which they have to wash off before moving on to the next activity.
  • “We were teaching them not just ‘rinse your hands,’ but ‘scrub them.’ And instead of having to dread washing their hands, they were able to get excited and laugh and have fun while they were doing that.”
  • They also reinforce social distancing by having the kids make “airplane arms” when they’re standing in line or moving from place to place. And children get their own materials, such as art supplies, to use from day to day, rather than sharing. Having individual materials worked so well, says Corral, that they plan to make it a policy in the future.
  • Of course, running things this way is expensive. Even after emergency state aid, her YMCA locations ran at a deficit, Corral says.
  • In New York, which is still operating its city-run child care centers, the rules are similar, and in some ways stricter. Face coverings are mandatory for all, whereas children at YMCA sites aren’t required to wear them. Social distancing is maintained as much as possible by everyone inside the building, reinforced with 6-foot-long posters of animals like sea turtles. And daily temperature checks of everyone coming in the building are done by school nurses, according to New York City Department of Education spokeswoman Katie O’Hanlon.
  • Officials with both organizations say they don’t know of any clusters of cases associated with a site. Corral, in Arizona, says she knows of one case in which a staff member, who didn’t work directly with children, tested positive, and another case in which a parent called in and volunteered to self-quarantine after an exposure.
  • Laimit, the nurse in Phoenix, credits the Valley of the Sun YMCA with “really great communication,” both about health practices and her daughter’s social and emotional needs.
  • “It takes a weight off of me as a parent, because when I’m at work, especially providing care for others — and it’s absolutely chaotic right now, Arizona is on the rise with their C19 cases — not having to worry about my daughter and her safety … it’s a savior for me. It’s a weight off of my shoulders.”
“There are ways to substantially reduce the risks”
  • Should parents across the country stop worrying about sending their kids off to camp and school, as long as a version of these guidelines is followed?
  • Dr. Joshua Sharfstein at the Johns Hopkins School of Public Health says we can learn from the YMCA and New York City examples, but we shouldn’t overgeneralize.
  • “These experiences illustrate that it’s possible to bring kids together without a guarantee of an outbreak or a serious situation developing,” he explains. On the other hand, they don’t guarantee the opposite.
  • Sharfstein agrees it’s OK to extrapolate — not only from essential worker child care in the U.S., but from the experiences of countries around the world where schools have already opened up. “There are ways to substantially reduce the risks when kids get together,” he says.
  • He also agrees with Haspel, the child care advocate, in saying that “there is converging evidence that the coronavirus doesn’t transmit among children like the flu — that it’s a lower risk.”
  • There are two related reasons for this, Sharfstein explains: One is that children seem to be less likely to get infected, and the second is that when they are infected they are much more likely to be mildly symptomatic or asymptomatic. If they’re not coughing or sneezing, it’s harder for them to spread the virus to others. The New Yorker reported that Iceland, which did extensive contact tracing, found only two examples of child-to-parent transmission.
A question of priorities
  • Sharfstein says there are still some really important things we don’t know — and that we’d like to know — as group child care and schools start to open up. He cites a May report from the Johns Hopkins Center for Health Security. It calls for a national research agenda to quickly address the outstanding questions about children and the coronavirus. Among them, says the report:
    • “How vulnerable to severe illness are students who have underlying health conditions, such as asthma, diabetes, or severe obesity? 
    • How safe is it for adults who themselves have serious underlying health conditions? 
    • How safe is it for teachers, administrators, and other school staff?  
    • Are certain school communities at greater risk than others relative to exposure, and should each school community be evaluated independently to determine level of risk?”
  • And then there’s the question of priorities. Among all the steps organizations are taking — hand-washing, masks, temperature checks, pods, social distancing, and guidelines about staying home if sick — which are the most important?
  • And crucially, how important is group size? The recommendation to keep groups of children small and separate imposes a particular burden on school districts. In most places, reducing class sizes means reducing in-person class time, staggering schedules and continuing remote learning in parallel with in-class instruction. That requires resources that not all students and schools have access to.
  • Right now, Sharfstein says, we just don’t know how important it is to limit group size. “I think it’s a failure that we haven’t prioritized opening schools.”
  • Prioritizing schools, he adds, means doing lots of research on children and the coronavirus as soon as possible to inform the right policies to put in place.

Source: What Schools Can Learn From Child Care Coronavirus Safety Plans

3. It’s Ridiculous to Treat Schools Like Covid Hot Zones  

  • ON MAY 18, education ministers from the EU gathered on a conference call to discuss the reopening of schools. Children had been back to class for several weeks in 22 European countries, and there were no signs yet of a significant increase in C19 infections. It was early still, but this was good news. More than a month later, the overall mortality rate in Europe has continued to decline. Now, as we look to the fall, the US belatedly appears keen to follow Europe’s lead.
  • The question of how US schools should be reopened—on what sort of schedule, with what degree of caution—has yet to be determined. But recent guidance from the US Centers for Disease Control and Prevention, released May 16, conjures up a grim tableau of safety measures: children wearing masks throughout the day; students kept apart in class, their desks surrounded by 6-foot moats of empty space; shuttered cafeterias and decommissioned jungle gyms; canceled field trips; and attendance scattered into every other day or every other week. Reports suggest that certain US schools may even tag their kids with homing beacons, to help keep track of anyone who breaks the rules and gets too close to someone else. It seems that every measure, no matter how extreme, will be taken in an effort to keep the students and the staffers safe.
  • This could be a grave mistake. As children return to school this fall, we must take a careful, balanced view of all the safety measures that have been proposed and consider which are really prudent—and which might instead be punitive.
  • It’s certainly true that reopening our schools, however carefully, could increase transmission of the virus. Some countries that have done so—Israel and France, for instance—did see clusters of infections among students and staff. But these outbreaks were both small and expected, officials in both countries told the press; and the evidence suggests that the risks, overall, are very low.
  • Let’s review some facts: Children are, by and large, spared the effects of the virus. According to the latest data from the CDC, infants, little kids, and teenagers together have accounted for roughly 5 percent of all confirmed cases, and 0.06 percent of all reported deaths. The Covid-linked child inflammatory syndrome that received fervent media attention last month, while scary, has even more infinitesimal numbers. “Many serious childhood diseases are worse, both in possible outcomes and prevalence,” said Charles Schleien, chair of pediatrics at Northwell Health in New York. Russell Viner, president of the UK’s Royal College of Pediatrics and Child Health, noted that the syndrome was not “relevant” to any discussion related to schools.
  • There is also a wealth of evidence that children do not transmit the virus at the same rate as adults. While experts note that the precise transmission dynamics between children, or between children and adults, are “not well understood”—and indeed, some argue that the best evidence on this question is that “we do not have enough evidence”—many tend to think that the risk of contagion is diminished. Jonas F. Ludvigsson, a pediatrician and a professor of clinical epidemiology at Sweden’s Karolinska Institute, reviewed the relevant research literature as of May 11 and concluded that, while it’s “highly likely” children can transmit the virus causing C19, they “seldom cause outbreaks.” The World Health Organization’s chief scientist, Soumya Swaminathan, suggested last month that “it does seem from what we know now that children are less capable of spreading” the disease, and Kristine Macartney, director of Australia’s National Centre for Immunisation Research and Surveillance, noted a lack of evidence that school-aged children are superspreaders in her country. A study in Ireland found “no evidence of secondary transmission of C19 from children attending school.” And Kári Stefánsson, a leading researcher in Iceland, told The New Yorker that out of some 56,000 residents who have been tested, “there are only two examples where a child infected a parent. But there are lots of examples where parents infected children.” Similar conclusions were drawn in a study of families in the Netherlands.
  • None of this implies that C19 couldn’t still spread efficiently among a school’s adults—the teachers and staff. Under any reopening plan, those who are most vulnerable to the disease should be allowed to opt out of working onsite until there is a vaccine or effective treatment. And adults who are present, when around each other, should wear masks and maintain proper social distancing. Distancing among adults may be easier to implement in schools, where teachers tend to spend their days divvied up in different rooms, than it would be in some work environments that have already reopened, such as offices, factories, and stores.
  • A month ago, as schools were reopening in Europe, I made the case in WIRED that the US should consider doing the same. Asking when we should reopen, though, was somewhat easier than asking how. Lots of other countries are already in agreement on the first question, but it turns out there’s no consensus whatsoever on the second. Schools’ specific safety measures vary not only from one nation to another, but also, commonly, within each nation. In Taiwan and South Korea, among other countries, plastic barriers have been placed on students’ desks, creating Lilliputian cubicles. In France, some districts have children wearing both masks and plastic face shields; while others just use masks. In Germany, masks are suggested for common areas only. In Denmark and Sweden, masks for students are not required at all. Some countries are encouraging classes to be held outdoors. (Outdoor classwork is not mentioned in the CDC guidelines, though preliminary plans for some states and counties do list this as an option.)
  • Which of these measures are effective and appropriate? No one knows for sure. Still, it’s possible to flag the ones that seem least necessary. For instance, the French schools that employ the belt-and-suspenders approach of having students wear both face shields and masks, are doing so in direct contrast to a letter signed by the heads of 20 of the country’s pediatric associations, which states that wearing even just a mask—never mind the face shield—“is neither necessary, nor desirable, nor reasonable” in schools for children. Meanwhile, lower schools have been open in Sweden, without masks, for the entirety of the pandemic, and there has been little evidence of major outbreaks coming out of them.
  • Ludvigsson told me that the widespread use of masks in schools “cannot be motivated by a need to protect children, because there is really no such need.” He’s similarly unimpressed by efforts to implement plastic barriers, playground closures, or any other measure beyond common-sense distancing and hygiene. Such precautions to prevent the spread of the infection from children to adults make no sense, he said, “since children are very unlikely to drive the pandemic.” Another Karolinska Institute epidemiologist, Carina King, said there is currently “weak evidence on children transmitting to each other or adults within school settings,” and suggested the most appropriate safety measures for schools might include testing and contact tracing, improved ventilation, and keeping students with a single group of peers throughout each day.
  • A report released last week by a panel of experts affiliated with the Toronto Hospital for Sick Children in partnership with the Ontario Ministry of Education, recommends against masks in class, noting that it is “not practical for a child to wear a mask properly for the duration of the school day.” The report also advises that “strict physical distancing is not practical and could cause significant psychological harm,” since playing and socializing are “central to child development.” Instead, the report recommends the adoption of smaller class sizes, so long as this does not disrupt a school’s daily schedule.
  • Strangely, American policy officials have not said much about the potential infeasibility and associated costs of the most extreme measures on the table. It’s not a big deal for an adult to wear a mask in a store for 15 minutes. But it’s entirely different to ask a child to wear a cloth face covering, as the CDC recommends for US schools, over many hours every day. The guidelines helpfully suggest that children “should be frequently reminded not to touch the face covering.” Have these people ever been around a bunch of 7-year-olds?
  • One of the more ostensibly benign, but actually most consequential, measures is the spacing of desks 6 feet apart. As a practical matter, few US schools have the room to accommodate all their students being so spread out. This means many institutions will be all but required to operate at reduced capacity, with students spending up to half their time at home.
  • The alternating-days approach is euphemistically referred to as “blended learning.” Considering the dismal failure that “distance learning” has proven to be in much of the country this spring, it implies that students will be educated for only half the year. Kids affected by the spring’s school closures are already showing knowledge deficits—what’s being termed “the C19 slide”—and the learning gaps are disproportionately wider for lower-income students. Worse, perhaps, than being off for a block of time, is the intermittence that blended learning will oblige. Students need continuity in attendance to prosper, socio-emotionally and educationally. (This problem will only be exacerbated by inevitable closures as new cases are found. None of the experts I spoke with could give clear benchmarks for what prevalence of infection should trigger a closure.)
  • There also has been little acknowledgement or plan for how working parents are supposed to earn a living when their children are home for half of every school day, or every other school day, or every other week. “No credible scientist, learning expert, teacher, or parent believes that children aged 5 to 10 years can meaningfully engage in online learning without considerable parental involvement,” stated an editorial in JAMA Pediatrics. Nevertheless, the prospect of having children sit alone and stare at a computer screen instead of engaging with their teachers and peers is not only a certainty for many students in the US, it’s one that some officials—such as New York governor Andrew Cuomo—have characterized as educational progress. Last month, Cuomo wondered aloud at a press briefing why, with the power of technology, the “old model” of physical classrooms still persists at all.
  • Blended learning appears to have become accepted as a foregone conclusion for US schools, with little acknowledgement of how radical it is.
  • When students are actually in the schools, the overarching theme will be one of isolation: desks spaced apart and turned to face the same direction; closure of communal areas such as dining halls; staggered arrival and departure times to avoid any socializing before and after school; limited extracurricular activities; low-occupancy buses with one child per bench, seated in every other row. This deprivation of touch and physical proximity to others is unhealthy in the short term. Over a span of many months (and perhaps more than a year), one must imagine an existential toll on children when their physical experience with each other is that of repelling magnets.
  • In theory, many US schools could choose to avoid the most oppressive measures. The CDC itself presents a graded set of safety rules—some for “distancing,” others for “enhanced distancing”—that are meant to correspond to different levels of disease risk in the community. The phrases if possible and if feasible are peppered throughout the document, which also notes that “all decisions about following these recommendations should be made in collaboration with local health officials and other state and local authorities.”
  • But veering from the CDC’s or states’ advice would require a renegade spirit not likely to be found among those who’ve risen in such bureaucracies. While hedged language empowers localities to make choices on their own, an official guideline that suggests doing something “if possible” is like a mafioso asking a shopkeeper to do him “a favor.” I live in New York state, where guidelines for reopening have not yet been issued by the governor’s office. Yet the superintendent of my district’s schools has already sent an email to parents suggesting that we procure face shields for our children for the fall.
  • When much of the world reopened their schools this past spring, America neglected to follow. Now, the US seems eager to copy the most excessive measures implemented elsewhere, despite the evidence of minimal pediatric risk and infectiousness, and against the advice of many epidemiologists, infectious disease specialists, and pediatricians, and with a seeming obliviousness to their costs.
  • For years, many schools have had their drama and arts departments budgets reduced. It would be a sour irony if mandatory masks, half-vacant school buses, and shuttered jungle gyms ended up as our schools’ most grand theatrical production.

Source: It’s Ridiculous to Treat Schools Like Covid Hot Zones 

J. Projections & Our (Possible) Future

1. ‘A new and dangerous phase’: WHO issues a dire warning as cases grow in 81 countries  

  • The World Health Organization issued a dire warning on Friday that the coronavirus pandemic is accelerating, and noted that Thursday was a record day for new cases — more than 150,000 globally.
  • “The world is in a new and dangerous phase,” said Dr. Tedros Adhanom Ghebreyesus, the director general of the W.H.O. “Many people are understandably fed up with being at home. Countries are understandably eager to open up their societies and their economies. But the virus is still spreading fast. It is still deadly, and most people are still susceptible.”
  • If the outbreak was defined early on by a series of shifting epicenters — including Wuhan, China; Iran; northern Italy; Spain; and New York — it is now defined by its wide and expanding scope. According to a Times database, 81 nations have seen a growth in new cases over the past two weeks, while only 36 have seen declines.
  • Dr. Tedros said that almost half of the new cases reported on Thursday came from the Americas. Large numbers are also being reported from Africa, South Asia and the Middle East.
  • Dr. Tedros urged individuals to continue to maintain distance from others, to cover their noses and mouths with masks when appropriate and to wash their hands. He said nations must continue to find, isolate, test and care for every person infected with the virus, and to test and quarantine every contact. “We call on all countries to exercise extreme vigilance,” he said.
  • But risks are multiplying as nations begin to reopen their economies.
  • In India, which initially placed all 1.3 billion of its citizens under a lockdown — then moved to reopen even with its public health system near the breaking point — officials reported a record number of new cases Wednesday. And the virus is now spreading rapidly in nearby Pakistan and Bangladesh as well.
  • It took Africa nearly 100 days to reach 100,000 cases, the WHO has noted, but only 19 days to double that tally. South Africa now averages a thousand more new cases each day than it did two weeks ago.
  • And some countries where caseloads had appeared to taper — including Israel, Sweden and Costa Rica — are watching them rise again. Costa Rica’s health minister said Friday that the country was halting reopening its economy because of the increase in cases.

Source: ‘A new and dangerous phase’: WHO issues a dire warning as cases grow in 81 countries 

K. Pandemic Economy

1. IMF says global economic collapse will be worse than feared  

Emerging recovery likely to disappoint even if countries refuse to shut down during a resurgence of the coronavirus
  • The International Monetary Fund on Wednesday painted a bleak portrait of the global economy, saying the coronavirus pandemic has caused more widespread damage than expected and will be followed by a sluggish recovery.
  • The global economy will shrink this year by 4.9% percent, worse than the 3% percent decline predicted in April, the IMF said.
  • No major economy is escaping the pandemic. The U.S. economy, the world’s largest, is expected to shrink this year by 8%. Countries that use the single European currency are headed for a decline of more than 10% while Japanese output will fall by 5.8%, the IMF said.
  • The Chinese economy, suffering the twin ravages of the pandemic and the trade war with the United States, is projected to eke out just a 1% gain — its worst performance in several decades.
  • “Maybe we can say the world has bottomed out, for now, and we’re in a recovery phase,” said Gita Gopinath, the IMF’s chief economist. “But still, the strength of the recovery is highly uncertain because there is no solution yet to the health crisis.”
  • By the end of next year, the pandemic will have cost the global economy $12.5 trillion in lost output, she added.
  • Current conditions are considerably more dire than the “unprecedented decline in global activity” that the fund projected two months ago. Since mid-April, economic data suggest “even deeper downturns than previously projected,” the fund said.
  • Fund officials blamed the darker forecast on the effects of social distancing; scarring to global production capacity from the lockdown of activity; and the productivity cost of new safety and hygiene rules. Some economies also are still struggling to control the coronavirus, the fund added without naming specific governments.
  • The forecast assumes countries will not reimpose comprehensive lockdowns even if the pandemic flares up again.
  • Government crisis-fighting efforts — including $11 trillion in spending and tax cuts — have kept the economic collapse from worsening, the fund said.
  • “Today’s IMF report is a warning to the world about what will happen if policymakers take their foot off the gas,” said Josh Lipsky, former IMF senior adviser who is now with the Atlantic Council. “ … The uncertain spread of the virus, risk of rising trade tensions and debt vulnerabilities in emerging economies all lead to the same conclusion — we have not done enough.”
  • Along with backing continued central bank support for low interest rates, the IMF is calling for wealthy nations to grant substantial debt relief to the world’s poorest countries. Earlier this month, the fund approved its 70th request for emergency financial aid, a $148 million loan for Guinea.
  • The funds are intended to help Guinean officials pay for urgently needed medical programs to deal with a worsening local coronavirus outbreak.
  • The fund’s economic forecast is more downbeat than some major investment firms. Goldman Sachs, for example, earlier this month raised its U.S. forecast to -4.2% from -5.2%.
  • The fund also issued a warning to investors, who have been buoyed by a stock market recovery from the lows of late March.
  • “The extent of the recent rebound in financial market sentiment appears disconnected from shifts in underlying economic prospects,” the fund said.
  • If investors subsequently decide they have been overly optimistic, financial conditions could tighten and further hobble the recovery, the fund warned.
  • That is not the only question clouding the forecast. Uncertainty over the pandemic’s future course, including prospects for a vaccine, weigh on assessments of economic growth. A medical breakthrough could render obsolete forecasts of a decline.
  • “Downside risks, however, remain significant,” the fund cautioned.
  • Low-income countries also are likely to be especially hard hit, with inequality set to worsen, the fund said. Progress in recent years on reducing the share of the world’s population living in extreme poverty — less than $1.90 per day — could reverse amid the global economic hurricane.
  • Earlier this month, Kristalina Georgieva, the fund’s managing director, called the pandemic recession “a crisis like no other” and said that by the end of this year, an unprecedented 170 countries would see average individual incomes fall.

Source: IMF says global economic collapse caused by coronavirus will be even worse than feared

L. Johns Hopkins C19 Update

June 23, 2020

1. Cases & Trends

India, Pakistan & Bangladesh
  • India has reported a new record high daily incidence, nearly 16,000 new cases. India’s daily incidence has increased by 60% since June 11, and its epidemic continues to accelerate. India is currently #3 in terms of daily incidence. After a recent peak in daily incidence on June 13 (6,825 new cases), Pakistan has reported decreased daily incidence, with the exception of a spike on June 19. Pakistan’s daily incidence is down to 3,892 new cases, a 43% decrease from the peak and its lowest daily total since June 3. It appears that Pakistan may have passed its initial peak. Pakistan fell to #8 globally in terms of daily incidence. Since its recent peak on June 16 (4,008 new cases), Bangladesh’s daily incidence has held relatively consistent at 3,500 new cases per day. Notably, Bangladesh’s test positivity continues to hold steady at approximately 20%, which is considerably higher than the WHO’s 5% benchmark for relaxing social distancing measures. Bangladesh climbed to #9 globally in terms of daily incidence.
Central & South America
  • Brazil reported its second highest daily incidence to date, 39,436 new cases. This is second only to June 19, which was elevated due to reporting delays from the previous day. It appears that Brazil’s epidemic may be continuing to accelerate. Brazil is currently #2 globally, behind the United States, in terms of daily incidence. Broadly, the Central and South American regions are still major C19 hotspots. Including Brazil, the region represents 5 of the top 12 countries globally in terms of daily incidence—including Mexico (#5), Chile (#6), Peru (#11), and Colombia (#12)—and 5 of the top 13 in terms of per capita daily incidence—Chile (#4), Panama (#6), Brazil (#9), Peru (#10), and Bolivia (#13).
Eastern Mediterranean Region
  • Iran reported 2,531 new cases, holding relatively consistent with other recent reports. Since a second peak on June 5, Iran has reported approximately 2,300-2,500 new cases per day. Iran remains #13 globally in terms of daily incidence. Overall, the Eastern Mediterranean Region remains an emerging hotspot, representing 5 of the top 11 countries in terms of per capita incidence: Qatar (#1), Bahrain (#2), Oman (#3), Kuwait (#8), and Saudi Arabia (#11). Additionally, nearby Armenia is #5. The region also includes several notable countries in terms of total daily incidence. In addition to Iran and Pakistan, Saudi Arabia is #10 and Iraq is #14, and several other countries in the region are reporting more than 1,000 new cases per day.
  • STAT News updated its C19 Tracker to enable the display of national, regional, state, and local C19 data for many countries over a variety of time windows, ranging from daily to 1-month averages. The dashboard includes daily and cumulative incidence and deaths and daily recovered cases (total and per capita) as well as daily testing totals. Additionally, the dashboard shows relative changes for the selected time window—eg, relative increase or decrease in the weekly average incidence compared to the previous week.
United States
  • The US CDC reported 2.30 million total cases (26,643 new) and 120,333 deaths (410 new). 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; California and New York state with more than 175,000; 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 incidence is clearly increasing. Typically, early week reporting by the CDC is lower due to reporting delays over the weekend; however, even those troughs this week are elevated compared to the peak day from the week of June 7-13. 
  • According to the New York Times analysis, more than half of US states are reporting increased C19 incidence over the past 2 weeks. Some of these states—including Florida, Idaho, Hawai’i, Kansas, Missouri, Montana, Nevada, and Washington—reported several weeks of decreasing incidence but are now heading toward a second peak. Other states—such as Alabama, Arizona, California, North Carolina, South Carolina, Tennessee, and Texas—never really appeared to bring their respective epidemics under control, reporting generally increasing incidence from the beginning. ProPublica also provides analysis of SARS-CoV-2 testing, and several states continue to exhibit worrisome trends. Florida, South Carolina, Texas, and Utah are reporting test positivity greater than 10% and increasing, and Arizona is at 21% and increasing. Additionally, Alabama and Georgia are at 9% and increasing. Based on the STAT News C19 Tracker dashboard, the national 1-week average daily incidence is nearly as high as it was at the initial peak on April 10 (31,363 new cases). After falling as low as 20,338 new cases on June 9, the national weekly average is currently 29,681 new cases per day and still increasing exponentially.

2. US C19 Age Shift 

  • The US C19 incidence continues to increase, since early June, coinciding with states’ efforts to relax social distancing and resume normal activities, but US C19 deaths have steadily decreased since mid-April. One potential explanation for these differing trends is a shift in age distribution of C19 patients toward younger age groups. Several states that are currently reporting surges in C19 incidence — including Arizona, California, Florida, Texas, and Washington—have exhibited an increasing proportion of cases among younger adults (e.g., in their 20s and 30s). A number of factors are likely contributing to this trend. One possible driver is increased social interaction following the relaxation of social distancing restrictions, which has been observed among younger individuals who are at lower risk of severe disease and death. Despite the lower risk, Dr. Anthony Fauci noted yesterday in his testimony to the US House of Representatives Energy and Commerce Committee that some younger individuals do get severe C19 disease and die. Additionally, as testing and contact tracing capacity has increased nationwide, it has facilitated the detection of milder cases and asymptomatic infections, which appear to be more common among younger individuals. Early in the US epidemic, limited testing capacity was largely focused on hospitalized patients, which skewed to toward older patients.
  • While many of the newly identified C19 cases may be among younger individuals who are at lower risk for severe disease and death, any increase in cases in the community increases transmission risk, including to higher-risk individuals. Some health experts view the shift toward younger cases as an “ominous” signal that could forecast future increases in severe disease and death as transmission spreads beyond younger demographic groups. Notably, several of these states are also exhibiting increased C19 hospitalizations, which indicates that the increasing incidence is not limited to mild cases and asymptomatic infections. In fact 7 states—Arizona, Arkansas, California, North Carolina, South Carolina, Tennessee, and Texas—are reporting record numbers of hospitalized C19 patients.

3. US Visa Restrictions  

  • US President Donald Trump issued an executive order that extends restrictions on several classes of visas through the end of 2020. The order will reportedly not affect individuals who have already received visas or seasonal farm workers, and there are exceptions for certain professions, including coronavirus researchers. It is not clear, however, if the renewal process will be impacted. The order to restrict visas will apply to the following categories: (1) H1-B visas, which allow workers with advanced degrees to be hired into positions with specialist skill sets; (2) H2-B visas, which apply primarily to seasonal workers in industries such as agriculture, food processing, hospitality, and healthcare; (3) J-1 visas, which are used by many university students to complete their education at US universities; and (4) L visas for individuals in managerial positions often employed by multinational companies. The administration justified the decision as a mechanism to improve job opportunities for Americans and mitigate the severe economic impacts from the C19 pandemic. The announcement garnered criticism by those who accuse the administration of exploiting the pandemic to advance an agenda of restricting immigration and by companies that rely on these visas to bring specialized workers to the United States. 

4. Robot C19 Care Unit 

  • Healthcare systems are facing pressure, with increasing numbers of patients needing care for C19. The use of robotic technology to improve healthcare delivery offers the opportunity to enhance capacity without necessarily needing to increase the human capital behind healthcare operations. During the early stages of the pandemic in China, robots supplemented a shortage of appropriately skilled healthcare workers to care for C19 patients. As we have covered previously, robots have been employed during the pandemic to mitigate transmission risk for healthcare workers and to monitor social distancing in public spaces. The market for robotic technology is fairly nascent in many areas, but the integration of robotic technology into industries such as hospitality is gaining in reach. At the Wuhan Hongshan Sports Centre, a temporary clinical ward caring for approximately 200 people infected with C19, robot healthcare workers carry out tasks such as monitoring patients’ vital signs, delivering food and medication, and cleaning and disinfecting, with oversight and control by human healthcare workers. 

5. Digital Disparities  

  • C19 has brought to light social inequities around the world. One emerging challenge, particularly as many countries implement remote education programs and begin to evaluate how to resume classes for children and university students, is disparities in access to digital services and internet access. School closures and social distancing orders at home have created a stronger reliance on technology as a means to access social support systems and connect to routine aspects of daily life. 
  • In Chile, for example, disparities in internet access has impacted students’ ability to learn in the C19 environment. For 47% of students in Chile, access to a computer with an internet connection to support online learning is not available. For these students, “internet cafes” are essential to submit assignments and remain on schedule with their coursework; however, a city-wide “lockdown” in Santiago, Chile’s capital city, forced internet cafes to shut down, effectively preventing many students from accessing their school materials. The pandemic continues to exacerbate existing social, racial/ethnic, and economic disparities, and technical solutions to challenges posed by the pandemic and associated social distancing restrictions could potentially compound these inequities.

6. Dexamethasone Clinical Trial 

  • Researchers from the United Kingdom published (preprint) preliminary results from the dexamethasone arm of the UK RECOVERY clinical trials. Highlights from the findings were published via a press release last week, but this manuscript provides further details. The study yielded promising results, including a 34% decrease in mortality among patients receiving mechanical ventilation and a 20% decrease among patients receiving oxygen therapy. However, the researchers highlighted relative risk reduction among the most serious cases, but the original trial design did not specify analyzing these subgroups. 
  • Additionally, more than a quarter of the patients were still under treatment at the time of data collection, so their outcomes are unknown. The data does provide evidence that dexamethasone provides treatment benefit, but further study is needed to determine longer-term effects, including for mild or moderate disease. WHO Director-General Dr. Tedros Adhanom Ghebreyesus highlighted the value of the preliminary data and noted that the next challenge is scaling up production. The drug is relatively inexpensive, and there are already multiple manufacturers distributed around the world, which will factor positively into efforts to expand global availability. 

7. Decontaminate PPE at Home

  •  The US Department of Homeland Security developed a process for people to “decontaminate” personal protective equipment (PPE), including N95 respirators and masks, at home using only a fairly common kitchen appliance, a programmable multicooker or pressure cooker. Multicookers, such as the Instant Pot, have gained popularity in the United States and elsewhere in recent years. In light of the limited supply of various types of PPE, scientists at DHS developed a process that would enable people to clean their PPE at home so it can be reused safely. Multicookers enable users to generate moist heat, which has been identified by the US CDC as an effective method for killing the SARS-CoV-2 virus. The instructions—and accompanying video—direct users to place water in the multicooker and insert a wire rack (to prevent the respirator from sitting in the water). The respirator (up to 3 at a time) should be placed inside a paper bag and set on the rack, and the unit should be set at 149°F (65°C) for 30 minutes. Once the cycle is complete, users should remove the bag and open it for 1 hour to allow the respirators to cool and dry.

8. Coronavirus Vaccine Candidates

  • Global efforts continue to develop and evaluate vaccine candidates against SARS-CoV-2. Researcher from the United Kingdom published (preprint) findings from an animal study evaluating the immune response following 1 and 2 doses of the SARS-CoV-2 vaccine developed at the University of Oxford Jenner Institute. Following a study in non-human primates that demonstrated that the vaccine generated an immune response against SARS-CoV-2, this study aimed to understand the effect of a “prime-boost” vaccination schedule on the associated immune response. The study compared a single dose of the vaccine against 2 doses administered 28 days apart in both mice and pigs. The mouse model did not demonstrate a major difference between the single dose and prime-boost vaccinations. The researchers note, however, that the immune response was at the upper end of the spectrum for both study groups, which could limit the ability to discern any differences. In the pig model, the researchers identified a significant increase in various aspects of the immune response among those pigs that received the prime-boost vaccination compared to those that received a single dose. While animal models are not always representative of human immune responses, these data could indicate that multiple doses of the vaccine could be required to confer sufficient immunity against SARS-CoV-2 in humans. Further research is necessary to better characterize the effect of prime-boost vaccination on the degree and duration of immunity, particularly in humans. Phase I clinical trials using a single dose of the vaccine have been completed, and Phase 2 and 3 trials are already underway.
  • Sanofi Pasteur is collaborating with partners to develop and test multiple vaccine candidates, although the clinical trial schedule is several months behind some other products, such as the Oxford University vaccine. Recently, senior officials at Sanofi indicated that they believe their candidate vaccines could potentially make up time against other companies’ candidates and even reach the market first. Sanofi’s collaboration with GlaxoSmithKline, is a recombinant vaccine, which uses a vaccine delivery platform that could enable them to more rapidly scale up production capacity. At this time, Sanofi believes that it has 2 products that could receive regulatory approval in 2021. Sanofi is already scaling up production of its recombinant vaccine in anticipation of favorable results from Phase 1/2 trials this fall, with the aim of producing 100 million doses available by the end of 2020 and another 1 billion doses by the end of 2021. Additionally, Sanofi is partnering with Translate Bio, a smaller biotechnology company, to develop mRNA-based vaccine candidates, which are expected to have a slightly longer timeline.
  • During his testimony yesterday before the US House of Representatives Energy and Commerce Committee, Dr. Anthony Fauci commented that he is “cautiously optimistic” that a vaccine could begin to be made available by the end of 2020. Numerous researchers and manufacturers have candidate vaccines at various stages of development, and multiple manufacturers are already scaling up production to facilitate larger clinical trials and early distribution, including under Emergency Use Authorization. There is still considerable uncertainty regarding the timeline to the availability of a safe and effective SARS-CoV-2 vaccine, but accelerated trials and production could potentially make Dr. Fauci’s timeline feasible. If that is the case, this would likely be the shortest time from development to availability for any vaccine in history.

L. Links to Other Interesting Stories

‘I’ve never seen such sticky blood’ says thrombosis expert

NASA Astrobiologists Progressing on Antiviral Solutions for COVID-19

TB cases and deaths predicted to spike due to COVID-19

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