Recent Developments & Information
June 30, 2020
Reliable information is the best tool available to protect your family from the pandemic and its shockwaves
“It’s likely nearly half the US will have had COVID-19 by year’s end.”Scott Gottlieb, former FDA Commissioner
“The Texas Medical Center issued a statement about ICU capacity that unnecessarily alarmed our community, making it inaccurately appear that hospitals are in an imminent ICU capacity crisis. But, we do have the capacity to care for many more patients, and have lots of fluidity and ability to manage. It is completely normal for us to have ICU capacities that run in the 80s and 90s. That’s how all hospitals operate.”Marc Boom, Houston Methodist CEO
“We have a lot of capacity. There is not a scenario, in my opinion, where the demand for our beds … would eclipse our capability. I cannot imagine that. I just cannot.”Marc Wallace, Texas Children’s Hospital CEO
“The ICU capacity in Houston that is being reported is base capacity. We have the ability to go far higher than that in terms of ICU beds. We are seeing younger patients, we are seeing a shorter length of stay, we are seeing lower immortality, and we are seeing lower ICU utilization.”Aaron Ginn, co-founder of the Lincoln Network
A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
C. US Hotspots
1. Top 5 States in Deaths & Cases (5/29)
D. Potential Treatments
E. New Scientific Findings & Research
F. Concerns & Unknowns
G. Technology vs. C19
H. The Road Back?
I. Pandemic Economy
K. Johns Hopkins C19 Update
L. Links to Scientific & Other Notable Stories
A. The Pandemic As Seen Through Headlines
(In no particular order)
- WHO fears coronavirus pandemic ‘not even close to being over’
- WHO plans to launch investigation into China next week
- Nursing Homes Account For 11% Of COVID-19 Cases, 43% Of Deaths In US
- Arizona Closes Bars, Gyms & Movie Theaters For 30 Days As COVID-19 Cases, Hospitalizations Climb
- California sees its case count explode, surpassing 200,000 known infections
- LA issues “dire” warning about “deteriorating” conditions
- NJ cancels plans to resume indoor dining
- India reports new daily record with almost 20,000 new cases
- Bangladesh reports record daily case jump
- Deaths in NY drop to just 8
- Gov. Cuomo may delay indoor dining in NYC amid coronavirus resurgence
- NJ Gov. Murphy ‘indefinitely’ postpones the reopening of indoor restaurant dining
- China Seals Off County of 400,000 to Stem Beijing Cluster
- The Second Round Of Lockdowns Won’t Be As Easy As The First
- 41% Of Business Closures On Yelp Have Permanently Closed As V-Shaped Recovery Implodes
- In Florida, the daily case count has increased fivefold in two weeks.
- Florida’s new surge in cases arising from reopening of beaches, bars, restaurants and other social activities
- Coronavirus spike forces Miami to close beaches for July 4 weekend
- Rooftop pool at lux Ravel Hotel to screen summer revelers by nasal swab
- JFK opens first coronavirus testing site for employees at US airport
- Pediatricians call for kids to return to classrooms for upcoming school year
- A third of NY kids with Kawasaki-like disease had other medical woes
- Some high-end NYC hotels not changing sheets, wiping down surfaces
- NY Gov. Cuomo says MTV VMAs will be held at Barclays Center on Aug. 30
- Women ‘on precipice’ in developing countries amid coronavirus
- Many Covid Patients Have Terrifying Delirium
- Virus Cases Surge by 75 in Australia’s Hotspot State Victoria
- Coronavirus drug remdesivir to run $3,120 for patients with private insurance
- Gov. DeSantis blames young people partying for coronavirus surge
- Dr. Fauci warns anti-vaxxers could ruin any chance at COVID-19 herd immunity
- Broadway coronavirus shutdown extended to January 2021
- AMC delays movie theater reopening by 2 weeks due to coronavirus
- Thailand ‘Business-Travel Bubbles’ to Start Soon for Some Groups
- Workers Who Fled Indian Cities Don’t Want to Return
- Justice Department Says Mask Exemption Cards Are Fake
- Researchers report nearly 300 cases of inflammatory syndrome tied to Covid-19 in kids
- The Lone Star state is fast becoming the new center of America’s pandemic
- Las Vegas casinos could ditch cash amid coronavirus fears
- Leicester might be UK’s first local lockdown in coronavirus pandemic
- Health care workers in Minnesota forced to reuse masks due to shortage
- Monkey gangs are taking over Thailand amid the coronavirus
- Travel Will Never, Ever Go Back To The Way It Was Pre-COVID
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day. Green highlights indicate a decrease or no change and yellow highlights indicate an increase.
1. Cases & Tests
- Total Cases = 10,402,906 (+1.6%)
- New Cases = 164,619 (+1,447)
- Growth Rate of New Cases (7 day average) = 2.1% (-0.7%)
- New Cases (7 day average) = 173,867 (+3,557)
- New cases have decreased for 3 consecutive days (3 day average of cases has declined approx. 9% since 6/27)
- Although decreasing, the 7 day average growth rate in new cases remains high
- 7 day average of new cases is at a record high
- More than one million cases are now being reported each week
US Cases & Testing:
- Total Cases = 2,681,811 (+1.7%)
- New Cases = 44,734 (+4,194)
- Percentage of New Global Cases = 27.2% (+2.4%)
- Growth Rate of New Cases (7 day average) = 4.8% (-0.7%)
- New Cases (7 day average) = 41,688 (+1,891)
- Total Number of Tests = 33,189,513 (+743,813)
- Percentage of positive tests (7 day average) = 6.9% (+0%)
- Second highest number of new cases
- 7 day average of new cases, which has been rapidly rising since 6/9, a new record high on 6/29 (6th consecutive daily record)
- Although decreasing, the 7 day average growth rate in new cases is very high
- Total Deaths = 507,528 (+0.7%)
- New Deaths = 3,450 (-4)
- Growth Rate of New Deaths (7 day average) = -1.3% (-1.7%)
- New Deaths (7 day average) = 4,583 (-62)
- New deaths have declined for 4 consecutive days
- 3 day average of new deaths has decreased by approx. 27% since 6/25
- 7 day average of new deaths has been generally stable since 6/23
- Total Deaths = 128,783 (+0.3%)
- New Deaths = 346 (+61)
- Percentage of Global New Deaths = 10% (1.7%)
- Growth Rate of New Deaths (7 day average) = -0.6%
- New Deaths (7 day average) = 593 (-3)
- 7 day average of new deaths is lowest since March 30
- 3 day average has decreased by 51.2% since 6/25
- 7 day average of new deaths continue to decline as 7 day average of new cases continue to rise
C. US Hotspots
1. Top 5 States in Deaths & Cases (6/29)
- California 41
- Massachusetts 35
- Florida 28
- Texas 21
- Mississippi 20
- California 6,896
- Florida 5,266
- Texas 6,315
- Arizona 3,079
- Georgia 2,207
Deaths Per 1 Million Population
- New Jersey 1,703
- New York 1,619
- Connecticut 1,212
- Massachusetts 1,174
- Rhode Island 893
2. C19 Surge Begins Reaching Older, More Vulnerable Floridians
- Florida is reporting an unprecedented number of C19 cases, but Governor Ron DeSantis has pointed to the relatively low median age of the sick — 36 — to suggest that the outbreak isn’t having serious clinical consequences.
- But now, record numbers of Floridians 75 and older are testing positive for C19, according the latest report from Sunday, which reflects data through Saturday.
- Older Floridians largely avoided the state-wide uptick in cases earlier in the month. However, that has been changing in the past week.
- Florida hasn’t seen a departure from its relatively low rate of C19 deaths, but it can take weeks from onset of symptoms to death, and the surge in infections is recent.
- The new positivity rate — which measures the proportion of people testing positive for the first time compared to the day’s overall testing — started climbing significantly about two weeks ago.
D. Potential Treatments
1. RCSI begins clinical trial for drug therapy for severe C19 infection
- Clinician scientists at RCSI University of Medicine and Health Sciences have begun a clinical trial of a promising therapy for critically ill C19 patients in intensive care.
- In a paper published in the American Journal of Respiratory and Critical Care Medicine, the team, led by RCSI Professors Gerry McElvaney and Ger Curley, describe changes in the body’s normal inflammatory response in patients infected with C19, in particular among those who require admission to intensive care.
- The team has begun a randomized double blind placebo controlled clinical trial of alpha-1-antitrypsin to treat critically ill patients mechanically ventilated in ICU with C19 associated Acute Respiratory Distress Syndrome. Alpha-1-antitrypsin is a naturally occurring human protein produced by the liver and released into the bloodstream which normally acts to protect the lungs from the destructive actions of common illnesses.
- “The current management of severe C19 remains supportive, focusing on supplemental oxygen and ventilator support in the event of acute respiratory failure. Despite the implications for global health, the inflammatory characteristics of patients with C19 are not yet fully understood. A greater understanding of how the body’s inflammatory mechanisms are impacted upon by C19 could open the door to several potential therapies including antiviral medications and targeted immune-modulators such as alpha-1-antitrypsin.”
- Prof. Ger Curley, RCSI Professor of Anaesthesia and Critical Care and Consultant in Anaesthesia and Intensive Care in Beaumont Hospital explained that “we know from in-hospital studies that many C19 patients in ICU develop severe inflammation throughout the body with a disproportionately high rate of progression to acute respiratory distress syndrome, acute renal failure, shock and heart arrhythmia.”
- In a collaboration between the Departments of Medicine and Critical Care and Anaesthesia, a team of clinician scientists led by Prof. McElvaney and Prof. Curley sought to ascertain the type of inflammation affecting the C19 patient in ICU, and to determine whether there was a relationship between this type of inflammation and the need for intubation and mechanical ventilation.
- The study showed that a number of highly inflamed proteins were all increased in infected patients compared to healthy controls. There was also a difference in the profiles of patients in ICU and those who were infected but stable.
- Prof. Curley explained, however, that the most unanticipated differentiating factor between patients with stable and severe disease was not the degree of increase in inflammatory proteins, but rather the relative decrease in levels of an anti-inflammatory protein which indicates that the patients’ anti-inflammatory mechanisms were failing.
- “This finding suggests to us that a therapy which augments the body’s own inflammation resolving mechanisms might have a positive impact. Alpha-1 protects the airway from damage during acute pulmonary infection. It is also a potent anti-inflammatory and acts to protect the immune system. Of particular relevance to C19, it has been shown to modulate the production and activity of several key pro-inflammatory proteins”, explained Prof. Curley.
- “We are confident that this clinical trial will demonstrate the potential for Alpha-1 to improve the outcomes for patients with the most severe C19 induced respiratory difficulties.”
E. New Scientific Findings & Research
1. Bacterial Predator Could Reduce C19 Deaths – “Potential Game Changer”
- A type of virus that preys on bacteria could be harnessed to combat bacterial infections in patients whose immune systems have been weakened by the coronavirus, according to an expert at the University of Birmingham and the Cancer Registry of Norway.
- Called bacteriophages, these viruses are harmless to humans and can be used to target and eliminate specific bacteria. They are of interest to scientists as a potential alternative to antibiotic treatments.
- In a new systematic review, published in the journal Phage: Therapy, Applications and Research, two strategies are proposed, where bacteriophages could be used to treat bacterial infections in some patients with C19.
- In the first approach, bacteriophages would be used to target secondary bacterial infections in patients’ respiratory systems. These secondary infections are a possible cause of the high mortality rate, particularly among elderly patients. The aim is to use the bacteriophages to reduce the number of bacteria and limit their spread, giving the patients’ immune systems more time to produce antibodies against the coronavirus.
- Dr. Marcin Wojewodzic, a Marie Sklodowska-Curie Research Fellow in the School of Biosciences at the University of Birmingham and now researcher at the Cancer Registry of Norway, is the author of the study. He says: “By introducing bacteriophages, it may be possible to buy precious time for the patients’ immune systems and it also offers a different, or complementary strategy to the standard antibiotic therapies.”
- Professor Martha R.J. Clokie, a Professor of Microbiology at the University of Leicester and Editor-in-Chief of PHAGE journal explains why this work is important: “In the same way that we are used to the concept of ‘friendly bacteria’ we can harness ‘friendly viruses’ or ‘phages’ to help us target and kill secondary bacterial infections caused by a weakened immune system following viral attack from viruses such as C19”.
- Dr. Antal Martinecz, an expert in computational pharmacology at the Arctic University of Norway who advised on the manuscript says: “This is not only a different strategy to the standard antibiotic therapies but, more importantly, it is exciting news relating to the problem of bacterial resistance itself.”
- In the second treatment strategy, the researcher suggests that synthetically altered bacteriophages could be used to manufacture antibodies against the coronavirus which could then be administered to patients via a nasal or oral spray. These bacteriophage-generated antibodies could be produced rapidly and inexpensively using existing technology.
- “If this strategy works, it will hopefully buy time to enable a patient to produce their own specific antibodies against the coronavirus and thus reduce the damage caused by an excessive immunological reaction,” says Dr. Wojewodzic.
- Professor Martha R.J. Clokie’s research focuses on the identification and development of bacteriophages that kill pathogens in an effort to develop new antimicrobials: “We could also exploit our knowledge of phages to engineer them to generate novel and inexpensive antibodies to target C19. This clearly written article covers both aspects of phage biology and outlines how we might use these friendly viruses for good purpose.”
- “This pandemic has shown us the power viruses have to cause harm. However, by using beneficial viruses as an indirect weapon against the coronavirus and other pathogens, we can harness that power for a positive purpose and use it to save lives. The beauty of nature is that while it can kill us, it can also come to our rescue.” adds Dr Wojewodzic.
- “It’s clear that no single intervention will eliminate C19. In order to make progress we need to approach the problem from as many different angles and disciplines as possible.” concludes Dr. Wojewodzic.
2. Is Coronavirus Burning Out?
- More than half a million people have died from C19 globally. It is a major tragedy, but perhaps not on the scale some initially feared. And there are finally signs that the pandemic is shuddering in places, as if its engine is running out of fuel. This has encouraged many governments to relinquish lockdowns and allow everyday life to restart, albeit gingerly.
- The spread of the coronavirus has been difficult to predict and understand. On the Diamond Princess cruise ship, for example, where the virus is likely to have spread relatively freely through the air-conditioning system linking cabins, only 20% of passengers and crew were infected. Data from military ships and cities such as Stockholm, New York and London also suggest that infections have been around 20% – much lower than earlier mathematical models suggested.
- This has led to speculation about whether a population can achieve some sort of immunity to the virus with as little as 20% infected – a proportion well below the widely accepted herd immunity threshold (60-70%).
- The Swedish public health authority announced in late April that the capital city, Stockholm, was “showing signs of herd immunity” – estimating that about half its population had been infected. The authority had to backtrack two weeks later, however, when the results of their own antibody study revealed just 7.3% had been infected. But the number of deaths and infections in Stockholm is falling rather than increasing – despite the fact that Sweden hasn’t enforced a lockdown.
- Hopes that the C19 pandemic may end sooner than initially feared have been fueled by speculation about “immunological dark matter”, a type of pre-existing immunity that can’t be detected with coronavirus antibody tests.
- Antibodies are produced by the body’s B-cells in response to a specific virus. Dark matter, however, involves a feature of the innate immune system termed “T-cell mediated immunity”. T-cells are produced by the thymus and when they encounter the molecules that combat viruses, known as antigens, they become programmed to fight the same or similar viruses in the future.
- Studies show that people infected with the coronavirus indeed have T-cells that are programmed to fight this virus. Surprisingly, people never infected also harbor protective T-cells, probably because they have been exposed to other coronaviruses. This may lead to some level of protection against the virus – potentially explaining why some outbreaks seem to burn out well below the anticipated herd immunity threshold.
- Young people and those with mild infections are more likely to have a T-cell response than old people – we know that the reservoir of programmable T-cells declines with age.
- In many countries and regions that have had very few C19 cases, hotspots are now cropping up. Take Germany, which quickly and efficiently battled the virus and has had one of the lowest death rates among the large northern European countries.
- Here, the R number – reflecting the average transmission rate – has risen again, below 1 until June 18, but rocketing to 2.88 just days later, only to drop again a few days later. It may be tempting to argue that this could be because the hotspots never got close to the 20% infection that was seen in other regions.
- But there are counter examples, albeit particularly in older and immunocompromised populations. In the Italian C19 epicenter in Bergamo, a town where one in four residents are pensioners, 60% of the population had antibodies by early June.
- The same is true in some prisons: at the Trousdale Turner Correctional Center in Hartsville, US, 54% of inmates had tested positive for C19 by early May. And more than half of the residents in some long-term care facilities have also been infected.
Genes and environment
- So how do we explain this? Could people in places with higher rates of positive antibodies have a different genetic make-up?
- Early in the pandemic, there was much speculation about whether specific genetic receptors affected susceptibility to the coronavirus. Geneticists thought that DNA variation in the ACE2 and TMPRSS2 genes might affect susceptibility to, and severity of, infection. But studies so far have shown no compelling evidence supporting this hypothesis.
- Early reports from China also suggested that blood types may play a role, with blood type A raising risk. This was recently confirmed in studies of Spanish and Italian patients, which also discovered a new genetic risk marker termed “3p21.31”.
- While genetics may be important, the environment also matters. It is well known that airborne transmission of droplets is enhanced in colder climates. Super-spreading events in several meat production facilities where the indoor climate is cold suggest this has enhanced contagion. People also tend to spend more time indoors and in close proximity during inclement weather.
- Warm weather, however, brings people together, albeit outdoors. Indeed, June has been uncharacteristically hot and sunny in many northern European countries, causing parks and beaches to be overrun and social distancing rules flouted. This will likely drive contagion and cause new C19 outbreaks in the weeks to come.
- Yet another factor is how interpersonal interactions affect contagion. Some previous models have assumed that people interact in the same way regardless of age, well-being, social status and so forth. But this isn’t likely to be the case – young people, for example, are likely to have more acquaintances than the elderly. Accounting for this reduces the herd immunity threshold to around 40%.
Will C19 disappear?
- The lockdowns enforced far and wide, combined with the responsible actions of many citizens, have undoubtedly mitigated the spread of the coronavirus and saved lives. Indeed, in cases such as Sweden – where lockdown was eschewed and social distancing rules were relatively relaxed – the virus has claimed an order of magnitude more lives than in its pro-lockdown neighbors, Norway and Finland.
- But it is unlikely that lockdowns alone can explain the fact that infections have fallen in many regions after 20% of a population has been infected – something that, after all, happened in Stockholm and on cruise ships.
- That said, the fact that more than 20% of people have been infected in other places means that the T-cell hypothesis is unlikely to be the sole explanation either.
- Indeed, if a 20% threshold does exist, it applies to only some communities, depending on interactions between many genetic, immunological, behavioral and environmental factors, as well as the prevalence of pre-existing diseases.
- Understanding these complex interactions is going to be necessary if one is to meaningfully estimate when the coronavirus will burn itself out. Ascribing any apparent public health successes or failures to a single factor is appealing – but it is unlikely to provide sufficient insight into how C19, or whatever comes next, can be defeated.
3. Existing drugs can prevent the coronavirus from hijacking cells
Researchers evaluate how the new coronavirus rewires human proteins for its own replication, and identify several antiviral drugs ready for clinical trials
- An international team of researchers has analyzed how the coronavirus hijacks the proteins in its target cells. The research, published in the journal Cell, shows how the virus shifts the cell’s activity to promote its own replication and to infect nearby cells.
- The scientists also identified 7 clinically approved drugs that could disrupt these mechanisms, and recommend that these drugs are immediately tested in clinical trials.
- The collaboration included researchers at EMBL’s European Bioinformatics Institute (EMBL-EBI), the Quantitative Biosciences Institute’s Coronavirus Research Group in the School of Pharmacy at University of California San Francisco (UCSF), the Howard Hughes Medical Institute, the Institut Pasteur, and the Excellence Cluster CIBSS of the University of Freiburg.
- Viruses are unable to replicate and spread on their own: they need an organism – their host – to carry, replicate, and transmit them to further hosts. To facilitate this process, viruses need to take control of their host cell’s machinery and manipulate it to produce new viral particles. Sometimes, this hijacking interferes with the activity of the host’s enzymes and other proteins.
- Once a protein is produced, enzymes can change its activity by making chemical modifications to its structure. For example, phosphorylation – the addition of a phosphoryl group to a protein by a type of enzyme called a kinase – plays a pivotal role in the regulation of many cell processes, including cell-to-cell communication, cell growth, and cell death. By altering phosphorylation patterns in the host’s proteins, a virus can potentially promote its own transmission to other cells and, eventually, other hosts.
- The scientists used mass spectrometry, a tool to analyze the properties of a sample by measuring the mass of its molecules and molecular fragments, to evaluate all host and viral proteins that showed changes in phosphorylation after the coronavirus infection. They found that 12% of the host proteins that interact with the virus were modified. The researchers also identified the kinases that are most likely to regulate these modifications. Kinases are potential targets for drugs to stop the activity of the virus and treat C19.
The extraordinary behavior of infected cells
- “The virus prevents human cells from dividing, maintaining them at a particular point in the cell cycle. This provides the virus with a relatively stable and adequate environment to keep replicating,” explains Pedro Beltrao, Group Leader at EMBL-EBI.
- The coronavirus not only impacts cell division, but also cell shape. One of the key findings from the study is that infected cells exhibit long, branched, arm-like extensions, or filopodia. These structures may help the virus reach nearby cells in the body and advance the infection, but further study is warranted.
- “The distinct visualization of the extensive branching of the filopodia once again elucidates how understanding the biology of virus-host interaction can illuminate possible points of intervention in the disease,” says Nevan Krogan, Director of the Quantitative Biosciences Institute at UCSF and Senior Investigator at Gladstone Institutes.
Old drugs, new treatments
- “Kinases possess certain structural features that make them good drug targets. Drugs have already been developed to target some of the kinases we identified, so we urge clinical researchers to test the antiviral effects of these drugs in their trials,” says Beltrao.
- In some patients, C19 causes an overreaction of the immune system, leading to inflammation. An ideal treatment would relieve these exaggerated inflammatory symptoms while stopping the replication of the virus. Existing drugs targeting the activity of kinases may be the solution to both problems.
- The researchers identified dozens of drugs approved by the FDA or ongoing clinical trials that target the kinases of interest. Seven of these compounds, primarily anticancer and inflammatory disease compounds, demonstrated potent antiviral activity in laboratory experiments.
- “Our data-driven approach for drug discovery has identified a new set of drugs that have great potential to fight C19, either by themselves or in combination with other drugs, and we are excited to see if they will help end this pandemic,” says Krogan.
- “We expect to build upon this work by testing many other kinase inhibitors while identifying both the underlying pathways and additional potential therapeutics that may intervene in C19 effectively,” says Kevan Shokat, Professor in the Department of Cellular and Molecular Pharmacology at UCSF.
4. New evidence for how blood clots may form in very ill C19 patients
- Scientists have new evidence that overactive neutrophils–a common type of circulating immune cell–may drive the life-threatening blood clots and inflammation that occur in some patients with C19. High levels of the sticky, pathogen-trapping webs produced by the cells were associated with the most severe cases of C19 in a study reported online in the journal Blood.
- Neutrophil extracellular traps (NETs) are a type of defense that the immune system deploys against certain pathogens–webs of DNA and toxins that ensnare and destroy viruses and bacteria.
- When too many of these NETs accumulate during a persistent infection, they can lead to acute respiratory distress syndrome, which leads many patients with C19 to require intensive care.
- Researchers at Cold Spring Harbor Laboratory (CSHL), University of Utah Health, PEEL Therapeutics and Weill Cornell Medicine collaborated to investigate NETs suspected role in C19, collecting blood samples from 33 hospitalized patients, as well as autopsy tissue. They found that biomarkers of NET formation were more abundant in patients who required ventilation, and highest in the three study participants who eventually died from C19.
- When the team examined the lungs of the patients who died, they found tiny clots of tangled NETs and blood platelets known as microthrombi scattered through the tissue. “It will be important to investigate NETs role in clot formation (thrombosis) not only in light of the C19 pandemic, but also to understand their broader role in disease,” says CSHL Associate Professor Mikala Egeblad.
- “Excess NETs are formed in other viral diseases,” she says. “We also know that clotting is a major cause of death in people with end-stage cancer, so what we are learning in C19 may help us understand basic properties in cancer and other diseases.”
- In the laboratory, neutrophils from patients with C19 churned out exceptionally high levels of NETs, and the researchers found healthy neutrophils behaved the same way when they were exposed to plasma from patients with the illness. They could stop NET production, however, by exposing cells to neonatal NET-Inhibitory Factor (nNIF), an anti-inflammatory peptide from umbilical cord blood that protects newborn babies.
- Several therapeutic strategies for dismantling NETs or preventing their formation are currently under investigation. These include the nNIF peptide, which is in pre-clinical development by PEEL Therapeutics. “Although further studies will be required, the NET-inhibitory protein may block exaggerated NET formation in C19 patients,” says Christian Con Yost, whose laboratory at University of Utah Health discovered nNIF in 2016.
5. Even in worst C19 cases, body launches immune cells to fight back
- A new study from researchers at La Jolla Institute for Immunology (LJI) and Erasmus University Medical Center (Erasmus MC) shows that even the sickest C19 patients produce T cells that help fight the virus. The study offers further evidence that a C19 vaccine will need to elicit T cells to work alongside antibodies.
- The research, published June 26, 2020 in Science Immunology, also reveals that both Dutch and American patients have similar responses to the virus. “This is key to understanding how the immune response fights the virus,” says LJI Professor Alessandro Sette, Dr. Biol. Sci., who co-led the study with Erasmus MC Virologist Rory de Vries, Ph.D. “You want vaccine approaches to be grounded in observations from rather diverse settings to ensure that the results are generally applicable.”
- For the study, the researchers followed ten C19 patients with the most severe disease symptoms. All ten were admitted to the ICU at Erasmus University Medical Center, in the Netherlands, and put on ventilators as part of their care. Two of the patients eventually died of the disease. An in-depth look at their immune system responses showed that all ten patients produced T cells that targeted the coronavirus. These T cells worked alongside antibodies to try to clear the virus and stop the infection.
- “Activating these cells appears to be at least as important as the production of antibodies,” says Erasmus MC Virologist Rory de Vries, Ph.D., who co-led the study with Sette.
- These findings are in line with a recent Cell study from Sette, LJI Professor Shane Crotty, Ph.D., and LJI colleagues that showed a robust T cell response in individuals with moderate cases of C19. In both studies, the T cells in these patients prominently targeted the “spike” protein on the coronavirus.
- The virus uses the spike protein to enter host cells, and many vaccine efforts around the world are aimed at getting the immune system to recognize and attack this protein.
- The new study offers further evidence that the spike protein is a promising target and confirms that the immune system can also mount strong responses to other targets on the virus.
- “This is good news for those making a vaccine using spike, and it also suggests new avenues to potentially increase vaccine potency,” says Daniela Weiskopf, Ph.D., research assistant professor at LJI and first author of the new study.
6. Huge Gap Between C19 Infections and Known Cases
- Newly published antibody test results from half a dozen parts of the country confirm that C19 infections in the United States far outnumber confirmed cases. The ratio of estimated infections to known cases in these studies, which the CDC reported on Friday, range from 6 to 1 in Connecticut as of early May to 24 to 1 in Missouri as of late April.
- These results confirm something we already knew: The C19 infection fatality rate—deaths as a share of all infections—is much lower than the crude case fatality rate—deaths as a share of known cases. That is bound to be true when testing is limited and a virus typically produces mild or no symptoms. At the same time, the CDC’s antibody studies imply that efforts to control the epidemic through testing, isolation, quarantine, and contact tracing will not be very effective, since they reach only a small percentage of virus carriers.
- The CDC analyzed blood samples drawn for routine tests unrelated to C19 from patients in New York City, Connecticut, South Florida, Missouri, Utah, and western Washington state. Although these samples may not be representative of the general population, they provide a clearer picture of virus prevalence than screening limited to people who sought virus tests because they had symptoms consistent with C19 or because they were in close contact with known carriers.
- In New York City, where the samples were drawn from March 23 through April 1, nearly 7% tested positive for C19 antibodies, implying that infections outnumbered reported cases during that period by 12 to 1. The prevalence estimated by a state-sponsored antibody study conducted from April 19 to April 28 was three times as high, although the ratio of estimated infections to known cases (about 11 to 1), was similar. The difference in estimated prevalence can be at least partly explained by the spread of the virus between early and late April.
- The gap between the two estimates may also be partly due to differences between the samples used in the studies. The CDC study was based on patients whose doctors ordered routine blood tests, while the New York State Department of Health study used blood drawn from randomly selected shoppers. Infections might have been unusually common among people who ventured out to stores during the study period, either because they were more likely to encounter carriers or because they had already recovered from C19 and therefore felt safe leaving their homes. (Then again, the health department study would have missed people who were self-isolating because they had symptoms or because they had close contact with people who had C19.)
- In South Florida, where the samples analyzed by the CDC were collected from April 6 through April 19, almost 2% tested positive. That is just one-third the antibody prevalence that University of Miami researchers found in a random sample of Miami-Dade County residents about a week later. As with New York City, some of the difference might be due to rising infections, and some of it might be due to differences in sampling methods. The CDC study did not use a random sample of the local population, and it included patients from Broward, Martin, and Palm Beach counties as well as Miami-Dade. It is also possible that the antibody test used by the University of Miami researchers, which has relatively low specificity, generated more false positives than the test used by the CDC.
- The CDC put the ratio of infections to confirmed cases in South Florida at 11 to 1, which is the same as the ratio it estimated in Utah, where the samples were collected from April 20 through May 3, and in western Washington, where the samples were collected from March 23 through April 1. Connecticut, where the blood was drawn from April 26 through May 3, had the lowest ratio of estimated infections to confirmed cases: 6 to 1. Missouri, where samples were collected from April 20 through April 26, had the highest ratio: 24 to 1.
- What do these findings imply about the infection fatality rate (IFR) in these places? New York City had recorded 2,580 C19 deaths as of April 1, when the CDC estimates 641,800 residents had been infected, which implies an IFR of 0.4%. (The IFR implied by the state health department’s study, by contrast, was around 0.6%.) The C19 death toll in Connecticut was 2,495 as of May 3, when the CDC estimates the state had 176,700 infections. That implies a much higher IFR: 1.4%.
- Utah had recorded 57 C19 deaths as of May 3, when the CDC estimates the state had 47,400 infections, implying an IFR of just 0.1%. Missouri’s death toll was 388 as of April 26, when the state had an estimated 161,900 infections. That implies an IFR of about 0.2%.
- These are just snapshots, and the IFRs in Utah and Missouri may have risen as the epidemic progressed in those states, especially if people infected in May were more vulnerable to the disease. But even now, there is a striking gap between the crude case fatality rates in New York City and Connecticut (8.4% and 9.3%, respectively) and the crude CFRs in Utah and Missouri (0.8% and 4.9%, respectively). That suggests C19 patients have fared worse in New York City and Connecticut than they have in Utah and Missouri, for reasons that may include the prevalence of preexisting medical conditions, the stress that the epidemic put on local health care systems, and policies regarding high-risk people such as nursing home residents.
- It is plausible that the IFR for C19, as well as the crude CFR, would vary from one part of the country to another, depending on local conditions. Based on the CDC’s “best estimates” of the death rate among all Americans who develop C19 symptoms (whether or not they are tested for the virus) and the percentage of infections that are asymptomatic, the nationwide IFR is something like 0.26%.
- Virus testing in the United States has expanded considerably since early May, which helps explain why the nationwide crude CFR has been falling, from more than 6% on May 16 to less than 5% today. As more people with mild or no symptoms get tested, the denominator includes more low-risk cases, driving down the apparent death rate. The gap between confirmed cases and total infections also could shrink as testing is expanded, but that depends on the pace of new infections, which have been rising at a fast clip in several states.
- In Texas, where newly confirmed cases rose 10-fold between May 26 and June 25 before falling slightly, the share of virus tests that were positive rose from 4.3% on May 26 to 13.2% on June 26, which indicates that expanded testing is not keeping pace with rising infections. It looks like the gap between confirmed cases and infections is growing in places like Texas, while it is shrinking in places like New York City, where the test positivity rate (based on a three-day average) plummeted from 70% on March 30 to 2% on June 25.
- When the ratio of infections to confirmed cases is high, there is little hope of containing transmission by identifying and quarantining carriers and their contacts, even if a state has the capacity to do contact tracing. The CDC’s antibody research “underscores that there are probably a lot of people infected without knowing it, likely because they have mild or asymptomatic infection,” CDC scientist Fiona Havers told The New York Times. “But those people could still spread it to others.”
- The light gray lining of this dark cloud is that newly infected people in states such as Texas, Florida, Arizona, and California are substantially younger now than they were earlier in the epidemic, which means the death rate in those places should be falling. The seven-day average of newly reported C19 deaths in Texas fell from 58 on April 30, when the statewide lockdown was lifted, to 20 on June 13. It has since risen to 29 and probably will climb more as recently contracted cases progress. But the outcome would be far worse if new C19 patients in Texas were older.
- Since neither contact tracing nor a vaccine is likely to save high-risk Texans, the ultimate death toll will depend largely on precautions aimed at protecting them. Gov. Greg Abbott has responded to the new wave of infections, which he says is driven largely by young people who have been getting together for drinks in close proximity, by closing bars. But if young Texans are increasingly disinclined to follow social distancing rules, that step may not accomplish much. They can still get together in private, and their risk of exposure will in any case be higher as they return to work. Nor can those people, whose own risk of dying from C19 is very low, necessarily be counted on to avoid contact with Texans who are much more vulnerable to the disease.
- The onus for preventing contact between potential carriers and high-risk individuals seems to be shifting, fairly or not, from the first group to the second. Minimizing C19 deaths will require adapting to that reality.
F. Concerns & Unknowns
1. When C19 hits the brain, it can cause strokes, psychosis and a dementia-like syndrome
- A new survey reveals a wide range of serious psychiatric and neurological complications tied to C19 — including stroke, psychosis, and a dementia-like syndrome. The study underscores how aggressively the coronavirus can attack beyond the lungs, and the risk the disease can pose to younger adults.
- The study looked at 125 hospitalized patients with C19 who also had some sort of neuropsychiatric complication. Fifty-seven had had an ischemic stroke, caused by a blood clot in the brain. The second most common issue, affecting 39 patients, was an altered mental state, researchers reported. That included encephalitis (an inflammation of the brain that can cause a number of symptoms, from confusion to mobility problems) and encephalopathy (a general term for a disease that alters brain function). Ten patients were newly diagnosed with psychosis, and six had cognitive issues akin to dementia, according to the study, published in the Lancet Psychiatry.
- “What was particularly interesting was that this spanned the neurological spectrum,” said senior author Benedict Michael of the University of Liverpool, a neurologist specializing in infectious diseases.
- The people in the study ranged from their 20s to their 90s, and the researchers noted that, because they focused on hospitalized patients, the complications detailed likely represent the most serious ones.
- Whereas the strokes were more common among older patients, the researchers found that about half of those who experienced altered mental status were younger than 60.
- Smaller studies and case reports from China and other European countries had raised the connection between C19 and neuropsychiatric complications, but for the new study, the researchers set out to get a full picture of the range of those complications. To amass as broad a data set as possible, they built a reporting network across the United Kingdom that enlisted specialists in stroke, neurology, psychiatry, and critical care.
- “Everybody is focused on mortality, which they should, and respiratory problems, which is the main cause of death,” said Mark George, a psychiatrist and neurologist at the Medical University of South Carolina, who was not involved with the study. But, George said, “the virus certainly does have brain effects.”
- As the pandemic has spread around the globe, clinicians have found themselves treating complications in just about every bodily system as a result of C19 — including diabetes, kidney damage, even lesions on people’s toes. With some of these, it’s thought that because there are so many global cases occurring so quickly, doctors are able to notice enough rare occurrences to make a connection.
- But with complications in the brain, experts are still trying to figure out exactly how rare they are. The more severe problems might occur infrequently, but scientists and doctors were clued into the virus’ targeting of the nervous system early on, when a loss of smell and taste became one of the more common symptoms of the inscrutable virus. Many patients have also reported fatigue, depression, and anxiety.
- It’s unclear exactly what’s causing each neuropsychiatric issue: the viral infection itself; the body’s immune response, which is responsible for other, sometimes fatal complications following infections; or a combination of the two. (The study also noted that altered mental status is not uncommon in people admitted to the hospital with severe infections generally, especially those who require intensive care.)
- “This actually is a direct effect, in some people, of the virus going into brains,” George said.
- It’s long been known that viral infections can cause lasting neurological complications; the 1918 flu pandemic was similarly associated with encephalitis in some patients. But Michael, the new study’s senior author, said the C19 pandemic presented an opportunity for scientists to discover how a virus can cause those complications, given how widespread the coronavirus is and the new technology researchers have.
- What remains unknown is how long these complications — or sequelae, in science-speak — may last for people with C19. Michael said the research team was working to follow the patients in the study.
- “Ask me in six months and then we will have some degree of a handle on it.”
F. Technology vs. C19
1. Coronavirus tracker shows exponential growth of virus in 34 States
- Instagram co-founder Kevin Systrom told CNBC on Monday the coronavirus tracking website he helped build is showing concerning levels of spread in many states across the U.S.
- Epidemiologists use something called an R0, or R naught, as a way to measure how a virus is spreading. For example, an R0 of 1 means the average person who is infected with the virus will be expected to spread it to one other person; a higher R0 means the virus will spread exponentially.
- Systrom said his site, http://rt.live, reports the estimated rate of transmission, or Rt, in each state. The Rt metric, derived from R0, seeks to measure the transmission rate in a specific population and a specific moment in time.
- Appearing on “Squawk Box,” Systrom said that 34 states in the U.S. have an estimated rate of coronavirus transmission above 1.0, defined on rt.live as an indication the virus will spread quickly. A value less 1.0 suggests the spread will stop.
- “So you have an incredible rebound,” said Systrom. “People like to say we’re not in a second wave. I don’t know what a second wave [is] if that’s not a second wave.”
- Nevada has the highest estimated rate of transmission of 1.64, according to rt.live on Monday morning. Montana and Florida have estimated transmission rates of 1.41 and 1.4, respectively. The areas with the estimated lowest rates are Connecticut and Washington D.C., each at 0.77. Massachusetts is the next lowest at 0.81.
- He emphasized the Rt, the rate of transmission, is “one metric of many” that people should use. Rt.live gets its data from the Covid Tracking Project, Systrom said. He recommended that people also rely on state health department data. “Check lots of sites. Triangulate for yourself because these are all models,” he added.
- Dr. Scott Gottlieb, a former FDA commissioner, told CNBC that rt.live is valuable because it’s “giving you an indication of what the new cases are telling you.”
- “It’s very hard to just interpret from new cases being reported on a daily basis what that means with respect to whether or not the epidemic is expanding and how quickly it’s expanding,” Gottlieb said on “Squawk Box,” appearing with Systrom.
- Gottlieb: It’s likely nearly half the US will have had C19 by year’s end.
- Below are the current R0 scores as estimated by https://rt.live
I. The Road Back?
1. Deaths Can Be Reduced by More Than 66% if Half Use Masks and Social Distancing
- With the advent of an infectious disease outbreak, epidemiologists and public health officials quickly try to forecast deaths and infections using complex computer models. But with a brand new virus like the one that causes C19, these estimates are complicated by a dearth of credible information on symptoms, contagion and those who are most at risk.
- My team at the Goldenson Center for Actuarial Research has developed a free, user-friendly computer model that has a different goal. It demonstrates how infections and deaths progress on a daily basis over a three-month period depending on how people behave in response to the outbreak. This model allows the public to input data that demonstrate how changes in safety measures in their communities, including wearing face covering and social distancing, can significantly impact the spread of this virus and mortality rates.
- Our Goldenson Center C19 model uses a hypothetical 1,000-person population and calculates outcomes using three types of information: the initial number of infections, social distancing, and personal protection measures that include wearing masks, frequent hand-washing and staying quarantined if exhibiting C19 symptoms. Our model then uses this initial information to project on a daily basis the cumulative infections and deaths over a three-month period. It’s not based on actual disease data and is designed to demonstrate the effects of safety measures, rather than make specific predictions.
- This simple actuarial model uses general guidelines, rather than data and assumptions about C19 specifically, to simulate the effect of safety protocols. Here, a hypothetical group of 100 infected people out of a population of 1,000, with 10% observing good safety protocols, leads to hundreds of infections and deaths after three months. Goldenson Center at the University of Connecticut, Author provided.
- This simulation shows the effect on the same hypothetical group of 100 infected people out of a group of 1,000 where 80% of people wear masks and practice social distancing, which slows the infection rate to almost zero after two months. Goldenson Center for Actuarial Research, CC BY-NC-ND
Why it matters
- By inputting different assumptions, people can see how their community’s personal actions can change the course of this pandemic – and how poor protocols can trigger exponential spread of the virus.
- For example, let’s assume that 100 people are infected out of a population of 1,000, with one in 10 wearing masks, keeping appropriate distance and quarantining if necessary. The model shows that 30 days later, the virus would have killed 156 people. After three months, the death toll reaches 460 – with 510 now infected.
- However, our model shows that if half the population practices safe protocols, infections after 90 days drop to 293 and deaths drop even more dramatically, to 149 – about one-third of the lives lost under looser measures.
- The main takeaway is that safety measures that are within our control have significant impact – and ignoring those protocols can have dire consequences.
- If a state opens up and maintains safety measures for at least three months, the virus will be contained and possibly eliminated.
- On the other hand, if a state opens up too soon and its residents ignore safety protocols, there could be an exponential increase in C19 deaths within months. It’s important for the public to realize that the spread of the virus is impacted only by personal behavior.
- Our model shows that there must be continued emphasis on maintaining necessary safety measures as we relax shelter-in-place rules and get people back to work. Practicing common-sense social distancing, wearing masks in public and quarantining when necessary is a small inconvenience for a limited amount of time – that will contain the devastation of this virus and ensure that our economy is restored.
2. How Much Testing Is Needed to Contain the Virus?
- The US has run 83.24 tests per thousand individuals, according to numbers from Our World in Data. By comparison, Russia, which is also being hit hard by the virus, has run 120.07 tests per thousand people.
- The US is currently testing about 500,000 people per day. The country’s testing capacity has significantly improved since the pandemic began. Still, a Washington Post survey of about 20 states last month found the country was running at least 235,000 fewer tests a day than it could have run. While places with spikes in infections—like Arizona—are facing shortages, large swaths of the country are actually reporting underutilized availability.
- On the one hand, this could mean we can immediately test more people—we just have to get the word out. But on the other hand, that greater capacity also presents an opportunity to rethink the role of testing during a pandemic as we seek to reopen the economy. Finding new infections is not the only way to use this untapped reservoir.
How bad is the situation?
- Most health experts will tell you that testing is vital in controlling the pandemic. On a personal level, testing can tell you whether you’re infected, regardless of whether you’re showing symptoms. If you test positive, you can isolate yourself to protect others, and contact tracers can try to find people you may have exposed, to isolate them as well. Testing can also tell us where new infections are popping up, so authorities can limit the scope of the outbreak and warn neighboring communities that might be hit next. If we don’t have enough testing, we can’t do any of these things well, and that lets the virus spread faster.
- Another issue: the jury is still out on exactly how much asymptomatic cases contribute to transmission of C19. But if it turns out asymptomatic transmission is a major problem, “we’re only going to get ahead of this if we’re able to identify people who don’t know they’re infected,” says Ann Kiessling, the director of the Bedford Research Foundation, a lab in Massachusetts. “They’re the ones who are going to infect you tomorrow.”
- So how much testing should the US really be doing? American public health experts have never agreed. The economist Paul Romer has said we need to be doing 30 million tests a day. A model developed by the Safra Center at Harvard called for 10 million tests a day.
- Ashish Jha, the director of Harvard’s Global Health Institute, and his colleagues came up with a much more modest number for what’s acceptable: 900,000 a day. Their model begins with the idea that everyone with even mild symptoms of influenza-like illness should be tested. Jha’s best guess at the moment is that there are probably about 100,000 new cases of C19 throughout the country every day. Assuming that perhaps about 20% of those people won’t show symptoms, then that’s 80,000 who need to be tested. Plus, each positive case is estimated to have about 10 contacts who ought to be identified and tested. Plug in a host of other variables (like the rate of new infections and the impact of reopenings), and you get a minimum of 900,000 tests a day.
- “I would take 30 million tests if we had it,” says Jha. “I think 3 to 5 million would be great—I think that’s an ideal range. But 900,000, we think, is a minimum we need to aim for.”
- So why isn’t the US isn’t meeting this number? In the early stages of the pandemic, the system simply couldn’t meet the demand. People who did not have clear symptoms of a moderate or severe infection were often turned away from testing. By the end of April, the country was still running under 300,000 tests a day, according to the Covid Tracking Project.
- Nowadays larger labs around the country have acquired more equipment and resources necessary to run many more covid diagnostic tests, and many smaller labs have pivoted to focus entirely on covid testing. And yet, as the Washington Post found, a state like Utah is running only a third of the 9,000 tests it could run every day. In California, Governor Gavin Newsom has admitted that the state could test 100,000 people a day but is using only 40% of that capacity. The Boston Globe reported a few weeks ago that Massachusetts had the potential to process 30,000 tests a day but was averaging less than one-third of that. Thousands of tests in Oregon, Los Angeles, Texas, and elsewhere go unused every day. The US could immediately do hundreds of thousands more tests if so inclined. So why isn’t it?
- “We’re still operating on the mindset of a testing scarcity,” says Jha. Though capacity has improved, he notes, most states either haven’t eased up restrictions against testing people with mild or no symptoms, or haven’t encouraged more of those people to seek testing. Instead, many communities have simply elected to open their economies back up—even New York City, the epicenter of the pandemic in North America. The US is now seeing a surge of new cases.
- Not every health expert is gung-ho about mass testing. Michael Hochman, a physician at the Keck School of Medicine of the University of Southern California, thinks we could get by with the current level of 500,000 a day. He wrote an op-ed in Stat last month arguing that there are some downsides to mass testing, including the cost, the potential for infection to spread at testing sites themselves, and the concerning prospect of false negatives. He would prefer to limit testing to the symptomatic, and instead have communities maintain a greater focus on simpler day-to-day habits like social distancing, wearing face masks, washing hands frequently, and keeping surfaces clean. Places that have managed the virus well, like South Korea, Taiwan, Japan, Iceland, and Hong Kong, have had successful testing programs, but he thinks the reason they’re now able to open up their economies more widely has more to do with how they made face masks the norm.
- Michael Mina, an epidemiologist at Harvard University, says we certainly need more testing, but he adds that viral testing is most important at the beginning of a pandemic, when cases are spiking and it’s critical to find and isolate those who are infected. Later on, he says, “we don’t necessarily want to be testing everyone if viral presence is low.” That’s when serological testing, which looks for the presence of antibodies indicating a previous infection, can provide a better sense of how the epidemic is trending in a community in the long run and whether it’s safe to open things up again. Mina also suggests that the additional testing capacity will be more valuable in the fall, when an expected second wave of infections hits the US.
- But even if you think current testing levels are fine for now, there’s an argument to be made that we’re wasting this untapped capacity if we just wait until the second wave hits.
Rethinking the role of testing
- Kiessling is one researcher who has seen how testing facilities are being underutilized. Every Tuesday for the last six weeks, the First Parish Unitarian Church in Bedford, Massachusetts, hosts a C19 testing clinic administered by her lab. As a local lab with a smaller operation, Kiessling believed she and her team at BRF would be able to return test results to people in under 48 hours, versus the 7 to 14 days many people around the country have been forced to wait.
- Early on, the testing site was getting upwards of 100 people. Numbers have since decreased bit by bit. When I went, on June 16, only 30 people were registered, and a few didn’t even show up. At full capacity, the lab could be running 200 tests a day, but it rarely meets those limits these days.
- Why have numbers plummeted so drastically? “We don’t really know why,” says Ryan Kiessling, BRF’s operations manager. “It seems to be fatigue.” That’s probably a pretty good theory.
- According to a Gallup poll this month, many Americans think the situation in the US is getting better. With more businesses and more recreation areas like beaches opening up again, people are more willing to let their guard down and abandon the wearying habits they’ve kept up for several months: they are increasingly resuming regular activities, and the number of Americans practicing isolation dropped from 75% to 58% in May. And that also means they may view testing with diminished importance. “People are just feeling really tired about anything that has to do with covid at this point,” he says. “They just want it to be over, even though it’s not.”
- It’s easy to understand that people want to go back outside. It might also be easier to accept if we were taking advantage of all the testing capacity at our disposal. Ann Kiessling thinks we could test people regularly (at least every 14 days) to ensure they’re safe to go back to work or school, and get results fast enough to isolate them immediately if it turns out they’re infected.
- This isn’t exactly a brand-new idea—many employers are already looking into mandatory regular testing for employees to open offices back up. But she wants to take this idea a step further, and use testing as a means to soften social distancing rules in certain situations.
- For example, let’s say a school or day-care center wants to reopen. It’s going to be extremely difficult to maintain stringent social distancing in these types of settings. But one solution could be to mandate that all employees and all children enrolled be tested regularly (perhaps multiple times a week) and rigorously monitored for any potential symptoms. This could make it possible to safely open these places back up. And it could be accomplished with all the extra testing capacity sitting idle right now.
- If done carefully, such a plan could work in offices too. Social distancing is very important to stopping the spread of the virus, and we don’t want to ease those requirements on a whim. But, says Kiessling, if you’re working with a small group of the same people, and your job doesn’t require you to interact face to face with strangers, regular testing might lower the level of risk to a point you and your coworkers find acceptable.
- But the Massachusetts health department and the state’s local boards of health have not revised their guidelines to make testing part of the strategy for reopening businesses or schools. Kiessling says she’s brought it up quite a few times with state and local health officials, especially at the behest of several businesses that simply can’t operate under current social distancing requirements—to no avail. Officials simply seem uninterested in trying to expand the role of testing. “It’s stupid,” she says.
- Rethinking how we use excess testing capacity might be a moot point in a few months anyway: when the weather gets colder, the virus is expected to hit hard again, and many areas could be overwhelmed as they were in March and April. The system could be pushed to its limits once more.
- Jha suggests that if capacity becomes scarce again, we could stretch it out with strategies like pooling, in which test samples from multiple individuals are processed as a single assay: if it’s positive you have to go back and retest the samples one by one to see who’s infected, but if it comes out negative, you can rule out infection for many people all at once. Ultimately, though, he is concerned. “If we’re really stuck at testing numbers of around 400,000 to 500,000 a day,” he says, “it’s going to be very hard for us to do anything useful in terms of keeping this virus under control.”
3. Scientists at DHS labs are uncovering the secrets of coronavirus
- Within the Department of Homeland Security’s research and development arm, the age-old mission to secure and protect people has grown amid the coronavirus to include doing the most good and doing it for the world’s good.
- The Science and Technology Directorate arm, or S&T, of the DHS is not like its other agencies that focus on immigration, border operations, or cybersecurity. Its five labs scattered across the United States, as well as contract private sector partners, study chemical, explosives, radiological, and food supply issues that could affect the department’s quarter of a million employees, as well as 800,000 local, state, tribal, and territorial law enforcement officers.
- It was January when staff at one of the labs, the National Biodefense Analysis and Countermeasures Center at Maryland’s Fort Detrick, were told to put their normal assignments away and focus solely on the coronavirus that was pelting China. While the private sector was shifting resources to come up with a vaccine, S&T pivoted to researching other aspects of the virus, as it did during the anthrax threat in the early 2000s and Ebola outbreak in 2014.
- “We’re not doing research for the sake of answering questions. We’re interested in doing science because there is application — there is a need,” said general biological scientist Dr. Lloyd Hough, the lead for S&T’s Hazard Awareness & Characterization Technology Center and head of Probabilistic Analysis for National Threats Hazards and Risks.
- Hough told the Washington Examiner that his team started by creating an internal document that listed the 15 biggest questions about the virus, as well as known answers to some of those questions. They picked three questions that had not been answered by the scientific and medical community and chose to study these specific issues because of their relevance to the DHS workforce and potential to help billions of people worldwide who have been affected by the pandemic. The government’s top scientists began looking at how temperature and humidity affect the virus’s ability to remain in the air and on surfaces and at ways to get rid of it.
- “The research that they’re doing is really applicable to not just the folks within DHS, not just the law enforcement officials, or the policymakers — this is really something that everyday Americans can benefit from,” said Anne Cutler, a spokeswoman for S&T.
- The air and surface studies both commenced in February. Scientists inserted coronavirus particles into synthetic saliva and phlegm, then placed it onto surfaces or blasted it into the air, similar to how a person would cough. They learned humid, hot environments made it harder for the virus to multiply and that such a setting helped kill it. John Verrico, a spokesman for S&T, said findings like those had big benefits for all people, not just federal workers.
- “If sunlight kills the virus in a matter of minutes, you might want to grab a shopping cart outside rather than one that’s in the store,” said Verrico.
- With a better understanding of what settings the virus could not thrive in, Hough instructed his team to focus on decontamination, due to the national shortage of masks, as well as the complicated and expensive means by which they must be sterilized. The CDC recommended the use of germicidal lights and vaporous hydrogen peroxide for cleaning N95 masks, which Hough said are not easy for most people to purchase or use.
- Knowing that moist heat made it hard for the virus to survive, the scientists looked at easier ways to use heat and steam against it. The solution, scientists found, was the multicooker, a kitchen appliance that, in recent years, has become the in-gadget for cooking food.
- “It’s an easy to access device. They’re not very expensive, and we were looking for something like that,” said Hough.
- The multicooker should be set at 149 degrees Fahrenheit, which is the hottest moist heat N95 masks can be in without melting. The mask is put in a brown paper bag, placed in a half-inch of water, and put into the multicooker for 30 minutes for sterilization.
- “We can use this in small offices. It doesn’t necessarily have to be limited to DHS, but individuals who have access to and are wearing N95 masks,” Hough said. “It could be first responders, it could be a paramedic unit, it could be a Border Patrol station where they could have access to buy a multicooker, to buy the brown paper bags, and be able to decontaminate these masks.”
- The air, surface, and multicooker findings were published in scientific journals and have been viewed widely since the findings were released in May and June, Cutler said.
- Hough’s team will continue studying these specific issues, especially as U.S. cases tick up, hoping to give not just Americans, but the world, practical solutions to defeating an invisible enemy.
H. Pandemic Economy
1. Virus Plus Unrest Equals NYC Real Estate Collapse
- It reads like the script for the business version of a disaster movie: office buildings lose 40% of their value, a third of hotels go bankrupt, residential rents plummet. Yet that, according to Barry Sternlicht, is the real-life future for New York real estate.
- The coronavirus pandemic has left New York at a “tipping point,” Sternlicht, the billionaire founder of Starwood Capital Group, said in a Bloomberg “Front Row” interview. Having suffered the country’s worst outbreak, then watched as businesses were looted during unrest in late May, New Yorkers are re-evaluating the city’s density, run-down infrastructure and high cost of living. Some families have already left.
- But there’s more to his thesis than the virus. Sternlicht blames a “blue state” mentality that favors organized labor and sees taxing the well-off as the best way to close budget gaps. He himself is one of several finance titans who left the New York area to take up residence in Miami, largely because of the lower tax burden.
- “If they raise taxes, more people leave and the social burden of those that are less fortunate falls on an ever-smaller revenue base,” he said. “The services of the city get worse, the city gets dirtier, the police show up less often. It’s a negative cycle.”
- New York has been counted out before. In the 1970s, it almost went bankrupt after President Gerald Ford denied the city federal aid. New York bounced back after the Sept. 11, 2001, terrorist attacks leveled the World Trade Center, and again after the financial crisis wiped out some 100,000 jobs in the city and almost $3 billion of tax revenue.
- As Sternlicht sees it, this time is different. So long as there’s no C19 vaccine and the virus is spreading, big city tourism, sports and events such as conventions will be largely on hold. While Starwood, which has some $60 billion in assets, can withstand the hit to its 1 Hotel locations near Central Park and on the Brooklyn waterfront, as well as to its Baccarat Hotel New York in midtown Manhattan, many other property owners can’t.
- “I think a quarter, a third of hotels in New York City could go bankrupt,” Sternlicht said. “It’s going to be ugly. You tell me when big businesses are going to force their clients or customers or employees to go to a group meeting in Vegas or in New Orleans or in Orlando.”
- It’s not that Sternlicht is down on all real estate, and some of Starwood’s properties are holding up comparatively well. Tenants in its 80,000 apartment units nationwide are mostly paying rent on time, and hotels in drive-to markets such as Miami are still attracting guests. Also, unemployment is likely to decline, he said, with people returning to work.
- Malls are one exception, with C19 intensifying the damage already done by Amazon.com Inc. At the same time, tenants that consistently draw shoppers in person, such as Apple Inc.’s stores, are turning the tables on their landlords by suggesting they get paid to locate or stay in a given mall, Sternlicht said.
- “It’s very hard to value these assets, and it’s going to be a long time before that landscape has reached equilibrium,” he said. “Amazon was a pandemic to retail.”
- As dismal as that sounds, Sternlicht has an even gloomier view for New York office buildings. Demand from tech companies such as Amazon and Facebook Inc., both of which secured new space during the pandemic, will disappear if millennials don’t want to live in the city — and they don’t, he said.
- WeWork, which became New York’s largest tenant in 2018, is shrinking its footprint globally. Wall Street chiefs are talking openly about needing less overall real estate or opening offices in the suburbs so employees who live there and are fearful of catching the virus don’t have to ride trains, buses or the subway.
- The result may be the city’s biggest real estate slump in at least three decades. According to Cushman & Wakefield data going back to 1990, Manhattan rents haven’t fallen by more than 20% in a single year.
- “Rents could drop 25% in New York — office rents. I think expenses could go up 25%. You could see office values drop 40% because of that,” Sternlicht said. “It’s probably going to be the toughest office market in the country.”
- And if jobs move elsewhere, the residential market will collapse too. Landlords are “desperate” to retain young tenants and increasingly willing to cut apartment rents by as much as 25%, Sternlicht said.
- That’s where his “negative cycle” kicks in. As New York’s income base erodes and strains on social programs and infrastructure intensify, he predicted that quality of life will deteriorate, more wealthy residents will leave and tax rates will inevitably increase on those who remain.
- In April and May, New York had the largest percentage of residents looking for homes to buy in other metro areas, according to data released Thursday by real estate brokerage Redfin Corp. The top search destination for New Yorkers on Redfin’s platform was Atlanta.
- Starwood Capital has been investing in so-called red states with Republican governors, such as Florida, Texas and Tennessee, Sternlicht said, because they have growing populations, companies are relocating there and the non-union construction costs are much lower than in blue states run by Democrats.
- “I don’t think you can make New York miserable for the affluent and expect it to be successful for everyone,” Sternlicht said. “There are other incredible places in the country — or they will be incredible when all the New Yorkers populate them.”
1. Lockdowns May Temporarily Contain the Virus, But Won’t Prevent It From Returning
- After 3 months of non-stop controversy, Sweden’s top epidemiologist is about to go on vacation.
- Anders Tegnell is unlikely to stray far from home, after much of the European Union excluded Sweden from safe travel lists. His decision to advise against a Swedish lockdown has coincided with one of the world’s highest C19 mortality rates. But Tegnell insists Sweden’s strategy remains widely misunderstood.
- Over the past week, the epidemiologist has made headlines by lashing out at the World Health Organization and labeling as “mad” countries that opted for strict lockdowns.
- Throughout it all, Tegnell has argued that the world is only in the first stage of dealing with a long, uncertain battle with C19. That’s why Sweden’s strategy — keep much of society open, but train people to observe distancing guidelines — is the only realistic way to cope in the long run, he says.
- “I’m looking forward to a more serious evaluation of our work than has been made so far,” Tegnell said in a podcast published by Swedish public radio. “There is no way of knowing how this ends.”
- On Friday, Tegnell won a very public victory against the WHO, after lambasting the organization for making a “total mistake.” The WHO named Sweden on a list of 11 European countries where it said “accelerated transmission has led to very significant resurgence that, if left unchecked, will push health systems to the brink.”
- While Sweden remains on the list available on the WHO’s website, the organization has amended its assessment, and said Swedish contagion rates are in fact “stable.” It linked the high number of cases to an increase in testing.
- William Hanage, associate professor of epidemiology at Harvard’s School of Public Health in Boston, said “Sweden’s policy is unusual in that it took a much less stringent approach to preventing transmission, but interestingly it implemented those measures at a very early stage in the pandemic, before large amounts of community spread had occurred.”
- “Sweden’s approach may be sustainable in ways other countries’ have not proven to be,” according to Hanage. “It should be noted that lockdowns are a response to an imminent surge into health care, with the goal of stopping as many transmission chains as quickly as possible. The full accounting will only be possible after the pandemic.”
- But the Swedish approach has come at a cost, and its death toll per 100,000 is now five times that in neighboring Denmark, according to Johns Hopkins University data. The strict lockdown the Danes imposed in mid-March has since been wound back after the virus was ostensibly brought under control.
- In Sweden, it is “bluntly not clear how the vulnerable are expected to be protected,” Hanage said. “Once you get a very large outbreak in one age group, it becomes more difficult to protect others.” It’s a scenario that has played out bleakly in Sweden’s nursing homes, where the death rate has been brutally high, prompting at least one criminal investigation.
- In an interview with Dagens Nyheter, Tegnell said he’s not sure he would have imposed a stricter lockdown in Sweden with the benefit of hindsight, seeming to walk back a view he has previously articulated.
- “Maybe. I don’t know,” he said. “But you have to consider whether there are other tools that work just as well.”
- Tegnell’s main concern is that strict lockdowns may temporarily contain the virus, but won’t prevent it from returning. He also says lockdowns come at an avoidable cost.
- “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.” He lists domestic abuse, loneliness and mass unemployment.
- In its emailed comment on Friday, the WHO said “there are several very positive trends in Sweden, notably, a continued decrease in new cases presenting with severe disease, a gradual decrease in patients admitted into intensive care since April, and continued decreasing numbers of new C19 deaths.”
- “Sweden has involved the community in the response, and has been able to keep transmission to levels that can be managed by the Swedish health system,” the organization said.
- Ultimately, it’s too early to know which model is the smartest when dealing with the current pandemic.
- “Sweden’s approach has been widely misrepresented as doing nothing. It’s not,” Hanage said. “Given a starting point in which it has been decided an outbreak is inevitable, the question becomes how to mitigate it and preserve health care, and the earlier on in the outbreak you take action to slow transmission, the less intense that action needs to be — initially.”
- “Sweden’s strategy, in that sense, has been smarter than those countries’ that encouraged transmission until shutdowns became necessary,” Hanage said. “However, it has come at a great cost in terms of mortality in vulnerable groups…It also needs to be flexible and responsive; if a surge is building, you need to be able to detect it and know what you will do to avert it.”
- “As for the overall outcome,” Hanage said, “time will tell.”
K. Johns Hopkins C19 Update
June 29, 2020
1. Global Report: Cases & Trends
- The WHO C19 Situation Report for June 28 reports 9.84 million cases (189,077 new) and 495,760 deaths (4,612 new). This is the highest daily incidence reported to date, and the global totals could surpass 10 million cases and 500,000 deaths in today’s Situation Report. The pandemic continues its acceleration.
India, Pakistan & Bangladesh
- India reported 19,459 new cases, its second highest daily incidence to date. This slight decrease from its record high the previous day is consistent with India’s recent reporting trend, and we expect India to report increasing incidence as the week continues. India’s daily incidence has essentially doubled since June 11, and its epidemic continues to accelerate. India is currently #3 globally in terms of daily incidence.
- Pakistan reported 3,557 new cases. This is elevated compared to late last week, but it is still considerably lower than its June 13 peak (6,825 new cases). Pakistan is now #12 globally in terms of daily incidence and continues to fall down the list.
- Following several days of slightly lower daily incidence, Bangladesh reported 4,014 new cases, its highest daily incidence to date. Bangladesh has reported 4 of its 7 highest daily totals over the past 5 days. Bangladesh remains at #9 globally in terms of daily incidence.
- Brazil reported 30,476 new cases. While this is fewer new daily cases than were reported over the weekend, it is considerably higher than early week reports in previous weeks. We expect Brazil to report increasing incidence in the coming days. Brazil is currently #2 globally in terms of daily incidence. Daily incidence in both Brazil and the United States are increasing, and both are reporting nearly double the daily incidence as India.
Central & South America
- Mexico has reported decreasing daily incidence for 3 consecutive days; however, Mexico does not yet appear to have reached its peak. Based on recent trends, we expect Mexico to report increasing daily incidence over the coming days. Mexico is currently #6 globally in terms of daily incidence. Broadly, the Central and South American regions are still a major C19 hotspot. Including Brazil and Mexico, the region represents 5 of the top 11 countries globally in terms of daily incidence, including:
Eastern Mediterranean Region
- Overall, the Eastern Mediterranean Region remains a global hotspot as well, representing 5 of the top 10 countries in terms of per capita incidence: Bahrain (#1), Qatar (#2), Oman (#4), Kuwait (#8), and Saudi Arabia (#10). Additionally, nearby Armenia is #5. Notably, Bahrain overtook Qatar as #1 globally in terms of per capita daily incidence. Qatar’s per capita daily incidence has decreased by nearly 60% since May 31. The region also includes several notable countries in terms of total daily incidence. In addition to Pakistan, Saudi Arabia is #11, Iran is #13, and several other countries in the region are reporting more than 1,000 new cases per day.
- South Africa is among the top countries globally in terms of both per capita (#11) and total daily incidence (#5). South Africa reported its 5 highest daily incidence over the past 5 days, and its daily incidence has nearly doubled since June 19.
- The US CDC reported 2.50 million total cases (44,703 new) and 125,484 deaths (508 new). The CDC reported the United States’ 2 highest daily totals over the past 2 days, and 4 of the top 5 over the past 4 days.
- In total, 19 states (increase of 1) and New York City reported more than 40,000 total cases, including California and New York City with more than 200,000; New Jersey and New York state with more than 170,000; and Florida, Illinois, and Texas with more than 130,000.
- Following an overall decrease in daily incidence from mid-April through the end of May, the United States’ national C19 incidence is clearly increasing. The United States’ daily incidence has nearly doubled since June 9, up from 20,338 new cases per day to 38,006 (7-day average).
- The Johns Hopkins CSSE dashboard reported 2.56 million US cases and 125,927 deaths as of 12:30pm on June 29.
2. US Epidemic & Response
- Numerous US states have begun to slow reopening or reverse course by suspending efforts to progress through recovery plans or re-instituting previously lifted policies and strengthening statewide or local restrictions in order to mitigate community transmission risk and ensure sufficient health system capacity.
- Following weeks of increasing C19 incidence, hospitalizations, and test positivity, Florida Governor Ron DeSantis issued an executive order reversing some recent efforts to ease social distancing restrictions. Notably, the order, issued on Friday, prohibits on-site consumption of alcohol at bars statewide, which some state officials have blamed for statewide increases in transmission. Florida has reported its 6 highest daily case counts over the past 6 days, including its record of 9,557 on June 26. The Florida Department of Health only reports current C19 hospitalizations (as opposed to providing a longer-term display); however, the Florida Agency for Health Care Administration indicates that 23.2% of the state’s adult intensive care unit (ICU) beds are available as of today, which would rank it #48, ahead of only Rhode Island and Arizona—according to analysis by COVID Exit Strategy. In terms of testing, Florida’s positivity increased from 2% for the week of May 17 to 11.7% last week, and it is currently 15.5%, according to the Johns Hopkins SARS-CoV-2 testing dashboard. Like Texas last week, reinstituting social distancing restrictions represents a major shift for Florida, which implemented restrictions later than many states and began lifting them earlier and more aggressively than many states. While Florida reported promising C19 trends for several weeks, health officials and experts warned that increased social interaction could facilitate increased community transmission.
- Florida continued to ease social distancing, even in the midst of increasing transmission. Florida’s daily incidence (7-day average) climbed from 584 new cases per day on May 11 to 876 on June 3 (50% increase), when Florida entered Phase 2 of its recovery plan. Notably, testing inherently lags behind infection, on the order of several weeks for C19. From there, Florida’s daily incidence doubled by June 15 and again by June 24—and it is on pace to double again in the next day or so. It could potentially take several weeks before we begin to observe any effects of the newest order on Florida’s C19 epidemic.
3. US C19 Mortality
- In addition to Florida, Texas and California also closed bars either statewide or in high-risk areas. Some believe that bars can be epicenters of community transmission, particularly among younger individuals. The United States continues to report decreasing C19 deaths, but health experts warn that increasing C19 mortality could be coming in the near future. As we covered previously, the age distribution of recent C19 cases in the United States is shifting toward younger individuals, particularly in areas that are reporting surges in incidence. While younger individuals are at lower risk for severe disease and death, there is concern that increased transmission among younger, healthier portions of the community could drive increased transmission among higher-risk parts of the community.
- Additionally, increased hospitalizations place additional burden on hospitals and health systems, which could affect the quality of care patients may receive. This was a major challenge in areas affected severely early in the pandemic, including New York, northern Italy, and Wuhan, China.
- Increased hospitalizations are stressing health system capacity in some affected areas in the United States, including Texas and Arizona, which could potentially limit care available to some patients and contribute to increased mortality as patient surge continues and worsens.
- Reported C19 deaths also tend to lag several weeks behind trends in incidence, because it takes time for patients to progress through the various stages of disease. Dr. Anthony Fauci recently highlighted this issue, noting in his testimony to the US Congress that he expects to see increased C19 deaths in the coming weeks commensurate with the increased incidence we are currently observing.
4. China Vaccine
- The Chinese military reportedly received authorization to administer a SARS-CoV-2 vaccine candidate to service members. The vaccine, Ad5-nCoV, was developed as a collaboration between CanSino Biologics and the People’s Liberation Army, and it uses an adenovirus-based delivery mechanism. The vaccine has previously demonstrated safety and the ability to induce a protective immune response against SARS-CoV-2 in humans.
- Researchers previously published Phase 1 clinical trial data in The Lancet. The data also included preliminary efficacy data, which showed that the vaccine induced an immune response in some individuals. Approximately half of the study participants had pre-existing immunity to the adenovirus strain used in the vaccine, however, which may have “dampened” their immune response.
- Other vaccine development efforts have moved away from this particular strain of adenovirus due to high levels of exposure, potentially 70% or more in some populations. This new authorization is limited to Chinese military service members only, and it does not apply to the general public, healthcare workers, or others. Further study is necessary to better characterize the immune response associated with this vaccine.
5. Pooled Testing
- As the United States and other countries look ahead to more fully relaxing social distancing measures, testing capacity is a critical barrier to proceeding with these plans. Pool testing, a method of testing patients for SARS-CoV-2 as a group instead of as individuals, is one potential option to dramatically increase testing capacity. Pool testing combines samples from multiple individuals in order to reduce the amount of testing materials needed to conduct tests (compared to multiple individual tests) and return results to individuals more quickly. If the pooled sample tests negative, then it can be assumed that nobody in that pool is infected, and no further testing is necessary. If a sample is positive, then each person in that pool can be tested individually to determine who among them is infected. In low prevalence settings, pooling the samples can reduce the overall tests performed.
- Dr. Deborah Birx, the White House Coronavirus Response Coordinator, stated that the method could increase testing capacity by 900%, which would enable the United States to conduct 5 million tests per day.
- The US FDA is working to validate pooled sample techniques. A study published in The Journal of the American Medical Association: Network Open illustrates the potential benefits of pooled testing, particularly if disease prevalence in the test population is less than 30%.
- The authors warn that false negatives could increase due to pooled sampling techniques due to diluting positive samples with multiple negative samples, so test characteristics and processes could be closely selected and monitored.
6. C19 Clinical Manifestations
- Clinicians and researchers continue to study the clinical manifestations of C19. A study published in The Lancet: Psychiatry discusses the neurological and neuropsychiatric complications of 153 C19 cases in the United Kingdom. A review of existing peer-reviewed literature regarding neurological or psychiatric manifestations of C19 yielded only small case studies or studies utilizing vague descriptions of symptoms such as “dizziness” or “headache.”
- Surveillance of UK patients, collected retrospectively, provided more detailed data across a larger study population. The researchers identified a range of neurological presentations, including cerebrovascular events (e.g., ischaemic stroke, intracerebral hemorrhage); altered mental status, including patients with encephalopathy or encephalitis and patients with presentation of psychiatric conditions (e.g., dementia-like symptoms) after their C19 diagnosis.
- STAT News published an overview of efforts to better understand non-respiratory symptoms of C19. SARS-CoV-2 binds to ACE2 receptors in order to enter human cells, which could potentially account for the virus’ effects throughout the body. ACE2 receptors are present on a variety of cell types, including blood vessels, kidneys, the gastrointestinal tract, and “even in the testes.” Effects on blood vessels could impact blood flow and clot formation, which could potentially explain a variety of complications, including “COVID toe,” painful swelling and redness in the toes of some C19 patients.
- The Access to C19 Tools Accelerator (ACT-Accelerator) is a global effort—unveiled in April by the WHO, France, the European Commission, and the Bill and Melinda Gates Foundation—that aims to facilitate rapid development and global equitable access to new tools to combat C19.
- On Friday, ACT-Accelerator published its “investment case,” which outlines timelines and priorities for investment. The plan calls for US$31.3 billion in investments, distributed across 3 primary pillars—vaccines (US$18.1 billion), therapeutics (US$7.2 billion), and diagnostics (US$6 billion)—over the next 12-18 months. So far, a total of US$3.4 billion has been donated, leaving US$27.9 billion remaining, US$13.7 billion “to cover immediate needs” over the next 6 months.
- This plan would aim to provide 500 million diagnostic tests, 245 treatment courses, and 2 billion vaccines by 2021, much of which will be allocated to low-and-middle-income countries. Notably, the plan to provide 2 billion doses of vaccine relies on donations of 950 million doses by upper middle- and high-income countries that are capable of purchasing their own vaccine, through the Gavi Advance Market Commitment for C19 Vaccines facility. In addition to the 3 primary pillars, a fourth pillar is directed at strengthening health system capacity, including training and personal protective equipment management, but the proposed budget for these activities is still under development.
L. Links to Other Scientific & Notable Stories
- Covid-19: Oxford team begins vaccine trials in Brazil and South Africa to determine efficacy
- This coronavirus mutation has taken over the world. Scientists are trying to understand why.
- CanSino’s COVID-19 vaccine candidate approved for military use in China
- Diabetes drug combats some severe C19 symptoms in women
- Experts Identify Steps to Expand and Improve Antibody Tests in COVID-19 Response
- Experts are calling for a 9/11-style commission on U.S. coronavirus response. Here’s where it could start
- Don’t fear a coronavirus spike — wear your mask and watch the real measures
- Three Months In, Many Americans See Exaggeration, Conspiracy Theories and Partisanship in COVID-19 News