Recent Developments & Information
July 24, 2020
Without reliable information, we rely on fear or luck.
“I don’t see the coronavirus disappearing the way SARS 1 did. The reason I say that is it is so efficient in its ability to transmit from human to human that I think we ultimately will get control of it. I don’t really see us eradicating it.”Dr. Fauci
“The guidelines that we put out a couple of months ago, those should be followed and appreciated as the vehicle to open the country, as opposed to the obstacle to opening the country.”Dr. Fauci
“It’s disconcerting when you see people are not listening. I could show you some of the emails and texts I get — everybody seems to have my cellphone number — that are pretty hostile about what I’m doing, as if I’m encroaching upon their individual liberties.”Dr. Fauci
1. Remote Learning? No Thanks. Get Ready for Microschools.
J. Links to Other Stories
- Rapid Decay of Coronavirus Antibodies in Persons with Mild C19 Our findings raise concern that immunity against the coronavirus may not be long lasting in persons with mild illness, who compose the majority of persons with C19.
- What scientists are learning about how long Covid-19 immunity lasts C19 antibody testing, long-term immunity, vaccines, herd immunity (and more!), explained.
- Coronavirus vaccines leap through safety trials — but which will work is anybody’s guess Scientists caution against comparing immune responses shown in early-stage trials, and say there might be more than one path to an effective vaccine.
- C19 Vaccines With ‘Minor Side Effects’ Could Still Be Pretty Bad The risk of nasty side effects in the Moderna and Oxford trials should be made clear now, before it ends up as fodder for the skeptics.
- Findings from Real-World Data Study Reveal Higher Risk of Hospitalization and Death Among Cancer Patients with C19
- Rapid Scaling Up of C19 Diagnostic Testing in the US — The NIH RADx Initiative
- What Does It Mean to Say a New Drug ‘Works’? C19 is a new disease. Remdesivir is an experimental drug. How can scientists tell if it’s successful while the world shifts around them?
- Potent neutralizing antibodies directed to multiple epitopes on SARS-CoV-2 spike
- Feasibility of Separate Rooms for Home Isolation and Quarantine for COVID-19 in the United States
- To Navigate Risk In a Pandemic, You Need a Color-Coded Chart Is going to the dentist more dangerous than grocery shopping? Public health groups want to help us weigh everyday risks with to easy-to-read guides.
- Over Half of U.S. Companies Plan Virus Contact Tracing for Employees
- National Academies Launch Study on Equitable Allocation of a C19 Vaccine
- Opinion: My patients want the good old days of office visits. That’s not happening any time soon
- Contact Tracing, a Key Way to Slow C19, Is Badly Underused by the U.S. Despite tracing’s success in other countries, the U.S. government has failed to adequately fund or apply the tool.
- Every Decision Is A Risk. Every Risk Is A Decision. We can’t live like we did before coronavirus. We won’t live like we did immediately after it appeared, either. Instead, we’re in the muddy middle, faced with choices that seem at once crucial and impossible, simple and massively complicated. These choices are an everyday occurrence, but they also carry a moral weight that makes them feel different than picking a pasta sauce or a pair of shoes. In a pandemic that’s been filled with unanswerable questions and unwinnable wars, this is our daily Kobayashi Maru. And no one can tell us exactly what we ought to do.
- The TB experiment that proved airborne disease transmission In 1956, tuberculosis was a major global killer, and it disproportionately affected military veterans hospitalized in the Veterans Administration hospital system. An experiment not only proved the airborne disease transmission of tuberculosis for the first time, but also quantified how many TB infections could be expected to result from exposure to a given number of patients over a defined interval.
- Our history is a battle against the microbes: we lost terribly before science, public health, and vaccines allowed us to protect ourselves Our history is a battle against the microbes: we lost terribly before science, public health, and vaccines allowed us to protect ourselves.
- How bats have outsmarted viruses—including coronaviruses—for 65 million years
- U.S. Disaster Response Scrambles To Protect People From Both Hurricanes And C19
- German coronavirus experiment enlists help of concertgoers German scientists are planning to equip 4,000 pop music fans with tracking gadgets and bottles of fluorescent disinfectant to get a clearer picture of how C19 could be prevented from spreading at large indoor concerts.
- What Does It Cost to Run a Restaurant During the Pandemic? During a period when restaurants are facing unprecedented economic pressure, they’re also incurring new and ongoing expenses.
- A list of US Chains that require masks can be found here.
A. The Pandemic As Seen Through Headlines
(In no particular order)
- Dr. Fauci doesn’t believe COVID-19 will ever be eradicated
- CDC says US could see 175,000 deaths by Aug. 15
- First Covid Vaccine May Be Approved in 2020, EU Regulator Says
- U.S. reaches deal with Pfizer, BioNTech to distribute potential coronavirus vaccine
- Yale epidemiologist says hydroxychloroquine could save up to 100,000 lives if used for coronavirus
- Studies show T cells’ crucial role in coronavirus protection
- Roche Chief Urges Careful Use of Scarce Coronavirus Tests
- California surpassed New York for the most reported cases of any state
- California Orders Millions More Masks With Virus Cases at Record
- Recent data show state coronavirus ‘hotspots’ Arizona, Texas, Georgia could be turning corner
- Arizona COVID hospitalizations plunge, Georgia deaths are at 3-month low, and Texas shows signs of peaking
- Alabama reports COVID-19 record
- Gov. Holcomb mandates masks in Indiana
- DeSantis says teachers eager to get back to classroom
- Dr. Fauci says reopening schools should be a “goal”
- Iran suffers record daily deaths
- Australia suffers 2nd highest daily total in Victoria
- Barcelona hear of latest Spanish outbreak
- India reports record jump in new cases
- South Africa now has fifth biggest outbreak
- Immunity passports are going nowhere
- Covid Antibodies Fade Rapidly, Raising Risk of Lost Immunity
- Arizona is recording more than 3,000 new cases a day on average this month — double what it was in mid-June — but some disease specialists are cautiously optimistic that the crisis may be retreating
- The average number of daily new cases in Spain has more than tripled in the month since its state of emergency ended
- New York City is experiencing the lowest number of new coronavirus cases since the pandemic began — and has not seen an uptick throughout the reopening process
- NYC Mayor de Blasio says he won’t make final decision on reopening schools until September
- More Jobless, Depressed Economic Activity Point to U.S. Recovery Stalling
- Senate Republicans to unveil $1T COVID-19 stimulus bill
- Stuck-at-Home Parents Want More Support for Home Schooling
- Australia Sets Record for Virus Cases With Victoria Surge
- Tokyo Virus Cases Jump to Single-Day Record of Around 360, Media Say
- Hong Kong’s unraveling is a warning
- Over 4.5 million undetected Covid-19 infections and recoveries in Delhi
- The World Is Masking Up, Some Are Opting Out
- Measures to fight the coronavirus have nearly wiped out the flu in the Southern Hemisphere, which may mean good news for the U.S. and Europe once their winter starts
- China Offers Loan for Latin American Shot Access
- Southwest says it will no longer let travelers without masks fly, enacting the strictest policy among U.S. airlines
- Southwest will test thermal cameras to detect fevers in Dallas
- Doctor wears 6 masks at once to prove oxygen levels will be just fine
- Director of CDC ‘absolutely’ comfortable sending grandkids to school
- Many scientists are skeptical of anecdotal reports that people have been infected with the coronavirus twice. “What’s more likely is that some people have a drawn-out course of infection”
- Amtrak will ban passengers who refuse to wear a mask
- Emirates announces it will cover passengers’ coronavirus medical bills
- The FDA got a lot more flexible during Covid — and pharma’s already pushing to make it permanent
- Palestinian man climbs hospital wall to be near mom dying of COVID-19
- Baseball is back
- The annual banquet in Stockholm to celebrate the winners of the Nobel Prize has been canceled because of the pandemic
- One in three American museums may not survive the pandemic
- Disney delays ‘Mulan,’ ‘Star Wars,’ ‘Avatar’ and other films due to COVID-19 crisis
- Most Americans accept they’ll probably only attend virtual parties for the rest of 2020
- Miami Beach mayor wants to ban alcohol sales after midnight, rebrand party scene
- The Models Were Wildly Wrong About Reopening Too
- Coronavirus Traveled Nearly 30 Feet At German Slaughterhouse Where 1,500 Employees Contracted Virus
- Amtrak issues new mask guidelines for riders
- Emirates now says it will cover the costs of passengers’ coronavirus-related medical expenses in an effort to encourage more travelers to fly
- Apple reportedly delays launch event for new 5G iPhones
- World leaders to send videos instead of traveling to UN in NYC in September
- Man climbs hospital wall to be near mom dying of COVID-19
- Broadway icon Ellen’s Stardust Diner may take final bow in August
- Coronavirus fleers send Hamptons home prices through the roof
- Trump says he would take coronavirus vaccine first — or last
- Filipino president corrected after he suggests cleaning face masks with gasoline
- Colorado bans restaurants, bars from serving booze after 10 p.m.
- Ship owners struggle to bring home crews amid coronavirus chaos
- The return of baseball helps Fox reel in ‘tsunami’ of ad dollars
- Major Hollywood Studio Orders “AI-Driven” Face-Mask Detection Robots
- Humanitarian aid from top donors drops even as need soars
- All AMC theaters will stay closed until August
- Russian nurse who wore see-through gown lands TV spot as weather forecaster
- ‘Panera Karen’ claims masks won’t stop COVID-19 since pants don’t contain farts
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day. Green highlights indicate a decrease or no change and yellow highlights indicate an increase.
1. Cases & Tests
- Total Cases = 15,641,987 (+1.8%)
- New Cases = 276,000 (-4,430) (-1.6%)
- New Cases (7 day average) = 241,765 (+3,760) (+1.6%)
- Second highest number of new cases
- Number of new cases have been trending higher since the beginning of the pandemic
- 1,000,000+ new cases approx. every 4 days
- 7 day average of new cases on 7/23 was a record high
US Cases & Testing:
- Total Cases = 4,169,991 (+1.7%)
- New Cases = 69,116 (-2,851) (-4.0%)
- Percentage of New Global Cases = 25.0%
- New Cases (7 day average) = 67,852 (-611) (-0.9%)
- Total Number of Tests = 51,552,175
- Percentage of positive tests (7 day average) = 8.5%
- 42.9% of all new cases are from 3 States (CA, TX and FL)
- 7 day average of new cases has declined for 2 consecutive days, indicating that the increase beginning on 6/9 may have peaked
- Percentage of positive tests has stabilized
- Total Deaths = 635,666 (+1.0%)
- New Deaths = 6,309 (-818) (-11.5%)
- New Deaths (7 day average) = 5,494 (+65) (+1.2%)
- 3 day average of new deaths has increased from 4,529 on 7/21 to 6,403 on 7/23, an increase of 41.4%
- 7 day average of new deaths has been generally increasing since 5/26
- 7 day average of new deaths has increased from 4,146 on 5/26 to 5,494 on 7/23, an increase of 32.5%
- Total Deaths = 147,333 (+0.8%)
- New Deaths = 1,150 (-55) (-4.6%)
- Percentage of Global New Deaths = 18.2%
- New Deaths (7 day average) = 887 (+25) (+2.9%)
- 54.9% of all new deaths are from 4 States (CA, TX, FL and AZ)
- 7 day average of new deaths has been trending higher since 7/5
- 7 day average of new deaths has increased from 516 on 7/5 to 887 on 7/23, an increase of 71.9%
- Highest 7 day average of new deaths since 6/6
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (7/23)
Source: Worldometer and The Covid Tracking Project
4. Where in the U.S. the virus is under control
- As of this week, coronavirus cases are rising in 41 American states, and in many regions the situation has never been worse. Hospitalizations are nearing a record national high and deaths are the highest they have been since late May.
- But amid this devastating wave, one region has managed to get the virus under control: the Northeast. New cases there remain below their April peak, and the region has five of the country’s nine states with flat or falling case levels.
- In just over two months, states along the East Coast — from Delaware to Maine — have gone from the country’s worst hot spot to something resembling Europe. As in Italy and Spain, the Northeast was devastated by a rush of infections and deaths, and state leaders responded — after some initial hesitation — with strict lockdowns and large investments in testing and contact tracing. Like their European counterparts, Northeasterners also mostly followed the rules, including wearing masks, and have supported tough measures to bend the curve.
- If the trends in the United States continue, the differences between the Northeast and the rest of the nation may become so pronounced by the fall flu season that some experts say they may resemble two different countries: one with overwhelmed hospitals and ballooning cases, and another that continues to wrestle a little with the virus, but manages to keep its economy in OK shape.
Source: New York Times Coronavirus Updates
C. New Scientific Findings & Research
1. How Deadly Is C19? Researchers Are Getting Closer to an Answer
- Six months into the pandemic, researchers are homing in on an answer to one of the basic questions about the virus: How deadly is it?
- Researchers, initially analyzing data from outbreaks on cruise ships and more recently from surveys of thousands of people in virus hot spots, have now conducted dozens of studies to calculate the infection fatality rate of C19.
- That research—examining deaths out of the total number of infections, which includes unreported cases—suggests that C19 kills from around 0.3% to 1.5% of people infected. Most studies put the rate between 0.5% and 1.0%, meaning that for every 1,000 people who get infected, from five to 10 would die on average.
C19 Fatality: Analyzing the Evidence
- A comparison of 26 studies that estimate the disease’s infection fatality rate* found varying results but pinpointed an overall rate of around 6.8 deaths per 1,000 infections (0.68%).
- The estimates suggest the new coronavirus is deadlier than the seasonal flu, though not as lethal as Ebola and other infectious diseases that have emerged in recent years. The coronavirus is killing more people than the deadlier diseases, however, in part because it is more infectious.
- “It’s not just what the infection-fatality rate is. It’s also how contagious the disease is, and Covid is very contagious,” said Eric Toner, an emergency medicine physician and senior scholar at Johns Hopkins Center for Health Security, who studies health-care preparedness for epidemics and infectious diseases. “It’s the combination of the fatality rate and the infectiousness that makes this such a dangerous disease.”
- Health authorities and researchers have been working to gauge the death rate from the coronavirus to better understand the risk of the disease, estimate how many people might die and respond with the necessary public-health measures.
- Pinpointing that rate has been challenging, however, because a significant chunk of cases have few to no symptoms or haven’t been tested. The rate also varies depending on factors such as a person’s age and the strength of a jurisdiction’s health-care system.
- “It’s very difficult to measure, but robust studies are finding a clear signal in the noise,” said Timothy Russell, a research fellow at the London School of Hygiene and Tropical Medicine.
- A study by Dr. Russell and colleagues published in February that examined data from China and an outbreak on the Diamond Princess cruise ship put the infection-fatality rate at around 0.6%.
- More than 14.7 million people have been infected with the coronavirus across the globe, and over 609,000 people have died, with nearly a quarter of the fatalities in the U.S., according to data compiled by Johns Hopkins University. That means that among confirmed global cases, roughly 4.2% of those people died.
- The percentage of deaths among people with confirmed infections is higher than the percentage of deaths among infections overall, researchers say, because so many milder and asymptomatic C19 cases go missed.
- The CDC has estimated that for every known case of C19, roughly 10 more went unrecorded through the beginning of May. The total number of infections ranges from six to 24 times more than confirmed cases depending on the state, the agency said Tuesday in a paper published in the journal JAMA Internal Medicine.
- “The hard bit really is to work out how many people have been infected,” said Lucy Okell, who alongside colleagues at Imperial College London estimated the infection-fatality rate in China at 0.66% in a paper published in March.
- To come up with an estimate for the fatality rate, some researchers take the known cases and numbers of deaths, then estimate the proportion missed or asymptomatic cases. Death tallies, however, might also miss undetected C19 fatalities, and researchers must adjust for that as well.
- Other researchers develop estimates based on results from antibody test surveys, which scan the blood of participants for signs of past infections.
- Yet antibody testing data has its own flaws, as scientists work to understand the immune response to the virus. The researchers must also tweak their estimates to compensate for the risk of faulty test results or delays between infection and death.
- No matter their approach, the researchers use complex mathematical models and statistical techniques to fine-tune their estimates.
- An analysis of 26 different studies estimating the infection-fatality rate in different parts of the globe found an aggregate estimate of about 0.68%, with a range of 0.53% to 0.82%, according to a report posted in July on the preprint server medRxiv, which hasn’t yet been reviewed by other researchers.
- “To say that we will ever have one absolute true estimate is erroneous. We can get an idea of a trend, but we need to be mindful that this can change and vary,” said Lea Merone, a public-health physician and health economist at James Cook University in Australia who co-wrote the paper. “It is context dependent.”
- The CDC is now using the report as the basis for its own best-estimate for the infection-fatality rate in its pandemic planning scenarios. The agency’s estimate is 0.65% as of July 10, higher than its previous estimates.
- The fatality rate for an individual varies, sometimes markedly, depending on factors such as age, sex and the presence of pre-existing medical conditions, studies show.
- Researchers in the U.S. and Switzerland examined data from the Swiss city of Geneva to calculate fatality rates for different age groups. They found those over 65 had an infection-fatality rate of 5.6%—40 times the risk of someone in their 50s.
- Quality and access to health care and treatment could shift the mortality rate. Better treatment in the future could push the rate down, but a situation in which a hospital system is overwhelmed can drive the rate up, said Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong who co-wrote the July medRxiv paper.
- An infection-fatality rate of roughly 0.6% is six times greater than the 0.1% estimate for seasonal influenza, which is based on CDC data. Though researchers point out the estimates are calculated in different ways and the flu estimate doesn’t take asymptomatic cases into account.
- Diseases such as SARS, or severe acute respiratory syndrome; MERS, or Middle East respiratory syndrome; and Ebola are much deadlier, with case fatality rates ranging from roughly 10% to 50%.
- There have been far fewer deaths from those diseases than the new coronavirus and even the seasonal flu because they aren’t nearly as infectious or widespread.
- SARS and MERS have killed 774 and 858 people, respectively. More than 11,300 people have died from Ebola.
- Also, many doctors worry C19 might result in longer-term complications for some patients, especially those who have spent weeks in the hospital before being discharged.
- “There’s this narrative I think a lot of people have that you get the disease and you die, or you’re fine. And that’s not true,” Dr. Toner said. “There’s a large range of health-care consequences for people who get severely ill, not just death.”
2. Cholesterol Drug Fenofibrate may Downgrade C19 to Common Cold Level
- A study conducted by professor Yaakov Nahmias at Hebrew University in Israel has found that an existing cholesterol drug, fenofibrate, could ‘downgrade’ C19 threat level to that of a common cold.
- The findings come from lab tests on human lung tissue infected with the coronavirus.
- According to the research, the virus leads to deposits of lipids in the lungs. Nahmias partnered with Mount Sinai Medical Center researcher Dr Benjamin tenOever to gain better insights into the coronavirus mechanism of attack on the human body.
- The researchers observed that the virus changes lipid metabolism in human lungs. They believe that halting this process could help prevent the onset of problems that increase the severity of the disease.
- While the coronavirus hinders the ability of the body to break down fat, fenofibrate starts this process by binding and activating the DNA site that is blocked by the virus.
- Nahmias was quoted by The Times of Israel as saying: “The interesting thing about our study is that fenofibrate actually binds and activates the very site on the DNA that the virus shuts down — a part of our DNA that allows our cells to burn fat.
- “Virus infection causes the lung cells to start building up fat, and fenofibrate allows the cells to burn it.”
- This mechanism of the drug could reduce the virus’ ability to reproduce or even make it disappear.
- Nahmias added: “Your body can easily deal with the virus, all we need to do is deal with the symptoms. We need to give the body time to clear the virus without going into respiratory failure.
- “And it’s by doing this that I think we can transform it into something far less serious, something like the common cold.”
- The Jerusalem Post noted that the researchers are advancing the drug into animal studies in New York, the US and intend to fast-track clinical trials in Israel and the US within the coming weeks.
3. Immunity Likely to Last at Least 6 Months After Infection
- Sweden’s top health authority says people who have had the coronavirus are likely to be immune for at least 6 months after being infected, whether they’ve developed antibodies or not.
- In new guidance published on Tuesday, the Swedish Public Health Agency said it’s now considered safe for individuals who’ve been infected to come into contact with people in high-risk groups.
- “We don’t see cases of people falling ill twice from C19,” state epidemiologist Anders Tegnell said during a press conference in Stockholm. “Hence, our assessment is that if you do get C19 you are immune, even if you don’t develop antibodies.”
- But the agency also said that people deemed to be immune can still act as carriers of the virus in society, and must therefore continue to observe social distancing and hygiene guidelines.
- The antibody response to C19 is being closely studied by scientists around the world for indications of how long-lasting immunity may be. While there’s little evidence to suggest reinfections are occurring, health experts have yet to pin down exactly how long immunity might last.
- A recent study from King’s College London showed that the level of antibodies may drop to a degree that makes them undetectable as soon as 3 months after infection. However, the body also mounts other forms of immunity responses, including from so-called T-cells, which appear to play an important role in protecting against reinfection with C19.
- Research from Sweden’s Karolinska Institutet has indicated that about twice as many people infected by C19 have developed a T-cell mediated immunity response as those who have a detectable level of antibodies.
- “The risk of being reinfected and of transmitting the disease to other people is probably very close to zero,” Tegnell said. “Therefore, we think that you can meet other people, even if they are in a high-risk group.”
- Tegnell said he expects a vaccine to be ready for distribution in Sweden “sometime during the first half of 2021,” barring setbacks in the development process.
- AstraZeneca Plc has signed an agreement to supply up to 400 million doses to European countries from the end of 2020. The company’s joint efforts with the University of Oxford to develop a vaccine showed promising results this week. But Tegnell said that “anything else would have been a disaster for AstraZeneca.”
- Tegnell remains a controversial figure for his decision to advise against imposing a proper lockdown in Sweden. The country currently has one of the highest death rates in the world, measured per 100,000, according to data compiled by Johns Hopkins University.
- But there are also signs that the contagion rate in Sweden is slowing, and Tegnell insists his strategy will ultimately be proven a success. That’s as he comes under attack from academics and scientists in his own country, who say he has mishandled the crisis.
What the CDC Says on Immunity
- The CDC currently recommends that people who have recovered from C19 should follow quarantine recommendations if they are identified as a contact of a new case when more than 3 months have passed since the onset of the disease.
- On Tuesday, Tegnell said Sweden “probably” has achieved a fairly high rate of immunity, which he predicts will protect his country from new outbreaks.
- “The upshot is that the epidemic is now slowing down very drastically, in a way that I think few of us would have thought a few weeks ago,” he said. “I am very happy about that. It makes it easier for health care services, and we have fewer fatalities.”
4. New coronavirus mutation causes outbreaks to spread more quickly
- A new coronavirus mutation has become the most dominant strain of the virus — and is causing outbreaks to spread more quickly across the world, an expert said.
- Professor Nick Loman, of the University of Birmingham, who is part of the C19 Genomics Consortium, told BBC Radio 4’s “Today” program that the mutation, known as D614G, is forming clusters more quickly in the UK than the original virus from Wuhan.
- “It exists in the spike protein, which is a very important way that the coronavirus can enter human cells, and we have been noticing in the UK and worldwide that this mutation has been increasing in frequency,” Loman said. “This mutation was predicted first by computer modeling to have some impact on the structure of that protein and the ability of the virus to bind and enter cells and then quite recently was shown in laboratory experiments to increase the infectivity of cells.”
- Scientists came to the conclusion after analyzing more than 40,000 genomes in the UK, according to Loman.
- The new mutation, however, is not believed to cause a greater risk of death or lengthier hospital stays, the Telegraph reported.
- Loman called the mutation “the most dominant mutation — it’s about 75 percent of cases.”
- “This increase in this mutation is a worldwide phenomenon,” he added. “The original virus out of Wuhan had the D-type, but the G-type has become much more dominant across the world, including the UK.”
- However, the strain is not expected to impact the process of finding a vaccine for C19, he added.
- He also attempted to alleviate any concerns that the mutation might signal a deadly new phase for the coronavirus.
- “It’s a small impact, we think, and we’re not completely confident about that, but we found by testing what happened in the UK that the viruses that contained the G-type of mutation seemed to form clusters of cases faster, which ended up being bigger than viruses with the D-mutation,” the professor said. “We didn’t see any significant association with survival and the length of hospital stays with this mutation — we don’t think this mutation is important in changing virulence. The effect seems to be on transmissibility.”
- Dr. Heidi J. Zapata, a Yale Medicine infectious disease specialist and immunologist, also said there’s not enough conclusive evidence to suggest the virus is becoming more infectious or deadly.
- “Currently, we do not have sufficient evidence to come to any conclusions about the virus becoming more malicious or benign,” Zapata told CNET. “We simply know that certain variants have become more prominent, such as the D614G strain. However, currently, our evidence about D614G shows that it is not causing different clinical outcomes in humans.”
5. People more likely to contract C19 at home
- South Korean epidemiologists have found that people were more likely to contract the new coronavirus from members of their own households than from contacts outside the home.
- A study published in the CDC on July 16 looked in detail at 5,706 “index patients” who had tested positive for the coronavirus and more than 59,000 people who came into contact with them.
- The findings showed that less than 2% of patients’ non-household contacts had caught the virus, while nearly 12% of patients’ household contacts had contracted the disease.
- By age group, the infection rate within the household was higher when the first confirmed cases were teenagers or people in their 60s and 70s.
- “This is probably because these age groups are more likely to be in close contact with family members as the group is in more need of protection or support,” Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention (KCDC) and one of the authors of the study, told a briefing.
- Children aged nine and under were least likely to be the index patient, said Dr. Choe Young-june, a Hallym University College of Medicine assistant professor who co-led the work, although he noted that the sample size of 29 was small compared to the 1,695 20-to-29-year-olds studied.
- Children with C19 were also more likely to be asymptomatic than adults, which made it harder to identify index cases within that group.
- “The difference in age group has no huge significance when it comes to contracting C19. Children could be less likely to transmit the virus, but our data is not enough to confirm this hypothesis,” said Choe.
- Data for the study was collected between Jan. 20 and March 27, when the new coronavirus was spreading exponentially and as daily infections in South Korea reached their peak.
D. Improved & Potential Treatments
1. Potent Neutralizing Antibodies Isolated From C19 Patients – Could Be Mass-Produced to Suppress Virus
- Researchers at Columbia University Irving Medical Center have isolated antibodies from several C19 patients that, to date, are among the most potent in neutralizing the coronavirus.
- These antibodies could be produced in large quantities by pharmaceutical companies to treat patients, especially early in the course of infection, and to prevent infection, particularly in the elderly.
- “We now have a collection of antibodies that’s more potent and diverse compared to other antibodies that have been found so far, and they are ready to be developed into treatments,” says David Ho, MD, scientific director of the Aaron Diamond AIDS Research Center and professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, who directed the work.
- The researchers have confirmed that their purified, strongly neutralizing antibodies provide significant protection from coronavirus infection in hamsters, and they are planning further studies in other animals and people.
- The findings were published on July 22, 2020 in the journal Nature.
Why look for neutralizing antibodies
- One of the human body’s major responses to an infection is to produce antibodies–proteins that bind to the invading pathogen to neutralize it and mark it for destruction by cells of the immune system.
- Though a number of drugs and vaccines in development for C19 are in clinical trials, they may not be ready for several months. In the interim, coronavirus neutralizing antibodies produced by C19 patients could be used to treat other patients or even prevent infection in people exposed to the virus. The development and approval of antibodies for use as a treatment usually takes less time than conventional drugs.
- This approach is similar to the use of convalescent serum from C19 patients, but potentially more effective. Convalescent serum contains a variety of antibodies, but because each patient has a different immune response, the antibody-rich plasma used to treat one patient may be vastly different from the plasma given to another, with varying concentrations and strengths of neutralizing antibodies.
Sicker patients produce more potent antibodies
- When coronavirus arrived and led to a pandemic at the beginning of the year, Ho rapidly shifted the focus of his HIV/AIDS laboratory to work on the new virus. “Most of my team members pretty much have been working nonstop 24/7 since early March,” says Ho.
- The researchers had easy access to blood samples from patients with moderate and severe disease who were treated at Columbia University Irving Medical Center in New York City, the epicenter of the pandemic earlier this year. “There was plenty of clinical material, and that allowed us to select the best cases from which to isolate these antibodies,” Ho says.
- Ho’s team found that although many patients infected with coronavirus produce significant quantities of antibodies, the quality of those antibodies varies. In the patients they studied, those with severe disease requiring mechanical ventilation produced the most potently neutralizing antibodies.
- “We think that the sicker patients saw more virus and for a longer period of time, which allowed their immune system to mount a more robust response,” Ho says. “This is similar to what we have learned from the HIV experience.”
- The majority of anti-coronavirus antibodies bind to the spike glycoprotein–a feature that gives the virus its corona–on the virus’s surface. Some of the most potent antibodies were directed to the receptor binding domain (where the virus attaches to human cells), but others were directed to the N-terminal region of the spike protein.
- The Columbia team found a more diverse variety of antibodies than previous efforts, including new, unique antibodies that were not reported earlier.
- “These findings show which sites on the viral spike are most vulnerable,” Ho says. “Using a cocktail of different antibodies that are directed to different sites in spike will help prevent the virus becoming resistant to the treatment.”
Implications for vaccines
- “We discovered that these powerful antibodies are not too difficult for the immune system to generate. This bodes well for vaccine development,” Ho says. “Vaccines that elicit strong neutralizing antibodies should provide robust protection against the virus.”
- Antibodies may also be useful even after a vaccine is available. For example, a vaccine may not work well in the elderly, in which case the antibodies could play a key role in protection.
Implications for immunity
- This research demonstrates that people with severe disease are more likely to have a durable antibody response, however more research needs to be done to answer the critical question about how long immunity to C19 will last.
- The researchers are now designing experiments to test the strategy in other animals, and eventually in humans.
- If the animal results hold true in humans, the pure, highly neutralizing antibodies could be given to patients with C19 to help them clear the virus.
- Although tremendously informative for researchers developing vaccines and antiviral therapies, the findings are early-stage preclinical results and the antibodies are not yet ready for use in people.
2. NIH to start ‘flurry’ of large studies of potential C19 treatments
- The National Institutes of Health is preparing to launch a “flurry” of large clinical trials to test new approaches to treating C19, according to the agency’s director, hoping to expand what for now remains a limited arsenal of therapies to help people with the disease.
- In an interview, NIH Director Francis Collins characterized the studies as “really well-powered, rigorously designed clinical trials.”
- Among the trials, he said: studies of antiviral monoclonal antibodies to treat C19 in both hospitalized patients and patients who can be treated at home; studies of drugs to quell overreaction of the immune system that the agency has picked from dozens of approved treatments; and studies of blood thinners in very sick C19 patients to prevent problems caused by blood clots. Those treatment studies will be on top of the work that the NIH is also doing on vaccines, including the C19 vaccine being developed by Moderna Therapeutics.
- Currently, only two drugs have been shown to be effective in patients with the disease. In clinical trials, Gilead’s remdesivir reduced the time it took patients to recover; dexamethasone, a steroid, prolonged survival in the sickest patients in a study conducted in the U.K.
- Collins, who has been at the NIH for 27 years before becoming director in 2009, said he has become “obsessed” with the agency’s efforts to test medicines as treatments for C19. He compared the tense and urgent effort to test C19 treatments and vaccines to his time running the Human Genome Project, when there was a heated competition to deliver results before a private-sector project. He said the current effort is far more important.
- “Nobody was going to die if we didn’t get the genome project done on a certain day,” Collins said.
- Roughly a hundred people across government, academia, and industry have been working to organize large, systematic trials as part of the NIH’s Accelerating C19 Therapeutic Interventions and Vaccines (ACTIV) effort. The goal of the public-private partnership is to develop a coordinated approach to prioritizing and speeding development of treatments and vaccines.
- Researchers have registered with the U.S. government to begin more than 1,200 C19 studies, according to a STAT analysis. But 38% were small — consisting of fewer than 100 patients. That disorganized effort is unlikely to deliver clear answers about what treatments work and what treatments don’t. Collins said that’s why ACTIV is important. “I think it has been just what was needed to keep us from going down a pathway of continued small studies and chaos about results,” Collins said.
- The new trials will be part of that effort. Regeneron Pharmaceuticals, which is developing an anti-C19 antibody cocktail and is participating in an NIH trial on using such antibodies for prevention, will not be included in the antibody treatment trial. But Collins said that other major drug makers would be included. The decision of whether to participate in the studies is entirely up to the manufacturers, and he said that he has no complaints when a company, such as Regeneron or, on vaccines, Pfizer, decides it can move faster on its own.
- Collins also warned that the science around both treatments and vaccines is complicated and unpredictable, and requires doing lots of different things with the knowledge that some will fail. But the only solution, he said, is to run many studies in parallel.
- Collins said the NIH has aimed not to duplicate efforts being undertaken elsewhere, which is why the U.S. studied remdesivir but not dexamethasone. However, the NIH, the U.K., and the World Health Organization all conducted their own randomized studies of hydroxychloroquine in hospitalized patients; all were negative.
- Regardless, Collins promised that the government is going to make sure that trials are conducted rigorously “so that you’re not wasting time, money, or people’s willingness to volunteer.” And he promised that despite the need for speed in vaccine development, there would be no cutting corners.
- “We will not put something out, and FDA won’t let us, that is not safe and effective. That’s the bottom line,” Collins said. “Even if we come up empty, I will not tolerate the idea that you put something out that’s actually harmful.”
- The NIH is also trying to fix another problem: the need for better, faster C19 tests, through a $1.5 billion effort called the Rapid Acceleration of Diagnostics or RADx initiative,which Collins and his colleagues described in an editorial in the New England Journal of Medicine on Wednesday.
- Current testing technology based on the polymerase chain reaction “doesn’t seem to work very well in terms of handling the demand when the demand starts going up higher and higher,” Collins said. RADx has settled on a “Shark Tank”-like format where small startups audition technologies to receive NIH support. Applications have come from 600 efforts, of which 27 have entered the shark tank stage; one is getting ready to begin efforts aimed at manufacturing scale up and clinical validation. Most of these efforts, Collins said, are point-of-care tests.
- The goal, he said, is to have an impact soon. Said Collins: “We’re not going to invest in any test that can’t be scaled up to sufficient numbers to have an impact in the coming months.”
E. New CDC Guidance
1. C19 Patients No Longer Need Tests to End Isolation
- Most Americans recovering from C19 can come out of isolation without further testing to show they no longer carry the coronavirus, federal health officials said on Wednesday.
- Instead, patients may be judged to have recovered if 10 days have passed since they first felt ill; they no longer have any symptoms, such as shortness of breath or diarrhea; and they have not had a fever for 24 hours without taking fever-reducing medicine.
- The new recommendations are not rules but guidelines intended for patients, doctors and health policymakers. The revisions should help relieve the burden on the country’s testing system, the CDC said.
- Previously, one way to get out of isolation was to have two negative diagnostic tests, also called PCR tests, for the virus taken 24 hours apart. But now there are testing delays of up to two weeks in parts of the country, and numerous studies show that mildly ill people are almost never infectious 10 days after symptoms begin.
- Public health experts generally agreed that the change was safe.
- “This is anchored in evidence,” said Dr. Wafaa El-Sadr, professor of epidemiology at the Mailman School of Public Health at Columbia University. “I think it makes sense.”
- Nursing homes and hospitals are likely to feel the biggest effects of the change, said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University’s medical school.
- For example, many nursing homes will not accept hospitalized elderly patients after they recover until they pass the two diagnostic tests. That has sometimes added weeks to these hospital stays for no medical reason, he said.
- Earlier isolation guidelines were more conservative. When the disease first broke out in China, all patients with the illness — even mild cases — were immediately moved away from their families for 14 days, and not released until they had two negative PCR tests.
- But the science has changed, and the situation in the United States is different. In this country, most people who are ill isolate themselves at home, even though that risks infecting their families.
- Many diagnostic tests remain positive even weeks after patients have fully recovered. Experts now believe those tests are reacting to dead viral fragments still being cleared by the body, not to a live virus that can infect anyone else.
- The guidelines also say that people who know they have recovered from a C19 infection do not need to retest or go into quarantine even if they are exposed to another infected person.
- The demand for tests is so high, and the delays so long, that it seemed pointless to require them anymore.
- People who are severely ill may take longer to become virus-free and may need to isolate themselves for up to 20 days, but they should seek a doctor’s advice, the new C.D.C. guidelines said.
- Those who test positive but never experience symptoms may leave isolation 10 days after their first positive test.
- The new isolation guidelines do not affect people who are asked to quarantine themselves for 14 days after arrival in a new state or a new country, or after exposure to a known case.
- That guideline is based on the virus’s maximum incubation period — the time from infection to first symptoms — not on the recovery time.
- But some experts speculated that the new change might eventually lead to a shortening of the quarantine period, too.
- Such a change might be made on scientific grounds. “But quarantine decisions for visitors from foreign countries might ultimately be made jointly with the U.S. State Department, and there might be other considerations,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
F. Concerns & Unknowns
1. Chronic conditions put nearly half of US adults at risk for severe C19
- About 47% of US adults have an underlying condition strongly tied to severe C19 illness, researchers at the CDC have found.
- The model-based study, published today in the CDC’s Morbidity and Mortality Weekly Report, used self-reported data from the 2018 Behavioral Risk Factor Surveillance System and the US Census.
- Researchers analyzed the data for the prevalence of chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic kidney disease (CKD), and obesity in residents of 3,142 counties in all 50 states and the District of Columbia. They defined obesity as having a body mass index (BMI) of 30 kg/m2 or higher.
- They found that prevalence patterns generally followed population distributions, with high numbers in large cities, but that these conditions were more prevalent in rural than in urban areas. Counties with the highest prevalence of these conditions were generally clustered in the Southeast and Appalachia.
- Severe C19 disease, requiring hospitalization, intensive care, and mechanical ventilation or leading to death, is most common in people of advanced age and in those who have at least one of the previously mentioned underlying conditions.
- A CDC analysis last month of US C19 patient surveillance data from Jan 22 to May 30 showed that those with underlying conditions were hospitalized six times more often, needed intensive care five times more often, and had a death rate 12 times higher than those without these conditions. But the authors of today’s reported noted that the earlier study defined obesity as a BMI of 40 kg/m2 or higher and included some conditions with mixed or limited evidence of a tie to poor coronavirus outcomes.
Prevalence of underlying conditions in rural, urban counties
- Median estimated county prevalence of any underlying illness was 47.2% (range, 22.0% to 66.2%). Numbers of people with any underlying condition ranged from 4,300 in rural counties to 301,744 in large cities.
- Prevalence of obesity was 35.4% (range, 15.2% to 49.9%), while it was 12.8% for diabetes (range, 6.1% to 25.6%), 8.9% for COPD (range, 3.5% to 19.9%), 8.6% for heart disease (range, 3.5% to 15.1%), and 3.4% for CKD, 3.4% (range, 1.8% to 6.2%).
- Nationwide, the overall weighted prevalence of adults with chronic underlying conditions was 30.9% for obesity, 11.4% for diabetes, 6.9% for COPD, 6.8% for heart disease, and 3.1% for CKD.
- The estimated median prevalence of any underlying condition generally increased with increasing county remoteness, ranging from 39.4% in large metropolitan counties to 48.8% in rural ones.
Resource allocation, preventive health measures
- The authors noted that access to healthcare resources in some rural counties may be poor, adding to the risk of severe C19 outcomes.
- “The findings can help local decision-makers identify areas at higher risk for severe C19 illness in their jurisdictions and guide resource allocation and implementation of community mitigation strategies,” they wrote.
- “These findings also emphasize the importance of prevention efforts to reduce the prevalence of these underlying medical conditions and their risk factors such as smoking, unhealthy diet, and lack of physical activity.”
- The researchers called for future studies to include the weighting of the contribution of each underlying illness according to the risk of serious C19 outcomes and identifying and integrating other factors leading to susceptibility to both infection and serious outcomes to better estimate the number of people at increased risk for C19 infection.
2. Doctors Shocked by Heart Damage in C19 Patients
- A series of autopsies conducted by LSU Health New Orleans pathologists shows the damage to the hearts of C19 patients is not the expected typical inflammation of the heart muscle associated with myocarditis, but rather a unique pattern of cell death in scattered individual heart muscle cells. They report the findings of a detailed study of hearts from 22 deaths confirmed due to C19 in a Research Letter published in Circulation.
- “We identified key gross and microscopic changes that challenge the notion that typical myocarditis is present in severe coronavirus infection,” says Richard Vander Heide, M.D., Ph.D., Professor and Director of Pathology Research at LSU Health New Orleans School of Medicine. “While the mechanism of cardiac injury in C19 is unknown, we propose several theories that bear further investigation that will lead to greater understanding and potential treatment interventions.”
- The team of LSU Health pathologists led by Dr. Vander Heide, an experienced cardiovascular pathologist, also found that unlike the first SARS coronavirus, coronavirus was not present in heart muscle cells. Nor were there occluding blood clots in the coronary arteries.
- Their previously reported results revealed diffuse alveolar damage (DAD) – damage to the small airspaces of the lung where gas exchange occurs – along with blood clots and bleeding in the small blood vessels and capillaries of the lung, were the major contributors to death.
- “These findings, along with severely enlarged right ventricles, may indicate extreme stress on the heart secondary to acute pulmonary disease,” adds Sharon Fox, MD, PhD, Associate Director of Research and Development in the Department of Pathology at LSU Health New Orleans School of Medicine.
- The autopsies, believed to be some of the first reported from the US, were conducted on 22 patients who died of C19 at University Medical Center in New Orleans. The majority were African American. The ten male and twelve female patients ranged in age from 44-79. Although there were other underlying conditions, the majority had high blood pressure, half had insulin-treated type 2 diabetes, and about 41% had obesity.
- The LSU Health New Orleans pathologists, as have others, also found viral infection of some of the cells in the lining of the smaller blood vessels (endothelium). Although at low levels, it may be enough to cause dysfunction leading to individual cell death. The effects of the so-called “cytokine storm” (severe overreaction of the immune system cells fighting the infection) associated with COVID may also play a role.
- “Given that inflammatory cells can pass through the heart without being present in the tissue proper, a role for cytokine-induced endothelial damage cannot be ruled out,” says Dr. Vander Heide.
F. The Road Back?
1. Science Tells Us That Masks Can Save Us From More Lockdowns
- The American conversation around masks and C19 has taken a dizzying turn. For months, wearing masks has been politicized as a sign of liberal leanings. But in recent days, ever more governors — many of them Republican — have moved to mandate masks. This week President Trump — arguably the nation’s most visible mask un-enthusiast — started referring to wearing them as “patriotic.”
- Now prominent scientists are proposing a radical — and hopeful — possibility: Even as coronavirus cases spiral upward across the United States to levels surpassing this spring’s surge, these experts argue that if Americans start wearing masks en masse, the U.S. may yet avoid a return to lockdown measures.
- “Look, we’ve never tried to use masks as our primary strategy when outbreaks are this bad,” says Ashish Jha, director of the Harvard Global Health Institute. “But I do believe that if we want to avoid a complete lockdown, we’ve got to at least give it a shot.”
- It’s worth stressing what a leap this idea represents from earlier discussions of masks as just one of many commonsense precautions that people could and should take.
- But when it comes to masks as all-but-panacea, what is the scientific evidence? Here’s a primer.
Modest — but widespread — protection adds up fast
- It seems obvious that masks would reduce the spread of a respiratory bug like the coronavirus to at least some degree. After all, when a healthy person wears a mask, the barrier filters out some airborne droplets containing the virus. Even more importantly, when a sick person wears a mask, the barrier holds in many of the viral droplets they exhale.
- But quantifying the magnitude of this effect on an entire population is more complicated. There are reams of studies using a range of methods to determine how much mask wearing curbs transmission. Many compare what has happened in places where most people have used masks with what has happened in settings where most have not.
- These include analyses from China, Germany and states within the United States.
- Ali Mokdad is on a research team that has tried to make sense of a large number of these studies. Mokdad and colleagues with the University of Washington’s Institute for Health Metrics and Evaluation did what’s called a meta-analysis.
- “You take every study that has been published on the protective effect of masks, and then you reanalyze all the data,” says Mokdad.
- Their bottom-line estimate: If 95% of people wear cloth masks when they’re out and about interacting with other people, it reduces transmission by at least 30%. In other words, each infected person will go on to infect 30% fewer people.
- Mokdad stresses that this is a conservative finding. It uses the lower bound within the range of estimates. And it assumes all the masks are cloth rather than surgical masks or N95 respirators, which are even more effective. “Widespread mask [use] could be even more powerful,” says Mokdad, because some portion of people would likely be using those more protective versions.
- Yet even with a 30% reduction in transmission, the cumulative impact on a community can be massive. To understand why, it helps to consider some math: The coronavirus spreads exponentially. For example, let’s say in a place where no one is wearing masks, each infected person is currently passing the virus to 1.03 others. This means 100 infected people will go on to infect 103 others, who in turn infect 106 others, who infect 109 and so on. The result is that in, say, seven five-day cycles of infection, a total of 889 people will have contracted the virus.
- But if you curb the transmission rate by 30%, this means that instead of infecting 1.03 others, each infected person passes the virus on to only 0.72 others. So now 100 infected people go on to infect only 72 people. These 72 go on to infect just 52 people in the next cycle. By the seventh cycle, only 10 new people are infected, and only a total of 332 people have contracted the virus altogether. Essentially, instead of exponential growth you’ve triggered what’s called exponential decay.
- To see how this would translate for the entire U.S. population, Mokdad’s team at IHME ran a simulation. Based on the pandemic’s current trajectory through the U.S., they forecast that by Nov. 1, nearly 80,000 more people will die from C19. But if Americans ramp up from their current level of mask use to 95% use, about 34,000 of those deaths could be avoided, says Mokdad.
An alternative to lockdowns
- It gets better. Mokdad’s team estimates that communities where the virus is now surging out of control could still avoid economy-killing lockdowns if they would massively increase mask use.
- Here’s how they figure this. Based on the U.S. experience this past spring, Mokdad’s team estimates there’s a point at which local or state health officials will feel they have no choice but to reimpose lockdowns, in spite of the economic and political consequences. That point, they estimate, is when the number of daily deaths tops eight per million people.
- Texas is one month from hitting this threshold, according to IHME’s current forecast. But if 95% of residents there started wearing masks right now, IHME forecasts that Texas would bend its curve enough to remain under the threshold and could avoid a lockdown.
- “There is a lot of hope here,” says Mokdad.
- Harvard’s Jha may seem an unlikely candidate to second that view. He helped build a rating tool for counties and states to determine when the coronavirus is spreading so widely that the only way to get a handle on it is to revert to stay-at-home mode. (His group’s tool is based on a different metric for out-of-control outbreaks: 25 new daily cases per 100,000.) And right now the tool is showing 11 states in that red zone and another 20 one notch below in the orange zone.
- And yet, Jha says, “If you look at the hottest of the hot spots in America — Arizona, Texas, Florida, South Carolina — can they avoid a full shelter in place? With masks, I think there may be a window.”
- As for those states with slightly lower but still relatively high levels of transmission, universal masking could make it possible to keep up a fairly robust range of activities. Drinking and eating at indoor bars and restaurants would be too dangerous, he says.
- But, says Jha, “I think if you’re wearing masks, you probably can get some number of people back into offices. You probably can’t go back to the original level of office occupancy. But you can start getting some people back in, especially if you can improve ventilation.” The same applies to nonessential retail businesses and even, he says, schools — especially middle and high school, where not just teachers but students could likely wear masks.
- “There is no single thing that gets us everything we want,” says Jha. “But universal masking is a really critical part of letting us get, like, 80% of our lives back.”
- At a news conference last week, Adm. Brett Giroir, assistant secretary for health at the Department of Health and Human Services, also endorsed that view. If the worst hot spots close indoor bars, limit indoor dining to 25% capacity and increase mask use to around 90%, “with these simple measures, our models say that’s really as good as shutting down,” said Giroir. “These simple [acts] can really shut down the outbreak without completely shutting down your local area.”
Can Americans get to near-universal mask use?
- Of course the operative word in universal-masking strategies is “universal.” Is it conceivable that so many Americans would adopt the practice?
- Mokdad notes that a number of places have achieved high levels — Singapore, South Korea, Taiwan, Japan.
- IHME’s analysis also suggests that even without mandates, across the U.S. once coronavirus cases start to rise, people start to ramp up mask wearing and social distancing of their own accord. (In fact, in Arizona, where officials have not mandated comprehensive stay-at-home orders despite daily death counts that have surpassed the eight-per-million threshold, IHME projects the infection curve will soon go down largely because of voluntary actions by residents.) When it comes to social distancing, there is evidence that once it is mandated, people tend to practice it to an even greater degree. So it’s possible that the recent move toward mandatory masking in many states will have that effect as well.
- Still, Mokdad notes that the U.S. has a long way to go to reach 95% masking. His best estimate is that nationwide about 40% of people are regularly wearing masks. And in some hot spots, the figure is closer to 20%.
But are masks alone really enough?
- Natalie Dean, a biostatistician at the University of Florida, says she’s wary of focusing too heavily on masks.
- For one thing, Dean is leery of the studies comparing outcomes in mask-wearing and non-mask-wearing settings. “I find those types of before-and-after studies a bit hard to interpret, just because usually there is a lot else going on at the same time,” she says.
- Indeed, it’s worth noting that while many countries in Asia with high mask use have managed to keep the virus controlled, two countries in South America where mask use was also high in some parts — Chile and Brazil — have seen raging outbreaks. Mokdad says one reason may be that those countries are in the Southern Hemisphere, so their outbreaks coincided with cold weather, which seems to correlate with higher transmission of the virus. But if true, that could diminish the benefit that mask wearing could have in the U.S. come autumn.
- Furthermore, says Dean, even if you could accurately tease out the effect of mask use, applying that information to simulations of how the outbreak might progress is fraught.
- “If we’ve seen anything with modeling, it’s that human behavior is so complicated that things change very quickly,” says Dean. “So our ability to predict the impact of any particular element is really tricky.”
- This isn’t to say that Dean doesn’t support widespread use of masks. She says she thinks they could be very useful. But, she says, the key is not to portray masks as a “silver bullet” solution rather than emphasizing all the other types of precautions that communities need to be following, including social distancing, hand hygiene, better testing, contact tracing and isolation of infectious people.
- The problem with the universal-masking strategy is “the idea that if we just did this one thing perfectly, that we would be fine,” says Dean. “I think the real solution is going to be doing a lot of things OK.”
2. Here’s one way to make daily C19 testing feasible on a mass scale
- It’s impossible to contain C19 without knowing who’s infected: until a safe and effective vaccine is widely available, stopping transmission is the name of the game. While testing capacity has increased, it’s nowhere near what’s needed to screen patients without symptoms, who account for nearly half of the virus’s transmission.
- Our research points to a compelling opportunity for data science to effectively multiply today’s testing capacity: if we combine machine learning with test pooling, large populations can be tested weekly or even daily, for as low as $3 to $5 per person per day.
- In other words, for the price per test of a cup of coffee, governments can safely reopen the economy and halt ongoing C19 transmission—all without building new labs and without new drugs or vaccines.
- Most people get tested for the coronavirus because they experienced symptoms, or came in close contact with someone who did. But as offices and schools come under pressure to reopen, organizations will need to grapple with an unpleasant truth: relying on symptoms to guide testing will miss asymptomatic and pre-symptomatic cases, and put everyone at risk.
- The current alternatives, though, are not appealing. Infrequent testing (monthly seems to be the default in many proposals) or haphazard screening allow active cases to spread the virus for weeks before it’s caught. And the price is still high at $100 to $200 or more per test.
- Pooled testing, guided by machine-learning algorithms, can fundamentally change this calculus. In pooled testing, many people’s samples are combined into one. If no virus is detected in the combined sample, that means no one in the pool is infected. The entire pool can be cleared with just one test.
- But there’s a catch: if anyone in the pool is infected, the test will be positive and more testing will be required to figure out who has the virus.
- So a key part of knowing how to pool is knowing the likelihood that certain people in the group will be positive, and separating them from the rest. How do we know that risk? That’s where machine learning comes in.
- The risk of infection is evolving rapidly in the United States—the relative odds in New York and Florida have reversed in a matter of weeks. Risk also differs significantly between people—compare a health-care worker with an employee working remotely. Estimating this risk for each person is a perfect job for machine learning.
- Using publicly available data from employers and schools, epidemiological data on local infection and testing rates, and more sophisticated data on travel patterns, social contacts, or sewage (pdf), if available, modelers can predict anyone’s risk of having C19 on a day-by-day basis. This allows highly flexible approaches to pooling that drive huge efficiency gains.
- Another advantage: pooled testing gets more efficient when disease prevalence is lower. If a population—say, all students at a university—is tested daily, the risk of infection is dramatically lowered for everyone in the group, simply because testers remove positives from tomorrow’s pool when they diagnose them today. That means tomorrow’s pool can be even larger, which reduces the number of tests needed and thus the cost of testing the population. And with more frequent testing, people who are infected but don’t have symptoms can stay home, further reducing spread and making pooled testing even more efficient.
- As a result, high-frequency pooled testing with machine learning costs far less than you might think. According to our analysis, testing daily costs only twice as much as testing monthly. And daily testing can actively suppress the virus, whereas monthly testing really only allows us to see how badly things have gone.
- This effect can be so powerful, in fact, that under some conditions—such as in meatpacking plants or nursing homes—increasing frequency can actually lower the number of tests needed, and thus the cost of testing a population, in a given time period. You read that right: testing more often can actually be less expensive for the health-care system.
- The last pillar of prevention through testing requires accounting for the virus’s spread between people and, therefore, for risk that is correlated. Using machine learning to model social networks has been a growing focus for researchers in computer science, economics, and other fields. Such algorithms, combined with data on jobs, classrooms, university dorms, and many other settings, allow machine-learning tools to estimate the potential that different people will interact. Knowing this likelihood can make group testing even more powerful.
- Is high-frequency pooled testing feasible in the real world? While we don’t want to minimize the logistical challenges, they are just that—challenges, not deal-breakers. The FDA has just approved the first use of pooled testing, and research increasingly shows that this technique is sensitive enough to detect positive cases. So as long as labs are willing, testers can start pooling today.
- Though some have called into question the feasibility of pooling given the scale of the current outbreak, this is only a challenge because we traditionally rely on coarse—and, as we show in our paper, potentially inaccurate—estimates of virus prevalence in large populations. Instead, machine learning can give us the precise individual-level estimates we need to make pooling work even at high prevalences, by identifying those likely to test positive and keeping them out of large pools.
- Frequency also pays huge dividends when virus prevalence is high. Before pooled testing is implemented—say, at a factory or school—the entire population could complete a one-time screening. Infected people would stay home until they recovered, and high-frequency pooled testing would keep prevalence low by catching disease early.
- The logistics of sample collection and pooling in different settings must also be addressed. We’re encouraged by the increasing evidence for products, some approved by the FDA, that allow people to collect and submit their own test samples. One is based on saliva, which means collection costs can be kept low even at large scale.
- It’s high time for high-frequency testing to become a core part of the US strategy to combat C19 and reopen the economy. Pooled testing that harnesses the power of machine learning makes paying the associated costs not only viable but, when weighed against the alternative of prolonged closures, a tremendous deal.
3. Public health group calls for standardized data collection to more clearly track C19
- In a new review of the C19 response across the country, a group of public health experts conclude that critical data the public needs to assess their risks and tailor their behaviors is often unavailable.
- The assessment, released Tuesday by the nongovernmental organization Resolve to Save Lives, calls on states and communities to start recording and sharing standardized data on 15 key metrics, so that people — and health departments — can get a clearer picture of how the response to the pandemic is working in their area.
- Tom Frieden, president and CEO of Resolve, which is an initiative of the global health organization Vital Strategies, said there is currently both a glut of data and a scarcity of information — a situation that needs to change if the country has any hope of gaining ground against the coronavirus.
- “People are just drowning in case counts and testing numbers, and they’re not seeing what’s really important,” Frieden told STAT in an interview in which he explained the thinking behind the plan.
- More important than the sheer number of C19 tests administered is the number of tests processed within 48 hours, said Frieden, a former director of the Centers for Disease Control and Prevention. Many test results — he estimated maybe as many as three-quarters of tests conducted — are processed days after the swabs were taken. That tells the tested person whether they were infected at the time of testing, but can’t be used as an indicator of their current Covid infection status.
- Other metrics that should be commonly collected and reported, the group said, include daily C19 hospitalization rates per capita in each community and state; the percentage of licensed hospital beds occupied by confirmed or suspected Covid patients; the percentage of new cases among quarantined people; and the percentage of new cases with a known epidemiological link to previously confirmed cases.
- Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, said the type of standardized data collection and reporting that Resolve is proposing is a key tool for combatting the spread of the virus.
- “I don’t know how you can judge where you’re at if you don’t have this kind of information,” he said. “I think the information’s not just timely for what’s happening today but it allows you then to plan for what you must do to bring those numbers down tomorrow.’’
- Frieden acknowledged some state officials may have at least some of the information, but it isn’t being posted because they are afraid to share it for fear of being blamed for the sorry state of the pandemic response. “A lot of these indicators, if we reported them, would be bad,” he said.
- But Frieden said the public has the right to know these key facts, many of which need to be broken down by age, sex, race, and ethnicity.
- “If — and I admit it’s an if — if we can get states to report this, then we’re going to be in much better shape. And in the absence of strong national leadership, at least being on the same page is … something that can help us get our response to a much better shape,” he said.
- “What gets measured can get managed. And what gets measured and reported publicly, can absolutely get better,” he said. “Right now, we’re not managing this response well at all.’’
- Asked why an NGO, not the CDC — which he led through the 2009 flu pandemic — is trying to rally states to collect standardized, useful data, Frieden sighed.
- “We are where we are.”
G. Back to School!?
1. Remote Learning? No Thanks. Get Ready for Microschools.
- The coronavirus is so widespread in the U.S. that many schools are unlikely to reopen anytime soon. Already, some large school districts — in Atlanta, Houston, Los Angeles, Phoenix, suburban Washington and elsewhere — have indicated they will start the school year entirely with remote classes. Yet many parents and children are despondent about enduring online-only learning for the foreseeable future.
- So it makes sense that the topic of home schooling is suddenly hot.
- Parents who never before considered home schooling have begun looking into it — especially in combination with a small number of other families, to share the teaching load and let their children interact with others. Some are trying to hire private tutors.
- One example is a popular new Facebook group called Pandemic Pods and Microschools, created by Lian Chang, a mother in San Francisco.
- Emily Oster, a Brown University economist who writes about parenting, has predicted that clusters of home-schooling families are “going to happen everywhere.”
- Of course, many middle-class and poor families cannot afford to hire private tutors, as my colleague Eliza Shapiro pointed out. But there is nonetheless the potential for a home-schooling boom that is more than just a niche trend among the wealthy.
- Consider that the population of home-schoolers — before the pandemic — was less affluent than average:
|Income||% of Families with Kids||Homeschoolers|
|$50,000 to $75,000||16.1%||25.7%|
|$75,000 to $100,000||13.3%||15.9%|
|More than $100,000||33.8%||18.9%|
- Eliza told me that she thought many families, across income groups, were likely to consider pooling child-care responsibilities in the fall. Children would remain enrolled in their school and would come together to take online classes in the same house (or, more safely, backyard). In some cases, these co-ops might morph into lessons that parents would help lead.
- As for high-income families, they may end up having a broader effect if a significant number pull their children out of school and opt for home schooling. “We could see a drain on enrollment — and therefore resources — into public schools,” Eliza said.
- As Wesley Yang, a writer for Tablet magazine, asked somewhat apocalyptically, “Did public schools in major cities just deal themselves a deathblow?” And L’Heureux Lewis-McCoy, a professor at New York University, recently told the science journalist Melinda Wenner Moyer that any increased privatization of education was likely to “widen the gaps between kids.”
- It’s too early to know whether home schooling is more of a real trend or a social-media fad. But the U.S. is facing a dire situation with schools: Remote learning went badly in the spring. The virus continues to spread more rapidly than in any country that has reopened schools. And, as Sarah Darville points out in an article for the upcoming Sunday Review section, the federal government has done little to help schools.
- No wonder parents are starting to think about alternatives.
- How can school districts respond? Jay Mathews, a Washington Post education writer, has a suggestion: Superintendents should abandon trying to devise a single solution for an entire school system.
- “Let principals and teachers decide,” Mathews writes. “They know their students better than anyone except parents, who would just as soon get back to work.” His column includes specific ideas he has heard from teachers.
Source: New York Times Coronavirus Updates
2. Which Colleges Will Survive
By Scott Galloway
- Our fumbling, incompetent response to the pandemic continues. In six weeks, a key component of our society is in line to become the next vector of contagion: higher education. Right now, half of colleges and universities plan to offer in-person classes, something resembling a normal college experience, this fall. This cannot happen. In-person classes should be minimal, ideally none.
- The economic circumstances for many of these schools are dire, and administrators will need imagination — and taxpayer dollars — to avoid burning the village to save it. Per current plans, hundreds of colleges will perish.
- There is a dangerous conflation of the discussion about K-12 and university reopenings. The two are starkly different. There are strong reasons to reopen K-12, and there are stronger reasons to keep universities shuttered. University leadership needs to evolve from denial (“It’s business as usual”) and past bargaining (“We’ll have a hybrid model with some classes in person”) to citizenship (“We are the warriors against this virus, not its enablers”).
- Think about this. Next month, as currently envisioned, 2,800-plus cruise ships retrofitted with whiteboards and a younger cohort will set sail in the midst of a raging pandemic. The density and socialization on these cruise ships could render college towns across America the next virus hot spots.
- Why are administrators putting the lives of faculty, staff, students, and our broader populace at risk?
- The ugly truth is many college presidents believe they have no choice. College is an expensive operation with a relatively inflexible cost structure. Tenure and union contracts render the largest cost (faculty and administrator salaries) near-immovable objects. The average salary of a full professor (before benefits and admin support costs) is $104,820, though some make much more, and roughly 50% of full-time faculty have tenure. While some universities enjoy revenue streams from technology transfer, hospitals, returns on multibillion-dollar endowments, and public funding, the bulk of colleges have become tuition dependent. If students don’t return in the fall, many colleges will have to take drastic action that could have serious long-term impacts on their ability to fulfill their missions.
- That gruesome calculus has resulted in a tsunami of denial.
- Universities owning up to the truth have one thing in common: They can afford to. Harvard, Yale, and the Cal State system have announced they will hold most or all classes online. The elite schools’ endowments and waiting lists make them largely bulletproof and more resilient to economic shock than most countries — Harvard’s endowment is greater than the GDP of Latvia. At the other end of the prestige pole, Cal State’s reasonable $6,000 annual tuition and 85% off-campus population mean the value proposition and underlying economic model remain largely intact even if schooling moves online.
Who Thrives, Survives, Struggles, or Perishes?
- Over the past month, we assembled a worksheet that looks at the immunities and comorbidities of 436 universities included in U.S. News & World Report’s Best Colleges rankings. This dataset compiles numbers from the Integrated Postsecondary Education Data System (IPEDS) maintained by the U.S. Department of Education, U.S. News & World Report, Google Keyword Planner, Niche.com’s Student Life Grades, and the Center on Education and the Workforce. This dataset should not be taken as peer-reviewed or final. It’s a working document that seeks to analyze and understand the U.S. college and university landscape and to help universities craft solutions.
- We plotted each university across two axes (four quadrants):
- Value: (Credential × Experience × Education) ÷ Tuition.
- Vulnerability: Endowment ÷ Students and Percentage of International Students. Low endowment and dependence on full-tuition international students make a university vulnerable to Covid-19 shock, as they may decide to sit out this semester or year. Consumers generally don’t like to pay the rack rate at a hotel whose general manager harasses them and is a bigot. But I digress.
- Thrive: The elite schools and those that offer strong value have an opportunity to emerge stronger as they consolidate the market, double down on exclusivity, and/or embrace big and small tech to increase the value via a decrease in cost per student.
- Survive: Schools that will see demand destruction and lower revenue but will be fine, as they have the brand equity, credential-to-cost ratio, and/or endowments to weather the storm.
- Struggle: Tier 2 schools with one or more comorbidities, such as high admit rates (anemic waiting lists), high tuition, or scant endowments.
- Perish: Sodium pentathol cocktail of high admit rates, high tuition, low endowments, dependence on international students, and weak brand equity.
- The worksheet is here. Our aim is to catalyze a conversation about how universities can adjust their value proposition.
Phase 3 Spread
- The United States has 4% of the world’s population and 25% of the world’s C19 infections and deaths. Phase 1 of the spread was enabled by a mix of arrogance and incompetence. It appears the virus did not get the memo about our exceptionalism and is indifferent to our optimism. The venues for spread were cruise ships and nursing homes. Phase 2 found governors infected with the same arrogance, enabling a younger generation of superspreaders. Again, the virus appeared rude and unwilling to read the room and recognize our desire to return to normalcy. A Phase 3 wave appears to be forming, due to a mix of economic pressure and lack of imagination on the part of academic leadership.
- “These plans are so unrealistically optimistic that they border on delusional and could lead to outbreaks of C19 among students, faculty, and staff,” says Laurence Steinberg, PhD, a psychology professor at Temple University.
- Small college towns across the country are being set up for disaster. Distancing, plexiglass, quaranteams, reconfigured dorms, A/B class shifts—all efforts taken in good faith, doubtlessly endorsed by medical advisers. But on-campus measures will only be effective with adherence to off-campus measures. It’s delusional to think students will keep six feet apart.
- The bucolic, culturally rich college towns across the United States may pay a steep price. Many are not prepared for a surge of infections. Some have permanent populations with high numbers of retirees attracted by the cultural benefits of a nearby college. Other at-risk cohorts include cafeteria workers, maintenance crews, security guards, librarians, bartenders, cab drivers, their spouses and family members, and anyone else unfortunate enough to have made the once perfectly reasonable decision to live in a college town. And if/when there is an outbreak, the health care infrastructure of these university towns could be overrun in a matter of weeks, if not days.
What Needs to Happen
- University leadership across the United States should immediately announce that fall classes will be all online, no in-person classes. It will be economically devastating for the weakest. State governments desperate for cuts in the face of shrinking tax revenues will need help from the federal government: If we can give Kanye $5 million, we can help save Purdue. The fed just expanded the Main Street Lending Program to nonprofits, including universities. Alumni who have parlayed their education into fortunes should step up and make sure the next generation can follow.
- But assistance will only go so far. Schools will have to undertake what firms ranging from Nike and Condé Nast to Wells Fargo and Walgreens have done: cut costs and prices. Most important, colleges should not waste this crisis and should demand their organization become facile with big and small tech to dramatically increase enrollments while lowering costs.
- College-town elected officials and their universities should regulate the incursion of superspreaders and ask most/all to take their online classes from home. Living on campus and taking classes online, as Harvard is doing, is dangerous but possibly worthwhile, especially for vulnerable populations like international students, who were threatened with deportation. Creative solutions can be found. Explore all options instead of being in denial. Denial is more expensive than facing reality.
- University leadership and faculty aim to help young people find their greatness. Part of that charge is to instill grit, perspective, a sense of curiosity and innovation, citizenship, and a comity of man. We should lead by example.
H. Johns Hopkins COVID-19 Update
July 22, 2020
1. Cases & Trends
- The WHO COVID-19 Situation Report for July 21 reports 14.56 million cases (213,637 new) and 607,781 deaths (4,083 new). The pandemic has been ongoing for more than 6 months and continues to accelerate.
- At least 9 countries are reporting test positivity greater than 20%, considerably higher than the WHO recommendation of 5% to support easing social distancing measures. Of these countries, 6 are located in the Americas: Argentina, Bolivia, Colombia, Costa Rica, Mexico, and Panama. The top tier also includes Bangladesh, Oman, and South Africa. Notably, all of these countries are reporting increasing test positivity as well, which indicates that transmission is outpacing national testing capacity. Other notable countries include India at 10.3% (more than tripled since May 3) and the US at 8.5% (up nearly 90% since June 16). Test positivity data are unavailable for many countries, so it is likely that additional countries around the world are facing similar challenges. While these figures are concerning, a number of countries are reporting low test positivity, including Australia, Malaysia, New Zealand, South Korea, and most countries in Europe.
South & Central America
- Brazil reported 41,008 new cases and remains #3 globally in terms of daily incidence*. The daily incidence is slightly lower than the same day during the previous several weeks, providing further evidence that Brazil has passed a peak or reached a plateau. Colombia reported 7,033 new cases, its fourth highest daily incidence to date, and its epidemic continues to accelerate. Colombia is currently #5 globally with respect to daily incidence, and Mexico (6,859 new cases) is #6. Broadly, the Central and South American regions are still major C19 hotspots. Including Brazil, Colombia, and Mexico, the region represents 5 of the top 10 countries globally in terms of daily incidence, along with Peru (#8) and Argentina (#9). Additionally, the region includes 7 of the top 16 countries in terms of per capita daily incidence: the US (#4), Brazil (#7), Colombia (#10), Bolivia (#13), Peru (#14), Chile (#15), and the Dominican Republic (#16).
India & Bangladesh
- India reported 37,724 new cases and remains #2 globally in terms of daily incidence*. India’s daily incidence has more than doubled since the beginning of July and appears to be increasing rapidly. Bangladesh continues to report slowly decreasing daily incidence; however, it is also reporting decreased testing while its test positivity remains slightly above 20%. This could indicate that Bangladesh’s decreased incidence could be driven more by reduced testing than slowing transmission. Bangladesh is #10 globally in terms of daily incidence.
- South Africa reported 13,449 new cases, and it remains among the top countries globally in terms of both per capita (#5) and total daily incidence (#4).
Eastern Mediterranean Region
- The Eastern Mediterranean Region remains a global C19 hotspot, particularly with respect to per capita daily incidence. The region represents 4 of the top 12 countries globally—Oman (#1), Bahrain (#2), Qatar (#11), and Kuwait (#12). . Nearby Israel (#6) and Armenia (#8), both in the WHO’s European region, are among the top countries globally as well. The Eastern Mediterranean also includes several of the top countries in terms of total daily incidence—including Saudi Arabia (#11), Iran (#12), Iraq (#13), and Pakistan (#15)—as well as nearby Israel (#16).
- The US CDC reported 3.82 million total cases (57,777 new) and 140,630 deaths (473 new). In total, more than half of US states and New York City reported more than 40,000 total cases, including California with more than 375,000 cases; Florida with more than 350,000; Texas with more than 325,000; New York City with more than 200,000; and 8 additional states with more than 100,000. The US is #4 globally in terms of per capita daily incidence.
- Daily C19 incidence at the national level in the US may be approaching a peak or plateau. The 7-day average daily incidence appears to have passed an inflection point, and the increasing trend is beginning to taper off. The record high daily total of 74,710 reported last week was a substantial increase over the previous week’s high (66,281 new cases reported on July 11), so the late-week reporting this week will provide important insight into the future trajectory of the US epidemic. C19 mortality in the US continues to increase slowly as well. The average mortality is currently 800 deaths per day, up from 581 deaths per day on July 8.
- At the state level, several hard-hit states appear to be peaking or plateauing as well. Arizona, California, Florida, and Texas are all exhibiting relatively steady or decreasing daily incidence over the past week or so; however, Arizona, Florida, and Texas continue to report record mortality (and continuing to increase). Florida and Texas are both now averaging more than 100 deaths per day, and Arizona is reporting more than 80 deaths per day. Notably, Arizona is reporting more than 1.1 daily deaths per 100,000 population, which is more than double the current rate in Florida and Texas. Additionally, Florida is still reporting more new cases per capita than New York did at its first peak in April. Arizona’s peak value exceeded New York’s as well, but it has since fallen back below that level. A number of other states continue to exhibit increasing incidence, including Alabama, Georgia, Louisiana, Maryland, Tennessee, Virginia, and Washington.
- Our team feels that any increased transmission resulting from Independence Day celebrations should be just starting to become evident in disease surveillance and reporting. In addition, a number of states have strengthened or re-imposed certain social distancing restrictions over the past several weeks. There are a number of complex factors impacting SARS-CoV-2 transmission across the US.
- The Johns Hopkins CSSE dashboard reported 3.92 million US cases and 142,350 deaths as of 12:30 pm on July 22.
2. Mandatory Mask Use
- Mask mandates are becoming increasingly common across the US. Available evidence continues to support mask use as an effective mechanism for reducing transmission risk, and many elected officials continue to recommend mask use, even if they are not mandating it. Masks use is now mandatory in more than half of US states; however, the exact details vary by state. Generally, mask orders require individuals to wear masks in public spaces where it is not feasible to maintain social distancing, particularly indoors, but they may not require mask use at all times when in public. Governors in several other states, including Georgia and Florida, have resisted state-level mandates, instead electing to encourage the public to participate. Notably, Georgia Governor Brian Kemp filed a lawsuit against Atlanta’s Mayor and City Council over the city’s local mask mandate, arguing that the governor’s executive order prohibits local governments from taking actions more restrictive than the state’s requirements. Some health experts, elected officials, and labor union leadership have called for a national mask order, but US President Donald Trump and Surgeon General Jerome Adams have opposed this approach—although, Surgeon General Adams did plead with viewers to wear masks during a recent interview. President Trump did, however, recently encourage the use of face masks as “patriotic,” in contrast to his past opposition to and/or mixed messaging regarding mask use as a means of controlling the C19 epidemic.
- In the absence of a national mandate—and in some cases, statewide mandate—a number of retail and other businesses are implementing their own mask requirements. A number of the country’s largest retail chains—including Walmart, Target, CVS, Walgreens, and Kroger—will require mask use in all of their stores nationwide, regardless of whether the state or city has a policy in place or not. Additionally, several major hotel chains are requiring masks to be worn in public spaces within their hotels, such as the lobby. A week after reopening its Florida theme parks, Disney issued an update to its mask mandate that prohibits visitors from eating and drinking while walking around the park in order to improve compliance with the requirement. But not all businesses are taking this approach. Family Dollar and Dollar Tree, for example, have reportedly lifted their mandatory mask policies in favor of requesting mask use in states and cities without mask mandates. Analysis by Goldman Sachs estimates that a national mandate could increase mask use by 15% and reduce the need for more restrictive social distancing measures, potentially mitigating US$1 trillion in economic losses associated with those restrictions.
- Internationally, France and England both recently implemented nationwide mask mandates, largely similar to many state and local mandates in the US. France requires mask use on public transit and in public when appropriate physical distancing cannot be maintained. Violations in France could reportedly be met with a €135 fine. In the UK, masks requirements vary, to some degree, by country. In England, masks will be required in shops, but the mandate will reportedly only apply to patrons, not employees. Violations could result in fines of up to £100. Scotland maintains a similar policy regarding mask use in shops, but fines are limited to £60. Masks are also required while using public transit.
3. EU Economic Stimulus Package
- The EU reached an agreement on a new stimulus package to address economic shortcomings driven by the C19 pandemic. European leaders held a 5-day summit in Brussels to discuss pathways forward to bolster the bloc’s economy and mitigate the financial impact of C19. The stimulus package includes €390 billion for grants, focusing largely on countries hit the hardest by C19, most notably Italy and Spain, as well as €360 billion in low-interest loans available to all EU countries. Certain technical aspects of the deal are still being worked out, and the European parliament must still approve the final plan.
4. US Schools
- States and school systems in the US continue to develop and debate plans to send students back to school for in-person learning for the start of the 2020-21 school year, which typically begins in late August or early September in most states. The Florida Education Association, a labor union representing Florida educators, filed a lawsuit against Florida Governor Ron DeSantis following his push for a return to in-person schooling starting at the end of August. The lawsuit claims that the current C19 epidemiological situation in Florida makes it unsafe for teachers and students to return to schools and calls for substantive action to provide PPE for schools and resources to develop online curricula. Similarly, “a group of students, parents, teachers, and a bus driver” in Detroit, Michigan, filed a lawsuit with the aim of closing summer school programs as C19 incidence increases. In Harris County, Texas, one of the largest counties in the US, the County Judge and health department announced that the start of in-person classes and other school-related activities, including sports and clubs, for kindergarten through 12th grade will be delayed until at least October due to “severe and uncontrolled disease transmission in [the] community,” with more than 35,000 active cases in the county.
5. Reporting C19 Deaths in Italy
- Due to a variety of limitations, including testing capacity and strategy, reported C19 deaths may underestimate the pandemic’s true mortality. Researchers in Italy conducted a study to compare the number of reported deaths to the total number of excess deaths as a way to better characterize the true impact of C19. In Italy, reported C19 deaths account for deaths in individuals with positive SARS-CoV-2 tests, either in hospitals or a limited number of nursing homes, but individuals who died from presumed C19 in their homes or in nursing homes without testing capacity are not counted in the national total. The researchers compared the number of deaths from all causes in January-March 2020—across 1,869 cities, representing 21.4% of the total population—to the average number of deaths over the same 3-month period in 2015-19 to determine the total increased mortality during Italy’s C19 epidemic.
- The researchers identified a 104.5% increase in the number of deaths reported March 1-April 4, 2020, compared to 2015-2019, which corresponds to more than 21,000 deaths above the historical average during that period. Nearly half of all of the deaths reported March 1-April 4, 2020, (19,824) were in the Lombardy region, the area in Northern Italy hit hardest by C19, corresponding to an increase of 173.5% compared to 2019. For comparison, Italy reported 27,682 total C19 deaths nationwide through the end of April, not much more than the excess deaths identified in this limited population over only a 1-month period. This study does not directly compare the excess deaths to the reported C19 deaths over the period of study, and it included only municipalities that reported a 20% increase in deaths between March 1 and April 4. While it is not possible to attribute the cause of all of these excess deaths to C19, this study provides further evidence that reported C19 deaths are likely underestimating the burden of the pandemic, whether due to the disease itself or downstream effects on health systems and society.
6. US Government Vaccine Deal with Pfizer
- The US government has finalized an agreement with Pfizer and BioNTech to acquire 100 million doses of their candidate SARS-CoV-2 vaccines, worth US$1.95 billion. Additionally, the US government could purchase an additional 500 million doses under the agreement. Pfizer and BioNTech currently have several candidate vaccines in the development pipeline, including various stages of clinical trials. According to a press release issued by Pfizer, the companies aim to begin Phase 2b/3 clinical trials later this month with the goal of securing US FDA authorization for at least one vaccine by October and delivering the vaccine doses by the end of 2020. The companies also hope to expand production to a total of 1.3 billion doses by the end of 2021. The agreement was signed as part of Operation Warp Speed, which has resulted in similar agreements—to support research and development, scale up manufacturing capacity, and purchase vaccine doses—with other pharmaceutical companies pursuing their own candidate vaccines.
7. Airborne Transmission
- While we continue to learn more about the SARS-CoV-2 virus, many uncertainties remain, particularly with respect to modes of transmission. As we previously covered, emerging evidence supports the possibility of airborne/aerosol transmission of the virus, and a number of health experts recently called on the WHO to update its transmission and infection control guidance to place greater emphasis on airborne transmission risk. The WHO did issue updated guidance on SARS-CoV-2 transmission, which noted the possibility of airborne transmission. However, the document continues to emphasize that droplet transmission is believed to be the principal driver of the pandemic.
- A recent study published (preprint) by researchers at several US health and academic institutions provides additional evidence supporting the possibility of airborne transmission. The researchers collected aerosol samples from 6 C19 patient treatment areas to determine the presence of SARS-CoV-2 in the airborne environment. The specimens were analyzed to identify the presence of infectious virus in various particle sizes—greater than 4.1 µm, 1-4 µm, and less than 1 µm—via “real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), cell culture, western blot, and transmission electron microscopy (TEM).” The study identified viral RNA in all 6 patient rooms and in all 3 particle sizes. Additionally, the researchers were able to culture viable virus from multiple aerosol samples in the “less than 1 µm” category. While this study demonstrates that viable virus can be present in aerosol form, additional research is necessary to determine the role it plays in transmission. In particular, questions remain regarding the infectious dose for SARS-CoV-2, especially with respect to the amount of virus present in aerosols, and how long the virus can remain viable in aerosol form.