Recent Developments & Information
July 16, 2020
Without reliable information, we rely on fear or luck.
“We’ve got to almost reset our response and say, OK, let’s stop this nonsense and figure out how can we get our control over this now, and looking forward, how can we make sure that next month, we don’t have another example of California, Texas, Florida and Arizona, because those are the hot zones now, and I’m looking at the map, saying we got to make sure it doesn’t happen in other states. So rather than these games people are playing, let’s focus on that.”Dr. Fauci
A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
C. New Scientific Findings & Research
D. Improved & Potential Treatments
E. Concerns & Unknowns
F. Back To School!?
H. Projections & Our (Possible) Future
I. Practical Tips & Other Useful Information
J. Johns Hopkins COVID-19 Update (7/15)
K. Links to Other Stories
Novel test method detects coronavirus in highly diluted gargle samples Pharmacists at Martin Luther University Halle-Wittenberg (MLU) have succeeded in detecting small amounts of coronavirus using mass spectrometry. For their investigation, they used gargle solutions of C19 patients. The novel method might supplement conventional tests. It is currently undergoing improvements and might be available as standard diagnostic tool for C19 in the future.
Penn researchers find three distinct immune responses for sicker COVID-19 patients Researchers from the Penn Institute of Immunology discovered three distinct immune responses to the SARS-CoV2 infection that could help predict the trajectory of disease in severe COVID-19 patients and may ultimately inform how to best treat them.
Researchers identify genetic factors that may influence COVID-19 susceptibility A new Cleveland Clinic study has identified genetic factors that may influence susceptibility to C19. Published today in BMC Medicine, the study findings could guide personalized treatment for C19
Baby boy infected with coronavirus in womb French study is believed to be the first such confirmed case but doctors say the infant has made a good recovery
New normal: How far is safe enough? Among the many ways C19 has reshaped our lives, one of its most enduring effects may be changes to the way we use and move through public spaces. Parks, restaurants, theatres and more all pose hazards for virus transmission, and governments are setting out new restrictions to make these places safer
First data for Moderna Covid-19 vaccine show an immune response Moderna’s C19 vaccine led patients to produce antibodies that can neutralize the novel coronavirus that causes the disease, though it caused minor side effects in many patients, according to the first published data from an early-stage trial of the experimental shot
Has Covid Brought an End to Helicopter Parenting? The pressures of the pandemic have forced families to abandon the hypervigilant approach popular since the 1990s. That could help kids become more independent, but also comes with risks
The Math of Social Distancing Is a Lesson in Geometry How to safely reopen offices, schools and other public spaces while keeping people six feet apart
Ups and downs in COVID-19 data may be caused by data reporting practices Findings suggest epidemiological models should account for problems with diagnosis and reporting
Rapid genome sequencing and screening help hospital manage COVID-19 outbreaks Cambridge researchers have shown how rapid genome sequencing of virus samples and enhanced testing of hospital staff can help to identify clusters of healthcare-associated C19 infections
A. The Pandemic As Seen Through Headlines
(In no particular order)
- Global sentiments towards COVID-19 shifts from fear to anger
- COVID-19 vaccine trial produces antibodies in everyone tested, report says
- COVID-19 could be controlled in 2 months if people wear masks: CDC director
- CDC director defends the shift of virus data collection away from his agency
- Scientists find no virus risk based on blood type
- Trump administration to ratchet up testing at nursing homes
- 1% of US population officially has coronavirus. Experts say real number is much higher
- GOP may move Florida convention outside as COVID-19 cases soar
- Philadelphia Cancels All Large Events Through February 2021 Due To COVID-19 Risks
- Philly Mayor’s Ban On Large Events “Does Not Apply” To Protests Or “Demonstrations”
- Chicago’s mayor and Illinois’s governor sound loud cautions amid rising cases
- Weighing the risks as cases spike, more major school districts go online
- NYC preparing hotel contracts for potential ‘Wave 2’ of coronavirus
- Florida hospital system CEO says ICUs are stocked, fully prepared, and not overwhelmed
- Officials across the U.S. increase restrictions, though Georgia’s governor forbids local face-mask mandates
- Alabama hospitalizations hit record high
- Pennsylvania reinstates state-wide restrictions
- South African virus cases top 300,000
- Brazil President Jair Bolsonaro tests positive for the virus (again)
- California shatters record with 11,142 cases reported
- Fauci says confident of vaccine by year-end
- 2021 Rose Bowl Parade on New Year’s Day has been canceled
- Oklahoma Gov. Kevin Stitt tests positive for COVID-19 as cases rise in state
- The worst appears to be over for Arizona
- US national parks could be the next battleground in reopening
- Most Americans believe their jobs will never return to normal
- Most Americans had a tech ‘wake-up’ call during coronavirus lockdown
- All Walmarts, Sam’s Clubs to require shoppers wear masks
- New Orleans bars forced to shut down again after coronavirus spike
- Coronavirus forced job cuts at a third of small businesses
- Tokyo was expected to report a single-day record of more than 280 new cases on Thursday
- Tokyo raises alert level to the highest of four
- India reported 32,695 new coronavirus infections, its highest single-day caseload yet
- Several Indian states are reintroducing social distancing measures that they lifted in June
- India’s total caseload — the world’s third-largest, after the US and Brazil — is nearing one million
- The authorities in the Philippines have empowered the police to fan out home-to-home in search of infected people, triggering an uproar among human rights groups
- Tom Hanks says coronavirus made his bones feel like ‘soda crackers’
- Florida labs not reporting negative test results, report says
- Judge orders New Jersey movie theaters to stay closed for now
- NYC Sanitation Department serving airline food to quarantining residents
- FDA adds 50 more toxic hand sanitizers to recall list
- JetBlue will continue to block middle seats until at least September
- MLB has umpire exodus over coronavirus worries
- Hawaii delays reopening tourism until September
- Coronavirus cases reportedly surging at Tesla facility in California
- Tokyo enlists nightclub workers for videos to help fight coronavirus
- 28 Million More Americans Could Wind Up Homeless Due To The COVID-19 Pandemic
- Mitch McConnell open to a second round of stimulus checks, sources say
- There Are Already Nationwide Shortages Of Aluminum Cans, Soda, Flour, Canned Soup, Pasta, & Rice
- In the shadow of the pandemic, overdose deaths in the U.S. have soared
- Childhood vaccination rates have plunged during the pandemic, and WHO warned that the long-term effects from missed inoculations could be worse than Covid-19
- Israel is encouraging everyone to hug a tree to overcome detachment
- Demand for robot cooks heats up as restaurants combat coronavirus
- Michigan house party linked to 43 new coronavirus cases
- As record temperatures sear the South and Southwest, the outbreak makes it harder to open cooling centers
- Amazon tells warehouse workers they can take extra time to wash hands
- Researchers create heated air filter that ‘instantly’ kills coronavirus
- Apple asks retail employees to work remotely as pandemic rages on
- Pornhub Offers Free Advertising For Small Businesses Crushed By Pandemic
- Back To School? “No Thanks” Say Millions Of Newly Homeschooling Parents
- The COVID-19 Panic Shows Us Why Science Needs Skeptics
- NYC Residential Sales Tumble 25% As COVID-19 Chaos Strikes In H1
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 = 13,683,686 (+1.8%)
- New Cases = 234,245 (+14,499)
- Growth Rate of New Cases (7 day average) = 1.4%
- New Cases (7 day average) = 217,932 (+3,071)
- Second highest number of new cases
- 1,000,000+ new cases every 5 days
- 7 day average of new cases on 7/15 was a record high
US Cases & Testing:
- Total Cases = 3,616,747 (+2.0%)
- New Cases = 71,670 (+6,076)
- Percentage of New Global Cases = 30.6%
- Growth Rate of New Cases (7 day average) = 2.2%
- New Cases (7 day average) = 65,096 (+1,403)
- Total Number of Tests = 44,844,982
- Percentage of positive tests (7 day average) = 8.9%
- Number of new cases on 7/15 was second highest
- 7 day average of new cases on 7/15 was a record high
- Percentage of positive tests remains high
- Total Deaths = 586,193 (+1.0%)
- New Deaths = 5,844 (+476)
- Growth Rate of New Deaths (7 day average) = 0.9%
- New Deaths (7 day average) = 5,000 (+43)
- Number of new deaths have increased for 3 consecutive days
- 7 day average of new deaths has increased daily since 7/4, with an increase of 10.1% during that period
- Total Deaths = 140,140 (+0.7%)
- New Deaths = 997 (+62)
- Percentage of Global New Deaths = 17.1%
- Growth Rate of New Deaths (7 day average) = 2.1%
- New Deaths (7 day average) = 754 (+15)
- Number of new deaths has increased for 4 consecutive days
- Highest 7 day average of new deaths since 6/16
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (7/15)
Source: Worldometer and The Covid Tracking Project
C. New Scientific Findings & Research
1. C19 severity is increased in patients with ANY obese body mass index
- The risk of greater C19 severity and death is higher in people with any obese body mass index (BMI), according to a study to be published in the European Journal of Endocrinology. The study findings showed that BMI over 30 was associated with a significantly higher risk of respiratory failure, admission to intensive care and death in C19 patients, regardless of age, gender and other associated diseases.
- Obesity is a growing, global epidemic linked to numerous diseases and an increased risk of death. Since the onset of the C19 pandemic, several studies have implicated obesity as a risk factor for more severe effects and death in coronavirus infection. The UK and USA guidelines for identifying those at greater risk are set at a BMI of 40 and above. However, these recommendations were necessarily based on smaller studies and limited data, given the novelty and fast progression of the coronavirus pandemic.
- Dr Matteo Rottoli and colleagues from the Alma Mater Studiorum University of Bologna in Italy, analyzed the outcomes of almost 500 patients hospitalized with C19. Again, they found that obesity was associated with a significantly higher risk of severity and death but also that any BMI higher than 30 was associated with these adverse outcomes.
- Dr Rottoli comments, “Our study showed that any grade of obesity is associated with severe C19 illness and suggests that people with mild obesity should also be identified as a population at risk.”
- The association between higher BMI and severe C19 illness is strong but the cause remains to be explained. An impaired immunological response to viral infections, alterations of lung function and obesity-related chronic inflammatory states have all been suggested as the link. The next step for this research would be to understand these mechanisms.
- “Our hypothesis is that coronavirus infection outcomes depend on the metabolic profile of patients and that obesity, interlaced with diabetes and metabolic syndrome are involved too,” says Dr Rottoli.
- Dr Rottoli cautions, “The BMI cut-off should be reassessed to ensure we identify everyone at higher risk of serious infection and to avoid underestimating the potential population impact of coronavirus infection, particularly in Western countries with higher obesity rates.”
- Dr Rottoli recommends that people and health-care practitioners should be aware of the increased risk of C19 illness with any grade of obesity.
2. C19 Risk Doesn’t Depend (Much) on Blood Type
- Early in the C19 pandemic, researchers found preliminary evidence suggesting that people’s blood type might be an important risk factor — both for being infected by the virus and for falling dangerously ill.
- But over the past few months, after looking at thousands of additional patients with C19, scientists are reporting a much weaker link to blood type.
- Two studies — one at the Massachusetts General Hospital and the other at Columbia Presbyterian Hospital in New York — did not find that Type A blood increases the odds that people will be infected with C19.
- The new reports do find evidence that people with Type O blood may be slightly less likely to be infected. But the effect is so small that people shouldn’t count on it. “No one should think they’re protected,” said Nicholas Tatonetti, a data scientist at Columbia University.
- Reviewing medical records for 7,770 people who tested positive for the coronavirus, Dr. Tatonetti and a graduate student, Michael Zietz, found that people with Type A blood were at a somewhat lower risk of being placed on ventilators. People who were Type AB were at a higher risk, but the scientists cautioned that this result might not be reliable because there were so few patients with that blood type in their analysis.
- Dr. Tatonetti and Mr. Zietz released the initial results from 1,559 patients at Columbia Presbyterian Hospital in April. Their larger survey is now under review for publication in a scientific journal.
- The other new study, carried out at Massachusetts General Hospital, offers a somewhat different picture. The researchers also found that people with Type O were slightly less likely to get C19. But blood type did not affect whether people would have to be placed on ventilators, or their odds of dying.
- Anahita Dua, a vascular surgeon at the hospital and the senior author of the study, said that blood type was not something she’d consider when judging the risks faced by patients who tested positive for C19. “I wouldn’t even bring it up,” she said.
3. Travel from New York City seeded the nationwide C19 crisis
- Travel from New York City seeded outbreaks all over the United States before city officials instituted social distancing guidelines, new research shows.
- Geneticists tracked mutations of the virus, where infected people traveled, and models of outbreaks across the country, to find that more infections nationwide came from the viral outbreak in New York City, according to the New York Times.
- While the outbreak on the West Coast, starting in Washington, spurred more outbreaks in California and Oregon, the virus that originated in New York propagated even more infections in coastal states, other western states, midwestern states, and southern states.
- Waiting to institute travel restrictions and social distancing guidelines in the city fueled the outbreaks in Louisiana, Arizona, Texas, and other states. Acting earlier, geneticists said, could have blunted the virus’s force.
- “It means that we missed the boat early on, and the vast majority in this country is coming from domestic spread,” said Kristian Andersen, a professor in the department of immunology and microbiology at Scripps Research. “I keep hearing that it’s somebody else’s fault. That’s not true. It’s not somebody else’s fault, it’s our own fault.”
- New York officials waited to take action until after hundreds of cases cropped up in the city, and it wasn’t until March 24 that the White House Coronavirus Task Force advised recent travelers from New York City to self-quarantine. Four days later, Rhode Island Gov. Gina Raimondo issued an executive order mandating that all travelers into the state from New York City must self-quarantine for two weeks.
- However, the data shows that the virus had already spread so widely that neither statewide quarantine measures nor President Trump’s ban on travel from Europe instituted on March 11 made much of a difference.
- The findings suggest that states beginning to loosen restrictions and lift lockdowns will affect other states and their recovery from the virus. As the virus travels from person to person, it replicates and mutates. However, geneticists can still trace the virus’s origin. Most samples from infected people in Texas, Ohio, Louisiana, Idaho, Wisconsin, and other states contain mutations that can be traced back to the viral outbreak in New York City earlier this year.
- “New York acted as the Grand Central Station for this virus, with the opportunity to move from there in so many directions, to so many places,” said David Engelthaler, infectious disease expert at the Translational Genomics Research Institute in Arizona.
D. Improved & Potential Treatments
1. Common FDA-approved drug may effectively neutralize coronavirus
- A common drug, already approved by the Food and Drug Administration (FDA), may also be a powerful tool in fighting C19, according to research published this week in Antiviral Research.
- The coronavirus uses a surface spike protein to latch onto human cells and initiate infection. But heparin, a blood thinner also available in non-anticoagulant varieties, binds tightly with the surface spike protein, potentially blocking the infection from happening. This makes heparin a decoy, which might be introduced into the body using a nasal spray or nebulizer and run interference to lower the odds of infection. Similar decoy strategies have already shown promise in curbing other viruses, including influenza A, Zika, and dengue.
- “This approach could be used as an early intervention to reduce the infection among people who have tested positive, but aren’t yet suffering symptoms. But we also see this as part of a larger antiviral strategy,” said Robert Linhardt, lead author and a professor of chemistry and chemical biology at Rensselaer Polytechnic Institute. “Ultimately, we want a vaccine, but there are many ways to combat a virus, and as we’ve seen with HIV, with the right combination of therapies, we can control the disease until a vaccine is found.”
- To infect a cell, a virus must first latch onto a specific target on the cell surface, slice through the cell membrane, and insert its own genetic instructions, hijacking the cellular machinery within to produce replicas of the virus. But the virus could just as easily be persuaded to lock onto a decoy molecule, provided that molecule offers the same fit as the cellular target. Once bound to a decoy, the virus would be neutralized, unable to infect a cell or free itself, and would eventually degrade.
- In humans, the coronavirus binds to an ACE2 receptor, and the researchers hypothesized that heparin would offer an equally attractive target. In a binding assay, the researchers found that heparin bound to the trimeric coronavirus spike protein at 73 picomoles, a measure of the interaction between the two molecules.
- “That’s exceptional, extremely tight binding,” said Jonathan Dordick, a chemical and biological engineering professor at Rensselaer who is collaborating with Linhardt to develop the decoy strategy. “It’s hundreds of thousands of times tighter than a typical antibody antigen. Once it binds, it’s not going to come off.”
- Internationally recognized for his creation of synthetic heparin, Linhardt said that, in reviewing sequencing data for the coronavirus, the team recognized certain motifs on the spike protein and strongly suspected it would bind to heparin. In addition to the direct binding assay, the team tested how strongly three heparin variants — including a non-anticoagulant low molecular weight heparin — bind to the coronavirus, and used computational modeling to determine the specific sites where the compounds bind to the virus. All the results confirm heparin as a promising candidate for the decoy strategy. The researchers have subsequently initiated work on assessments of antiviral activity and cytotoxicity in mammalian cells.
- “This isn’t the only virus that we’re going to confront in a pandemic,” Dordick said. “We don’t really have great antivirals, but this is a pathway forward. We need to be in a position where we understand how things like heparin and related compounds can block virus entry.”
- In previous work, a team led by Linhardt and Dordick demonstrated the decoy strategy on viruses with a mechanism similar to the coronavirus. In 2019, the team created a trap for dengue virus, attaching specific aptamers — molecules the viral latches will bind to — precisely to the tips and vertices of a five-pointed star made of folded DNA. Floating in the bloodstream, the trap lights up when sprung, creating the world’s most sensitive test for mosquito-borne diseases. In work prior to that, they created a synthetic polymer configured to match the sialic acid latch points on influenza virus, reducing influenza A mortality in mice from 100% to 25% over 14 days.
- “This innovative approach to effectively trapping virusus is a prime example of how biotechnology approaches developed at Rensselaer are being brought forward to address challenging global health problems,” said Deepak Vashishth, the director of the Center for Biotechnology and Interdisciplinary Studies at Rensselaer, of which both Dordick and Linhardt are a part. “Professors Dordick and Linhardt have worked collaboratively across disciplines, and their research shows promise even beyond this current pandemic.”
- “Characterization of glycosaminoglycan and novel coronavirus (SARS-CoV-2) spike glycoprotein binding interactions” was published in Antiviral Research. At Rensselaer, Linhardt and Dordick were joined on the research by Fuming Zhang, and also by researchers at the University of California San Diego, Duke University, and the University of George, Athens with support from the National Institutes of Health.
E. Concerns & Unknowns
1. What to Make of Research Suggesting Immunity to C19 Is Short-Lived
- Yesterday, a preprint that was recently posted to the server medRxiv (meaning the study has not undergone peer review, an important step for accurate science research) generated a flurry of excitement — and criticism — for its implication that immunity to the coronavirus might only last a few months. The paper suggested that the levels of antibodies people produce in response to C19 infection rapidly decline after they hit their peak.
- The paper’s findings, which were covered by large news outlets like The Guardian, CNBC, and CNN, suggest that people’s immunity after a C19 infection wanes over time. And that doesn’t seem to bode well for hopes of herd immunity or a vaccine. A couple days earlier, Vox published a story written by a doctor suggesting that a patient who recovered from C19 got reinfected, raising similar concerns about immunity to the coronavirus.
- But as critics pointed out on Twitter, these case studies need to be a part of a larger understanding and study of C19 and immunity. The study has not yet been reviewed by scientists, and the Vox story is a single opinion piece about one case. Importantly, this framing also assumes that antibodies are the only way to achieve immunity, which is simply not the case.
- In the medRxiv study, King’s College London researchers repeatedly tested the antibody levels of 96 people who tested positive for C19 between March and June. They observed that while 60% of people had a “potent” antibody response around 23 days after their symptoms first appeared, only 16.7% of them still had the same level of potency an average of 65 days later. They also found that people who had more severe C19 infections tended to have more and longer-lasting antibodies than people with milder cases.
- Altogether, the findings raised concerns that antibodies can’t be counted on to provide long-lasting protection to the virus — which is troubling, given that a successful vaccine is generally thought of as one that produces long-lasting antibodies.
- But antibodies aren’t the only way in which the body can fight C19, thanks to the existence of the immune system’s multiple branches. It’s understandable if you didn’t know that they exist: Over the course of the pandemic, many science experts and communicators (myself included) have written about immunity solely as it relates to antibodies, but the reality is actually much more complex than that.
- The antibody-mediated branch of the immune system has been widely discussed during the pandemic — specifically, its ability to respond to infection by making neutralizing antibodies, the kind that can fight off the virus upon future encounters. Neutralizing antibodies are the ones that the preprint refers to, that vaccines are meant to produce, that antibody tests try to detect, and that are sought in convalescent plasma. But there are many more types of antibodies that also work toward immunity — they just haven’t been talked about as much.
- The other main branch of the immune system is known as cellular immunity or cell-mediated immunity. It doesn’t have much to do with antibodies at all. Instead, it relies on two types of immune cells, B-cells and T-cells, which have different methods of fighting off pathogens they have previously encountered. There is ongoing research on cellular immunity to C19, but it too hasn’t been talked about as much. If antibody-mediated immunity turns out to have a limited role in C19 infection, cell-mediated immunity could be a much-needed alternative or complement.
- I keep returning to a Twitter thread by Eric Topol, MD, chair of Innovative Medicine at Scripps Research, on how to think about new research on immunity and the coronavirus. In it, he emphasizes the importance of acknowledging the immune system’s other branches. “So when you interpret seroprevalence, serology, antibody only data, please keep the incomplete nature of that assessment in terms of the broader cellular immune response to the coronavirus,” he writes. “There’s a lot more to learn about the stuff we don’t measure.” He also points to research showing that cells that aren’t normally considered to be part of the immune system, like those in the thymus or liver, have their own immune-like response to the coronavirus.
- There remain several ongoing questions about reports of people testing positive for C19 after seemingly recovered from the virus. Are they having a relapse of symptoms, or did they indeed catch C19 a second time? Scientists are still working through the possibilities.
- A newsletter from the Johns Hopkins Center for Health Security sent out today similarly cautions readers about interpreting the medRxiv paper and the Vox story. The “duration of immunity is unclear,” it says, and it’s “unknown whether or not recurrent infections are tied to waning immunity after initial infection.” Furthermore, it notes, just because a person tests positive for antibodies doesn’t mean they’re protected from reinfection, since antibody tests don’t necessarily pick up on the neutralizing antibodies required for immunity.
- In a blog post published today, Francis Collins, MD, director of the National Institutes of Health, acknowledges “rare reports” of people who recover from C19 only to test positive again. (Though he doesn’t specify which reports.) He says that “these results might be explained by reports that the virus can linger in our systems,” but reiterates that many questions remain about immunity. In a recent study, Collins points out, macaques that had been deliberately infected with C19 mounted a protective antibody response when they were reinfected 28 days later.
- None of this is to say that the King’s College London study or the case study described in Vox can’t be meaningful — just that their findings (which need to be studied and replicated before they are considered strong evidence) represent only one part of the potential immune response to C19. This is helpful to keep in mind when thinking about the World Health Organization’s recent acknowledgment that antibodies may wane after several months and the recent study by the Spanish government that found antibodies could disappear after a few weeks. It isn’t known whether antibodies last a long time, whether they actually protect us from reinfection, and whether cell-mediated immunity has a role to play, but at this point, being uncertain how to answer these questions leaves us in a better state than definitively answering them with a “no.”
2. Nearly one-third of children tested for COVID in Florida are positive
- Nearly one-in-three children tested for the new coronavirus in Florida has been positive, and a South Florida health official is concerned the disease could cause lifelong damage even for children with mild illness.
- Dr. Alina Alonso, Palm Beach County’s health department director, warned county commissioners Tuesday that much is unknown about the long-term health consequences for children who catch C19.
- “They are seeing there is damage to the lungs in these asymptomatic children. … We don’t know how that is going to manifest a year from now or two years from now,” Alonso said. “Is that child going to have chronic pulmonary problems or not?”
- Some studies suggest that children are less likely to catch C19 than adults. Children are also far less likely to die of the disease. About 17,000 of Florida’s roughly 287,800 cases have been people younger than 18. Of the 4,514 C19 deaths reported by Florida as of Tuesday, four have been younger than 18.
- Still, it’s possible C19 could have long-term consequences that will take time to understand, Alonso said.
- “This is not the virus you bring everybody together to make sure you catch it and get it over with,” she said. “This is something serious, and we are learning new information about this virus every day.”
- State statistics also show the percentage of children testing positive is much higher than the population as a whole. Statewide, about 31% of 54,022 children tested have been positive. The state’s positivity rate for the entire population is about 11%.
- See the FL DOH test results here: Coronavirus: characteristics of cases in pediatric Florida residents <18 years old
F. Back to School!?
1. German study finds no evidence coronavirus spreads in schools
- Schools do not play a major role in spreading the coronavirus, according to the results of a German study released on Monday.
- The study, the largest carried out on schoolchildren and teachers in Germany, found traces of the virus in fewer than 1% of teachers and children.
- Scientists from Dresden Technical University said they believe children may act as a “brake” on chains of infection.
- Prof Reinhard Berner, the head of pediatric medicine at Dresden University Hospital and leader of the study, said the results suggested the virus does not spread easily in schools.
- “It is rather the opposite,” Prof Berner told a press conference. “Children act more as a brake on infection. Not every infection that reaches them is passed on.”
- The study tested 2,045 children and teachers at 13 schools — including some where there have been cases of the virus. But scientists found antibodies in just 12 of those who took part.
- “This means that the degree of immunization in the group of study participants is well below 1 per cent and much lower then we expected,” said Prof Berner. “This suggests schools have not developed into hotspots.”
- The study was carried out at schools in three different districts in the region of Saxony.
- The decision was highly controversial at the time. Parents won the right to keep their children at home after a legal challenge, and the regional government ordered the study to determine whether the policy had been right.
- The findings are likely to be the subject of much public debate in Germany, with full class sizes planned to resume at schools across the country after the summer holidays.
- The study tested the blood of around 1,500 children aged between 14 and 18 and 500 teachers aged between 30 and 66 for antibodies to the virus.
- Five of those who took part had previously tested positive for the virus. The study’s authors said the fact that only seven others were found to have antibodies suggested the virus did not spread rapidly in a school setting.
- Another 24 of those who took part had family members who had tested positive, but only one of these was found to have developed antibodies.
- “This means the majority of schoolchildren do not get infected themselves despite an infection in the household,” said Prof Berner.
- “We have to take this finding into account when deciding on measures to limit social contact.”
- The study was carried out at 13 schools in the districts of Dresden, Bautzen and Görlitz in May and June.
2. Israelis Fear Schools Reopened Too Soon as C19 Cases Climb
- Some Israeli public-health officials are blaming the country’s decision to reopen schools in May for helping fuel a large new wave of coronavirus infections that has prompted authorities to shut down sections of the economy once again.
- In recent weeks, the number of new cases of C19 has risen to around 1,500 per day nationwide from a low of fewer than 50 a day about two months ago.
- The surge followed outbreaks in schools that by Monday had infected at least 1,335 students and 691 staff since the schools reopened in early May, according to the education ministry.
- Epidemiological surveys by Israel’s health ministry showed that after Israel opened its entire school system without restrictions on May 17, a spike in infections occurred among the country’s youth that later spread to the general population. Government figures also showed that in the month of June schools were the second-highest known place of infection outside people’s own communities.
- Now, event halls and bars across the country have also been ordered closed again, and the government has warned additional restrictions could be necessary.
- In early May, when infections ebbed, the government of Prime Minister Benjamin Netanyahu reopened much of the Israeli economy and society, including the schools, in a push to revive business activity and get Israelis back to work. After a phased return to the classroom, the government imposed few restrictions on schools.
- Israel’s top public health official, Siegal Sadetzki. resigned last week in protest of the government’s handling of the coronavirus pandemic, including the school re-openings.
- “Much of the source of the second wave stems from the opening of the education system in a way that was not adapted to corona and mass-gatherings,” she said in a Facebook post explaining her resignation.
- While some argue the schools were a major contributor to the overall surge, others say it is difficult to separate them from the broader reopening.
- Israeli authorities allowed for the quick resumption of large gatherings like weddings and prayer services. There was little enforcement of rules requiring masks in public.
- “Due to the fact that the restrictions were released very fast, it’s difficult to disentangle the effects of each separately,” said Eli Waxman, a physicist who heads the panel of experts advising the government on the coronavirus. “There was a lot of pressure, a lot of political pressure and this led to this too-fast pace. There was also an unjustified feeling—that we warned against—that this is over.”
- Countries around the world are weighing the risks of sending children back to class against the consequences of leaving schools closed.
- European countries that reopened schools this spring largely avoided outbreaks, with no major flare ups after students returned to classrooms in 22 countries.
- Their school systems followed a variety of social-distancing approaches. The Netherlands halved class sizes and enforced social distancing, but not for students under 12. In Denmark, students were kept within small groups.
- Israel, by contrast, had stopped imposing any social-distancing restrictions by mid-May. After initially phasing in the reopening of the schools, classes quickly returned to full size, with as many as 40 students.
- Danniel Leibovitch, principal of a Jerusalem high school that had the most significant outbreak, with more than 150 cases among students and staff, said he knew his school had a large outbreak once two people with no interaction both tested positive.
- “It’s pretty clear that in coronavirus conditions, you cannot continue to teach in full classrooms without a massive outbreak,” Mr. Leibovitch warned.
- Now Israel’s education ministry has developed different models for the reopening of the schools in the fall to be used depending on the level of infections. Each plan will be applied according to the local infection level, rather than nationally, according to Inna Zaltsman, a senior education ministry official.
- If infections are considered under control, students in kindergarten through fourth grade will return to school as normal, while middle- and high-school students will have a mix of in-person and distance learning as well as plastic barriers in classrooms to separate students as much as possible.
- If infections rise further, younger children will attend school in capsules, while those in grades five through 12 will study from home. In case of a large surge, only younger students will continue to go to school, but with ample social-distancing protocols.
- Teams are working on creating a guidebook to help schools switch between in-school and distance learning, or how to social distance with school celebrations and graduation ceremonies.
- See a summary of global school reopenings here:
Summary of School Re-Opening Models and Implementation Approaches During the COVID 19 Pandemic Executive Summary of Models of Schools
1. State Reopenings Stall Amid C19 Resurgence
- All 50 states had started reopening but several have now either paused their efforts or started backtracking amid a resurgence in C19 infections. Arizona, California, Texas and Florida had all made u-turns with bars, beaches, cafes, nightclubs and gyms shuttering again by the end of June. By mid-July they had been joined by Nevada, Colorado, New Mexico, Louisiana and Michigan, according to The New York Times.
- On the other hand, several states have finished reopenings in July, with the majority of the Midwest now fully open again. East Coast and Mid-Atlantic states are also mostly continuing or have completed reopening, showing how the C19 resurgence in the U.S. has affected the Southern and Western States disproportionally.
H. Projections & Our (Possible) Future
1. Prepare for a winter C19 spike now
- We should prepare now for a potential new wave of coronavirus cases this winter, according to the UK’s Academy of Medical Sciences. Health-care systems tend to struggle in winter anyway because infectious diseases spread faster as we spend more time in poorly ventilated indoor spaces, and because conditions like asthma, heart attacks, and stroke tend to be exacerbated in colder temperatures. But if you factor a potential winter rise in C19 infections that could be worse than the initial outbreak, a backlog of patients with other conditions, and exhausted frontline workers, health-care systems could be pushed beyond their limit, the academy has warned in a new report (read the report here).
- The academy has modeled the “reasonable worst-case scenario” for the UK and says the number of C19-related hospital deaths between September 2020 and June 2021 could reach 119,900, more than double the 45,000 deaths in the UK so far. The researchers think deaths are likely to peak in January and February. This figure doesn’t include potential deaths in care homes, which account for about a third of all deaths in England so far. Although the report relates specifically to the UK, the same conclusions could be drawn for many countries around the world. However, it’s worth remembering it is a model of worst-case outcomes, and doesn’t consider potential new drugs, treatments, or vaccines. It’s also based on the assumption that it won’t be feasible to introduce a lockdown in the UK again.
What can we do about it?
- To avoid the dire situation the academy outlines, it will be crucial to minimize transmission in the community through measures like social distancing and hand washing, the academy said. It’s also important to build up stockpiles of adequate personal protective equipment for health and social care staff, ramp up testing and tracing programs, create an early warning system to monitor and manage a winter wave, and inoculate the elderly and health-care workers against flu.
- [Note: In addition, we recommend that you consider stocking up on supplies of items that were not available during the first wave. Many stores now have supplies of hand sanitizer, paper towels, toilet paper and other household cleaning items. We’ve also seen supplies of N95 and KN95 masks available on Amazon. Consideration should be given to stockpiling essentials such as drugs and goods produced overseas that you need/want.]
2. The Realities of a C19 Vaccine
- Many hope that at least one of the C19 vaccine trials underway will prove successful by late fall, blazing a path to developing a vaccine by winter and containment of the virus by next summer. The goal is to conduct mass immunizations of the population, getting enough people protected to prevent community spread of the infection.
- While it’s possible that those most at risk—health-care workers, first responders, and nursing-home residents—may receive the vaccine in time to reduce hospitalizations, protect hospitals from being overwhelmed, and avert many deaths by early next year, it’s probably overly optimistic to expect mass immunization in that time frame. While multiple Covid-prevention vaccine trials are planned or already underway, only one of the Covid-targeted vaccines, the so-called Oxford vaccine, has started its final human trial phase (with its first enrollment on May 28).
- Two of the trial’s primary goals are protection from infection for six months and no observed serious side effects. The Oxford vaccine investigators estimate that 10,000 participants would be needed to demonstrate that the vaccine works. With the declining amount of virus in the U.K., where the trial was being conducted, they needed to add study sites in Brazil and South Africa, where the disease is more common. Recruitment started in these countries at the end of June.
- Even with quick enrollment, it’s easy to see that the evidence required by the FDA for vaccine approval may not be ready until January 2021. A National Institutes of Health trial of the Oxford vaccine, with 30,000 participants, will start in the U.S. in August but will probably not show results until early spring. Other vaccines, including the Moderna RNA vaccine, will not begin recruitment for its final human-trial phase until late July, again pushing possible approval into next year.
- Even after a vaccine has been approved, producing it in mass quantities takes time. One potential strategy for speeding up availability is to start production before FDA approval, though private industry is hesitant to take that risk. To this end, the U.S. government, as part of its Operation Warp Speed initiative, along with other national and international nongovernmental organizations, is paying for preapproval mass production of the most promising vaccines, including the Oxford vaccine. The hope is that enough vaccine will be available for mass immunization when approval is granted, but supply-chain problems could arise that would delay that goal.
- Even with a ready supply of an approved and effective vaccine, mass vaccination can’t happen without broad popular acceptance. Based on the nation’s experience with annual influenza immunization, this will be a challenge. For the 2018–2019 flu season, vaccination coverage among adults was only 45.3%. Considering that only six months of data would exist, at best, for any Covid vaccine by January 2021, it’s likely that uptake will be lower than the influenza number because people will be more cautious about trying the new vaccine. A low uptake, combined with the FDA’s statement that the vaccine needs to protect only 50% of those immunized, suggests that only 25% of the population may be protected—a level inadequate to stop community spread of Covid. Moreover, this calculation assumes that efforts to immunize people en masse will roll out quickly and efficiently.
- It’s reasonable to conclude that we may see continued outbreaks for more than one to two years, despite feverish efforts to develop a vaccine. As such, the U.S. needs to come to terms with a stubborn reality regarding C19: namely, that the virus may persist into the foreseeable future. Given the consequences of many of the mitigation efforts on mental health, unemployment, education, and the economy, America needs to reckon honestly, and apolitically, with what science tells us about the virus—who is getting infected and what we can do to prevent infection, absent a vaccine. We shouldn’t use the hope of a vaccine to delay this discussion. The vaccine will come when it comes.
3. The date that proves the first wave of the coronavirus is far from over
- Since the pandemic began, the threat of a second, deadlier wave of coronavirus has captured the public imagination. The fear, which provokes viral Facebook posts and influences government strategy, is that this pandemic will follow a trajectory similar to that of the 1918 Spanish flu. Two-thirds of the 50 million who died would do so from October to December 1918, during a so-called “second wave”. But this fear may be misdirected. The world is still yet to hit the peak of the first wave. And, until we get a vaccine, it likely never will.
- Across the world, the pandemic is still accelerating. The first case was reported in China in late December. It took three months from that date to reach one million cases. The leap from 12 million cases to 13 million cases took just five days. A Reuters tally puts the total number of dead at 570,000. Daily deaths peaked in mid-April at 10,000 a day; since then they have hovered around the 5,000 mark.
- Countries continue to break grim records. In Latin America, where the disease is accelerating fastest, Brazil reported another 24,000 cases on July 12, bringing its total to 1.87 million. India, initially successful at containing the virus, reported a record spike on July 11 – 27,114 cases – taking the national total to more than 800,000.
- In the world’s worst-hit nation, the United States, 20 states and Puerto Rico reported a record-high average of new infections over the past week, according to the Washington Post. Five states — Arizona, California, Florida, Mississippi and Texas — also broke records for average daily fatalities in that period. The US total is now more than 3,290,000 cases and 132,000 deaths. “In most of the world, the virus is not under control,” WHO director-general Tedros Adhanom Ghebreyesus said last week. “It is getting worse.”
- While the spread of the virus in each country will be driven by a variety of factors, the one thing that links high infection and death rates is the severity of a country’s interventions – its school and work closures, restrictions on international and domestic travel, bans on public gatherings, public information campaigns, as well as testing and contact tracing. Researchers from the University of Oxford collected daily data on a range of containment and closure policies for 170 countries from January 1 until May 27. The findings were conclusive: the earlier and harsher a country’s lockdown, the lower their eventual death toll. “The case is closed in terms of how best to contain this,” says Amitava Banerjee, associate professor in clinical data science at University College London. “The less stringent your measures, the more deaths you have, by a country mile.”
- Easing these lockdowns has proven challenging – nations that previously had the outbreak under control have reported new outbreaks. Israel, for instance, reported almost 1,000 new cases on July 5 and had to reimpose restrictions. South Korea has reported several new infection clusters stemming from nightclubs and offices.
- The importance of government intervention may explain why the virus hasn’t yet ravaged lower-income countries. “One of the reasons that some low-income countries have had relatively lower cases is because they followed the advice better,” says Banerjee. He gives the example of Dharavi in Mumbai, India, which is one of Asia’s largest slums. “Compared with any metric on the planet, it is terribly deprived, but had relatively fewer cases and a lower mortality rate,” he says. The reason? People wore masks and the authorities implemented an aggressive test and trace system alongside use of GPS and CCTV surveillance.
- Lower-income countries also have younger populations, for instance, who are generally at lower risk of hospitalization and death. The timing of when the epidemic reached a country will also have an effect. “If for example, the virus was in Europe in January, we didn’t see the big outbreaks until March – it took three months for the infection rate to be high enough to be noticed in hospitals,” says Martin Hibberd from the London School of Hygiene and Tropical Medicine. As a result, some countries with relatively few cases right now may be at the very start of their first wave.
- These disparities between nations mean that it may not be appropriate, at a global level, to think in terms of waves. The concept assumes that all countries are at similar stages of the pandemic, and that the data we have on the virus’s progress is accurate. This, of course, isn’t true – neither transmission nor data about this transmission are synchronized between countries. The UK, for example, only tests those displaying symptoms, and while our infection rate may be plateauing, we haven’t seen it reduce to single or double figures, like in New Zealand or Iceland.
- “I think waves are a useful concept for individual countries or in the regions of countries, but it’s not a very useful concept about the world’s progress,” says Hibberd. “If you think about influenza, we don’t call it waves when it comes back every year – we call that seasonal flu.”
- Because of this, we will likely never see a global second wave, but rather a series of localized flare-ups. International travel will be disrupted almost indefinitely, and nations will fall in and out of favor as holiday destinations depending on their grip on the virus. In January, you wouldn’t have wanted to travel to China; now, it is one of the safer destinations.
- Then there are other countries, like the US, that have never been in control. Speaking about waves in this context is currently nonsensical – infection rates need to go way down before they can rise again in a second wave. “In the United States we are not seeing anything that I would consider to be a second wave,” says Loren Lipworth-Elliot, an epidemiologist at Vanderbilt University in Nashville, Tennessee. “We are definitely in the first wave, if you want to call it a wave – it’s just a long, lingering epidemic.”
- Keeping the virus under control over a prolonged period of time is key. A report from The Academy of Medical Sciences commissioned by the UK’s chief scientific adviser Patrick Vallance, has warned that coronavirus infections could grow “out of control” this winter. That second spike could cause 120,000 deaths in a worst-case scenario.
- But not every country needs to end up like the US. The spiralling rate of infection there is the result of a botched governmental response, not an inevitable trajectory. Nor is it likely that the infection rate of the second wave will ever reach the ferocity of the first.
- The 1918 flu pandemic is misleading in this sense. We are far more vigilant about public health than we were 100 years ago – or even six months ago. “In that instance the second peak was worse than the first,” says Nicola Stonehouse, professor of molecular virology at the University of Leeds. “That’s where that worry comes from. But we are in a different position now.”
I. Practical Tips & Other Useful Information
1. Weight Loss May Reduce C19 Risk – Research Identifies Maximum Weight Loss for the Cost
- Losing weight during the C19 pandemic has increasing urgency because obesity increases the risk of severe disease and death. Two-thirds of U.S. adults are overweight or obese, according to the Centers for Disease Control and Prevention.
- A new Northwestern Medicine remote weight-loss program, called Opt-IN, provides maximum weight loss for the lowest cost and with much less hassle than the gold-standard National Diabetes Prevention Program (DPP), the most successful behavioral non-drug treatment currently available.
- According to a new study, the Opt-IN program helped participants in a clinical trial lose 11 to 13 pounds, which is equivalent to the DPP’s success rate.
- The study findings were published today (July 14) in the journal Obesity, the primary obesity publication.
- “This matches the gold standard, so it’s as good as it gets,” said senior study author Bonnie Spring, director of the Institute for Public Health and Medicine’s Center for Behavior and Health at Northwestern University Feinberg School of Medicine. “What’s novel is how participants get there.”
- Compared to the DPP treatment — a year-long program costing around $1,500 that requires weekly 90-minute in-person meetings with highly trained and paid medical professionals — the Opt-IN program is cheaper and much less burdensome, Spring said. Opt-IN is fully remote and costs participants between $324 and $427, depending on their package.
- Spring said while there has been a lot of effort made in the U.S. to try to make the DPP treatment more accessible and affordable, like offering it in YMCAs, uptake has been minimal. She cited reasons such as users having a hard time getting to the in-person meetings because of childcare or transportation challenges.
- “All these traditional treatments have not been scalable because they’re not accessible,” said Spring, who also is the chief of behavioral medicine in the department of preventive medicine at Feinberg. “And they’re expensive and burdensome. The direction we’ve gone in with Opt-IN is to meet people where they are, and these days — especially during the C19 pandemic — that means in their homes.
- The higher rate of severe cases of C19 among young adults in the U.S. than other countries like China, Spain and Italy seems to be because obesity is much more common here, Spring said.
- “To tackle the obesity behemoth, we are going to need to make obesity treatment much more accessible and affordable,” Spring said. “The Opt-IN study demonstrates how we could do that.”
- The study had 562 Chicago-area adult participants who were overweight or obese begin a bare-minimum “core” program to achieve weight loss: goals, online lessons and a custom-designed weight-loss intervention app. Similar to commercial weight-loss apps on the market, this app helps users predetermine how many calories are in a food before they eat it and helps track their caloric intake and exercise throughout the day. Unlike other apps, however, this one sends the user’s data directly to their coach, which Spring said helps keep users accountable.
- Spring and her team then layered on and tested other treatment components added to the basic core program. The most cost-effective treatment package included 12 health-coaching calls, progress reports sent to the person’s primary care physician and a “buddy” who was trained to help support weight loss.
- The study tested more expensive treatment components, like 24 coaching calls instead of 12 and meal replacement products, but they were left out of the final Opt-IN program, because results showed that they didn’t increase weight loss.
How much weight did they lose?
- At $427 per person, the Opt-IN method produced an average weight loss of 13.4 pounds after six months, with 51.8% of the sample losing 7% of their initial body weight. The comparable DPP treatment also produces weight loss of 7% of initial body weight in 50% of enrollees, but at a much greater burden and cost.
- A cheaper treatment package for $324 that includes only the core app and online lessons plus 12 coaching calls resulted in an estimated 11.5-pound average weight loss, or at least 5% weight loss for more than 50% of participants over six months.
- “Not fixing our national obesity problem invites the oncoming tsunami of diabetes, heart disease, some cancers and other chronic diseases for which obesity heightens risk, yet preventive services, including obesity treatment, are woefully lacking from our current health care delivery system,” Spring said. “We hope our study helps to convince payers to cover, employers to offer and individuals to engage in preventive care.”
J. Johns Hopkins C19 Update
July 15, 2020
1. Cases & Trends
- The WHO COVID-19 Situation Report for July 14 reports 12.96 million cases (196,775 new) and 570,288 deaths (3,624 new). The Americas region continues to lead in new cases, accounting for 110,549 (56.2%) of new cases and 1,853 (51.1%) of new deaths.
India, Pakistan & Bangladesh
- India continues its trend of increased daily C19 incidence, posting its highest daily total to date with 29,429 new C19 cases. India has seen a continued rise in cases and remains #3 globally in terms of daily incidence behind the United States and Brazil. Pakistan continues to report decreasing incidence since its peak in mid-June, reporting only 2,165 new cases on July 14. The country has lowered its total number of active cases to under 80,000, half of which are within the Sindh Province. Bangladesh has had a recent uptick in daily incidence, reporting over 3,500 new cases for the first time since July 1. As of July 14, Bangladesh’s test positivity rate was at 25%.
Brazil & Mexico
- Brazil reported 41,875 new cases, continuing a recent trend of highly variable daily incidence. The past two weeks saw a flattening of newly reported C19 cases in Brazil, each ending with around 260,000. Brazil remains #2 globally in terms of daily incidence, however the most recent data suggests that Brazil and India may be nearing similar daily incidence rates. Mexico reported 7,051 new cases, after 2 days of reporting daily incidence less than 5,000. Similarly to Brazil, Mexico has reported fluctuating daily incidence rates likely due to the county’s reporting and surveillance systems.
Eastern Mediterranean Region
- Israel reported 1,728 new C19 cases. Since the beginning of the month, Israel has had a daily incidence of over 1,000 on all but one day, and in total, has continued to see an upward trend. It has been noted in past update letters that the Eastern Mediterranean Region remains a global hotspot in terms of per capita incidence, including 5 of the top 10 countries (Oman, Bahrain, Israel, Qatar, and Kuwait).
- South Africa remains among the top countries globally in terms of both per capita (currently #4) and total daily incidence (currently #4). South Africa reported 11,369 new cases on July 15, joining the US, India and Brazil as the only countries reporting over 10,000 new cases.
- The US CDC reported 3.35 million total cases (58,858 new) and 135,235 deaths (351 new). The 7-day average for daily incidence has risen steadily since it’s plateau in early June, and now sits at 58,619, its highest total since the pandemic began. In total, 24 states (increase of 2) and New York City have reported more than 40,000 total cases, including California with almost 330,000 cases; Florida and Texas with more than 250,000 cases; and 6 additional states and New York City with more than 100,000. The Johns Hopkins CSSE dashboard reported 3.45 million US cases and 136,807 deaths as of 1:00pm on July 15.
2. Medical Countermeasures Advancements
- A new paper published in the New England Journal of Medicine outlines new results of Moderna’s phase 1 trials for its mRNA SARS-CoV-2 vaccine candidate. The trial enrolled 45 healthy adults ages 18-55 to partake in a dose escalation experiment. Participants were broken into 3 groups, each receiving a different dosage of the vaccine candidate. Participants received 2 doses of the vaccine candidate 28 days apart, and were tested for resulting antibody response throughout the study period. The results showed a promising level of immune response after the second vaccine in each dosage group. The study noted several adverse outcomes amongst participants, but none of serious safety concern. There is no expert consensus on this study’s results, but many acknowledge that it is a positive step toward vaccine development. According to a post on clinicaltrials.gov, Moderna has plans to start a 30,000 person phase 3 trial later this month.
- Two new papers published earlier this week outlined the potential use of tocilizumab, a drug typically used forrheumatoid arthritis, to treat severe C19 patients. The first paper, published in the Journal of Infection, examined the safety and efficacy of tocilizumab in severe and critical C19 patients. The paper provided a retrospective analysis of patients from a singular hospital who were given tocilizumab treatment when diagnosed with severe C19 disease. In total, 74 patients were given such treatment and subsequently compared to 148 matched controls. The paper found that these patients were more likely to survive their illness than matched controls, but that adverse events resulted in longer hospitalization time. The second paper, published in Clinical Infectious Diseases, looked at the effectiveness of tocilizumab treatment in patients suffering from C19 that required mechanical ventilation. The paper compared 78 patients who received tocilizumab and 76 that did not, and found that the treatment was associated with a 45% decrease in patient mortality. While these papers present only initial findings, it opens the door for future research in this area.
- A systematic review of the current landscape of clinical trials for C19 therapeutics in the United States was published in JAMA Network Open on Monday – “Characteristics of the Multiplicity of Randomized Clinical Trials for Coronavirus Disease 2019 Launched During the Pandemic.” Of the 674 trials yielded from the search, 83.4% were randomized multigroup studies and only 71.1% of studies included a validated control group such as standard of care or a placebo group. The most commonly tested interventions involved chloroquines (143 trials). The research letter findings also discusses issues regarding multiplicity where many clinical trials are being conducted to test the same therapeutic. Authors note that practice could increase the likelihood of finding a positive result based on chance and lead to complications in trial management, including competition for recruitment, that could lower statistical relevance.
3. Highlights From the WHO Director General Briefing
- On Monday, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus gave his opening remarks during a media briefing regarding the ongoing C19 pandemic. The Director-General noted that countries fall into four categories: those that quelled their C19 outbreak within the first few cases being reported, those that experienced a major outbreak that was brought under control through strong leadership and public health measures, those that overcame their initial peak but are struggling after lessening restrictions and those that are undergoing intense transmission. He noted three steps for future outbreak control: “(1) A focus on reducing mortality and reducing transmission, (2) an empowered, engaged community that takes individual behavior measures in the interest of each other, and (3) strong government leadership and with coordination of comprehensive strategies that are communicated clearly and consistently”.
4. US Response
- The US continues to see increased C19 activity across the country. States that have seen spikes in cases are now faced with the decision of whether to revert back to more stringent community mitigation measures in an attempt to reduce the spread of the virus. Yesterday, California Governor outlined that California will be asking businesses to alter their operations once again and announced that both Los Angeles and San Diego school districts will start this fall online. Many US businesses and economists have expressed concerns that the resurgence of C19, and the corresponding transition to restricted business activity, will threaten the country’s economic recovery. This comes amidst news that some of the US’ economic buffering plans, including certain unemployment benefits, are lapsing, leaving many unemployed in an economically vulnerable position.
- News broke yesterday that the current Presidential Administration has ordered hospitals to bypass the CDC when sharing C19 data with the US government. The new process would have data sent to a central database within HHS. Officials from the president’s administration have suggested that this move was used to improve information access for the White House coronavirus task force, allowing the group to make decisions around the allocation of supplies including PPE and medical countermeasures. Many experts worry that this transition may limit data access and harm public transparency. The Presidential Administration has also asked governors to consider sending the National Guard to assist in hospital data collection efforts.
5. US Mask Usage
- CDC leadership, including Dr. Robert Redfield, Dr. Jay Butler and Dr. John Brooks, published a commentary in JAMA on Tuesday to promote the universal use of masks for healthcare workers, patients and in the community. The commentary referenced multiple academic papers that support mask usage to prevent the spread of SARS-CoV-2. Two new articles were also published by CDC’s Morbidity and Mortality Weekly Report yesterday: “Factors Associated with Cloth Face Covering Use Among Adults During the C19 Pandemic – United States, April and May 2020” and “Absence of Apparent Transmission of SARS-CoV-2 form Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy – Springfield Missouri, May 2020”. The first article described online surveys conducted in April and May regarding attitudes and behavior regarding mask usage, recent time spent outside the home and demographic characteristics. Findings indicate that rates of face covering usage increased after the White House Coronavirus Task Force and CDC recommended use of a cloth face covering when outside the home. These conclusions support consistent public health messaging promoting the use of face masks. The second article described a case study wherein two hair stylists were found to be SARS-CoV-2 positive but did not transmit to any of their 139 clients. Both the stylists and clients wore face masks due to city ordinance and company policy, which may have protected against onward transmission.
6. WHO Vaccine Landscape
- Earlier today, the WHO published a draft of landscape documents tracking the current C19 vaccines under development. The document reports the platform basis, type, developer, viruses targeted, and status of clinical and regulatory evaluation for 23 candidates in clinical evaluation and 140 candidates in preclinical evaluation. Of the candidates undergoing clinical trials, there are 10 candidates undergoing only Phase 1 trials and 8 candidates undergoing combined Phase 1/2 trials. Two candidates are in Phase 1 trials and Phase 2 trials separately. Three candidates are undergoing Phase 3 trials: an inactivated candidate by Sinovac, a non-replicating viral vector candidate by University of Oxford and AstraZeneca, and an RNA candidate by Moderna and the National Institute of Allergy and Infectious Diseases.