Recent Developments & Information
July 28, 2020
Without reliable information, we rely on fear or luck.
New Tool For Assessing Risk of Infection:
New Tool for Assessing Risk of Infection
New data from the City Health Dashboard, a project run by New York University Langone Health, shows how drastically the risk of C19 infection can vary from neighborhood to neighborhood within the same city. The Dashboard, which has data on in 500+ cities, provides the risk of a city and the neighborhoods in that city, as well as the average level of risk for neighborhoods in the 500 largest cities. The risk level of your city/neighborhood can be found at https://www.cityhealthdashboard.com/. [Note: We think the Dashboard is worth looking at. Surprisingly (to me), NYC currently has an average higher risk level than the city average, but my neighborhood has a lower level of risk than NYC and the city average, but some neighborhoods in NYC remain at very high risk.]
Adults interested in participating in the Moderna vaccine trial can visit coronaviruspreventionnetwork.org.
A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
C. New Scientific Findings & Research
1. Can masks work both ways?
6. Recovery of Patients Not Requiring Hospitalization
D. Improved & Potential Treatments
3. The Race for a C19 Vaccine Is Headed Into Its Final Laps
E. Concerns & Unknowns
F. The Road Back?
G. Back To School!?
H. Projections & Our (Possible) Future
I. Practical Tips & Other Useful Information
1. Giving Convalescent Plasma
J. Johns Hopkins COVID-19 Update (7/27)
K. Links to Other Stories
- Hospitalized C19 Patients Have Low Risk of Stroke Penn study suggests ischemic stroke likely due to existing risk factors, rather than C19
- Low vitamin D level associated with increased risk of C19 infection There is a significant association of low plasma vitamin D level with the likelihood of C19 infection among patients tested for C19, even after
- Risk, uncertainty and fear of failure: Why scientists aren’t celebrating a coronavirus vaccine yet Scientific community wrestling with how to deal with both public hesitancy and overblown expectations for a potential jab.
- Yale to lead trial of potential C19 treatment Yale School of Medicine and the biopharmaceutical firm AI Therapeutics have launched a multi-institutional clinical trial of a drug for treating C19. The drug has a proven safety record. Preliminary research has shown it can block cellular entry and trafficking of the coronavirus.
- FDA Authorizes First Diagnostic Test for Screening of People Without Known or Suspected COVID-19 Infection FDA reissued an emergency use authorization to include testing for people who do not have C19 symptoms or who have no reason to suspect C19 infection, and to allow pooled sample testing.
- Estimated County-Level Prevalence of Selected Underlying Medical Conditions Associated with Increased Risk for Severe C19 Illness Three recent studies have reported that underlying medical conditions are highly prevalent among U.S. C19 patients requiring hospitalization and ICU admission. The median county prevalence of any of 5 underlying medical conditions that increase the risk for severe C19 associated illness was 47.2%, and prevalences were higher in counties in the southeastern US and in more rural counties.
- Celltrion launches human clinical trials of potential C19 antibody treatment South Korean biopharma giant Celltrion has launched phase 1 clinical trials of a potential antiviral antibody treatment for C19. The clinical study follows promising preclinical results for the virus treatment candidate and has received approval from the Korean Ministry of Food and Drug Safety.
- Dogs can identify COVID-19 patients Trained detection dogs can identify respiratory secretion samples from hospitalized and clinically diseased coronavirus infected individuals. This data may form the basis for the reliable screening method of coronavirus infected people.
- Robots that kill viruses in 10 minutes unleashed in hospitals for Covid-19 fight The £71,000 roaming robots are the latest cutting edge technology to be employed by the frontline in the Covid-19 battle. The huge wheeling machines will be vital according to NHS nurses.
- Non-neuronal expression of coronavirus entry genes in the olfaory system suggests mechanisms underlying C19-associated anosmia
- Can The Coronavirus Be Transmitted by Mosquitoes? A new study is the first to confirm that coronavirus cannot be transmitted to people by mosquitoes.
- Luck? Genetics? Italian island spared from COVID outbreak Researchers are trying to determine why none of Giglio Island and its 800+ inhabitants never determined any C19 symptoms even though the conditions seemed favorable for the disease to spread like wildfire.
- Can Covid Spread With Air Conditioning? HVAC Makers Plan Upgrades With research showing the coronavirus may spread through shared air, property managers are rushing to upgrade heating, ventilation and air conditioning systems before reopening buildings. That’s leading to costly upgrades for equipment that armies of professionals used to take for granted.
- You Can Stop Cleaning Your Mail Now People are power scrubbing their way to a false sense of security
A. The Pandemic As Seen Through Headlines
(In no particular order)
- Coronavirus Is Back With a Vengeance in Places Where It Had All but Vanished
- White House Chief of Staff: New COVID-19 treatments may be days away
- More than 150 vaccine candidates are in trials around the world
- Scientists are 3-D printing miniature human organs to test coronavirus drugs
- Virus Can Travel 26 Feet at Cold Meat Plants With Stale Air
- New COVID-19 cases hit record highs in more than a dozen states while Texas, Florida, Arizona and California finally start to plateau
- Dr. Birx urges regions with rising infections to close bars, cut back on indoor dining and to mandate face masks
- Health and Human Services Secretary Alex Azar says the leveling off of cases in the hotspot states is because people are social distancing and wearing masks
- Azar warns US isn’t ‘out of the woods yet’ with the pandemic
- Arizona reports just a single death on Monday
- Florida sees smallest number of new cases since July 9
- Florida’s total number of reported coronavirus cases has surpassed that of New York (but NY has 5.5x more confirmed deaths than Florida)
- For Guatemalans in Florida, essential work leads to a coronavirus outbreak
- Texas caps off Monday with encouraging daily decline
- California sees new cases, deaths decline
- New York State, NYC COVID-19 hospitalizations hit record low
- Houston, Miami, other cities face mounting health care worker shortages as infections climb
- NY Governor Cuomo blames NY Post for rising COVID-19 rates in Florida and Arizona
- NYC Public Advocate’s plan for reopening schools would keep kids home until at least October
- Protesters in Puerto Rico blame tourists’ heedless behavior for rising cases
- Belgium plans “total lockdown” amid COVID-19 comeback
- Merkel’s chief of staff says rise in COVID-19 cases is “cause for concern”
- UK weighs adding France, Germany to quarantine list
- Spain Faces a Possible Second Major Coronavirus Outbreak as French Infections Rise
- European reopening in disarray after UK quarantines Spain
- European stocks slide, shaken by travel restrictions on Spain
- Australia’s Victoria State reported another 532 new cases
- Australia warns Melbourne lockdown may be extended
- Hong Kong suffers biggest daily jump in domestically transmitted cases
- Fresh Virus Wave Worsens Hong Kong’s Already Disastrous Outlook
- Hong Kong shuts down restaurants
- Vietnam will evacuate 80,000 tourists from the city of Danang after four residents tested positive
- Vietnam bans wildlife imports, markets amid new health fears
- China reports another 61 cases on the mainland
- US national security adviser tested positive for the coronavirus
- North Korea declared a national emergency after accusing a defector of bringing the virus across the border from South Korea
- Nicaragua’s COVID-19 crisis demands a response
- Mexican state health minister dies after being hospitalized for COVID-19
- India’s Poor Risk Falling Through the Gaps as Schools Go Digital
- New app tells you if you’ve been exposed to COVID-19. Will anyone use it?
- Work absences in April highest on record, suggesting under-count of COVID cases
- Parents in ICE Detention Have to Decide Whether to Keep Their Children or Release Them to Sponsors
- Oregon officer in quarantine after man with COVID-19 spits on him at McDonald’s
- New Jersey cops reportedly bust 700-person house party
- Miami Police Setting Up ‘Mask Traps,’ Issuing $100 Fines to People Wearing Masks Improperly
- What’s The Point of a Test That Takes 19 Days for Results?
- Trump official admits COVID-19 test results take too long to come back
- Google will allow nearly all of its 200,000 employees to work from home until at least next July — the first major corporation to announce such an extended timetable
- More pastors say they won’t hold in-person services until 2021
- 11 million households could be evicted over the next four months
- 60% of U.S. Restaurants Closed During Virus Lockdown Won’t Reopen
- Notre Dame Withdraws as Host Site for First 2020 Presidential Debate
- Democratic National Convention to Be Limited to 2 Primetime Hours Per Night
- Time means nothing. Can the return of sports change that?
- Scientists discover why coronavirus patients lose sense of smell – and offer hope to those who haven’t got it back yet
- Pandemic Panic: Children Forced by Parents to Live Outside
- Two Major League Baseball games scheduled for Monday were postponed after 14 members of the Miami Marlins tested positive for the virus
- MLB season now in jeopardy after COVID-19 outbreak hits Marlins
- NBA Player Excused from Bubble to go to Funeral – Goes to Stripe Club
- Arizona State swimmers won’t compete due to coronavirus
- The wine market has collapsed during the pandemic, prompting winemakers across France to make a painful decision: converting unsold product into hand sanitizer’
- Regal Cinemas to reopen Aug. 21 in time for ‘Tenet’ premiere
- Hasbro expects its TV and movie production back by September
- NYC bars hit with dozens of violations for breaking COVID-19 rules
- Defiant Texas bar owners plan to reopen despite COVID-19 shutdown order
- NJ gym owners arrested after repeatedly ignoring COVID-19 lockdown orders
- Catalonia leader warns youngsters to stop partying or face new lockdown
- Iran Claims Domestic Coronavirus Medicine Will Debut in Three Weeks
- Man Allegedly Pepper Sprayed for Not Wearing Mask at Dog Park
- Planet Fitness to require members to wear face masks while working out in gyms
- Dog Influencers Take Over Instagram After Pandemic Puppy Boom
- In NYC, tailors have seen business rebound as people struggling with the “Quarantine 15” request lengthened waistbands and roomier jackets
- Man stuns Londoners by wearing a face mask — as a G-string
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day. Green highlights indicate a decrease or no change and yellow highlights indicate an increase.
1. Cases & Tests
- Total Cases = 16,635,955 (+1.3%)
- New Cases = 218,331 (-6,590) (-2.9%)
- New Cases (7 day average) = 255,720 (+1,818) (+0.7%)
- Number of new cases have declined for 3 consecutive days
- However, 7 day average of new cases on 7/27 increased to a record high
- Decline in number of new cases is part of a weekly cycle (starting on Saturday) in which cases typically decline 3-4 days, and then increase for 3-4 days, with the result being a steadily rising 7 day average
- 1,000,000+ cases every 4 days
US Cases & Testing:
- Total Cases = 4,433,410 (+1.4%)
- New Cases = 61,571 (+5,441) (+9.7%)
- Percentage of New Global Cases = 28.2%
- New Cases (7 day average) = 67,621 (-195) (-0.3%)
- Total Number of Tests = 55,018,236
- Percentage of positive tests (7 day average) = 8.0%
- 7 day average of new cases has declined for 2 consecutive days, indicating that the increase beginning on 6/9 may have peaked and is starting to decline
- Percentage of positive tests has significantly decreased over the last week, declining from 8.5% on 7/20 to 8.0% on 7/27
- Total Deaths = 656,085 (+0.6%)
- New Deaths = 4,202 (-110) (-2.6%)
- New Deaths (7 day average) = 5,649 (+18) (+0.3%)
- Number of deaths has declined for 5 consecutive days, decreasing from 7,122 on 7/22 to 4,202 on 7/27, a decrease of 41%
- However, the 7 day average of new deaths has been generally increasing since 7/2
- 7 day average of new deaths has steadily increased from 4,571 on 7/2 to 5,694 on 7/27, an increase of 24.6%
- Decline in number of new deaths is part of a weekly cycle (starting on Thursday) in which cases typically decline 4-5 days, and then increase for 2-3 days, with the result being a steadily rising 7 day average
- Total Deaths = 150,444 (+0.4%)
- New Deaths = 596 (+146) (+32.4%)
- Percentage of Global New Deaths = 14.2%
- New Deaths (7 day average) = 948 (+11) (+1.2%)
- 7 day average of new deaths has been trending higher since 7/5, but the growth rate appears to be decreasing, which may indicate that 7 day average of new deaths may be nearing its peak
- 7 day average of new deaths has increased from 516 on 7/5 to 948 on 7/27, an increase of 83.7%
- Highest 7 day average of new deaths since 6/5
3. Coronavirus outbreak shows signs of slowing in Arizona, Texas and Florida
- Coronavirus outbreaks in Arizona, Florida and Texas appear to be slowing down as more people practice social distancing and states halt reopening plans.
- On Sunday, Arizona reported a 13% drop in the seven-day average of new C19 cases, logging 2,627 newly diagnosed cases over the previous 24 hours, down from 3,022 the previous week, according to a CNBC analysis of data compiled by Johns Hopkins University.
- The state has also begun to see signs that its C19 hospitalizations may be slowing down, according to data compiled by the Covid Tracking Project, a volunteer group founded by journalists from The Atlantic magazine. As of Sunday, coronavirus hospitalizations also fell by about 14% from the previous week to a seven-day average of 2,919.
- Cases in Texas have fallen almost 19% over the previous week, hitting roughly 8,404 daily new cases based on a seven-day moving average on Sunday, according to the CNBC analysis. Its peak in average daily new cases was 10,572 on July 20. CNBC uses a seven-day average to calculate C19 trends because it smooths out inconsistencies and gaps in state data.
- Although Texas is showing signs that its number of new infections is starting to slow, it hit a record high in average hospitalizations of 10,840 C19 patients on Sunday. The same day, the state also broke a grim record of average daily new deaths of 152.
- Florida has just begun seeing its curve start to flatten since reaching a record-high average of daily new cases of 11,870 on July 17, according to data from Johns Hopkins. On Sunday, the state had 10,544 average new cases, which is an 8% decrease compared with a week ago.
- However, the state is still reporting growth in hospitalizations and fatalities as the virus continues to hit densely populated cities in southern Florida.
- U.S. Secretary of Health and Human Services Alex Azar said Monday that officials are starting to see a leveling-off of cases in hard-hit states due to people “stepping up to the plate.”
- “It’s due to the fact that people are actually wearing masks. They’re wearing their masks. They’re social distancing. They’re engaging in good personal hygiene,” Azar said on “Fox and Friends.”
- Dr. Scott Gottlieb, former Food and Drug Administration commissioner, also said Monday that hot-spot states in the Sunbelt region of the U.S. are starting to plateau in the number of new C19 cases.
- “On the whole, it looks like Arizona, Texas and probably Florida at the very least are starting to hit a plateau,” he said on “Squawk Box.” “Arizona looks like they’re starting to come down the epidemic curve slowly. I think these are going to be extended plateaus. I think we’re going to hang out at the level of infection that we’re at right now.”
- However, Gottlieb cautioned that “even as these states come down, other states look like they are heating up, and so they’ll start to offset the gains we are making in the Sunbelt.”
- For the first time since June 12, the rate of growth in average daily new C19 cases fell across the U.S. on Sunday compared with a week ago. Nationally, there were an average of 65,809 daily new cases on Sunday, a 1.6% decrease from the previous week, based on a seven-day moving average.
- While the number of new coronavirus cases across the U.S. has been on the decline for the past few days, it does not paint an accurate picture of the rate of infection. Weekend reporting from states tends to be delayed as some counties only release their numbers on weekdays.
- Gottlieb also said that some states have not been reporting their numbers reliably since the Department of Health and Human Services instructed all hospitals to stop reporting their data to the Centers for Disease Control and Prevention’s long-standing National Healthcare Safety Network. Instead, hospitals now have to report to HHS through a new portal that went live a week ago.
4. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (7/27)
Source: Worldometer and The Covid Tracking Project
5. Mortality & Hospitalization
- A number of US states continue to report increasing C19 mortality, even as some states appear to be reaching a peak or plateau in daily incidence and the national daily incidence is leveling off. The US reported more than 1,000 deaths per day for 4 consecutive days last week, and multiple states are still reporting record numbers of daily deaths.
- This recent surge is accelerating C19’s rise through the top causes of death in the US. With 145,982 deaths, C19 would currently be the #6 cause of death in the US—ahead of Alzheimer’s disease, diabetes, and influenza and pneumonia—based on official 2018 data from the CDC. Projections based on the CDC’s ensemble C19 model indicate that C19 could surpass stroke, chronic lower respiratory disease, and unintentional injury (ie, accidental death) to become #3 by the middle of August. Based on current trends, it is unlikely that deaths from C19 could surpass cancer (599,274 deaths) and heart disease (655,381 deaths) this year.
- Reports continue to emerge about hospitals and health systems in severely affected parts of the country struggling to handle C19 patient surge. Many of these reports address challenges in densely populated urban areas—such as Miami, Florida, and Houston, Texas—but rural areas are struggling as well, particularly those with fewer hospitals available to serve the population. In one example, a hospital in Starr County, Texas, has been forced to establish ethics and triage committees to prioritize C19 patients to receive care, because the hospital cannot accommodate the demand. The hospital quickly filled its 8 existing intensive care unit (ICU) beds and expanded to 29 beds, but it is still transferring patients to other counties.
- If beds, mechanical ventilators, or other limited resources are not available, the committees will determine which patients are most likely to survive and admit them for care. Those who are not likely to survive may be sent home to be cared for by family members. Texas Governor Greg Abbott announced that the US Department of Defense is deploying medical resources, including US Navy SEAL doctors to support the C19 response in southern Texas, where Starr County is located. If hospitals and health systems are unable to handle C19 cases, particularly serious and severe C19 patients, it could drive continued increases in C19 mortality.
Source: Johns Hopkins COVID-19 Updates
C. New Scientific Findings & Research
1. Can masks work both ways?
- Face coverings have been touted as one of best ways to prevent those around you from contracting the coronavirus. Now, there is mounting evidence that masks also protect the people wearing them.
- Different kinds of masks “block virus to a different degree, but they all block the virus from getting in,” said Dr. Monica Gandhi, an infectious disease physician at the University of California, San Francisco.
- Dr. Gandhi and her colleagues make this argument in a paper that will be published in the Journal of General Internal Medicine. Drawing from animal experiments and observations of various events during the pandemic, they contend that people wearing face coverings will take in fewer coronavirus particles, which could make the disease less severe.
- One animal study in China placed hamsters infected with the coronavirus alongside healthy ones, some of which were separated by a buffer of surgical masks. Many of the hamsters behind the masks didn’t get infected, while those that did showed milder symptoms.
Source: New York Times Coronavirus Updates
2. Insufficient vitamin D increases risk of severe C19
- Low levels of vitamin D may put people at risk for developing C19, according to a new study by Leumit Health Care Services and Bar-Ilan University’s Azrieli Faculty of Medicine.
- “The main finding of our study was the significant association of low plasma vitamin D level with the likelihood of C19 infection among patients who were tested for C19, even after adjustment for age, gender, socioeconomic status and chronic, mental and physical disorders,” said Dr. Eugene Merzon, head of Leumit’s Department of Managed Care and its leading researcher. “Furthermore, low vitamin D level was associated with the risk of hospitalization due to C19 infection, although this association wasn’t significant after adjustment for other confounders.”
- Vitamin D has long been understood to impact immune response. According to Dr. Milana Frenkel-Morgenstern, leader of the Azrieli Faculty of Medicine research group, as much as 70% of the adult population worldwide is vitamin D insufficient or deficient.
- The Leumit and Bar-Ilan scientists analyzed if the risk of developing C19 or becoming hospitalized because of it increases for people who have a low level of vitamin D.
- They studied 782 Israeli C19-positive patients and 7,825 negative patients and determined that a low plasma vitamin D level appears to be an independent risk factor for C19 infection and hospitalization.
- “We don’t know the mechanism,” Frenkel-Morgenstern said. “What we do know is that people who develop severe COVID and were hospitalized – these people have significantly low vitamin D levels.”
- The research has just been accepted to be published in The FEBS Journal on molecular, cellular and biochemical life sciences.
- This is the largest study of its kind to date, Frenkel-Morgenstern said. Similar studies have yielded the same results.
- A report published earlier this month in Clinical Neurology News stressed the importance of individuals obtaining the daily recommended dose of vitamin D in helping to ward off the novel coronavirus. Studies have suggested that taking vitamin D supplements and spending 30 minutes in sunlight in the summer could help.
- “Our finding is in agreement with the results of previous studies in the field,” said Dr. Ilan Green, head of Leumit’s Research Institute. “Reduced risk of acute respiratory tract infection following vitamin D supplementation has been reported.”
- The next step will be to evaluate this and other factors in association with mortality due to C19, the press release said.
3. Seaweed extract outperforms C19 drug remdesivir in the lab
- Remdesivir was the first major pharmaceutical breakthrough of the coronavirus pandemic: Research has found it’s able to help some patients recover faster from severe cases of the illness and may make it more likely that they survive. But a new study suggests that an extract from seaweed may outperform the drug.
- The extract, called RPI-27—found in the same type of seaweed that you might eat in sushi—helps trap the virus before it can infect human cells. Researchers at Rensselaer Polytechnic Institute tested the extract in the cell studies, along with the blood thinner heparin, which has a similar effect.
- When someone is infected with the coronavirus, a spike-shaped protein in the virus attaches to a receptor on a human cell and then inserts its genetic material. But if another protein with the right fit is already attached to the receptor, the virus can attach to it instead, trapping the virus in place as it harmlessly degrades.
- “You’ve effectively blocked infection by serving as a decoy,” says Jonathan Dordick, the lead researcher and a professor of chemical and biological engineering at Rensselaer Polytechnic Institute. “Effectively, it interferes with and it pulls away the virus, and therefore the virus can’t bind to the surface of the cell. Once it’s latched on to by these compounds—these seaweed extracts or heparin—it likely decomposes and it would not be effective.”
- In cell tests in the lab, RPI-27 was nearly 10 times as active as remdesivir at blocking infection, meaning a much smaller dose was needed to inhibit infection. Heparin was slightly less active than remdesivir but could also be used in treatment. Separate tests showed that the compounds worked without causing any damage to the cells. The researchers are now beginning the next step of animal trials.
- But it should be generally safe: “Anytime you eat seaweed in something like sushi, you’re going to be taking in these compounds,” he says. Because only a small concentration is needed, and the compound is found in edible seaweed, a treatment could get FDA approval fairly quickly because the substance is considered GRAS, or generally recognized as safe.
- Heparin is usually given through an IV, because it’s used to treat blood clots. But an IV treatment could pose other problems for patients. However, it could also be given through an inhaler directly into the lungs, which Dordick says has been tested and shown to have little to no effect on bleeding. The researchers are now talking to clinical partners about potentially testing a nasal spray using heparin, since it’s thought that C19 infections often begin in the nasal passages.
- “You could dissolve this in saline, just like any other nasal spray,” he says. “You could just take some of that prophylactically several times a day. We would expect that it would bind very well to the virus, essentially inactivating it. And that would be a way that would prevent it from ultimately making it down into the lungs.” The seaweed extract could potentially be used in a similar way. Like remdesivir, which had already progressed through several trials for Ebola before pivoting to C19, it’s helpful that heparin is already an approved drug. “These are the fastest ways to get things to the patient,” he says.
4. As C19 surges, researchers amass lung scans to build AI systems for patient care
- At first, the images of lungs infected by the novel coronavirus were hard to come by. It was early in the pandemic, and Joseph Paul Cohen, a researcher at the University of Montreal, was trying to stockpile radiology scans to train an artificial intelligence model to recognize warning signs of severe illness.
- With so few images available, the work was next to impossible. But in recent weeks, the resurgence of C19 in the U.S. and other hotspots has solved that problem, allowing him to amass hundreds of lung scans from clinical reports published around the world. “We’re at a good number now,” said Cohen. “There’s a sufficient amount to start doing this.”
- Little more than six months after the pandemic emerged, a number of researchers and companies are already testing the ability of AI systems to aid diagnosis of C19 from lung images, and with the data on patients flowing more freely, researchers like Cohen say they can begin to build more reliable AI models that seek to predict the severity of disease, gauge patients’ response to various treatments, and determine whether they are likely to need a ventilator or transfer to an intensive care unit.
- Radiologists said demand for such AI-powered tools may increase significantly in the months ahead, as surging numbers of infections threaten to strain medical resources in the United States and around the globe.
- “If this hangs around, having (AI) to help triage cases could be valuable,” said Bibb Allen, chief medical officer for the data science institute at the American College of Radiology. “But we’ve got to build it first. That’s kind of where we are.”
- The college, the professional society for radiologists, has created a repository of C19 images from around the world and posted use cases on its website that may help in managing these patients. The organization does not recommend use of imaging for screening patients, due to high cost and the difficulty of distinguishing C19 from other lower respiratory infections. But its use cases include efforts to use AI to characterize the extent of illness based on lung images, to help treat patients and manage hospital resources.
- Researchers at academic hospitals across the United States are using CT scans, chest X-rays, and lung ultrasound images to help build predictive AI models to support treatment of C19, including at Stanford University, Ohio State University, University of Pennsylvania, and Emory University.
- Multiple AI teams have formed within the University of California. On its San Diego campus, a research team worked with Amazon Web Services to train an AI to spot early signs of pneumonia, a common cause of death in C19 patients. The system, which analyzes chest X-rays, is not intended to diagnose C19, but to flag patients that may become severely ill.
- In one case, the AI detected signs of pneumonia in a man with no symptoms who was given a chest X-ray for other reasons. The patient was then tested for C19 and found to be positive. He was admitted when symptoms developed and eventually recovered.
- “We were much more proactive in hospitalizing him early,” said Christopher Longhurst, a physician and chief information officer at the University of California, San Diego. “We’ve seen a number of cases now where the AI is clearly influencing clinical management.”
- Longhurst said the hospital is finishing up a clinical study of the use of the AI in treating C19 patients and expects to publish its results after they are peer-reviewed. He added that the data appear to be positive, but that the system needs further testing and evaluation in clinical settings.
- “Algorithms in imaging are becoming pretty effective,” Longhurst said. “But the question is how do you really implement them in a way that really helps doctors and patients.”
- That is the biggest challenge facing AI in the treatment of C19 and many other conditions. AI models often appear to perform well in carefully structured experiments, but the real test comes when they are deployed in actual patient care, where they must be able to perform consistently across diverse groups of patients and deliver information to doctors in a way that’s compatible with their computer systems and work routines.
- “What does a community practice physician like me do with a freely available algorithm,” said Allen, the official of the American College of Radiology who practices in Alabama. “Where would I put it? How would I run it? What would the output be? The clinical integration of these algorithms isn’t there yet.”
5. A popular heartburn medicine doesn’t work as a C19 antiviral
- An over-the-counter heartburn remedy probably won’t directly stop coronavirus infections, a new study suggests.
- Anecdotal reports from China suggested people hospitalized with C19 who were taking famotidine (Pepcid) had better outcomes than people who took a different type of antacid called a proton pump inhibitor. But famotidine has no direct antiviral activity against the coronavirus, according to preliminary results reported July 15 at bioRxiv.org.
- Those findings, which have not been reviewed by other scientists yet, suggest famotidine won’t help prevent coronavirus infections or illness. But they don’t rule out that the drug might help in other ways, says Mohsan Saeed, a virologist at Boston University School of Medicine. “We’re not challenging that famotidine might help,” he says. “We’re saying that the mechanism of action is not antiviral.”
- The result isn’t a complete surprise. “A compound of this nature having any role in infectious disease is kind of a head-scratcher,” Saeed says. But a couple pieces of evidence had hinted that it might help against the virus.
- Besides the reports out of China, two studies using computer simulations of coronavirus proteins predicted that famotidine might dock with and inhibit important viral enzymes called proteases that help the virus replicate. Based on those findings, Northwell Health in the New York City area began a clinical trial to test the antacid against the coronavirus in people.
- “We were kind of surprised, because there is no laboratory evidence to show that this compound might have some effect,” Saeed says.
- The data that originally suggested benefits from famotidine aren’t strong enough to justify basing treatments on the drug, says Tobias Janowitz, an oncologist and biomedical scientist at Cold Spring Harbor Laboratory in New York, who was not involved in the study. “Everything that has been published so far cannot be considered evidence for clinical efficacy,” he says. That includes a small study Janowitz was involved in which also found hints that over-the-counter Pepcid might improve symptoms for some people diagnosed with C19.
- Just “because a statistical association exists in these anecdotal reports doesn’t mean it is actually doing anything,” Shmuel Shoham, an infectious disease specialist at Johns Hopkins Medicine said June 26 during a news conference announcing the Infectious Diseases Society of America’s revised treatment guidelines. The infectious disease society doesn’t recommend taking famotidine as a coronavirus treatment outside of a clinical trial.
- To test famotidine’s antiviral activity, Saeed teamed up with Ali Munawar, cofounder and chief executive of Boston-based Bisect Therapeutics, Inc. Munawar’s lab did two different biochemical analyses to test whether Pepcid can bind to viral proteases as the computer simulations had predicted. Neither test showed any sign of binding.
- But it was still possible that the antacid might work in other ways against the protease enzyme. So the team conducted separate analyses of enzyme activity which found no protease inhibition at all.
- The team also tested whether famotidine could stop the coronavirus from infecting monkey cells or human lung cells grown in lab dishes. “We did not see any effect on viral infection,” Saeed says. By comparison, the antiviral drug remdesivir “nicely inhibited viral replication,” he says (SN: 7/13/20).
- While the work has not yet been vetted by other scientists for publication in a scientific journal, the results are in line with unpublished findings from Janowitz’s Cold Spring Harbor colleagues Leemor Joshua-Tor and Nicholas Tonks who found that famotidine doesn’t inhibit the proteases as predicted, he says.
- Researchers say there is still a chance that famotidine might help slow the hyperactive immune system reactions known as cytokine storms, which do damage in some severely ill C19 patients (SN: 7/2/20).
- “We’re not shutting the door on this being an effective therapy,” Shoham said, but doctors should not prescribe the drug to treat C19 and people should not take over-the-counter Pepcid as a coronavirus remedy. The antacid needs further study in randomized clinical trials, he said. Janowitz and colleagues are planning just such a trial.
6. Recovery of Patients Not Requiring Hospitalization
- The US CDC C19 Response Team, in collaboration with researchers from across the US, published analysis on the long-term health effects of C19 in patients who did not require hospitalization. The study, published in the CDC’s Morbidity and Mortality Weekly Report, investigated recovering C19 patients’ return to normal health status.
- Based on interviews with 270 C19 patients who were not admitted to the hospital for treatment, 35% reported that they had not yet returned to their normal level of health at the time of the interview, conducted 14-21 days after their positive coronavirus test.
- The proportion of patients who had not yet fully recovered increased with age, ranging from 26% for patients aged 18-34 years to 47% for patients aged 50 years and older, and with the number of underlying health conditions, ranging from 28% for individuals with zero or one pre-existing health condition to 57% for individuals with 3 or more underlying health conditions.
- The most common persistent health conditions following coronavirus infection were cough (43% of those who reported experiencing the symptom at the time of their test), fatigue (35%), and shortness of breath (29%).
- Among those whose symptoms resolved, the median time for individual symptoms to resolve was 4-8 days after the test date. Interestingly, among participants that reported returning to their normal health status, 34% still reported experiencing at least 1 of 17 symptoms associated with C19 at the time of their interview.
- Most studies on the long-term health effects of C19 focus on hospitalized or severe cases, but this study provides evidence that even C19 patients who are not ill enough to warrant hospitalization can experience longer-term health effects. Depending on the severity and duration of these chronic conditions, they could potentially impact individuals’ ability to resume normal activities after recovery from the acute stage of the disease.
Source: Johns Hopkins COVID-19 Updates
D. Improved & Potential Treatments
1. Researchers Identify 21 Existing Drugs That Could Treat C19
- A Nature study authored by a global team of scientists and led by Sumit Chanda, Ph.D., professor at Sanford Burnham Prebys Medical Discovery Institute, has identified 21 existing drugs that stop the replication of the coronavirus.
- The scientists analyzed one of the world’s largest collections of known drugs for their ability to block the replication of the cornavirus, and reported 100 molecules with confirmed antiviral activity in laboratory tests. Of these, 21 drugs were determined to be effective at concentrations that could be safely achieved in patients. Notably, four of these compounds were found to work synergistically with remdesivir, a current standard-of-care treatment for C19.
- “Remdesivir has proven successful at shortening the recovery time for patients in the hospital, but the drug doesn’t work for everyone who receives it. That’s not good enough,” says Chanda, director of the Immunity and Pathogenesis Program at Sanford Burnham Prebys and senior author of the study. “As infection rates continue to rise in America and around the world, the urgency remains to find affordable, effective, and readily available drugs that can complement the use of remdesivir, as well as drugs that could be given prophylactically or at the first sign of infection on an outpatient basis.”
Extensive testing conducted
- In the study, the research team performed extensive testing and validation studies, including evaluating the drugs on human lung biopsies that were infected with the virus, evaluating the drugs for synergies with remdesivir, and establishing dose-response relationships between the drugs and antiviral activity.
- Of the 21 drugs that were effective at blocking viral replication, the scientists found:
- 13 have previously entered clinical trials for other indications and are effective at concentrations, or doses, that could potentially be safely achieved in C19 patients.
- Two are already FDA approved: astemizole (allergies), clofazamine (leprosy), and remdesivir has received Emergency Use Authorization from the agency (C19).
- Four worked synergistically with remdesivir, including the chloroquine derivative hanfangchin A (tetrandrine), an antimalarial drug that has reached Phase 3 clinical trials.
- “This study significantly expands the possible therapeutic options for C19 patients, especially since many of the molecules already have clinical safety data in humans,” says Chanda. “This report provides the scientific community with a larger arsenal of potential weapons that may help bring the ongoing global pandemic to heel.”
- The researchers are currently testing all 21 compounds in small animal models and “mini lungs,” or lung organoids, that mimic human tissue. If these studies are favorable, the team will approach the FDA to discuss a clinical trial(s) evaluating the drugs as treatments for C19.
- “Based on our current analysis, clofazimine, hanfangchin A, apilimod and ONO 5334 represent the best near-term options for an effective C19 treatment,” says Chanda. “While some of these drugs are currently in clinical trials for C19, we believe it’s important to pursue additional drug candidates so we have multiple therapeutic options if the coronavirus becomes drug resistant.”
Screening one of the world’s largest drug libraries
- The drugs were first identified by high-throughput screening of more than 12,000 drugs from the ReFRAME drug repurposing collection—the most comprehensive drug repurposing collection of compounds that have been approved by the FDA for other diseases or that have been tested extensively for human safety.
- The drug screen was completed as rapidly as possible due to Chanda’s partnership with the scientist who discovered the first SARS virus, Kwok-Yung Yuen, M.D., chair of Infectious Diseases at the University of Hong Kong; and Shuofeng Yuan, Ph.D., assistant research professor in the Department of Microbiology at the University of Hong Kong, who had access to the coronavirus in February 2020.
- Biotech company Moderna has been making some pretty promising strides in developing and testing its C19 vaccine. The company just announced it was working with the National Institutes of Health to launch what will be one of the largest vaccine C19 trials, a phase 3 study enrolling tens of thousands of American volunteers to assess whether the vaccine could truly protect people from infection. Here’s what you need to know.
- The phase 3 trial: The study will enroll up to 30,000 participants, from 89 sites across the nation. Half will receive two shots of the vaccine set 28 days apart, while the other half will receive two shots of a saltwater placebo. It will be a double-blind study, meaning neither the participants nor the medical staff handling injections will know who is getting the vaccine and who is getting the placebo. Researchers are interested in seeing not just how well the vaccine prevents infection, but also whether it can limit the severity of the illness when infections still do occur.
- Questions about C19 immunity: There’s still a lot we don’t know about how C19 immunity works and how long it lasts—and these questions will play a big role in how strongly we can rely on a vaccine to put an end to the pandemic. The phase 3 trial will be critical in shedding light on these questions.
- If it does work, what can we expect? Moderna has said that should the vaccine prove effective, it would be able to deliver between 500 million doses a year, and possibly up to a billion doses a year starting in 2021. The company has said it will seek to sell the vaccine for profit.
- What other vaccines are at this stage? According to the New York Times’ vaccine tracker, there are four other vaccines undergoing phase 3 trials—one spearheaded by researchers from the University of Oxford and AstraZeneca (which is testing people from several countries and is the largest trial in the world), and three from Chinese groups. Pfizer and a German company called BioNTech are also working on an mRNA vaccine that is expected to start a phase 3 trial of their own by the end of July.
Source: MIT Technology Review
3. The Race for a C19 Vaccine Is Headed Into Its Final Laps
- In the U.S., a vaccine made by Cambridge, Mass.-based biotech firm Moderna (in collaboration with the National Institute of Allergy and Infectious Diseases) entered phase 3 trials today, typically the last major hurdle before approval. 30,000 volunteers across the country will receive two doses of either Moderna’s vaccine or a dummy shot; researchers are looking to see if the vaccine prevents infection and continues to be safe. In earlier tests, the vaccine triggered the desired immune response, and recipients reported relatively mild side effects, if any. If all goes well, results from the study could come as early as November.
- Meanwhile on the other side of the planet, researchers at Chinese biotech firm SinoVac are also making steady progress on a vaccine of their own, TIME’s Charlie Campbell reports . The company’s vaccine, dubbed “CoronaVac,” also recently began phase 3 trials involving 9,000 volunteers in hard-hit Brazil (Moderna’s vaccine needs to be stored below freezing, but CoronaVac has a three-year shelf life, making it better suited for use in hotter climates). While new vaccines typically take years to develop, CoronaVac could be up for regulatory approval next year. “Do you really think this is fast? Compared with the spread of the virus, it’s not fast enough,” SinoVac CEO Yin Weidong told Campbell.
- The speed at which these and other vaccine candidates are being developed and tested is, by most measures, good news. But in a world where some people are already skeptical of existing, proven vaccines, the breakneck scientific pace will give ammunition to those seeking to sow fear and doubt about the results—”how could we trust anything made so quickly?” the thinking might go. Public health experts are already on the information offensive, assuring people that the vaccines are undergoing rigorous testing. “Yes, we’re going fast, but no, we are not going to compromise safety or efficacy,” U.S. National Institutes of Health Director Francis Collins said on a media call today.
- That multiple companies and teams in multiple countries are working on multiple vaccines is good news for humanity writ large. There’s nothing wrong with a little scientific competition— the U.S. would surely not have landed on the moon as early as it did were the Soviets not breathing down the Americans’ proverbial neck. There’s an element of national pride on the line—if American researchers beat their Chinese counterparts at creating a vaccine for a virus that originated in China, particularly nationalist politicians might frame it up as the U.S. fixing a mess China started.
- For the rest of us, having multiple promising candidates increases the odds that at least one, and hopefully more, will be safe and effective. That different vaccines may have different advantages and disadvantages, as the Moderna and SinoVac vaccines do, is a benefit, too, giving us strategic options for global deployment.
- But that brings up another big question: once a vaccine is ready, how do we best produce and distribute it across the world? Therein lies another winner’s advantage, and another very good reason to (safely) hustle to the finish line.
Source: Time Coronavirus Brief
E. Concerns & Unknowns
1. C19 vaccines could come with a kick
- While the world awaits the results of large clinical trials of C19 vaccines, experts say the data so far suggest one important possibility: The vaccines may carry a bit of a kick.
- In vaccine parlance, they appear to be “reactogenic,” meaning they have induced short-term discomfort in a percentage of the people who have received them in clinical trials. This kind of discomfort includes headache, sore arms, fatigue, chills, and fever.
- As long as the side effects of eventual C19 vaccines are transient and not severe, these would not be sources of alarm — in fact, they may be signals of an immune system lurching into gear. It’s a simple fact that some vaccines are more unpleasant to take than others. Think about the pain of a tetanus shot, for instance.
- “I think one of the things we’re going to have to realize is that all of these vaccines are going to be reactogenic…. They’re all going to be associated with reactions,” said Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program in Nashville, Tenn.
- “I think if you were to point out that, look, this is going to be a little bit painful, but there’s an end to it, and there’s a greater good to be gained here, I think that that’s probably worthwhile,” agreed Brian Southwell, senior director of the science in the public sphere program at the Center for Communication Science at RTI International, a think tank located in Research Triangle Park, N.C.
- At least two manufacturers, Cambridge, Mass.-based Moderna and CanSino, a Chinese vaccine maker, stopped testing the highest doses of their C19 vaccines because of the number of severe adverse events recorded among participants in their clinical trials.
- Ian Haydon, one of the volunteers who received the highest dose in the Moderna Phase 1 clinical trial, ended up seeking medical care after he spiked a fever of 103 Fahrenheit 12 hours after getting a second dose of the vaccine. (Most C19 vaccines will likely require two doses to work.)
- The side effects are being seen across a number of different vaccines, made in different ways. This does not appear to be a problem linked to a specific type of C19 vaccine.
- The Oxford University-AstraZeneca vaccine, which uses a harmless-to-humans virus that infects chimpanzees as its backbone, saw adverse events reported by 60% of recipients in its early phase trial, reported last week in the journal The Lancet. Half of patients who got the highest dose of the Pfizer-BioNTech vaccine — which like Moderna’s is a messenger RNA vaccine — reported side effects.
- Even after abandoning study of its highest dose, CanSino saw nearly three-quarters of the people in the vaccine arms in its Phase 2 trial report side effects, though none was severe. The CanSino vaccine uses a human adenovirus as its backbone.
- Getting people prepared for the fact that the C19 vaccines may be reactogenic lets them know what to expect when a vaccine becomes available, said Kathleen Neuzil, director of the Center for Vaccine Development at the University of Maryland School of Medicine.
- “As with many vaccines, we have found that if we let people know what to expect, then they have fewer concerns if side effects happen,” Neuzil said.
- There’s plenty of evidence that people will accept reactogenic vaccines — will virtually rush to get them — if they are concerned enough about the condition the vaccine is designed to prevent.
- Edwards said GSK’s shingles vaccine, Shingrix, which reportedly makes people feel pretty miserable for a short period after injection, is a perfect example. Despite the possibility of discomfort, from the moment the vaccine was brought to market, the company could not keep up with the crush of demand for it. (GSK recently announced the vaccine was no longer in short supply.)
- Most people know someone who has had shingles; they’ve heard how painful the condition — a reactivation of latent varicella virus, a late side-effect of chickenpox infection — is for people who develop it.
- But the behavior of many Americans suggests they don’t see C19 as a particular threat, with many resisting wearing masks and following the social distancing recommendations that have successfully driven down transmission in a number of other parts of the world.
- A variety of polls suggest between half and 70% of Americans plan to be vaccinated when C19 vaccines become available, figures that raise concerns in some quarters about the ability of vaccines to trigger herd immunity in the U.S. population.
- Noel Brewer, a professor of health behavior at the University of North Carolina, isn’t worried at this point about those polling numbers. At present, it’s not even clear if vaccines will work, he said, which means pollsters are asking people about hypothetical decisions they may have to make at some unknown point in the future.
- “It’s all just a bunch of question marks,” said Brewer, who actually thinks the polling numbers look pretty good under the circumstances. “Once folks are faced with a specific vaccine and a particular effectiveness profile and so on, they can then make a decision based on a thing, as opposed to an idea of a thing.”
- For most people right now, C19 is invisible “unless you are in an ICU,” he said. “For most of us every day, we don’t see people who are really sick.”
- Brewer, who is on a World Health Organization subcommittee on C19 vaccine safety, said people do expect some discomfort from getting vaccinated.
- “The real question is: How much discomfort compared to what other things they may be facing? So, if you’re 70 years old and you can’t leave your house at all, you’re going to have one calculus as compared to if you’re someone who’s 20 years old,” he said.
- Conditions at the time the vaccine becomes ready for use will be a big influencing factor when the public is offered vaccines, said Southwell. In the meantime, though, he thinks it is critical to communicate with the public about issues like how vaccines are made and that the C19 vaccines may be reactogenic.
- People are paying attention to these issues, he said, arguing that members of the public have a greater capacity to understand than they are generally given credit for.
- “There might be a much greater case for acceptance if we do our work in building trust now and laying the groundwork now,” said Southwell. “But we’re not necessarily as focused on that as we could be.”
2. C19 infections leave an impact on the heart, raising concerns about lasting damage
- Two new studies from Germany paint a sobering picture of the toll that C19 takes on the heart, raising the specter of long-term damage after people recover, even if their illness was not severe enough to require hospitalization.
- One study examined the cardiac MRIs of 100 people who had recovered from C19 and compared them to heart images from 100 people who were similar but not infected with the virus. Their average age was 49 and two-thirds of the patients had recovered at home. More than two months later, infected patients were more likely to have troubling cardiac signs than people in the control group: 78 patients showed structural changes to their hearts, 76 had evidence of a biomarker signaling cardiac injury typically found after a heart attack, and 60 had signs of inflammation.
- These were relatively young, healthy patients who fell ill in the spring, Valentina Puntmann, who led the MRI study, pointed out in an interview. Many of them had just returned from ski vacations. None of them thought they had anything wrong with their hearts.
- ‘“The fact that 78% of ‘recovered’ [patients] had evidence of ongoing heart involvement means that the heart is involved in a majority of patients, even if C19 illness does not scream out with the classical heart symptoms, such as anginal chest pain,” she told STAT. She is a cardiologist at University Hospital Frankfurt. “In my view, the relatively clear onset of C19 illness provides an opportunity to take proactive action and to look for heart involvement early.”
- The other study, which analyzed autopsy results from 39 people who died early in the pandemic and whose average age was 85, found high levels of the virus in the hearts of 24 patients.
- “We see signs of viral replication in those that are heavily infected,” Dirk Westermann, a cardiologist at the University Heart and Vascular Centre in Hamburg, said in an interview. “We don’t know the long-term consequences of the changes in gene expression yet. I know from other diseases that it’s obviously not good to have that increased level of inflammation.”
- Taken together, the two studies, published Monday in JAMA Cardiology, suggest that in many patients, C19 could presage heart failure, a chronic, progressive condition in which the heart’s ability to pump blood throughout the body declines. It is too soon to say if the damage in patients recovering from C19 is transient or permanent, but cardiologists are worried.
- “These are two studies that both suggest that being infected with C19 carries a high likelihood of having some involvement of the heart. If not answering questions, [they] prompt important questions about what the cardiac aftermath is,” said Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Health System in New York. He was not involved in either study.
- “The question now is how long these changes persist,” he added. “Are these going to become chronic effects upon the heart or are these — we hope — temporary effects on cardiac function that will gradually improve over time?”
- Since the pandemic began, people with underlying cardiovascular problems such as high blood pressure, coronary artery disease, or heart failure have been known to be at higher risk for infection and death. The connection between C19 and blood clots emerged later, after doctors began connecting the pulmonary aneurysms, strokes, and heart attacks they were seeing to the virus.
- Cardiac problems in recovering patients could belong to a pattern of lingering symptoms. Tomey sees signs of weakness in patients who had C19 in March or April, when the disease was surging in New York.
- “Patients come to my office saying, ‘hey, I’m a 31-year-old who used to run and be completely unlimited in my exercise, and now I get palpitations walking across the street. Or I get out of breath climbing up to my second-floor apartment,’” he said. “Individuals are exquisitely tuned in to their own capacity for exercise, so I take that very seriously. Our challenge is to understand the why.”
- Marc Pfeffer, a cardiologist at Brigham and Women’s Hospital in Boston, called both the autopsy and MRI studies a sobering warning. He was not involved in either. He’s concerned about relatively young people losing their cardiac health reserves, which typically decrease with age and can set the stage for heart failure.
- “We knew that the coronavirus doesn’t spare the heart,” he said. “We’re going to get a lot of people through the acute phase [but] I think there’s going to be a long-term price to pay.”
- In an editorial about the two studies, Clyde Yancy, a cardiologist at Northwestern’s Feinberg School of Medicine, and Gregg Fonarow, a cardiologist at UCLA’s Geffen School of Medicine, pushed for more research into the problem.
- “If this high rate of risk is confirmed, … then the crisis of C19 will not abate but will instead shift to a new de novo incidence of heart failure and other chronic cardiovascular complications,” they wrote. “We are inclined to raise a new and very evident concern that cardiomyopathy and heart failure related to C19 may potentially evolve as the natural history of this infection becomes clearer.”
- Asked if there is something that can be done for patients now, Mount Sinai’s Tomey said, “I would love to have the answer to that question.”
F. The Road Back?
1. Effectiveness of non-pharmaceutical interventions against C19 in 41 countries
- Governments are attempting to control the coronavirus pandemic with nonpharmaceutical interventions (NPIs). However, it is still largely unknown how effective different NPIs are at reducing transmission.
- Data-driven studies can estimate the effectiveness of NPIs while minimizing assumptions, but existing analyses lack sufficient data and validation to robustly distinguish the effects of individual NPIs.
- We collect chronological data on NPIs in 41 countries between January and May 2020, using independent double entry by researchers to ensure high data quality. We estimate NPI effectiveness with a Bayesian hierarchical model, by linking NPI implementation dates to national case and death counts. To our knowledge, this is the largest and most thoroughly validated data-driven study of NPI effectiveness to date.
- Our results suggest that, by implementing effective NPIs, many countries can reduce R0 below 1 without issuing a stay-at-home order.
- We find a surprisingly large role for school and university closures in reducing C19 transmission, a contribution to the ongoing debate about the relevance of asymptomatic carriers in disease spread.
- Banning gatherings and closing high-risk businesses can be highly effective in reducing transmission, but closing most businesses only has limited additional benefit.
Source: The effectiveness of eight nonpharmaceutical interventions against COVID-19 in 41 countries (full study is available to be downloaded)
2. “Reality” Will Win Against COVID Fearmongering (Eventually)
Excerpt from a post on Facebook by Mike Rowe
- On March 15th, the day after my part of the country was locked down, I posted a link to an interview with Dr. Michael Osterholm. I’m posting it again, because I believe you and everyone else in the country would benefit from listening carefully to what he has to say.
- Dr. Osterholm is the Director of Infectious Disease Research and Policy at the University of Minnesota. This is the same epidemiologist who ten years ago, predicted a coronavirus would come from China and turn our country upside down. In his book “Deadliest Enemies,” he anticipated the utterly irresponsible way in which the media would report on the situation, the completely opportunistic and shamelessly political way our leaders would likely react, and the unprecedented chaos and confusion that would arise from all the mixed messages from the medical community. His resume is unexampled, https://bit.ly/3jvzQTW, and his analysis of the situation is the most logical and persuasive of any I’d heard so far.
- He’s also the only expert I know of who hasn’t walked back his numbers, reconsidered his position, or moved the goalposts with regard to what we must do, what we can do, and what he expects to happen next. I say all of this because Dr. Osterholm publicly predicted – in early March – that we could conservatively see over 100 million COVID cases in this country, with a very strong possibility of 480,000 fatalities – even if we successfully “flattened the curve.”
- It took me a few weeks to accept this scenario, because 480,000 fatalities is a frightening number, and lot of other experts were saying lots of conflicting things. But eventually, I came to the conclusion that Dr. Osterholm was probably correct, and quickly navigated the four stages of grief that usually precede acceptance – denial, anger, bargaining, and depression. By late April, I had come to accept Dr. Osterholm’s predictions as a matter of fact. Since then, I’ve had three full months to come to terms with the fact that, a) I am probably going to get C19 at some point, b), I am almost certainly going to survive it, and c), I might very well give it to someone else.
- I hope that doesn’t sound blasé, or glib, or fatalistic, or selfish. Four-hundred eighty thousand deaths is an obvious tragedy, and I’m deeply sympathetic to all who have been impacted thus far. I’m also very concerned for my parents, and everyone else in a high risk category. But when Dr. Osterholm says that COVID can be slowed but not stopped, I believe him. When he says a vaccine will not necessarily hasten herd immunity, I believe him. And when he says that people have confused “flattening the curve” with “eliminating the virus,” I believe him.
- Thus, for the last three months, I’ve been operating from the assumption that this is a year-round virus that’s eventually going to infect 100 million people and kill roughly 1/2 of one percent of those infected, conservatively. I’ve accepted those numbers. Unfortunately, millions of others have not.
- Many people have no sense of where this is headed, and I understand why. They’ve been betrayed by a hysterical media that insists on covering each new reported case as if it were the first case. Every headline today drips with dread, as the next doomed hotspot approaches the next “grim milestone.” And so, for a lot of people, everyday is Groundhogs Day.
- They’re paralyzed by the rising numbers because the numbers have no context. They don’t know where it will end. But Dr. Osterholm says he does, and I’m persuaded that he’s correct.
- He might be wrong, and frankly, I hope he is, but either way, he’s presented us with a set of projections based on a logical analysis, and accepting those projections has allowed me to move past denial, anger, bargaining, and depression, and get on with my life with a better understanding of what the risks really are.
- Fact is, we the people can accept almost anything if we’re given the facts, and enough time to get evaluate the risk and make our own decisions. Last year in this country, there were six million traffic accidents and 36,000 fatalities. Tragic, for sure. But imagine for a moment if no one had ever died from a car accident. Imagine if this year, America endured six million traffic accidents and 36,000 fatalities…for the first time ever. Now, imagine if these accidents and fatalities – over 16,000 and 90 per day respectively – imagine if they were reported upon like every new incidence of COVID. What would that do to our willingness to drive? For a while, I suspect it would keep us all off the roads, right? I mean, six million accidents out of the blue is a lot to process, and 36,000 deaths is scary – especially if you don’t know how high that number could get. It would take us a while to access the risk, before we blindly hopped into our cars again. Eventually though – after getting some context and perspective – we’d be able to evaluate the relative danger of operating a motor vehicle. Then, we could decide for ourselves when to drive, where to drive, and how much to drive. And so we do.
- Again, don’t misunderstand. I’m not ignoring COVID, or downplaying COVID, or pretending the risks at hand aren’t real. Nor am I comparing COVID cases to car accidents – I’m simply comparing the fear of each to the other, and the fear that always accompanies uncertainty. I don’t want to get this disease or give it to someone else, any more than I want to be in a car car wreck that injures someone else. But I’ve accepted certain things about the pandemic, and now, I’ve gotten used to the risk as I understand it. I take precautions. I get tested as often as I can, and if I can’t physically distance, I wear a mask – especially around higher risk people. Likewise, I wear a seatbelt, obey the speed limits, and check my mirrors before changing lanes. Yes – I’m aware that we’d all be a lot safer if we kept our cars in the garage. I’m also aware we’d be a lot safer if we all kept ourselves in the house. But that’s not why cars, or people, exist.
- Anyway, that’s a long way of saying that I have accepted Dr. Osterholm’s numbers, and now, after three months of acceptance, I’ve made a decision on how I wish to live my life. Sooner or later, you will too. We all will.
3. Can Covid Spread With Air Conditioning? HVAC Makers Plan Upgrades
- The long-staid world of HVAC is suddenly in the spotlight.
- With research showing the coronavirus may spread through shared air, property managers are rushing to upgrade heating, ventilation and air conditioning systems before reopening buildings. That’s leading to costly upgrades for equipment that armies of professionals used to take for granted.
- Building specialists are poring over how well heavy-duty filters block microbes and considering whether to install systems that use ultraviolet light or electrically charged particles in the ductwork to kill the virus. Companies including Honeywell International Inc., Carrier Global Corp. and Trane Technologies Plc are benefiting from the surge in demand, offering everything from air-monitoring sensors to portable filter machines to help make up for deficiencies in ventilation.
- “Every building is going to have some kind of solution. Is it going to be 100%? No,” said Hani Salama, head of the New York chapter of the Building Owners and Managers Association. “But it’s going to be better than what they have now, and will help mitigate some of these airborne transmission issues that everybody is afraid of.”
- Much of the concern for buildings has been centered on whether the virus can spread through surfaces, prompting remedies such as new cleaning procedures, gallons of hand sanitizer and touchless doors and bathroom fixtures. However, more than 200 researchers have urged the World Health Organization to recognize the disease can spread through air currents.
- A study this spring led by researchers at the University of Oregon found the presence of the virus in a quarter of HVAC systems in hospitals that treated C19 patients. The findings suggest the potential for transmission from shared air from locations separate from the infected person, the authors said.
- Not all experts agree. The virus would be diluted and decayed even if it were to get into the air ducts, making them ineffective conduits, said Edward Nardell, a Harvard University professor who researches airborne transmission. He’s more concerned with people returning to buildings with inadequate air circulation, which can allow the virus to linger in a room.
- For building owners, the trade-offs abound. It’s best to let in more fresh air, but that puts a strain on cooling or heating. Dense filters that trap more microbes are coveted, yet can choke off airflow and worsen ventilation if a building’s fans aren’t powerful enough. And most solutions require more energy consumption.
- Building-safety products are proving to be a bright spot for sales at companies like Honeywell, which has technology for “frictionless entry,” automatic temperature-taking and sensors that monitor air quality. Carrier, which specializes in HVAC and reports earnings this week, has seen its stock more than double since its separation in March from the former United Technologies Corp.
- “We’re seeing a very huge demand,” said Manish Sharma, chief technology officer for Honeywell’s building technologies unit. “Everyone wants to see how you can get back to business.”
- Air conditioning upgrades are a top priority for landlords, said Salama of the New York association, even as it’s unclear when office workers will return. His company, Capital Properties, is swapping out 900 air conditioning filters at its two Manhattan office buildings for double the price it would normally pay.
- Many of the methods to reduce pathogens have been around for years, such as UV light and bipolar ionization, which releases electrically charged atoms that attach to and neutralize viruses and bacteria. Those technologies were geared more to hospitals than commercial buildings, which put more of an emphasis on saving energy than killing germs. That’s changing now.
- Allan Reagan, chief executive officer of Flix Brewhouse, adopted elaborate protocols for sanitizing and creating social distancing at his 10 dine-in movie houses. As the risk of airborne spread drew more attention, he hired Trane Technologies to install bipolar ionization for all 87 of the company’s screening auditoriums, at $1,500 a piece.
- A study showing the system kills as much as 99% of pathogens won Reagan over, and Flix Brewhouse opened in San Antonio to the public for two weeks to try the system. He said the venue had about 700 visitors, including 50 employees, and he hasn’t heard of any Covid cases that arose. All of Flix’s theaters are closed for now, mainly because of a lack of new films from Hollywood, he said.
- “We tried it out, declared victory, and we’ll come back when we have some good content,” Reagan said. “In the meantime, we’ll be retrofitting our other theaters. So when they reopen we’ll have this technology across the circuit.”
- Fredric Lubit, a dentist with two offices in New Jersey, purchased four Carrier OptiClean air scrubbers at $4,500 each. The machine, which looks similar to a tall filing cabinet, sucks air though a high-efficiency particulate air, or HEPA, filter. He also purchased a $10,000 machine for each office that saturates a room with UV light for two minutes to destroy microbes.
- Carrier began designing the OptiClean in March by hot-rodding the inside portion of a residential HVAC system with a bigger fan and motor, along with other parts. The product was initially aimed at hospitals, but demand is now coming from schools and small offices, said Chris Nelson, president of Carrier’s HVAC unit, who declined to provide sales numbers.
- It’s unclear whether the virus could squeeze through. While studies have shown HEPA filters can block particles as small as 0.1 micron, tiny enough for the coronavirus particles that can float on air, the rating on the heavy-duty filters is only for particles the size of 0.3 microns, according to a July 9 paper by consulting firm McKinsey & Co.
- For Lubit, the outlay is still worthwhile.
- “You can’t put a price on your health, your staff’s health and, in my case, patients’ health,” he said.
G. Back to School!?
1. CDC: The Importance of Reopening America’s Schools this Fall
- As families and policymakers make decisions about their children returning to school, it is important to consider the full spectrum of benefits and risks of both in-person and virtual learning options.
- Parents are understandably concerned about the safety of their children at school in the wake of C19. The best available evidence indicates if children become infected, they are far less likely to suffer severe symptoms. Death rates among school-aged children are much lower than among adults.
- At the same time, the harms attributed to closed schools on the social, emotional, and behavioral health, economic well-being, and academic achievement of children, in both the short- and long-term, are well-known and significant.
- Further, the lack of in-person educational options disproportionately harms low-income and minority children and those living with disabilities. These students are far less likely to have access to private instruction and care and far more likely to rely on key school-supported resources like food programs, special education services, counseling, and after-school programs to meet basic developmental needs.
- Aside from a child’s home, no other setting has more influence on a child’s health and well-being than their school. The in-person school environment does the following:
- provides educational instruction;
- supports the development of social and emotional skills;
- creates a safe environment for learning;
- addresses nutritional needs; and
- facilitates physical activity.
- This paper discusses each of these critical functions, following a brief summary of current studies regarding C19 and children.
C19 and Children
- The best available evidence indicates that C19 poses relatively low risks to school-aged children. Children appear to be at lower risk for contracting C19 compared to adults.
- To put this in perspective, according to the CDC, as of July 17, 2020, the United States reported that children and adolescents under 18 years old account for under 7% of C19 cases and less than 0.1% of C19-related deaths. Although relatively rare, flu-related deaths in children occur every year. From 2004-2005 to 2018-2019, flu-related deaths in children reported to CDC during regular flu seasons ranged from 37 to 187 deaths. During the H1N1pandemic (April 15, 2009 to October 2, 2010), 358 pediatric deaths were reported to CDC. So far in this pandemic, deaths of children are less than in each of the last five flu seasons, with only 64. Additionally, some children with certain underlying medical conditions, however, are at increased risk of severe illness from C19.
- Scientific studies suggest that C19 transmission among children in schools may be low. International studies that have assessed how readily C19 spreads in schools also reveal low rates of transmission when community transmission is low. Based on current data, the rate of infection among younger school children, and from students to teachers, has been low, especially if proper precautions are followed.
- There have also been few reports of children being the primary source of C19 transmission among family members. This is consistent with data from both virus and antibody testing, suggesting that children are not the primary drivers of C19 spread in schools or in the community. No studies are conclusive, but the available evidence provides reason to believe that in-person schooling is in the best interest of students, particularly in the context of appropriate mitigation measures similar to those implemented at essential workplaces.
- Extended school closure is harmful to children. It can lead to severe learning loss, and the need for in-person instruction is particularly important for students with heightened behavioral needs.
- Following the wave of school closures in March 2020 due to C19, academic learning slowed for most children and stopped for some. A survey of 477 school districts by the University of Washington’s Center on Reinventing Public Education found that, “far too many schools are leaving learning to chance.” Just one in three school districts expected teachers to provide instruction, track student engagement, or monitor academic progress for all students, and wealthy school districts were twice as likely to have such expectations compared to low-income districts.
- We also know that, for many students, long breaks from in-person education are harmful to student learning. For example, the effects of summer breaks from in-person schooling on academic progress, known as “summer slide,” are also well-documented in the literature. According to the Northwest Evaluation Association, in the summer following third grade, students lose nearly 20% of their school-year gains in reading and 27% of their school-year gains in math. By the summer after seventh grade, students lose on average 39% of their school-year gains in reading and 50% of their school-year gains in math. This indicates that learning losses are large and become even more severe as a student progresses through school. The prospect of losing several months of schooling, compared to the few weeks of summer vacation, due to school closure likely only makes the learning loss even more severe.
- Disparities in educational outcomes caused by school closures are a particular concern for low-income and minority students and students with disabilities. Many low-income families do not have the capacity to facilitate distance learning (e.g. limited or no computer access, limited or no internet access), and may have to rely on school-based services that support their child’s academic success. A study by researchers at Brown and Harvard Universities assessed how 800,000 students used Zearn, an online math program, both before and after schools closed in March 2020. Data showed that through late April, student progress in math decreased by about half, with the negative impact more pronounced in low-income zip codes. Persistent achievement gaps that already existed before C19, such as disparities across income levels and races, can worsen and cause serious, hard-to-repair damage to children’s education outcomes. Finally, remote learning makes absorbing information more difficult for students with disabilities, developmental delays, or other cognitive disabilities. In particular, students who are deaf, hard of hearing, have low vision, are blind, or have other learning disorders (e.g., attention deficit hyperactivity disorder (ADHD)) and other physical and mental disabilities have had significant difficulties with remote learning.
Social and Emotional Skill Development
- Schools play a critical role in supporting the whole child, not just their academic achievement. In addition to a structure for learning, schools provide a stable and secure environment for developing social skills and peer relationships. Social interaction at school among children in grades PK-12 is particularly important for the development of language, communication, social, emotional, and interpersonal skills.
- Extended school closures are harmful to children’s development of social and emotional skills. Important social interactions that facilitate the development of critical social and emotional skills are greatly curtailed or limited when students are not physically in school. In an in-person school environment, children more easily learn how to develop and maintain friendships, how to behave in groups, and how to interact and form relationships with people outside of their family. In school, students are also able to access support systems needed to recognize and manage emotions, set and achieve positive goals, appreciate others’ perspectives, and make responsible decisions. This helps reinforce children’s feelings of school connectedness, or their belief that teachers and other adults at school care about them and their well-being. Such routine in-person contacts provide opportunities to facilitate social-emotional development that are difficult, if not impossible, to replicate through distance learning.
- Additionally, extended closures can be harmful to children’s mental health and can increase the likelihood that children engage in unhealthy behaviors. An environment where students feel safe and connected, such as a school, is associated with lower levels of depression, thoughts about suicide, social anxiety, and sexual activity, as well as higher levels of self-esteem and more adaptive use of free time. A longitudinal study of 476 adolescents over 3 years starting in the 6th grade found school connectedness to be especially protective for those who had lower connectedness in other areas of their lives, such as home, and to reduce their likelihood of substance use.
- Further, a review of studies conducted on pandemics found a strong association between length of quarantine and Post Traumatic Stress Disorder symptoms, avoidance behavior, and anger. Another review published this year found that post-traumatic stress scores of children and parents in quarantine were four times higher than those not quarantined.
- In-person schooling provides children with access to a variety of mental health and social services, including speech language therapy, and physical or occupational therapy to help the physical, psychological, and academic well-being of the child. Further, school counselors are trained in the mental health needs of children and youth and can recognize signs of trauma that primary caregivers are less able to see because they themselves are experiencing the same family stresses. School counselors can then coordinate with teachers to implement interventions to offer children a reassuring environment for regaining the sense of order, security, and normalcy.
- Without in-person schooling, many children can lose access to these important services. For example, we know that, even outside the context of school closures, children often do not receive the mental health treatment they need. Among children ages 9-17, it is estimated that 21 percent, or more than 14 million children, experience some type of mental health condition. Yet only 16 percent of those with a condition receive any treatment. Of those, 70-80% received such care in a school setting. School closures can be particularly damaging for the 7.4 million American children suffering from a serious emotional disturbance. For those individuals who have a diagnosable mental, behavioral or emotional condition that substantially interferes with or limits their social functioning, schools play an integral role in linking them to care and necessary support services.
- For children with intellectual or physical disabilities, nearly all therapies and services are received through schools. These vital services are difficult to provide through distance learning models. As a result, more children with disabilities have received few to no services while schools have been closed.
- Extended school closures deprive children who live in unsafe homes and neighborhoods of an important layer of protection from neglect as well as physical, sexual, and emotional maltreatment and abuse. A 2018 Department of Health and Human Services report found that teachers and other educational staff were responsible for more than one-fifth of all reported child abuse cases—more than any other category of reporter. During the C19 school closures, however, there has been a sharp decline in reports of suspected maltreatment, but tragically a notable increase in evidence of abuse when children are seen for services. For example, the Washington, D.C. Child and Family Services Agency recorded a 62% decrease in child abuse reporting calls between mid-March and April 2020 compared to the same time period in 2019, but saw more severe presentation of child abuse cases in emergency rooms. Children who live in a home or neighborhood where neglect, violence, or abuse occur, but who are not physically in school, are deprived of access to trained school professionals who can readily identify the signs of trauma and provide needed support and guidance.
- Extended school closures can be harmful to the nutritional health of children. Schools are essential to meeting the nutritional needs of children with many consuming up to half their daily calories at school.
- Nationwide more than 30 million children participate in the National School Lunch Program and nearly 15 million participate in the School Breakfast Program. For children from low-income families, school meals are an especially critical source of affordable, healthy foods. While schools have implemented strategies to continue meal services throughout periods of school closures, it is difficult to maintain this type of school nutrition program over the long-term. This is a particularly severe problem for the estimated 11 million food-insecure children, living in the United States.
- When schools are closed, children lose access to important opportunities for physical activity. Many children may not be sufficiently physically active outside of the context of in-school physical education (PE) and other school-based activities. Beyond PE, with schools closed, children may not have sufficient opportunities to participate in organized and safe physical activity. They also lose access to other school-based physical activities, including recess, classroom engagements, and after school programs.
- The loss of opportunities for physical activity from school closures, especially when coupled with potentially diminished nutrition, can be particularly harmful to children. Physical inactivity and poor nutrition among children are major risk factors for childhood obesity and other chronic health conditions. Over 75% of children and adolescents in the United States do not meet the daily physical activity level recommendations (60 minutes or more), and nearly half exceed 2 hours per day in sedentary behavior. Current models estimate that childhood obesity rate may increase by 2.4% if school closures continue to December 2020.
- Schools are an important part of the infrastructure of our communities, as they provide safe, supportive learning environments for students, employ teachers and other staff, and enable parents, guardians, and caregivers to work. Schools also provide critical services that help meet the needs of children and families, especially those who are disadvantaged, through supporting the development of social and emotional skills, creating a safe environment for learning, identifying and addressing neglect and abuse, fulfilling nutritional needs, and facilitating physical activity.
- School closure disrupts the delivery of in-person instruction and critical services to children and families, which has negative individual and societal ramifications.
- The best available evidence from countries that have opened schools indicates that C19 poses low risks to school-aged children, at least in areas with low community transmission, and suggests that children are unlikely to be major drivers of the spread of the virus.
- Reopening schools creates opportunity to invest in the education, well-being, and future of one of America’s greatest assets—our children—while taking every precaution to protect students, teachers, staff and all their families.
2. Listen to the science and reopen schools
By Benjamin Sommers, Joseph Allen, Sara Bleich and Jessica Cohen, professors at the Harvard School of Public Health.
- President Trump recently took to Twitter to demand that the country’s schools reopen in the fall. He has framed the conversation as one that pits fear-mongering Democrats opposed to in-person schooling against Republicans committed to reopening the economy. As public health professionals and parents of school-age children, we urge the country: Ignore Trump.
- Instead, listen to the science, which says that schools can — and should — reopen for in-person learning with appropriate risk reduction strategies, while officials also implement aggressive steps to keep community transmission low.
- Listen to the American Academy of Pediatrics, which argued for focusing on science and not politics in supporting a return to in-person schooling with new investments in safety, describing in-person school as “fundamental” to the well-being of the nation’s children.
- Prolonged time away from schools has led to months of lost learning and widened gaps in educational achievement, especially for some students of color and those in lower income households. Adding months more to this toll will be an educational disaster that some children may never recover from. School closures also threaten some children’s safety, due to increased child neglect, hurt children’s mental health, and keep many from getting enough to eat.
- The harms of school closure are clear. What about the risks of reopening?
- Multiple studies show that children are not only less likely to become seriously ill from C19, they are also only half as likely to get infected in the first place. Overall, the rate of infection requiring hospitalization among US school-age children (5 to 17) since the beginning of the pandemic though July 4 was roughly 1 in 20,000.
- What about the risk to teachers and staff? Again, listen to the science. A report led by the former head of the Centers for Disease Control and Prevention under President Obama concluded that children appear less likely than adults to transmit C19 to others — unlike other viruses like influenza — though this evidence is still limited and preliminary. Studies examining schools with known cases of C19 have shown low transmission rates — for instance, in one case, just two students and no teachers infected out of 863 close contacts. Others show zero confirmed infections even among teachers and students who sat in the same classroom with a symptomatic child.
- Other studies shed light on why childhood infection rates and school-based transmission may be so low. Compared to adults, children have lower levels of receptors in their airways that allow the coronavirus into our bodies. Children also may not generate as many breath droplets that can transmit COVID.
- Finally, what about impacts on the community as a whole? Studies show that social distancing measures have been critical to flattening the curve of C19 infection, but school closures may be among the least effective of those measures. A study of county rates of COVID across the United States from earlier this year found “no evidence that school closures influenced the growth rate” in COVID infections, and two international studies similarly found large reductions in COVID spread from social distancing policies in general, but no significant effect from school closures on their own.
- No scenario of in-person schooling is risk-free, and there will be infections. Israel has had nearly 2,000 student and teacher cases since reopening in May, though notably it reopened schools largely without classroom size limits or social distancing requirements. In contrast, 22 European countries have reopened schools without a rise in C19, and there has been little school-based spread in Asia.
- Unfortunately, little of this evidence is figuring into the current polarized political conversation. But it should.
- We are not advocating a return to schools as usual. Schools must aggressively implement proven risk reduction strategies. A layered approach should include rapid testing and contact tracing, physical distancing when possible, mask-wearing with breaks built into the day, frequent hand hygiene, and well-ventilated spaces. Districts should consider adding tents and trailers and converting gyms, cafeteria, and libraries to expand learning spaces. Staggering arrival and dismissal times and prohibiting parents from entering schools will limit one of the highest risks — having large numbers of adults in indoor spaces.
- A final critical step to reopening schools is to keep community rates of C19 low. Opening schools is safer and more feasible if we hold back on higher-risk reopening activities. State leadership is therefore critical, as school districts can’t control what happens in bars, gyms, large public gatherings (especially of adults), and other high-risk settings. It reflects poorly on our public priorities that even in Massachusetts, where C19 has been taken quite seriously, it remains unclear if our children will be allowed to return to school, even as adults return — without much debate — to far higher-risk locations like gyms and casinos.
- Reopening schools should not be an us-versus-them argument. It’s not a Democratic vs. Republican argument. It’s about our children and about the evidence. We should be following the science that says in-person schooling for our kids is too valuable to give up and that the risks of school-based transmission appear to be low. We should be investing in adequate testing and tracing resources, making our physical school environments safer, and encouraging a practical balance of social distancing in the classroom with learning and the reality of children’s lives.
- Ignore Trump. Listen to the evidence. Reopen the schools.
3. Universities are grappling with how to reopen safely amid a pandemic
- Come August, hundreds of universities across the United States are poised to reopen their campuses with a mix of online and in-person courses. Only a handful are aiming for an entirely online semester. But as the machinery of higher education cranks back into action, faculty, staff, and students are voicing concerns that, with C19 cases surging in many parts of the country, employees are being forced to put their health—and the health of others—at unnecessary risk.
- At many universities, employees will not be permitted to teach or work from home unless—due to age or preexisting health conditions—they’re at risk of a severe outcome from C19. The need to care for children and fear of infection aren’t valid reasons to work remotely, according to some universities. “Employees who care for or live with [high-risk] individuals … should plan to return to campus as scheduled,” the Georgia Institute of Technology’s (Georgia Tech’s) reopening guidelines stated as of 20 July.
- Academics across the country are dismayed. At Pennsylvania State University (Penn State), for instance, faculty published an open letter decrying the “limited amount of input faculty, staff, and graduate employees have had on decisions related to our safety.” At Georgia Tech, faculty released a similar letter saying the university’s reopening procedures “do not follow science-based evidence”—and that “no faculty, staff, or student should be coerced into risking their health and the health of their families by working … on campus when there is a remote/online equivalent.”
- Yet financial constraints and political pressure are compelling many universities to reopen. Burdened by budget cuts, many have already laid off or furloughed employees. Not reopening their campuses could mean a further loss of revenue. At several universities, students have petitioned and even sued—unsuccessfully thus far—for tuition refunds for the spring semester because they’re unable to access campus resources or receive in-person instruction.
- Universities that are slated to reopen have developed protocols to try to keep employees safe, with plans that call for physical distancing, mask-wearing, and reduced dorm occupancy. Some have made C19 tests mandatory and created plans to trace contacts and isolate suspected cases. “The health of faculty, staff, and students is the University’s top priority,” a Penn State official wrote in a statement to Science Careers.
- But sources at several universities told Science Careers that they consider the plans inadequate—for instance, because they don’t specify how many tests will be available each day or how students will be compelled to wear masks. “I fully expect that I’m going to need to be handing out surgical masks to my students, because some of them are going to come in with bandanas,” says Ian Chandler-Campbell, a Ph.D. student at Boston University who studies applied human development and teaches undergraduates.
- Even detailed reopening plans may not be able to contain transmission when thousands of students descend on campus using varied modes of transport, from parts of the country where cases are surging. The University of Washington, Seattle, is currently working to quell an outbreak in its fraternity houses, where at least 136 students have tested positive. At the University of North Carolina, Chapel Hill, 37 athletes, coaches, and staff tested positive. And a 21-year-old geology student at Penn State who was living off-campus died of C19 last month.
- Academics who are earlier in their careers face especially sharp dilemmas, points out Brian Magerko, a computer scientist at Georgia Tech. Many “are being told to choose between their career advancement and health,” says Magerko, who notes he faces less professional risk if he chooses to stay home because he has tenure. One faculty member at the University of Florida, who wished to remain anonymous because she’s not tenured, says that she has continued to work from home even though her university requires her to be on campus. She worries about her safety, with C19 cases on the rise in Florida. “It’s a huge professional risk, but I’ve been ignoring the rules,” the researcher says.
- Reopening campuses could also threaten the surrounding community. “Everyone is at risk here—by me going into class, I’m increasing the likelihood of my grocery store staff or their families getting ill,” Magerko says. “The idea of a university playing those kinds of odds is ethically troubling.”
- Holly Kleinschmidt, a Ph.D. student in biochemistry at Penn State, University Park, says she isn’t particularly worried about her own health. But she interacts with faculty, undergraduates, and other campus personnel on a daily basis and worries about the risks to others. “I usually see it as a good thing that I get to interact with so many different populations,” she says. “But in the context of a pandemic, I worry that if anyone is spreading the virus around, it’s going to be me.”
- For some, workplace regulations are little help. Under the Americans with Disabilities Act, employees who are age 65 or older or have preexisting conditions that make them more susceptible to C19 can request to work from home. Leave may be available to others who, for example, live with a high-risk family member through protections afforded by the Family and Medical Leave Act—but that leave is unpaid. “In my view, [university policies should] go beyond compliance with the law and do the right thing—which is to allow [employees] to work from home if they feel at risk,” says Arlene Kanter, a law professor at Syracuse University.
- “Getting everyone off campus who doesn’t need to be there … is the only solution,” Georgia Tech’s Magerko says. Unfortunately, that’s the “exact opposite” of what most schools are doing, he says.
H. Projections & Our (Possible) Future
1. Could C19 Have Seasons? NASA Searches for Signals in Earth Data
- NASA scientists are investigating potential relationships between the spread of the coronavirus and seasonal shifts in humidity, temperature, rainfall, and other environmental variables. They hope their work will clarify the role that weather and climate might play in influencing the spread of the virus.
- The idea that viral infections follow seasonal rhythms and geographic patterns is not new. This 1856 map by a Scottish cartographer shows prominent viruses and diseases (such as smallpox, goiter, and yellow fever) in relation to temperature and latitude.
- Research has shown that some respiratory viruses have clear seasonal rhythms. For instance, cases of influenza and several types of coronaviruses are known to surge in the winter. Outbreaks of enteroviruses usually happen in the summer. And some adenoviruses and rhinoviruses have no obvious seasonal cycle.
- The question confronting infectious disease experts and policymakers is: how will coronavirus behave?
- The most closely related viruses—four other types of spherical, spiked betacoronaviruses—offer a few clues. Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) have never spread widely or fast enough to show seasonality. But two endemic betacoronaviruses (OC43 and HKU1) that cause the common cold spread more in the winter. (Endemic viruses are always present; epidemic viruses spread rapidly in a region; pandemics spread globally.)
- If the C19 coronavirus favors winter like its cousins, cases of the disease would fade during the summer but then surge back in autumn or winter. There is worrisome precedent for this possibility. During the 1918 influenza pandemic, the first wave of illness came in the spring but was relatively modest. It was the second wave that arrived in fall 1918 that was catastrophic and caused tens of millions of deaths around the world.
- The science surrounding the potential seasonality of the coronavirus is far too new to say anything with certainty. “There is a real rush to get studies out now,” said Benjamin Zaitchik, a Johns Hopkins University researcher working on a NASA Applied Sciences project to investigate whether environmental factors are affecting the spread of the new coronavirus. “Everybody is trying to help, and many people feel like getting something out faster is how you help right now. But the public should understand that, even a few months into this, there is still nothing definitive regarding the seasonality of the virus.”
- One way that Zaitchik and other researchers hope to get some clarity is by making use of reanalysis datasets and models that synthesize disparate environmental data into a coherent whole. These systems generate consistent snapshots of Earth’s atmosphere and land and water surfaces over large areas and long time periods. This makes them especially useful for research on long-lasting global problems like climate change or the seasonality of an infectious disease.
- In their hunt for a potential seasonal C19 signal, Zaitchik and other scientists will lean on models and data from NASA, other major research organizations, and an international array of satellites, aircraft, and weather observation systems. NASA, NOAA, the Japan Aerospace Exploration Agency, the European Space Agency, and the European Centre for Medium-Range Weather Forecasts (ECMWF) are particularly well positioned to produce useful data for C19 studies because they maintain observing and computing systems capable of tracking things on a global scale.
How Can Seasons Affect a Respiratory Virus?
- There are some similarities in the structures of seasonal viruses that suggest certain features are important. For instance, several seasonal viruses have lipid envelopes that protect viral RNA and may help the viruses evade the human immune system. Some research indicates that these lipid envelopes become disorganized in warm, humid conditions, making it more difficult for viruses to spread. Other research into human anatomy indicates that the structures in the nose and throat that defend against infections generally function better in warmer, more humid conditions.
- Earth’s seasons bring pulses of green and white as regions of vegetation, snow, and ice expand and contract throughout the year. Seasonal changes have been shown to influence the spread of some diseases.
- Some very preliminary laboratory studies in 2020 pointed to a potential link between cold, dry conditions and increased transmission of the coronavirus, and several research groups started to look for similar patterns in real-world health and environmental data. One study noted that cities with the most severe outbreaks in late winter 2020 were mostly situated around the same latitude (30 to 50 degrees North) and had the same general temperature and humidity conditions.
- Each year in the United States, influenza follows a predictable pattern and reaches its peak during winter, when conditions are colder and drier.
- For now, correlations like these should be regarded as hypotheses, not proof of a connection. Standards for the collection of health data vary so dramatically between countries that comparing outcomes this early in a pandemic can suggest relationships that do not stand up to time and scrutiny. Beyond that, relationships between environmental variables and viral transmission could prove to be complex; they could play out differently in tropical climates at low latitudes compared to temperate climates at middle latitudes. In the case of influenza, dry winter air seems to help the virus spread at mid- and high latitudes, but there is evidence that extremely humid conditions in the wet season in the tropics also benefit the virus.
- Most of us focus on how temperatures change with the seasons, so it can be easy to forget just how much the seasons change the atmosphere. For instance, the amount of water vapor in the air drops significantly in the winter because the reduced sunlight limits evaporation from lakes and seas. When that dry outdoor air is pumped indoors and heated, it can get even drier; since warm air can hold more moisture than cold air, the relative humidity—a measure of how much moisture the air can hold—drops substantially.
- Preliminary research indicated that the cities with the most C19 cases early in 2020 shared similar temperature and humidity conditions. A significant amount of disease transmissions clustered between 5°C and 10°C (between 40°F and 50°F) and at specific humidities of 5 g/kg.
- “For SARS-CoV-2, it is too early to say,” said Jeffrey Shaman, a Columbia University epidemiologist who has studied the seasonality of respiratory viruses for decades. “But if I were to put money on it, I would bet that there is seasonality to this virus and that, like with influenza and the endemic betacoronaviruses, it will track with environmental conditions such as temperature and especially absolute humidity.”
Finding Patterns in a Flood of Data
- Given the hints that moisture may be important to the survival and transmission of seasonal respiratory viruses, Zaitchik and colleagues are examining a broad array of environmental variables. And that is why they think global atmospheric models and reanalysis datasets will be useful in advancing the study of C19 seasonality.
- Weather stations and other ground-based monitoring tools are scattered unevenly throughout the world, and the majority of them are clustered in a handful of wealthy countries. This means they tend to offer regional views, rather than a consistent, global view of water vapor, humidity, temperature, and other variables that change with the seasons.
- Atmospheric reanalysis datasets get around this limitation by repeatedly blending model simulations of the state of the atmosphere with massive amounts of data from satellites, weather balloons, aircraft, ships, and weather stations. Reanalysis systems constantly adjust what they are simulating by adding new real-world measurements. It is like a forecast that keeps updating itself, while also keeping a retrospective view of what happened.
- Both temperature and humidity follow daily and seasonal rhythms, which are observed and measured by NASA instruments and represented by models.
- Data from two major atmospheric reanalysis models have already been used in studies of the relationship between weather, climate, and disease, and they could be critical to breakthroughs in coronavirus seasonality. One dataset is the ERA-5 from the ECMWF and the other is the Modern Era Retrospective-Analysis for Research and Applications (MERRA-2) from NASA.
- “There really is no more accurate and spatially consistent four-dimensional snapshot of the atmosphere than what you get from these reanalysis products,” said Rob Gelaro, a research meteorologist with NASA’s Global Modeling Assimilation Office, which runs MERRA-2. “Every six hours, MERRA-2 absorbs at least 5 million observations and generates a snapshot of the global atmosphere for a given moment.”
- MERRA-2 is officially a NASA reanalysis product, drawing data from several NASA and NOAA satellites such as Terra, Aqua, and the Tropical Rainfall Measuring Mission. But really it is a blend of the world’s best weather data from dozens of satellites and weather monitoring systems. Since it would be quite expensive and logistically impossible for one country to launch all of the satellites and manage all of the observing systems needed to achieve global coverage, countries divide the costs and management challenges and then share the data. ERA-5 works in the same way.
- The richness, breadth, and depth of reanalysis data is what makes it so useful. “We are using these models to look closely at temperature and humidity data, but we are not stopping with that,” said Zaitchik. “We will also be looking at several other parameters—rainfall, soil moisture, evapotranspiration, winds, surface pressure, evaporative fraction, and UV exposure—that might help us detect a signal or understand something about disease transmission.” With the help of a reanalysis tool called the North American Land Data Assimilation System, Zaitchik and his team should also be able to connect epidemiology and weather down to the county level for North America and Europe because environmental and public health data are more detailed and consistent in these developed countries.
Pandemics In Any Season
- Even with access to powerful datasets and models, scientists say it will take time to disentangle the role of seasonal change from the other factors influencing coronavirus, such as travel and economic restrictions or wearing masks.
- “Seasonal variability may prove to be only a minor factor, slowing but not stopping the virus in summer, until more immunity builds up in the population,” said Harvard University epidemiologist Marc Lipsitch. “New viruses have a temporary but important advantage—few or no individuals in the population are immune to them.”
- Environmental conditions have more impact on some viruses than others. Humidity levels change the contagiousness of influenza, as well as two betacoronaviruses that cause the common cold. It remains to be seen how the coronavirus behaves.
- A Princeton University team underscored this point in a study published in May 2020. They used 2014-2020 absolute humidity data from ERA-5 and MERRA-2 to develop scenarios for how the coronavirus might spread if seasonal effects prove to be similar to those for influenza and common cold betacoronaviruses. Their conclusion was that during the pandemic stage of an emerging virus, seasonality could only drive “modest” changes to a pandemic’s size.
- Rachel Baker, the lead Princeton researcher on that study, explained that the the coronavirus pandemic could eventually settle into a pattern of seasonal outbreaks. “But it will probably take some time to actually see that in the data,” she said. “Ideally, you would have enough data to be able to look at viral activity in the same city over multiple seasons—probably at least three years—before we would be able to say with confidence that there is a seasonal signal and be able to describe it.”
- So while scientists like Baker, Shaman, and Zaitchik are hustling to find clues, definitive answers about the seasonality of the coronavirus will not be forthcoming for several seasons.
- “As you take in this constant drumbeat of new information and research, remember that this virus is new to science and people have only just started studying it,” Zaitchik said. “Doing high-quality, definitive science takes time, sometimes a long time. The appetite for answers is understandably intense, but we also have to try to balance that hunger with patience.”
I. Practical Tips & Other Useful Information
1. Giving Convalescent Plasma
By Trisha Duval
- The upside to getting and recovering from C19 is that afterwards you can donate convalescent plasma. I was sick in late March/early April and thought I might have C19, but I didn’t know for sure until it was confirmed by a blood test in which the antibodies were detected. After I received my ‘positive’ result, I contacted the New York Blood Center about donating plasma – to my surprise they were booked a month out with other people who had also volunteered to donate convalescent plasma.
- My first appointment was in mid-June and it was a relatively easy and painless process. The actual plasma donation only took about 45 minutes, but between the wait time when I arrived, filling out a questionnaire, a screening interview, set up, and the time spent hooked up to the machine, the visit lasted about 2.25 hours. The process is similar to donating blood, but in this case your blood is removed, run through a centrifuge and returned through an IV in cycles during which you squeeze a ball when the blood is being removed and rest your hand when the blood is being returned.
- Afterwards, I was given juice, potato chips and a box of Girl Scout cookies. I felt slightly fatigued that evening and the next day, but it didn’t affect my activities. This was so easy that I am doing it again this week (hopefully they still have Do-si-dos!).
2. A Guide to Food Shopping and Outdoor Dining During Coronavirus
- Months into the coronavirus pandemic, many people say shopping for food and dining at reopened restaurants remains a fraught experience.
- Supermarkets and restaurants have introduced measures to keep their stores safe, including plexiglass dividers, capacity limits and requirements for customers and employees to wear masks. But food-safety guidelines continue to evolve as we learn more about how the new coronavirus is transmitted.
- Here is the latest on how to stay safe while shopping for groceries and eating in public.
Should I wear gloves while shopping for groceries?
- Experts who earlier wondered whether the virus can be spread from surfaces such as groceries and shopping carts now believe that airborne transmission among people in enclosed spaces is a far more common path of transmission. Along with wearing masks, frequent handwashing is a good way to mitigate any risk of picking up any virus lingering on surfaces, they say.
- But gloves can create a false sense of security and make hand hygiene tougher to maintain, said Shira Doron, hospital epidemiologist and infectious-disease physician at Tufts Medical Center.
- “You can contaminate yourself if you touch your face with them,” Dr. Doron said
Are reusable bags riskier than paper or plastic?
- Many grocery chains barred reusable bags at the start of the pandemic, reverting to single-use plastic and paper bags. But reusable bags carry little to no risk of spreading the virus, experts say. Contact among cashiers, baggers and shoppers presents a greater risk, said Margaret Viebrock, a professor of food safety and nutrition at Washington State University.
- Maintaining distance during these interactions and washing or sanitizing your hands afterward can help, she said. People should also wipe down the counter after loading items from bags, especially if they touched the floor in a public place. Washing reusable bags more frequently will help with overall hygiene.
Should I wipe down groceries when I get home, too?
- There is no need to wipe down produce, fruit and other raw food items because the virus isn’t foodborne. Washing produce with soap can lead to toxicity, said Kimberly Baker, director of the food-systems and -safety program at Clemson University. While the virus can last on surfaces for a couple of days, there has been no evidence that people can catch the virus from packaging, she said. There is also no evidence of the virus traveling on cash.
- Basic food-safety measures are also becoming important as consumers limit trips out of their homes and keep food for longer. Remember to wash hands after touching raw food and to separate raw meat from other foods in the refrigerator.
Can I host a potluck?
- Eating at a potluck is safe. The virus is neutralized in the stomach because acids break it down, said Ben Chapman, a professor and food-safety specialist at North Carolina State University. He added that there has been no reported case of transmission through food.
- But using common utensils and wait lines does make buffet tables or food bars risky. Most grocers and restaurants have closed hot food bars and buffets for this reason.
- Experts recommend providing plates and utensils for each diner and enough garbage cans to promote cleanliness and discourage congregating. Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital, suggested hosts offer single-use cups for snacks and condiments to minimize contact among guests.
Can I become infected if workers who packaged or shipped my food had C19?
- The likelihood of catching the virus through plant workers is close to zero, said Craig Hedberg, professor of environmental health sciences at the University of Minnesota. He said the virus will die by the time food gets delivered to one’s home.
- On the other hand, interacting with grocery-store or restaurant employees carries more risk, he said; the level of threat depends on time and proximity. “Now is not the right time to have a 15-minute conversation about which wine to pick,” said Martin Wiedmann, a professor of food science at Cornell University.
At restaurants, should I eat outside or inside?
- Dining outdoors is better because the risk of infection is higher in indoor spaces with poor ventilation, experts say. How people behave when eating has a much bigger impact on transmission than how food is cooked, Dr. Wiedmann said.
- Experts recommend wearing masks when diners aren’t sitting at a table to eat or drink; servers should cover their faces whenever possible. When taking off masks, people should keep them clean and stored in separate bags.
Are bars riskier than restaurants?
- Distancing is tougher to regulate when people are standing, moving around and shouting. Experts say alcohol consumption can also loosen adherence to safety practices, making bars more hazardous than restaurants unless they have plexiglass dividers between seats. Yelling and shouting can release droplets into the air that can infect people.
Are restaurant restrooms safe?
- No outbreak has been linked to public restrooms, experts say, but using shared restrooms increases the risk of infection. Flushing toilets and turning on dryers can stir air movement, said Robert Amler, dean of health sciences and practice at New York Medical College. People should use paper towels rather than dryers and go to restrooms one at a time if possible. Above all, being conscientious about wearing masks, washing hands and keeping a distance from others is the best way to fight the pandemic, said Dr. Doron of Tufts Medical Center.
J. Johns Hopkins COVID-19 Update
July 27, 2020
1. Cases & Trends
- The WHO COVID-19 Situation Report for July 26 reports 15.75 million cases (200,625 new) and 640,016 deaths (7,097 new). The global daily incidence does not include data for the US—the second time in the past week or so—and we expect the actual global daily incidence to be approximately 275,000 new cases, which would be the third highest to date. The WHO reported the 2 highest global daily incidence totals on July 24 and July 25—284,196 and 284,083 new cases, respectively.
- Brazil has reported 4 of its 5 highest daily totals over the past 5 days, including its record of 67,860 new cases on July 22. Over the past several weeks, Brazil’s daily incidence appeared to be plateauing; however, the data reported over the past several days is considerably higher than the previous few weeks. In fact, Brazil set a weekly incidence record with 319,653 new cases reported for Week 30 (July 19-25). Brazil surpassed India for #2 globally in terms of daily incidence, but they are essentially equal.
Central & South America
- Broadly, the Central and South American region remains a major C19 hotspot. Colombia reported 8,181 new cases, its third highest daily incidence to date. It appears as though Colombia’s incidence may be starting to level off, but more data is needed to evaluate longer-term trends. Colombia remains #5 globally with respect to daily incidence. Mexico’s daily incidence reporting varies widely from day to day, but the overall trend is clearly increasing. Looking at its 7-day average, it is clear that Mexico’s C19 epidemic continues to accelerate, but the increase in daily incidence may be starting to slow to a small degree. Mexico remains #6 globally in terms of daily incidence. Including Brazil, Colombia, and Mexico, the Central and South American 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), Brazil (#4), the US (#5), and Colombia (#10)—and a number of other countries in the region are reporting more than 100 new daily cases per million population.
India & Bangladesh
- India has reported 48-50,000 new cases for each of the past 4 days. India’s weekly trend over the past several weeks has been to report dramatically increasing incidence for several days, peaking Saturday or Sunday before decreasing slightly and beginning the pattern again. Last week, however, India’s daily incidence only increased for 2 days before several days of relatively consistent reports. India fell to #3 globally in terms of daily incidence, but its average daily incidence is essentially equal to Brazil’s. Bangladesh continues to report slowly decreasing daily incidence. Its daily testing appears to have leveled off after 2 weeks of steady decline; however, its test positivity appears to have increased slightly, up from 20-23% from late May through early July to 23-25% since then. Bangladesh remains #10 globally in terms of daily incidence.
- South Africa reported 11,233 new cases, and it remains among the top countries globally in terms of both per capita (#6) and total daily incidence (#4). South Africa’s daily incidence appears to have reached a peak or plateau, and it has reported slightly decreasing daily incidence over the past week, currently in the range of 11,000 new cases per day.
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 3 of the top 10 countries globally—Oman (#1), Bahrain (#2), and Kuwait (#9). Nearby Israel (#7), in the WHO’s European region, is 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.
- Luxembourg is #8 globally in terms of per capita daily incidence.
- The US CDC reported 4.16 million total cases (64,582 new) and 145,982 deaths (969 new). The US surpassed 4 million cases in its July 24 update. The US also reported more than 1,000 new deaths for 4 consecutive days, July 22-25, and nearly reached that benchmark again in the July 26 update. The US reported 2 of its 3 highest daily incidence totals over the weekend, including the record high of 74,818 new cases on July 25 (corresponding to July 24 data on the epi curve). Notably, the national 7-day average daily incidence appears to have reached a plateau at 66-67,000 new cases per day. While this is a promising sign, it is still more than twice the average daily incidence at the country’s first peak in mid-April. California, Florida, and New York are reporting more than 400,000 cases; Texas is reporting more than 375,000; and 8 additional cases are reporting more than 100,000. The US remains #5 globally in terms of per capita daily incidence and #1 in terms of total daily incidence.
- California is reporting 453,659 cases, and Florida surpassed New York (411,736 cases) to become #2, with a total of 423,855 cases. With an average daily incidence of nearly 9,000 new cases per day, Texas (381,656 cases) could surpass New York by the late this week. With nearly 10,000 new cases per day, California could surpass 500,000 cumulative cases by late this week as well. Florida continues to report nearly 11,000 new cases per day. Additionally, California, Florida, and Texas continue to report increasing daily C19 deaths. Texas is averaging more than 150 deaths per day, Florida is reporting more than 125, and California is reporting more than 100. On a per capita basis, Arizona is reporting more than 1 death per 100,000 population per day, compared to approximately 0.5 for Florida and Texas and 0.25 for California.
- The Johns Hopkins CSSE dashboard reported 4.26 million US cases and 147,103 deaths as of 1:00 pm on July 27.
2. Vaccines & Therapuetics
- A 2-dose candidate coronavirus vaccine developed by Moderna, Inc. and the US National Institute of Allergy and Infectious Diseases (NIAID), mRNA-1273, will begin Phase 3 clinical trials today. Trial participants will include approximately 30,000 healthy, adult volunteers at 89 clinical research sites in the US. Sites chosen include those that are predicted to be emerging C19 hotspots as well as areas that already have sustained community transmission. Doses will be given via intramuscular injections 28 days apart, but the researchers are hopeful that there will be evidence of immunity following the first dose. The trial will be double-blind, randomized, and placebo-controlled. If fewer than 150 participants develop C19 of the 30,000 enrolled, the trial will be considered a success by trial organizers. The US Biomedical Advanced Research and Development Authority (BARDA) has contributed $472 million to support further development efforts for the vaccine in addition to the $483 million that the federal agency contributed in April. There are currently 3 other candidate vaccines undergoing Phase 3 clinical trials, including 2 in China and one in the UK.
- A commentary published last week in JAMA proposed pooling the results of clinical trials that were not initially designed to function as a network in order to establish a more robust dataset for evaluating candidate drugs. As we covered previously, many research sites enroll only a small number of participants in C19 trial, which does not provide sufficient data to evaluate efficacy. By pooling results across multiple trials, it could be possible to generate enough data to characterize the drugs’ effects. Statistical stumbling blocks would need to be overcome, including merging data from studies with different designs, as well as details regarding data sharing and safety monitoring agreements. Despite these challenges, pooling data from multiple trials could warrant further investigation as a mechanism to make use of disparate datasets to contribute to evaluating candidate C19 drugs.
- As investigational vaccines progress through clinical trials, scientists, response leaders and governments are beginning to theorize what rollout of an approved vaccine would like and how to counter potential obstacles. One such obstacle may be concern regarding negative associated side effects. Often, reactions associated with vaccines are mild, such as the muscle soreness at the injection site, but a few participants in earlier clinical trials for candidate coronavirus vaccines, particularly those receiving higher doses, have experienced more severe reactions, including high fevers that require medical attention. There is concern that the fear of side effects may prevent individuals from getting vaccinated, so public messaging is already being crafted to educate the public on the benefits and risks and counter anticipated misinformation in order to increase the likelihood that the vaccine will be broadly accepted.
3. Wuhan Institute of Virology
- A senior researcher at the Wuhan Institute of Virology (WIV) in China participated in an interview with Science to address concerns and accusations that the coronavirus may have originated in laboratories at the facility.
- Dr. Shi Zhengli, who researches bat coronaviruses, stated that, while her lab has detected and studied more than 2,000 coronaviruses (mostly genetic sequences extracted from bat fecal specimens), her lab has only grown 3 coronavirus strains in culture, all related to the original coronavirus that emerged in 2003. She pushed back against claims that researchers at WIV developed the virus and released it, deliberately or accidentally.
- Following the emergence of the coronavirus in Wuhan, China, the US National Institutes of Health terminated a funding grant that, in part, supported coronavirus research efforts at WIV, reportedly due to concerns about biosafety practices at the facility.
4. Nonprofit Organizations
- In 2017, nonprofit organizations became the third largest employer industry in the US; however, like all major industries, they have faced significant impacts from the C19 pandemic. Projections indicate that nonprofit organizations lost more than 1.6 million workers between March and May, according to a report by the Johns Hopkins Center for Civil Society Studies. The study also found that many nonprofit organizations struggled to access federal funding support under the Paycheck Protection Program, despite meeting the criteria.
- A separate analysis—conducted by Candid, a philanthropic research group—projects that tens of thousands of US nonprofit organizations could ultimately be forced to close as a result of the pandemic. Many of these operations provide safety net services for high-risk and vulnerable populations, including health clinics, food pantries, and other charities. Efforts are underway to save these establishments by scaling up federal aid and establishing mutual aid partnerships at the grassroots level to multiply the impact of limited resources across multiple service organizations.
5. US Economic Relief
- Lawmakers continue negotiations today as federal protections against evictions and temporary unemployment benefits are scheduled to expire this week. These unemployment benefits have provided unemployed individuals with an additional $600 per week, but extending these benefits is one of many potential stumbling blocks in ongoing efforts to develop a “Phase 5” federal C19 economic relief package.
- Due to the broad range of potentially contentious issues associated with a new emergency funding bill, White House Chief of Staff Mark Meadows and Treasury Secretary Steven Mnuchin have suggested that in order to avoid the unemployment stumbling block, negotiations may need to occur on an issue-by-issue basis rather than as a single, comprehensive package. Senate leadership are expected to unveil a legislative proposal this afternoon.
- Regardless, pressure is mounting for legislators to find solutions to mitigate the economic impact of the US C19 epidemic. Even if new funding is agreed to quickly, implementing the plan at the federal and state level could potentially delay distribution by weeks or months, depending on the complexity of the plan. The Congressional Budget Office forecasts that long-term economic effects could persist for years, particularly with respect to unemployment.
6. North Korea
- North Korea announced the country’s first suspected case of C19. According to North Korean state media, the case was identified in an individual who had previously defected to South Korea and recently crossed the border back into North Korea. The individual reportedly exhibited symptoms associated with C19, but there are currently no reports that the individual has tested positive for coronavirus infection.
- The city of Kaesong, near the border with South Korea, is reportedly under “lockdown” following the identification of the suspected case, but it is difficult to accurately determine the current state of the response and degree of restrictions in place in North Korea. This appears to be the first time that the North Korean government has acknowledged a C19 case in the country. The case is not included in the most recent WHO C19 Situation Report.
- On Saturday, Vietnam reported its first locally acquired C19 case in 100 days, a 57-year old man in Danang with no history of international travel. Vietnam has mobilized response operations to execute contact tracing and widespread testing in the area. Health officials continue to emphasize the importance of mask use, physical distancing, and handwashing among the public to mitigate transmission risk and prevent an outbreak. Vietnam has been lauded as a success due to its low incidence (fewer than 500 cases) and zero reported deaths thus far during the pandemic.
- Since the initial reporting Saturday, 3 additional residents of the city have tested positive for SARS-CoV-2, and now 80,000 people, predominantly domestic tourists, are reportedly being evacuated from the city by government officials. Dispersing potentially exposed travelers across the country could risk geographic spread of the disease, not all travelers will be required to quarantine after returning home. Beginning Tuesday, mass gatherings and non-essential services with potential for prolonged close contact (e.g., beauty salons, bars) will be closed in Da Nang.
- Schools, tourist sites, restaurants, and other businesses will be permitted to remain open with precautions in place, such as reduced occupancy, use of personal protective equipment, and temperature screening.