Coronavirus Update

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Coronavirus Update 7-7

Recent Developments & Information 

July 7, 2020

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

“Anybody who thinks that it has become more mild or gone away or that somehow the problem’s going to solve itself is kidding themselves.  It’s still a very lethal virus, it still infects people very, very readily.  And I think humanity isn’t used to dealing with those realities.” 

Danny Altmann, Professor of Immunology, Imperial College London

“When people talk or laugh, they create an “invisible mist” or a “droplet cloud” of tiny particles that floats around near their head. That fog can hold enough virus to transmit the disease; walking into it is akin to someone spitting on your face.” 

Donald G. McNeil Jr., New York Times Science Reporter

“Evidence is also mounting that Covid-19 is more of a blood vessel disease than a respiratory disease. While the virus enters the body through the lungs, it seems to do its damage by attaching to the insides of blood vessels, infecting organs, like the kidneys and the brain, with lots of fine blood vessels.”  

Donald G. McNeil Jr., New York Times Science Reporter

Index

A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
C. Hotspots

1. Top 5 States in Deaths & Cases (7/6) 

D. Assessing Risk

1. These activities put you most at risk of getting C19 

E. New Scientific Findings & Research

1. Four promising antiviral drug candidates identified  

2. Researchers identify multiple molecules that shut down coronavirus polymerase reaction  

3. “Targeting peptide” discovery offers hope as new, highly effective anti-inflammatory  

4. Cell ‘membrane on a chip’ could speed up screening of drugs for C19 

5. Coronavirus can live for 4 days on animal skin 

6. Scientists rule out asthma as trigger for C19 severity  

F. Potential Treatments

  1. Antibody cocktail entering late-stage clinical trials  

G. Concerns & Unknowns

1. Immunity to coronavirus is fragile and short-lived   (!)

2. Herd Immunity May Be Unachievable   (!)

3. A ‘mild’ case of C19 can be much worse than you think  

H. Projections & Our (Possible) Future

1. Americans will be wearing masks for ‘several years’  

I. Back to School!? 

1. We Have to Focus on Opening Schools, Not Bars  

J. Pandemic Economy

1. Five charts tracking the U.S. economy amid the coronavirus pandemic  

K. Johns Hopkins COVID-19 Update
L. Links to Other Stories

A. The Pandemic As Seen Through Headlines

(In no particular order)

B. Numbers & Trends

Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day.  Green highlights indicate a decrease or no change and yellow highlights indicate an increase. 

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

1. Cases & Tests

Worldwide Cases:  
  • Total Cases = 11,732,996 (+1.6%)
  • New Cases = 171,548 (-6,800)
  • Growth Rate of New Cases (7 day average) = 0.8% (-0.3%)
  • New Cases (7 day average) = 191,671 (+1,494)
Observations:
  • Number of new cases have declined for 3 consecutive days 
  • 7 day average growth rate in new cases has declined below 1%
  • 7 day average of new cases was a record high on 7/6
US Cases & Testing: 
  • Total Cases = 3,040,833 (+1.9%)
  • New Cases = 50,586 (+4,654)
  • Percentage of New Global Cases = 29.5% (+4.5%)
  • Growth Rate of New Cases (7 day average) = 1.7% (+0.1%)
  • New Cases (7 day average) = 51,364 (+832)
  • Total Number of Tests = 38,217,640 (+616,826)
  • Percentage of positive tests (7 day average) = 7.5% (+0%)
Observations:
  • 7 day average of new cases was a record high on 7/6 (record high for 28 consecutive days) 
  • 3 day average of new cases has declined by 14.1% since 7/3

2. Deaths

Worldwide Deaths: 
  • Total Deaths = 540,137 (+0.7%) 
  • New Deaths = 3,692 (+138)
  • Growth Rate of New Deaths (7 day average) = 0.7% (+0.4%)
  • New Deaths (7 day average) = 4,563 (+31)
Observations:
  • Number of new deaths has decreased for 3 consecutive days
  • 7 day average of new deaths has declined 5.3% since 6/22 (stable)
US Deaths: 
  • Total Deaths = 132,979 (+0.3%)
  • New Deaths = 378 (+116) 
  • Percentage of Global New Deaths = 10.2% (+3.1%)
  • Growth Rate of New Deaths (7 day average) = (+0.3%) 
  • New Deaths (7 day average) = 517 (+1)
Observations:
  • 7 day average of new deaths has declined by 77.1% since 3/21
  • 3 day average of new deaths has declined by 56.7% since 7/2

C. US Hotspots

1. Top 5 States in Deaths & Cases (7/6)

New Cases
  1. Texas   8,598
  2. California   6,491
  3. Florida    6,336
  4. Arizona   3,536

5. North Carolina   1,548

Total 26,509  (53.3% of total new cases)

New Deaths
  1. California     76 
  2. Florida     46
  3. Texas     45
  4. New Jersey     23
  5. New York      19

209 (57.9% of total new deaths)

Highest Deaths Per 1 Million Population 
  1. New Jersey 1,723
  2. New York 1,659
  3. Connecticut 1,217
  4. Massachusetts 1,189
  5. Rhode Island     906
Deaths Per 1 Million Population (Most Populated States)
  1. California     163
  2. Texas       94
  3. Florida     176
  4. New York            1,659
  5. Illinois     571

United States     402

D. Assessing Risk 

1. These activities put you most at risk of getting C19 

  • The Know Your Risk During C19 infographic from the Texas Medical Association is one of many new infographics helping people understand their level of risk when leaving home during the pandemic.
  • Ranked by physician experts from the TMA C19 Task Force and the TMA Committee on Infectious Diseases.
Image

Source: Texas Medical Association

E. New Scientific Findings & Research  

1. Four promising antiviral drug candidates identified  

  • University of South Florida Health (USF Health) Morsani College of Medicine scientists recently worked with colleagues at the University of Arizona College of Pharmacy to identify several existing compounds that block replication of the coronavirus (SARS-CoV-2) within human cells grown in the laboratory. The inhibitors all demonstrated potent chemical and structural interactions with a viral protein critical to the virus’s ability to proliferate.
  • The research team’s drug discovery study appeared June 15 in Cell Research, a high-impact Nature journal.
  • The most promising drug candidates – including the FDA-approved hepatitis C medication boceprevir and an investigational veterinary antiviral drug known as GC-376 – target the coronavirus’ main protease (Mpro), an enzyme that cuts out proteins from a long strand that the virus produces when it invades a human cell. Without Mpro, the virus cannot replicate and infect new cells. This enzyme had already been validated as an antiviral drug target for the original SARS and MERS, both genetically similar to the coronavirus.
  • “With a rapidly emerging infectious disease like C19, we don’t have time to develop new antiviral drugs from scratch,” said Yu Chen, PhD, USF Health associate professor of molecular medicine and a coauthor of the Cell Research paper. “A lot of good drug candidates are already out there as a starting point. But, with new information from studies like ours and current technology, we can help design even better (repurposed) drugs much faster.”
  • Before the pandemic, Dr. Chen applied his expertise in structure-based drug design to help develop inhibitors (drug compounds) that target bacterial enzymes causing resistance to certain commonly prescribed antibiotics such as penicillin. Now his laboratory focuses its advanced techniques, including X-ray crystallography and molecular docking, on looking for ways to stop the coronavirus.
  • Mpro represents an attractive target for drug development against C19 because of the enzyme’s essential role in the life cycle of the coronavirus and the absence of a similar protease in humans, Dr. Chen said. Since people do not have the enzyme, drugs targeting this protein are less likely to cause side effects, he explained.
  • The four leading drug candidates identified by the University of Arizona-USF Health team as the best (most potent and specific) for fighting C19 are described below. These inhibitors rose to the top after screening more than 50 existing protease compounds for potential repurposing:
    • Boceprevir, a drug to treat Hepatitis C, is the only one of the four compounds already approved by the FDA. Its effective dose, safety profile, formulation and how the body processes the drug (pharmacokinetics) are already known, which would greatly speed up the steps needed to get boceprevir to clinical trials for C19, Dr. Chen said.
    • GC-376, an investigational veterinary drug for a deadly strain of coronavirus in cats, which causes feline infectious peritonitis. This agent was the most potent inhibitor of the Mpro enzyme in biochemical tests, Dr. Chen said, but before human trials could begin it would need to be tested in animal models. Dr. Chen and his doctoral student Michael Sacco determined the X-ray crystal structure of GC-376 bound by Mpro, and characterized molecular interactions between the compound and viral enzyme using 3D computer modeling.
    • Calpain inhibitors II and XII, cysteine inhibitors investigated in the past for cancer, neurodegenerative diseases and other conditions, also showed strong antiviral activity. Their ability to dually inhibit both Mpro and calpain/cathepsin protease suggests these compounds may include the added benefit of suppressing drug resistance, the researchers report.
  • All four compounds were superior to other Mpro inhibitors previously identified as suitable to clinically evaluate for treating the coronavirus, Dr. Chen said.
  • A promising drug candidate – one that kills or impairs the virus without destroying healthy cells — fits snugly, into the unique shape of viral protein receptor’s “binding pocket.” GC-376 worked particularly well at conforming to (complementing) the shape of targeted Mpro enzyme binding sites, Dr. Chen said. Using a lock (binding pocket, or receptor) and key (drug) analogy, “GC-376 was by far the key with the best, or tightest, fit,” he added. “Our modeling shows how the inhibitor can mimic the original peptide substrate when it binds to the active site on the surface of the cornavirus main protease.”
  • Instead of promoting the activity of viral enzyme, like the substrate normally does, the inhibitor significantly decreases the activity of the enzyme that helps the coronairus make copies of itself.
  • Visualizing 3-D interactions between the antiviral compounds and the viral protein provides a clearer understanding of how the Mpro complex works and, in the long-term, can lead to the design of new C19 drugs, Dr. Chen said. 
  • In the meantime, he added, researchers focus on getting targeted antiviral treatments to the frontlines more quickly by tweaking existing coronavirus drug candidates to improve their stability and performance.

Source: Compounds halt SARS-CoV-2 replication by targeting key viral enzyme

2. Researchers identify multiple molecules that shut down coronavirus polymerase reaction  

  • The coronavirus uses a protein called polymerase to replicate its genome inside infected human cells. Terminating the polymerase reaction will stop the growth of the coronavirus, leading to its eradication by the human host’s immune system.
  • Researchers at Columbia Engineering and the University of Wisconsin-Madison have identified a library of molecules that shut down the coronavirus polymerase reaction, a key step that establishes the potential of these molecules as lead compounds to be further modified for the development of C19 therapeutics. Five of these molecules are already FDA-approved for use in the treatment of other viral infections including HIV/AIDS, cytomegalovirus, and hepatitis B. The new study was published on June 18, 2020, in Antiviral Research.
  • The Columbia team initially reasoned that the active triphosphate of the hepatitis C drug sofosbuvir and its derivative could act as a potential inhibitor of the cornavirus polymerase based on the analysis of their molecular properties and the replication requirements of both the hepatitis C virus and coronaviruses. Led by Jingyue Ju, Samuel Ruben-Peter G. Viele Professor of Engineering, professor of chemical engineering and pharmacology, and director of the Center for Genome Technology & Biomolecular Engineering at Columbia University, they then collaborated with Robert N. Kirchdoerfer, assistant professor of biochemistry and an expert in the study of coronavirus polymerases at University of Wisconsin-Madison’s Institute for Molecular Virology and the department of biochemistry.
  • In an earlier set of experiments testing the properties of the polymerase of the coronavirus that causes SARS, the researchers found that the triphosphate of sofosbuvir was able to terminate the virus polymerase reaction. They then demonstrated that sofosbuvir and four other nucleotide analogues (the active triphosphate forms of the HIV inhibitors Alovudine, Zidovudine, Tenofovir alafenamide, and Emtricitabine) also inhibited the coronavirus polymerase with different levels of efficiency.
  • Using the molecular insight gained in these investigations, the team devised a strategy to select 11 nucleotide analogue molecules with a variety of structural and chemical features as potential inhibitors of the polymerases of SARS-CoV and the coronavirus (SARS-CoV-2). While all 11 molecules tested displayed incorporation, six exhibited immediate termination of the polymerase reaction, two showed delayed termination, and three did not terminate the polymerase reaction.
  • Prodrug medications of five of these nucleotide analogues (Cidofovir, Abacavir, Valganciclovir/Ganciclovir, Stavudine, and Entecavir) that terminate the coronavirus polymerase reaction are FDA-approved for the treatment of other viral infections and their safety profiles are well established. Once the potency of the drugs to inhibit viral replication in cell culture is demonstrated in future investigations, then the candidate molecules and their modified forms may be evaluated for the development of potential C19 therapies.
  • “In our efforts to help tackle this global emergency, we are very hopeful that the structural and chemical features of the molecules we identified, in correlation with their inhibitory activity to the coronavirus polymerase, can be used as a guide to design and synthesize new compounds for the development of C19 therapeutics,” says Ju. 

Source: Researchers identify multiple molecules that shut down SARS-Cov-2 polymerase reaction 

3. “Targeting peptide” discovery offers hope as new, highly effective anti-inflammatory  

  • A collaboration between the University of Toronto’s Faculty of Dentistry and the National Jewish Health in Denver — the top-ranked respiratory research hospital in the U.S. — has yielded a new drug discovery that could be useful to combat inflammation of all varieties and shows promise in fighting acute respiratory illnesses such as C19.
  • Called TAT CARMIL1, the “drug” is actually a combination of two naturally occurring peptides that, when combined, work together to penetrate a cell’s membrane in order to dampen an acute inflammatory response.
  • In this first ex vivo study, the peptide reduced collagen degradation by up to 43%. If deployed early enough, the researchers say, the peptide could allay some of the worst damage caused by acute inflammatory responses.
Dousing Cytokine Storms
  • Acute infections can cause inflammatory responses known as “cytokine storms,” a term that has gained in popularity during the C19 pandemic.
  • This storm is a natural defense response to an acute infection. Cytokines are a type of immune response cell, but when the body becomes overwhelmed by infections such as those caused by influenza, H1N1 or C19, it can release an unregulated flood of cytokines into the body.
  • In those instances, infection-busting cytokines can cause severe damage in the body — everything from holes in the lung tissue to vascular damage and blot clots, with the most acute cases causing death.
Targeted Pathways, Precision Medicine
  • Dr. Greg Downey, pulmonologist, professor and executive vice president, academic affairs in the Department of Medicine at the National Jewish Hospital, who co-authored the study, calls the peptide discovery “exciting.”
  • Here’s how it works: the peptide combines a segment of a naturally occurring protein, CARMIL1, with a peptide “vehicle,” TAT, that brings the CARMIL1 directly into the cell. That enables the CARMIL1 to calm the inflammatory storm. The CARMIL peptide effectively blocks a family of cytokines, called interleukin1, from signalling and reproducing in vast quantities.
  • “There are a lot of people looking at these areas, but this study gives the first indication of how these CARMIL proteins are involved with this pathway,” Downey adds.
  • But what makes the discovery so unique is how precise it is. The TAT CARMIL1 peptide targets two receptors, sticking to both the cell’s surface and its cell substrate, where it adheres to other cells.
  • “The two receptors necessary for it to work supplies an unusual level of specificity,” explains Chris McCulloch, professor at the Faculty of Dentistry and a co-lead of the study. “We think the unusual nature of this pathway might restrict its side effects.”
  • That could make the peptide an unusually strong candidate as a potential drug. Drugs designed to work in conjunction with this peptide would need to target cells at both receptors, narrowing the potential field of candidates from tens of thousands to hundreds.
  • “This is a precise pathway to deal with a precise issue,” says Downey.
The Future is Carmil
  • Next, the team hope to track the peptide’s success in in vitro models. Given the broad applicability of the peptide, which can be combined with other drugs, such as cancer or arthritis drugs, the discovery could one day become a useful ally in the fight against all types of inflammation.
  • Still, Downey cautions, more work needs to be done. The initial study shows that the storm-stopping peptide is most effective when it is applied as an early intervention. That, says Downey, is impractical: “In the clinical world the reality is that you don’t have that luxury.”

Source: https://www.eurekalert.org/pub_releases/2020-07/uot–pd070220.php

4. Cell ‘membrane on a chip’ could speed up screening of drugs for C19 

  • Researchers have developed a human cell ‘membrane on a chip’ that allows continuous monitoring of how drugs and infectious agents interact with our cells, and may soon be used to test potential drug candidates for C19.
  • The researchers, from the University of Cambridge, Cornell University and Stanford University, say their device could mimic any cell type–bacterial, human or even the tough cells walls of plants. Their research recently pivoted to how C19 attacks human cell membranes and, more importantly, how it can be blocked.
  • The devices have been formed on chips while preserving the orientation and functionality of the cell membrane and have been successfully used to monitor the activity of ion channels, a class of protein in human cells which are the target of more than 60% of approved pharmaceuticals. The results are published in two recent papers in Langmuir and ACS Nano.
  • Cell membranes play a central role in biological signalling, controlling everything from pain relief to infection by a virus, acting as the gatekeeper between a cell and the outside world. The team set out to create a sensor that preserves all of the critical aspects of a cell membrane–structure, fluidity, and control over ion movement–without the time-consuming steps needed to keep a cell alive.
  • The device uses an electronic chip to measure any changes in an overlying membrane extracted from a cell, enabling the scientists to safely and easily understand how the cell interacts with the outside world.
  • The device integrates cell membranes with conducting polymer electrodes and transistors. To generate the on-chip membranes, the Cornell team first optimized a process to produce membranes from live cells and then, working with the Cambridge team, coaxed them onto polymeric electrodes in a way that preserved all of their functionality. The hydrated conducting polymers provide a more ‘natural’ environment for cell membranes and allows robust monitoring of membrane function.
  • The Stanford team optimized the polymeric electrodes for monitoring changes in the membranes. The device no longer relies on live cells that are often technically challenging to keep alive and require significant attention, and measurements can last over an extended time period.
  • “Because the membranes are produced from human cells, it’s like having a biopsy of that cell’s surface – we have all the material that would be present including proteins and lipids, but none of the challenges of using live cells,” said Dr Susan Daniel, associate professor of chemical and biomolecular engineering at Cornell and senior author of the Langmuir paper.
  • “This type of screening is typically done by the pharmaceutical industry with live cells, but our device provides an easier alternative,” said Dr Róisín Owens from Cambridge’s Department of Chemical Engineering and Biotechnology, and senior author of the ACS Nano paper. “This method is compatible with high-throughput screening and would reduce the number of false positives making it through into the R&D pipeline.”
  • “The device can be as small as the size of a human cell and easily fabricated in arrays, which allows us to perform multiple measurements at the same time,” said Dr Anna-Maria Pappa, also from Cambridge and joint first author on both papers.
  • To date, the aim of the research, supported by funding from the United States Defense Research Projects Agency (DARPA), has been to demonstrate how viruses such as influenza interact with cells. Now, DARPA has provided additional funding to test the device’s effectiveness in screening for potential drug candidates for C19 in a safe and effective way.
  • Given the significant risks involved to researchers working on the coronavirus, scientists on the project will focus on making virus membranes and fusing those with the chips. The virus membranes are identical to the coronavirus membrane but don’t contain the viral nucleic acid. This way new drugs or antibodies to neutralize the virus spikes that are used to gain entry into the host cell can be identified. This work is expected to get underway on 1 August.
  • “With this device, we are not exposed to risky working environments for combating the coronavirus. The device will speed up the screening of drug candidates and provide answers to questions about how this virus works,” said Dr Han-Yuan Liu, Cornell researcher and joint first author on both papers.
  • Future work will focus on scaling up production of the devices at Stanford and automating the integration of the membranes with the chips, leveraging the fluidics expertise from Stanford PI Juan Santiago who will join the team in August.
  • “This project has merged ideas and concepts from laboratories in the UK, California and New York, and shown a device that works reproducibly in all three sites. It is a great example of the power of integrating biology and materials science in addressing global problems,” said Stanford lead PI Professor Alberto Salleo.

Source: Cell ‘membrane on a chip’ could speed up screening of drug candidates for COVID-19

5. Coronavirus can live for 4 days on animal skin 

  • The novel coronavirus can live for days on animal skin, according to researchers from the biggest US military bioweapons laboratory.
  • In Fort Detrick, Maryland, army researchers tested the virus on the surface of various substances, including uncirculated paper currency supplied by the US Secret Service and unused cotton-polyester fabric, according to a non-peer-reviewed paper posted on the preprint site medRxiv.org on Friday.
  • Read the study here: Modeling the Stability of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on Skin, Currency, and Clothing
  • They found that of the samples, the virus could survive the longest at room temperature on pig skin – up to four days. And it remained stable on the skin in refrigerated temperatures throughout the two-week experiment.
  • The researchers with the United States Army Medical Research Institute of Infectious Diseases said they were concerned that meat plants could help the coronavirus spread.
  • “Without an extensive testing and contract tracing program, transmission around meatpacking plants will likely continue to be an issue,” said the team led by David Harbourt from the base’s biosafety division.
  • The US study followed a surprise outbreak of the coronavirus in Beijing last month. Most of the 300-plus cases of C19 were linked to a food market selling meat and vegetable products from home and abroad. The outbreak led to a partial lockdown of China’s capital and virus testing for more than 10 million residents.
  • Chinese health authorities suspected the virus might have entered the market via imported frozen meat, but they had no direct evidence.
  • Harbourt and his colleagues put Sars-CoV-2 on pig skin and kept the samples at 4 degrees Celsius (39.2 degrees Fahrenheit), the temperature pork is usually kept at in meat packing and processing plants. The viral strains had an average “half-life” – the time it takes for half of the pathogens to die out – of nearly 47 hours. Viable strains remained detectable for as long as two weeks in the chilled conditions.
  • The coronavirus was relatively unstable. It used single-stranded RNA to store genetic information instead of the stronger, double-stranded DNA. But some previous studies found the novel coronavirus could stay longer in the environment than others.
  • “It is likely that any viral shedding from either symptomatic or asymptomatic workers in the absence of appropriate [personal protective equipment] would remain viable for an extended period of time on the surface of meat products or other surfaces,” the researchers said.
  • “Even with extensive cleaning, transmission could still occur in the presence of asymptomatic, undiagnosed workers due to both the enhanced stability of the virus and the high viral loads even asymptomatic cases maintain in the nasal passages.”
  • The Fort Detrick team found that the virus died faster as temperatures rose. Pig skin samples remained positive for four days at room temperature (22 degrees Celsius) and only eight hours in summer heat (37 degrees Celsius).
  • Pig skin resembles human skin and the effects on the two would likely be similar, according to the researchers. So there was “need for continued hand hygiene practices to minimize … transmission both in the general population as well as workplaces where close contact is common”.
  • In the same experiment, the army lab also tested uncirculated one- and 20-dollar bills, finding the virus could stay on the surface of 20-dollar notes for up to a day in room temperature – three times longer than on the one-dollar bill. However the difference was not statistically robust due to limited sample size and required further investigation.
  • “It is possible that differences in ink type, concentration, or both, affected virus stability,” the paper said.
  • The notes came from the US Secret Service, which protects the president, senior government officials and their families. At least eight secret service agents assigned to Vice-President Mike Pence’s team recently tested positive, according to a CNN report on Friday. The researchers did not reveal more details on the Secret Service’s involvement in the study.
  • A Chinese government scientist studying the novel coronavirus in Beijing said that the Ford Detrick study could be “closer to real life” than some previous studies that found the virus could survive on non-organic surfaces such as cardboard for days.
  • Those studies used a high viral load that could be unrealistic in real life settings, said the scientist who requested not to be named due to media policy.

Source: Coronavirus can live for four days on animal skin: US study

6. Scientists rule out asthma as trigger for C19 severity  

  • Asthma does not appear to increase the risk for a person contracting C19 or affect its severity, according to new research.
  • The team from Rutgers University in the US found that people with asthma – even those with diminished lung function who are being treated to manage asthmatic inflammation – seem to be no worse affected by the coronavirus than a non-asthmatic person.
  • “Older age and conditions such as heart disease, high blood pressure, chronic obstructive pulmonary disease, diabetes and obesity are reported risk factors for the development and progression of C19,” said Reynold A. Panettieri Jr, a pulmonary critical care physician and director of the Rutgers Institute for Translational Medicine and Science.
  • However, asthma is not yet proven as one such risk factor.
  • “There is limited data as to why this is the case — if it is physiological or a result of the treatment to manage the inflammation,” said Panettieri Jr in a paper published in the Journal of Allergy and Clinical Immunology.
  • Inhaled corticosteroids, which are commonly used to protect against asthma attacks, also may reduce the virus’ ability to establish an infection.
  • However, studies have shown that steroids may decrease the body’s immune response and worsen the inflammatory response.
  • Children and young adults with asthma suffer mainly from allergic inflammation, while older adults who experience the same type of airway inflammation can also suffer from eosinophilic asthma — a more severe form.
  • In these cases, people experience abnormally high levels of a type of white blood cell that helps the body fight infection, which can cause inflammation in the airways, sinuses, nasal passages and lower respiratory tract, potentially making them more at risk for a serious case of C19.
  • In addition, an enzyme attached to the cell membranes in the lungs, arteries, heart, kidney and intestines that has been shown to be an entry point for the coronavirus into cells is increased in response to the virus.
  • “This enzyme is also thought to be beneficial in clearing other respiratory viruses, especially in children. How this enzyme affects the ability of the coronavirus to infect people with asthma is still unclear,” said the study.
  • However, older people with asthma who also have high blood pressure, diabetes or heart disease may have similar instances of C19 as non-asthmatics with those conditions, the researchers stressed.
  • Future studies should address whether inhaled steroids in patients with asthma or allergies increase or decrease the risks of the coronavirus infection, and whether these effects are different depending on the steroid type.

Source: Coronavirus: Scientists rule out asthma as trigger for Covid-19 severitys

F. Potential Treatments

1. Antibody cocktail entering late-stage clinical trials  

  • An antibody cocktail designed to prevent and treat C19 is now entering late-stage clinical trials, according to reports. 
  • When naturally infected with C19, the body generates Y-shaped molecules called antibodies that latch onto the virus and mark it for destruction, or hinder its ability to infect healthy cells, Live Science previously reported. These antibodies can be drawn from recovered C19 patients and injected into sick patients to bolster their immune systems against the virus, a treatment known as convalescent plasma therapy. 
  • But convalescent plasma therapy has its limitations; plasma donations from different patients contain different mixtures of antibodies, and some antibodies may target C19 more effectively than others, according to a report published in June in the Journal of Clinical Virology. For instance, some antibodies directly prevent the virus from entering cells in the first place — so-called neutralizing antibodies — while others may not prevent infection, but instead direct other immune molecules to destroy infected cells. 
  • To overcome this limitation, and avoid relying on a limited supply of plasma, several drug developers have turned to monoclonal antibodies — antibodies carefully selected for their ability to target specific pathogens, such as the coronavirus, and then mass-produced in a lab.  
  • Now, one such therapy, known as REGN-COV2, has entered Phase 3 clinical trials to evaluate whether the treatment can prevent C19 infection among healthy people who have had close contact with an infected person, such as a housemate, according to ClinicalTrials.gov. In the trial, 2,000 participants at 100 sites across the U.S. will receive either the drug or a placebo, and the results will show how well the drug works compared with the placebo medication, and if there are any safety concerns that pop up, according to a statement from Regeneron Pharmaceuticals, the biotechnology company that developed the drug. The trial will be jointly run with the National Institute of Allergy and Infectious Diseases (NIAID). 
  • REGN-COV2 contains two antibodies that latch onto and help to neutralize the coronavirus, hampering its ability to infect healthy cells, according to the statement. The two antibodies bind to the virus’s spike protein, a structure that juts from the surface of the pathogen and plugs into cells to trigger infection. Regeneron scientists  found the two antibodies by studying genetically modified mice with human-like immune systems and antibodies collected from human C19 patients.
  • The Phase 3 trial will monitor how many participants contract C19 within a month of treatment, using viral genetic tests and evaluations of participants’ symptoms, according to ClinicalTrials.gov. Participants will continue to be monitored for infections, hospitalizations and related medical complications for up to eight months post-treatment, as well as any side effects linked to the drug itself. 
  • While the Phase 3 trial assesses REGN-COV2 as a preventative therapy, the drug will also be tested as a treatment for patients already ill with C19. In two Phase 2/3 clinical trials, one for hospitalized patients and one for non-hospitalized patients, the researchers will assess whether the drug reduces the amount of virus shed by infected individuals and improves clinical outcomes, as compared with a placebo. The Phase 2/3 trials will include 850 hospitalized patients and 1,050 non-hospitalized patients at 150 sites in the U.S., Brazil, Mexico and Chile. 
  • “We are running simultaneous adaptive trials in order to move as quickly as possible to provide a potential solution to prevent and treat C19 infections, even in the midst of an ongoing global pandemic,” Dr. George Yancopoulos, Co-Founder, President and Chief Scientific Officer of Regeneron, said in the statement.
  • If the FDA approves the drug at the end of Phase 3 trials, REGN-COV2 would then move on to the last phase called Phase 4, during which the drug could enter widespread use and its short- and long-term effects would be monitored in thousands of patients.

Source: Coronavirus-fighting antibody cocktail being tested in thousands of people

G. Concerns & Unknowns

1. Immunity to coronavirus is fragile and short-lived  

  • It is not a “safe bet” to rely on immunity to C19 as a strategy for coping with the pandemic, one expert has warned, adding that herd immunity strategies were “probably never going to work.”
  • Speaking Monday on CNBC’s “Squawk Box Europe,” Danny Altmann, professor of immunology at Imperial College London, said that in towns and cities where there had been coronavirus infections, only 10% to 15% of the population was likely to be immune.
  • “And immunity to this thing looks rather fragile — it looks like some people might have antibodies for a few months and then it might wane, so it’s not looking like a safe bet,” he said. “It’s a very deceitful virus and immunity to it is very confusing and rather short-lived.”
  • He also raised questions about the likely success of so-called herd immunity — when a population is allowed some exposure to the virus in order to build immunity among the general population — which has been cited by health officials in Sweden, which controversially avoided a lockdown.
  • Despite a global race to find a vaccine for the coronavirus, experts remain uncertain about whether the antibodies present in people who have had the virus actually provide immunity to reinfection.
  • Top White House health advisor Dr. Anthony Fauci speculated last month that if C19 behaved like other coronaviruses, there “likely isn’t going to be a long duration of immunity” from antibodies or a vaccine. 
  • Meanwhile, the WHO has stated that it remains unclear whether those who have already caught the virus once will be immune to getting it again.
  • Imperial College London’s Altmann said Monday that he was expecting a second wave of C19, and that although governments were much better prepared for a resurgence in infections, the situation remained “very, very scary.”
  • “Anybody who thinks that it has got more mild or gone away or that somehow the problem’s going to solve itself is kidding themselves,” he told CNBC. “It’s still a very lethal virus, it still infects people very, very readily. And I think humanity isn’t used to dealing with those realities.”
  • He also emphasized that it was difficult to make predictions about if or when an effective vaccine for C19 might be identified.
  • “The devil is in the detail, vaccines aren’t that easy,” Altmann said. “There’s more than 100 in trial at the moment and many things can go wrong along the way. I place no bets at the moment myself.”
  • David King, former chief scientific adviser to the U.K. government, warned in an interview with Sky News on Sunday that the U.K. would have an additional 27,000 deaths from C19 if it stayed on its current trajectory. To date, 44,305 people have died from C19 in the U.K., according to data compiled by Johns Hopkins University.
  • Altmann told CNBC that he agreed with this projection “to some extent,” claiming that a lot of scientists, immunologists and vaccine experts still felt “very scared” about the pandemic.
  • He acknowledged that policymakers needed to find a balance between protecting public health and preventing socioeconomic disasters, but added: “We need to continue to be led by the science and the medicine and do the right thing. And doing the right thing means everything you can do to block transmission.”

Source: Immunity to the coronavirus is ‘fragile’ and ‘short-lived,’ immunologist warns

2. Herd Immunity May Be Unachievable  

  • Spain’s large-scale study on the coronavirus indicates just 5% of its population has developed antibodies, strengthening evidence that a so-called herd immunity to C19 is “unachievable,” the medical journal the Lancet reported on Monday.
  • The findings show that 95% of Spain’s population remains susceptible to the virus. Herd immunity is achieved when enough of a population has become infected with a virus or bacteria — or vaccinated against it — to stop its circulation.
  • The European Center for Disease Control told CNN that Spain’s research, on a nationwide representative sample of more than 61,000 participants, appears to be the largest study to date among a dozen serological studies on the coronavirus undertaken by European nations.
  • It adds to the findings of an antibody study involving 2,766 participants in Geneva, Switzerland, published in the Lancet on June 11.
  • There have been similar studies in China and the United States and “the key finding from these representative cohorts is that most of the population appears to have remained unexposed” to C19, “even in areas with widespread virus circulation,” said a Lancet commentary published along with Spain’s findings.
  • “In light of these findings, any proposed approach to achieve herd immunity through natural infection is not only highly unethical, but also unachievable,” said the Lancet’s commentary authors, Isabella Eckerle, head of the Geneva Centre for Emerging Viral Diseases, and Benjamin Meyer, a virologist at the University of Geneva.
  • Doctors are uncertain whether having antibodies to the coronavirus means someone cannot be infected again. It’s not clear how long or how well antibodies protect people from the virus.
  • Spain’s peer-reviewed study began in April while the nation remained on a strict lockdown, and was conducted by leading government research and epidemiological agencies.
  • “The relatively low seroprevalence observed in the context of an intense epidemic in Spain might serve as a reference to other countries. At present, herd immunity is difficult to achieve without accepting the collateral damage of many deaths in the susceptible population and overburdening of health systems,” the report reads.
  • The Spanish study’s lead author, Marina Pollán, who is director of the National Center for Epidemiology, told CNN: “Some experts have computed that around 60% of seroprevalence might mean herd immunity. But we are very far from achieving that number.”
  • The Lancet published results of the first phase of Spain’s study, conducted from April 27 to May 11, which showed a nationwide antibody prevalence of 5%.
  • But the Madrid metropolitan area, the hardest-hit in the country by C19, had more than 10% prevalence, and densely urban Barcelona had 7%, while many other coastal provinces had far lower rates.
  • Similarly, Geneva’s prevalence was 10.8% in the Swiss study conducted from April to early May, the Lancet reported.
  • “With a large majority of the population being infection naïve, virus circulation can quickly return to early pandemic dimensions in a second wave once measures are lifted,” the Lancet’s commentary authors Eckerle and Meyer wrote of the findings.
  • Spain’s second study phase results were released on June 4, showing a 5.2% national prevalence, just slightly higher than in the first phase. The results from the third and final phase were made public on Monday; they showed that national prevalence remained at 5.2%, Pollán said.
  • Read the Lancet study here: Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study 

Source: Spain’s coronavirus antibodies study adds evidence against herd immunity

3. A ‘mild’ case of C19 can be much worse than you think  

  • Conventional wisdom suggests that when a sickness is mild, it’s not too much to worry about. But if you’re taking comfort in World Health Organization reports that over 80% of global C19 cases are mild or asymptomatic, think again. As virologists race to understand the biomechanics of the coronavirus, one thing is becoming increasingly clear: even “mild” cases can be more complicated, dangerous and harder to shake than many first thought.
  • Throughout the pandemic, a notion has persevered that people who have “mild” cases of C19 and do not require an ICU stay or the use of a ventilator are spared from serious health repercussions. Just last week, Mike Pence, the US vice-president, claimed it’s “a good thing” that nearly half of the new C19 cases surging in 16 states are young Americans, who are at less risk of becoming severely ill than their older counterparts. This kind of rhetoric would lead you to believe that the ordeal of “mildly infected” patients ends within two weeks of becoming ill, at which point they recover and everything goes back to normal.
  • While that may be the case for some people who get C19, emerging medical research as well as anecdotal evidence from recovery support groups suggest that many survivors of “mild” C19 are not so lucky. They experience lasting side-effects, and doctors are still trying to understand the ramifications.
  • Some of these side effects can be fatal. According to Dr. Christopher Kellner, a professor of neurosurgery at Mount Sinai hospital in New York, “mild” cases of C19 in which the patient was not hospitalized for the virus have been linked to blood clotting and severe strokes in people as young as 30. In May, Kellner told Healthline that Mount Sinai had implemented a plan to give anticoagulant drugs to people with C19 to prevent the strokes they were seeing in “younger patients with no or mild symptoms”.
  • Doctors now know that C19 not only affects the lungs and blood, but kidneys, liver and brain – the last potentially resulting in chronic fatigue and depression, among other symptoms. Although the virus is not yet old enough for long-term effects on those organs to be well understood, they may manifest regardless of whether a patient ever required hospitalization, hindering their recovery process.
  • Another troubling phenomenon now coming into focus is that of “long-haul” C19 sufferers – people whose experience of the illness has lasted months. For a Dutch report published earlier this month (an excerpt is translated here) researchers surveyed 1,622 C19 patients with an average age of 53, who reported a number of enduring symptoms, including intense fatigue (88%) persistent shortness of breath (75%) and chest pressure (45%). Ninety-one per cent (91%) of the patients weren’t hospitalized, suggesting they suffered these side-effects despite their cases of C19 qualifying as “mild”. While 85% of the surveyed patients considered themselves generally healthy before having C19, only 6% still did so one month or more after getting the virus.
  • After being diagnosed with C19, 26-year-old Fiona Lowenstein experienced a long, difficult and nonlinear recovery first-hand. Lowenstein became sick on 17 March, and was briefly hospitalized for fever, cough and shortness of breath. Doctors advised she return to the hospital if those symptoms worsened – but something else happened instead. “I experienced this whole slew of new symptoms: sinus pain, sore throat, really severe gastrointestinal issues,” she told me. “I was having diarrhea every time I ate. I lost a lot of weight, which made me weak, a lot of fatigue, headaches, loss of sense of smell …”
  • By the time she felt mostly better, it was mid-May, although some of her symptoms still routinely re-emerge, she says.
  • “It’s almost like a blow to your ego to be in your 20s and healthy and active, and get hit with this thing and think you’re going to get better and you’re going to be OK. And then have it really not pan out that way,” says Lowenstein.
  • Unable to find information about what she was experiencing, and wondering if more people were going through a similarly prolonged recovery, Lowenstein created The Body Politic Slack-channel support group, a forum that now counts more than 5,600 members – most of whom were not hospitalized for their illness, yet have been feeling sick for months after their initial flu-like respiratory symptoms subsided. According to an internal survey within the group, members – the vast majority of whom are under 50 – have experienced symptoms including facial paralysis, seizures, hearing and vision loss, headaches, memory loss, diarrhea, serious weight loss and more.
  • “To me, and I think most people, the definition of ‘mild’, passed down from the WHO and other authorities, meant any case that didn’t require hospitalization at all, that anyone who wasn’t hospitalized was just going to have a small cold and could take care of it at home,” Hannah Davis, the author of a patient-led survey of Body Politic members, told me. “From my point of view, this has been a really harmful narrative and absolutely has misinformed the public. It both prohibits people from taking relevant information into account when deciding their personal risk levels, and it prevents the long-haulers from getting the help they need.”
  • At this stage, when medical professionals and the public alike are learning about C19 as the pandemic unfolds, it’s important to keep in mind how little we truly know about this vastly complicated disease – and to listen to the experiences of survivors, especially those whose recoveries have been neither quick nor straightforward.
  • It may be reassuring to describe the majority of C19 cases as “mild” – but perhaps that term isn’t as accurate as we hoped.

Source: Think a ‘mild’ case of Covid-19 doesn’t sound so bad? Think again | Adrienne Matei

H. Projections & Our (Possible) Future

1. Americans will be wearing masks for ‘several years’  

  • Health experts won’t ask Americans to take off their masks any time soon.
  • That’s the take of Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. He has been preparing for an outbreak like the novel coronavirus as part of his work for years.
  • Johns Hopkins practices virus simulations as part of its preparedness protocol, with the goal of offering public health experts and policymakers a blueprint of what to do in a pandemic. One of those simulations took place in October 2019, when Toner and a team of researchers launched a coronavirus pandemic simulation in New York, running through various scenarios on how residents, governments and private businesses would hypothetically react to the threat.
  • One thing that stood out to him: Face coverings are a vital defense to stop the spread of the virus. He believes C19 won’t slow down in the U.S. even as states start to slowly reopen.
  • “There’s going to be no summertime lull with a big wave in the fall,” he said as part of CNET’s Hacking the Apocalypse series. “It’s clear that we are having a significant resurgence of cases in the summer, and they’ll get bigger. And it’ll keep going until we lock things down again.”
  • Toner, contrasting the novel virus to seasonal influenza, said until there is a vaccine, communities’ best defense to fight it is through creating distance and wearing masks.
  • “I think that mask wearing and some degree of social distancing, we will be living with — hopefully living with happily — for several years,” he said. “It’s actually pretty straightforward. If we cover our faces, and both you and anyone you’re interacting with are wearing a mask, the risk of transmission goes way down.”
  • “They will get over it,” he says. “It’s just a question of how many people get sick and die before they get over it.”

Source: Coronavirus expert says Americans will be wearing masks for ‘several years’

I. Back to School!?

1. We Have to Focus on Opening Schools, Not Bars  

Opinion by Juliette Kayyem

  • If American society is going to take one major risk in the name of reopening, ideally it should be to send children back to school. This issue is personal for me. I have three kids, one in college and two in a local public high school. It’s now early July, and we still have no idea whether or how they will be returning to classes that, ordinarily, would resume just weeks from now. My children’s summer has been idle. They have no jobs and not much summer programming to keep them busy. I try to convince myself they aren’t missing out on much. Hey, I grew up in the ’80s, I think, and all we did during the summer was hang out at the beach. Most days, I make it to about 10 a.m. before I rouse them.
  • I’m lucky, at least in comparison with working parents who have younger kids, because my teenagers are mostly coping and don’t need me—or want me—to keep them occupied. Our stresses as a family are merely those of inconvenience, and we still find our current situation unsustainable. Parents who have no control over their own work schedule are far worse off, as are younger children for whom an indefinite absence from the classroom holds many dangers—the mental-health and emotional risks of long-term isolation, the greater likelihood of abuse and neglect going undetected, the internet-access disparities that turn some of the most vulnerable students into virtual dropouts.
  • In the past week or so, more and more Americans have suddenly remembered that fall comes after summer. Recent headlines have heaped scorn upon the values of a society that seemingly prioritized inessential businesses over schools. “We Have to Focus on Opening Schools, Not Bars,” The New York Times declared. “Close the Bars. Reopen the Schools,” a piece in Vox implored. The hashtag #schoolsbeforebars is trending.
  • Reopening indoor bars—closed spaces where wearing masks and maintaining social distancing are difficult—was clearly a mistake. Yet approximately zero public officials believe that letting adults drink is more important than educating kids, and any implication that reopening bars and reopening schools are roughly equivalent tasks badly understates the enormous barriers to the latter. From the government’s perspective, the only thing bars need is permission to reopen. Once they get it, owners and employees can go back to work, and the money starts flowing.
  • Schools do not have a simple on-off switch. To reopen schools will not just take a lot of money. Classroom layouts, buildings, policies, schedules, extracurricular activities, teacher and staff assignments, and even curricula must all be altered to minimize the risk of coronavirus transmission. Stakeholders—including teachers’ unions, scared parents, and the colleges and universities that will someday enroll a portion of the 50 million students in the nation’s public K–12 schools—all have interests, some not easily avoided or ignored by a governor. Assigning a young, healthy high-school math teacher to substitute for a second-grade reading teacher with chronic health conditions—or inviting idle recent college graduates to sign on as teaching assistants—might sound easy on paper; in reality, the regulations meant to ensure that adults in classrooms are appropriately trained and vetted to work with children are also impediments to making rapid personnel moves in a crisis. Without clear direction and substantial financial support from the state or federal agencies, the easiest course for school administrators is to say nothing. According to a survey in mid-June, 94% of K–12 superintendents weren’t ready to announce when or how their schools would reopen.
  • Two things need to happen before students can go back to school: First, Americans and their elected representatives must consciously decide that children’s needs are worth accepting some additional risk. Second, states and communities must commit the money and effort necessary to reinvent education under radically changed circumstances. Even in states where case counts have plunged, doing what’s right for children will require a massive civic mobilization.
  • The problem isn’t that policy makers—many of them parents too—don’t know what families are going through. It’s that, fundamentally, the way public officials thought about the consequences of this crisis was flawed. Early in the pandemic, authorities viewed the closure of schools as essential to preventing the spread of a deadly new disease. The federal government and the states have no firm plans for restarting school in August and September because they had no such plans in February and March; public officials simply didn’t classify education as a crucial form of infrastructure in need of protection.
  • The Department of Homeland Security identifies 16 infrastructure sectors as “so vital to the United States that their incapacitation or destruction, would have a debilitating effect on security, national economic security, national public health or safety.” Those sectors include agriculture, communications, electricity, financial services, health care, transportation systems, water, and even dams. The official list guides how local, state and federal homeland-security experts spend their time and resources. For each sector, a major federal agency is in charge of determining the best way to prevent essential functions from harm and support their recovery if necessary. (Water security falls under the Environmental Protection Agency, for example, and financial services under the Department of the Treasury.)
  • Bars are not on the list of essential sectors. But neither are schools. The lingering uncertainty about whether in-person education will resume isn’t the result of malfeasance, but utter nonfeasance.
  • Four months of stay-at-home orders have proved that, if schools are unavailable, a city cannot work, a community cannot function, a nation cannot safeguard itself. That the federal government deemed schools a potential health threat to be shut down during a pandemic—but not an essential service—may reflect the American view of education as a state and local matter. More likely, the omission reflects a lack of imagination. In March, few foresaw that the shutdown measures would go on this long, and almost everyone assumed that the U.S. government in particular would spend the time far more wisely.
  • In my work in security and disaster management, I have advised a number of public and private entities about how to move forward during a pandemic. I am currently part of a consulting team advising the state of Massachusetts, where I live, specifically on its school reentry plans. As my children sleep in day after day, and their memories of their most recent in-person classes grow hazier and hazier, I am desperate for my state to reopen schools and hope it gets the details right. Massachusetts seems to have weathered one of the nation’s worst outbreaks reasonably well; infection rates have declined to the point that—with protocols in place to protect children, teachers, and staff—students might be able to go back to at least some normal classes. The harm they face from staying home is enormous. I would accept additional risk for the good of my three teenagers, and children younger than them would benefit even more from being in school.
  • The notion that schools can’t open again to students until a vaccine arrives should not be the guiding moral standard. The vaccine may never come, and the many other nations that handled their outbreaks far more successfully than the U.S. can show Americans what to do and what not to do when reopening schools. Americans must learn to manage around the virus, to mitigate its potential for spread. Fall isn’t far off, and school systems nationwide need to make up for lost time. A bar doesn’t need a groundswell of public support to reopen, but schools most certainly do.

Source: Reopening Bars Is Easy. Schools Are Difficult.

J. Pandemic Economy

1. Five charts tracking the U.S. economy amid the coronavirus pandemic  

  • The United States has reported record increases in coronavirus cases with spikes seen in states well underway in their reopening progress. The rising case numbers have caused states to alter their recovery plans, delay reopening measures and even re-institute restrictions on businesses. Data from key sectors could help illustrate the impact these changes have on the country’s economic progress. 
  • These five charts illustrate trends in various industries important to the U.S. economic recovery. 
Direction requests
  • Requests for transit directions on Apple Maps are still nowhere near pre-pandemic levels, according to data from the navigation app. However, driving and walking direction requests have surged from their low points during the early stages of the outbreak. Travelers may be more inclined to driving and walking rather than using public transportation as coronavirus cases continue to increase.
Restaurant bookings
  • Restaurant bookings appeared to be recovering since they fell to zero in late March and April, according to data from reservation service OpenTable. However, there have been recent declines in bookings that could be influenced by rising coronavirus cases. The increasing cases have even caused states to rethink reopening measures affecting businesses like restaurants and bars. Texas dropped restaurants’ dining capacity from 75% to 50%, while California ordered indoor businesses, including restaurants, to close in 19 counties. New Jersey and New York City have even delayed the resumption of indoor dining.
Hotel occupancy 
  • Ahead of the Fourth of July weekend, the U.S. hotel occupancy rate has continued to creep upward and is now at 46%, according to data from global hospitality research company STR. Norfolk/Virginia Beach, Va., was the only travel market to surpass a 60% occupancy level. Destinations like Boston, Orlando, Florida and Oahu Island, Hawaii, saw some of the lowest occupancy rates this week among STR’s top 25 travel markets.
Air travel 
  • The number of daily travelers passing through airport security checkpoints has continued to increase slightly, according to data from the Transportation Security Administration. However, Americans continue to face limitations on their flight options, with the European Union still denying entry to U.S. travelers. Flight operators like American Airlines are also planning to continue reduced schedules over the next few months. American told employees on Thursday that it is overstaffed by more than 20,000 employees for its lighter fall schedule. 
Home purchases 
  • Mortgage applications for buying a single-family home are 15% higher than the same week last year, according to data from the Mortgage Bankers Association. However, they did decline slightly from last week despite mortgage rates hitting a record low. “Investors are contemplating the risks of the recent resurgence of C19 cases to the labor market and economy,′ said Joel Kan, MBA’s associative vice president of economic and industry forecasting, in a statement.

Source: https://www.cnbc.com/2020/07/05/here-are-five-charts-tracking-the-us-economy-amid-the-coronavirus.html 

K. Johns Hopkins COVID-19 Update

July 6, 2020

1. Cases & Trends

Overview
  • The WHO C19 Situation Report for July 5 reports 11.13 million cases (203,836 new) and 528,204 deaths (5,195 new). 
  • The WHO reported more than 200,000 new cases in a single day for the first time on July 4, and it took only 6 days for the global cumulative incidence to go from 10 million to 11 million cases. The pandemic has been ongoing for more than 6 months, and it continues to accelerate. 
  • In terms of daily incidence, Asia, North America, and South America are reporting approximately the same number of cases, and Africa has surpassed Europe. Africa is now representing more than 8% of the global daily incidence, compared to less than 7% for Europe. Asia, North America, and South America all represent approximately 25-30%.
India, Pakistan & Bangladesh
  • India continued its recent increase, reporting a record high for daily incidence on July 5 (24,850 new cases) and remaining #3 globally. 
  • Pakistan has reported nearly 2 weeks of decreased daily incidence, and its total active cases reached a peak on July 1 (108,642 active cases). Since then, Pakistan’s active cases dropped below 100,000 for the first time since June 17—currently 95,407 active cases. Pakistan fell to #11 globally in terms of daily incidence. 
  • After reporting a steady increase in daily incidence to its highest daily total on July 1 (4,019 new cases), Bangladesh has reported 4 consecutive days of lower daily incidence—approximately 2,750-3,250 new cases per day. The increase in Bangladesh’s daily incidence appeared to be tapering off slightly toward the end of last week; however, additional data is needed to determine if this is the beginning of a longer-term trend. Bangladesh fell to #12 globally in terms of daily incidence.
Central & South America
  • Brazil continues to report increasing daily incidence. Last week, Brazil reported 263,337 new cases, its highest weekly total to date. Brazil remains #2 globally, behind only the US, in terms of daily incidence. 
  • Mexico reported a record daily incidence on July 5 (6,914 new cases), and its epidemic continues to accelerate. Mexico remains #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 10 countries globally in terms of daily incidence — including: Colombia (#8), Chile (#9), and Peru (#10). 
  • Additionally, several other countries are reporting more than 1,000 new cases per day. Central and South America also represent 5 of the top 13 countries in terms of per capita daily incidence—Panama (#3), Chile (#6), Brazil (#7), Peru (#12), and Bolivia (#13).
Eastern Mediterranean Region
  • Overall, the Eastern Mediterranean Region remains a global hotspot as well, representing 5 of the top 11 countries in terms of per capita incidence: Bahrain (#1), Oman (#2), Qatar (#4), Kuwait (#8), and Saudi Arabia (#11). Additionally, nearby Armenia is #5. 
  • Notably, Qatar’s per capita incidence has fallen to #4 globally, decreasing by nearly 70% since its peak in late May. The region also includes several notable countries in terms of total daily incidence. In addition to Pakistan, Saudi Arabia is #7, Iran is #13, and several other countries in the region are reporting more than 1,000 new cases per day.
Africa
  • South Africa is among the top countries globally in terms of both per capita (#9) and total daily incidence (#4). South Africa reported 6,945 new cases—its second highest daily total to date—and its epidemic continues to accelerate. 
  • Notably, most countries in Africa continue to report low per capita and total daily incidence. On a per capita basis, only 6 countries—Cape Verde, Djibouti, Mauritania, South Africa, Swaziland, and Western Sahara—are reporting more than 25 new daily cases per million population. With the exception of South Africa, these are relatively small countries. 
  • Over the past 2 weeks, only 4 African countries have reported more than 5,000 new cases—Egypt (20,020), Ghana (5,931), Nigeria (8,467), and South Africa (99,448).
United States
  • The US CDC reported 2.84 million total cases (52,228 new) and 129,576 deaths (271 new). The US has reported more than 50,000 new cases for 4 consecutive days, including a record high of 57,718 on July 4. In total, 21 states (increase of 2) and New York City reported more than 40,000 total cases, including California with more than 250,000 cases; New York City with more than 200,000 cases; and Florida, New York state, and Texas with more than 175,000. The current daily incidence in the US is more than 50% higher than its first peak in mid-April. The daily incidence has more than doubled since June 9, up from 20,338 new cases per day to 47,389 yesterday (7-day average).
  • The Johns Hopkins CSSE dashboard reported 2.90 million US cases and 130,007 deaths as of 11:30pm on July 6.

2. Airborne Transmission 

  • The WHO, US CDC, and other experts have continually emphasized that respiratory droplets are the main driver SARS-CoV-2 transmission; however, 239 scientists from 32 countries are reportedly challenging that notion in an open letter to the WHO. The authors argue that airborne transmission may be playing a larger role in the pandemic than previously believed, which would significantly impact future prevention strategies and the resources needed to fulfill them. 
  • While droplet transmission risk can be mitigated via physical distancing and barriers like face shields and face masks, airborne transmission would mean that virus particles could linger in the air for prolonged periods of time or travel longer distances, including via ventilation systems, instead of quickly settling on surfaces. If this is the case, mask usage could be necessary in many more environments, particularly indoors, even if the recommended physical distancing (e.g., 6-foot separation) is maintained. Additionally, individuals at elevated exposure risk, such as healthcare workers, could need N95 respirators instead of surgical or medical masks.
  • The existing WHO guidance emphasizes that aerosol transmission is possible, including during aerosol-generating medical procedures, but it is not a primary driver of community transmission. The authors of the forthcoming letter criticize the WHO’s unwillingness to address emerging evidence supporting the role of aerosol/airborne transmission. Experts broadly acknowledge the difficult task the WHO faces in developing universal guidance for the world and navigating a complex political climate on a tight budget, but some believe that the WHO should reconsider the evidence. The letter will reportedly be published in the journal Clinical Infectious Diseases in the coming days.

3. Superspreader Events

  • A number of reports have emerged over the past several weeks about “superspreader” events, which are events or gatherings that have been identified as a possible or likely source of numerous subsequent infections, potentially from as few as a single infected individual. Coverage of these events have increased in recent weeks, as countries, states, and cities have relaxed social distancing measures and resumed many normal community activities. 
  • Examples include exposures at weddings and birthday parties, dinner parties, university parties and spring break, family gatherings, and restaurants and bars, some of which have been linked to dozens of new cases. With bars and nightclubs closed in some locations, large parties with club-like atmospheres are reportedly being held at private residences. In several instances, an individual that attended these events felt healthy at the time and then were later determined to be infectious.
  • The Independence Day holiday weekend in the US provided ample opportunity for these types of gatherings, and much like the Memorial Day holiday in late May, it could be several weeks before we begin to see any signs of increased transmission stemming from these events. The UK recently permitted bars to resume in-person operations, which reportedly resulted in crowding and disregard of physical distancing guidance that could provide similar elevated risk of transmission. 
  • Other upcoming opportunities for superspreading events include political rallies, debates, and conventions associated with the 2020 US elections. Notably, the Texas Republican party reportedly intends to host its election convention in person late next week, which could draw thousands of attendees as the state continues to report record daily totals for C19 incidence, deaths, and hospitalizations as well as elevated test positivity.

4. Reversing Course on Social Distancing 

  • A number of US states have reversed course on their efforts to relax social distancing measures, in response to recent concerning C19 trends. One analysis published by The New York Times found that 19 states are pausing their recovery plans or reinstituting or strengthening existing social distancing restrictions. Multiple states recently announced the closure of businesses that pose elevated exposure risk, including bars, movie theaters, and gyms/fitness centers that were previously permitted to reopen. Some of these efforts have met significant opposition from business owners and patrons, and some states have had to threaten regulatory or legal action to prompt compliance with the new restrictions. 
  • Several states have also implemented mandatory mask use in many or all public spaces, including stores and restaurants. In fact, nearly half of all US states now have some form of mask mandate, including 7 that implemented new policies since the second half of June. Notably, analysis published by Forbes shows that 10 states are reporting level or decreasing C19 incidence over the past 2 weeks, and 7 of these states had mandatory mask policies in place since at least the middle of May.
  • In response to increasing C19 transmission in Arizona, the Mexican state of Sonora implemented border restrictions in advance of the Independence Day holiday weekend. The policy limited border crossings from Arizona into Mexico to essential purposes only. Sonora’s beach towns are a common vacation destination for Arizonans. A number of beaches throughout Florida were also closed for the Independence Day weekend. Many of these beaches were previously open as Florida progressed through its recovery plan.
  • As we have discussed previously, the effects of changes to social distancing policies and practice will likely not be immediately evident. The current ongoing surge in C19 incidence followed several weeks after many states began to ease social distancing policies in late May and early June. People who were infected immediately prior to these most recent changes, or are infected as adherence increases, will likely not be detected for several days or possibly weeks.

5. Racial Inequities 

  • The New York Times published in-depth analysis of national and local racial and ethnic disparities, based on federal C19 data on nearly 1.5 million C19 cases. In the US, Black and Latino communities have been disproportionately affected by the epidemic compared to White communities. The study estimates that Black and Latino individuals are 3 times as likely to be infected by the coronavirus and twice as likely to die from C19 as White individuals. Native Americans and Asians are disproportionately affected by C19 as well.
  • Notably, many racial and ethnic minorities work in essential jobs, including in healthcare settings and service or production jobs, many of which cannot be performed remotely. Continued contact at work, particularly in environments that facilitate transmission (e.g., meat processing facilities, warehouses, long-term care facilities), increases transmission risk among these populations. 
  • Additionally, racial and ethnic minorities are also disproportionately affected by comorbidities associated with increased risk of severe C19 disease and death, which further compounds these disparities. There are many complex and interdependent factors that drive the elevated C19 risk for racial and ethnic minorities, and further research is necessary to better characterize these relationships and implement effective interventions to mitigate their effects, both for C19 and for many other health risks.

6. Spain Coronavirus Prevalence

  • Spain continues to study the national and sub-national prevalence of the coronavirus infection. Spain was among the hardest-hit countries early in the pandemic, and researchers have endeavored for several months to better characterize the scale of its epidemic. 
  • A new study published in The Lancet surveyed more than 35,000 households nationwide, using a randomized sampling methodology based on “province and municipality size.” In total, the study included more than 61,000 individual participants (75% response rate) who participated in both a questionnaire, including symptom history and C19 risk factors, and a serological test. 
  • The study estimates the national seroprevalence to be 5.0%, with variations identified by age and location. Seroprevalence in children under the age of 10 was estimated at 3.1%, and seroprevalence was higher in Madrid (greater than 10%) and lower in coastal communities (less than 3%). The results also indicate that approximately one-fifth to one-third of SARS-CoV-2 infections could be asymptomatic or only mildly symptomatic, which could potentially correspond to 376,000 to 1.04 million infections nationwide.

7. Australia Closes State Border  

8. Federal Workforce Back in the Office 

  • US government employees under numerous government departments are beginning to return to the office. Each department is addressing the return of personnel differently. While many federal government offices and services can continue to function remotely, others (e.g., passport processing) may require in-person work. 
  • While some offices, particularly senior department leadership, are centralized in Washington, DC, others (e.g., Veterans Affairs) are distributed widely across the country, which makes it difficult to resume operations uniformly across their various facilities. Additionally, Washington, DC, is surrounded by Maryland and Virginia, both of which are implementing their own response and recovery plans, and many federal employees make their daily commute from their homes in these states. 

9. Hydroxychloroquine

  • Despite multiple previous studies that have failed to demonstrate efficacy, hydroxychloroquine continues to be evaluated as a possible treatment option for C19. Clinicians at the Henry Ford Health System in Michigan (US) published findings from a recent study that indicate that the drug could provide treatment benefit. 
  • The study, published in the International Journal of Infectious Diseases (IJID), involved a retrospective review of 2,541 C19 patients from March 10 and May 2. The researchers found that 13.5% of those treated with hydroxychloroquine died, compared to 26.4% of patients that were not treated with the drug. Notably, the study was not a randomized controlled trial (RCT), and the patients were prescribed hydroxychloroquine under “specific protocol criteria.” Other researchers have raised concerns about the study’s design, in particular that selection of patients based on specific criteria could potentially bias the results. The WHO announced on Saturday that it is discontinuing the hydroxychloroquine arm of its SOLIDARITY Trial, as interim data have not demonstrated sufficient treatment benefit. The WHO is also discontinuing the lopinavir/ritonavir arms of the trial.
  • A study conducted by STAT News, in collaboration with Applied XL, evaluated the relative investments in studying various prospective C19 treatment options. The researchers found that effort to study hydroxychloroquine far outweighs other possible therapeutics, including several that have already demonstrated efficacy against the disease; 1 out of every 6 studies has evaluated hydroxychloroquine. The STAT News study found that 237,000 total patients had been enrolled in hydroxychloroquine/chloroquine studies, which potentially hindered efforts to evaluate other drugs that might be more likely to demonstrate a positive effect by drawing patients away from those trials. Many of these smaller studies are conducted independently, as opposed to collaboratively (i.e., utilizing the same trial protocol across multiple facilities) in order to increase the sample size and statistical power. Larger studies, such as the UK’s RECOVERY Trial and the WHO’s SOLIDARITY Trial, have provided a common platform for conducting studies and compiling larger datasets across multiple testing sites. These studies have already yielded results, including demonstrating efficacy of dexamethasone as a C19 treatment.

L. Links to Other Stories

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