Coronavirus Update 7-26

Nature study identifies 21 existing drugs that could treat C19 Multiple drugs improve the activity of remdesivir, a current standard-of-care treatment for C19.

C19 Replicating RNA Vaccine Has Robust Response in Both Young and Old Animal Models A single dose induced antibodies in nonhuman primates. The vaccine’s design has advantages of safety, cost, scalability, and storage.

In cell studies, seaweed extract outperforms remdesivir in blocking C19 virus In a test of antiviral effectiveness against the virus that causes C19, an extract from edible seaweeds substantially outperformed remdesivir, the current standard antiviral used to combat the disease.

Health, well-being and food security of families deteriorating under C19 stress The ongoing disruptive changes from efforts to reduce the spread of C19 are having a substantial negative impact on the physical and mental well-being of parents and their children across the country, according to a new national survey published today in Pediatrics.

Malaria Drug Chloroquine Does Not Inhibit C19 Infection in Human Lung Cells The malaria drug chloroquine, which has been demonstrated to inhibit the coronavirus infection of African green monkey kidney cells, is not able to prevent infection of human lung cells with the novel coronavirus. Chloroquine is therefore unlikely to prevent the spread of the virus in the lung and should not be used for the treatment of C19.

Neuroscience Could Be the Key to Getting People to Wear Masks Some neuroscientists believe that lessons from their field, applied appropriately, could help break the impasse and persuade more people to follow scientists’ recommendations.

A. Numbers & Trends

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

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

1. Cases & Tests (7/25)

Worldwide Cases:

Total Cases = 16,190,310 (+1.6%)
New Cases = 258,896 (-30,101) (-10.4%)
New Cases (7 day average) = 253,247 (+4,553) (+1.8%)

Observations:

Number of new cases was a record high (288,997) on 7/24
1,000,000+ new cases every 4 days
7 day average of new cases was a record high on 7/25

US Cases & Testing:

Total Cases = 4,315,709 (+1.6%)
New Cases = 67,413 (-10,565) (-13.6%)
Percentage of New Global Cases = 26.0%
New Cases (7 day average) = 68,920 (+594) (+0.9%)
Total Number of Tests = 53,352,250
Percentage of positive tests (7 day average) = 8.3%

Observations:

Number of new cases was a record high (77,978) on 7/24
7 day average of new cases has been basically stable (flat) since 7/19, indicating that the growth in the 7 day average of new cases since 6/9 may have peaked

2. Deaths

Worldwide Deaths:

Total Deaths = 647,602 (0.9%)
New Deaths = 5,717 (-482) (-7.8%)
New Deaths (7 day average) = 5,659 (+164) (+3.0%)

Observations:

Number of new deaths have decreased 4 consecutive days
Number of new deaths has declined 1,404 over last 4 days
7 day average of new deaths have increased from 4,146 on 5/26 to 5,659 on 7/25, an increase of 36.5%

US Deaths:

Total Deaths = 149,398 (+0.6%)
New Deaths = 908 (-233)
Percentage of Global New Deaths = 15.9%
New Deaths (7 day average) = 931 (+13) (+1.4%)

Observations:

Number of new deaths has declined for 4 consecutive days
7 day average of new deaths have increased from 516 on 7/5 to 931 on 7/25, an increase of 80.4%
Highest 7 day average of new deaths since 6/5

3. Top 5 States in Cases, Deaths, Hospitalizations, and Positivity (7/25)

Source: Worldometer and The Covid Tracking Project

4. Hotspot States — Are they cooling off?

Florida

Since peaking at 15,300 new cases on July 12, the number of new cases has been declining. Over the past week ending July 24, the average number of new cases has declined 9.6%, falling to 10,724 new daily cases compared to 11,865 cases the week before.
The percentage of tests that were positive has leveled-off. The positivity rate (over a 7-day average) reached its highest level of 19.9% on July 11. Since then, the rate has declined but it remains elevated at 19.1%.
As expected, the average number of daily deaths has risen with the number of new cases. Over the last week ending July 24, the average number of daily deaths has increased 20.8%, rising to 122 deaths per day compared to 101 deaths the week before.
Florida began reporting C19 hospitalizations on July 10. Since then, the number of patients in the hospital increased 32% to 9,200 patients on July 24. However, this number is down 4% from a high of 9,520 patients on July 21.
While the number of deaths (a lagging indicator) is increasing, the number of new cases, the positivity rate and the number hospitalizations have all decreased over the last week.
One additional factor to consider is the slowdown in testing. Testing backlogs of more than 7 days are being reported by the testing labs. The decline in new cases and leveling-off of positivity could be a function of this slowdown. The number of hospitalizations is a better indicator of the current trend. This is an important number to watch over the next week.

Texas

Texas hit a peak of 14,916 new cases on July 17. While the overall trend looks flat over the last week, the number of new cases is now declining. Over the past week ending July 24, the average number of new cases has declined 3.4%, falling to 8,893 new daily cases compared to 9,210 cases the week before.
The percentage of tests that were positive is clearly trending lower. The positivity rate (over a 7-day average) reached its highest level of 18.8% on July 12 and has declined 26.6% to 13.8% on July 24.
The average number of daily deaths continues to increase. Over the last week ending July 24, the average number of daily deaths has increased 60.9%, rising to 140 deaths per day compared to 87 deaths the week before.
The number of C19 has leveled off relative to the number of new cases. Since passing 10,000 C19 patients in the hospital on July 10, there are currently 10,893 C19 patients. While this is an increase, the growth rate over this period was on July 24. However, this number is down 4% from a high of 9,520 patients on July 21.
While the number of deaths (a lagging indicator) is increasing, the number of new cases, the positivity rate and the number hospitalizations have all decreased over the last week.
One additional factor to consider is the slowdown in testing. Testing backlogs of more than 7 days are being reported by the testing labs. The decline in new cases and leveling-off of positivity could be a function of this slowdown. The number of hospitalizations is a better indicator of the current trend. This is an important number to watch over the next week.

California

California cases began rising during the 2nd and 3rd week of June, and have been steadily rising since. It hit a high of 12,807 new cases on July 22 followed by 12,040 on July 23.
While the average positivity rate has been increasing since June 23, California’s positivity rate has remained below 10% during the 2nd wave. This is in sharp contrast to FL, TX and AZ which have all had positivity rates greater than the high teens. California’s average positivity rate reached a peak of 8.4% on July 12 followed by a decline. Since July 18, the rate has increased back to 8.0%.
Between June 1 to July 8, daily deaths averaged 62. Since July 8, average deaths have increased to 102 per day. Hospitalizations have increased but at a more controlled rate. Current hospitalizations as of July 24 were 8,820, an increase of 4.4% over the week before. As can be seen in the chart below, California’s daily death and hospitalization charts do not show the rapid increases as seen in FL, TX and AZ.
Overall, the situation in California bears a close watch. Gov Newsom implemented a second shut down of bars and restaurants on July 13, so it will be worth watching whether or not the trends improve.

Arizona

Arizona hit a peak of 4,877 new cases on July 1, and the average number of new cases leveled-off between July 1 and July 14. The number of new cases has declined since. Since 24, the average number of new cases declined 22.7% to 2,540.
The percentage of tests that were positive is clearly trending lower. The positivity rate (over a 7-day average) reached its highest level of 18.8% on July 12 and has declined 26.6% to 13.8% on July 24.
The average number of daily deaths continues to increase. Over the last week ending July 24, the average number of daily deaths has increased 60.9%, rising to 140 deaths per day compared to 87 deaths the week before.
The number of C19 hospitalizations has leveled off relative to the number of new cases. Since passing 10,000 C19 patients in the hospital on July 10, there are currently 10,893 C19 patients. While this is an 8.6% increase, the daily growth rate over this period was only 0.6%.
Arizona, which has been in the national spotlight for the last month, is clearly showing signs of cooling off. New cases peaked more than two weeks ago and the number of hospitalizations has been trending lower for the last week. The growth rate in new deaths has slowed down as well. The only trend that is of concern is the recent uptick in positivity. After trending lower since July 10, the average rate began increasing again on July 18. This contrast to the number of new cases is worth watching during the coming week.

Source: Worldometer and The Covid Tracking Project

B. New Scientific Findings & Research

1. Can You Get C19 Again? It’s Very Unlikely, Experts Say

The anecdotes are alarming. A woman in Los Angeles seemed to recover from C19, but weeks later took a turn for the worse and tested positive again. A New Jersey doctor claimed several patients healed from one bout only to become reinfected with the coronavirus. And another doctor said a second round of illness was a reality for some people, and was much more severe.
These recent accounts tap into people’s deepest anxieties that they are destined to succumb to C19 over and over, feeling progressively sicker, and will never emerge from this nightmarish pandemic. And these stories fuel fears that we won’t be able to reach herd immunity — the ultimate destination where the virus can no longer find enough victims to pose a deadly threat.
But the anecdotes are just that — stories without evidence of reinfections, according to nearly a dozen experts who study viruses. “I haven’t heard of a case where it’s been truly unambiguously demonstrated,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health.
Other experts were even more reassuring. While little is definitively known about the coronavirus, just seven months into the pandemic, the new virus is behaving like most others, they said, lending credence to the belief that herd immunity can be achieved with a vaccine.
It may be possible for the coronavirus to strike the same person twice, but it’s highly unlikely that it would do so in such a short window or to make people sicker the second time, they said. What’s more likely is that some people have a drawn-out course of infection, with the virus taking a slow toll weeks to months after their initial exposure.
People infected with the coronavirus typically produce immune molecules called antibodies. Several teams have recently reported that the levels of these antibodies decline in two to three months, causing some consternation. But a drop in antibodies is perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University.
Many clinicians are “scratching their heads saying, ‘What an extraordinarily odd virus that it’s not leading to robust immunity,’ but they’re totally wrong,’” Dr. Mina said. “It doesn’t get more textbook than this.”
Antibodies are not the only form of protection against pathogens. The coronavirus also provokes a vigorous defense from immune cells that can kill the virus and quickly rouse reinforcements for future battles. Less is known about how long these so-called memory T cells persist — those that recognize other coronaviruses may linger for life — but they can buttress defenses against the new coronavirus.
“If those are maintained, and especially if they’re maintained within the lung and the respiratory tract, then I think they can do a pretty good job of stopping an infection from spreading,” said Akiko Iwasaki, an immunologist at Yale University.
Megan Kent, 37, a medical speech pathologist who lives just outside Boston, first tested positive for the virus on March 30, after her boyfriend became ill. She couldn’t smell or taste anything, she recalled, but otherwise felt fine. After a 14-day quarantine, she went back to work at Melrose Wakefield Hospital and also helped out at a nursing home.
On May 8, Ms. Kent suddenly felt ill. “I felt like a Mack truck hit me,” she said. She slept the whole weekend and went to the hospital on Monday, convinced she had mononucleosis. The next day she tested positive for the coronavirus — again. She was unwell for nearly a month, and has since learned she has antibodies.
“This time around was a hundred times worse,” she said. “Was I reinfected?”
There are other, more plausible explanations for what Ms. Kent experienced, experts said. “I’m not saying it can’t happen. But from what I’ve seen so far, that would be an uncommon phenomenon,” said Dr. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine.
Ms. Kent may not have fully recovered, even though she felt better, for example. The virus may have secreted itself into certain parts of the body — as the Ebola virus is known to do — and then resurfaced. She did not get tested between the two positives, but even if she had, faulty tests and low viral levels can produce a false negative.
Given these more likely scenarios, Dr. Mina had choice words for the physicians who caused the panic over reports of reinfections. “This is so bad, people have lost their minds,” he said. “It’s just sensationalist click bait.”
In the early weeks of the pandemic, some people in China, Japan and South Korea tested positive twice, sparking similar fears.
South Korea’s Centers for Disease Control and Prevention investigated 285 of those cases, and found that several of the second positives came two months after the first, and in one case 82 days later. Nearly half of the people had symptoms at the second test. But the researchers were unable to grow live virus from any of the samples, and the infected people hadn’t spread the virus to others.
“It was pretty solid epidemiological and virological evidence that reinfection was not happening, at least in those people,” said Angela Rasmussen, a virologist at Columbia University in New York.
Most people who are exposed to the coronavirus make antibodies that can destroy the virus; the more severe the symptoms, the stronger the response. (A few people don’t produce the antibodies, but that’s true for any virus.) Worries about reinfection have been fueled by recent studies suggesting that these antibody levels plummet.
For example, a study published in June found that antibodies to one part of the virus fell to undetectable levels within three months in 40% of asymptomatic people. Last week, a study that has not yet been published in a peer-reviewed journal showed that neutralizing antibodies — the powerful subtype that can stop the virus from infecting cells — declined sharply within a month.
“It’s actually incredibly depressing,” said Michael Malim, a virologist at King’s College London. “It’s a huge drop.”
But other work suggests that the antibody levels decline — and then stabilize. In a study of nearly 20,000 people posted to the online server MedRxiv on July 17, the vast majority made plentiful antibodies, and half of those with low levels still had antibodies that could destroy the virus.
“None of this is really surprising from a biological point of view,” said Florian Krammer, an immunologist at the Icahn Mount Sinai School of Medicine who led that study.
Dr. Mina agreed. “This is a famous dynamic of how antibodies develop after infection: They go very, very high, and then they come back down,” he said.
He elaborated: The first cells that secrete antibodies during an infection are called plasmablasts, which expand exponentially into a pool of millions. But the body can’t sustain those levels. Once the infection wanes, a small fraction of the cells enters the bone marrow and sets up shop to create long-term immunity memory, which can churn out antibodies when they’re needed again. The rest of the plasmablasts wither and die.
In children, each subsequent exposure to a virus — or to a vaccine — boosts immunity until, by adulthood, the antibody response is steady and strong.
What’s unusual in the current pandemic, Dr. Mina said, is to see how this dynamic plays out in adults, because they so rarely experience a virus for the first time.
Even after the first surge of immunity fades, there is likely to be some residual protection. And while antibodies have received all the attention because they are easier to study and detect, memory T cells and B cells are also powerful immune warriors in a fight against any pathogen.
A study published July 15, for example, looked at three different groups. In one, each of 36 people exposed to the new virus had T cells that recognize a protein that looks similar in all coronaviruses. In another, 23 people infected with the SARS virus in 2003 also had these T cells, as did 37 people in the third group who were never exposed to either pathogen.
“A level of pre-existing immunity against SARS-CoV2 appears to exist in the general population,” said Dr. Antonio Bertoletti, a virologist at Duke NUS Medical School in Singapore.
The immunity may have been stimulated by prior exposure to coronaviruses that cause common colds. These T cells may not thwart infection, but they would blunt the illness and may explain why some people with C19 have mild to no symptoms. “I believe that cellular and antibody immunity will be equally important,” Dr. Bertoletti said.
Vaccine trials that closely track volunteers may deliver more information about the nature of immunity to the new coronavirus and the level needed to block reinfection. Research in monkeys offers hope: In a study of nine rhesus macaques, for example, exposure to the virus induced immunity that was strong enough to prevent a second infection.
Researchers are tracking infected monkeys to determine how long this protection lasts. “Durability studies by their nature take time,” said Dr. Dan Barouch, a virologist at Beth Israel Deaconess Medical Center in Boston who led the study.
Dr. Barouch and other experts rejected fears that herd immunity might never be reached.
“We achieve herd immunity all the time with less than perfect vaccines,” said Dr. Saad Omer, the director of the Yale Institute for Global Health. “It’s very rare in fact to have vaccines that are 100% effective.”
A vaccine that protects just half of the people who receive it is considered moderately effective, and one that covers more than 80% highly effective. Even a vaccine that only suppresses the levels of virus would deter its spread to others.
The experts said reinfection had occurred with other pathogens including influenza — but they emphasized that those cases were exceptions, and the new coronavirus was likely to be no different.
“I would say reinfection is possible, though not likely, and I’d think it would be rare,” Dr. Rasmussen said. “But even rare occurrences might seem alarmingly frequent when a huge number of people have been infected.”

Source: Can You Get Covid Again? It’s Very Unlikely, Experts Say

2. Scientists Uncover Evidence That a Level of Pre-Existing C19 Immunity Is Present in the General Population

Summary:

Singapore study shows that coronavirus-specific T cells are present in all recovered C19 patients.
These T cells were also found in all subjects who recovered from SARS 17 years ago, and in over 50% of both SARS-CoV-1 and SARS-CoV-2 uninfected individuals tested, suggesting that a level of pre-existing SARS-CoV-2 immunity is present in the general population.
Infection and exposure to coronaviruses induces long-lasting memory T cells, which could help in the management of the current pandemic.
The T cells, along with antibodies, are an integral part of the human immune response against viral infections due to their ability to directly target and kill infected cells.
A Singapore study has uncovered the presence of virus-specific T cell immunity in people who recovered from C19 and SARS, as well as some healthy study subjects who had never been infected by either virus.
The study by scientists from Duke-NUS Medical School, in close collaboration with the National University of Singapore (NUS) Yong Loo Lin School of Medicine, Singapore General Hospital (SGH) and National Centre for Infectious Diseases (NCID) was published in Nature. The findings suggest infection and exposure to coronaviruses induces long-lasting memory T cells, which could help in the management of the current pandemic and in vaccine development against C19.
The team tested subjects who recovered from C19 and found the presence of coronavirus-specific T cells in all of them, which suggests that T cells play an important role in this infection.
Importantly, the team showed that patients who recovered from SARS 17 years ago after the 2003 outbreak, still possess virus-specific memory T cells and displayed cross-immunity to the coronavirus.
“Our team also tested uninfected healthy individuals and found SARS-CoV-2-specific T cells in more than 50% of them. This could be due to cross-reactive immunity obtained from exposure to other coronaviruses, such as those causing the common cold, or presently unknown animal coronaviruses. It is important to understand if this could explain why some individuals are able to better control the infection,” said Professor Antonio Bertoletti, from Duke-NUS’ Emerging Infectious Diseases (EID) program, who is the corresponding author of this study.
Associate Professor Tan Yee Joo from the Department of Microbiology and Immunology at NUS Yong Loo Lin School of Medicine and Joint Senior Principal Investigator, Institute of Molecular and Cell Biology, A*STAR added, “We have also initiated follow-up studies on the C19 recovered patients, to determine if their immunity as shown in their T cells persists over an extended period of time. This is very important for vaccine development and to answer the question about reinfection.”
“While there have been many studies about the coronavirus, there is still a lot we don’t understand about the virus yet. What we do know is that T cells play an important role in the immune response against viral infections and should be assessed for their role in combating the coronavirus, which has affected many people worldwide. Hopefully, our discovery will bring us a step closer to creating an effective vaccine,” said Associate Professor Jenny Low, Senior Consultant, Department of Infectious Diseases, SGH, and Duke-NUS’ EID program.
“NCID was heartened by the tremendous support we received from many previous SARS patients for this study. Their contributions, 17 years after they were originally infected, helped us understand mechanisms for lasting immunity to SARS-like viruses, and their implications for developing better vaccines against COVID-19 and related viruses,” said Dr Mark Chen I-Cheng, Head of the NCID Research Office.
The team will be conducting a larger study of exposed, uninfected subjects to examine whether T cells can protect against C19 infection or alter the course of infection. They will also be exploring the potential therapeutic use of SARS-CoV-2-specific T cells.

Source: Scientists Uncover Evidence That a Level of Pre-Existing COVID-19 / SARS-CoV-2 Immunity Is Present in the General Population

3. Unsung Immune Cells Take Over When Covid Antibodies Wane

Antibodies have become a familiar word in the pandemic era, perhaps suggesting they’re the best hope for keeping the deadly coronavirus at bay. But when crucial vaccine data was released this week, the spotlight panned to an unsung immune player: T cells.
AstraZeneca Plc, Pfizer Inc. and partner BioNTech SE, as well as China’s CanSino Biologics Inc. all hailed the presence of these white blood cells in vaccine recipients as a sign their experimental shots show promise.
Thrust into focus by recent studies, T cells are a reminder that the body’s defenses rely on more than one weapon, and that much of the immune response to C19 is still a mystery — especially after researchers revealed that the more lauded antibodies lack staying power.
“Antibodies are only a very small part of the picture,” said Paul Griffin, an associate professor of medicine at the University of Queensland in Brisbane, who is leading clinical studies in Australia of two potential C19 vaccines. But “we’re really not there yet in terms of fully understanding” people’s immunity to the new coronavirus.
As the pandemic took the world by storm, scientists first focused on antibodies — proteins that stick to and disable foreign invaders — because eliciting them is the basis for most successful vaccines. The immune proteins are also easier to measure than T cells and can be used to gauge prior infection.
The study showing they wane quickly in patients with mild disease dealt a blow to hopes that antibodies will provide some lasting form of immunity.

Unsung Warriors

T cells, by contrast, are able to kill virus-infected cells, remember past diseases for decades, and rouse fresh antibody soldiers long after the first have left the battlefield. People infected with another coronavirus that was responsible for the SARS epidemic in 2003, for example, still have a T-cell response to the disease 17 years later.
That suggests T cells may still, at least hypothetically, be ready to protect SARS survivors against the infection almost two decades later, and might bolster their defense against C19.
“Antibodies wane after a certain period of time,” said Thomas Schinecker, who heads the diagnostics unit of Swiss drugmaker Roche Holding AG. “This doesn’t mean that there is no immunity, it just means that potentially the memory cells, T cells and others, will then be triggered to respond much better the second time so that you don’t have any severe response.”
One study found that some patients with no symptoms of C19 had T-cells that recognized the virus — even when they had no detectable antibodies. Another pointed to a level of immunity in people who never encountered the pathogen, possibly because of exposure to one or more of the coronaviruses that cause the common cold.

‘Head Start’

“The immune system is all about memory,” said Alessandro Sette, a researcher at La Jolla Institute for Immunology in San Diego, who demonstrated last month the potential for pre-existing coronavirus cross-reactive T cell responses in healthy donors. “Maybe you have a preexisting little bit of memory response, your immune system has a head start compared to someone who doesn’t.”
It’s possible that cross-reactivity is greater in individuals who recently experienced a cold caused by one of the four commonly circulating coronaviruses, Sette said in an interview Thursday.
Scientists are interested in studying people living on an island off the coast of Tuscany, where the incidence of C19 was very low, despite infected travelers from mainland Italy bringing it across, he said. The previous year, people there had experienced a particularly bad bout of the common cold. “Some of the people I talked there with speculated that maybe this has something to do” with it, Sette said.
More research is needed to determine whether pre-existing T cells that cross-react with the coronavirus may explain why some Covid patients are barely affected while others get very sick and even die. What’s clear is that a balance of both antibodies and T cells is necessary for optimal defense, according to the University of Queensland’s Griffin.

Blunting the Pandemic

Corey Smith, head of translational and human immunology at the QIMR Berghofer Medical Research Institute in Brisbane, says the findings about antibodies’ short duration don’t mean immunity wanes completely, precisely because of T cells.
So-called helper T cells, as well as memory T and B cells are able to prime antibodies to respond to a subsequent infection before it causes severe symptoms, said Smith, who is studying the immune response to the coronavirus.
The virus, like other coronaviruses that cause the common cold, may have a way of evading antibodies, leading to reinfection, Smith said. “But there’s enough cellular immunity to put a dampener on any severe symptoms.”
If could be that T cells are what ultimately subdue and blunt the pandemic virus that’s killed more than 600,000 people in less than seven months.
“If we can’t eradicate it, does it end up as a kind of a circulating virus, another cold virus?” Smith said. “I’m not sure, but it’s interesting.”

Source: Unsung Immune Cells Take Over When Covid Antibodies Wane

4. Herd Immunity Threshold May Be Much Lower Than Believed

Herd immunity to C19, the disease caused by the CCP virus, could be achieved with fewer people being infected than previously estimated, new research suggests.
According to an Oxford University study (pdf), the herd immunity threshold (HIT) may be lower than previous estimates because many people may already be innately immune to C19—without ever having caught the disease.
A team of researchers from the University of Oxford’s Zoology Department, led by Professor Sunetra Gupta, produced a model that suggests as little as 20% of the population may need to be resistant to the virus to prevent a resurgence of an epidemic.
The study, which was published on July 16, is yet to be peer-reviewed.
“It is widely believed that the herd immunity threshold required to prevent a resurgence of coronavirus is in excess of 50% for any epidemiological setting,” the paper says.
The researchers suggest that many people may have already built up some degree of resistance to the virus from exposure to seasonal coronaviruses, such as the common cold.
Herd immunity is achieved when enough people in a population have immunity to an infection to be able to effectively stop that disease from spreading. It lowers the chances of the virus being transmitted from person to person and reaching those who haven’t been infected yet.
People can become immune to certain viruses after surviving infection or being vaccinated. Typically, at least 70% of a population must be immune to achieve herd immunity. But how long immunity lasts varies depending on the virus.
“Here, we demonstrate that HIT may be greatly reduced if a fraction of the population is unable to transmit the virus due to innate resistance or cross-protection from exposure to seasonal coronaviruses,” wrote study authors Jose Lourenco, Francesco Pinotti, Craig Thompson, and Gupta.
“These results help to explain the large degree of regional variation observed in seroprevalence and cumulative deaths, and suggest that sufficient herd immunity may already be in place to substantially mitigate a potential second wave,” they added.
The researchers said that when people who are resistant to a virus mix with non-resistant people, the HIT drops significantly.
“Given the mounting evidence that exposure to seasonal coronaviruses offers protection against clinical symptoms, it would be reasonable to assume that exposure to coronavirus itself would confer a significant degree of clinical immunity,” the researchers suggest.
“Thus, a second peak may result in far fewer deaths, particularly among those with comorbidities in the younger age classes.”

Source: Herd Immunity Threshold Against COVID-19 May Be Lower Than Believed: Researchers

5. Breakthrough test can quickly tell you the strength of your immunity

A novel coronavirus antibody test kit can provide faster results than existing ones, and it can measure the strength of the immune response to C19 or coronavirus vaccination.
The cPass test looks for neutralizing antibodies, which are the proteins that can bind to the spike protein of SARS-CoV-2 and render it useless. The virus won’t be able to infect cells and multiply inside them.
The test is already undergoing review with the US Food and Drug Administration and has been approved for use in the European Union and Singapore.
How long does C19 immunity last once you survive the illness or receive a vaccine? That’s the critical answer the world needs to better handle the ongoing novel coronavirus pandemic. What we know so far is that the immune system can repel the virus and that reinfection is unlikely in the first weeks and months following the primary infection. Researchers think the immunity to the novel coronavirus can’t be better than the resistance to the other human coronaviruses that cause common colds. If accurate, that means we might get C19 again after up to a year after the first bout. Also, if immunity is short-lived, then we’ll need to be vaccinated regularly to keep staying protected.
Recent research also showed that the antibodies might disappear from the blood within two to three months of infection. We’d still be protected, as the immune response is more complicated than that. White blood cells, called T cells, would be able to engage the virus and help produce new antibodies in the future. But if tests can’t detect antibodies after three months, officials looking to track the disease and measure herd immunity will not get accurate results from current tests. This is where a breakthrough coronavirus test comes into play, as it’s been specifically designed to return quick results on a certain type of antibody that actually measures the strength of your immune response to C19.
Neutralizing antibodies are proteins that can bind to the spike protein of the coronavirus, the protein that makes up its corona, or crown. As a result, the virus can’t connect to ACE2 receptors on human cells, and can’t enter them. Without this step, the virus can replicate, and it’s essentially neutralized from doing any harm. That’s why vaccine makers are looking to induce neutralizing antibodies with their experimental drugs. And why monoclonal antibodies are drugs based on neutralizing antibodies that can block the virus. Similarly, plasma therapies rely on the transfer of neutralizing antibodies from a C19 survivor to a patient with a weaker immune response.
Researchers from GenScript Biotech came up with an assay that doesn’t look for antibodies in general, as it happens with the other antibody tests in use out there. Instead, it tries to detect only the neutralizing antibodies in a patient’s bloodstream. This test is much faster than traditional antibody tests, providing answers in as little as an hour compared to a few days. And the result doesn’t require the use of live virus and biosafety containment for the tests.
The company published a study in Nature that explains how the test works. Called cPass, the test was used in two cohorts of patients in Singapore and China measuring 375 and 250 subjects, respectively. The study compared traditional cell- and virus-based detection test (cVNT) with the new surrogate virus neutralization test (sVNT) and found that the latter (the cPass test) detected neutralizing antibodies from patients with 95%-100% sensitivity and 99.93% specificity.
The researchers also proved that even if patients had a low level of IgG and IgM antibodies, the cPass test still detected a significant level of neutralizing activity. If confirmed by future testing, this could be a massive deal for antibody testing. cPass assays could be used to see whether a C19 is developing neutralizing antibodies, and could be used to measure the immunity of a community after an outbreak or after a vaccination campaign.
“As long as you have a small amount of neutralizing antibody, the patient may still be immune to the virus,” GenScript’s Eric Wang told Forbes.
The scientist explains the cPass uses a different testing principle. “We don’t detect the antibody itself, but instead, we check the blood for anything which blocks the binding of the virus [spike protein] to the hACE2 receptor on human cells,” Wang said. “It’s a functional assay that specifically looks for the neutralizing antibody.”
The announcement also says that results from two SARS serum panels showed that neutralizing antibodies were detectable 17 years after the initial infection, which is promising news. That’s not to say the SARS-CoV-2 neutralizing antibodies will last as long, but the cPass test works on other pathogens.
The cPass SARS-CoV-2 Neutralization Antibody Detection Kit is under review for Emergency Use Authorization (EUA) with the US Food and Drug Administration (FDA), the company said. The test kit is already allowed for use in the European Union and obtained provisional authorization in Singapore.

Source: Breakthrough coronavirus test can quickly tell you the strength of your immunity

6. Coronavirus Has a “Camouflage” That Causes Cells Not to Recognize It – “Fundamental Advance in Our Understanding of the Virus”

With an alarm code, we can enter a building without bells going off. It turns out that the coronavirus 2 has the same advantage entering cells. It possesses the code to waltz right in.
In Nature Communications, researchers at The University of Texas Health Science Center at San Antonio (UT Health San Antonio) reported how the coronavirus achieves this.
The scientists resolved the structure of an enzyme called nsp16, which the virus produces and then uses to modify its messenger RNA cap, said Yogesh Gupta, PhD, the study lead author from the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio.
“It’s a camouflage,” Dr. Gupta said. “Because of the modifications, which fool the cell, the resulting viral messenger RNA is now considered as part of the cell’s own code and not foreign.”
Deciphering the 3D structure of nsp16 paves the way for rational design of antiviral drugs for C19 and other emerging coronavirus infections, Dr. Gupta said. The drugs, new small molecules, would inhibit nsp16 from making the modifications. The immune system would then pounce on the invading virus, recognizing it as foreign.
“Yogesh’s work discovered the 3D structure of a key enzyme of the C19 virus required for its replication and found a pocket in it that can be targeted to inhibit that enzyme. This is a fundamental advance in our understanding of the virus,” said study coauthor Robert Hromas, MD, professor and dean of the Long School of Medicine.
In lay terms, messenger RNA can be described as a deliverer of genetic code to worksites that produce proteins.

Source: SARS-CoV-2 Coronavirus Has a “Camouflage” That Causes Cells Not to Recognize It – “Fundamental Advance in Our Understanding of the Virus”

C. Improved & Potential Treatments

1. Is a new steroid treatment a miracle solution for C19?

Everything’s bigger in Texas, as those of us who grew up there like to say, and we’ve been known to enjoy telling the occasional tall tale. Is a recently discussed potential treatment for C19 one of those, or is the fast-talking Texan behind the claim really onto something?
Richard Bartlett made waves in a July 2 interview that already has racked up 4.1 million views online. In the interview, Bartlett, who has practiced medicine for 28 years and was part of former Texas Gov. Rick Perry’s Health Disparities Task Force, boasted a 100% survival rate for his patients since March by using his treatment strategy, centered around an inhaled steroid called budesonide.
“We have cracked the case,” the doctor said. He emphatically doubled down in an interview last week: “The cat is out of the bag. We have an answer for this. We don’t need another answer.”
Well, with C19, nothing has been that simple. But the “silver bullet,” as Bartlett called it, isn’t new at all, which is part of what makes it so intriguing. And despite very reasonable pushback from some sectors of the medical community, it’s worth a closer look.
For more than 20 years, doctors have prescribed budesonide, an anti-inflammatory, as preventive medicine for asthmatics. Inhaled corticosteroids, in fact, have been used for some time in patients of all ages, and very safely. On a theoretical basis, employing steroids to fight C19 makes practical sense.
Here’s why: Scientists have learned that the morbidity from this disease occurs not only because of the devastating effects of the virus, but also from an inflammatory state that begins about a week or so into the illness. If physicians can interfere before this cascade of inflammation begins, the theory goes, we might prevent the disease from progressing in severity, and keep patients out of hospitals, intensive care units, and morgues.
Besides the budesonide, Bartlett’s cocktail includes an antibiotic called clarithromycin, along with zinc (to enhance immune function) and low-dose aspirin (to help prevent clotting issues seen with the disease). He recommends beginning twice-daily treatments early—even before a C19 test result has been returned—via a nebulizer machine. A nebulizer deposits the medicine directly into the lungs, specifically targeting tissue locally, and thus prevents many of the systemic side effects that come from taking steroid medicines by mouth or intravenously.
We use steroids to treat many diseases, like rheumatoid arthritis and lupus, as well as allergic reactions, precisely to reduce inflammation. And a recently published study noted significantly lower death rates both in seriously ill C19 patients and in patients needing oxygen when they were given intravenous steroids.
The supporting science for inhaled steroids, though, remains sketchy. Bartlett has written a paper with case reports describing favorable outcomes for two of his patients with the regimen, and he associates low C19 death rates in South Korea, Japan, Taiwan, and Singapore partly with their purported use of inhaled corticosteroids. But evidence of that is scant, and other news sources attribute the successes to aggressive action on travel restrictions, mask wearing, testing, and contact tracing with strict quarantining—not budesonide.
As for inhaled steroids in the treatment of C19, we mostly have case reports and lab data rather than human trials. Japanese and Chinese physicians have each published case reports on three patients with confirmed C19 who improved after receiving an inhaled steroid called ciclesonide. In the U.S., in a lab study, researchers showed that budesonide inhibited the ability of a different coronavirus (one of the causes of the common cold) to replicate itself and inflame the airways. But the truth is that we do not have any randomized studies yet of inhaled steroid use in actual C19 patients. Several such randomized control trials—the gold standard—are underway in France, Sweden, Spain, and the U.K.
Assessing risk is critical here. The primary concern is that if one suppresses the body’s immune response with steroids too early in the course of C19, the viral aspect of the disease may worsen. That could lead to more severe pneumonia, among other possibilities. Studies have shown that patients with chronic obstructive pulmonary disease (COPD) who received inhaled steroids had higher incidences of pneumonia, and both asthmatic and COPD patients were more prone to upper respiratory infections when inhaled steroids were given.
So did Richard Bartlett find a silver bullet, or is it snake oil? We’ll know with more certainty in several months, when some of these trials conclude. In the meantime, though, it’s important to remember that doctors do sometimes use medicines “off label,” or for conditions other than what they are intended to treat. That’s exactly what Bartlett is doing, and he says he will continue.
A new and lethal virus like C19 requires us as physicians to follow the science, of course, but we are also duty bound to listen to doctors on the front line and around the world. Their work with experimental treatments, especially while using medications with long track records of safety, may well prove critical in the interim.

Carolyn Barber has been an emergency department physician for 25 years, is cofounder of the homeless work program Wheels of Change, and is a nationally published author.

Source: Richard Bartlett says budesonide is a ‘silver bullet’ for COVID. Is that true?

2. The Vaccine Race – Where do we stand?

The WHO reports that there are currently 142 potential vaccines in what is known as the “preclinical evaluation” phase. These are vaccines that are basically still being tested in a lab, with scientists iterating and testing over and over on animals or in test tubes.
It’s possible that a future global vaccine lives among those 142 – but at this point it seems more likely that the vaccine will come from one of the 24 that have begun to be tested on actual humans. Of those 24, 4 have reached Phase III which is the most rigorous test phase.
To get to Phase III you pretty much need to demonstrate that your potential vaccine is safe, that it has no serious side-effects, and that it is showing signs of producing the kind of response that can fight the virus or disease.
Phase III takes this a step further, testing on thousands of people to get more detailed data on efficacy (does this vaccine work in a lab under optimal conditions) and effectiveness (does this vaccine work in slightly sub-optimal conditions, like the real world). Safety is obviously tested too but in a more specific way – looking for adverse effects for people with different underlying health conditions, ages etc.

So what looks promising?

This week Oxford University announced the results of their combined Phase I and II trial for their vaccine ChAdOx1 nCoV-19. The “Chad” vaccine triggered an immune response (antibodies and T-cells) and it appeared safe. The UK has already ordered 100 million doses of the vaccine.
In China, there are 3 vaccines in a Phase III trial, and the US company Moderna, which has been granted $483,000,000 by the US government, is also about to start its Phase III trial in the next week or so.
Considering vaccines usually take about 10 years to develop, test and produce, if the world manages to get one out to people by mid-2021 – which is the timeline most experts think we’re on – it’ll be a phenomenal achievement.

Source: The Vaccine Race — Chartr: Data Storytelling

D. New CDC Guidance

1. CDC changes C19 guidance on how long patients need to be isolated

People who have been confirmed with mild to moderate C19 can leave their isolation without receiving a negative test, according to recently revised guidance from the Centers for Disease Control and Prevention.
Increasing evidence shows that most people are no longer infectious 10 days after they begin having symptoms of C19. As a result, the CDC is discouraging people from getting tested a second time after they recover.
“For most persons with C19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms,” the CDC says.
For people who have tested positive but don’t have symptoms, “isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.”
Dr. Joshua Barocas, an infectious disease physician at the Boston Medical Center, said many doctors have felt for months that a negative test to end isolation was not a practical solution.
“What we had seen clinically very much aligns with these new guidelines, at least for the vast majority of people,” he told NBC News. “It’s one of those cases in which the CDC is now catching up to the clinician.”
There are exceptions for the 10-day guidance, including people with compromised immune systems who may be infectious for a longer period of time.
For the average immunocompetent person, I think we can feel quite confident that after 10 days, they’re no longer contagious,” Dr. William Schaffner, an infectious disease specialist at Vanderbilt University told NBC News.
In a briefing with reporters last week, Brett Giroir, the assistant secretary for health at the Department of Health and Human Services, said that a required negative test after a confirmed infection was because of early outbreaks in cruise ships where people were quarantined and looking to get out.
“That is no longer needed, and it is medically unnecessary,” he said.
The CDC also notes that virus fragments have been found in patients up to three months after the onset of the illness, although those pieces of virus have not been shown to be capable of transmitting the disease.
“You could be positive by PCR test long after no longer being infectious,” Giroir said during the Health and Human Services briefing July 14. Some people were getting tests four to six times. You don’t need to be retested unless you’re critically ill or immunosuppressed in which you could shed virus longer.”
The recommendation of 10 days is specifically for those who test positive for the coronavirus and have been asked to self-isolate. It doesn’t apply to people who need to quarantine to keep from possibly spreading the virus. The incubation period for the virus is 14 days, health experts say, so anyone who has been exposed to the virus would need to quarantine to see if they become sick.

Source: CDC changes COVID-19 guidance on how long people need to be isolated

2. CDC School Guidance

As the US moves toward the scheduled start of the 2020-21 school year, the US CDC published several updated guidance documents to support schools in preparing for classes in the midst of the C19 pandemic. A number of prominent US government officials, including President Trump, have publicly called for schools to resume in-person classes, but many state governments, school officials and teachers, and health experts warn that might not be feasible or safe in some circumstances. The updated guidance includes information for schools regarding the current understanding of C19 risk to children and their role in driving transmission in the community and at home as well as recommendations for implementing appropriate social and physical distancing (including mask use), enhanced hygiene and sanitation, and disease surveillance and monitoring systems. The guidance also includes considerations based on the current level of community transmission, including the possible need to close schools due to uncontrolled community spread. In addition to schools, the CDC offers tools and information aimed at parents to help evaluate risk.
The updated CDC guidance includes a statement that explicitly emphasizes the importance of in-person school for children. Some media reports have characterized this as a push by the CDC to resume in-person classes during the pandemic, as it focuses primarily on the benefits of in-person learning rather than public health considerations related to C19. The statement highlights the disproportionate impact of remote classes on lower-income students, racial and ethnic minorities, and students with disabilities or special needs as well as the importance of services schools provide beyond education that support these and other students. Notably, the CDC emphasizes repeatedly that the risk to students—including direct health risks to children and risks of spreading the disease at home—are relatively low in communities with low levels of coronavirus transmission. The statement largely focuses on the impact for students and does not fully address the risks to teachers, staff, and family members.

Source: Johns Hopkins COVID-19 Updates

3. Mixed messages in the CDC’s new guidelines for reopening schools

In the anguished battle over reopening America’s schools, the nation is divided into distinct, sometimes overlapping groups. There are those who want schools to fully reopen in the fall in order to restore normalcy for children or to help reopen the economy or both, and others who are much more concerned that in-person instruction could seed broader outbreaks.
Into this morass comes a package of documents from the Centers for Disease Control and Prevention about reopening schools, a second attempt after President Trump assailed the agency’s original recommendations last month as “very tough and expensive.” This time there’s something for everyone.
The documents include an opening statement that offers a full-throated call to reopen schools this fall, sounding at times more like a political speech than a scientific document. The CDC did not write it; the statement was created by a working group convened by officials at the Department of Health and Human Services.
It lists many reasons children benefit from being in school, and downplays potential health risks, repeatedly describing children as unlikely to catch or spread the virus, even though the transmission risk is not definitively known.
But the package also includes information that some epidemiologists said was helpful, including checklists for parents and mitigation measures for schools, like keeping desks at least six feet apart, teaching hand-washing and mask-wearing, and keeping small groups of children in one classroom all day.
Our colleague Abby Goodnough, who covers health care for The Times, told us that after all of the back and forth on back-to-school guidelines, “the CDC’s job is done for now.”
“It’s now pretty fully in the hands of local school districts and principals and superintendents to figure this out,” she said, “and there’s really not a lot of time left to make these decisions.” Because the new materials are of two minds — arguing for children to return to school while recommending very cautious guidelines for doing so — it won’t go far in mending the splits dividing Americans about how and when to reopen schools.
“It’s confusing,” she told us. “I would say that instead of providing clarity or creating a truce, it just kind of digs people into their differing positions on this even more.”

Source: New York Times Coronavirus Updates

E. Concerns & Unknowns

1. Why is obesity so common in C19 patients?

A hormone that connects the body’s metabolism and immune response system may explain why C19 is so dangerous for people with obesity.
“The problem for people with obesity is that their leptin levels are always high, and that can affect the response to a C19 infection,” said Candida Rebello, PhD, RD, lead author of a new paper that traces the link between obesity and the virus.
The hormone leptin regulates appetite and metabolism. Leptin also regulates the cells that fight infection. Leptin is produced by fat cells, and to a lesser extent by tissues in the lungs. The more fat a person has, the more leptin circulates in their body.
Elevated leptin levels hamper the body’s ability to fight off infections, in the lungs and elsewhere, Dr. Rebello said. High leptin levels promote a low-grade systemic inflammatory state.
“If you have obesity, there are a number of underlying health issues that make it more difficult for you to fight off a C19 infection,” said John Kirwan, PhD, Pennington Biomedical Executive Director and a co-author of the review. “Your entire body, including your lungs, may be inflamed. Your immune response is likely compromised, and your lung capacity reduced.
“Add in a virus that further weakens the body’s ability to fight infection, that can limit the body’s ability to control lung inflammation, and you have the recipe for disaster.”
C19 vaccine developers should take the immunocompromised state resulting from obesity into consideration, in much the same way they would advancing age.
The researchers say the role of leptin in C19’s development bears investigation along with the viral proteins that alter the immune systems of people with obesity. One potential avenue of treatment may be a drug that prevents inflammatory responses to the virus.
Another potential avenue of investigation includes examining how proinflammatory fat tissue in people with obesity might contribute to activating fewer infection-fighting cells and why those cells die more quickly.

Source: Why is obesity so common in COVID-19 patients?

2. Young, healthy adults with mild C19 also take weeks to recover

Young, previously healthy adults can take weeks to fully recover from even a mild C19 infection, with about a fifth of patients under 35 years reporting not returning to their usual state of health up to 21 days after testing positive, according to the Centers for Disease Control and Prevention (CDC).
A telephone survey across 13 states of symptomatic adults with mild C19 found 35% had not returned to their usual state of health when interviewed two to three weeks after testing, the CDC reported in the Morbidity and Mortality Weekly Report on Friday.
Cough, fatigue and shortness of breath were among the symptoms reported while testing that persisted even weeks later, according to the report.
The findings indicate recovery can be prolonged even in young adults without chronic medical conditions, making a case for public health messaging to target populations that might not perceive C19 as being a severe illness.
Between April 15 and June 25, telephone interviews were done with a random sample of people over 18 years of age who got themselves tested for C19 at an outpatient visit, CDC said.
The interviews were done 14 to 21 days after the test date, and patients were asked about symptoms during testing, whether they had returned to their usual state of health, and if they suffer from a chronic medical condition.
Among 292 people interviewed, 274 reported experiencing one or more symptoms at the time of testing. Among symptomatic respondents who reported not having returned to their usual state of health, 26% were between 18 and 34 years of age, 32% were between 35 and 49 years, and 47% were over 50.
Researchers said social distancing, frequent handwashing, and the consistent and correct use of face coverings in public should be encouraged to slow the spread of C19.

Source: Young, healthy adults with mild COVID-19 also take weeks to recover: CDC

3. Actual C19 case count could be 6 to 24 times higher than estimates

The coronavirus may be an even bigger problem than previously thought.
The Centers for Disease Control and Prevention published a new study that found that the numbers of C19 cases in some areas of the US were more than 10 times higher than reported between March and May.
Based on antibody testing, places including New York and South Florida had drastically more coronavirus cases than were initially reported during the first wave, according to the paper, published in JAMA Internal Medicine on Tuesday.
More than 16,000 samples were collected from San Francisco, Connecticut, southern Florida, Louisiana, Minneapolis, Missouri, New York City, Philadelphia, Utah and western Washington. The number of people who tested positive for coronavirus antibodies — meaning they had the virus at one point — was much higher than the number of cases reported from the same time.
Limited testing availability during this period and the fact that many carriers of the virus can be asymptomatic may have contributed to the striking disparity, the researchers said.
“The findings may reflect the number of persons who had mild or no illness or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population,” the study reads.
In Connecticut, where the lowest gap was found, infections were six times higher than the state reported. In Missouri, positive antibody tests were 23.8 times higher than actual reported cases — the highest discrepancy cited in the study.
Most other cities in the study had cases more than 10 times more than previously known.
Not all patients sought health care in the first wave, but the study suggests that in New York City, cases could have been 1,000 times greater than the 545 reported on March 16.
However, just because many more people carry C19 antibodies than previously known does not mean most people are immune to the disease.
“At present, the relationship between detectable antibodies to [the coronavirus] and protective immunity against future infection is not known,” the study says.
However, early trials of a C19 vaccine have sparked immune system responses: “These early results hold promise,” vaccine developer Sarah Gilbert told Reuters.

Source: US coronavirus infections 10 times higher than reported: CDC

F. The Road Back?

1. What Arizona’s Tenuous Virus Plateau Could Teach Us

Is it possible to stabilize coronavirus infections without going into full lockdown? The hardest-hit Sun Belt states are offering a real-time experiment.
As the United States surpasses four million known coronavirus cases, far more than any other country, new outbreaks are sending thousands of seriously ill people to hospitals and driving a new wave of funerals. But there are also initial signs that new infections may be leveling off in some places, including in some of the worst hot spots.
That may be most visible in Arizona.
Only a few weeks ago, Arizona was leading the nation in coronavirus infections per capita, as the virus spread across many Sun Belt states that had opened quickly in late spring. Facing a mounting crisis in June, Gov. Doug Ducey, a Republican, reversed himself and allowed cities and counties to order residents to wear masks. He also rolled back some earlier reopenings, and directed bars, indoor gyms, water parks and movie theaters to shut down again.
About a month later, the number of patients hospitalized with the virus is starting to decline. As of Friday afternoon, Arizona was the only state where known new daily cases were decreasing, a milestone that reflected, in part, just how dire conditions had been.
“It is possible in the course of a month to begin to really turn things around. We saw that in March and April,” said Dr. Tom Inglesby, the director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.
The question now is whether it is possible to do so while avoiding another full lockdown, and states like Arizona are offering a real-time experiment.
“In some ways, it is like a large-scale version of a clinical trial,” Dr. Inglesby said. “Arizona is one of the states involved and is going through a crisis and now is taking a certain set of interventions, and we are seeing if those interventions work.”
Arizona has often been mentioned in the same breath as Florida and Texas, after all three states experienced alarming rates of growth this summer, driving the worst of the outbreak in the Sun Belt. The states are each led by a Republican governor who issued stay-at-home orders in the spring, and who resisted shutting back down completely when the virus later arrived in full force. Instead, the states took a targeted approach, pairing limitations on bars with mask requirements, either locally or statewide.
Texas and Florida are also seeing slight signs of improvement, though each is averaging more than 9,000 new confirmed cases a day and both have hot spots that have high rates of hospitalization.
Arizona is now averaging 2,600 new cases a day, down from 3,800 earlier this month. The number of new cases can depend on testing, an issue Arizona has struggled with, but the number of people hospitalized with the virus — a real-time measure of who is seriously sick — has also started to decline. Arizona had 2,844 people who tested positive or who were suspected of having C19 hospitalized on Thursday, about an 11 percent decline from mid-July. (The state does not release local data on hospitalizations, so it was unclear how stressed hospitals were in metro areas like Phoenix.)
Arizona is still leading the nation in deaths per capita, which are seen as a lagging indicator of the current state of the virus, but nevertheless offer a stark reminder of the devastation brought on the state after a swift reopening. Cases are now plateauing at a level much higher than when Arizona initially shut down in March, and the number of people on ventilators on Thursday, 575, was down from a high of 687 a week earlier.
“We’ve stabilized at 95 miles an hour, and that is not the speed that we want to be going,” said Dr. Joshua LaBaer, director of the Biodesign Institute at Arizona State University. “Ideally, we don’t want this car moving at all.”
Big problems persist for researchers trying to piece together more precisely how the virus is spreading in Arizona, including the lag times in the reporting of coronavirus cases and in confirming test results. Sonora Quest, one of the state’s largest labs, disclosed on Thursday that it had about 55,000 tests that had not been processed, and that it was taking between nine and 12 days to obtain most results, far longer than the 24-hour turnaround time public health experts recommend.
Arizona has a relatively high positive test rate, a key measure of both the spread of the virus and the effectiveness of the state’s response. High positive test rates can indicate insufficient testing, experts say.
Even so, disease specialists say Arizona is getting some things right. Dr. LaBaer noted that Governor Ducey changed his tone on prevention efforts and began wearing a mask in public.
Geography may also play a role. About 5.5 million of Arizona’s seven million residents — about three in four people — live in Maricopa County, which includes Phoenix, and Pima County, which includes Tucson. Both issued orders requiring face masks a little more than a month ago, in mid-June.
The Navajo Nation, hit by severe outbreaks in March and April, has also vigorously introduced measures such as mask mandates, checkpoints and curfews. The reservation, which spreads over parts of Arizona, New Mexico and Utah, has reported fewer than 50 new cases a day over the past week, compared with more than 170 a day a few weeks ago.
With prevention efforts on the rise, the vast majority of Arizonans have been living with mask mandates and more shutdowns for about a month, about the time experts say it takes to start seeing the effect of new policies.
By contrast, many of Florida’s 21 million residents are spread out across big and midsize cities, with overlapping city and county governments. With mask orders in place in many of the largest counties, and with a statewide limit on bars since late June, the state has shown some small declines in new cases in recent days for an average of 10,000 cases a day, down from 11,800 last week.
In Texas, whose 29 million residents are spread across 254 counties, Gov. Greg Abbott shut down bars in late June and issued a statewide mask requirement about three weeks ago. The state is now averaging more than 9,000 cases a day, down from more than 10,000 a few days ago. In Houston, officials are seeing reason for hope amid a slight drop in hospitalizations, even as the virus has overwhelmed hospitals in other parts of Texas, including the border region known as the Rio Grande Valley.
“We are cautiously optimistic that we’re seeing a leveling off,” said Catherine Troisi, an infectious-disease epidemiologist at UTHealth School of Public Health in Houston, who said the combination of measures seemed to be working.
But she cautioned that it may be too early to tell how significantly the intermediate measures had stopped the spread. “Is the best we can do plateauing, or can we actually start to see a decrease?” she said. A lot of that is dependent on individual behavior.”
Trish Riley, executive director of the National Academy for State Health Policy, said she had seen some Sun Belt states using lessons learned from the Northeast, which generally shut down quickly in the spring and took a slower, targeted approach to reopening. In many places in the Sun Belt, it has been the opposite: slow to shut down, quick to reopen and, now, a targeted approach to scaling back again.
One notable outlier is California, which was the first state to issue a stay-at-home order and where a spring lockdown lasted longer than those in many other states. But after keeping the state closed through late May, Gov. Gavin Newsom, a Democrat, faced increasing pressure and ceded much of the decision-making to local officials, leading to a ramped-up reopening. The state is now experiencing a surge of new infections and recently surpassed New York in having the most cases of any state.
“This disease is so profoundly challenging to predict,” Ms. Riley said, citing California as an example. “It’s really challenging.”
For Arizona to go beyond leveling off new cases to bring the virus under control, the actions of businesses like the Greenwood Brewing in downtown Phoenix, and their patrons, remain crucial. On Friday, signs at every entrance to the brewery instructed people to wear masks in compliance with Phoenix’s citywide mandate.
Megan Greenwood, the brewery’s founder, said that her staff had masks behind the bar to give to people who walked in without one, but that, so far, they had not been necessary.
“We haven’t actually had to give anybody a mask,” Ms. Greenwood said. “We haven’t even had people going to the bathroom without their mask on. They know that masks are required.”

Source: What Arizona’s Tenuous Coronavirus Plateau Could Teach Us

G. Mental Health

1. Don’t Get Depressed Over Those Covid Antibody Studies

It’s hard to imagine more depressing news than some recent studies showing that antibodies to C19 fade within a few weeks — a blow to any hopes for a vaccine, or for any chance of getting out of the pandemic without years of hardship.
Don’t let it raise your blood pressure. Pendulum swinging is all part of a common pattern in health reporting, where all the attention goes to extremes — total gloom or total sunshine — when reality is somewhere in between. It can seem jarring, when this news about fast-fading antibodies comes out within a few days of the hopeful news that several human vaccine studies are showing promising results. Some vaccine makers are already moving into massive-scale efficacy trials that could yield early results before the end of this year.
One reason for the seemingly discordant news is that vaccines can induce a stronger immune response than natural infections — and for that reason several vaccine researchers I spoke to said they were unfazed. “None of these findings is any reason to stop or slow down vaccine work,” says Harvard vaccine researcher Dan Barouch. “If anything, it should redouble our efforts if natural immunity fades quickly.”
But beyond that, natural immunity might hold up better than these first studies suggest. Those studies showing the fast fade relied on fewer than 100 people. But this week, another team released a study that followed 19,860 patients in New York City, and found that more than 90% of them had produced the kind of antibody response likely to fight off reinfection, and it was still going strong three months after recovery. (The study hasn’t been published yet, but the team, associated with Mt. Sinai, has published many other high-profile C19 papers.)
And so it still seems likely that at least one of the many vaccine candidates will give long-enough protection to end the pandemic. Monday, one of the leading vaccine teams, from Oxford University and AstraZeneca, released results showing their vaccine induced a strong antibody response in more than 1,000 test subjects with only transient side effects — soreness at the injection site, fatigue and fever.
The Lancet published these results along with promising ones from a different vaccine from the Chinese company CanSino. In total, the World Health Organization has tallied 23 vaccine candidates already being tested in humans. Several are moving to efficacy studies involving tens of thousands of volunteers.
That doesn’t mean the bad news on natural immunity should be discounted — it just needs to be taken in context. One study out of China and published in Nature Medicine focused on those poorly understood asymptomatic cases — people who never report any symptoms but test positive for the virus. The other discouraging study came out of Kings College in the U.K., and followed 64 people. That study, still unpublished, showed their antibodies started to fade after just eight weeks, sometimes to undetectable levels. And today, another group from UCLA released data from a small cohort of patients in a letter to the New England Journal of Medicine. They, too, found antibodies waned in a few weeks.
But experts say it had already been well understood that natural antibodies would eventually fade, and that very mild or asymptomatic cases might not generate a robust antibody response. Arthur Krieg, a physician and founder of Checkmate Pharmaceuticals, says the beauty of vaccines is that they can produce the kind of antibody response only seen in severe cases, but without the suffering and danger.
He also says vaccines — and natural infections — can induce longer-lasting protection with T-cells, which are different from antibodies. T-cells can detect and kill cells infected with the virus even after antibodies fade. Some of the vaccine candidates can induce a protective T-cell response in addition to antibodies.
There’s also hope for vaccine-aided herd immunity, he says. Vaccines often don’t work well in immune-compromised people or the elderly, but if most healthy, younger people get vaccinated, the virus could die out from a lack of susceptible hosts.
This still leaves open the nagging question of why studies of natural immunity yield such different results. Anna Wajnberg, a physician at Icahn School of Medicine at Mt. Sinai and co-author of the new, larger study, says it may come down to differences in the subjects studied and the antibody tests used.
Her subjects were people who had gotten C19 and volunteered to donate convalescent plasma after they recovered. That’s an experimental treatment meant to enlist other people’s antibodies to boost immunity in severely ill patients. The researchers used a test method developed by virologist Florian Krammer, which picks out an antibody that’s known to attack the so-called spike protein the virus needs to get into cells.
What they observed was a small decrease in those with the highest antibody counts, and a slight increase among those with the lowest. That might have happened because some people take longer than others to produce a full immune response to an infection, says Wajnberg. She said it will take time to learn how long immunity lasts over the long term because the disease is so new, but they will keep following the nearly 20,000 people in their study for months to come.
The Chinese study looked only at people who tested positive but developed no symptoms. The weak antibody response measured in those subjects is not surprising since they may have been exposed to such a low viral load that they were able to clear infection without a full immune response.
More troubling are anecdotal reports of people being re-infected, but Wajnberg says this could be an exception to the rule. “With New York a raging epicenter of the pandemic, I would have thought we’d see more people get sick twice between February and April,” if indeed post-infection immunity didn’t work at all, she says.
These contradictory findings can come down to the disproportionate attention that goes to extreme, emotion-inducing messaging, and to the fact that the pace of science related to the pandemic is both frantic and slow. New studies are released by the minute — some careful, some shoddy — but the virus will only give up its secrets over the course of several months. Don’t let your hopes rise and fall on every new finding.

Source: Covid-19 Antibody Studies Don’t Rule Out Immunity or a Vaccine

H. New Technology & Equipment

1. MIT engineers designed an affordable, reusable face mask that’s as effective as an N95

At the beginning of the C19 pandemic, the shortage of N95 respirator masks presented a dire situation for the healthcare and frontline workers who needed them most. Essential workers who relied on N95 masks had no choice but to wear what were meant to be disposable N95 masks for weeks at a time. Some started disinfecting the masks to be redistributed and reused.
Now, as C19 infections surge and states such as Texas and Florida and hospitals and healthcare workers once again become overwhelmed with the volume of patients, N95 respirators still remain in short supply.
But engineers and researchers at MIT and Brigham and Women’s Hospital have created a new type of face mask that could be a game-changer. In a laboratory setting, the prototype worked as well as a N95 respirator at filtering out virus-containing particles.
The biggest innovation? While N95 masks are made entirely from a special material that filters out airborne droplets and fluids that could contain the C19 virus, the new MIT mask is made from silicone, with slots for just two small, disposable disks of the N95 material (which serve as filters). That means the masks themselves can be quickly and easily sterilized and reused, and though the small filters must be thrown out, each mask requires much less N95 material.
Called the iMASC, which stands for Injection Molded Autoclavable, Scalable, Conformable, this design could help solve shortage issues.

The new iMASC system can also be sterilized a few different ways without sacrificing its effectiveness, the researchers wrote in a paper published in the British Medical Journal Open. For example, researchers were able to use a steam sterilizer on the masks, put the masks in an oven, as well as soak them in both bleach and rubbing alcohol. (Treating used N95 masks with hydrogen peroxide disinfectants to neutralize any viruses requires special equipment and takes a few days. It also only allows the masks to be re-worn for one day at a time, up to 20 more times.)
The iMASC researchers “wanted to maximize the reusability of the system,” Giovanni Traverso, an MIT assistant professor of mechanical engineering and a gastroenterologist at Brigham and Women’s Hospital, said in a press release.
The new mask could also be more environmentally-friendly — it uses less disposable material, which produces much less waste than tossing a whole mask, Adam Wentworth, a research engineer at Brigham and Women’s Hospital and a research affiliate at the Koch Institute, said in a press release.
So far, the masks have proven effective and comfortable.
A group of 24 healthcare workers (including nurses, physicians and technicians) wore the new masks and completed tests that involved breathing, talking, moving their head and body and making facial expressions. The participants said that the mask fit well and felt breathable. Most importantly, the mask successfully filtered out a sugar solution in the air that was used to mimic aerosolized respiratory droplets.
More tests need to be done, and the group is currently working on a second mask design.
The team plans to eventually have the rubber mask approved by the Food and Drug Administration and the National Institute for Occupational Safety and Health. Once complete, the masks could cost hospitals $15 each, Fast Company reported. (N95 masks can cost between $2.80 and $6.95 per unit, according to data compiled by nonprofit Project N95.)
The ultimate goal is to make the masks available for healthcare workers as well as the general public, but there is no timeline as of yet.

Source: MIT researchers designed reusable N95 face mask for healthcare workers

2. Single-Use Masks Could Be a Coronavirus Hazard – Here’s What You Need to Know

In Melbourne and Mitchell Shire, it is now mandatory for anyone leaving their homes to wear a mask. Many people have already been wearing masks for some time in a bid to protect themselves and others from C19. Evidence has shown masks likely do reduce the spread of C19, so wearing them is a good thing – particularly as Victoria continues to grapple with a second wave.
But one conversation we’re not having enough is around how to safely dispose of single-use masks. Disposing of used masks or gloves incorrectly could risk spreading the infection they’re designed to protect against.

A convenient choice

While reusable cloth masks are an option if you’ve been able to buy one or even make one yourself, disposable, single-use surgical masks appear to be a popular choice. They provide protection and they’re cheap and convenient.
It’s estimated the global use and disposal of masks and gloves will amount to 129 billion face masks and 65 billion plastic gloves for every month of the C19 pandemic.
The effect on the environment is an important but separate issue to the health risks we’re discussing here.
Alarmingly, from what we’ve observed, people are discarding masks in communal rubbish bins and even leaving them in empty shopping trolleys.
People should know better than to leave used masks lying around. But they can’t be expected not to discard them in public bins when there’s no other option, and when they’re not given any advice on how to dispose of them properly.
Importantly, while there are clear guidelines on the disposal and separation of medical waste within health-care settings, guidelines for disposal of surgical masks in public settings are unclear.
The Victorian government simply advises they be disposed of “responsibly in the rubbish bin,” meaning they will be mixed with ordinary waste.
This is in contrast to personal protective equipment (PPE) used in health-care settings, which is disposed of separately to regular waste, transported to a sealed landfill, and in some cases incinerated.

Why could this be a danger?

We don’t yet know a whole lot about the survival of the coronavirus on textile materials.
One study published in the medical journal The Lancet found no infectious coronavirus could be detected on textile materials after 48 hours.
A review study that looked at the survival of a range of pathogens on textiles found viruses could survive longer than 48 hours, though not as long as bacteria.
Although we need more research on this topic, it seems there is potential for cross-contamination, and therefore possibly C19 infection, from disposed of masks.
In all likelihood, other people, such as supermarket staff collecting trolleys, or waste handlers, will come into contact with discarded masks well within that 48 hour window.
In addition, if the discarded mask is carrying infectious particles, it may be possible for these to cross-contaminate the surfaces they come into contact with, such as shopping trolleys. And we know the coronavirus survives more readily on hard surfaces than porous ones, so this is a worry.

Who needs to act?

This issue is a potential biosecurity concern, and we need segregation of used masks from ordinary waste immediately. We urge attention from the Victorian government and local councils to act on this issue, including in the following ways:
- create general awareness of this problem, potentially by including messaging around how to properly dispose of masks in directives on their use
- install pop-up secured bins in public places such as shopping centers for used masks and gloves
- workers collecting the waste should follow biohazard protocols similar to those used to manage waste collected from health-care settings.

What you can do

In the first instance, please don’t leave your used masks and gloves in a shopping trolley, or lying around anywhere else.
The safest thing to do is to put used masks and gloves into a plastic bag when you take them off, and seal it. Then, when you’re back at home, throw the bag away into a closed bin.
Hopefully, we will have further directions on how to dispose of these items soon.

Source: Single-Use Masks Could Be a Coronavirus Hazard – Here’s What You Need to Know

I. Projections & Our (Possible) Future

1. Covid could become the new common cold

One of the hardest things, for me at least, about the whole C19 period has been coming to terms with the timescale. In March, back when it was all unfolding, it was frankly weird to think that this — the strange new rules on who you can see and when you can leave your house and what life is like now — was going to be how we lived for months. Even four months later, the idea that it’s going to carry on for many more months or a year is kind of difficult to grasp.
But the big hope has always been the vaccine. At some point, we’ll develop a vaccine that works, we’ll build factories that can churn out millions of doses a day, and then we’ll all be set free. That’s the way out. If you’ve been anything like me, you’ve had that as a sort of promised land. I kind of imagine a great hand emerging from a cloud to deliver it, like God in a Terry Gilliam animation, with a plainchant choir singing in the background.
That hope is important, so you may have been alarmed if you read something in the last few days that seemed to say the hope was false: that herd immunity is impossible, and that vaccines won’t work, because immunity to C19 only lasts a few months. “With coronavirus antibodies fading, vaccine hopes fade too,” said one particularly doom-laden headline. “Immunity to the coronavirus may only last a few months,” says another.
This comes off the back of a preprint from scientists at King’s College London, which looked at 64 patients who had had coronavirus (and 30 uninfected controls), and tracked their level of antibodies in the months after infection. It did, indeed, find that in a lot of patients — the ones who’d had a milder case of the disease — the number of antibodies in the blood decline quite quickly.
What that doesn’t mean, necessarily, is that there is no long-term immunity, or that vaccines are pointless, or that our only hope is for treatments. Let me try to explain why.
First, it absolutely is the case that with many coronaviruses, reinfection is possible. (Although we call COVID-19 “the coronavirus”, there are many others. There are four different seasonal coronaviruses that cause the common cold; SARS and MERS, much more severe diseases, were both coronaviruses too.)
With the seasonal cold coronaviruses, says Rupert Beale, group leader at the Crick Institute’s Cell Biology of Infection laboratory, about 90% of people have had at least three of them by adulthood, and will, on average, be reinfected with each of them about once every five years.
Babak Javid, a professor of immunology at the University of California San Francisco, agrees. But both of them make an important point: just because you can be reinfected, doesn’t mean that the reinfection is as bad as the original. Javid says that “the only definitive data we have with immunity and coronaviruses” comes from studies from a few decades ago, so-called “human challenge” studies, in which people were deliberately given the common cold and then their immune responses were tracked.
Crucially, they found that if patients had detectable levels of antibodies before they were given the virus, they were immune. But, as you’d expect, people who didn’t have the antibodies got a cold — and then developed antibodies. The studies found, as with the current coronavirus, that the number of antibodies in the bloodstream then tailed off rapidly.
A year later, the scientists tried infecting them again. They “were virologically affected”, says Javid – that is, if you swabbed them and tested for a virus, you would find it — but “they had no symptoms whatsoever, even in people with no antibody response”. The period in which they were themselves infectious appears to have been much shorter, as well.
Part of what’s going on here is that antibodies are only part of your body’s immune response to infection. Antibodies are proteins that latch onto infectious agents like viruses and bacteria and destroy them; they are produced by cells in your blood called B-cells. The precise shape of an antibody determines whether it will be able to destroy an invader. Very roughly, if an antibody turns out to be effective at killing some virus in your bloodstream, your B-cells will start producing loads more of that antibody to kill the virus. Then those antibodies will hang around in your blood, and your B-cells will “remember” how to make them, so next time the virus turns up, your body will be ready to fight them off.
But there’s more going on. There are also T-cells. Again, very roughly (and with apologies to Dr Beale if I’ve misunderstood his explanation), there are two kinds of T-cell. One helps B-cells produce antibodies. The other, “killer” T-cells, detect the presence of (usually) virus in infected cells of your body, and then kills those cells. They’re important in this story.
“Broadly speaking,” says Beale, “antibodies prevent infection; killer T-cells help you get over disease.” Just like antibodies, killer T-cells have disease-specific responses – if you have one of the common cold coronaviruses, your body will have a T-cell response to that coronavirus.
That is, probably, part of why — even in people who have no detectable antibodies — reinfections are much less severe than first infections. You may not have enough antibodies to prevent you getting the disease in the first place, but you do have the T-cell response to fight it off quickly and easily. It is very possible, says Beale, that that is what will happen with C19. “It’s behaving exactly as you’d expect for a respiratory coronavirus,” he says. Javid points out that in both SARS and MERS there is a very strong T-cell response “even five or 10 years later”.
There’s another point, which is that the tests used to detect antibodies are (deliberately) not very sensitive. The tests are designed to avoid false positives, because telling someone that they’ve had the disease and are immune when they’re not is much more dangerous than telling them that they’re not immune when they are. So the threshold for a “positive” response is quite high.
The necessary tradeoff is that there are more false negatives. By analogy: say you’re trying to decide whether someone is a Terry Pratchett fan. You set up a very simple test: you ask them “how many Terry Pratchett books have you read?” Then you set a minimum threshold.
If you set the threshold very low, say one or two, you’ll accurately identify all the fans, but you will also let in a lot of non-fans who just happen to have read Good Omens. Whereas if you set it very high, say 15, you’ll accurately weed out all the non-fans, but you might miss out on loads of real fans who are still working their way through the Discworld series for the first time. This is a zero-sum game: setting your threshold higher means more false negatives; setting it lower means more false positives. It’s unavoidable.
The same goes on with antibody tests. If you want to be more sensitive (get fewer false negatives), you can lower your threshold, but that means you’ll have more false positives; if you want to be more specific (fewer false positives), you raise your threshold, but that means you’ll have more false negatives. Unless you develop a new and better test, there is no third option, The tests have usually gone for specificity, rather than sensitivity.
That’s probably wise, but it presents a problem in that even very low levels of antibodies may offer protection. “In some monkey studies where they re-challenged,” says Javid — meaning giving the virus to monkeys who’d already had it — “very very low levels of antibodies were protective.” A lot of the tests use cut-offs that are higher, he says, “than what animal studies say are protective”.
All that said, it probably is the case that people who’ve had milder cases will have antibody responses that wane quite quickly, in months rather than years, according to both Javid and Beale.
It’s important to say that this doesn’t mean that vaccines won’t work. For one thing, says Javid, vaccine immune responses are “both qualitatively and quantitatively different” from immune responses to natural infection, when it comes to both antibodies and T-cells. That’s not a good thing or a bad thing, necessarily; it could be either, and “there’s no way to tell a priori”. But it does mean that it’s perfectly possible that natural infection could cause this tailed-off antibody response, while a vaccine has a more long-lasting one; or it could be the other way around. Or they could be largely the same. We’ll just have to wait and see, although the early noises from Oxford and elsewhere seem largely optimistic.
What it probably does mean, according to Beale, is that the most likely outcome is that C19 becomes “the fifth seasonal coronavirus”. Assuming that a mild case of the disease only sparks a relatively short-term immunity, but that reinfection with the virus is far less dangerous because of the T-cell response (or whatever else is going on), then once everyone’s immune system is prepared for it, as with the common cold coronaviruses, we could see it going around as an inconvenient but not devastating seasonal illness. “If you’re vaccinated or infected, then it’ll be much less severe,” he predicts. “I’ll be genuinely surprised if that’s not where we end up.”
(He notes, however, that he has been genuinely surprised once already by C19, specifically by the effectiveness of the drug dexamethasone in treating it. It’s still a novel disease and we shouldn’t get complacent that we know everything about it.)
Javid agrees. “This was predictable,” he says. “We kind of knew this was going to be the case months ago, it’s just that now we’ve had long enough to check.”
Even if we don’t ever eradicate the disease, we will probably end up in a place where we can live with it. In the meantime, though, it’s still absolutely crucial that we control the disease. Beale in particular says that “policy-wise, it’d be completely insane to let it get out of control now,” because “by this time next year” it’s likely that we will have an effective and widely available vaccine. “Better to lock down even at considerable economic cost and wait for that,” he says, although he acknowledges the calculus changes if the vaccine will be much longer coming.
Javid adds that “As with everything Covid, it’s going to come down to how well we protect our vulnerable population,” which in the UK at least isn’t something we’ve conspicuously excelled at.
So there’s no need to panic; it seems to be unfolding as expected. I don’t want to be too harsh on anyone for the perhaps over-alarmist reporting; science writing in a fast-moving pandemic is bloody hard (I’ve discovered). But, so far, at least, I don’t think we need to start worrying that vaccines won’t work or that we’ll all be getting a life-threatening course of C19 every calendar year. The hope that we’ll get out of this in a reasonable timescale, and life will return to something relatively normal before we’re all too old to enjoy it, is still very much there.

Source: Covid could become the new common cold

2. Reducing Wildlife Trafficking and Forest Loss Could Prevent Future Pandemics

Governments might be able to prevent future pandemics by investing as little as $22 billion a year in programs to curb wildlife trafficking and stem the destruction of tropical forests, a new analysis by an international team of scientists and economists shows.
Compared to the $2.6 trillion already lost to C19, and the more than 600,000 deaths the virus has caused so far, that annual investment represents an exceptional value, the experts argue.
They estimate that the total cost, in current dollars, of the preventive measures they recommend over the next 10 years is only about 2% of the estimated eventual costs of the C19 pandemic, which some economists predict could top $5 to 15 trillion.
The team, which was led by scientists at Princeton and Duke universities, published its peer-reviewed analysis July 24 in Science.
In their paper, the experts note that C19, SERS, HIV, Ebola and other viruses that have spread from animal hosts to humans over the last century have been linked to close contact between people and live primates, bats or other wildlife. In some cases, the animals have infected humans directly; in others, the route of infection has been indirect, through livestock the humans ate.
The paper’s authors also note that locations near the edges of tropical forests where more than 25% of the original forest has been lost tend to be hotbeds for these animal-to-human virus transmissions. For example, bats, which are the probable reservoirs of Ebola, SARS and the virus behind C19, are more likely to feed near human settlements when their original forest habitats are disturbed by road building, logging or other human activities. This has been a key factor in the emergence of viral outbreaks in West Africa, Malaysia, Bangladesh and Australia, said Andrew Dobson, professor of ecology and evolutionary biology at Princeton.
Wildlife markets and the legal and illegal trade of wildlife for pets, meat or medicine add to these risks by bringing humans into close – and often poorly regulated – contact with animals that may carry a virus, said Stuart Pimm, Doris Duke Professor of Conservation Ecology at Duke..
“Surprise, surprise, wild animals can harbor a lot of nasty things,” Pimm said. “The good news is, by investing between $22 and $31 billion dollars a year in programs to monitor and police the wildlife trade and curb tropical deforestation, we could stop future pandemics before they start and substantially reduce the odds of having something like C19 happen again.”
Dobson and Pimm’s co-authors on the new analysis included environmental and medical scientists, economists and conservation practitioners from 14 institutions or nonprofits.
Their recommendations, which are summarized in the paper, include spending about $500 million a year to expand and enhance wildlife-trade monitoring programs and technologies. Currently, the organization charged with this task, the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES), has a net annual worldwide budget of just $6 million, and many of its 183 signatory countries are several years in arrears with their payments. Aside from bolstering the organization’s effectiveness, the added dollars would enable the use of regional and national groups to augment CITES’ efforts.
Other recommendations made in the paper are:
- Investing between $217 and $279 million annually on early detection and control measures. This includes the creation of a library of virus genetics that could be used to pinpoint the source of a newly emerging pathogen early enough to slow or stop its spread, and, ultimately, help speed the development of serology tests to monitor future outbreaks and vaccines to help prevent them.
- Investing more than $19 billion each year on programs to end the wild meat trade in Chins and educate consumers and hunters about its potential risks.
- Investing up to $9.6 billion a year on programs and policies that would reduce tropical deforestation by 40%.
- Allocating up to $852 million a year to reduce viral spillovers, or inter-species transmissions, in livestock.
Co-authors of the new study hail from Conservation International; the University of California-Santa Barbara; Boston University; Arizona State University; the University of Illinois at Urbana-Champaign; Harvard University; Earth Innovation Institute; EcoHealth Alliance; the University of Wisconsin-Madison; and World Wildlife Fund International. Duke Kunshan University; Rice University; George Mason University; the Safina Center; and Federal University of Rio de Janeiro.

Citation: “Ecology and Economics for Pandemic Prevention,” Andrew P. Dobson, Stuart Pimm, Lee Hannah, Les Kaufman, Jorge A. Ahumada, Amy W. Ando, Aaron Bernstein, Jonah Busch, Peter Daszak, Jens Engelmann, Margaret Kinnaird, Binbin Li, Ted Loch-Temzelides, Thomas Lovejoy, Katarzyna Nowak, Patrick Roehrdanz,and Mariana M. Vale; Science, July 24, 2020. DOI: 10.1126/science.abc3189

J. Practical Tips & Other Useful Information

1. Homemade C19 Face Masks Likely Need at Least 2 Layers to Be Effective – 3 Layers Is Better

Home-made cloth face masks likely need a minimum of two layers, and preferably three, to prevent the dispersal of viral droplets from the nose and mouth that are associated with the spread of C19, indicates a video case study published online in the journal Thorax.
Viral droplets are generated during coughing, sneezing, or speaking. And face masks are thought to protect healthy people from inhaling infectious droplets as well as reducing the spread from those who are already infected.
But worldwide shortages of personal protective equipment during the pandemic have led some health agencies, such as the CDC, to recommend the use of home-made cloth face coverings as an alternative to surgical face masks.
Several types of material have been suggested for these, but based on little or no evidence of how well they work.
A team of Australian researchers therefore compared the effectiveness of single and double-layer cloth face coverings (175 g/m² cotton fabric, with a thread count of 170/ inch) with a 3-ply surgical face mask (Bao Thach) at reducing droplet spread.
The single layer covering was made from a folded piece of cotton T shirt and hair ties; the double layer covering was made using the sew method, as set out by CDC.
The researchers used a tailored LED lighting system and a high-speed camera to film the dispersal of airborne droplets produced by a healthy person with no respiratory infection, during speaking, coughing, and sneezing while wearing each type of mask.
The video recording showed that the 3-ply surgical face mask was the most effective at reducing airborne droplet dispersal, although even a single layer cloth face covering reduced the droplet spread from speaking.
But a double layer covering was better than a single layer in reducing the droplet spread from coughing and sneezing, the recording showed.
This is just one case, added to which several other factors contribute to the effectiveness of cloth face masks, note the researchers. These include the type of material used, design and fit, as well as the frequency of washing.
Nevertheless, based on their observations, a home made cloth mask with at least two layers is preferable to a single layer mask, they say, adding: “Guidelines on home-made cloth masks should stipulate multiple layers.”
And they emphasize: “There is a need for more evidence to inform safer cloth mask design, and countries should ensure adequate manufacturing or procurement of surgical masks.”

Source: Homemade COVID-19 Face Masks Likely Need at Least 2 Layers to Be Effective – 3 Layers Is Better

K. Silver Linings

1. C19 Measures Have All but Wiped Out the Flu in the Southern Hemisphere

For the past two months, as winter descended on Chile, infectious-disease specialist Claudia Cortés worked tirelessly to keep a wave of critically ill C19 patients alive in the hospital where she works. At the same time, she worried about what would happen when the usual wave of influenza patients arrived.

They never came

From Argentina to South Africa to New Zealand, countries in the Southern Hemisphere are reporting far lower numbers of influenza and other seasonal respiratory viral infections this year. In some countries, the flu seems to have all but disappeared, a surprise silver lining that health experts attribute to measures to corral the coronavirus, like mask use and restrictions on air travel.
The decline could be good news for health officials in the U.S. and Europe worried about a possible second wave of coronavirus infections this fall and winter. Not only is the coronavirus more likely to spread as people gather indoors during cold weather, but it is also flu season, meaning hospitals could get a double whammy of influenza and C19 patients, both of whom sometimes require intensive-care treatment.

Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, has warned that the fall and winter could see both respiratory epidemics—C19 and seasonal influenza—circulating side by side, overwhelming hospitals.
“I do think the fall and winter of 2020 and 2021 are going to be probably one of the most difficult times that we’ve experienced in American public health,” Dr. Redfield told the Journal of the American Medical Association in early July.
But the news from the Southern Hemisphere offers some hope. The decline isn’t just for flu, but for other respiratory viruses as well, such as respiratory syncytial virus, which largely affects children, and pneumococcal disease.
“We keep checking for the other viruses, but all we’re seeing is Covid,” said Dr. Cortés, the Chilean doctor. Of roughly 1,300 C19 patients she has treated since late March, only a handful had the flu. “We were surprised by the decline in the other viruses like influenza. We never dreamed it would practically disappear,” she said.
Chile has recorded only 1,134 seasonal respiratory infections so far this year, compared with 20,949 during the same period last year. In the first two weeks of July—the equivalent to early January in the Northern Hemisphere and the height of the local flu season—the country reported no new confirmed influenza cases.

In the last two weeks of June, Australia registered only 85 new laboratory-confirmed influenza cases, compared with 22,047 confirmed cases for the two weeks through June 30 a year earlier, according to Australia’s National Notifiable Diseases Surveillance System.
In New Zealand, there are fewer hospitalizations than normal at this time of year, and the death rate has fallen.
“This [decline of other respiratory viruses] surprised me,” said Dr. Sylvain Aldighieri, deputy director of the Department of Health Emergencies at the Pan American Health Organization, the Western Hemisphere arm of the World Health Organization. “We were expecting a double burden of cases, because in countries like Chile and Argentina, the flu winter epidemic places a high burden on health-care services.”
Dr. Aldighieri, however, warned that without the strict containment measures taken by Southern Hemisphere countries, influenza would probably have returned as usual. He said hospitals and doctors in the U.S. and Europe should prepare for a normal flu season as their economies reopen and restrictions are lifted.

Taming of the Flu

The Northern Hemisphere’s influenza season can stretch from October to May. But by March of this year, with Covid lockdowns in place in many countries, flu cases fell dramatically. The Southern Hemisphere is now seeing a similar drop-off in what is normally its peak flu season.
Many Southern Hemisphere countries took a range of steps to contain the coronavirus. Argentina, South Africa and New Zealand imposed strict lockdowns, while Australia allowed some businesses to stay open but restricted many others. Most countries banned large gatherings and closed schools, while citizens adopted frequent hand-washing, social distancing and wearing masks.
Restricting incoming air travel helped Southern Hemisphere countries block one traditional source of infection: travelers arriving from the Northern Hemisphere at the end of the northern flu season in March and April. Those travelers could infect people in the south, where it would spread as the weather chilled. Countries including Chile, Argentina, Australia and New Zealand have barred international arrivals since March.
“Strict border restrictions and alert-level-based response including social-distancing measures has had an impact,” said Dr. Sarah Jefferies, a public-health physician at New Zealand’s Institute of Environmental Science and Research, which monitors flu trends and provides data to the WHO.
Since the U.S. and Europe haven’t restricted international travel nearly as much, they will be more prone to having travelers import the flu, said Dr. Aldighieri.
Richard Medlicott, a general medical practitioner in a suburb of the New Zealand capital of Wellington, estimated the number of influenza patients had dropped at his clinic by 90% compared with last winter. For all types of respiratory illness the decline was about 60%, he said.
Dr. Medlicott said one big factor was having schools and child-care centers closed. “Children are the main reservoir [of these viruses],” he said. “They haven’t been at child care and that has meant they’ve had less chance to spread it in the community.”
Habits intensified by the pandemic such as hand washing and new behaviors such as coughing into the elbow also helped contain the spread of flu and other respiratory diseases, he said.
Some of these behaviors are likely to stick. Combined with increased use of medical consultations by video—away from doctors offices and hospitals where germs are prevalent—that could suppress the flu in subsequent years, said Dr. Medlicott, a former medical director of the Royal New Zealand College of General Practitioners.
Stepped-up vaccination for flu since the coronavirus pandemic began has also likely helped. Countries including Australia and Chile report far higher rates of vaccination than in previous years, as fears of coronavirus prompted elderly and other at-risk people to get the shots.
Evidence that steps like social distancing also slowed other respiratory viruses first emerged in the Northern Hemisphere in March, when the traditional flu season ended earlier than expected in countries ranging from Japan to the U.S.
In Australia, influenza cases usually begin rising in March, April and May. Then, in June, “things really start to get going,” said Professor Ian Barr, deputy director of the WHO Collaborating Centre for Reference and Research on Influenza at the Doherty Institute for Infection and Immunity, a nonprofit research center in Melbourne.
But instead, the number of influenza cases has tapered off, from around 15% of the five-year average in March to just 4% of the five-year average in June, he said. In Australia, confirmed flu cases plunged 84% to 20,739 from the beginning of January to June 30, compared with 132,424 during the same period the previous year.
Dr. Rod Pearce, an Australia-based general practitioner who also works at a C19 testing clinic near Adelaide, said his clinic has found only one positive flu case out of around 1,000 tests done so far.
In Argentina, the number of laboratory-confirmed flu cases fell 64% to 151,189 from January through early July, compared with an average of 420,737 during the same period the previous five years, according to government figures.
“Covid has displaced all the other viruses, which makes me certain that it is far more transmissible,” said Dr. Gustavo Lopardo, an infectious-disease specialist and professor at the University of Buenos Aires.
Even in countries that have struggled to contain the virus, like Brazil, the winter flu season was far more mild. Brazil has had more than 80,000 coronavirus-related deaths, but saw flu cases fall by about 40% and flu deaths by half.
In South Africa, which has been under a strict lockdown for three months, there were never enough flu cases to say a seasonal epidemic had begun, say doctors there.
“We are certainly pushing the bounds of when it should have started now so I think it’s correct to assume that this is a real phenomenon,” said Richard Lessells, an infectious-disease specialist at the University of KwaZulu-Natal.
The country of 60 million people usually sees some 50,000 severe flu cases a year, leading to around 12,000 deaths. Dr. Lessells said the low number of flu infections this year was likely due to steps to prevent the spread of the coronavirus and a government push for people to get the flu vaccine.
New Zealand’s flu-surveillance program indicates only 0.7% of the population had influenza-like symptoms such as fever and cough in the first week of July, a fraction of the 3.0% to 4.3% range for the previous two years in June and July. The decline has meant lower than normal hospitalizations overall, even with coronavirus patients counted.
In the Auckland region, the weekly hospitalization rate was down to two people per 100,000 by mid-July compared with the long-term average of 8.5 for this time of year. It is also the lowest since a tracking program for acute respiratory infections began in the Auckland region in 2012.
For influenza itself, there have been zero hospitalizations in the Auckland region—home to a third of New Zealanders—since late March.
Deaths have also fallen, by about 5% in the first half of the year compared with the previous year and are also down from 2018 and 2017. Researchers at the University of Otago said the reduced deaths are “unlikely to be a chance finding” and could be linked to several factors stemming from the lockdown, including lower levels of respiratory illness, fewer road crashes, reduced air pollution and a decline in fatal work accidents.
However, the researchers said it is possible deaths will rebound later on due to factors such as delayed cancer treatment and higher unemployment, which is associated with increased suicide and cardiovascular disease.
And in New Zealand, which has lifted virtually all coronavirus restrictions, Dr. Jefferies cautioned that there were still a few more months of winter and spring left and that greater economic activity could lead to an uptick in influenza in coming months, especially if people get careless about social distancing.

Source: Covid-19 Measures Have All but Wiped Out the Flu in the Southern Hemisphere

L. Johns Hopkins COVID-19 Update

July 24, 2020

1. Numbers & Trends

Overview

The WHO COVID-19 Situation Report for July 23 reports 15.01 million cases (247,225 new) and 619,150 deaths (7,097 new). This is the second highest global daily total to date, and it is 21,044 more new cases than the same day the previous week (226,181 cases on July 16). Based on this trend, we expect the WHO to report record high global incidence today and/or tomorrow.

Central & South America

After recent data indicated that it was reaching a peak or plateau, Brazil reported its 2 highest daily totals over the past 2 days—67,860 and 59,961 new cases, respectively. These are considerably higher than the highest days in recent weeks, which were consistently around 45-46,000 new cases. Brazil remains #3 globally in terms of daily incidence, but it closed the gap with India. Colombia reported 7,945 new cases, its fourth highest daily incidence to date. Colombia is currently #5 globally with respect to daily incidence. Mexico reported 8,438 new cases, its highest daily incidence to date. Mexico is #6 globally in terms of daily incidence. Broadly, the Central and South American regions remain 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 Argentina (#8) and Peru (#9). Multiple other countries in the region are reporting more than 1,000 new cases per day. Additionally, the region includes 4 of the top 10 countries in terms of per capita daily incidence—Panama (#3), the US (#5), Brazil (#8), Colombia (#9)—and a number of other countries are reporting more than 100 new daily cases per million population.

India & Bangladesh

India reported nearly 50,000 new cases, doubling its daily incidence since July 9. India remains #2 globally in terms of daily incidence. Bangladesh continues to report slowly decreasing daily incidence; however, it is also reporting decreased testing while its test positivity remains steady, slightly above 20%. This could indicate that Bangladesh’s decreased incidence could be driven more by reduced testing than slowing transmission. Bangladesh remains #10 globally in terms of daily incidence.

South Africa

South Africa reported 13,104 new cases, and it remains among the top countries globally in terms of both per capita (#4) 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. Oman is currently the only country averaging more than 250 new cases daily per million population*. The region represents 4 of the top 12 countries globally—Oman (#1), Bahrain (#2), Kuwait (#11), and Qatar (#12). Nearby Israel (#6) and Armenia (#10), both in the WHO’s European region, are among the top countries globally as well. While no countries in the region are in the top 10 in terms of total daily incidence, many are reporting more than 1,000 new cases per day.

Russia

Russia continues to report steadily declining daily incidence, but it remains #7 globally. Luxembourg is #7 globally in terms of per capita daily incidence.

United States

The US CDC reported 3.95 million total cases (70,106 new) and 142,755 deaths (1,078 new). On July 22, the CDC reported more than 1,000 deaths for the first time since early June, and it has now exceeded that threshold for the second consecutive day. The US could potentially surpass 150,000 deaths by the end of next week. Additionally, both of the last 2 updates exceeded the daily incidence for the corresponding day from the previous week by more than 2,000 cases. The 7-day average daily incidence is 66,920 cases, the country’s highest to date, indicating that daily incidence continues to increase, even if it is potentially beginning to level off.

More than half of US states have reported more than 40,000 total cases, including California and New York with more than 400,000 cases; Florida and Texas with more than 350,000; and 8 additional states with more than 100,000. The US fell to #5 globally in terms of per capita daily incidence, but it remains #1 in terms of total daily incidence.

We expect the US to surpass 4 million cumulative cases in this afternoon’s update. From the first case reported in the US on January 22, it took 81 days to reach 500,000 cases and 98 total days to reach 1 million cases. From there:
- 1 million to 2 million cases: 44 days
- 2 million to 3 million cases: 27 days
- 3 million to 4 million cases: 14 days

California (425,616 cases) surpassed New York (410,450 cases) to become #1 in the US in terms of cumulative C19 incidence. With an average daily incidence of more than 11,000 cases, we expect Florida (402,312 cases) to surpass New York today, and with approximately 10,000 new cases per day, Texas (361,125 cases) could surpass New York by the middle-to-end of next week. California (nearly 10,000 new cases per day) could surpass 500,000 cumulative cases by the end of next week.

The Johns Hopkins CSSE dashboard reported 4.06 million US cases and 144,552 deaths as of 12:30 pm on July 24.

2. NIH Clinical Trials

The US NIH is initiating several clinical trials as part of the Accelerating C19 Therapeutic Interventions and Vaccines (ACTIV) public-private partnership. Initiated on April 17, the goal of this effort is to develop a coordinated research strategy to speed up the development of C19 candidate pharmaceuticals. ACTIV has 4 fast-track areas of focus, including pre-clinical treatments, accelerating clinical testing for vaccines and treatments, improving clinical trial capacity, and accelerating evaluation of vaccine candidates. The new trials include antiviral monoclonal antibodies, for both hospitalized and at-home patients; drugs to reduce dangerous inflammatory responses to C19; and drugs to treat blood clotting. A principal goal of the program is to ensure coordinated and standardized protocols and study designs across multiple testing sites in order to promote robust analyses. More than 1,200 clinical trials have been registered with the US government for C19 drugs, and nearly 40% of them involved fewer than 100 patients. This disorganized approach likely will not yield robust data to support effective analysis of many candidate drugs, and ACTIV aims to improve consistency and coordination nationwide.

NIH Director Dr. Francis Collins and several NIH colleagues published a special report in The New England Journal of Medicine that outlined the Rapid Acceleration of Diagnostics program (RADx), led by NIH in partnership with other US government entities, including the Biomedical Advanced Research and Development Authority (BARDA) and the Department of Defense. RADx was conceived to support rapid development and production of novel diagnostics, including the use of “innovative diagnostic technologies.” Perhaps most notably, it is “expressly focused on health disparities,” rather than purely technical challenges. The program includes 4 principal components, each with a specific focus. Three of the components focus on technical aspects of product research, development, and production, and the fourth is dedicated to improving equity among underserved populations. Racial and ethnic minorities are disproportionately affected by C19, and this component, RADx-UP, aims to characterize the factors driving this elevated burden and improve access to testing among high-risk populations, including through community engagement activities.

3. US C19 Resurgence

The US continues to battle a resurgence of C19, driven largely by states that were not severely affected early in the US epidemic. As noted above, the US reported 1 million cases over the past 2 weeks alone, and numerous states are exhibiting concerning trends. Current data indicate stark regional differences in the severity of the current C19 resurgence. States in the Northeast, including New England and the Mid-Atlantic region—particularly the northern portion, including Connecticut, New Jersey, and New York—appear to be faring considerably better than the South, Southwest, West, and Midwest. These differences are evident across all major indicators, including incidence, mortality, test positivity, and hospitalizations.

Increasing C19 hospitalizations, in particular, have garnered considerable attention, following reports that hospitals and health systems are struggling to meet the C19 patient surge. Newly published data from HHS shows multiple states in these severely affected regions reporting more than 25% of inpatient hospital beds currently occupied by C19 patients, including Arizona, California, Georgia, New Mexico, and Texas. Several other states in the South, Southwest, and West—including Alabama, Arkansas, Louisiana, Mississippi, Nevada, and South Carolina—are reporting that more than 15% of inpatient beds are occupied by C19 patients. Additionally, analysis from the COVID Tracking Project indicates that national C19 hospitalizations are now equal to the country’s first peak in mid-April. In the first peak, C19 cases were largely concentrated in a few major metropolitan areas—including Boston, Detroit, and New York—and overwhelmed local health systems, which accounts, to some degree, for the higher per capita incidence in these areas. Now, the cases are spread out across a much larger geographic area and population, and more hospitals and health systems, and the overall mortality is lower than it was early in the US epidemic (although beginning to increase again). If continued uncontrolled transmission continues, however, it could necessitate spreading limited health resources (eg, mechanical ventilators, investigational treatment drugs) more thinly across the country, which could exacerbate recent increases in mortality. Statistically speaking, some portion of hospitalized patients are expected to die from C19, so as hospitalizations increase, so will C19 mortality, particularly if available resources are exhausted.

These state- and regional-level disparities have driven a number of states to implement domestic travel advisories or restrictions. Some states require arriving travelers to be tested for SARS-CoV-2 and/or provide documentation of a recent negative test, and some require or recommend self-quarantine, typically for 14 days. Some of these requirements pertain to specific states, and others are broadly applied to all out-of-state travelers. Connecticut, New Jersey, and New York previously implemented a joint policy that requires travelers arriving from severely affected states to quarantine themselves for 14 days upon arrival. The initial list was relatively limited, with only 9 affected states; however, it has ballooned to more than 30 states, covering approximately two-thirds of the entire US population. Additionally, the Ohio Department of Health issued a similar travel advisory for any state reporting test positivity of 15% or greater. The new Ohio policy currently covers 9 states. The Ohio Department of Health recommends 14-day self-quarantine and temperature/symptom monitoring for individuals with recent travel to the affected states, but it does not appear to be mandatory. Interestingly, it appears that Florida’s mandatory quarantine for travelers arriving from the New York tri-state area, implemented earlier in the US epidemic, remains in effect, despite the fact that Florida is currently reporting more than 11 times the combined daily incidence of New York, New Jersey, and Connecticut.

In response to surging C19 incidence in Florida, US President Donald Trump announced that activities for the Republican National Convention scheduled in Jacksonville will be cancelled. Some convention activities were originally moved from Charlotte, North Carolina, after disagreements regarding the state’s restrictions on large gatherings; however, Republican delegates will reportedly still meet in Charlotte to announce President Trump as the Republican nominee for the 2020 presidential election.

4. International C19 Resurgence

In addition to the US, some other countries are beginning to experience their own C19 resurgence. Many countries are still experiencing the effects of their initial wave of transmission; however, some countries that previously contained their epidemic are now facing increased transmission, some on a national scale and others more localized. Both Tokyo, Japan, and Melbourne, Australia, are reporting major outbreaks, which have resulted in the need to re-institute some social distancing restrictions—although not to the level of full “lockdown.” Spain, one of the most severely affected countries early in the pandemic is now exhibiting increased transmission again, following the relaxation of nationwide social distancing policies. These increases are much smaller than those observed in the US, but they are concerning nonetheless. In the absence of a vaccine, any increase in social contact will result in increased transmission, so it is likely that we will continue to observe this trend as national, regional, and local governments attempt to strike the right balance between C19 risk and economic and social benefits.

Despite early success in containing its C19 epidemic, South Africa has also recently exhibited a resurgence of C19. Notably, South Africa is reporting an increase in excess all-cause mortality, which could potentially be the result of redirecting healthcare resources and services toward the C19 response. While the country’s C19 deaths now exceed 6,000, excess deaths related to natural causes have surpassed 17,000. South Africa accounts for more than half of all C19 cases on the African continent. With the surge in C19 incidence, South African President Cyril Ramaphosa decided to close schools for several weeks. President Ramaphosa also implemented a temporary ban on alcohol sales and a mandatory curfew in the hopes that a decrease in alcohol-related incidents will make more hospital beds available for C19 patients and others. Many hospitals in highly populated areas are already reaching their capacity, and oxygen supplies running low.

5. US Economic Stimulus

The US government continues to evaluate options for a possible “Phase 5” C19 funding bill, but considerable uncertainty remains regarding the content and timeline. Senate Majority Leader Mitch McConnell was expected to release a draft bill this week as a starting point for debate in the Senate, but it appears that it may be delayed until at least next week as details are finalized. The funding bill could potentially provide support for hospitals and health systems and state and local governments as well as individuals. Individual stimulus payments and expanded federal unemployment benefits are among a long list of high-profile priorities. A report by The Hill indicates that the Senate bill is expected to include similar stimulus payments as the previous phase of funding, possibly US$1,200 per person for everyone with an annual income of $75,000 or less. Senator McConnell previously suggested that the income cap could be lowered for this round to US$40,000, but there are indications that this may have changed.

Considering that the current expanded federal unemployment insurance, an extra US$600 per week, is scheduled to expire next week, it is possible that individuals receiving those benefits could lose that additional funding for a period of weeks while a bill is finalized and implemented. It is unclear if any temporary measures are being evaluated to prevent these payments from lapsing. The Senate bill will reportedly not include a payroll tax cut for businesses, previously a priority for President Trump, following opposition from Republican Senators. Again, these negotiations are ongoing, and the Senate draft has yet to be finalized and released. The House of Representatives passed its own funding bill several weeks ago, but there will likely be substantial differences between the House and Senate proposals. There appears to be pressure to reach an agreement soon in order to provide economic support as states continue to maintain, and in some cases strengthen, social distancing policies, but the exact path forward is not clear at this time.

6. Safer Neutralization Assay

There are many different kinds of SARS-CoV-2 serological tests, all of which detect the presence of immune response to previous SARS-CoV-2 infection. Neutralization assays detect neutralizing antibodies, or antibodies that correspond to protective immunity. Because neutralization assays require live virus in order to challenge the patient’s antibodies in culture, most of these tests must be performed in high-containment laboratory settings. High-containment laboratories are less common than those operating under lower biosafety levels, so critical research on protective immunity via neutralizing antibodies has been slow.

A study published in Nature presents a surrogate viral neutralization test (sVNT) that can be performed at the BSL-2 level, as opposed to the BSL-3 level. In the sVNT protocol, conjugated SARS-CoV-2 receptor binding domain and patient blood serum are added to an ELISA plate coated in human ACE-2 receptor. If the patient serum contains neutralizing antibodies, they will block the binding action of the receptor binding domain to the human ACE-2 receptor, which can be quantified using indirect ELISA techniques. The researchers demonstrated that the sVNT protocol exhibited high correlation with results obtained from conventional VNT and pseudovirus VNT techniques. This assay and others like it could accelerate research on protective immunity as the pandemic progresses by allowing it to be conducted in more laboratories and at lower biosafety levels.

7. C19 in Refugee Populations

As the C19 pandemic continues, it is clear that some populations are at elevated risk of infection, severe disease, and death, in particular, racial and ethnic minorities. Refugee populations face even greater risk, stemming from conditions in densely populated refugee camps, barriers to accessing health services (including investigational treatment drugs), pre-existing health conditions and poor nutrition, other communicable disease risks (eg, cholera), and limited access to reliable infrastructure like clean water. Additionally, the pandemic is limiting international aid for these populations, as donor countries focus resources domestically to control their own epidemics. Reduced humanitarian aid, including for routine immunizations, can compound the health impact of C19, especially for children, who suffer most during humanitarian crises. Experts at Johns Hopkins University will host a webinar on July 29 (1pm EDT/5pm GMT) to discuss the impact that C19 is having on refugee populations and the response efforts needed to protect children, including through routine immunizations and a potential C19 vaccine. The speakers will include Dr. Shaun Truelove from the Johns Hopkins International Vaccine Access Center and Dr. Paul Spiegel, Director of the Johns Hopkins Center for Humanitarian Health. Advance registration is required to participate.