Recent Developments & Information
July 14, 2020
Without reliable information, we rely on fear or luck.
“I respect Dr. Fauci a lot, but he is not 100% right, and he also doesn’t necessarily have the whole national interest in mind, and he admits that. He looks at it from a very narrow public health point of view. I don’t think we need to shut down again — at least in most places around the country —Americans should avoid bars and wear a mask in public.”Adm. Brett Giroir, testing coordinator at the Department of Health and Human Services
“If We Can Reopen Walmart, We Can Reopen Schools.”Florida Governor DeSantis
A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
C. Airborne Transmission
D. New Scientific Findings & Research
E. Improved & Potential Treatments
F. Concerns & Unknowns
G. Projections & Our (Possible) Future
H Johns Hopkins COVID-19 Update
I. Links to Other Stories
Does UV light kill the new coronavirus? The short answer is yes. But it takes the right kind of UV in the right dosage, a complex operation that is best administered by trained professionals.
Coronavirus hijacks cells, forces them to grow tentacles, then invades others Scientists are looking at how the coronavirus invades cells to find the right drugs to target it
The Messy Reality of Reopening Colleges Howard University and the UC system are returning to “hybrid” teaching, bringing some students back to campus. Their leaders explain their plans.
Delirium, Brain Inflammation, Nerve Damage and Stroke Linked to COVID-19 Neurological complications of Covid-19 can include delirium, brain inflammation, stroke, and nerve damage, finds a new UCL and UCLH-led study.
Engineers Design a Reusable, Silicone Rubber Face Mask With an N95 Filter The prototype mask, which includes an N95 filter, can be easily sterilized and worn many times.
Scientists evaluated the perspectives of zinc intake for COVID-19 prevention According to current research, adequate zinc status can bring down the likelihood of infectious respiratory diseases, pneumonia and its complications
COVID-19: Considering meditation and yoga as adjunctive treatment The anti-inflammatory and other beneficial effects of meditation and yoga practices make them potential adjunctive treatments of COVID-19
The Role of Cognitive Dissonance in the Pandemic The minute we make any decision—I think COVID-19 is serious; no, I’m sure it is a hoax—we begin to justify the wisdom of our choice and find reasons to dismiss the alternative.
Covid-19 Case Counts Have Been Spiking for Weeks. Why Aren’t Deaths Experts say a handful of variables explain the apparent disconnect between cases and deaths
A. The Pandemic As Seen Through Headlines
(In no particular order)
- Coronavirus crisis may get “worse and worse and worse”, warns WHO
- Covid-19 Reinvades US States that Beat it Back Once
- US approves accelerated trials for 2 vaccine candidates
- California Orders Bars, Gyms & Indoor Dining To Close In 30 Counties In Biggest COVID-19 Reopening Rollback Yet
- LA Mayor Garcetti Warns He Is On Brink Of Issuing A Total Shutdown Order As Coronavirus Hospitalizations, ICU Cases Hit New High
- Travelers from 19 states to N.Y., required to quarantine, will also be asked to provide contact information
- Between two hot spots, Oregon now sees a rise in new cases. ‘We are not an island,’ Gov. Kate Brown says.
- Oregon announces new restrictions
- California hospitalizations hit record highs
- Florida reports another 12,000+ new cases
- ‘We have a long road ahead,’ Florida’s governor warns
- Texas may be forced to roll back more of its reopening plans
- Tennessee recorded more than 2,500 new cases on Monday, a record
- Kansas officials announced more than 880 new cases on Monday, the highest single-day total in that state
- Washington State announced more than 1,080 cases, a record
- US deaths climb by fewer than 500 cases
- NYC Reports No New COVID-19 Deaths For 24 Hours In Major New Milestone
- Atlanta, L.A., San Diego to keep schools closed
- NY Gov. Cuomo says schools won’t reopen until it’s safe
- Cuomo: ‘We’re Not Going to Use Our Children as Guinea Pigs’
- ‘Absolutely’ reopen schools: 5 of 5 pediatricians would send their kids back to class
- College Professors Fear Returning to Campus
- Surgeon General On Prior Anti-Mask Statements: ‘When We Learn More, Our Recommendations Change’
- Michigan Sheriffs Refuse to Enforce Gretchen Whitmer Mask Mandate
- Dr. Fauci: “In 50 years, we’ll talk about COVID-19 like the Spanish flu”
- White House reportedly cancels Dr. Fauci media appearances
- Trump insists he and Dr. Fauci have ‘very good relationship’
- A record 5.4 million people lost their health coverage amid the pandemic, a study found
- Refrigerated trucks requested in Arizona, Texas as morgues reach capacity amid COVID-19 surge
- Peru passes 330,000 cases; 2nd biggest outbreak in Latin America
- Mexico, surpassing Italy, now has the fourth-highest death toll
- Hong Kong reported another 52 new cases
- Hong Kong Adopts Its Strictest-Ever Virus Measures as City Reels
- Hong Kong closes restaurants, gyms; Hong Kong Disneyland to close July 15
- South Korea confirmed 62 new cases
- China warns on travel to Australia
- Thailand tightens borders over fears of second wave of coronavirus
- From Flour to Canned Soup, Coronavirus Surge Pressures Food Supplies
- “It’s Unlike Anything We’ve Seen” – Hong Kong Discovers COVID-19 Mutation That Makes Virus 30% More Infectious
- ‘Broken Heart Syndrome’ has increased during coronavirus pandemic
- South Africa returns to alcohol ban to free up hospital space amid coronavirus surge
- US Recovery Stalls As Pandemic ‘Second Wave’ Threatens To Unleash Double-Dip Recession
- More Than Half Of COVID-19 Patients In New Study Have Heart Damage
- Ohio County Implements Hotline to Report People Not Wearing Masks
- Forget about that overseas holiday: Qantas cancels all international flights until MARCH next year
- Mystery as Argentine sailors infected with virus after 35 days at sea
- It’s just nuts to praise New York’s ‘success’ against coronavirus
- New Yorkers fear another coronavirus outbreak headed to NYC
- Banning airplane middle seats could dramatically help cut coronavirus risk on flights
- Bats offer COVID-19 treatment clues, scientists say
- PepsiCo sees surge in snacks as soft drink sales fizzle
- CUNY planning for most classes to be online this fall amid coronavirus concerns
- Texas dog first animal in state confirmed to have coronavirus
- Soda cans are the latest victim of supply shortages due to coronavirus
- Stars love sexy bandana styes: Are they hot but useless as face masks?
- Florida strip clubs shuttered for lack of social distancing
- UK pub installs electric fence at bar to ensure social distancing
- How to Shoot a Sex Scene in a Pandemic: Cue the Mannequins
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 = 13,229,695 (+1.6%)
- New Cases = 201,806 (+7,377)
- Growth Rate of New Cases (7 day average) = 2.1%
- New Cases (7 day average) = 213,364 (+4,296)
- Number of new cases has decreased for 4 consecutive days
- 1,000,000+ new cases every 5 days
- 7 day average of new cases on 7/13 was a record high
- 7 day average of new cases has increased every day since 5/26
US Cases & Testing:
- Total Cases = 3,479,483 (+1.9%)
- New Cases = 65,488 (+7,139)
- Percentage of New Global Cases = 32.5%
- Growth Rate of New Cases (7 day average) = 3.5%
- New Cases (7 day average) = 62,243 (+2,129)
- Total Number of Tests = 43,252,833
- Percentage of positive tests (7 day average) = 8.7%
- Number of new cases on 7/13 was second highest
- 7 day average growth rate remains very high
- 7 day average of new cases on 7/13 was a record high
- 7 day average of new cases have increased every day since 6/9
- Percentage of positive tests remains high
- Total Deaths = 574,981 (+0.7%)
- New Deaths = 3,905 (-136)
- Growth Rate of New Deaths (7 day average) = 0.6%
- New Deaths (7 day average) = 4,978 (+30)
- Number of new deaths have declined for 3 consecutive days
- 7 day average of new deaths has increased daily since 7/4, with an increase of 9.6% during that period
- Total Deaths = 138,247 (+0.3%)
- New Deaths = 465 (+86)
- Percentage of Global New Deaths = 11.9%
- Growth Rate of New Deaths (7 day average) = 1.7%
- New Deaths (7 day average) = 753 (+12)
- 3 day average of new deaths has declined 44.6% since 7/9
- 7 day average growth rate of new deaths is very high
- 7 day average of new deaths has increased 45.9% since 7/5
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (7/13)
Source: Worldometer and The Covid Tracking Project
C. Airborne Transmission
1. How to Reduce the Risk of Airborne Transmission
- This was the week airborne transmission became a big deal in the public discussion about C19. Over 200 scientists from around the world cosigned a letter to the World Health Organization urging it to take seriously the growing evidence that the coronavirus can be transmitted through the air. WHO stopped short of redefining C19 as airborne but did acknowledge that more research is “urgently needed to investigate such instances and assess their significance for transmission of C19.”
- “I honestly don’t know what people are waiting for,” says microbiologist Chad Roy of Tulane University in the US. “It doesn’t take WHO coming out to make a proclamation that it’s airborne for us to appreciate this is an airborne disease. I don’t know how much clearer it needs to be in terms of scientific evidence.”
How to stay safe
- Roy would like to see aggressive mandates on strict mask use for anyone leaving home. “This virus sheds like crazy,” he says. “Masking can do an incredible amount in breaking transmission. I think anything that can promote the use of masking, to stop the production of aerosols in the environment, would be helpful.”
- Brosseau, however, says that though masks can limit the spread of larger particles, they are less helpful for smaller ones, especially if they fit only loosely. “I wish we would stop relying on the idea that face coverings are going to solve everything and help flatten the curve,” she says. “It’s magical thinking—it’s not going to happen.” For masks to really make a difference, they would need to be worn all the time, even around family.
- Brosseau does believe the evidence is trending toward the conclusion that airborne transmission is “the primary and possibly most important mode of transmission for the coronavirus.” She says, “I think the amount of time and effort devoted to sanitizing every single surface over and over and over again has been a huge waste of time. We don’t need to worry so much about cleaning every single surface we touch.” Instead, the focus should be on other factors, like where we spend our time.
- One of the biggest questions we still have about C19 is how much of a viral load is needed to cause infection. The answer changes if we think it is aerosols that we need to worry about. Smaller particles won’t carry as large a viral load as bigger ones, but because they can linger in the air for much longer, it may not matter—they’ll build up in larger concentrations and get distributed more widely the longer an infected person is around to expel aerosolized virus.
- The more people you have coming in and out of an indoor space, the more likely it is that someone who is infected will show up. The longer those infected individuals spend in that space, the higher the concentration of virus in the air over time. This is particularly bad news for spaces where people congregate for hours on end, like restaurants, bars, offices, classrooms, and churches.
- Airborne transmission doesn’t necessarily mean these places must stay closed (although that would be ideal). But wiping down surfaces with disinfectant, and having everyone wear masks, won’t be enough. To safely reopen, these spots will not just need to reduce the number of people allowed inside at any given moment; they will also need to reduce the amount of time those people spend there. Increasing social distancing beyond six feet would also help keep people safer.
- Ventilation needs to be a higher priority too. This is going to be a big problem for older buildings that usually have worse ventilation systems, and areas with a lot of those might need to remain closed for much longer. The impact of asymptomatic spread (transmission by people who don’t feel ill) and superspreaders only compounds the problem even further.
- But research conducted by the US Department of Homeland Security has shown that in the presence of UV light, aerosolized particles of the size the Tulane researchers studied would disappear in less than a minute. A number of businesses have begun deploying UV-armed robots to disinfect hospital rooms, shopping malls, stores, public transit stations, and more.
- For many places, considerable delays in economic reopening might ultimately be the price of getting the virus under control. Otherwise the kind of thing that happened when a single open bar in Michigan led to an outbreak of more than 170 new cases could become commonplace.
- For Brosseau, the best strategy is simply to behave as we did in the early days of lockdown—stay home, and avoid coming into contact with anyone you don’t live with. And if you have to leave home, she says, “all I can say is spend as little time as possible in an enclosed space, in an area that’s well ventilated, with as few people as possible.”
2. WHO still skeptical coronavirus lingers in air
- If you happened to read The New York Times this week, you may be under the false impression that the World Health Organization significantly changed its stance on whether the coronavirus spreads by lingering in the air.
- Around midday Thursday, the paper declared: “W.H.O., in Reversal, Affirms Virus May Be Airborne Indoors.” The paper also called it an “admission” and, in a subsequent article, said the WHO had “conceded.” The articles both noted that a group of more than 200 researchers had also published a commentary piece this week urging the WHO and other public health bodies to acknowledge and address the potential for airborne transmission of the coronavirus.
- The problem: the WHO did not change its stance on airborne transmission. And, as such, it did not issue any new recommendations or guidance on how people can stay safe.
- What the organization did do is release an update of its review of the data on transmission, which it said it had been working on for weeks—well before the published commentary.
- In its updated scientific brief on transmission, the WHO said, basically, the same thing it has said for months on airborne transmission. That is: the question of whether the coronavirus lingers in the air is a topic of active discussion and, while it may be possible in some settings, the data in aerosol transmission so far is inconclusive or unconvincing. But, as always, the WHO welcomes more high-quality research on this topic.
- In the latest brief, the WHO reviewed recent physics studies looking at aerosol production, but it noted: “the proportion of exhaled droplet nuclei or of respiratory droplets that evaporate to generate aerosols, and the infectious dose of viable coronavirus required to cause infection in another person are not known.”
- It reviewed experiments on droplets and aerosols from normal speech and coughing and concluded, “To date, transmission of the coronavirus by this type of aerosol route has not been demonstrated; much more research is needed.” Likewise, studies using nebulizers to suspend the coronavirus in the air “do not reflect normal human cough conditions,” the WHO concluded.
- The WHO noted that clinical reports of exposed health workers “suggest that aerosol transmission did not occur in this context.” And, the organization added, air sampling in health care settings has been inconsistent in finding genetic traces of the virus.
- Perhaps there was some rush to declare victory in the great aerosol war because the WHO did discuss recent reports of possible airborne transmission in specific outbreaks.
- The WHO noted in the updated brief:
- [S]ome outbreak reports related to indoor crowded spaces have suggested the possibility of aerosol transmission, combined with droplet transmission, for example, during choir practice, in restaurants, or in fitness classes. In these events, short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out.
- It seemed some were happy that the WHO acknowledged the existence of these reports—though the main purpose of these periodically updated scientific briefs is to review new data. And perhaps some interpreted the “cannot be ruled out” piece as the WHO admitting it as a possibility. But, of course, the WHO went on: “However, the detailed investigations of these clusters suggest that droplet and [transmission from contaminated surfaces or objects] could also explain human-to-human transmission within these clusters.”
- This is not exactly a warm embrace of the airborne transmission. It’s more like the brief, awkward sideways hug you’d give a friend who doesn’t shower enough.
- But most importantly, it’s not substantively different from what the WHO has said before on this. The organization said something very similar in its June 5 guidance on masks. Likewise, in the previous version of the scientific brief on transmission, published March 29, the WHO acknowledged the possibility of airborne transmission, writing: “To date, some scientific publications provide initial evidence on whether the C19 virus can be detected in the air.”
- But, it cautioned, “[t]hese initial findings need to be interpreted carefully.” Just as it did in the updated version of the brief, the WHO went on to note the weaknesses of the data, suggesting that it was not yet convinced. And, as always, it called for more research.
- When Ars reached out to the WHO to ask if the new scientific brief represented a “reversal” on its stance, a spokesperson responded concisely: “WHO has not changed its guidance.”
D. New Scientific Findings & Research
1. 40% of People Infected with C19 are Asymptomatic; Infection Fatality Rate Estimated at 0.65%
- New guidance by the Centers for Disease Control and Prevention estimates that 40% of people infected with C19 are asymptomatic and the chance of transmission from people with no symptoms is 75%.
- In updated guidance also reported by CNN, the agency expanded its “current best estimate” based on data from late last month to raise the rate of people infected with C19 who are asymptomatic from 35%, which was reported in late May, to 40%. The agency previously estimated that the chance of transmission of the virus from asymptomatic people was 100%, CNN reported.
- The new report also included an “Infection Fatality Ratio,” which counts deaths in symptomatic and asymptomatic cases to more accurately capture “disease severity.” Under the new metric, the CDC estimated that 0.65% of people infected with C19 are forecasted to die.
[Note: The Infection Fatality Rate is an average rate. In reality, the risk of younger people is much less and the risk of older people is higher.]
2. Asymptomatics May Not Be Spreading the Coronavirus
- A study by Chinese scientists found that the coronavirus may be producing defective “dummy” particles, causing some people without symptoms to test positive for the pathogen.
- About 20% of coronavirus cases are asymptomatic and some researchers are concerned that these “silent spreaders” are sowing seeds for outbreaks around the world.
- In one case, a patient in the southwestern Chinese city of Chongqing tested positive throughout a 45-day hospital stay without any sign of illness.
- It is not known why some people do not show symptoms but new research suggests that these cases need not be cause for great concern.
- In a non-peer-reviewed paper posted in the preprint platform bioRxiv.org on Thursday, researchers led by Professor Li Lanjuan from the State Key Laboratory for Diagnosis and Treatment of infectious Diseases at Zhejiang University found that a cell infected by the virus could release a large number of unknown particles.
- The particles had incomplete coronavirus genes and were not encased in protective membranes. Some of them looked smaller than normal viruses and many were irregular in shape.
- It was the first time scientists had seen such a particle near a cell infected with the coronavirus, and it was not clear what they were.
- Li suspected these were DIPs, or defective interfering particles.
- DIPs are inaccurate copies the virus makes as it replicates. The coronavirus stores its genes in single-stranded, relatively loose ribonucleic acid, which is prone to replication errors, such as the loss of protein-related genes.
- There was “minor deletion in the genome and massive quantity of the particles”, Li and her collaborators at Tsinghua University in Beijing said in the paper.
- These particles could “explain for the asymptomatic infection on the molecular level”.
- Some researchers have suggested that symptom-free carriers could be the initial cause of a surge in cases in some countries but there has been no evidence so far of viral reproduction from these cases.
- Such concerns prompted the World Health Organization to withdraw a statement in April that asymptomatic patients were unlikely to spread the virus.
- But an epidemiologist at the Chinese Academy of Sciences in Beijing, who was not authorized to speak to the media, said the new research could bolster the WHO’s initial assessment.
- “The new discovery may throw the WHO a lifesaver to get out of the hot water,” he said.
- However, the epidemiologist also said the study may “have raised more questions than answers”.
- That is because the defective particles may also be hitching a ride on a full virus and help with infection after entering a host cell.
- In the paper, Li and the team said that a small number of full viruses were detected with the particles. Whether they could lead to some symptoms remained unclear, they said.
- The researchers also found evidence that a dominant viral strain circulating in Europe and the United States was more infectious than those in China because it has more spike proteins.
- Li, who proposed the lockdown of the central city of Wuhan in late January, also said that on average, each coronavirus had on its envelope 26 spike proteins, which bind with human cells.
- That is about a tenth of the number on influenza viruses but roughly the same as HIV, a highly infectious pathogen.
- Having fewer spike proteins did not make the novel coronavirus less infectious. Like HIV, it was quite the opposite, according to the study. While the exact number on each virus varied, the fewer the spikes, the more efficiently the virus could bind with a cell, the researchers found.
3. Common Molecular Feature of Antibodies that Neutralize the Coronavirus Discovered, Boosting C19 Vaccine Prospects
- A team led by scientists at Scripps Research has discovered a common molecular feature found in many of the human antibodies that neutralize the coronavirus.
- The scientists, whose study appears today (July 13, 2020) in Science, reviewed data on nearly 300 anti-SARS-CoV-2 antibodies that their labs and others have found in convalescent C19 patients over the past few months. They noted that a subset of these antibodies is particularly powerful at neutralizing the virus — and these potent antibodies are all encoded, in part, by the same antibody gene, IGHV3-53.
- The scientists used a powerful tool known as X-ray crystallography to image two of these antibodies attached to their target site on the coronavirus. The resulting atomic-structure details of this interaction should be useful to vaccine designers, as well as to scientists hoping to develop antiviral drugs targeting the same site on the coronavirus.
- Prior research suggests that antibodies encoded by IGHV3-53 are generally present, at least in small numbers, in healthy people’s blood. The results therefore offer hope that using a vaccine to boost levels of these ever-present antibodies will protect adequately against the virus.
- “This type of antibody has been isolated frequently in studies of C19 patients, and we can now understand the structural basis for its interaction with the coronavirus,” says the study’s senior author Ian Wilson, DPhil, Hansen Professor of Structural Biology and Chair of the Department of Integrative Structural and Computational Biology at Scripps Research.
- “This study provides important inspiration for effective C19 vaccine design,” says co-author Dennis Burton, PhD, professor and co-chair of the Department of Immunology and Microbiology at Scripps Research.
- The research was a collaboration chiefly involving the Wilson and Burton labs, and the Scripps Research-based Neutralizing Antibody Center of IAVI, a prominent non-profit vaccine research organization.
- Although several potential vaccines are already in clinical trials, scientists don’t yet have a full understanding of the molecular features that would define a protective antibody response. In the new study, the scientists took a big step toward that goal.
- The team started by analyzing 294 different coronavirus-neutralizing antibodies isolated from C19 patients’ blood over the past few months. Antibodies are Y-shaped proteins made in immune cells called B-cells. Each B-cell makes a specific antibody type, or clone, which is encoded by a unique combination of antibody genes in the cell. The scientists found that an antibody gene called IGHV3-53 was the most common of the genes for the 294 antibodies, encoding about 10% of them.
- The scientists also noted that the IGHV3-53-encoded antibodies in their study contain an unusually short variant of the CDR H3 loop, normally a key target-binding element. These antibodies are nevertheless very potent against the coronavirus when compared to other antibodies not encoded by IGHV3-53.
A powerful response right off the bat
- The IGHV3-53 antibodies had yet another property suggesting that boosting their numbers would be a good and achievable aim for a coronavirus vaccine: They appeared to have mutated only minimally from the original versions that would be circulating, initially in small numbers, in the blood of healthy people.
- Normally, when activated by an encounter with a virus to which they fit, B-cells will start proliferating and also mutating parts of their antibody genes, in order to generate new B-cells whose antibodies fit the viral target even better. The more mutations needed for this “affinity maturation” process to generate virus-neutralizing antibodies, the harder it can be to induce this same process with a vaccine.
- Fortunately, the IGHV3-53 antibodies found in the study seemed to have undergone little or no affinity maturation and yet were already very potent at neutralizing the virus — which hints that a vaccine may be able to induce a protective response from these potent neutralizers relatively easily.
- “Coronaviruses have been around for hundreds to thousands of years, and one can imagine that our immune system has evolved in such a way that we carry antibodies like these that can make a powerful response right off the bat, so to speak,” Wilson says.
Map for vaccine-makers, gauge for clinical trials
- Wilson’s team used high-resolution X-ray crystallography to image two different IGHV3-53 antibodies bound to their target on the coronavirus. This target, known as the receptor binding site, is a crucial structure on the viral “spike” protein that normally connects to a receptor on human cells to begin the process of cell infection. Many of the antibodies that neutralize the coronavirus appear to do so by blocking this virus-receptor connection.
- “We were able to reveal unique structural features of these IGHV3-53-encoded antibodies — features that facilitate their high binding affinity and their specificity for the coronavirus receptor binding site,” says co-first author Meng Yuan, PhD, a postdoctoral research associate in the Wilson lab.
- The detailed atomic-scale structural data should be of interest to vaccine designers and drug developers. Moreover, the researchers say, the identification of IGHV3-53-encoded antibodies as key elements of the immune response to C19 suggests that levels of these antibodies might be useful as an indirect marker of success in ongoing and future vaccine trials.
4. Immune analysis in 50 patients uncovers ‘hallmark’ of severe C19
- By studying fifty C19 patients, researchers in France identified a unique signature – a combination of deficiency in a response of a particular interferon, as well as exacerbated inflammation – in the most critically ill.
- They propose this signature, which may be a hallmark of severe C19, provides a rationale for therapeutic approaches that combine interferon supplementation with neutralization of inflammatory signaling.
- C19 is characterized by distinct patterns of disease progression depending on the patient, which implies patients exhibit different immune responses to the coronavirus.
- So far, studies suggest some 5-10% of patients progress to severe or critical disease.
- However, little is known about the immunological features involved in C19 severity. To help to fill this gap, Jérome Hadjadj and colleagues analyzed immune cells of C19 patients with symptoms ranging from mild to critical.
- The critical patients exhibited a distinctive dual signature involving a deficiency in responses of type I interferons, proteins that help fight viral infections, as well as exacerbated proinflammatory signaling.
- While recent work to investigate the role of interferon signaling in C19 patients has shown that local interferon signaling may be important to mitigate disease progression, the results of Hadjadj et al. suggest broader production of interferons may in fact be beneficial.
- The work of these studies collectively reinforces a growing hypothesis that the location, timing, and duration of interferon exposure are critical parameters underlying the success of therapeutics for coronavirus infections.
- Hadjadj et al. also suggest severely ill C19 patients could be treated with a combined approach focused on interferon administration and adapted anti-inflammatory therapies, “a hypothesis worth cautious testing,” they say.
5. Scientists focus on how immune system T cells fight coronavirus in absence of antibodies
- As scientists question whether the presence, or absence, of antibodies to the novel coronavirus can reliably determine immunity, some are looking to a different component of the immune system, known as T cells, for their role in protecting people in the pandemic.
- Recent studies show that some recovered patients who tested negative for coronavirus antibodies did develop T cells in response to their C19 infection.
- While the studies are small and have yet to be reviewed by outside experts, some scientists now say that people who experience a mild illness, or no symptoms at all, from the new coronavirus, may be eliminating the infection through this T cell response.
- The findings add to the evidence that an effective C19 vaccine will need to prompt T cells to work in addition to producing antibodies, and may have implications for several treatments in development. They may also shed light on how immunity to new exposure to infection could work.
- “There is mounting evidence that people exposed to the virus have a transient (short-lived) antibody response, or have a T cell response in spite of a minor or absent antibody response,” Dr. Alessandro Sette, professor and member of the La Jolla Institute’s Infectious Disease and Vaccine Center in California, told Reuters.
- When a virus gets past the body’s initial defenses – which include infection-fighting white blood cells – a more specific “adaptive” response kicks in, triggering production of cells that target the invader. These include antibodies that can recognize a virus and lock onto it, preventing its entry into a person’s cells, as well as T cells that can kill both invaders and the cells they have infected.
- Six months into a global C19 pandemic that has infected more than 12 million people, questions remain about whether the antibody response to this virus is robust and lasts over time. That could mean T cells have a more important role in offering protection against the illness.
- “T cells are often important in controlling viral infections. We are seeing evidence of that,” John Wherry, director of the University of Pennsylvania’s Institute for Immunology, told Reuters.
- A recent small French study here not yet reviewed by experts, found that six out of eight family members in close contact with relatives who had C19 developed a T cell response, but did not test positive for antibodies.
- A Swedish study of 200 people found a strong T cell response in most individuals who had mild illness or no symptoms following coronavirus infection, regardless of whether they showed an antibody response. The finding suggests that coronavirus infection rates may be higher than what has been studied using antibody tests alone, the researchers said.
Memories of Coronavirus
- The focus on T cell responses could also shed light on the prospect for longer-term immunity.
- There is some evidence that T cells developed after exposure to other coronaviruses that cause the common cold could help fight off the new coronavirus.
- A study led by the La Jolla Institute detected T cells that reacted to the coronavirus in about half of stored blood samples collected between 2015 and 2018, suggesting that the immune system cells developed after previous infection with circulating common cold coronaviruses, and that they might help protect against the new virus.
- “It is a potentially encouraging piece of evidence,” Wherry said.
- Vaccine candidates against C19 currently in the works aim to generate antibody and T cell responses, and the recent findings highlight the importance of gauging the T cell response seen in human clinical trials.
- “We believe that the optimal vaccine design would be one that induces both an antibody and T cell response,” Sette said.
- After an infection or vaccination, the immune system retains a number of “memory” cells that are already primed to quickly attack the same virus in case of a future infection.
- Many countries are using blood tests that look for antibodies to estimate how many people have been infected with the new virus even if they never showed symptoms. But scientists still do not know how antibody levels correlate to exposure to the virus or how long they may last. There are also questions about exactly which combination of immune-system cells will result in significant protection.
- Measuring the level of memory T cells is much more complicated, especially if the cells are in lymph nodes or other hard-to-access areas of the body. In addition, T-cell responses are highly variable.
- “It is a lot easier to collect antibody data,” said Dr. Daniela Weiskopf, an assistant professor at the La Jolla Institute.
E. Improved & Potential Treatments
1. Itolizumab approved by India as life-saving C19 medicine for moderate to severely ill patients; 100% of patients given drug in trial recovered
- Kiran Mazumdar Shaw, Executive Chairperson of Biocon Limited, Bengaluru, announced Monday that Biocon has received the Drugs Controller General of India’s (DCGI) approval to market Itolizumab (ALZUMAb) Injection 25mg/5mL solution for emergency use in India for the treatment of cytokine release syndrome (CRS) in moderate to severe ARDS (acute respiratory distress syndrome) patients due to C19.
- Itolizumab is the first novel biologic therapy to be approved anywhere in the world for treating patients with moderate to severe C19 complications. Biocon has repurposed Itolizumab, an anti-CD6 IgG1 monoclonal antibody launched in India in 2013 as ALZUMAb® for treating chronic plaque psoriasis, for the treatment of CRS in moderate to severe ARDS patients due to C19.
- Itolizumab will be manufactured and formulated as an intravenous injection at Biocon’s bio-manufacturing facility at Biocon Park, Bengaluru.
- The approval of Itolizumab, from the DCGI is based on the results from the successful conclusion of a randomized, controlled clinical trial at multiple hospitals in Mumbai and New Delhi. The study focussed on the safety and efficacy of Itolizumab in preventing CRS in moderate to severe ARDS patients due to C19.
- The primary endpoints for reduction in mortality rate were met and other key secondary endpoints for efficacy and biomarkers were also achieved. Over 100 people in Maharashtra, Gujarat and Delhi have been cured who were given Itolizumab drug.
- Speaking on the development, Kiran Mazumdar Shaw said, “As an innovation-led biopharmaceuticals company, I am proud of the successful outcome of the pivotal study we conducted with our novel immuno-modulating anti-CD6 monoclonal antibody, Itolizumab, which has proven to be an efficacious intervention in treating the serious hyper-immune response seen with C19. The data is compelling and I am too confident that this ‘first-in-class’ biologic will save lives and help reduce the mortality rate in our country.”
- Kiran Mazumdar Shaw further said, “This positions India amongst the leading global innovators in their effort to overcome the C19 pandemic. The randomized control trial indicated that all the patients treated with Itolizumab (ALZUMAb®) responded positively and recovered. The control arm that did not receive Itolizumab unfortunately had deaths.
- Itolizumab is now approved for the treatment of CRS in patients with moderate to severe ARDS due to C19. We plan to take this therapy to other parts of the world impacted by the pandemic.”
- “Itolizumab’s unique mechanism of action made it an ideal candidate for treating the ‘cytokine storm’, which is a leading cause of death in C19 patients. I am pleased that our R&D and clinical teams delivered on this promising hypothesis in such a short period of time. It is a proud moment for all of us at Biocon and we would like more and more patients to benefit from this therapy. I also thank the investigators and the regulators for the sense of urgency that they displayed in this study,” Shaw added.
2. Drug linked to 45% lower risk of dying among C19 patients on ventilators
- Critically ill C19 patients who received a single dose of a drug that calms an overreacting immune system were 45% less likely to die overall, and more likely to be out of the hospital or off a ventilator one month after treatment, compared with those who didn’t receive the drug, according to a new study by a team from the University of Michigan.
- The lower risk of death in patients who received intravenous tocilizumab happened despite the fact that they were also twice as likely to develop an additional infection, on top of the novel coronavirus.
- The study is published in the peer-reviewed journal Clinical Infectious Diseases after being available as a preprint last month.
- It suggests a benefit from timely and targeted efforts to calm the “cytokine storm” caused by the immune system’s overreaction to the coronavirus.
- Tocilizumab, originally designed for rheumatoid arthritis, has already been used to calm such storms in patients receiving advanced immunotherapy treatment for cancer.
- The researchers base their conclusions on a thorough look back at data from 154 critically ill patients treated at Michigan Medicine, U-M’s academic medical center, during the first six weeks of the pandemic’s arrival in Michigan from early March to late April. The analysis looked at patients’ records through late May.
- During that time, when little was known about what would help C19 patients on ventilators, about half of the studied patients received tocilizumab and half did not. Most received it within the 24-hour period surrounding their intubation.
- This created a natural opportunity for comparing the two groups’ outcomes in an observational study, though clinical trials are still needed to truly see if the drug provides a benefit, the authors say.
- Lead author Emily Somers, Ph.D., Sc.M., an epidemiologist who has studied both rheumatologic and immunologic diseases, says the research team went into their analysis uncertain whether they would find a benefit, a risk, or no clear effect associated with tocilizumab in the patients with life-threatening C19. But they knew it was a critically important question that they were uniquely positioned to answer at that point in the pandemic.
- “One role of epidemiology is to rigorously evaluate real-world data on treatment effects, especially when evidence from clinical trials is not available. We kept trying to prove ourselves wrong as signals of benefit emerged in the data, both because of the immediate implications of these data, and in part because of concern about the supply of the medication for other patients,” she says. “But the difference in mortality despite the increase in secondary infection is quite pronounced, even after accounting for many other factors.”
- The ASP group developed treatment guidelines provided to Michigan Medicine physicians in mid-March that identified tocilizumab as a potentially beneficial therapy for the most severely ill C19 patients. Those guidelines also pointed out its risks and the lack of evidence for its use in C19, and recommended a dose of 8 milligrams per kilogram.
- This led some physicians to choose to use it, while others did not – setting the stage inadvertently for a natural comparison.
F. Concerns & Unknowns
1. One-third of young adults may be at risk of severe C19, especially if they smoke or vape
- One-third of young people across the country may be at risk of getting seriously sick with C19, especially if they smoke or vape, according to a UCSF study published Monday in the Journal of Adolescent Health.
- Smoking was the most common risk factor for severe C19 complications among otherwise largely healthy young people, the study found.
- For young men, smoking or vaping may more than double the potential of being hospitalized, needing intensive care, or even dying from the virus.
- For young women, who suffer more from other risk factors, smoking or vaping could increase the possibility 1½ times.
- “I think most young adults don’t think they’re at risk,” said senior author Dr. Charles Irwin Jr., director of the UCSF Division of Adolescent and Young Adult Medicine. “To me, that was shocking to find that smoking contributed so much to being at risk. … It’s a message that you might be able to do something about.”
- The study sounds the alarm as coronavirus cases among youth appear to be driving the nation’s surge. Young people between 18 and 29 are filling more hospital beds than at the start of the pandemic, with a 299% increase in hospitalizations from mid-April to late June, according to a UCSF analysis of Centers for Disease Control and Prevention data. At UCSF, 14% of people in the same age range who tested positive through the health system needed inpatient care.
- To find the risks for this growing group, the study analyzed medical data from 8,405 men and women ages 18 to 25 through the National Health Interview Survey, a representative data set based on annual surveys from 2016 to 2018.
- The authors looked for C19 risk factors, defined by the CDC as heart conditions, diabetes, asthma, immune conditions, liver conditions, obesity and smoking. The study authors added e-cigarettes to tobacco and cigars because of research showing they cause similar lung damage.
- Of the young people surveyed, 20% had smoked in the past 30 days.
- Among the whole group, the risk of getting severely sick from C19 was 32%. That risk was cut in half — to 16% — when smokers were taken out of the equation, revealing how smoking alone spiked the likelihood of young people being hospitalized or dying from the virus.
- “It’s really the vulnerable point for the young adult group right now,” said study author Sally Adams, specialist at UCSF Division of Adolescent and Young Adult Medicine.
- The authors also analyzed gender, race, income and health insurance compared with risk factors. Men were more likely to smoke and were at increased risk of getting sicker from C19, although nonsmoking women had higher rates of asthma, immune conditions and obesity that made them more vulnerable to the virus.
- Among races, whites were at increased risk to get severely sick, in line with higher smoking rates. People who were low income and uninsured were more likely to smoke, which raised their health risks.
- The study highlighted the risks to young people as cases among the age group rise nationally and locally. In California, new coronavirus cases among people under age 35 surged by 73% in the last two weeks of June compared to the first two weeks of the month, while infections among people over 50 rose 42%, an analysis of California Department of Public Health data revealed.
2. People with coronavirus symptoms more likely to have psychiatric disorders and loneliness
- People who have or had C19 symptoms are more likely to develop general psychiatric disorders and are lonelier, with women and young people more at risk, says a just-published study co-authored at Cambridge Judge Business School.
- Having a job and living with a partner are significant protective factors against general psychiatric disorders and loneliness, says the study in the journal Psychiatry Research, based on 15,530 UK respondents, which is described as the first such large-scale, nationally representative survey in a developed country.
- Although there has been previous research on specific coronavirus-related disorders such as anxiety, depression and insomnia, prior to this research we knew “little about the broader psychological impact of the pandemic on a wider population”, says the study in the journal’s September 2020 issue.
- “Only focusing on specific disorders underestimates the psychiatric burdens of the pandemic in more subtle forms and overlooks the needs for psychiatric care of the people who have not been clinically diagnosed,” the study says.
- “Although the minor psychiatric disorders are often less urgent concerns of the public health policies, they are not negligible given the large proportion of the population that have been affected,” says the study co-authored by Lambert Zixin Li of Stanford University, who holds an MPhil in Innovation, Strategy & Organisation from Cambridge Judge Business School (MPhil 2018), and Senhu Wang, a Research Fellow at the Centre for Business Research at Cambridge Judge Business School, who holds a PhD in Sociology from the University of Cambridge.
- The study measures general psychiatric disorders based on the 12 items in the widely accepted General Health Questionnaire, which looks at factors ranging from depressive anxiety symptoms to confidence to overall happiness, while loneliness was assessed by a question adapted from the English Longitudinal Study on Aging about how often respondents felt lonely in the previous four weeks.
- “Loneliness is linked to long-term health outcomes including all-cause mortality, so public health policies need to be aware of the (mental) health consequences of the disease control measures,” the study says.
- The research found that 29.2% of all respondents (representing the general British population) scored ‘4’ (the “caseness” or clinical referral threshold) or more on a five-point scale for general psychiatric disorders, while 35.86% of respondents sometimes or often feel lonely; further analysis of the results showed that those who have or had coronavirus symptoms were more likely to have such disorders or feel lonely.
- “People with current or past C19 symptoms were perhaps more likely to develop general psychiatric disorders because they are more anxious about infection, and their greater loneliness may reflect the fact that they were isolated from family and friends,” says co-author Senhu Wang of the Centre for Business Research at Cambridge Judge.
- Women and young people (aged 18-30) who responded were significantly more at risk from general psychiatric disorders and loneliness, which the study says may reflect the fact that, compared to older people, these younger people’s social and economic lives are more disrupted by the public health crisis.
- Having a job and living with a partner are both “significant protective factors”, said the study, which suggested further research into how social support from work and family buffer the psychological impacts of a pandemic.
- The survey was conducted toward the end of April, at a time when there were around 23,000 coronavirus-related deaths in the UK. The study found no significant differences across different UK regions on either general psychiatric disorder or loneliness.
- “Future research and public health policies need to move beyond specific psychiatric disorders to attend to the general psychiatric disorders and loneliness of a larger proportion of the population,” the study concludes. “They need to pay special attention to vulnerable populations including women, the younger, the unemployed, those not living with a partner, and those who have or had C19 symptoms.
- “A pandemic like C19 could exaggerate social disparities in mental health in subtle ways, calling for research on effective interventions such as mindfulness, mediation-based stress reduction and timely provision of psychiatric services.”
3. C19 may have ‘devastating impact’ on the heart
- More than half of heart scans among hospitalized C19 patients are abnormal, suggesting the coronavirus may have a devastating impact on this vital organ, according to new research.
- A study from 69 countries, funded by the British Heart Foundation (BHF), found that 55% of 1,261 patients studied had abnormal changes to the way their heart was pumping, with around one in seven showing evidence of severe dysfunction.
- The majority (901 patients) had never been diagnosed with heart problems before, leading scientists to conclude that C19 itself may seriously affect the heart.
- Among this group, heart scans were abnormal in 46% of patients and 13% had severe disease.
- Just over half (54%) of all the scans were performed in intensive care, with others carried out on general wards, heart and lung wards and in A&E.
- Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and a consultant cardiologist, said: “Severe C19 illness can result in damage to the heart and circulatory system.
- “We urgently need to understand more about why this is happening so we can provide appropriate care – both short and long term.
- “This global study – carried out at the height of the pandemic – shows that we must be on the lookout for heart complications in people with C19 so that we can adapt their treatment if needed.”
- The study, published in the European Heart Journal – Cardiovascular Imaging, found the abnormalities were almost evenly split between the left and right chambers of the heart.
- Some 3% of patients had suffered a recent heart attack, according to the scans.
- As a result of their scan, one third of patients had their treatment changed, including being given medicines for heart failure, or more careful control of fluids and therapy designed to support heart function.
- The study was carried out by researchers from the British Heart Foundation Centre of Research Excellence at the University of Edinburgh.
- The team cautioned that the study cannot conclude how common heart changes are in people who did not receive scans.
- They stressed that all patients in the study were in hospital and had suspected heart complications.
- Professor Marc Dweck, who led the research, said: “C19 is a complex, multi-system disease which can have profound effects on many parts of the body, including the heart.
- “Many doctors have been hesitant to order echocardiograms for patients with C19 because it’s an added procedure which involves close contact with patients.
- “Our work shows that these scans are important – they improved the treatment for a third of patients who received them.
- “Damage to the heart is known to occur in severe flu, but we were surprised to see so many patients with damage to their heart with C19 and so many patients with severe dysfunction.
- “We now need to understand the exact mechanism of this damage, whether it is reversible and what the long-term consequences of C19 infection are on the heart.”
G. Projections & Our (Possible) Future
1. British scientists predict second coronavirus wave when winter comes
- Scientists are warning that a second wave of the coronavirus could hit in winter when temperatures drop, more than likely forcing another round of lockdowns to keep the infection from spreading.
- A senior member of Britain’s Scientific Advisory Group for Emergencies told The Sun newspaper that C19 flourishes in colder temperatures and could spread rapidly when the mercury dips to 39 degrees.
- “It is really important that people get ready for the challenges that winter will undoubtedly bring,” said an unnamed senior official with the group.
- Scientists are monitoring spikes in the spread of the coronavirus in Melbourne, Australia’s second-largest city. As the country heads into the Southern Hemisphere’s winter, authorities ordered a second six-week lockdown last week after the confirmation of 75 new cases.
H. Johns Hopkins C19 Update
July 13, 2020
1. Cases & Trends
- EPI UPDATE The WHO COVID-19 Situation Report for July 12 reports 12,552,765 cases (230,370 new) and 561,617 deaths (5,285 new), continuing an overall trend of reporting over 200,000 new cases per day.
Central & South America
- Brazil has officially reported 24,831 new cases, more than 1.86 million cases total. This daily incidence is nearly 20,000 cases lower than the most recently reported daily incidence of about 42,000 last week. Brazil still remains #2 globally in terms of daily incidence, following the US. However, today appears to be the third consecutive day of decreasing incidence. Mexico reported 5,822 new cases, now ranking #6 globally in terms of daily incidence. The reported number of new cases today is lower than the more than 7,000 reported most recently on July 10; however it is too early to tell whether this indicates a longer term trend. Central and South America still remain a concerning locus of increasing daily C19 incidence, with Colombia (#7), Peru (#8), Argentina (#9), and Chile (#11) all within the top 15 countries reporting highest daily incidence. Additionally, Panama (#3) , Brazil (#8) and Chile (#10) are all within the top 10 countries of per capita daily incidence. Central and South American countries also represent 5 of the top 18 countries in terms of per capita daily incidence.
India, Pakistan & Bangladesh
- India has continued to report increasing daily incidence, with 28,151 new cases, and remaining #3 globally in terms of daily incidence. Pakistan has continued a downward trend in daily incidence since its peak last month, with 2,769 new cases reported in the last 24 hours compared to 2,954 two days ago. Additionally, the country’s active cases, currently totaling 84,442, has continued to remain below 90,000. Pakistan has fallen to #13 globally in terms of daily incidence, now currently below Bangladesh. Bangladesh has also reported steady daily incidence as well, reporting 3,099 cases in the past 24 hours compared to 2,949 new cases reported on July 10.
Eastern Mediterranean Region
- Israel, reporting increasing incidence last week, is currently demonstrating a small dip in its incidence over the past two days. Israel has now fallen one position lower to from #10 to #11 globally in terms of per capita daily incidence. The Eastern Mediterranean Region remains a hotspot based on per capita incidence, representing 5 of the top 10 countries in terms of per capita incidence: Oman (#1), Bahrain (#2), Qatar (#7), Kuwait (#9), and Israel (#11). Armenia has jumped to #6 in global per capita incidence. Additionally, Saudi Arabia is #10 in daily incidence, reporting 2,852 new cases, alongside Iraq as a country in the region reporting over 1,000 new cases per day.
- Remaining #4 in total daily incidence as well as per capita daily incidence, South Africa remains a country of concern with fluctuating incidence that is currently at 12,058 new cases today, compared to 13,497 new cases yesterday and 12,348 new cases on July 11.
- The US CDC reported a total of 3.29 million total cases (60,469 new) and 134,884 total deaths (312 new today, 906 yesterday). While the number of new cases reported today is currently lower than that reported on Friday, July 10 (64,771 new), it continues the trend of reporting over 50,000 new cases per day. A total of 22 states and New York City have reported more than 40,000 total cases, unchanged from Friday. States with some of the highest case counts include California with over 300,000 cases, Florida and Texas each with over 250,000, and New Jersey, New York City, New York State, and Illinois with at least 150,000 cases. Over the weekend, Florida broke a US state record of daily new cases, with over 15,200 new cases in a day, making it the single-largest increase in daily case counts reported by any state. In addition, 3 additional states have at least 100,000 cases. There has been a 68% increase in number of new daily cases reported compared to 2 weeks ago, up from 32,220 to 54,100 cases yesterday (Two Week Tracker).
- Regional analysis of state-level C19 data continues to show the epidemic accelerating across most regions in the US. The South, Southwest, West, and Midwest regions all have demonstrated marked increases in daily new cases, with the rate of increases also accelerating particularly in the South. The midwest, after having successfully slowing its epidemic by mid-June, is now approaching the similar weekly incidence rates it experienced during its first peak in early May. While the Midwest has reported about 5% test positivity that has been steadily increasing since June 18th, the South and Southwest have about 13% and 18% test positivity, respectively, compared to about 2% in mid-Atlantic and New England.
- The Johns Hopkins CSSE dashboard reported 3.32 million US cases and 135,295 deaths as of 1:15pm on July 13.
2. US Response
- Testing challenges and limitations that have hampered the US response efforts from the first days of the pandemic have increased as C19 incidence continues to resurge. According to the CDC, the US has conducted 40,787,857 tests across the country, of which approximately 9% have come back positive nationwide. As supply chain limitations and infrastructure challenges became evident in March, the Trump Administration assigned ADM Brett Giroir to address testing efforts and ensure national scale up, with a goal of having the capacity to conduct at least 500,000 tests per day. Much of the response efforts to expand testing, however, fell substantially onto state and local officials to manage, and although testing capacity increased across the US as a whole, wide disparities remain across states remain. As case counts rise, many states are now reporting substantial delays in receiving test results, sometimes taking up to 14 days. In addition to supply constraints and lab capacity limitations, logistical challenges such as transporting large numbers of samples, and communicating results to public health responders in a timely manner have caused delays.
- Separately, about 1,000 current employees at the United States Centers for Disease Control and Prevention (CDC) – equivalent to at least 9% of the organization’s total workforce – have signed a letter addressed to CDC Director Dr. Robert Redfield regarding racial discrimination in the workplace and racism as a greater public health crisis. The letter comes at a particularly fraught time for CDC as the organization.
3. Remdesivir Supply Chain Issues
- Remdesivir, produced by Gilead Sciences, is one of the few therapeutics that has received emergency use authorization for treatment of the disease outside of research studies. However, access to the medication has been inconsistent. Despite the US receiving 940,000 doses in donations and buying about 500,000 doses of the drug, hospitals across the country have reportedly experienced substantial and critical shortages. The supply is predicted to be sufficient through the end of September, but some health departments have already reportedly run out of their allocation. As of now, allocation is reportedly determined proportionally according to the CDC’s Healthcare Safety Network, US Health and Human Services Protect and Teletracking, a private company, but experts are concerned that data used to make these allocations may be out of date and not predictive of future C19 hot spots and related burdens on health systems.
4. Outbreak at Okinawa Base
- The United States Marine Corps houses about half of the 55,000 US troops in Japan, or approximately 20,000 service members, in Okinawa. The Japanese island community has experienced only 148 confirmed infections of C19 since February, but American troops have reported 94 new cases today at three bases on the island. Governor Denny Tamaki of the prefecture expressed concern for whether the bases’ response will be sufficient to prevent a new wave of infection.The base has reportedly been on a virtual lockdown that bans travel off-base without prior approval as well as other restrictions.
5. Report on Healthcare Workers
- Amnesty International, a nongovernmental organization committed to responding to human rights abuses, released a report today regarding the abuses inflicted on healthcare workers and other essential workers during the C19 pandemic. The report notes that government protections for this group have thus far been inadequate and makes specific recommendations for improvement. Amnesty International notes that at least 3,000 health workers in 79 countries have died from C19, and that healthcare workers are sometimes forced to work under inhumane conditions with threats of violence and stigma hanging over them. The report indicates that health workers who identify as black, Asian or another minority ethnic group are at an increased risk of infection and death. Reports of community members harassing health workers with threats of violence or discrimination. At least ten countries have reported attempts to evict health workers due to their occupation and attacks on healthcare workers have been documented in at least eleven countries. The authors of the report advocate for increases in access to personal protective equipment for health workers, better recording of healthcare workers deaths due to C19, policy changes to limit reprisals against health workers who speak out, better compensation for health workers who become sick on the job and improvements in investigation of violence against health workers.
6. BCG Vaccine
- A study published in the Proceedings of the National Academies of the Sciences recently indicates that bacillus Calmette-Guérin (BCG) vaccine may provide cross-protection against C19, though the study authors note that further evaluation is needed. BCG vaccine is currently used in a limited number of countries to prevent tuberculosis, although its efficacy remains controversial. Authors of the study note that prior to the C19 pandemic, BCG was hypothesized to provide additional nonspecific immunity against respiratory diseases other than tuberculosis, reducing mortality due to respiratory diseases in vaccinated individuals compared to unvaccinated individuals. This study attempts to assess whether or not this effect is significant after controlling for confounding variables. The findings indicate that BCG vaccination may provide protection from severe C19 outcomes but controlled clinical trials and additional assessments are needed to confirm the hypothesis.
7. Coronavirus Immunity
- The immunity induced from coronavirus infection has yet to be fully understood and characterized, and the duration of immunity is unclear. News media recently reported anecdotal observations from a physician about a patient who tested positive while ill, fully recovered and then consistently tests negative, only to subsequently become severely ill and test positive months later, suggesting reinfection. Others have increasingly observed patients dealing with long-term infections that take many weeks or even months to clear with ebbs and lulls of symptoms.
- It is unknown whether or not recurrent infections are tied to waning immunity after initial infection. A recent study found that individuals infected could elicit a wide range of antibody levels, which could vary based on length of time of infection or severity of disease. Notably, the study observed that high binding antibodies were not necessarily always associated with the development of neutralizing antibodies, and thus the authors warned to demonstrate caution when using ELISAs and other antibody binding assays as an indicator of neutralizing antibodies, as seropositivity may not always mean protection from future infection. Furthermore, others have observed that some patients have never developed protective antibodies post-infection. The potential implications of waning or incomplete SARS-CoV-2 immunity may indicate that post-infection immunity is temporary or not robust enough to fight off a second infection, which in turn raises concerns for the potential efficacy of future vaccines. However, more research is needed to understand the duration and durability of immunity.