July 19, 2020
Without reliable information, we rely on fear or luck.
A. Numbers & Trends
B. New Scientific Findings & Research
1. New study shows 17 years of potential T cell immunity in SARS-infected patients [Highly Recommended]
C. Improved & Potential Treatments
D. Concerns & Unknowns
E. Back To School!?
F. The Road Back?
G. Johns Hopkins C19 Update
H. Links to Other Stories
Turmeric could have antiviral properties Curcumin, a natural compound found in the spice turmeric, could help eliminate certain viruses, research has found
You’re Using Disinfectants Wrong. Here’s How to Destroy 99.9% of Viruses/Coronaviruses and Bacteria Sure, you’ve got a product that says “kills germs” under your sink, but will it really destroy the new coronavirus on surfaces? Turns out that if you’re using a disinfectant the same way as a regular cleaner, you might not actually be disinfecting at all. To make sure you’re destroying 99.9% of viruses and bacteria, doing these three things is critical.
New journal will vet Covid-19 preprints, calling out misinformation and highlighting credible research The wild, wild west of C19 preprints is about to get a new sheriff. The MIT Press is announcing the launch of an open access journal that will publish reviews of preprints related to C19, in an effort to quickly and authoritatively call out misinformation as well as highlight important, credible research.
Respiratory droplet motion, evaporation and spread of COVID-19-type pandemics Mathematical model sheds light on the motion and evaporation of respiratory droplets responsible for disease transmission
Designing anew: Radical COVID-19 drug development approach shows promise University of Washington’s Baker Lab uses de novo computational design on TACC systems to create new therapeutics
Distorted passage of time during the COVID-19 lockdown Survey results suggest people in UK perceived time passing differently compared to pre-lockdown
COVID-19 brain complications found across the globe Cases of brain complications linked to C19 are occurring across the globe, a new review by University of Liverpool researchers has shown.
A. 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 (7/18)
- Total Cases = 14,414,454 (+1.6%)
- New Cases = 224,068 (-26,969) (-10.7%)
- New Cases (7 day average) = 223,776 (+992) (+0.5%)
- Number of new cases have declined for 3 consecutive days
- 7 day average of new cases was a record high on 7/18
US Cases & Testing:
- Total Cases = 3,833,271 (+1.7%)
- New Cases = 63,259 (-11,728)
- Percentage of New Global Cases = 28.2%
- Growth Rate of New Cases (7 day average) = 0.7%
- New Cases (7 day average) = 68,232 (+220) (+0.3%)
- Total Number of Tests = 47,598,277
- Percentage of positive tests (7 day average) = 8.5%
- 7 day average of new cases on 7/18 was a record high
- 7 day average of new cases has increased daily since 6/9
- Total Deaths = 604,240 (0.8%)
- New Deaths = 5,008 (-1,242) (-19.9%)
- New Deaths (7 day average) = 5,315 (+2) (+0.03%)
- Number of new deaths have decreased 3 consecutive days
- 7 day average of new deaths has decreased for the first time since 7/4
- Total Deaths = 142,877 (+0.6%)
- New Deaths = 813 (-133)
- Percentage of Global New Deaths = 16.2%
- Growth Rate of New Deaths (7 day average) = 1.8%
- New Deaths (7 day average) = 782 (+12)
- Number of new deaths has decreased slightly for 3 consecutive days
- Highest 7 day average of new deaths since 6/12
- 7 day average of deaths have increased from 516 to 787 since 7/5, an increase of 52.5%
3. Top 5 States in Cases, Deaths, Hospitalizations, and Positivity (7/18)
B. New Scientific Findings & Research
1. New study shows 17 years of potential T cell immunity in SARS-infected patients
- The latest research on T cells, white blood cells produced by the immune system to ward off infections through memory of past pathogens, show that even those patients who never develop antibodies or have lost them over time will retain T cell immunity that remembers to fight off coronaviruses in the future. Moreover, the study provides new evidence for the theory that herd immunity could be achieved at an approximately 20% infection rate for most cities, thanks to T cell cross-immunity from other coronaviruses.
- The latest panic being propagated by the media is that many people don’t produce antibodies and that even more of those infected will lose them over time, potentially opening them up to reinfection.
- Why we automatically assume the worst of this virus and base our response on the idea of this virus defying all known patterns remains a mystery, but this study from Singapore should place the onus on naysayers to show why this form of coronavirus would be different from others.
- Researchers in Singapore conducted a study, first out in preprint in May and now peer-reviewed and published at Nature, of 23 patients who recovered from SARS in 2003 and found that all 23 retained memory T cells induced by that original pathogen still in their systems. That in itself is terrific news to find this immunity after 17 years. Then they studied 36 convalescent coronavirus patients and found that they had also produced similar T cells. While the coronavirus is a new virus and distinct from SARS-CoV-1, there is strong reason to believe that T cell memory produced by the body to protect from future relapses of the coronavirus would not be weaker or more short-lived than T cell memory from SARS-1.
- If the implications of this research turn out to be true, it would mean that all those infected with the coronavirus will retain at least partial immunity to the virus. This doesn’t necessarily mean they will be fully immune. This would likely mean, for many previously infected patients, that they could theoretically test positive again with a PCR test, but the T cells would ward off the symptoms and reduce their infective capabilities to transmit to others.
- But there’s more good news, not just for those who have already gotten the virus but for many who may get it. Very few people in America have been exposed to SARS and would therefore not have that immunity. However, researchers have long suspected that there is cross-immunity from other coronaviruses – four of which are forms of the common cold that could account for anywhere between 15% and 30% of colds in a given year. The cross-immunity theory has been proven across other pathogens and was established during the H1N1 outbreak in 2009 when many people appeared to be immune, presumably, to similar prior outbreaks of seasonal H1N1 flues.
- Cross-immunity with other coronaviruses was at least partially confirmed when the researchers in the Singapore study found the samples of T cells from convalescent SARS-1 patients to have cross-reactive potential against the coronavirus during lab simulations. To test this out further on more common forms of coronavirus – OC43, HKU1, NL63, and 229E – they took samples from 37 random blood donors who had no history of SARS, C19, or contact with SARS/C19 patients. They found that 19 of the 37 had T cells that were reactive to the coronavirus, even though they had no known exposure to this virus.
- How can that be? A large portion of the population likely has at least partial cross-immunity through T cell memory cells induced by contracting one of those four common cold coronaviruses.
- This would explain why so many places seem to experience a burnout of the virus after it reaches only 15%-20% prevalence, according to serology tests. Yes, only 15%-20% have antibodies, but many more likely have cross-immunity through T cells, as Nobel laureate Michael Levitt, Oxford epidemiologist Sunetra Gupta, and Stanford Professor John Ioannidis predicted.
- This harmonizes with a previous study from the La Joya Institute of Immunology in California that showed such cross-reactive responses in 40%-60% of random blood donors
- This might also explain why so many people are found to be asymptomatic and possibly many more have had the virus asymptomatically but never tested positive for antibodies. Studies have found as many as 40% of asymptomatic patients lose antibodies after the early convalescent period.
- Thus, just because you find an antibody serology test implying only 5%-15% of the population has antibodies doesn’t mean that an even greater portion has not already been exposed to the virus but only produced T cells to ward it off, and a certain greater percentage never even became infected with the virus because they had full immunity. A study of 200 blood donors in Sweden found twice as many samples with T cells as samples with antibodies.
- Also, the same reason why someone initially got the virus asymptomatically, likely because of T cell memory produced by cross-immunity, is the same reason they will continue to be free of symptoms in the future, even if they don’t possess antibodies.
- The number of people who have this cross-immunity is likely different throughout the world. One recent preprint study analyzing T cell immunity in blood donors in Germany detected “Cross-reactive coronavirus T-cell epitopes revealed preexisting T-cell responses in 81% of unexposed individuals.” Accordingly, many people might stop making the antibodies after a few months or years, especially following a mild infection, but their immune system produces the cells that remember the recipe for defeating the virus if it returns.
- While we are still learning more about this virus and the human immune system response to it every day, these findings should make us optimistic in the long run, unless the media has made us immune to any good news.
2. Breakthrough blood test detects positive C19 result in 20 minutes
- World-first research by Monash University in Australia has been able to detect positive C19 cases using blood samples in about 20 minutes, and identify whether someone has contracted the virus.
- In a discovery that could advance the worldwide effort to limit the community spread of C19 through robust contact tracing, researchers were able to identify recent C19 cases using 25 microlitres of plasma from blood samples.
- The research team, led by BioPRIA and Monash University’s Chemical Engineering Department, including researchers from the ARC Centre of Excellence in Convergent BioNano Science and Technology (CBNS), developed a simple agglutination assay – an analysis to determine the presence and amount of a substance in blood – to detect the presence of antibodies raised in response to the coronavirus infection.
- Positive C19 cases caused an agglutination or a clustering of red blood cells, which was easily identifiable to the naked eye. Researchers were able to retrieve positive or negative readings in about 20 minutes.
- While the current swab / PCR tests are used to identify people who are currently positive with C19, the agglutination assay can determine whether someone had been recently infected once the infection is resolved – and could potentially be used to detect antibodies raised in response to vaccination to aid clinical trials.
- Using a simple lab setup, this discovery could see medical practitioners across the world testing up to 200 blood samples an hour. At some hospitals with high-grade diagnostic machines, more than 700 blood samples could be tested hourly – about 16,800 each day.
- Study findings could help high-risk countries with population screening, case identification, contact tracing, confirming vaccine efficacy during clinical trials, and vaccine distribution.
- This world-first research was published today (Friday 18 July 2020) in the prestigious journal ACS Sensors.
3. Scientists identify six different types of coronavirus with increasing severity levels
- Six distinct types of coronavirus have been identified by scientists in a breakthrough that promises to save lives by flagging the highest-risk patients.
- Analysis of thousands of cases by artificial intelligence software has revealed different “clusters” of symptoms and ranked them in order of severity.
- Headache and loss of smell are common to all six groupings, but the range of symptoms varies widely after that.
- Scientists at King’s College London (KCL) found that patients with the sixth type of Covid-19 are nearly 10 times more likely to end up needing breathing support than patients in the first group.
- This is significant because often patients only deteriorate to a critical stage several days after showing symptoms. The new ranking system should flag up the highest-risk cases and give doctors the opportunity to intervene earlier.
- The findings, derived from KCL’s symptom tracker app, used data from 1,600 users in the UK and US who had confirmed Covid-19. The resulting algorithm was then tested on an independent cohort of 1,000 users in the UK, the US and Sweden.
- “These findings have important implications for care and monitoring of people who are most vulnerable to severe Covid-19,” said Dr Claire Steves from KCL.
- “If you can predict who these people are at day five, you have time to give them support and early interventions such as monitoring blood oxygen and sugar levels, and ensuring they are properly hydrated – simple care that could be given at home, preventing hospitalisations and saving lives.”
- The least severe categories of the virus were characterised by flu-like symptoms, either with or without fever.
- Gastrointestinal problems, such as diarrhoea, dominate the third category, whereas fatigue, confusion and ultimately respiratory problems are associated with the increasingly severe fourth, fifth and sixth categories.
- The team discovered that only 1.5% of people with cluster one, 4.4% of people with cluster two and 3.3 per cent of people with cluster three Covid-19 required breathing support.
- These figures were 8.6%, 9.9% and 19.8% for clusters four, five and six respectively. Nearly half the patients in cluster six ended up in hospital, compared with just 16 per cent of those in cluster one.
- The study, published in a pre-print server called medRxiv, is yet to be peer-reviewed.
4. Coronavirus may be sexually transmitted and cause male infertility
- A new study claims the coronavirus can not only rob you of your taste and smell — it may leave men infertile and could be transmitted sexually.
- The study, published last month in JAMA, a monthly open-access medical journal published by the American Medical Association, found the presence of COVID-19 in 15% of semen samples collected.
- Researcher Dr. John Aitken likened it to the Zika virus. “It should be emphasized that spermatozoa have a demonstrable capacity to carry viral infections from the male to the female reproductive tract, As happens during the sexual transmission of Zika, for example,” he told local San Antonio Fox 8. Zika virus is a mostly mosquito-borne virus that can also be sexually transmitted.
- The study also found that COVID-19 in human sperm “leads to a build-up of angiotensin II, which is a hormone that regulates kidney function and blood pressure. Increased levels of this hormone cause an immune response against the invading COVID-19 virus particles that increases the availability of reactive oxygen species that causes cell death… Prolonged exposure to elevated angiotenstin II levels can lead to cell death in sperm.”
- The study notes it could “ultimately result in a loss of male fertility.”
5. Doctors discovered a new coronavirus symptom that patients didn’t even know they had
- Doctors in Spain think they’ve found a new coronavirus symptom that everyone has been missing until now. It’s not listed on the CDC or WHO webpages for the novel coronavirus for the time being. And, as you might have guessed, it won’t be enough on its own to help physicians diagnose the illness any faster.
- If you’re familiar with “COVID toe,” the skin lesions that can appear in some COVID-19 patients that were discovered months ago, it won’t surprise you to learn the virus can lead to dermatological symptoms. Researchers from Spain have now published a study in JAMA Dermatology detailing enanthem in patients with COVID-19.
- The study details previous work from Italy that identified exanthems, or skin rashes that were observed with some COVID-19 patients. Enanthem is a rash-like lesion that appears inside the mouth. The Spanish researchers say that the symptom may have gone unnoticed so far because many patients do not have their oral cavities examined. That’s a result of safety concerns and protocols, not an omission from treating physicians. The mouth is where droplets and aerosols that can spread the coronavirus originate, of course. Patients are advised to wear face masks and oral cavities can go unexamined, especially if there’s no complaint from the patient.
- The mouth rash symptom, like other COVID-19 signs, will not appear in all those infected. The researchers from the Hospital Universitario Ramon y Cajal in Madrid found that only six in 21 patients had enanthem. All the patients also featured skin rashes and tested positive for COVID-19. The doctors found different types of mouth rashes that are split into four categories: “petechial, macular, macular with petechiae, or erythematovesicular.”
- The doctors found that the appearance of lesions occurred anywhere between two and 24 days after the onset of COVID-19 symptoms and said that drug intake was not associated with the mouth rashes. As with other COVID-19 symptoms, these lesions can have different causes.
- As the scientists note, this work is preliminary and more research is required. They say that “the presence of enanthem is a strong clue that suggests a viral etiology rather than a drug reaction, especially when a petechial pattern is observed.” That’s the kind of detail that might be useful to other physicians, including dermatologists seeing patients who might not know they’ve been infected with the novel coronavirus.
- The CDC lists several coronavirus symptoms on its pages but does not mention any dermatological signs. The WHO has “rash on skin, or discoloration of fingers or toes” included in the “less common” list of COVID-19 symptoms.
C. Improved & Potential Treatments
1. Radiation emerges as an intriguing — and divisive — treatment for C19
- Back in 2013, toxicologist Edward Calabrese and a colleague at the University of Massachusetts, Amherst, were combing over a cache of century-old data on low-dose radiation therapy, hunting for evidence on the scientific idea that small doses of certain poisons might actually be beneficial. They found small amounts of radiation were surprisingly successful in combating pneumonia. Again and again, doctors reported symptoms subsided within hours of a single X-ray.
- Hardly anyone took notice. Calabrese’s ideas had sometimes been brushed off by his peers as too out-there, and the idea of low-dose radiation as therapy had long been dismissed in favor of more modern treatments. The paper only gained a smattering of citations.
- That all changed when C19 snowballed into a crisis, fueling fresh interest in anything that might ease the devastating cases of pneumonia in some patients.
- “Back in February, I started getting just dozens and dozens and dozens of emails from radiation oncologists —people who treat cancer patients with targeted radiation. And they had come across our paper and they thought that this might be a vehicle by which they could help suffering and dying Covid patients perhaps survive,” he said. “Clinical trials are now going on across the country.”
- There are at least a dozen trials worldwide testing low-dose radiation therapy, or LDRT, as a treatment for pneumonia related to C19, some spurred by the same historical data Calabrese and colleagues scoured years ago. The theory: Targeted radiation to the lungs will halt the out-of-control inflammation responsible for the devastating pneumonia that bookends the course of some C19 patients.
- But the revived interest in radiotherapy has sparked a debate among physicians and researchers, who are divided on whether the idea is even ready for test-driving in clinical trials. With little known about the way LDRT works on inflamed lungs, some experts say it might exacerbate respiratory damage, while introducing the additional risk of cancer. Others say patients participating in the trials may suffer by missing out on more promising treatments.
- On the other side, though, are experts who say there’s a clear and urgent need for C19 treatments that work, particularly for cases that become severe. Antibiotics can help treat cases of pneumonia from bacterial infections, but not those caused by viruses. Those experts argue compelling historical data gives LDRT a promising head start.
- “It seems to be such an almost emotional topic,” said Dörthe Schaue, a radiation oncologist at UCLA, on the debate raging over LDRT. “You get two extremes on the spectrum and the truth is probably somewhere in the middle, where you have to consider all the pluses and minuses.”
- The new wave of low-dose radiation trials are registered at academic centers and hospitals around the world, including in Italy, Spain, Iran, India, and the U.S. The studies are recruiting anywhere from 5 to 106 C19 patients with pneumonia, and half require participants to be at least 40 years of age.
- Arnab Chakravarti, chair of Ohio State’s radiation and oncology department, is spearheading two of the four LDRT trials in the U.S. The first trial, PREVENT, will enroll around 100 oxygen-dependent C19 patients at up to 20 hospitals around the country. The second trial, VENTED, is limited to Ohio State, where it will recruit 24 critically-ill patients who require ventilator support. Unlike PREVENT, VENTED is open to participants as young as 18.
- Chakravarti hypothesizes that LDRT will tamp down the unchecked inflammation that ultimately overwhelms the lungs of some C19 patients. In these individuals, immune cells overreact to the virus and secrete a dangerous excess of proinflammatory cytokines, known as a “cytokine storm.”
- “The severe illness and death that we see from C19 pneumonia appear to be mostly due to the inflammatory response to the infection in the lung tissues,” said radiation oncologist David Kozono, who is launching a LDRT trial at Brigham and Women’s Hospital. “The idea is that low-dose lung radiation has the potential to reduce this inflammatory response.”
- Some experts have theorized that small amounts of radiation might flip a switch on these immune cells so that they release soothing, anti-inflammatory cytokines instead, though this is just one among many proposed mechanisms.
- “The history of the utilization of ultra-low-dose radiation for viral pneumonia actually dates back to the 1920s and ’30s and ’40s — just post the Spanish flu pandemic in 1918,” Chakravarti noted. He said literature from that era indicates that LDRT was effective in 75 to 90% of influenza-induced viral pneumonia cases, though the therapy “fell out of favor” after the development of antiviral therapies and vaccines.
- Beyond historical data, Chakravarti said that his hypothesis is staked in recent evidence from an interim analysis of a clinical trial at Emory testing low-dose radiation in ten patients with C19. All of the first 5 patients, averaging 90 years of age, were alive two weeks after treatment, and researchers reported three patients were weaned off oxygen within 24 hours of receiving radiation.
- “So there is now accumulating data to support this type of approach not just in the setting of influenza viral pneumonia, but also in the setting of specifically C19 based on the small but very promising study from Emory University,” he said.
- The Emory researchers published updated data this month from 10 patients — including the initial 5 in the first study — in the preprint paper, which found that LDRT was associated with a reduction in clinical recovery time from 12 to three days. A single patient died, while another suffered gastrointestinal acute toxicity. They are now recruiting for a 52-person trial.
- Kozono, the Brigham and Women’s researcher, said the initial data from Emory was part of the reason they pushed to launch their own trial.
- But not all radiation experts are convinced that findings from such a small study are worth running with just yet.
- “No one’s going to be able to tell if it worked or not, unless it’s a huge trial. By that time there will be some other treatment like steroids, which is a lot less dangerous and makes a lot more sense and is a lot more scientifically based,” said Ralph Weichselbaum, a radiation oncologist at UChicago Medicine, referring to the initial five-person study. “It’s not thought-out. It’s not of value. I don’t take anything from these cases.”
- A number of experts, including Weischselbaum and colleagues from Duke, Stanford, and the University of Nevada, Las Vegas, wrote a letter about LDRT recently in the Journal of Radiotherapy and Oncology, describing the risks of the treatment as “unacceptable” for future clinical trials — especially in the absence of clinical or preclinical evidence that meets today’s experimental standards.
- But Mohammad Khan, a radiation oncologist leading the Emory trial, pushed back on those criticisms, citing another small study that supports the findings and arguing that Emory’s trial started out small to demonstrate safety and look for early signs of efficacy.
- The idea, too, has won the backing of Calabrese and Gaurav Dhawan, the collaborator on the 2013 study. They and other experts penned a paper in May supporting the idea of testing LDRT to fight C19, with caveats.
- “Certainly, we do not endorse the use of RT for all C19 patients; but we do offer its consideration for those patients who are most critical, and for whom other treatment options are unsuccessful or unavailable,” they wrote.
- But with limited understanding of how LDRT interacts with the systemic inflammation seen in C19, Weichselbaum said it’s possible that the therapy could put patients at risk of greater harm.
- “Everything I know about pulmonary effects of radiation would make something like this worse, not better,” he said. In their paper, Weichselbaum and his colleagues also expressed concern that radiation could kill the immune cells that the body deploys to fight C19, rendering it more susceptible to attack.
- That and other risks make LDRT a “double-edged sword,” according to Fatemeh Ghahremani and Amirhosein Kefayat, physicians in Iran who authored a letter cautioning colleagues against conducting further clinical trials before learning more about its effects. They warned that radiation therapy has actually been demonstrated in some studies to increase the activation, transcription, and spread of some viruses — which could prove harmful for patients with C19.
- There is research to suggest LDRT can combat the hallmark inflammation in people with arthritis. But Ghahremani and Kefayat said the treatment’s success in managing local inflammation doesn’t mean it will be able to beat back the extensive, systemic inflammation that ravages the lungs of some Covid patients.
- “Therefore, there is a high probability that the anti-inflammatory effect of LDRT may not be enough for inhibiting the C19 cytokine storm,” they said in an email to STAT.
- Experts said there are also still a number of unanswered questions about the cytokine storm itself. Among them: Why do only some patients experience it, and what role might age, gender, genetics, and weight play?
- “In my mind, we don’t really know what we’re dealing with,” said Schaue, the UCLA radiation oncologist.
- Schaue said there’s a need for carefully designed clinical trials that scrupulously record data about cytokine storms and the biological mechanisms at play. Other experts said so much is unknown that researchers launching clinical trials of LDRT for C19 should pause their projects and conduct more animal testing first.
- “In [our] opinion, the most ethical thing to do and conservative thing to do would have been to do this in some non-human primates first,” Weichselbaum said.
- Weichselbaum has another big ethical concern: Patients enrolled in radiation trials are being denied drugs “that might actually work in the long run.” With more than 1,200 clinical trials related to C19 registered worldwide since January — and a limited number of eligible patients who live close enough to study centers to participate — researchers might have to compete for participants. The worry is that recruitment for a LDRT trial might snatch a patient away from a drug trial that is safer or more promising.
- Kozono argued, however, that LDRT could prove faster-acting than the treatments currently being used, including the antiviral drug remdesivir.
- There’s also concern among some experts that LDRT might increase a patient’s risk of cancer. Kozono said that of all the possible risks of radiation, cancer was his chief concern as he prepared to enroll nearly 50 patients in his clinical trial. Still, he said the study will use such a low dose of radiation that the risk of cancer remains low, particularly when compared to the risks of a severe case of C19.
- “When one thinks about this being relatively low risk — one in 10,000 chance [of cancer] per year — compared to the very immediate life threatening consequences that this infection can pose, it may be a reasonable treatment to offer to the sort of patients we are aiming to help — people who are hospitalized, who need to be on oxygen or on ventilators because of pneumonia from this virus,” he said.
- Kozono added his study will include an extra cohort of patients who will receive LDRT in just one lung.
- “Our idea is that radiation to one lung might be enough to help the patient breathe, while cutting the exposure to radiation effectively in half,” he said. He added that leaving one lung untreated might also allow the body to straddle the fine line between running a robust immune response and getting overwhelmed by inflammation.
- In addition to the question of whether to treat one or both lungs, UCLA radiation oncologist William McBride said it is unclear when in the disease course physicians should administer LDRT.
- “It’s quite a complex disease. You don’t really know when to give the radiation,” he said.
- With so much still not known, McBride and other experts warn it is premature to champion LDRT over drugs currently in trial.
- “It’s not that low-dose radiation won’t work. I think it has a reasonable chance at the moment,” he said. But, he emphasized, it has to be done thoughtfully.
- “It’s not a slam dunk kind of therapy because of all these unknowns, and the speed with which the disease changes in the patient,” he added. “As a result, it’s quite hard to run a very tight clinical trial on itself and you need an awful lot of patients to prove it.”
2. Face Masks Really Do Matter. The Scientific Evidence Is Growing.
- Face masks are emerging as one of the most powerful weapons to fight the novel coronavirus, with growing evidence that facial coverings help prevent transmission—even if an infected wearer is in close contact with others.
- Robert Redfield, director of the Centers for Disease Control and Prevention, said he believes the pandemic could be brought under control over the next four to eight weeks if “we could get everybody to wear a mask right now.” His comments, made Tuesday with the Journal of the American Medical Association, followed an editorial he and others wrote there emphasizing “ample evidence” of asymptomatic spread and highlighting new studies showing how masks help reduce transmission.
- The research Dr. Redfield cited included a newly published study suggesting that universal use of surgical masks helped reduce rates of confirmed Covid-19 infections among health-care workers at the Mass General Brigham health-care system in Massachusetts.
- His comments are the clearest message yet from the CDC, amid fierce debate over facial coverings, fueled initially by shifting messages from federal and global officials about their necessity and then by those espousing individual liberties.
- Researchers from around the world have found wearing even a basic cloth face covering is more effective in reducing the spread of Covid-19 than wearing nothing at all. And many are now examining the possibility that masks might offer some personal protection from the virus, despite initial thinking that they mostly protect others.
- Experts caution that widespread masking doesn’t eliminate the need to follow other recommendations, like frequent handwashing and social distancing.
- In the absence of widespread availability of N95 masks—considered among the most effective but typically reserved for health-care workers— transmission can still be reduced with simple and affordable face coverings, the research shows. In a study published last month in the journal Physics of Fluids, researchers at Florida Atlantic University found that, of the readily accessible facial coverings they studied, a well-fitted homemade stitched mask comprising two layers of cotton quilting fabric was most effective for reducing the forward spread of droplets. The research was conducted using a mannequin’s head, an air compressor and a smoke generator that mechanically simulated a cough.
- The study found that aerosol-size droplets expelled from the mannequin with the double-layered cotton mask traveled forward about 2.5 inches on average, and that most of the leakage escaped from gaps between the nose and face. Loosely fitting facial coverings, including a folded cotton handkerchief with ear loops, as well as a bandanna were less helpful, the study found. With those masks, droplets traveled on average about 1.25 and 3.5 feet, respectively. In contrast, the study found droplets traveled about 8 inches on average with an off-the-shelf cone-shaped mask.
- Meanwhile, droplets from an uncovered cough traveled around 8 feet on average, though the study found that they could travel up to 12 feet—double the currently recommended social-distancing guideline of 6 feet. Leakage from a common disposable surgical mask wasn’t studied, though two of the study’s authors, Siddhartha Verma and Manhar Dhanak, said they are working on it.
- “It was surprising in a good way to see that a homemade mask could do so well…that we don’t have to get a very fancy mask,” Dr. Verma said. “A cotton mask can be washed at home and dried. Reusability is becoming important as we go into this for the long haul.”
- The amount of virus exposure might influence degree of sickness, according to a review of viral literature and Covid-19 epidemiology by Monica Gandhi, a professor of medicine at the University of California, San Francisco. She and her co-authors posit in the research, expected to be published this month in the Journal of General Internal Medicine, that masks provide an important barrier and could lead to a milder infection or even prevent one altogether. While cloth and surgical masks can widely vary, she believes some masks can likely filter out a majority of large viral droplets.
- Amy Price, a senior research scientist at Stanford’s Anesthesia Informatics and Media Lab, maintains, in contrast, that the primary benefit of wearing a mask is to protect others and reduce Covid-19 transmission. She believes that, excluding N95 masks, multilayered masks with a slightly waterproof outer layer best minimize spread. She said rubbing the outer layer of the mask with a latex glove before donning it creates static electricity—which Stanford researchers believe can better prevent virus particles from passing from the mouth to outside of the mask.
- Researchers are hopeful that more evidence about the personal protection masks could lead to more use in coming weeks. The CDC said the use of cloth face coverings while in public in the U.S. increased to 76.4% in mid-May, compared with 61.9% in April, according to internet surveys sent to roughly 500 adults each month.
- Some Americans who have resisted wearing masks have cited health concerns. However, leading medical groups said in a joint statement Thursday, “Individuals with normal lungs, and even many individuals with underlying chronic lung disease, should be able to wear a non-N95 facial covering without affecting their oxygen or carbon-dioxide levels.” Exemptions should be at the discretion of a physician, the groups said.
- Researchers say the benefits of widespread mask use were recently seen in a Missouri hair salon, where two stylists directly served 139 clients in May before testing positive for Covid-19. According to a recent report published by the CDC, both wore either a double-layered cotton or surgical mask, and nearly all clients who were interviewed reported wearing masks the entire time.
- After contact tracing and two weeks of follow-up, no Covid-19 symptoms were identified among the 139 clients or their secondary contacts, the report found. Of the 67 who were willing to be tested, all were negative for Covid-19.
- According to recent projections from the University of Washington’s Institute for Health Metrics and Evaluation, the Covid-19 death toll in the U.S. would rise to more than 224,000 by Nov. 1. The number is based on expectations that Covid-19 mandates will continue to be eased until rising cases prompt shutdowns again in some places. Almost 140,000 people have died from Covid-19 in the country so far, according to data compiled by Johns Hopkins University.
- Yet if 95% of the U.S. population began wearing masks, the expected death toll would drop by more than 40,000 cases to about 183,000 people, according to IHME.
- Wearing a mask is “one of the most urgent things we can do to get our country under control,” said Melanie Ott, director of the Gladstone Institute of Virology. “We’re all waiting for the vaccine, we’re waiting for therapeutics, and we’re not there.”
- “We have masks, we have social distancing, and we have testing,” she continued. “But there’s not much more in the toolbox here.”
D. Concerns & Unknowns
1. Most of the World May Face Covid Without a Vaccine
- Klaus Stohr has urged governments for many years to prepare for the grim possibility of a pandemic.
- In 2003, he played a key role in a World Health Organization investigation that swiftly identified a coronavirus as the cause of SARS. Stohr also sounded the alarm on the pandemic potential of avian flu, bringing countries and companies to the table to increase production of vaccines in case it began spreading widely in people.
- In Covid-19, which has killed almost 600,000 people, the world faces the crisis that the virologist has long feared. Stohr, who left the WHO to join drugmaker Novartis AG in 2007 and retired a couple of years ago, paints a sobering picture. He spoke with Bloomberg by phone, and his remarks have been edited for clarity and readability:
- Bloomberg: How do you see the pandemic advancing before a vaccine potentially is available?
- Stohr: The epidemiological behavior of this virus will not be that much different from other respiratory diseases. During winter, they come back.
- There will be another wave, and it will be very serious. More than 90% of the population is susceptible. If we do not tighten again to a serious lockdown or similar measures, the virus is going to cause a significant outbreak. Winter is coming before the vaccine. There will be an increase in cases, and there will be problems containing it because people seem not very amenable to more constraints in their movement and freedom.
- “It’s not the vaccine that’s going to end the pandemic. The virus will end this pandemic by burning every piece of dry wood it will find”
- Bloomberg: When do you predict vaccines may arrive?
- Stohr: Countries like Germany may have a significant amount of vaccine by the beginning of next year and a rollout that may take four, five, six months for the elderly. The strategy may be different for a country like Brazil, Argentina or Chile, which may never get a single dose of a vaccine and still has to cope.
- The world will be divided into two groups, those with vaccines and those with no vaccines.
- Bloomberg: How do you see worldwide immunity ramping up as vaccines are introduced and the disease spreads?
- Stohr: I would assume that by the middle of next year a significant portion of the world will have antibodies. That will increase gradually over time. Then there will be a third wave, and when that is over, I would think that 80% of the world may have antibodies if lockdowns are not instituted, which I doubt.
- Bloomberg: What does that mean for vaccines under development?
- Stohr: We’re in a big, big quandary. We have to throw all the resources we can afford toward the development of a vaccine. On the other hand, I believe common sense tells us vaccines will not be available for the majority of the world.
- There may be, by the end of this year or beginning of next year, a half a billion doses available. The world population is 7.5 billion. Particularly in those countries which have insufficient infrastructure and struggle with their health-care systems and have huge populations, what vaccine are they going to have?
- Bloomberg: A number of groups, including the WHO, are focusing on equitable access. Won’t that help tackle those concerns?
- Stohr: It would be irresponsible not to do anything. Nevertheless, the majority of the world population will not receive a vaccine. The virus will continue to spread, and it could take two to three years before the virus has affected a large majority of the population.
- It’s not the vaccine that’s going to end the pandemic. The virus will end this pandemic by burning every piece of dry wood it will find. The fire will not go out before the last susceptible person has been affected.
- Then the question is what role will any vaccine play afterward.
- “We cannot do the ostrich policy here and hope that some miracle will happen and the virus will disappear. The perfect strategy isn’t available”
- Bloomberg: You seem optimistic researchers will succeed in coming up with vaccines. How do you assess the prospects and potential risks?
- Stohr: The coronavirus is not a particularly difficult virus to handle. Even the conventional vaccines could make a difference, and we have different approaches, vector vaccines, mRNA. That is very promising.
- In the past, when a vaccine is introduced, you have a gradual increase in its use, in the number of people immunized, and if anything comes up, even very rare events, they will be noticed pretty early. But here, a vaccine will be used in large amounts, possibly hundreds of millions of doses, in a relatively short period of time, six months to a year. So the question is if there is anything possibly lingering in the vaccine that cannot be detected in the large-scale safety testing during the approval process.
- It could hit many, many people. If you immunize 500 million, and it’s only 1 in a million who is affected, you still have a significant number of people who may have safety problems, so that is something that has to be addressed. But one has to balance the concern about the impact of the disease against the concern of the possible impact of the use of the vaccine.
- Bloomberg: You’ve said countries need to adjust their strategies. What is the best approach governments can take?
- Stohr: We have to find a way to open our community in a way that supports our long-term medical goal, which is the least number of casualties over time, knowing that you cannot avoid the spread of infection. There is no other tool available. If you’ve got a medical problem, you go skiing, you break your leg, your knee ligament is torn, no problem, go to the doctor and get it fixed. We have no fix here.
- We have to live with this virus and we have to find a proper way to ensure that when we are through with this we look back and say we did the best to prevent death and disease. But we cannot do the ostrich policy here and hope that some miracle will happen and the virus will disappear. The perfect strategy isn’t available.
- Bloomberg: You’ve tackled other viruses from SARS to bird flu, are there any lessons from the past that are relevant today?
- Stohr: Since 2003 we’ve been talking about pandemic planning. Some countries developed these plans and used them. I believe those who had a decent pandemic plan were a couple of steps ahead. But there are still countries with no plans. The learning is get your pandemic plan ready.
- It may be clear that only those who will have vaccine production on their soil will have access to vaccines during the pandemic. I hope it’s not going to turn out this way, but I fear it will. That hopefully will result in more investment into pandemic preparedness and vaccine preparedness in the coming years, so that the next pandemic will be addressed better than this one.
2. The risk of catching C19 from contaminated surfaces, objects is ‘negligible’
- Emanuel Goldman’s mother-in-law was driving him up the wall.
- “‘Wipe down the groceries. Wipe down the handles of the bags from the people who delivered the food,‘” he recalls her saying.
- Her demands prompted Dr. Goldman, a professor of microbiology, biochemistry and molecular genetics at Rutgers University, to dig into the scientific literature on the transmission of human coronaviruses. What he found confirmed his suspicions: The risk of catching COVID-19 from touching contaminated surfaces and objects – or what scientists call fomites – is “negligible,” he said.
- Dr. Goldman is among a camp of researchers who now believe the chances of getting COVID-19 from fomites are probably much smaller than originally thought. Although they support hand hygiene and the cleaning and disinfecting of surfaces, they suggest other measures, such as physical distancing and wearing masks, play a far bigger role in preventing the spread of the new coronavirus. And if they’re right, that means pushing elevator buttons, touching door handles and allowing children on outdoor playground equipment are all less risky than previously believed.
- “You’ve [still] got to protect yourself,” Dr. Goldman said, emphasizing people should not ignore the seriousness of COVID-19. “But you’ve got to protect yourself correctly – not by worrying about surfaces, but by worrying about what you breathe.”
- In a comment published by The Lancet earlier this month, titled “Exaggerated risk of transmission of COVID-19 by fomites,” he noted that studies upon which assumptions about surface contamination are based do not reflect real-life situations. For example, multiple studies suggest human coronaviruses can survive on surfaces for several days. However, in these studies, researchers used amounts of these viruses that are several orders of magnitude larger than what people would normally encounter, he said.
- Some studies used 1 million to 10 million infectious virus particles for each sample. That would be the equivalent of collecting droplets from 10,000 to 100,000 infected people and applying them to one small area, Dr. Goldman said.
- “It’s absurd,” he said, noting he doesn’t dispute the quality of this research. Rather, “it just has nothing to do with the real world.”
- In studies using much smaller quantities, human coronaviruses are shown to survive for much shorter amounts of time. In one study, he said, they survived between one to three hours. In a different study, which he said better reflected the amount of virus people would typically encounter, no infectious virus particles were found after about an hour.
- Another problem with these types of studies is many of them looked for the presence of what’s called viral RNA, or the nucleic acid of the virus, but not necessarily the presence of actual viable virus – that is, virus that’s able to cause infection, said Gerald Evans, chair of the division of infectious diseases at Queen’s University.
- RNA is a sticky molecule, he said, explaining it adheres to surfaces and is difficult to get rid of.
- “Physically, it looks like a goo,” he said.
- The tests many scientists use, like those used to diagnose COVID-19 in people, home in on a piece of the viral RNA and amplify this target so that it can be detectable, Dr. Evans said. However, these tests do not determine whether there is any viable virus there. To do so, scientists need to take a sample collected from an area and put it into a cell culture, he explained. If a viable virus is present, it will infect the cells in the culture, whereas viral RNA, on its own, will not.
- Dr. Evans said researchers in China, who conducted an environmental study in hospitals and in public places, were able to find a viable virus only in highly contaminated areas – namely health care settings, such as in certain hospital bathrooms or change rooms where staff removed their personal protective equipment.
- The risk of catching COVID-19 from a surface also depends not only on the presence of a viable virus, but on how much of it is deposited there. Dr. Evans said people tend to shed the greatest amount of virus particles from their upper respiratory tract within a day or two of developing symptoms. For those with mild disease, after eight or nine days of being sick, “the amount of virus they’re shedding that’s actually infectious is virtually zero,” he said.
- Transmission through fomites also depends on many other variables, including the material upon which it is deposited. The virus is not able to survive as long on hard, non-porous materials such as stainless steel, where it is more exposed to the environment than, for example, on the palm of your hands and covered in respiratory secretions, he said.
- High temperatures and high humidity seem to reduce its ability to establish an infection, though the relationship is not always clear-cut, he added. Moreover, ultraviolet light from the sun likely renders the virus inactive, which is why using outdoor playground equipment is probably not so risky, he said.
- Given all these factors, Dr. Evans said it’s still worth investing in cleaning and disinfecting.
- But, he said, “The problem with disinfecting protocols – and I’m all for them by way… – is that it’s really not addressing the major route of transmission, which is respiratory droplet transmission.”
3. Is air conditioning helping spread COVID in the South?
- Drawing on insights from another deadly airborne disease, tuberculosis, a Harvard infectious disease expert suggested Friday that air conditioning use across the southern U.S. may be a factor in spiking COVID-19 cases and that ultraviolet lights long used to sterilize the air of TB bacteria could do the same for SARS-CoV-2.
- Edward Nardell, professor of medicine and of global health and social medicine at Harvard Medical School (HMS) and professor of environmental health and of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, said that hot summer temperatures can create situations similar to those in winter, when respiratory ailments tend to surge, driving people indoors to breathe — and rebreathe —air that typically is little refreshed from outside.
- “The states that, in June, are already using a lot of air conditioning because of high temperatures are also the places where there’s been greater increases in spread of COVID-19, suggesting more time indoors as temperatures rise,” Nardell said. “The same [thing] happens in wintertime, with more time indoors.”
- Though transmission of the SARS-CoV-2 virus has been understood to transmit mainly through large droplets expelled during coughing, sneezing, or talking, Nardell said that evidence has risen that at least some cases of COVID-19 occur via airborne transmission. That happens when virus particles contained in smaller droplets don’t settle out within six feet and instead hang in the air and drift on currents. Airborne transmission is thought to have been a factor in the coronavirus’ spread among members of a Washington choir, through an apartment building in Hong Kong, and in a restaurant in Wuhan, China, Nardell said.
- Airborne transmission would make people even more vulnerable to the virus in a closed room. Nardell said that in an office occupied by five people, as windows are closed and air conditioners turned on, CO2 levels rise steeply, a sign that occupants are rebreathing air in the room and from each other.
- “As people go indoors in hot weather and the rebreathed air fraction goes up, the risk of infection is quite dramatic,” Nardell said, adding that the data, while gathered related to tuberculosis, would apply to any infection with airborne potential.
- Nardell outlined the work Friday morning during an online presentation sponsored by the Massachusetts Consortium on Pathogen Readiness (MassCPR), an HMS-led collaboration of researchers from 15 Massachusetts institutions and the Guangzhou Institute for Respiratory Health in China. MassCPR’s aim is to foster research that will rapidly translate to the front lines of the COVID-19 pandemic.
- The 90-minute public briefing, focused on issues raised by reopening efforts, was hosted by HMS Dean George Daley and included presentations on Americans’ mobility during the pandemic, contact-tracing efforts, development of personal protective equipment, and of viral and antibody testing as ways to detect new cases and better understand the pandemic’s course through society.
- “We are united in our common goal to leverage our collective biomedical expertise to confront the immediate challenges of the COVID-19 pandemic,” said Daley, who serves on MassCPR’s steering committee. “But we are also committed to building a scientific community that is better-prepared for the next emerging pathogen.”
- In his presentation, Nardell, whose past work has focused on ways to combat drug-resistant tuberculosis, said a dynamic similar to that in the U.S. South is being replayed elsewhere in the world. He cited a rise in air conditioner sales in India, where the systems are designed to bring in little outside air, again increasing chances of transmission. India, with nearly 500,000 COVID-19 cases, reported 17,296 new cases and 407 deaths on Friday, according to the World Health Organization.
- Nardell said that being outside or increasing ventilation inside can be effective in slowing transmission, though the ventilation systems in many corporate settings limit how much fresh air can be brought in. Portable room air cleaners also can be used, though they can have limited air flow, he said. Germicidal lamps, a technology that Nardell said is almost 100 years old, have been proven effective in protecting against tuberculosis infection and are already in use in some settings to fight SARS-CoV-2. Compared with mechanical ventilation and portable room air cleaners, the lights, according to one study, have been shown to be up to 10 times more effective, Nardell said.
- The lamps are set up to shine horizontally, high in the room where sterilization is needed. Air currents, stirred in part by warmth from human bodies, circulate up to the ceiling, where the ultraviolet light kills floating pathogens, and then back down again. This technology, Nardell said, is not only proven, it can be deployed cheaply and easily in a number of settings as society reopens.
- The lights are not a panacea, however, and the predominant route of transmission needs to be considered in determining whether they are appropriate. Despite the need for disinfection in nursing homes, for example, transmission there may be mainly through close contact between staff and patients, making them less-than-ideal sites for the germicidal lights, Nardell said.
- “Where [the lights] should be considered in the upcoming resurgence … would be, obviously, in a health care setting, but also in public buildings such as stores, restaurants, banks, and schools,” Nardell said. “We need to know where transmission is occurring to know where they should go.”
E. Back to School!?
1. Please Don’t Make Me Risk Getting Covid-19 to Teach Your Child
- Every day when I walk into work as a public-school teacher, I am prepared to take a bullet to save a child. In the age of school shootings, that’s what the job requires. But asking me to return to the classroom amid a pandemic and expose myself and my family to Covid-19 is like asking me to take that bullet home to my own family.
- I won’t do it, and you shouldn’t want me to.
- I became an educator after a career as a nurse. I teach medical science and introduction to nursing to 11th and 12th graders at a regional skills center that serves students from 22 different high schools in 13 different school districts.
- My school district and school haven’t ruled out asking us to return to in-person teaching in the fall. As careful and proactive as the administration has been when it comes to exploring plans to return to the classroom, nothing I have heard reassures me that I can safely teach in person.
- More than 75 New York Department of Education employees have died of Covid-19. CDC guidelines say a return to traditional schooling with in-person classes would involve the “highest risk” for Covid-19 spread. But even in-person classes with students spaced apart and prevented from sharing materials are categorized as leading to “more risk.” The “lowest risk” for spread, according to the CDC, is virtual learning. I can’t understand why we would choose more risk than is necessary.
- It’s impossible to hear about the way parties, day camps and church services have led to outbreaks this summer without worrying about what will happen if kids and adults gather in the fall. It scares me to think of how many more lives will be lost. It terrifies me that I could be among those who lose their lives.
- I completely understand why parents and administrators want kids to return to school. When we first started online learning in March, it was miserable — pointless, even. Eventually, we established parameters, and I figured out how to teach kids across the northwest corner of Washington State virtually. During summer school, I’ve live-streamed my lectures into campgrounds, living rooms and bedrooms decorated with twinkly lights or festooned with posters. My virtual classroom includes pets and younger siblings.
- Yes, it has been hard. Yesterday, as several really adorable teenage faces laughed through the computer screen at my use of a Tyrannosaurus Rex to explain the sympathetic nervous system and the feeling of impending doom it can cause, I thought, “I miss them.” I wished I was standing in my favorite place in the world, my classroom — because, frankly, that T-Rex analogy is much better when accompanied by my dino walk.
- But it amazes me how fast students adapted to remote learning. I teach a particularly hands-on class. This summer, I’ve managed to teach them to type blood, to suture wounds and how the sensory system works. I’ve taught them all about infection control and epidemiology — they can not only tell you that you should wear a mask, but they can show you how to do it correctly. I used to put my hand over students’ hands to guide them through certain lessons. Now I use a GoPro camera. It’s hard, but they are learning.
- If I’m asked to return to the classroom as the pandemic rages, I will have to walk away. As deeply as I love teaching, I will not risk spreading this virus in a way that could hurt a child or a family member of a child. While children make up a small proportion of U.S. coronavirus cases and they are less likely to become seriously ill than adults, the virus might be linked to “multisystem inflammatory syndrome in children.” Plus, many of my students struggle with poverty or are from multigenerational households. I will not risk passing a virus to them that they might pass to their vulnerable loved ones. I won’t do it.
- It isn’t fair to ask teachers to buy school supplies; we aren’t the government. But we do it anyway. It isn’t fair to ask us to stop a bullet; we aren’t soldiers. But we go to work every day knowing that if there’s a school shooting, we’ll die protecting our students.
- But this is where I draw the line: It isn’t fair to ask me to be part of a massive, unnecessary science experiment. I am not a human research subject. I will not do it.
2. The case for reopening schools in Massachusetts
- As the tidal wave of COVID-19 infections hit Massachusetts, society as we know it shut down. Workplaces shuttered, schools closed, and non-essential workers stayed home. Those of us in health care braced for impact; we saw what happened in Italy and New York City, and we knew that we were not far behind looking at the epidemic curves. We now know we averted a catastrophe in the health care system by shutting down Massachusetts.
- As case counts declined there was a sense of relief, and tremendous gratitude for those who made sacrifices so our hospitals and health care workers could provide safe care for those impacted by COVID-19.
- But it also became apparent there were great harms associated with closures, particularly for children in the Commonwealth. For most children COVID-19 has not had the devastating and life-threatening physical health effects seen in adults. But the negative impact on their education, mental health, and social development has been substantial.
- Children with emotional, psychological, or developmental disabilities often receive necessary services through schools. Because some of these services were put on hold, continued school closures have been especially detrimental to this group of vulnerable children.
- The harms of remote learning have been felt most significantly by children already at risk. Children who rely on school lunch programs faced added food insecurity. Lack of access to technology and online resources significantly limited remote learning. We remain concerned with how school closures will exacerbate achievement disparities across income levels and ethnic and racial groups.
- In a short time, we have learned an extraordinary amount about the virus and its impact. Children are less susceptible to infection and less likely to become severely ill when infected with COVID-19. Thus far children have not been major drivers of transmission; and evidence from the pre-lockdown era points to lower rates of transmission in schools than in other community settings.
- Just as importantly, we also learned how to protect ourselves from exposure to the virus. Social distancing and universal mask usage are highly effective at preventing transmission, especially when combined with other mitigation strategies planned for schools.
- Still, the future of the epidemic is unknown. It is not unreasonable to think the virus may continue to circulate for a year or more.
- Recognizing the very real harms of school closures, the lower risk of infection in children, and our knowledge of how to protect both children and adults from transmission, we owe it to the children of Massachusetts to create a safe path to reopen schools in the fall.
- We know that for many parents, children, and teachers there will be fear about resuming in-person learning. We believe the DESE guidance, which has been endorsed by the Massachusetts Chapter of the American Academy of Pediatrics, appropriately considers the complexities of returning to school and outlines precautions necessary to minimize risks to both students and staff. The guidance acknowledges that until there is no community transmission that risk cannot be eliminated altogether, and there may be some high-risk individuals for whom continued remote learning options may still be needed.
- Some parents are also concerned about how their children will adapt to the new normal. We know children are resilient and adapt easily if adults around them provide reassurance and model the behaviors we want them to emulate. Just as we teach our children to tie their shoes, we can teach them to wear their face coverings.
- We have done a great job in Massachusetts, heeding the call for distancing to get our transmission rates down. We believe a return to school in this setting and with mitigation strategies is safe, and that Massachusetts can and should continue to be a model for safe reopening.
F. The Road Back?
1. The Greatest Coronavirus Risks When You Fly
- It’s one of the key questions for our economy, our family relations and our basic ability to break from the routine: Is it safe to fly on an airplane?
- The answer: not as safe as the airline industry would have you believe, but a lot safer than you might think.
- Airplane cabins are heavily ventilated, and robust airflow, mixed with fresh air, seems to lessen the spread of the virus that causes C19. Taken to its extreme, it’s the same idea that outdoors, with ample airflow and fresh air, is safer than indoors.
- “Contrary to what people believe, you’re not flying through the air in a sealed tube,” says Amanda Simpson, vice president for research and technology at Airbus Americas.
- Airlines and airplane manufacturers are mounting a major push to build confidence among travelers. They claim the brisk ventilation, along with significant filtering of the air and a constant infusion of fresh air from outside planes, makes airplane air safer from the virus than many other indoor public settings such as office buildings and restaurants. Wearing masks and using hand sanitizer after trips to the lavatory make the environment even safer, they say.
- Some public health experts suggest the risks are greater: Airflow and filtering may not help if someone next to you coughs or sneezes on you. And there’s no getting around the fact that people are packed closer together on airplanes than just about any other public setting.
- Airlines know this is a defining issue for the future of travel. A public-opinion study done in 11 countries for the International Air Transport Association, an airline group, the first week of June found that 65% of respondents listed sitting next to someone who might be infected as the top concern for people on aircraft. Using the restroom was second.
- “The overall risk, I think right now, I would put it at moderate,” says Mark Gendreau, chief medical officer at Beverly and Addison Gilbert hospitals outside Boston and an expert on disease transmission on airplanes.
- He was just asked to peer review a new study done in Germany by experts in airplane modeling that he thinks is instructive to travelers. The computer simulations showed the highest risk for Covid infection among air travelers is during boarding and deplaning. That’s when people are in close contact, sometimes with noses and mouths not far apart. Think of hoisting overhead bags into bins just above aisle-seat passengers.
- Howard Weiss, one of the authors of a 2018 study identifying transmission paths for respiratory diseases on airplanes, says the comparison to office air and other settings may not be very relevant. “Offices don’t have seats packed like airplanes do,” says Dr. Weiss, a biology professor at Penn State University.
- There are few known cases of transmission of coronavirus inside an airplane. Contact tracing after a flight March 31 between the U.S. and Taiwan with 12 symptomatic C19 passengers on board revealed no onboard transmission among 328 other passengers and crew, according to an IATA report. A flight from China to Canada with one symptomatic passenger revealed no onboard transmission. However, preliminary research on a London-to-Vietnam flight on March 2 suggests that one passenger likely infected 14 others, 12 of whom were seated nearby.
- Airlines say there haven’t been unusually high infection rates for flight attendants, who spend much more time in airplane cabins than most travelers. At American, flight attendants make up 21% of the workforce and 20% of the C19 cases, says David Seymour, chief operating officer. And 40% of the Covid cases among flight attendants are people who haven’t been to work in 14 days or longer.
- “If there were problems, the data would show it,” Mr. Seymour says.
- Scientific studies over many years looking at previous virus outbreaks, as well as the current pandemic, suggest that viral transmission between passengers on planes is low on the whole. But it isn’t without risk. One study of SARS, another coronavirus, found one infected person on a flight infected 22 others.
- “It is generally accepted right now that when the plane is in flight and the ventilation system is up and running, it does a really good job of clearing the air of infectious particles,” Dr. Gendreau says.
- Scientists generally believe the biggest risk comes from someone near you coughing and sneezing. That’s why masks become so important. Aviation health experts point to previous studies done on pandemics, including SARS and H1N1, that showed that the risk of infection was higher for people seated within two rows of an infected person.
- Because of a concern that some airlines may leave ventilation off even for a few minutes during boarding and deplaning, Boeing says it issued an advisory to airlines to use onboard power to run ventilation at full strength.
- Airlines aren’t required to comply, and the U.S. has no regulations requiring cabin ventilation systems be operated on the ground, according to the Federal Aviation Administration.
- Southwest, American and other airlines say they already have a standard practice of operating with full airflow on the ground as well as in the air. Southwest says its captains aren’t allowed to leave the cockpit until they confirm that the ventilation system is running on ground power.
- Aviation experts say airplane ventilation systems don’t do much for the large droplets: They’re too big to be sucked up quickly by airflow. That’s why those immediately around you could pose a danger. But experts say airplane ventilation likely does a lot to control aerosol contamination.
- Most of the industry says ventilation and masks make it safe to put people in middle seats. Airlines also note that many planes have two seats on one side of an aisle, so there are plenty of times when you are seated shoulder-to-shoulder without regard to a middle seat.
- The idea of blocking the middle seat seems a U.S. creation. A survey by consulting firm IdeaWorks found no effort to block middle seats among 17 non-U.S. airlines. Only Delta, Southwest, JetBlue, Alaska and Frontier are doing it.
2. Can This ‘Hazmat Suit For Flying’ Save Air Travel?
- It turns out that Naomi Campbell was tapping into a very real consumer sentiment back in March when she posted a photo on Instagram of herself at the airport wearing a white hazmat suit, goggles, face mask and latex gloves.
- As the air travel industry struggles though its gradual, faltering recovery during the pandemic, it has become painfully clear that millions of Americans share the model’s anxiety about flying when armed only with a face mask, hand sanitizer and crossed fingers.
- This might explain how a Jetson-esque item of next-level Personal Protective Equipment (PPE) has so quickly caught the fancy of anxious travelers.
- In only a dozen or weeks or so, a Canadian startup has sold tens of thousands of its futuristic BioVYZR online while its YouTube promo video racked up 2.2 million views. Meanwhile, the company has raised over $567,000 on the crowdfunding site Indiegogo as it took its idea from prototype to product.
- Don’t let the space-chic vibe fool you; this is no gimmick. The BioVYZR is a legit consumer-grade Powered Air Purifying Respirator (PAPR) using hospital-grade air-purifying technology similar to the respirators worn by frontline healthcare workers.
- The business has taken flight at a dizzying speed. Based in Toronto, Yezin Al-Qaysi launched VYZR Technologies only four months ago in response to what he saw as a dearth of good PPE options for a wide variety of people during the global pandemic.
- Admittedly, he had a head start on bringing his idea to market. “The BioVYZR was based on an existing design that I developed at my previous company as a solar visor to provide hands-free shade from the sun,” he says. “And we used that as a starting point to create something similar, but yet entirely different.”
- With a small staff of about 10 in-house employees plus a wider network of manufacturing partners, distributors and consultants, Al-Qaysi has been able to get the BioVYZR to market very quickly. Customers who pre-ordered visors at $249 apiece will receive them between the end of July and early August. “Newer customers should be getting them in the second half of August,” he says.
- While online commenters have dubbed the BioVYZR a “hazmat suit for flying,” Al-Qaysi says the visor was not specifically conceived for travel. “For us, it was all about essential workers and frontline staff, and the people who were really facing this every single day.” By far, the fledgling company’s biggest chunk of business to date has been from large institutions such as schools, dental clinics, hospitals, meatpacking plants, retail establishments, governments and companies that supply governments.
- Even so, it’s easy to see why people love this idea for air travel. Worn over the head and shoulders, the BioVYZR resembles an astronaut suit, with its bubble-like hood and large anti-fogging face shield. Designed to filter your personal air and shield your personal space, the fitted, one-size-fits-all neoprene vest provides a 360-degree seal thanks to adjustable side straps.
- Al-Qaysi and his team have been nimble in making improvements as they receive feedback from interested customers. “We started off with a very specific scope that this was going to be a shield. But as we put it out there on Indiegogo, we heard from doctors and dentists who told us what would make their lives easier,” he says.
- Such feedback is the reason the BioVYZR’s air purification system now has a blower to propel the flow of filtered air into the visor while maintaining an airtight seal around the air intake. The blower makes it “feel like there’s a constant gentle breeze on your face” and “reduces the heat deflection from the face shield, eliminates fogging, and prevents any particulates from reaching your face,” according to the product specs. There is a built-in rechargeable power supply for the blower, and there’s even a USB port for convenience.
- “We did a lot of research on this,” says Al-Qaysi. “We made sure that the battery was well below the carry-on limits on planes, which is around 20,000 mAh. Ours is about 10,000 mAh, which is the size of a standard power bank.”
- While noting that the BioVYZR is not yet approved by the FAA, Al-Qaysi says he’s hopeful the travel industry as a whole will be open to the idea. “The TSA hasn’t seen it. Airlines will start to see this product in the coming weeks for the first time, and we don’t know how they’re going to react.”
- Al-Qaysi says he would welcome a dialogue with airlines about any safety modifications that needed to be made. For example, he says they could create a solution that allows the wearer to open the visor quickly in an in-flight emergency should oxygen masks drop down.
- “The key here is to open up a conversation about how we’re going to get back to a little bit of normal, get the economy going, get the airlines going again before this damage becomes permanent, and large airlines have to shut down,” says Al-Qaysi.
- “Ultimately, at the end of the day, people want to feel safe,” he says. “But more than that, people want to actually be safe.”
- With new COVID-19 cases continuing to rampage across the United States, it’s possible you just might spot someone wearing a BioVYZR on a future flight or even — who knows? — on Ms. Campbell’s Instagram feed.
3. Covid-19 Remakes Elevator Etiquette
- Office-building owners are changing how people call for elevators and the rules for riding them to provide passengers more space amid the coronavirus pandemic.
- They are restricting capacity to just a few people standing in designated spots, upgrading ventilation systems and regularly sanitizing contact points such as handrails and buttons. Advanced automation systems from elevator companies and mobile apps already on the market are attracting higher demand from building owners trying to eliminate passenger crowding in elevator cars and the need to press buttons to select floors or hail an elevator car.
- “There’s a lot of anxiety,” said Chris Harihar, who in July returned to his Manhattan office for the first time in four months to find the elevator limited to just four passengers, one for each corner of the car, and in masks.
- “It’s going to be an inconvenience,” the communications executive said. “But for the sake of safety, I certainly understand it.”
- Some building-management companies are training staff to head off conflicts as more tenants confront the new protocols and long wait times on their return to work. Concierges and security guards are being asked to direct elevator traffic in lobbies and to remind riders to wear masks and refrain from talking inside elevators to reduce the spread of the virus.
- Michael Colacino, president of office-space brokerage SquareFoot Inc. in New York, said elevator usage remains a top concern of tenants contemplating the return to offices, especially the likelihood that some passengers won’t abide by the rules, causing confrontations with other passengers.
- “Dragging somebody off an elevator car is not something that building owners are going to relish,” Mr. Colacino said. “If you double the wait times, you double the unpleasantness.”
- Houston-based Hines Interests LP conducted a 25-minute training session this month for 1,500 of the real-estate investment-and-management firm’s U.S. employees. The training included conflict-resolution strategies and reminded Hines employees that building visitors and tenants are likely to be under stress after months of being away from their workplaces.
- “All of our social skills are a little rusty,” said Jessica Newhouse, Hines’s client-experience program manager.
- Hines, which has 322 properties in 106 U.S. cities, will urge or require those entering one of its buildings to wear masks in lobbies and on elevators, depending on local restrictions. Building staff will provide masks to those who don’t have them, Ms. Newhouse said.
- Building owners also are counting on staggered start times to alleviate rush-hour crowding in lobbies and elevator cars.
- Newer elevator banks often feature destination-dispatch systems by which passengers select their floors from a touchpad in the lobby or from an app on their mobile phones before an elevator arrives, instead of waiting to select floors from a bank of buttons once inside the car. The systems pool passengers going to the same or nearby floors, reducing a car’s stops. Now building managers say they can use the technology to limit riders for social distancing and keep people from squeezing into crowded cars.
- “We’ve all seen that person running to get an elevator and sticking his hand in the door and saying ‘Wait, one more!” said Ken Schmid, executive vice president of Americas for elevator manufacturer Kone Corp.
- Kone, Otis Worldwide Corp. OTIS 0.39% and Schindler Elevator Corp. say they have received orders since the pandemic began to upgrade some older elevators to the destination-dispatch systems. Other programs can even hail an elevator automatically when an employee or visitor passes through a turnstile with a building pass.
- Some building owners are upgrading elevator ventilation systems to expose recirculated air to ultraviolet light to destroy airborne viruses. Elevator buttons and handrails are being covered with antimicrobial coating to limit the risk of virus transmissions.
- In some cities, building owners are limited on how many people can return to offices. In New York, occupancy is restricted to 50% of the people authorized by building permits. Most buildings are well below that level as employees continue to work from home, making it easier to manage elevator usage and maintain distancing between people entering and exiting.
- “If you’re at 50% occupancy there’s not going to be long waits for an elevator,” said John Powers, a vice president in charge of 10 buildings in New York and New Jersey for real-estate investment firm Boston Properties Inc. BXP 1.96% “The issues will be when more people come back.”
G. Johns Hopkins C19 Update
July 17, 2020
1. Cases & Trends
- The WHO COVID-19 Situation Report for July 16 reports 13.37 million cases (226,181 new) and 580,045 deaths (5,579 new). The pandemic has been ongoing for more than 6 months and continues to accelerate. The America’s continues to be heavily impacted, accounting for 7,016,851 (52%) of total confirmed C19 cases globally and 132,700 (59%) of newly reported cases.
Central & South America
- Brazil reported 45,403 new cases, currently #2 globally in daily confirmed C19 cases. This week, newly reported daily incidence of cases has increased slightly, however daily incidence remains fairly stable suggesting a potential plateau in cases. Brazil remains #2 globally in terms of daily incidence, following only the US. Mexico reported 7,051 new cases and is ranked #5 in terms of daily incidence, however, Mexico and Russia remain closely tied for daily incidence. Broadly, the Central and South American regions are still major C19 hotspots. Including Brazil and Mexico, the region represents 6 of the top 13 countries globally in terms of daily incidence, including Colombia (#7), Argentina (#8), Peru (#9), and Chile (#13).
India, Pakistan & Bangladesh
- India reported its highest daily incidence to date, with 32,695 new cases. India remains #3 globally in terms of daily incidence. Pakistan continues to report decreasing incidence since its peak in mid-June, and its total active cases continue to decline, with currently 70,787 active cases and 2,085 new cases in the past 24 hours. Bangladesh continues to report decreased daily incidence as well, reporting 3,034 new cases. Bangladesh is now #10 globally in terms of daily incidence. Notably, Bangladesh’s test positivity remains slightly above 20% and the number of daily tests performed has decreased steadily since early July. This could indicate that Bangladesh’s decreased incidence could be driven more by reduced testing than slowing transmission.
- South Africa remains among the top countries globally in terms of both per capita (#5) and total daily incidence (#4). South Africa reported 13,172 new cases, with daily incidence steadily increasing throughout the week.
Eastern Mediterranean Region
- Overall, the Eastern Mediterranean Region remains a global hotspot, representing 5 of the top 10 countries in terms of per capita incidence: Bahrain (#1), Oman (#2), Qatar (#8), Kuwait (#7), and Saudi Arabia (#13).
- Montenegro has reported a spike in C19 cases now reaching the highest rate of active infections in the Western Balkans per 100,000 population after declaring the country “corona free” in June. There are currently 1,582 active infections in the country.
- Australia has been experiencing an increase in new cases since the end of June. The Ministry of Health reported 315 new cases bringing the total to 11,325 cases as of July 17, primarily due to an outbreak in the southeastern region of the country.
- The US CDC reported 3.48 million total cases (67,404 new) and 136,938 deaths (947 new). Thirty nine states are reporting increasing incidence of confirmed cases, with the largest outbreaks occurring in Texas and Florida. Both of those states reported a record number of new deaths with 110 and 156 new deaths respectively. Cases in the US have increased by 206% since June 9, up from 20,338 new cases per day to 62,324 yesterday (7-day average).
- The Johns Hopkins CSSE dashboard reported 3.59 million US cases and 138,543 deaths as of 12:00 pm on July 17.
2. Rwanda Response
- Rwanda has emerged as a leader in controlling the pandemic. In addition to fast implementation of strict lockdowns, Rwanda also has a robust testing and contact tracing program. Testing is widely and freely available, with testing sites being set up along high foot-traffic areas. Rwandan health authorities say that they have converted their widespread HIV testing capabilities for use in C19 testing. They also conduct pooled testing in order to process samples more quickly and return faster results.
- Police, college students, and healthcare workers have been recruited as contact tracers. In the Rusizi district, a hotspot in the country, people were largely compliant with the strict lockdowns and suspension of travel to and from the area. As a result, within-district mobility has begun to resume while travel in and out of the district is still banned. The combination of these measures in addition to mobility restrictions has allowed some places of worship to begin reopening under certain conditions this week.
- Despite these successes, the United Nations Population Fund (UNFPA) stated that C19 and its associated control measures could undo hard-earned gains against gender-based violence. In order to maintain momentum, UNFPA held a series of virtual seminars on June 30th targeting Rwandan youth to engage them in these issues.
3. Vaccine Update
- As vaccine candidates across the world continue to advance through clinical trials, certain candidates have already started to be used in select populations in some places outside a clinical trial framework. China has started vaccinating military service members with a vaccine candidate developed by Cansino Biologics, which is also undergoing clinical trials in Canada. Two products made by the Chinese-government affiliated company Sinopharm have been offered to employees of a state-owned oil company. The use of these experimental vaccines, none of which have completed the clinical trial process raises ethical and safety concerns.
- Meanwhile, news media have reported that intelligence officials have accused hackers of allegedly attempting to steal vaccine research from American, British, and Canadian organizations. According to Britain’s National Cyber Security Center, hackers tied to Russia have used malware and phishing emails to trick people into submitting security credentials and provide access to confidential information about vaccines in development. Russian officials have denied involvement in any attack. Intelligence officials from the three governments have warned that it is important for organizations to immediately address vulnerabilities identified by software companies to protect themselves from attacks. The news comes at a time of rising concern and questions about government transparency in the race to develop a vaccine.
- The US government, and in particular Operation Warp Speed, has received criticism about lack of transparency in selecting candidates to financially support, both from members of Congress and from members of the media and scientific community. Wide ranges in funding allocated to different pharmaceutical companies, several of which have little experience successfully producing licensed vaccines, have prompted concerns about conflicts of interest.
4. Mandatory Workplace Regulations
- Virginia has reportedly become the first state in the country to mandate coronavirus-related workplace safety measures. The measure, called an “emergency temporary standard” will compel companies to comply with safety measures or face up to $130,000 in fines. The measures include mandates focused on protective gear, disinfection and sanitation, and physical distancing, among other features. The move also protects employees who voice safety concerns to their employers. The measure is expected to last at least 6 months and comes amid measures by a growing number of US states to mandate face coverings in public.
- Mandates to wear masks have been enacted in a range of both Democratic and Republican-led states, despite early partisanship associated with mask wearing. However, the governor of Georgia has gone in the opposite direction, banning local governments in the state from requiring masks to be worn. While the governor’s spokesperson stated that the governor supports mask wearing, he received criticism from Atlanta Mayor Keisha Lance Bottoms, who herself has tested positive for C19 and has enforced mask mandates in Atlanta.
5. National Academies Report on School Reopening
- A new report from the National Academies of Medicine, Science, and Engineering discusses the risks and benefits of schools reopening for in-person learning amidst the C19 pandemic. The report outlines that for schools and districts that decide to physically reopen, they should prioritize doing so for students K-5 and those with special needs because they stand to benefit the most in terms of learning and psychosocial development. Recommendations for reopening are paired with mitigation measures necessary to reduce the risk of C19 transmission to students and their families, teachers, and staff.
- The report also emphasizes how the pandemic is reinforcing inequalities that exist across school systems and communities in the US, and it urges school districts to account for equity when deciding how and when to reopen. The report recommends that decisions should be made with sensitivity to local resources and an awareness that communities most heavily impacted by C19 are those often with resourced school districts. Ultimately the decision to resume in person learning is local and each district will need to determine the best course of action in consultation with parents, members of the community, teachers, and staff.
6. Healthcare Worker Infections in Kenya
- An outbreak of C19 in Pumwani Maternity Hospital in Kenya has resulted in 41 healthcare workers becoming infected. As the largest referral maternity hospital in the country performs between 50-100 deliveries daily. This latest incidence of healthcare worker infections brings the national total to 450 confirmed cases among healthcare workers as reported by the Ministry of Health on Wednesday July 15. This represents approximately 4.1% of the total confirmed cases in Kenya and thus far there have been 4 deaths among healthcare workers from C19.
- Nationally there is a shortage of N95 masks necessary for protecting healthcare workers against infection, requiring 24 hour use of the same mask while providing care. Unions representing a range of healthcare disciplines are emphasizing a need for additional personal protective equipment (PPE) to ensure the safety of healthcare workers. In addition to lack of adequate supply of PPE, some facilities have reported that PPE supplies are not at an appropriate quality to effectively protect.
- In response to the recent surge in infections at Pumwani Maternity Hospital, the Ministry of Health is conducting wide-scale testing of healthcare workers, and reduced care provided to only those most complex deliveries which cannot be performed in other facilities.
7. Latin America Surpasses US
- The total number of C19 deaths in Latin America and the Caribbean has surpassed those in the US and Canada. Latin America and the Caribbean is now reporting over 146,515 cumulative deaths, while the US and Canada are reporting over 144,451 cumulative deaths. Public health experts have been concerned with the severity of the outbreak in the region and the potential for outsized impacts from C19. With large divides between wealthy and impoverished communities, an ongoing migrant worker crisis, social and political unrest, large numbers of historically marginalized indigenous populations, and an aging population and infrastructure, the Latin American region has a number of vulnerabilities to lasting damage from C19.
- The outbreak in the region is thought to have started among wealthier people returning from international travel, but quickly moved to overpopulated urban centers and working class persons. In particular, migrant workers and informal workers are at higher risk of contracting C19 and potentially contributing to its spread. Many heads of state have struggled with the balance between controlling the pandemic in their territories and reopening their economies. Brazilian President Jair Bolsonaro was among the most insistent political leaders in his calls to reopen the Brazilian economy. Brazil now has the second highest case count in the world at 2,012,151 cases, behind the United States at 3,592,316 cases.
- While the working class of the region has already been heavily impacted by the pandemic, the political class is also beginning to be affected. At least three heads of state have tested positive for C19 with many other politicians also testing positive. Brazilian President Jair Bolsonaro, Bolivian Interim President Jeanine Añez, and Honduran President Juan Orlando Hernandez have all tested positive in recent weeks.