Recent Developments & Information
July 30, 2020
Without reliable information, we rely on fear or luck.
“When people mix, the virus moves.”Mike Ryan, executive director of WHO’s emergency program
“If we think of this pandemic as a fire, there are embers everywhere. You relax your vigilance and it takes off again.”W. Ian Lipkin, a professor of epidemiology at the Mailman School of Public Health at Columbia University.
“As we stare into either a health or an economic abyss, or both, what options do we have?”Firass Abiad, head of coronavirus response at Rafik Hariri University Hospital
“You can shut down businesses or keep them open. Close schools or stay in session. Wear masks or not. The virus will make its way through in either case, and if we protect the elderly then deaths will be spared.”Yinon Weiss
A. The Pandemic As Seen Through Headlines
B. Numbers & Trends
1. Cases & Tests
5. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (7/29)
C. Early Detection of C19
D. Sweden’s No-Lockdown Approach Is Working
E. New Scientific Findings & Research
F. Improved & Potential Treatments
G. Concerns & Unknowns
H. The Road Back?
I. Back To School!?
J. Projections & Our (Possible) Future
K. Practical Tips & Other Useful Information
L. Johns Hopkins COVID-19 Update (7/29)
M. Links to Other Stories
Anti-viral strategy with double effect Frankfurt scientists identify possible Achilles’ heel of coronavirus
The best lessons on eradicating coronavirus come not from Spanish flu, but smallpox Just like today, the US dragged its feet. But then came a moment of unprecedented global collaboration
Suffering From Covid for Months—and Battling Murky Test Results Too Doctors believe many people are fighting Covid symptoms long-term, but testing inconsistencies complicate the picture
Pregnant Black and Hispanic women five times more likely to be exposed to coronavirus Penn researchers found the rate of virus exposure among Black and Hispanic women to be five times higher than among White and Asian women
Social distancing varies by income in US Wealthier communities went from being the most mobile before the C19 pandemic to the least mobile, while poorer areas have gone from the least mobile to the most mobile, according to a study by the University of California, Davis.
Clinical trial tests oral cancer drug to combat respiratory symptoms of C19 Researchers are conducting a new clinical trial to determine if an oral cancer drug called ibrutinib can also help patients with cancer or other immunocompromised conditions recover from C19.
Could prior exposure to common cold viruses affect the severity of coronavirus symptoms? A study shows some healthy individuals possess immune cells capable of recognizing the coronavirus. The reason might be found in prior infections with ‘common cold’ coronaviruses. Whether this cross-reactivity has a protective effect on the clinical course in individuals infected with the coronavirus will now be addressed by the study.
ONR helps develop ventilators in fight against C19 The Office of Naval Research (ONR) recently sponsored work to develop low-cost, easily built ventilator prototypes for both hospital and field settings. The ventilators would be valuable in emergency situations involving large patient surges and a lack of life-sustaining equipment.
MIT Using Artificial Intelligence to Help Put an End to the C19 Pandemic C3.ai Digital Transformation Institute awards $5.4 million to top researchers to study how society responds to the pandemic.
Tracking symptoms with app an inexact predictor of coronavirus infection A new piece in Family Practice, published by Oxford University Press, indicates that tracking symptoms affiliated with the novel coronavirus through an app may not be a good predictor of the spread of the disease.
Spring school closures tied to drastic decrease in C19 cases, deaths Their projection found that, if schools had stayed open, there could have been roughly 424 more coronavirus infections and 13 more deaths per 100,000 residents over the course of 26 days. Extrapolate that to the American population, and the country might have seen as many as 1.37 million more cases and 40,600 more deaths
Pandemic Is Overwhelming U.S. Public Health Capacity In Many States. What Now? A return to more restrictive shutdowns of businesses and public gatherings is likely necessary in many places, public health leaders say, to bring the number of cases low enough that “test, trace and isolate” can be used to douse epidemic embers.
German And U.K. Officials Warn Of A Possible New C19 Wave In Europe The European Union successfully flattened the curve of COVID-19 cases in the spring – but a second wave could be building in parts of the EU, according to both British Prime Minister Boris Johnson and the head of Germany’s disease agency.
‘It’s like you injected adrenaline into them’: Facebook’s vaccine misinformation problem faces a new test with C19 As scientists begin to clear a path to a potential coronavirus vaccine, researchers and advocates are increasingly sounding the alarm over what they see as a looming threat: Facebook’s apparent inability to police dangerous falsehoods about vaccines.
Kodak Shifts Into Drug Production With Help of a $765 Million U.S. Loan Onetime photography leader is shifting into production of drug ingredients using a loan provided under the Defense Production Act
US grants $265m for Fujifilm’s C19 vaccine project Assistance comes as Trump administration pushes ahead with Operation Warp Speed
A. The Pandemic As Seen Through Headlines
(In no particular order)
- FDA could issue emergency use authorization on vaccine within a matter of weeks (!)
- Russia Hopes To Register World’s First COVID-19 Vaccine By Aug. 12
- Majority of people say they won’t take COVID-19 vaccine within first year
- Head of China CDC gets injected with experimental vaccine
- The World’s Supply Chain Isn’t Ready for a Covid-19 Vaccine
- Dr. Fauci warns against public skepticism about coronavirus vaccine
- CDC reports one-third of coronavirus survivors have symptoms that don’t go away
- Bill Gates sides with President Trump and says schools SHOULD reopen because ‘the benefits outweigh the costs’
- Philadelphia students to start school year online after public backlash
- Teacher’s union president says strikes probable in Texas, Arizona, Florida
- Dr. Fauci Says People Should “Probably Use Eye Shields” To Protect Against COVID-19
- Scientists identify six different ‘types’ of COVID-19 in new study
- President Trump revives push for hydroxychloroquine during White House COVID-19 briefing
- Hydroxychloroquine banned by Ohio pharmacy board for coronavirus treatment
- Hong Kong Faces Worst Wave of Virus, But It Can’t Lock Down
- Hong Kong leader warns hospital system could collapse as city on verge of outbreak
- Mumbai slums have highest coronavirus immunity rate, study says
- In Covid-19 Recovery, London Bets Big on Low Traffic
- Masks Made From Banana-Tree Species Cut Covid’s Plastic Waste
- Pandemic May Change ‘Work-Life Balance’ Forever
- Coronavirus may close one-third of America’s museums for good
- NFL is now on notice after MLB coronavirus outbreak
- McDonald’s sales plunge nearly 30% due to COVID-19
- 14 members of Texas family test positive for COVID-19 after mask-free party
- NY Governor Cuomo invites all MLB teams to play in New York state amid COVID-19 issues
- HVAC Business Is Booming Amid “Huge Demand” For Medical-Grade Ventilation Systems
- Brazil reports new record jump with nearly 70,000 cases in a day
- Texas suffers record jump in deaths as cases top 400,000
- Trump says US will send Texas 500 cases of remdesivir
- Rhode Island pauses reopening
- California suffers record jump in deaths
- New Jersey sees disturbing spike in new cases
- NJ Gov. Murphy slows NJ reopening
- Dr. Fauci “concerned” about MLB outbreak
- Sweden COVID-19 deaths near zero
- Florida suffers 2nd straight daily record death toll
- China suffers biggest jump in new cases since April
- Hong Kong cases top 3,000
- Philippines overtakes Mainland China total
- Osaka reports another 200+ new cases
- Europe scrambles to avoid a second coronavirus wave, as infections rise
- Sweden Defeated The Coronavirus Without A Lockdown – Now Its Companies Are Reaping The Benefits
- U.S. Is About to Unveil the Ugliest GDP Report Ever Record
- Trump urges Congress to stop evictions, pass stimulus checks
- Staten Island dog, first to test positive for COVID-19 in US, has died
- Speaker Nancy Pelosi plans to require face coverings on House floor
- Emmys 2020 will go virtual due to coronavirus crisis
- Broadway workers turn to side hustles with theaters closed
- Hawaii placed on Japanese list of safe travel destinations
- 40 NY state workers to spy on bars, restaurants in NYC area
- North Carolina puts curfew on alcohol sales as coronavirus spikes
- Unsettling number of people are still refusing to wear a mask at bars, restaurants
- Despite his first-pitch fail, Fauci is now on a baseball card
- A lot of Americans are eating comfort food daily to cope with stress
- Trump may give RNC speech, accept GOP nomination at White House
- Hajj begins in Saudi Arabia with 1,000 pilgrims instead of usual 2 million
- JetBlue to test ultraviolet cleaning technology aboard aircraft
- Pakistan urges worshippers to buy sacrificial animals online to prevent coronavirus surge
- Emirates Airlines will cover funeral costs if you catch C19 while flying
- Consumer Electronics Show 2021 will be an all-digital affair
- Masks are the new condoms — and Americans need to get on board now!
- France opens beach-side coronavirus testing sites in tourist areas
- Party’s over: 14 family members catch coronavirus after mask-free bash
- Man says he was bitten by bus passenger after asking him to wear mask
- UK government invests in sex-party startup amid coronavirus pandemic
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.
1. Cases & Tests
- Total Cases = 17,176,973 (+1.7%)
- New Cases = 290,135 (+41,940) (+16.9%)
- New Cases (7 day average) = 258,655 (+1,396) (+0.5%)
- Record high number of new cases
- Record high 7 day average of new cases
- 1,000,000+ cases every 4 days
US Cases & Testing:
- Total Cases = 4,568,037 (+1.5%)
- New Cases = 66,921 (+1,853) (+2.85%)
- Percentage of New Global Cases = 23.1%
- New Cases (7 day average) = 66,683 (-720) (-1.1%)
- Total Number of Tests = 56,684,379
- Percentage of positive tests (7 day average) = 7.7%
- 7 day average of new cases has declined for 4 consecutive days
- The decline in the 7 day average of new cases may indicate the increase beginning on 6/9 may have peaked on 7/25 and is starting to decline
- Percentage of positive tests has significantly declined from 8.5% on 7/20 to 7.7% on 7/29
- Total Deaths = 669,566 (+1.1%)
- New Deaths = 7,030 (+1,386) (+24.6%)
- New Deaths (7 day average) = 5,652 (-14) (+0.3%)
- Highest number of new deaths since May 6
- 7 day average of new deaths has steadily increased from 4,571 on 7/2 to 5,652 on 7/29, an increase of 23.6%
- At the time of the highest number of new deaths on a worldwide basis (4/18), confirmed total deaths was 7.2% of confirmed total cases. As of 7/29, confirmed total deaths is 3.9%, a reduction of lethality of 45.8%
- Total Deaths = 153,840 (+1.0%)
- New Deaths = 1,485 (+155) (+11.7%)
- Percentage of Global New Deaths = 21.1%
- New Deaths (7 day average) = 1,022 (+37) (+3.8%)
- Highest number of new deaths since 5/27
- 7 day average of new deaths has been trending higher since 7/5, with the average increasing from 516 on 7/5 to 1,022 on 7/29, an increase of 98.1%
- During the last week, the 7 day average of new deaths increased from 877 on 7/22 to 1,022 on 7/29, an increase of 16.5%
- The last peak in new deaths occurred 4/21, which was approximately 10 days after the peak in new cases, which may indicate at least another week of increases in new deaths
- At the time of the highest number of new deaths on a worldwide basis (4/21), confirmed total deaths was 5.6% of confirmed total cases. As of 7/29, confirmed total deaths is 3.4%, a reduction of lethality of 39.3%
3. Coronavirus makes a comeback around the world
- An unforeseen summer surge of coronavirus cases in countries that had seemingly quelled their outbreaks is helping to drive the unrelenting growth of the global pandemic, undercutting predictions that a “second wave” would not occur until the fall.
- Japan, Israel, Lebanon and Hong Kong are among dozens of places reporting record numbers of new cases in recent days, many weeks after they had crushed the curve of infections, reopened their economies and moved on.
- And in some countries that had brought numbers down, notably in Europe, the reopening of borders, bars and nightclubs is being blamed for a small but noticeable increase in cases.
- In Belgium and Spain, the number of daily infections has surpassed levels not seen since early May, prompting authorities to reimpose some recently lifted restrictions.
- “I’m afraid you are starting to see in some places the signs of a second wave of the pandemic,” British Prime Minister Boris Johnson said Tuesday, referring to Europe, as he sought to justify reimposing quarantine measures on travelers from Spain. Britain also is seeing more cases.
- The United States, Brazil and India are still fueling the bulk of the pandemic’s growth, accounting for nearly two-thirds of the new cases reported globally over the past week. Many other countries, including in Africa, Latin America and the Middle East, have not yet reached a peak in infections, officials at the World Health Organization say.
- But since the beginning of July, the number of new cases in Japan has climbed by more than 60%, a growth rate equivalent to the United States’, alarming a country that had trumpeted the “Japanese model” for containing the virus.
- “We now have got an epicenter developing within Japan. Unless we stop it with a full force as a nation, I worry that we might go the same way as New York or Milan,” said Tatsuhiko Kodama, a professor at the University of Tokyo who is leading a research project on the virus.
- In Australia and some other places such as Hong Kong and Israel, all of which had appeared to defeat the virus, infections are growing twice as quickly as in the United States, or even faster, suggesting there is no end in sight to the virus’s spread. A million new infections are now being reported every four days worldwide, pushing the total to well over 16 million cases.
- Infectious-disease specialists say that references to a “second wave” are not helpful, given that almost nowhere in the world has entirely banished the virus. Rather, they say, we can expect to see waves of growth and contraction as authorities relax and tighten containment measures.
- The July resurgence in countries that had boasted of success has meanwhile confounded hopes that summer would bring some respite, at least to countries in the Northern Hemisphere that seemed to have managed their coronavirus outbreaks well.
- Some of the countries where the case numbers are rising or raging are in the Southern Hemisphere, now experiencing midwinter, such as Brazil and Australia. But the new increases are also afflicting regions that had been bracing for a fall wave, predicted as people spend more time crowded together indoors and lower humidity facilitates the transmission of the virus, said Tim Spector, a professor of genetic epidemiology at King’s College in London. His team published a paper last week on how colder conditions affect the transmission of the novel coronavirus and the severity of C19, the illness the virus causes.
- A worrying question now, Spector said, is how much worse the coronavirus spread will become when winter does arrive in the Northern Hemisphere.
- “Everyone was predicting that as summer came, the United States, for example, would be fine, that they could get cases low before the winter struck. That’s not happening,” he said. “It’s a reasonable assumption that when winter comes, the frequency and doses of virus people are infected with will be greater and severity will increase again.”
- Overwhelmingly, governments and scientists attribute the resurgences to the relaxation of social distancing measures, the resumption of tourism and the reopening of nightclubs, bars and restaurants, where crowded conditions create optimal conditions for the coronavirus to spread.
- “When people mix, the virus moves,” said Mike Ryan, the executive director of the World Health Organization’s emergency program, at a virtual news briefing Monday.
- The good news, he said, is that many of the new outbreaks have been pinpointed, which helps the task of controlling them with isolation, testing and contact tracing. In Spain, outbreaks have been traced to migrant agricultural workers in the province of Aragon and to the reopening of nightclubs in Barcelona.
- But they also underscore the challenge of maintaining the vigilance required to keep the virus in check for months on end, experts say.
- “If we think of this pandemic as a fire, there are embers everywhere. You relax your vigilance and it takes off again,” said W. Ian Lipkin, a professor of epidemiology at the Mailman School of Public Health at Columbia University.
- People are growing tired of the pandemic’s impact on their lives, he said. “There’s a lot of pent-up economic anxiety and social anxiety, and this is lasting longer than anticipated,” Lipkin said.
- In Japan, record numbers of infections over the past week have been blamed on Tokyo’s hostess clubs. Yet the government and the public alike are resisting calls by health professionals for new restrictions that might further damage the economy.
- Some countries are battling far greater economic problems than Japan and face even tougher choices about curtailing economic activity to control the virus. One of those is tiny Lebanon, which won plaudits for containing the coronavirus with a swift and strict lockdown early on but has seen its case count more than double in the past month — to 4,021 as of Wednesday, according to Health Ministry figures.
- Lebanon also is confronting an economic collapse that began well before the pandemic and has accelerated despite the lifting of the restrictions in early June. The government on Tuesday reimposed a staggered lockdown that will shut down the country over the next two weekends and close the bars and nightclubs that had reopened, in some instances to huge crowds.
- Firass Abiad, who heads the coronavirus response at Lebanon’s biggest government hospital, the Rafik Hariri University Hospital, captured the country’s dilemma in a tweet. “As we stare into either a health or an economic abyss, or both, what options do we have?” he asked.
- There may be places in the world where increased testing explains some of the jump in numbers, experts say. The Israeli government points to the higher number of tests now being conducted to explain a huge second wave of infections that has given the country one of the highest surges in cases in the world, said Nadav Eyal, a journalist with Israel’s Reshet News.
- But the greater availability of tests cannot explain the overall numbers, hospitalizations and deaths, Lipkin said. Cases are rising, he reiterated, because people are letting their guard down.
- “We didn’t think we would see people relax as much as they have,” he said. “There’s a whole series of things we should have anticipated, could have anticipated and accounted for. But the majority of these increases are of our own making.
4. Young people are infecting older family members in shared homes
- As the death toll escalates in coronavirus hot spots, evidence is growing that young people who work outside the home, or who surged into bars and restaurants when states relaxed shutdowns, are infecting their more vulnerable elders, especially family members.
- Front-line caregivers, elected officials and experts in Houston, South Florida and elsewhere say they are seeing patterns of hospitalization and death that confirm fears this would happen, which were first raised in May and June. That was when Florida, Texas, Arizona, California and other states reopened in efforts to revive their flagging economies.
- The emerging trend highlights the difficulty of relying on the Trump administration’s strategy of sheltering the most vulnerable while the young and healthy return to work and school. That approach runs the risk of transmitting the virus when two or three generations share the same home and when many lower-income workers have little choice but to brave exposure to do their jobs.
- Young adults are among the essential workers who may be returning home to parents and grandparents. High school and college-age children may expose teachers, parents and grandparents.
- Sooner or later, doctors said, most older people and those with underlying health problems will mix with the younger generation.
- “We think when Texas started opening up, that was May 1, it was young people going to bars and restaurants, out and about, gathering socially,” said Pat Herlihy, chief of critical care at Baylor St. Luke’s Medical Center in Houston. “My hypothesis now is that they’re engaging with the larger families, they’re engaging with the 60- to 70-year-olds — parents uncles, aunts. They’re engaging much more with that vulnerable population.”
- Ethnically diverse parts of the Sun Belt, where caseloads are climbing fast, are home to a larger share of multigenerational families who live together than other sections of the United States. A record 64 million people — about 20% of the U.S. population — lived in homes with at least two adult generations or grandparents and grandchildren under 25 in 2016, according to an analysis of census data by the Pew Research Center.
- That is even more true for Hispanics, who have large populations in Florida, the Southwest and California. About 27% live in multigenerational households. The figure is similar for black people (26 percent) and Asians (29 percent), Pew found.
- The pandemic and its accompanying economic hardship also have forced some younger adults back into their parents’ homes.
- It is impossible to know how any person acquires the coronavirus, and with community transmission rampant across the Sun Belt, people can become infected in a variety of ways. So discussion of intergenerational transmission involves some speculation, as well as epidemiological modeling and research.
- In a heartfelt tale that has been seen around the globe, a Florida woman took to Facebook earlier this month to say she believes her 21-year-old stepson had infected her, her husband and their two younger children after he spent time with friends who were not wearing masks or social distancing.
- The father, 42-year-old John Place, spent 18 days on a ventilator before doctors were able to wean him from the device nearly two weeks ago, Michelle Zymet of Plantation, Fla., said in an interview Saturday. But Place is still seriously ill, hospitalized and suffering the debilitating effects of C19, Zymet said.
- “I pleaded with him, every day,” Zymet said of her stepson. “I was that maniac. ‘Please wear your mask. Hand sanitizer. Social distance.’ ”
- Younger adults need to understand that “you don’t live in a bubble,” she said. “You have to think about everybody in the community. Don’t just think about yourself.”
- In a post on her Facebook page, Zymet also said she was not “trying to bash my stepson or put this immense amount of guilt on him. … He feels terrible for what has happened and just wants others not to make the same mistake he did!”
- On Monday, the White House announced that national security adviser Robert C. O’Brien had contracted the coronavirus. O’Brien probably caught the virus from his daughter, said chief economic adviser Larry Kudlow. No further details were available.
- People in their 20s and 30s die of C19 in much smaller numbers than those 60 and older, and at first the death toll in the Sun Belt did not keep pace with infections. Now, however, epidemiologists’ prediction of a follow-up surge in fatalities is bearing out.
- The question is why.
- Experts note that younger people are disproportionately asymptomatic when they become infected, so some may not know they are bringing it home.
- Peter Paige, chief medical officer for Miami’s Jackson Health System, said that a month ago, about 40% of the people hospitalized for C19 in the system’s three facilities were 65 or older. Now that proportion has climbed to about 55%.
- About 60 to 65% of the people now dying of C19 are in that age range — a figure approaching the proportions of the early days of the pandemic, he said.
- In Jackson’s emergency departments, meanwhile, 85 to 90% of C19 patients are younger than 65, Paige said. Many do not need to be admitted.
- “It appears there’s a lot more positivity coming in the younger population, but it seems like a lot of the deaths are coming in that high-risk population,” he said.
- In recent days, the mayors of Miami, Miami-Dade County and Broward County said household transmission has become a critical factor in that area’s outbreak.
- “I would tell our residents … that they should consider, particularly if they have a multigenerational household, wearing masks indoors at times … and also respecting social distance when they’re at home,” Miami Mayor Francis Suarez (R) said at a news conference last week.
- Miami-Dade County Mayor Carlos A. Giménez also urged people to distance themselves from family members who may carry the virus without seeming to be sick.
- “Yes, I know it’s a sacrifice,” he said, “but do so because, again, just because it’s your son, or your daughter, or your cousin, or your mother, or your father, doesn’t mean they don’t have covid.”
- Recent research on household transmission is mixed. Researchers who studied household contacts in Guangzhou, China, in January and February estimated that close relatives living in the same home gave 12.4% of their family members the virus, according to research published last month in the journal Lancet Infectious Diseases.
- But a separate statistical analysis of 8 European countries earlier this month in the journal Proceedings of the National Academy of Sciences found no conclusive evidence that intergenerational relationships affected the spread or severity of the pandemic in those places.
- In Tennessee, data analyzed by John Graves, an associate professor of health policy at Vanderbilt University School of Medicine, showed an increase in infections among young adults in the Nashville and Memphis areas. Graves attributed the surge to that age group returning to downtown bars as the shutdown eased and, later, to Fourth of July gatherings.
- Now the data is starting to indicate that older adults are also becoming infected.
- “What that is suggestive of is that initial seeding is now starting to spread to older generations,” he said.
- The trend is not universal. In Los Angeles, which is experiencing a huge growth in cases, the outbreak still appears to be concentrated among younger adults, said Neha Nanda, medical director of infection prevention and antimicrobial stewardship at Keck Medicine of USC.
- The median age of people admitted to area hospitals during the first surge was about 60, while this time it is between 35 and 40, she said. Many young adults with C19 are sent home from emergency departments and testing sites because their symptoms are mild, she said.
- “I think it’s not happening as of yet,” Nanda said of older adults showing up at hospitals. “I would not exclude that possibility.”
5. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (7/29)
Source: Worldometer and The Covid Tracking Project
C. Early Detection of C19
1. Immune System Provides Early Warning Signs of Severe C19 Outcomes
- The differing immune system responses of patients with C19 can help predict who will experience moderate and severe consequences of disease, according to a new study by Yale researchers published July 27 in the journal Nature.
- The findings may help identify individuals at high risk of severe illness early in their hospitalization and suggest drugs to treat C19.
- Researchers examined 113 patients admitted to Yale New Haven Hospital, and analyzed the varying immune system responses they exhibited during their hospital stay, from admittance to discharge or death. They found that all patients shared a common C19 “signature” in immune system activity early in the course of disease. But those who experienced only moderate symptoms exhibited diminishing immune system responses and viral load over time. Patients who went on to develop severe cases of the disease showed no decrease in viral load or immune system reaction, and many of the immune signals in these patients accelerated.
- But even in the early course of treatment, researchers found indicators that predicted which patients were at greatest risk of developing severe forms of the illness.
- “We were able to pull out signatures of disease risk,” said senior author Akiko Iwasaki, the Waldemar Von Zedtwitz Professor of Immunobiology and Molecular, Cellular and Developmental Biology and investigator for the Howard Hughes Medical Institute.
- Researchers had known that the immune system unleashed a massive and damaging “cytokine storm” in severe cases of C19. But the specific elements of the immune system response most responsible for the damage were unknown.
- The Yale analysis found some intriguing links to poor outcomes. Curiously, said researchers, one risk factor was the presence of alpha interferon, a cytokine mobilized to combat viral pathogens such as the flu virus. However, C19 patients with high levels of alpha interferon fared worse than those with low levels.
- “This virus just doesn’t seem to care about alpha interferon,” Iwasaki said. “The cytokine appears to be hurting, not helping.”
- Another early prognosticator of poor outcomes is activation of the inflammasome, a complex of proteins that detects pathogens and triggers an inflammatory response to infection. Inflammasome activation was linked to poor outcomes and death in several patients.
- Researchers found that people who respond better to the infection tend to express high levels of growth factors, a type of cytokine that repairs tissue damage to the linings of blood vessels and lungs.
- Taken together, the data can help predict patients at high risk of poor outcomes, the authors said.
- They also said drugs that target specific causes of inflammation identified in the study could help treat patients at risk of developing severe cases of C19.
2. Smartwatch or Smart Ring Might Provide Early Detection of C19
[Note: There is evidence that those who have C19 can have an elevated resting heart rate about three days before symptoms]
- For the past three weeks I’ve worn an Oura ring, Fitbit, Garmin fitness band and Apple Watch, along with two high-tech skin patches, all packed with sensors. They’ve sent hundreds of temperature readings, blood oxygen levels, heart beats—even cough counts—to my phone. All to find out if I have C19. (I don’t. Confirmed with a real fun nasal-swab test.)
- Tech companies and medical researchers are hard at work figuring out if wearable devices can spot C19, the flu and other illnesses—even seeing if they can function as a personal early-detection system to contain the virus. They take wearable sensor data from both healthy people and those afflicted by Covid, compare and look for patterns in the data, then create artificial intelligence that could alert others whose own data patterns point to trouble.
- Results from Fitbit’s C19 study are already showing fluctuations in key metrics, such as heart rate and respiration, days before symptoms. Fitbit Inc. Chief Executive James Park told me the company, which Alphabet Inc.’s Google has agreed to buy, is working toward a system where flagged users could be instructed to quarantine and then, if symptoms appear, confirm with a test.
|The Oura ring measures skin temperature and the app calculates a baseline, then reports how far above or below that you are.|
- “If you can quarantine one to three days before your symptoms start, it could have a really meaningful impact on the course of the disease,” he said. The system—which Mr. Park says could have green, orange and red warning levels—might need regulatory approval before appearing in the Fitbit app.
- In a similar way, NBA players and staff are using the Oura ring in the “bubble” in Orlando, Fla., where they are now living and playing in isolation for their safety. If certain data points hit certain levels, authorized personnel can notify the wearers to get tested.
- So, hallelujah, we’re all saved?! No. It’s still the early days of all this, says Eric Topol, a cardiologist and executive vice president at Scripps Research, whom I recruited to help me make heads or tails of my data. This stands a chance of working only if all the physiological data collection is met with even further research, not to mention an abundant availability of at-home testing.
- “In the months ahead people will have at their home a testing kit that will give us an answer in 15 minutes, and hopefully people will be using wearables,” Dr. Topol said. “You wouldn’t do the test unless your sensors were coming together to tell you something is going on.”
- OK, but right now, was it possible to interpret what all of my sensors were coming together to tell me?
- The $299 Oura ring, an activity and sleep tracker for your finger, is one of the few wearables to offer temperature tracking. Since it’s not on your body, it doesn’t record core body temperature; rather, it takes readings for a few weeks to get a baseline temperature, then it reports fluctuations in that. On most days, the app said my temp was optimal. The most feverish I ever got was 0.6 degrees Fahrenheit.
|The Kinsa smart thermometer sends your temperature to your phone after you take it. The 48-hour TempTraq patch, which you place under your armpit, continuously sends temperature readings to your phone.|
- For comparison, I wore a TempTraq patch under my armpit for a few days. The patch wirelessly sends temperature to a smartphone app every 10 seconds, recording the history every four minutes. My average was 97.6 degrees.
- Using a Kinsa smart thermometer, I also took my temperature orally three times a day—including before getting out of bed in the morning to get my basal—at rest—temperature. The thermometer automatically sends your temp to an app on your smartphone. My average for the past week? 98.4 degrees.
- “Just your temperature data tells me very little,” Dr. Topol said. “The problem with temperature is more than half of people who have C19, people with a bona fide infection—they never mount a fever response.” He added, “The other thing of course is that you’re particularly infectious before you have a fever.”
- Tracking fevers in aggregate, however, can help. Kinsa is gathering anonymized data from its smart thermometers plotted by location to monitor spread and determine viral hot spots.
- Dr. Topol was far more eager to get his hands on my heart-rate and activity data. My resting heart rate for the past week, according to Oura, was 54 beats a minute. The Garmin Vivosmart 4, the Fitbit Charge 4 and the Apple Watch Series 5 all said 60 bpm—still good. (Oura says it measures heart rate only at night, hence the lower average.) The important thing is that there was no considerable variation from the week before, either.
- Dr. Topol said roughly a third of C19 infections are asymptomatic, but a change in heart rate might still indicate one. “The fact that your resting heart rate has never gone up is a really good sign that there’s nothing going on,” he said.
|Wearables from Apple, Fitbit and Garmin are all being used in different C19 studies to gather heart-rate data.|
- Michael Snyder, who is running a study at Stanford looking at data from Fitbits, Apple Watches, Garmins and more, told me that there is early evidence that those who have C19 can have an elevated resting heart rate about three days before symptoms.
- At Scripps, researchers had already found that resting heart-rate elevation, decreased physical activity and increased sleep were, in combination, a really crisp signal for detecting the flu. Early findings from the institute’s current Detect study looking at C19 have indicated the same.
- West Virginia University Rockefeller Neuroscience Institute researchers have been conducting research with Oura rings; early results show that it can detect C19-related symptoms up to three days before they show up. The University of California, San Francisco is running a similar study using the ring. (Oura is funding this one, though less than 10%.) Once the research is completed, Oura Health CEO Harpreet Singh Rai says the company will consider giving users a notification if it spots potential signs of illness.
Blood Oxygen and Cough Tracking
- Since an elevated heart rate or a drop in activity can be caused by lots of things, some researchers are focusing on specific C19 symptoms.
- A low blood-oxygen level, something in the low 90% range, or even dipping into the 80s, can be a signal for the severity of C19. That has made pulse oximeters—those little finger clips that measure blood oxygen (aka oxygen saturation or SpO2)—the hottest gadgets of the year.
|Garmin’s Vivofit 4 can measure blood-oxygen levels just like a dedicated pulse oximeter.|
- Most of Garmin’s latest wearables have this built right in. The Garmin Vivosmart 4 can take blood-oxygen levels periodically throughout sleep or users can take it manually. My watch said mine was, on average, 96%. My good old Walgreens finger oximeter consistently reported 98%.
- Dr. Topol said my scores were normal but that blood oxygen is only helpful for people already diagnosed with C19, to gauge the severity of the illness. He expects more wearables to get blood-oxygen monitoring this year.
- Fitbit already has such a sensor on some of its devices but it doesn’t offer a full read out; Mr. Park says the company is working to enable it. Current Apple Watch models don’t measure blood-oxygen levels; Apple is expected to launch a new model this fall that might.
- Another possible indicator? Your cough. Taped just below my suprasternal notch (that dip at the front base of the neck) is a little patch made by John Rogers’s biomedical engineering lab at Northwestern University. It measures temperature, heart rate, body motion and various other things, including chest wall movements and respiratory sounds for coughs.
- “For some C19 patients admitted in our hospitals, we observed coughing rates that reached an average of 100 per hour. You are far, far below that number. We also often see irregular respiratory and cardiac activity. We do not observe such features in your data,” said Mr. Rogers after his team analyzed my collected information.
- Researchers at the Embedded Systems Laboratory at the Swiss Federal Institute of Technology have started gathering recordings of C19 coughs to see if it is possible for a smartphone to identify some unique signature.
- One day will we be able to say, “Hey Siri, am I sick?” and get an instant diagnosis? Possibly. But for now I’m betting on wearables eventually being able to make an educated guess that I’m coming down with something, even if it can’t name the disease.
- Do I worry about the costs of that capability, and all the problems it will create? Of course. False positive alerts? Too much trust in the system? A lot more data in the hands of Big Tech? A widening socio-economic divide that grants better health to those who can afford the best smartwatch? Yeah, it could get ugly.
3. NYC doctor develops rapid, noninvasive C19 test
- A New York fertility doctor has developed a rapid, noninvasive coronavirus test that can deliver accurate results in 30 minutes or less, according to a preliminary study.
- The test, developed by Dr. Zev Williams, a reproductive endocrinologist who runs the Columbia University Fertility Center, uses a person’s saliva to screen for C19.
- A small sample of saliva is placed into a tube containing enzymes and a compound that causes a chemical reaction before the tube is then warmed up with a heat block. The liquid in the tube turns yellow when it’s positive for the virus or red when it’s negative.
- “We wanted to design a single step test where all the work was being done by enzymes and chemicals rather than cartridges and components,” Williams said, adding that enzymes and chemicals are easy to scale and distribute.
- The one-step, rapid test was able to detect as few as one or two copies of the SARs-CoV-2 virus in a microliter of saliva, according to a preliminary study published by Williams on MedRxiv — meaning that it can detect if a person is infected even if they only have a low concentration of the virus.
- “Low limits of detection help ensure that you can detect the virus in infected individuals, even if they are asymptomatic,” Williams explained.
- The study, which has not been peer-reviewed, also recorded sensitivity of 97% and specificity of 100%.
- Sensitivity refers to the ability of a test to correctly identify infected patients, while specificity is the ability of a test to correctly identify those who are not ill. In this case, when the sample was negative, the saliva test didn’t deliver a false positive result, while when the sample was positive, 97% of the time it was correctly detected.
- “This test is very, very simple, very fast and is extremely accurate,” said Dr. Henry Ji, chairman and CEO of Sorrento Therapeutics, which has partnered with Columbia University and is licensing the test.
- “Currently the accuracy of other tests is not there.”
- If the test proves successful in further testing, Williams hopes it can help curb the spread of the contagion by aiding contract tracing.
- “When you get the results back quickly it allows you to have the individual be self quarantined so that they’re not spreading it and it also allows you to do contact tracing,” Williams said.
- “If you get the results a week later, good luck trying to do contact tracing if they took the subway system once you’ve lost.”
- Current C19 testing involves a nasal swab and specialized laboratories and machinery, which slows testing down and has resulted in delays of days, or even weeks, in delivering results.
- “The problem is the delay between the time you test and the time you get the results,” said Dr. Alexis Nahama, SVP of regulatory affairs at Sorrento.
- “We need to bring the testing to the people versus taking the people’s samples and taking them to the lab because that’s where it breaks apart today.”
- Sorrento is conducting a larger study of the saliva test before applying for FDA emergency authorization next month.
- The cost per test is expected to be under $15, Williams said.
D. Sweden’s No-Lockdown Approach Is Working
1. Sweden Unveils ‘Promising’ C19 Data as New Cases Plunge
- As other countries face renewed outbreaks, Sweden’s latest C19 figures suggest it’s rapidly bringing the virus under control.
- “That Sweden has come down to these levels is very promising,” state epidemiologist Anders Tegnell told reporters in Stockholm on Tuesday.
- The Health Agency of Sweden says that since hitting a peak in late June, the infection rate has fallen sharply. That’s amid an increase in testing over the period. “The curves are going down and the curves for the seriously ill are beginning to approach zero,” Tegnell said.
- The development follows months of controversy over Sweden’s decision to avoid a full lockdown. The unusual strategy coincided with a much higher C19 mortality rate than elsewhere in the Nordic region. Per 100,000, Swedish deaths even exceeded those in the U.S. and Brazil.
- Tegnell also broached the subject of face masks, which the World Health Organization recommends people use when social distancing isn’t possible.
- “With numbers diminishing very quickly in Sweden, we see no point in wearing a face mask in Sweden, not even on public transport,” he said.
- Tegnell has consistently argued that Sweden’s approach is more sustainable than the sudden lockdowns imposed elsewhere. With the risk that C19 might be around for years, he says completely shutting down society isn’t a long-term option.
- Meanwhile, many countries that thought they’d brought the virus under control are now seeing second waves. Tegnell called those developments “worrying.”
- “The positive trend is reversing, with an increase in the number of cases in Spain, Romania and Belgium, among others,” he said.
2. Why Sweden Succeeded in “Flattening the Curve” and New York Failed
- Coronavirus deaths have slowed to a crawl* in Sweden.
- But the debate over Sweden’s approach to the C19 pandemic, which relied on individual responsibility instead of government coercion to maintain social distancing, is far from over.
- Last week, The New York Times labeled Sweden’s approach to the pandemic a “cautionary tale” for the rest of the world, claiming it “yielded a surge of deaths without sparing its economy from damage.”
- To be accurate, Sweden has outperformed many nations around the world with its “lighter touch” approach and was one of the few nations in Europe to see its economy grow in the first quarter of 2020.
- Meanwhile, Anders Tegnell, Sweden’s top infectious disease expert, continues to defend his nation’s approach to the pandemic.
- “I’m looking forward to a more serious evaluation of our work than has been made so far,” Tegnell said in a recent podcast published by Swedish public radio before taking a scheduled vacation. “There is no way of knowing how this ends.”
Sweden’s Actual Pandemic Performance
- Sweden has become a global lightning rod, but this has less to do with the results of its policies than the nature of its policies.
- While Sweden’s death toll is indeed substantially higher than neighbors such as Finland, Norway, and Denmark, it’s also much lower than several other European neighbors such as Belgium, the United Kingdom, Italy, and Spain.
- Indeed, a simple comparison between Belgium and Sweden—nations with rather similar populations—reveals that Belgium suffered far worse than Sweden from the coronavirus.
- The reason Sweden is a “cautionary tale” and Belgium is not is because Belgium followed the script. Early in the pandemic, Belgian officials closed all non-essential business and enforced strict social distancing rules.
- All non-emergency workers were told to stay home. Shopping was limited to a single family member. Individuals could leave for medical reasons or to walk a pet or get a brief bit of exercise—so long as social distancing was maintained.
- These lockdown protocols, the BBC reported, were strictly enforced by Belgian police using “drones in parks and fines for anyone breaking social distancing rules.”
A More Suitable ‘Cautionary Tale’
- Sweden clearly endured the pandemic better than Belgium, which had nearly twice as many C19 deaths despite its economic lockdown.
- Yet the Times chose Sweden as its “cautionary tale” because Sweden chose not to institute an economic lockdown. Sweden took such an approach for two reasons.
- First, as Tegnell has publicly stated, there is little to no scientific evidence that lockdowns work. Second, as evidence today shows, lockdowns come with widespread unintended consequences: mass unemployment, recession, social unrest, psychological deterioration, suicides, and drug overdoses.
- Even if Sweden has seen its death toll rise more sharply than Scandinavian neighbors such as Finland and Norway, it’s strange that the Times would go thousands of miles across an ocean and continent to find a “cautionary tale.” A far better cautionary tale can be found right under the Grey Lady’s nose.
- A simple comparison between New York and Sweden shows the Empire State has suffered far worse from C19 than the Swedes. Yinon Weiss, an entrepreneur and founder of Rally Point, recently compared Sweden and New York using data from the COVID Tracking Project.
- The first thing one notices about the comparison is that Sweden was able to “flatten the curve,” so to speak. Though the phrase is largely forgotten today, flattening the curve was originally the entire purpose of the lockdowns. To the extent that there was a scientific basis for lockdowns, it was in the idea that they were a temporary measure designed to help hospitals avoid being overwhelmed by sick patients.
- Dr Robert Katz, founding director of the Yale‐Griffin Prevention Research Center, observed that by flattening the curve “you don’t prevent deaths, you just change the dates.” But a temporary lockdown could at least prevent everyone from getting sick at once, which would be catastrophic.
- If flattening the curve was the primary goal of policymakers, Sweden was largely a success. New York, on the other hand, was not, despite widespread closures and strict enforcement of social distancing policies.
- The reason New York failed and Sweden succeeded probably has relatively little to do with the fact that bars and restaurants were open in Sweden. Or that New York’s schools were closed while Sweden’s were open. As Weiss explains, the difference probably isn’t related to lockdowns at all. It probably has much more to do with the fact that New York failed to protect the most at-risk populations: the elderly and infirm.
- “Here’s the good news: You can shut down businesses or keep them open. Close schools or stay in session. Wear masks or not,” says Weiss, a graduate of Harvard Business School. “The virus will make its way through in either case, and if we protect the elderly then deaths will be spared.”
- This is precisely the prescription Dr. John Ioannidis, a Stanford University epidemiologist and one of the most cited scientists in the world, has advocated since the beginning of the C19 pandemic.
- Like Tegnell, Ioannidis early on expressed doubts about the effectiveness of lockdowns and warned they could produce wide-ranging unintended outcomes.
- “One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health,” Ioannidis wrote in a STAT article in March. “Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric.”
- Sadly, many of the adverse consequences Ioannidis predicted have since come to pass, as he has acknowledged.
Is Sweden Truly a ‘Cautionary Tale’?
- Tegnell and Swedish leaders have mostly stood by their lighter touch approach, although there is a recognition that they, too, could have more effectively protected at-risk populations.
- “We must admit that the part that deals with elderly care, in terms of the spread of infection, has not worked. It is obvious. We have too many elderly people who have passed away,” Sweden’s Prime Minister Stefan Löfven said in June.
- Yet it’s a mistake to label Sweden’s approach a failure. As noted above, Sweden is being criticized less because of the results of their public health policies and more because of the nature of them.
- By embracing a much more market-based approach to the pandemic in lieu of a centrally planned one, Sweden is undermining the narrative that millions and millions of people would have died without lockdowns, as modelers predicted.
- Without Sweden and a few similar outliers, it would be far easier for central planners to say, Sure, lockdowns were harsh and destructive. But we had no choice.
- In the wake of the most destructive pandemic in a century, there will be considerable discussion as to whether the lockdowns, which stand to trigger a global depression in addition to other psychological and social costs, were truly necessary.
- In a sense, the disagreement over the pandemic largely resembles a much larger friction in society: should individuals be left free to pursue their own interests and weigh risks themselves or should they be guided, coerced, and protected by planners who want to do all this for them.
- As Ludwig Von Mises noted long ago, modern social conflict is largely a struggle over who gets to design the world, individuals or authorities. Mises saw few things more dangerous than central planners seeking to supplant the plans of individuals with plans of their own, which they see as a preeminent good.
- It was partly for this reason Mises saw market economies as superior to command economies.
- “Whatever people do in the market economy, is the execution of their own plans. In this sense every human action means planning,” Mises wrote in Socialism: An Economic and Sociological Analysis. “What those calling themselves planners advocate is not the substitution of planned action for letting things go. It is the substitution of the planner’s own plan for the plans of his fellow-men. The planner is a potential dictator who wants to deprive all other people of the power to plan and act according to their own plans. He aims at one thing only: the exclusive absolute pre-eminence of his own plan.”
- When Mises speaks of the “pre-eminence of his own plan,” it’s hard not to think of New York Gov. Andrew Cuomo, who in March sounded downright indignant when a reporter asked about nursing homes objecting to his plan of prohibiting them from screening for C19.
- “They don’t have the right to object,” Cuomo answered. “That is the rule, and that is the regulation, and they have to comply with it.”
- Cuomo clearly saw his central plan as superior to that of individuals acting within the marketplace.
- The policy of forcing nursing homes to take COVID carrying patients, which was adopted by numerous US states with high virus death tolls, is a stark contrast to Sweden’s market-based approach that trusted individuals to plan for themselves.
- “Our measures are all based on individuals taking responsibility, and that is … an important part of the Swedish model,” Hakan Samuelsson, the CEO of Volvo Cars, observed in April.
- Sweden’s approach of encouraging social distancing by giving responsibility to individuals may very well explain why the Swedes fared so much better than New York, where authorities disempowered individual actors and prevented nursing homes from taking sensible precautions.
- It’s almost absurd to look at New York’s pandemic plan and declare it superior to Sweden’s, yet many in the intellectual class will continue to hammer away at Sweden while ignoring the catastrophic numbers in New York, New Jersey, Massachusetts, and other states.
E. New Scientific Findings & Research
1. Surface transmission seems quite rare
- As a C19 summer surge sweeps the country, deep cleans are all the rage.
- National restaurants such as Applebee’s are deputizing sanitation czars to oversee the constant scrubbing of window ledges, menus, and high chairs. The gym chain Planet Fitness is boasting in ads that “there’s no surface we won’t sanitize, no machine we won’t scrub.” New York City is shutting down its subway system every night, for the first time in its 116-year history, to blast the seats, walls, and poles with a variety of antiseptic weaponry, including electrostatic disinfectant sprays. And in Wauchula, Florida, the local government gave one resident permission to spray the town with hydrogen peroxide as he saw fit. “I think every city in the damn United States needs to be doing it,” he said.
- To some American companies and Florida men, C19 is apparently a war that will be won through antimicrobial blasting, to ensure that pathogens are banished from every square inch of America’s surface area.
- But what if this is all just a huge waste of time?
- In May, the Centers for Disease Control and Prevention updated its guidelines to clarify that while C19 spreads easily among speakers and sneezers in close encounters, touching a surface “isn’t thought to be the main way the virus spreads.” Other scientists have reached a more forceful conclusion. “Surface transmission of C19 is not justified at all by the science,” Emanuel Goldman, a microbiology professor at Rutgers New Jersey Medical School, told me. He also emphasized the primacy of airborne person-to-person transmission.
- There is a historical echo here. After 9/11, physical security became a national obsession, especially in airports, where the Transportation Security Administration patted down the crotches of innumerable grandmothers for possible explosives. My colleague Jim Fallows repeatedly referred to this wasteful bonanza as “security theater.”
- C19 has reawakened America’s spirit of misdirected anxiety, inspiring businesses and families to obsess over risk-reduction rituals that make us feel safer but don’t actually do much to reduce risk—even as more dangerous activities are still allowed. This is hygiene theater.
- Scientists still don’t have a perfect grip on C19—they don’t know where exactly it came from, how exactly to treat it, or how long immunity lasts.
- But in the past few months, scientists have converged on a theory of how this disease travels: via air. The disease typically spreads among people through large droplets expelled in sneezes and coughs, or through smaller aerosolized droplets, as from conversations, during which saliva spray can linger in the air.
- Surface transmission—from touching doorknobs, mail, food-delivery packages, and subways poles—seems quite rare. (Quite rare isn’t the same as impossible: The scientists I spoke with constantly repeated the phrase “people should still wash their hands.”) The difference may be a simple matter of time. In the hours that can elapse between, say, Person 1 coughing on her hand and using it to push open a door and Person 2 touching the same door and rubbing his eye, the virus particles from the initial cough may have sufficiently deteriorated.
- The fact that surface areas—or “fomites,” in medical jargon—are less likely to convey the virus might seem counterintuitive to people who have internalized certain notions of grimy germs, or who read many news articles in March about the danger of C19-contaminated food. Backing up those scary stories were several U.S. studies that found that C19 particles could survive on surfaces for many hours and even days.
- But in a July article in the medical journal The Lancet, Goldman excoriated those conclusions. All those studies that made C19 seem likely to live for days on metal and paper bags were based on unrealistically strong concentrations of the virus. As he explained to me, as many as 100 people would need to sneeze on the same area of a table to mimic some of their experimental conditions. The studies “stacked the deck to get a result that bears no resemblance to the real world,” Goldman said.
- As a thousand internet commenters know by heart, absence of evidence is not evidence of absence. But with hundreds, and perhaps thousands, of scientists around the world tracing C19’s chains of transmission, the extreme infrequency of evidence may indeed be evidence of extreme infrequency.
- A good case study of how the coronavirus spreads, and does not spread, is the famous March outbreak in a mixed-use skyscraper in Seoul, South Korea. On one side of the 11th floor of the building, about half the members of a chatty call center got sick. But less than 1 percent of the remainder of the building contracted C19, even though more than 1,000 workers and residents shared elevators and were surely touching the same buttons within minutes of one another. “The call-center case is a great example,” says Donald Schaffner, a food-microbiology professor who studies disease contamination at Rutgers University. “You had clear airborne transmission with many, many opportunities for mass fomite transmission in the same place. But we just didn’t see it.” Schaffner told me, “In the entire peer-reviewed C19 literature, I’ve found maybe one truly plausible report, in Singapore, of fomite transmission. And even there, it is not a slam-dunk case. ”
- The scientists I spoke with emphasized that people should still wash their hands, avoid touching their face when they’ve recently been in public areas, and even use gloves in certain high-contact jobs. They also said deep cleans were perfectly justified in hospitals. But they pointed out that the excesses of hygiene theater have negative consequences.
- For one thing, an obsession with contaminated surfaces distracts from more effective ways to combat C19. “People have prevention fatigue,” Goldman told me. “They’re exhausted by all the information we’re throwing at them. We have to communicate priorities clearly; otherwise, they’ll be overloaded.”
- Hygiene theater can take limited resources away from more important goals. Goldman shared with me an email he had received from a New Jersey teacher after his Lancet article came out. She said her local schools had considered shutting one day each week for “deep cleaning.” At a time when returning to school will require herculean efforts from teachers and extraordinary ingenuity from administrators to keep kids safely distanced, setting aside entire days to clean surfaces would be a pitiful waste of time and scarce local tax revenue.
- New York City’s decision to spend lavishly on power scrubbing its subways shows how absurd hygiene theater can be, in practice. As the city’s transit authority considers reduced service and layoffs to offset declines in ticket revenue, it is on pace to spend more than $100 million this year on new cleaning practices and disinfectants. Money that could be spent on distributing masks, or on PSA campaigns about distancing, or actual subway service, is being poured into antiseptic experiments that might be entirely unnecessary. Worst of all, these cleaning sessions shut down trains for hours in the early morning, hurting countless late-night workers and early-morning commuters.
- As long as people wear masks and don’t lick one another, New York’s subway-germ panic seems irrational. In Japan, ridership has returned to normal, and outbreaks traced to its famously crowded public transit system have been so scarce that the Japanese virologist Hitoshi Oshitani concluded, in an email to The Atlantic, that “transmission on the train is not common.” Like airline travelers forced to wait forever in line so that septuagenarians can get a patdown for underwear bombs, New Yorkers are being inconvenienced in the interest of eliminating a vanishingly small risk.
- Finally, and most important, hygiene theater builds a false sense of security, which can ironically lead to more infections. Many bars, indoor restaurants, and gyms, where patrons are huffing and puffing one another’s stale air, shouldn’t be open at all. They should be shut down and bailed out by the government until the pandemic is under control. No amount of soap and bleach changes this calculation.
- Instead, many of these establishments are boasting about their cleaning practices while inviting strangers into unventilated indoor spaces to share one another’s microbial exhalations. This logic is warped. It completely misrepresents the nature of an airborne threat. It’s as if an oceanside town stalked by a frenzy of ravenous sharks urged people to return to the beach by saying, We care about your health and safety, so we’ve reinforced the boardwalk with concrete. Lovely. Now people can sturdily walk into the ocean and be separated from their limbs.
- By funneling our anxieties into empty cleaning rituals, we lose focus on the more common modes of C19 transmission and the most crucial policies to stop this plague. “My point is not to relax, but rather to focus on what matters and what works,” Goldman said. “Masks, social distancing, and moving activities outdoors. That’s it. That’s how we protect ourselves. That’s how we beat this thing.”
Source: The Scourge of Hygiene Theater
2. Computational gene study suggests new pathway for C19 inflammatory response
- Analyses of lung fluid cells from C19 patients conducted on the nation’s fastest supercomputer point to gene expression patterns that may explain the runaway symptoms produced by the body’s response to the coronavirus.
- A team led by Dan Jacobson of the Department of Energy’s Oak Ridge National Laboratory used the Summit supercomputer at ORNL to analyze genes from cells in the lung fluid of nine C19 patients compared with 40 control patients.
- The computational analyses suggest that genes related to one of the body’s systems responsible for lowering blood pressure — the bradykinin system — appear to be excessively “turned on” in the lung fluid cells of those with the virus. The results were published in eLife.
- Based on their analyses, the team posits that bradykinin — the compound that dilates blood vessels and makes them permeable — is overproduced in the body of C19 patients; related systems either contribute to overproduction or cannot slow the process. Excessive bradykinin leads to leaky blood vessels, allowing fluid to build up in the body’s soft tissues.
- Much attention has focused on what’s known as the cytokine storm, a severe reaction in which the body releases an excess of cytokines, a variety of small proteins that help regulate the immune system. Jacobson’s team thinks a bradykinin storm may instead be to blame for much of the viral pathogenesis. If the team’s disease mechanism model is accurate and substantiated by experimental analysis, it may mean that existing medicines could be repurposed to slow the pathogenesis of C19. This would require extensive clinical trials of drugs currently used to treat other bradykinin-related conditions.
- “If we can block this pathogenesis in severe patients, we can keep the human response from going overboard and give their immune system time to fight off the virus so they can recover,” Jacobson said.
- The bradykinin storm could explain the wide variety of symptoms experienced by C19 patients, such as muscle pain, fatigue, nausea, vomiting, diarrhea, headaches, and decreased cognitive function. Similar symptoms are also experienced by patients with other bradykinin-related conditions such as hereditary angioedema, a genetic condition that is characterized by episodes of severe swelling throughout the body.
- “This is one of those rare times where you can really tie everything back to a eureka moment,” said Jacobson, staff scientist in ORNL’s Biosciences Division. “I was looking at data, and I suddenly saw some very distinct patterns happening in the pathways of the renin-angiotensin and bradykinin systems. That led us to do a deep dive of the gene families of the blood pressure regulatory system.” The renin-angiotensin system, or RAS, and bradykinin pathway regulate blood pressure and fluid balance in the body.
- Using the Summit and Rhea supercomputers at the Oak Ridge Leadership Computing Facility, the team compared the genes of C19 patients against a control group and analyzed population-scale gene expression data — 17,000 samples from uninfected individuals — to see which genes were normally co-expressed, or turned on or off at the same time.
- Summit is currently the nation’s most powerful supercomputer, with a theoretical peak performance of 200 petaflops, or 200 quadrillion calculations per second. Jacobson and his colleagues required the power of Summit to run 2.5 billion correlation calculations that helped them understand the normal regulatory circuits and relationships for the genes of interest. With Summit, the team completed the calculations in one week rather than spending months doing them on a desktop computer.
- Researchers found an increased expression of enzymes that can trigger the production of bradykinin and a decreased expression of enzymes that would break down bradykinin — the perfect storm. The team also uncovered that an enzyme that forestalls the bradykinin cascade — the angiotensin-converting enzyme, known as ACE — was less expressed in C19 patients.
- At least ten existing drugs are known to act on the specific pathways Jacobson’s team studied, but large-scale clinical trials are needed to determine whether they might be effective at treating C19.
- “We believe that when you take the inhibition at the top of this pathway off, you end up with an out-of-control cascade that leads to an opening up of the blood vessels, causing them to leak,” Jacobson said. “If that happens in the lung, that’s not good. Immune cells that are normally contained in the blood vessels flood into the surrounding infected tissue, causing inflammation.”
- The lungs of C19 patients are known to have an increased amount of hyaluronic acid, a gooey substance found in connective tissues that can trap around 1,000 times its own weight in water to form a hydrogel. The team also found that genes in the cells of C19 patients increased the production of the substance and decreased its breakdown. The findings suggest that further experimental study of drug compounds known to slow the synthesis of hyaluronic acid and the mechanisms involved in the process is warranted.
- “When the lungs end up with an excess of hyaluronic acid in them, it’s like trying to breathe through Jell-O,” Jacobson said. “It reaches a point where regardless of how much oxygen you pump in, it doesn’t matter, because the alveoli in the lungs are filled with this hydrogel. With this excess of hyaluronic acid, any water leaking out of the blood vessels due to bradykinin will soak up this structure and the lungs become like a water balloon.”
- The team also used the Compute and Data Environment for Science, or CADES, at ORNL to determine which genes in the RAS-bradykinin pathways have vitamin D binding sites. The results of their analyses might help scientists determine through experimentation which parts of these pathways could potentially be influenced by vitamin D. Because vitamin D helps regulate the RAS and vitamin D deficiencies have already been associated with more severe illness in C19 patients, Jacobson said it’s another molecule worth further study.
3. Coronavirus research updates
28 July — Mutations allow virus to elude antibodies
- Mutations in the coronavirus might help the virus to thwart potent immune molecules.
- The blood of many people who recover from C19 contains immune-system molecules called neutralizing antibodies that disable particles of the new coronavirus. Most such antibodies recognize the new coronavirus’s spike protein, which the virus uses to infect cells. Researchers hope that these molecules can be used as therapies, and can be elicited by vaccines.
- Theodora Hatziioannou and Paul Bieniasz at the Rockefeller University in New York City and their colleagues engineered a version of the vesicular stomatitis virus, which infects livestock, to make the spike protein. They then grew the virus in the presence of neutralizing antibodies. The spike protein in the engineered viruses acquired mutations that allowed the viruses to escape recognition by a range of neutralizing antibodies.
- The team also found these mutations in SARS-CoV-2 samples from infected people around the world, although at very low frequencies. Treatment ‘cocktails’ of multiple neutralizing antibodies, each recognizing a different part of the spike protein, could stop the virus from evolving resistance to these molecules, the authors suggest. The findings have not yet been peer reviewed.
- Read the preprint study here
27 July — The power of China’s virus-control campaign is seen in pattern of symptoms
- In China, a key metric of epidemics called the serial interval shrank drastically soon after the new coronavirus’s arrival — a finding that underscores the success of China’s testing and isolation efforts.
- The serial interval is the average time between the onset of symptoms in a chain of people infected by a pathogen. Benjamin Cowling at the University of Hong Kong and his colleagues modelled the spread of SARS-CoV-2 in China and found that the serial interval plummeted from 7.8 days to 2.6 days over a 5-week period starting on 9 January.
- The researchers say that early isolation of cases prevented transmission that would otherwise have occurred later in an infectious period, leading to fewer cases and slowing the spread of the virus. As a result, most of the remaining transmissions occurred either before infected people showed symptoms or early in the symptomatic phase, and the serial interval shrank.
- The authors suggest the serial interval distribution be used in real time to track the changing transmissibility of the virus.
- Read the study here.
24 July — Dogs’ and cats’ infection rates mirror those of people
- Cats and dogs are just as likely to be infected with SARS-CoV-2 as people are, according to a survey in northern Italy that is the largest study of pets so far.
- Nicola Decaro at the University of Bari and his colleagues took nose, throat or rectal swabs of 540 dogs and 277 cats in northern Italy between March and May. The animals lived in homes with infected people, or in regions severely affected by C19.
- None of the pets tested positive for SARS-CoV-2 viral RNA, but in further tests of antibodies against the virus circulating in the blood of some animals, the researchers found that around 3% of dogs and 4% of cats showed evidence of previous infection.
- Infection rates among cats and dogs were comparable with those among people in Europe at the time of testing, suggesting that it is not unusual for pets to be infected. The findings have not yet been peer reviewed.
- Read the preprint study here.
24 July — Virus rips through Israeli school after masking is suspended
- More than 150 students at an Israeli secondary school were infected by the new coronavirus after students were allowed to remove their masks during a heat-wave.
- Roughly 10 days after Israeli schools fully reopened on 17 May, two students at a secondary school in Jerusalem were diagnosed with C19. Chen Stein-Zamir at the Ministry of Health in Jerusalem and her colleagues investigated the resulting outbreak and found that 153 students and 25 members of staff had become infected. By mid-June, a further 87 cases had occurred among the close contacts of people infected through the school outbreak.
- The virus’s spread was probably aided by a heat-wave that occurred between 19 and 21 May, prompting heavy use of air-conditioning and a suspension of the requirement that students wear face masks. Crowding might also have contributed: each of the school’s classrooms held 35 to 38 students, resulting in space allotments of 1.1–1.3 square meters per student.
- Read the preprint study here.
F. Improved & Potential Treatments
1. Which C19 treatments work and how close are we to getting more?
- As the World Health Organization (WHO) baldly reminds us, “there are no specific vaccines or treatments for C19”. However, trials of treatments are taking place. Some have shown promise in helping those infected by calming an overreacting immune system or targeting the coronavirus – either by destroying it or stopping it from replicating.
- Dexamethasone, a widely available steroid that dampens the immune response, became the first medicine shown to reduce deaths in C19 patients. The RECOVERY trial of more than 2000 people found that it reduced deaths in people on mechanical ventilators by a third – and by a fifth in those who received oxygen but not ventilation.
- “The trial showed it is beneficial to those who are severely affected,” says Sheuli Porkess at the Association of the British Pharmaceutical Industry. It is now being used by the National Health Service in the UK to treat C19.
- In June, the US bought up virtually all global stocks of the drug remdesivir, an antiviral that suggested promise against Ebola. The move came after one trial found that it reduced recovery time by 4 days in C19 patients.
- However, other studies have yielded mixed results: one in April showed no clinical benefit, while an analysis last month by Gilead, the company behind the drug, indicated a reduced risk of death in those severely affected by C19. Gilead cautions that more rigorous trials are needed. The drug has received emergency or conditional approval in a number of countries. The litmus test will come in a few weeks with the results of the international Solidarity trial.
- Trials are also looking at whether the anti-inflammatory tocilizumab, which is already used to treat arthritis, could be beneficial against C19.
- Another recent development relates to an inhaler-based treatment that delivers a protein called interferon beta to the lungs. A preliminary finding showed that it reduced the risk of patients going on to develop severe C19 by 79%, compared with a placebo group. However, this was a small, early trial of the drug, called SNG001, developed by UK firm Synairgen.
- The blood plasma of C19 survivors offers another possible treatment because it contains antibodies to the coronavirus. An alliance of companies formed in May to pool research on its use as a therapy for the disease. There are no trial results so far.
- New drugs might still emerge. Last week, an analysis of thousands of known drugs that have been approved or are under clinical investigation found 13 that inhibited the coronavirus’s replication in cultured cells.
As well as trying to use existing drugs to tackle C19, some pharmaceutical companies are exploring entirely new ones.
- In addition, researchers have started to rule out certain drugs. For example, hydroxychloroquine and lopinavir-ritonavir haven’t been shown to provide any benefit, at least in hospital settings.
- For now, the focus remains on treating the most severe, short-term problems caused by the illness. But with growing evidence pointing to longer term symptoms, treatments will be needed to tackle those too.
2. Plant Infused Honeysuckle Decoction May Provide an Effective Treatment to C19
- A practicable and reliable therapeutic strategy to treat C19: absorbed plant MIR2911 in honeysuckle decoction inhibits coronavirus replication and accelerates the negative conversion of infected patients.
- In a new study in Cell Discovery, Chen-Yu Zhang’s group at Nanjing University and two other groups from Wuhan Institute of Virology and the Second Hospital of Nanjing present a novel finding that absorbed miRNA MIR2911 in honeysuckle decoction (HD) can directly target coronavirus genes and inhibit viral replication. Drinking of HD accelerate the negative conversion of C19 patients.
- The search for clinically effective therapy for C19 has not been successful to date. Many broad spectrum anti-viral agents have failed the test. In previous studies, Zhang’s group has demonstrated that a plant microRNA, MIR2911, which is enriched in HD, could directly target influenza A viruses (IAV) including H1N1, H5N1 and H7N9. Drinking of HD can prevent IAV infection and reduce H5N1-induced mice death. They have also revealed that absorbed exogenous miRNAs (including MIR2911 in HD) can be packaged into exosomes, released to circulation, and then delivered into recipient cells as functional secreted miRNAs.
- In the current study, they report that MIR2911 in HD can also suppress C19. The coronavirus genome has up to 28 binding sites of MIR2911 which were confirmed by the classic luciferase assay. Cellular-exosomal-MIR2911 at 13.2 pM concentration (cellular exosomes were collected from culture medium of HEK293T cells transfected with synthetic MIR2911 or control ncRNA) inhibited 93% virus replication, indicating that exosomal MIR2911 directly and sufficiently inhibits coronavirus replication. The MIR2911 concentration in HD was about 52.5 pM (10.5 pmol/200 ml/30 g dried honeysuckle). Serum levels of MIR2911 in heathy volunteers two hours after drinking 200 ml HD were about 0.67 pM. The antiviral function of exosomes with/without MIR2911 collected from the same donor before and after drinking HD were assessed. Exosomes containing MIR2911 (MIR2911 levels: nondetectable before drinking; 57.9 fM after drinking) significantly inhibited virus replication.
- A clinical study further confirmed the anti-viral effect of MIR2911 from HD. Patients who already received routine antiviral therapy were divided into two groups, one group received additionally MIR2911 in HD (10.5 pmol/200 ml/30 g dried honeysuckle/day, MIR2911+), the other group receive normal traditional Chinese medicine (TCM) mixture (sequenced to be free of MIR2911-). The time taken to become coronavirus PCR-negative (TTN) significantly favored patients treated with HD-MIR2911 (median 4.0 vs 12.0 days, HR 0.11, 95% CI 0.025-0.46, P=0.0028), indicating that MIR2911 in HD accelerates the negative conversion of infected patients.
- This study demonstrated that absorbed plant MIR2911 in honeysuckle decoction inhibits coronavirus replication and accelerates the negative conversion of infected patients.
- It provides a practicable and reliable therapeutic strategy to treat coronavirus infection.
- This is the first time that exosomes with/without MIR2911 collected from the same donor before and after drinking HD ware used to assess absorbed dietary miRNA function, further supporting that absorbed dietary miRNA plays the important role of cross-kingdom regulation in human consumer.
- The data that MIR2911 (~60 fM) in exosomes significantly inhibits virus replication not only confirms the extra-high antiviral activity of MIR2911 (compared to that of remdesivir: 3.7 μM and Chloroquine: 10 μM) but also provides a novel and the most similar condition in vivo to assess the efficacy of potential drugs in vitro.
- “We wished we could provide really useful information to help stop the pandemic in the darkest hour”. Chen-Yu Zhang said. “The focus of this study is to demonstrate that absorbed plant MIR2911 in honeysuckle decoction inhibits coronavirus replication sufficiently. On the other hand, in the study titled “Decreased HD-MIR2911 absorption in human subjects with the SIDT1 polymorphism fails to inhibit coronavirus replication”, we have shown that synthetic MIR2911, cellular-exosomal MIR2911 and serum-exosomal MIR2911 directly inhibited coronavirus S-protein expression and SARS-CoV-2 replication.
- More importantly, decreased HD-MIR2911 absorption resulted in non-inhibitory effect on replication, indicating that MIR2911in HD is necessary to suppress coronavirus.
- Therefore, we propose medical doctors and scientists from all over the world to carry out HD-MIR2911 clinic trails in order to help treating C19.” Zhang added.
3. Coronavirus vaccine hope rises after a flurry of positive results
- AMID rising global numbers of daily coronavirus infections, a fresh flush of vaccine trial results is offering hope for the longer run.
- There are more than 160 coronavirus vaccines in development around the world. About 140 of these are at the preclinical stage, meaning they are still being looked at in laboratories and in animal tests. Another 25 are already being tested in people.
- The rate at which the tally has risen to 160-plus is unusually fast. “What is phenomenal is the numbers changing over the past few months. The amount of research is incredible,” says Sheuli Porkess at the Association of the British Pharmaceutical Industry.
- As the candidates advance, the World Health Organization (WHO) this month started to convene a working group to prioritize the most promising vaccines. “Practical realities will require a process that focuses global efforts on a small handful of candidates that may have the highest impact,” the WHO said.
- Four vaccines have made big steps in development in the past few weeks. Initial trials show that they can trigger an immune response and appear safe – but it is too early to say if they will protect against coronavirus and whether they will work across many different groups of people, including older individuals and those with chronic health issues.
- On 20 July, a team led by Sarah Gilbert at the University of Oxford and pharmaceutical company AstraZeneca showed that their ChAdOx1 nCoV-19 vaccine produced the desired immune responses without showing serious adverse reactions. That was in a combined phase I/II trial of 1077 volunteers (see “Trial phases”, below). It is now being tested in many thousands more people.
- Six days earlier, US company Moderna and the US National Institute of Allergy and Infectious Diseases revealed that 45 people had received their mRNA-1273 vaccine and shown an antibody response. On Monday, they began a phase III trial intended to have 30,000 participants.
- The other two most promising candidates are from CanSino Biologics in China, which published encouraging phase II trial results on the same day as the Oxford team, and another from German company BioNTech with pharmaceutical giant Pfizer, which published a promising preliminary report on 14 July.
- At this stage, we don’t know which, if any, of the vaccines will succeed. “The eyes of the world are on these that are closest. But without being pessimistic – I’m being realistic – drug development is a risky business,” says Porkess.
- The much larger phase III trials in coming months, involving thousands of people, will give a better idea of which vaccine might be deployed first. “This is the pointy end, this is when you are getting into real-world testing of a vaccine,” says Margaret Harris at the WHO.
- Any vaccines that are successful in clinical trials will still need to be manufactured at scale, which will affect the time it takes to get a vaccine for general use. “We are seeing things happening at unprecedented speeds. Maybe something could [be licensed for use] within 18 months from now,” says Porkess.
A vaccine is given to a small number of healthy people to see whether it is safe to use
A greater number and diversity of people are tested, to see if it triggers an immune response
Involves hundreds or thousands of people, including a control group to see if the vaccine works in the population at large
Because of the urgency of the current pandemic, some phases are happening in parallel
4. Dozens of scientists and others took a DIY C19 vaccine with no proof that it works
- The ingredients arrive by mail, to be prepared by recipients in their homes or labs. No, this isn’t a DIY meal kit — it’s an unproven C19 vaccine distributed by a group called the Rapid Deployment Vaccine Collaborative, or RADVAC, and no one knows if it actually works, MIT Technology Review reported.
- The collaborative, composed of more than 20 scientists, technologists and “science enthusiasts,” some affiliated with Harvard University and MIT, did not seek authorization from the U.S. Food and Drug Administration (FDA) before designing their vaccine, or before spraying it up their own noses. Nor did the group seek approval from any ethics board before launching the project and volunteering as their own test subjects in what could potentially be seen as an unofficial clinical trial, according to MIT Technology Review. They have also distributed materials for the vaccines to dozens in their social circles.
- The FDA did not immediately respond to questions from MIT Technology Review as to whether the initiative can be considered legal. However, geneticist Preston Estep, who founded RADVAC and serves as its chief scientist, said that the FDA does not have jurisdiction over the project because participants mix and administer the vaccine themselves, without paying the collaborative any fees in exchange. It remains to be seen whether the FDA might step in to regulate the project, particularly as more people learn about, and take, the experimental vaccine.
- “We don’t suggest people change their behavior if they are wearing masks, but [the vaccine] does provide potentially multiple layers of protection,” Estep told MIT Technology Review. However, RADVAC does not yet have evidence that the vaccine prompts an adequate immune response to be protective at all. The group has begun conducting studies to answer that question, some of which are being conducted in the Harvard lab of geneticist George Church, who has already taken two doses of the vaccine. (Estep is a former graduate student and current collaborator in Church’s lab.)
- “I think we are at much bigger risk from COVID [than from the experimental vaccine], considering how many ways you can get it, and how highly variable the consequences are,” Church told MIT Technology Review. Church added that, while he believes the vaccine is safe (in the absence of data proving that’s the case), he thinks the “bigger risk is that it is ineffective.” (Church is also head of Harvard’s Woolly Mammoth Revival team, whose aim is to insert genes from the extinct mammoth into DNA of Asian elephants.)
- But regardless of whether or not the vaccine grants protection against the coronavirus, vaccines always carry some risk of side effects. The more than 30 candidate C19 vaccines being tested in sanctioned clinical trials must undergo several rounds of efficacy and safety tests to be approved, Live Science previously reported. In early trials, vaccine developers watch for acute side effects that occur shortly after vaccine administration, which may include swelling, redness and soreness at the administration site, or potentially fever. In advanced clinical trials, they can monitor for side effects that may emerge when a vaccinated person becomes exposed to the virus in a real-world scenario.
- One side effect that could occur upon exposure is known as antibody dependent enhancement (ADE); this rare phenomenon paradoxically leaves the body more vulnerable to severe infection after vaccination, and was previously observed in animal studies of vaccines for coronaviruses related to SARS-CoV-2, Live Science previously reported.
- Self-experimenting with the RADVAC vaccine is “not the best idea — especially in this case, you could make things worse” by triggering ADE, George Siber, the former head of vaccines at the pharmaceutical company Wyeth, told MIT Technology Review. “You really need to know what you are doing here.”
- Siber added that, given the vaccine’s ingredients and its route of administration through the nose, he’s not sure that the vaccine would be potent enough to be protective, even if it is safe.
- RADVAC published a white paper detailing the recipe for the vaccine in July, with a disclaimer that states that anyone using the information must be a consenting adult, based in the U.S., who agrees to “take full responsibility” for their use of the information, vaccine and materials required for production and administration. In addition, anyone accessing the site must first “acknowledge and agree that any use of that information to develop and self-administer a substance is an act of self-experimentation,” the legality of which may differ depending on where you live.
- Below the disclaimers in the paper, the group describes the formulation of the vaccine, which contains short protein fragments, called peptides, found on the coronavirus. These peptides cannot cause C19 on their own, but should in theory be recognized by the immune system and prompt the construction of antibodies that can target and deactivate the virus. That said, Estep called Siber about the vaccine earlier this year and Siber told him that short peptides don’t consistently prompt a strong immune response, according to MIT Technology Review.
- In addition to peptides, the RADVAC vaccine contains chitosan, a substance found in the shells of crustaceans like shrimp, according to the white paper. The chitosan is intended to coat the peptides and ease their delivery through mucosal tissue in the nose, MIT Technology Review reported. The RADVAC developers chose to deliver their vaccine in a nasal spray, rather than through an injection, in an attempt to trigger a strong, localized immune response in the nose, where C19 infection often takes hold.
- Mucosal tissues, like that of the nose, have their own specialized fleet of immune cells that help guard the somewhat-permeable tissues against debris and pathogens, Live Science previously reported. Ideally, an effective C19 vaccine would trigger both this localized immune response and a systemic immune response throughout the body. Some experts share the view of RADVAC, in that they think C19 vaccines delivered through the nose would be more protective than injectable ones, The New York Times reported. However, Siber told MIT Technology Review that he’s not aware of any existing vaccines that are both based on peptides and delivered through the nose; studies would be needed to confirm that such vaccines could reliably trigger a robust immune response.
- While the underlying theory may prove true, the efficacy of individual vaccines can only be shown through rigorous analysis of the body’s immune response. RADVAC has not completed such studies.
- Having presented no evidence that the vaccine provides protection against C19, or that it’s safe to administer, the researchers have already distributed materials for the vaccine to others in their social circles.
- “We have delivered material to 70 people,” Estep told MIT Technology Review. “They have to mix it themselves, but we haven’t had a full reporting on how many have taken it.”
G. Concerns & Unknowns
1. C19 May Cause Deadly Blood Clots – Higher Risk for Some Women
- C19 may increase the risk of blot clots in women who are pregnant or taking estrogen with birth control or hormone replacement therapy, according to a new manuscript published in the Endocrine Society’s journal, Endocrinology.
- One of the many complications of C19 is the formation of blood clots in previously healthy people. Estrogen increases the chance of blood clots during pregnancy and in women taking birth control pills or hormone replacement therapy. If infected with C19, these women’s risk of blood clotting could be even higher, and they may need to undergo anticoagulation therapy or to discontinue their estrogen medicines.
- “During this pandemic, we need additional research to determine if women who become infected with the coronavirus during pregnancy should receive anticoagulation therapy or if women taking birth control pills or hormone replacement therapy should discontinue them,” said the study’s corresponding author, Daniel I. Spratt, M.D., of Maine Medical Center in Portland, Maine, and Tufts University School of Medicine in Boston, Mass. “Research that helps us understand how the coronavirus causes blood clots may also provide us with new knowledge regarding how blood clots form in other settings and how to prevent them.”
2. Obese Black and Minority Ethnic Communities Much Higher-Risk of Contracting C19
- Obese people among black and minority ethnic communities (BME) are at around 2 times higher the risk of contracting C19 than white Europeans, a study conducted by a team of Leicester researchers has found.
- Previous research has shown that ethnicity can alter the association between the body mass index (BMI) and cardiometabolic health so the researchers wanted to explore whether a person’s weight could change the relative risk of C19 across ethnic groups.
- Emerging C19 evidence has found that South Asian and black, African, or Caribbean populations are at a higher risk of becoming seriously unwell with the condition. In addition, a link with obesity has also been found.
- According to the results, the greater risk of C19 in BME people relative to white Europeans was only apparent at higher BMI values. For example, at a BMI value of 25 kg/m2, there was no difference in risk, whereas at a BMI of 30 kg/m2 the risk of C19 was nearly twice as high (1.75) and at 35 kg/m2 more than two and a half times higher (2.76) in BME individuals relative to white Europeans.
- Cameron Razieh, a PhD student at the University of Leicester, concluded: “Although limited by non-random testing for C19 within the UK, this data suggests that the association between BMI and the risk of C19 may vary by ethnicity and acts as an important effect modifier for the increased risk of C19 in BME populations. These results suggest that the combination of obesity and BME status may place individuals at particularly high-risk of contracting C19, which is consistent with findings for associations of BMI and ethnicity with cardiometabolic dysfunction.”
- Co-lead author, Professor Thomas Yates, Professor of Physical Activity and Health at the University of Leicester, said: “The role of obesity as risk factor for chronic disease is well established, however we need more research to understand its role as a risk factor for the C19 pandemic and how this affects different populations.”
3. Taller people face higher risk of catching C19
- People over six feet tall are more than twice as likely to be diagnosed with the coronavirus, the results of a new survey reveal.
- The global team of researchers, including experts from the University of Manchester and Open University, surveyed 2,000 people in the country, as well as the US, to determine whether their personal attributes, work and living practices might play a role in transmission, The Telegraph reported.
- The results found that taller people are at a higher risk, which researchers say suggests that the contagion is spreading through the air — because height would not be a factor if the virus was only contractible through droplets, according to the report.
- “The results of this survey in terms of associations between height and diagnosis suggest downward droplet transmission is not the only transmission mechanism and aerosol transmission is possible,” Professor Evan Kontopantelis, of the University of Manchester, told the outlet.
- “This has been suggested by other studies, but our method of confirmation is novel,” he added.
- “Though social distancing is still important, because transmission by droplets is still likely to occur, it does suggest that mask-wearing may be just as — if not more — effective in prevention. But also, air purification in interior spaces should be further explored.”
- Droplets are larger than aerosols and are thought to travel relatively short distances and plummet from the air, according to the report. But aerosols, which can build up in poorly ventilated areas, are carried by air currents.
- The study also found that using a shared kitchen or accommodation played a large role — especially in the US, where those circumstances made the chances of contracting the bug 3.5 times as high.
- In the UK, chances were 1.7 times higher.
H. The Road Back?
1. C19 risk model uses hospital data to guide policymakers when to tighten and loosen social distancing measures
- With communities throughout the United States combating surges in C19 cases and hospitalizations, researchers at The University of Texas at Austin and Northwestern University have created a framework that helps policymakers determine which data to track and when to take action to protect their communities.
- The model specifies a series of trigger points to help local entities know when to tighten social distancing measures to prevent hospitals from being overrun by virus patients. The method also aims to minimize the economic impact to communities by suggesting the earliest times for safely relaxing restrictions.
- The framework is described in a new paper out today in the Proceedings of the National Academy of Sciences. The United States’ continued high rate of infection means lawmakers around the country need to continue to make decisions about reinstating and relaxing social-distancing measures. Using hospital data, the new model lets local leaders know when it is time to tap the brakes on reopening versus easing restrictions.
- For example, in Austin, Texas, the modelers applied this framework to help city leaders decide when to toggle between five different C19 alert levels. The city is now tracking the daily number of new hospital admissions, and it recently tightened measures when the data surpassed the prescribed threshold.
- “We developed this framework to ensure that C19 never overwhelms local health care capacity while minimizing the economic and societal costs of strict social-distancing measures,” said Lauren Ancel Meyers, a co-author of the paper and the director of The University of Texas C19 Modeling Consortium.
- Northwestern’s Daniel Duque, the first author, said that “the approach provides clear indications of when measures should be enacted and relaxed to manage risk.”
- There are two key components to successfully implementing the strategy — closely monitoring data about hospitalizations for C19 and ensuring communities protect those most vulnerable to the disease.
- “While many cities have implemented alert levels and new policies, our research may be the first to provide clear guidance for exactly what to track (hospital admissions data) and exactly when to act (strict thresholds),” said David Morton, chair and professor of industrial engineering and management sciences at Northwestern and a co-author of the paper. “Communities need to act long before hospital surges become dangerous. Hospital admissions data give an early indication of rapid pandemic growth, and tracking that data will ensure that hospitals maintain sufficient capacity.” In recent weeks, public health officials have expressed concerns that hospitalization data has been inconsistent, as the federal government moved the data to a new portal housed within the Department of Health and Human Services.
- “C19 hospitalization data is vital to tracking the changing pace of the pandemic and informing good decision-making,” Meyers said.
- The team also determined that preventing an unmanageable surge in hospitalizations requires adherence to strict social distancing for high-risk populations, known as cocooning. For example, the researchers estimated that failing to protect vulnerable populations more than doubles resulting deaths while also doubling the number of days in lockdown to prevent overrunning hospitals.
- The framework combines two mathematical models: an underlying model that predicts how the pandemic will likely spread and an optimization model that uses admissions data from Austin hospital systems. It attempts to walk a fine line of preventing economic disaster and keeping hospital systems from becoming overwhelmed. Though the researchers used Austin data, the framework can easily be used by other communities with publicly available hospital admissions data.
- “This is a general framework that can be used to design multistage triggers — not just for lockdowns but for moving between phases — exactly like we have done for Austin,” Morton said. “Our framework has already guided policy changes in Austin.”
2. Making the indoors safer during COVID
- As schools prepare to reopen and more people are heading back to their offices and shared work spaces, Syracuse University Professor Jianshun “Jensen” Zhang offers a three-step plan to improve indoor air quality (IAQ) and help prevent the spread of COVID indoors.
- Zhang’s plan is detailed in a recent editorial published in the journal “Science and Technology for the Built Environment” called “Integrating IAQ control strategies to reduce the risk of asymptomatic coronavirus infections in classrooms and open plan offices.”
- “Classrooms and open-space offices present a special challenge because of their relatively large occupant density, which can lead to a higher chance of person-to-person cross infection in the space via airborne transmission as well as through direct or indirect contacts,” Zhang says. “As schools and businesses are making plans to reopen, how can the risk of such cross infection be minimized or prevented?”
- The coronavirus disease is a respiratory illness that can spread from person to person. The virus that causes C19 spreads, typically through respiratory droplets from coughing, sneezing, or talking. Some people without symptoms are able to spread the disease without knowing that they have it.
- Dr. Zhang, a professor in the Department of Mechanical and Aerospace Engineering and Director of the Building Energy and Environmental Systems Laboratory, writes that source control, ventilation and air cleaning – and combinations of all three – can offer important tools in preventing the spread of COVID within indoor spaces.
- Here’s a look at his three-step plan:
- Source control is the first and most important among all IAQ strategies. For preventing the spread of the coronavirus, that means detecting, tracking, and isolating infected persons; and preventing transmission from asymptomatic virus carriers.
- “The latter is more challenging in open space office or classroom settings in which air is typically well mixed,” Zhang writes. “To reduce the number of virus-containing aerosols emitted to the space from any possible virus carriers present, universal face masking, as well as hand sanitizing before entering the space is essential.”
- The next step in air quality is ventilation with a focus on supplying enough clean outdoor air to rooms and offices and effectively diluting the concentration of pollutants.
- “Mechanically ventilated classrooms and offices typically have about 20% of their air supplied from outdoors, and the rest is recirculated air. This is done to save heating and cooling energy while maintaining acceptable levels of IAQ,” Zhang says. “To reduce the risk of the coronavirus infection, the outdoor ventilation rate should be increased to the maximum operational capacity of the building ventilation system, which can be two or more times of that under the normal operation mode per the existing standard.”
- He also writes that any recirculated air needs to be filtered with HEPA filters or MERV 14 filters, to minimize cross-contamination.
- Zhang says that proper air distribution is essential for making sure the filtered air is reaching the people where they are. He says, “this is an area so far has been largely neglected in existing guidelines or recommended practices for reducing the coronavirus infection.”
- He points out that most classrooms and open plan offices in the United States use mixing ventilation (MV) for fresh air delivery. Air diffusers in MV are typically located close to the ceiling level, but Zhang recommends that air supply should be brought in through ground ventilation. The difference is that filtered air from the ceiling mixes with the exhaled breath of people who could be asymptomatic carriers of COVID.
- He said to prevent filtered air becoming contaminated, it should be pumped into a room through ground-level vents. Zhang recommends using “displacement ventilation,” which simply delivers the air supply at the floor level but exhausts it through vents in the ceiling.
- Air cleaning strategies involve applying air filtration or purification within a building, rooms, or at a personal level, such as a properly worn mask. But among all three, there must be high efficiency filters and sufficient airflow, writes Zhang.
- At the building level, high efficiency particulate (HEPA) filters in the recirculated or mixed air duct can reduce the cross contamination between rooms and increase the total clean air delivery rate (outdoor plus filtered air) for diluting the virus concentration in the ventilated space.
- Standalone room air cleaners with HEPA filters can also be used as a supplementary measure to further reduce the concentration of virus in the occupied space. Research has shown a range of clean air delivery rate (CADR) from 170 to 800?m3/h (or 100 to 470 CFM) with a median cost of $361 based on a comprehensive survey of off-the-shelf air cleaners available from the most popular online shopping sites. The results were consistent with an earlier laboratory study in which 6 portable air cleaners were tested for both particulate and volatile organic compounds removal performance. Zhang says that an air cleaner with a CADR of 722?m3/h (425 CFM) can double the clean air supply for 25 people in a classroom or open plan office.
- Zhang says this can be considered as a cost-effective supplementary measure for rooms where total ventilation airflow rate is insufficient. However, for spaces with displacement ventilation (DV), a room air cleaner should only be used with caution so that the desirable airflow pattern of DV is not disturbed.
- Zhang writes that these IAQ strategies can be used and implemented across multiple scales from an entire building to a room to an individual’s cubicle or personal space. In his editorial, Dr. Zhang also includes a table that shows the efficiency of different combinations of IAQ strategies and the associated costs.
I. Back to School!?
1. Here’s What We Know About Kids and C19
- Children typically are “superspreaders” of respiratory germs, which makes the fact that they don’t seem to be major transmitters of the coronavirus that causes C19 puzzling. They’re relatively absent among hospitalized patients, which initially was thought to be because they’re less likely to become seriously ill once infected. Later studies indicate that those of primary school age, at least, may be less likely to catch the virus in the first place. With schools and universities in the Northern Hemisphere considering reopening in August and September, scientists and public health authorities are trying to determine the role of young people in spreading the pathogen and how best to mitigate that threat.
1. To what extent are kids getting infected?
- Estimates by midyear indicated that only 2% to 5% of individuals with laboratory-confirmed C19 were under 18 years old. That’s well below that age group’s share of the global population, which hovers around 30%. Compared to adults, children with C19 typically have milder symptoms that are predominantly limited to the nose, throat and upper airway, and they rarely require hospitalization.
2. Are the risks spread evenly?
- Perhaps not. Children younger than 10 are significantly less susceptible to the virus than teenagers and adults, according to research by scientists at the Harvard T.H. Chan School of Public Health in Boston and the University of St Andrews in Scotland that was released ahead of peer review and publication in July. Susceptibility for children older than 10 was similar to adults apart from those over 60 years, who are at greater risk, they said. The findings are supported by a study published in June that used antibody tests to survey 2,766 people in Geneva. It found teenagers were almost as likely to have been infected by the virus as adults age 20 to 49, while children age 5 to 9 trailed well behind.
3. Why might younger kids be less susceptible?
- There are several theories. Scientists have posited that C19 might be sparing children because they are less exposed to the virus, with school closures and other distancing measures largely isolating them. It’s possible children mount a more robust initial immune response to the virus, giving the body a better shot at fending it off (and avoiding some complications adults get). It’s also been suggested that the receptor the virus uses to invade human cells is less mature in children, making it harder for it to cause an infection. Younger people are less commonly afflicted by hypertension, type-2 diabetes and other chronic conditions known to increase the risk of severe illness from C19. A low infection rate and mild symptoms among children were also seen during earlier outbreaks of two other novel coronaviruses, one in 2002-2003 that causes severe acute respiratory syndrome (SARS) and another starting in 2012 that causes Middle East respiratory syndrome (MERS).
4. Do kids spread the virus?
- There’s limited evidence. In a much-cited study of 5,706 coronavirus patients and their contacts in South Korea published July 16, researchers concluded that children younger than 10 spread the virus at the lowest rate. They found, however, that those age 10 to 19 were more likely to spread C19 within a household than younger children and adults were. The study had limitations. As with other similar studies, the researchers first identified an infected person and then tested that person’s contacts, which means they can’t be certain who started the chain. Plus, the study was conducted while schools were mostly shut down.
5. What’s happened where schools reopened?
- The evidence is preliminary and mixed. Denmark and Norway reopened schools in April and avoided subsequent outbreaks. Health specialists connect their success both to mitigation strategies including smaller classes and increased hand washing, and to the fact that overall cases were low at the time. Germany brought older students back to schools in small groups in early May when overall cases were moderately high and saw increased transmission among students, though not school staff. In Israel, schools were fully reopened without restrictions on May 17. Ten days later, a major outbreak occurred in a high school, followed by a significant wave of infections in the general population, prompting the government to shut down parts of the economy again. [Note 1: As noted in a prior Update, the Israeli outbreak followed after relaxing social distancing (40 kids per class) and wearing of masks.] [Note 2: Sweden kept its schools open during the entire outbreak – no studies have indicated any significant school outbreaks.]
6. How sick do children get?
- Scientists at the London School of Hygiene & Tropical Medicine in June found that clinical symptoms manifest in 21% of infections in 10- to 19-year-olds, rising to 69% in people older than 70. Death is extremely rare in children, although it can occur in those who are already very sick with cancer or other serious conditions. An uncommon but serious blood disorder has been associated with SARS-CoV-2, as the virus is called. Known as pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), it’s a potentially lethal condition, similar to Kawasaki disease. It occurs at a rate of about two per 100,000 people younger than 21 years — much less than the 322 per 100,000 in which coronavirus infection is diagnosed in that age group.
The Reference Shelf
- Related QuickTake explainers on unanswered questions about the coronavirus, how the virus spreads, “silent spreaders,” the race for a vaccine, and future pandemics.
- Researchers at the University of Edinburgh released an updated summary of evidence for transmission of the coronavirus by children in July.
- The U.S. National Academies provide guidance on reopening schools.
- The U.S. Centers for Disease Control and Prevention offer tips to protect children from the virus.
- The World Health Organization provides resources for caring for young children during the pandemic.
J. Projections & Our (Possible) Future
1. US Is At Start Of Sustained Downward Trajectory In Virus Spread
- In its daily coronavirus tracker, Goldman Sach’s chief economist Jan Hatzius writes that “new confirmed coronavirus cases are beginning to fall in an increasing number of states, and prevalence of COVID-like symptoms is decreasing in most states” which prompted the encouraging conclusion that “the US may be at the start of a sustained downward trajectory of virus spread.”
- As Hatzius further notes, “the states with the largest virus outbreaks over the past several weeks continue to improve.” Specifically, cases are now declining on a 14-day basis in Arizona, Florida, Texas, California, and South Carolina, and although available hospital capacity declined to very low levels in some regions of these states, government officials did not order sweeping lockdown measures.
- Yet while that is clearly great news for the US – and comes just as the number of new cases in China is once again spiking – the country is not out of the woods just yet.
- As Goldman concludes, although these states (and many others) are now improving by some measures, a major factor in determining state reopening and consumer activity will likely be the level of new confirmed cases, not just the trajectory. Here, after several weeks of increased virus spread, nearly 80% of the US is currently in a state with an elevated level of at least 100 per new daily cases per million residents.
- The bottom line: “although the virus situation may be improving, the degrees of reopening and consumer activity may still increase slowly until case levels are significantly lower.”
- In any case, the fact that US cases may have plateaued – according to Goldman – at a time when China is facing its latest spike in new covid cases, means that the political narrative is about to shift dramatically in the coming days.
K. Practical Tips & Other Useful Information
1. Ergonomics expert says work smarter at home
- Taking a few minutes to get that periodic cup of joe might not be such a bad idea.
- When working at home, it’s good to have a break, possibly every 30 minutes, to stay healthy and minimize injury to your back, shoulders and arms, says Kermit Davis, PhD, an expert in office ergonomics at the University of Cincinnati College of Medicine.
- “The body doesn’t like static postures continually,” says Davis, a professor in the UC Department of Environmental and Public Health Sciences. “You don’t want to do all sitting or all standing all the time. You want to alter your position and change it up throughout the day.”
- Workers across the nation have converted their basements, spare rooms, dining room tables or bedrooms into makeshift offices in the midst of the coronavirus pandemic. But few have much guidance when it comes to making these new spaces ergonomically safe, says Davis, who runs both UC’s graduate industrial hygiene and occupational ergonomics programs.
- “You can go home but you aren’t allowed to take the monitor, chair and most office equipment,” explains Davis. “You can use your laptop from home, but it is designed to be a short-term option. It should be used for a few hours while traveling. It is not meant to be used for eight or nine hours each day.”
- The screen and keyboard on laptops are smaller than a standard office computer, says Davis. As a result the user oftentimes looks downward since the smaller screen is well below eye height.
- Davis conducted an ergonomic assessment of employees at the University of Cincinnati sending out an email survey to 4,500 faculty and staff after the coronavirus pandemic prompted the university to join many other employers across the nation in sending workers home to continue operations. The survey had 843 people complete it. As part of the study, 41 employees sent Davis photos of workers at home workstations for ergonomic review. This subset showed some trends and offered a glimpse into what many who work from home are encountering.
- The survey’s findings were recently published in the scholarly journal Ergonomics in Design.
- Davis says the ergonomic evaluations of the home workstations identified many issues that could be adversely affecting the workers. Many chairs were the wrong height with about 41% too low and 2% too high. 53% of workers had armrests on their chairs, but 32% did not use them and for 18% of workers the armrests were improperly adjusted, the study found.
- Davis says not using the armrests causes contact stress on forearms when rested on the hard front edge of work surfaces and strain across the upper back as the arms need support. Also, support of the back of the chair was not used by 69% and often without any lumbar support for 73% of survey participants. That meant many individuals did not have proper support of their lower back, maintaining the lumbar curvature.
- The position of a computer monitor was often too low or off to the side. Three quarters of monitors were laptops, which were too low relative to the workers’ eye height, the study found.
- External monitors were also routinely set up too low in 52% of participants or too high in 4%. Another common issue with the monitors was the lack of the primary screens centered in front of the workers occurring in 31% of workers and resulting in twisting of the neck and/or back to view the monitor, according to the study.
- Davis says not everyone can spend hundreds of dollars on a new chair or other equipment when working from home. He says there are some cheap and easy fixes that will go a long way in improving the ergonomic well-being of office workers.
- Here are a few tips that might be helpful for the homebound office worker:
- Place a pillow on your seat to elevate the seat height.
- Place a pillow or rolled up towel behind your back to provide lumbar and back support.
- Wrap armrests when they are low and not adjustable.
- Move your chair closer to the desk or table to encourage having the back against the back of the seat.
- If a laptop is too low, place a lap desk or large pillow under the laptop to raise the monitor when using it on the lap.
- Use an external keyboard and mouse, along with raising the laptop monitor by placing a stack of books or a box under the laptop when using a laptop on a desk.
- An appropriate standing workstation should have the top of the monitor at eye height and directly in front, keyboard at a height so that forearms are parallel to the ground (approximately 90° elbow angle), and a soft or rounded front edge to the working surface.
- If obtaining a new chair or identifying an appropriate sitting workstation at home is not possible, rotating between a poor sitting workstation and a standing workstation would be the next best practice. There are many simple, makeshift standing workstations available in the home, including implementing the use of an ironing board, a kitchen counter, the top of a piano, a clothes basket placed upside down on a table or desk or a large box under the laptop.
- Davis says he worries that workers’ discomfort levels are increasing after more than 5 months of working remotely. “It’s not just ergonomics changing but also other factors: isolation, teamwork changes and work-life balance is distorted and changes in the stress level that people have,” he says.
L. Johns Hopkins COVID-19 Update
July 29, 2020
1. Cases & Trends
- The WHO C19 Situation Report for July 28 reports 16.34 million cases (226,783 new) and 650,805 deaths (4,153 new). The WHO reported 5 of the 6 highest daily incidence over the past 6 days.
- In total, 10 countries are reporting test positivity greater than 25%, well over the WHO’s benchmark of 5% to facilitate easing social distancing measures, and most are continuing to increase steadily. Notably, 7 of these countries are in the Americas; Bolivia, Brazil, and Mexico are currently reporting test positivity greater than 60%. By contrast, all countries in Europe are reporting test positivity of less than 10%, and most are less than 3%. Additionally, more than 25 countries are reporting more than 100% more cases than they did 2 weeks ago. Many of these countries are reporting relatively low daily incidence, so smaller changes in absolute numbers can result in large relative changes. But 11 countries are reporting more than 100 new cases per day, including several that were more severely affected early in the pandemic and are now experiencing a resurgence of transmission: Australia, Belgium, China, Japan, the Netherlands, and Spain. On a more positive note, there are currently no countries reporting more than 250 new daily cases per million population.
- Brazil reported 40,816 new cases. This is approximately equal to the corresponding day the previous week and fairly consistent with the several weeks before that; however, last week, Brazil reported significantly higher daily incidence later in the week. Brazil fell to #3 globally in terms of daily incidence, but its daily incidence is essentially equal to #2 India.
Central & South America
- Broadly, the Central and South American region remains a major C19 hotspot. Colombia reported 10,284 new cases, setting a new record high and exceeding 10,000 daily cases for the first time. After a week of reporting 6,500-8,000 new cases per day—Columbia’s daily incidence jumped by more than 2,000 cases. Colombia remains #5 globally with respect to daily incidence. Mexico’s daily incidence continues to vary widely, often jumping up or down by 1,500 cases or more from day to day. Looking at the 7-day average, Mexico’s increase in daily incidence may be starting to slow. Over the past 6 days, Mexico has consistently reported 6,500-6,700 new cases per day. 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 (#1), Brazil (#5), the US (#7), and Colombia (#9)—and a number of other countries in the region are reporting more than 100 new daily cases per million population.
India & Bangladesh
- India continues to report relatively consistent daily incidence—approximately, 48-50,000 new cases per day. This trend has now persisted for 6 days, following several weeks of exponential growth. India’s testing continues to increase, but its test positivity increased sharply over the course of the past week. India surpassed Brazil to regain the #2 position globally in terms of daily incidence, but its 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 7,232 new cases yesterday and 7,096 new cases on Monday, the country’s 2 lowest daily incidence since July 1. South Africa remains among the top countries globally in terms of both per capita (#8) and total daily incidence (#4). South Africa’s daily incidence appears to have reached a peak or plateau, and it has reported slightly decreasing average daily incidence over the past week or so.
- The Eastern Mediterranean region remains a global C19 hotspot, particularly with respect to per capita daily incidence. The region represents 3 of the top 10 countries globally—Oman (#3), Bahrain (#4), and Kuwait (#10). Nearby Israel (#6), 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.
- As a result of several recent days of reporting more than 300 new cases, Montenegro has climbed rapidly into the global top 10 in terms of per capita daily incidence (#2).
- The US CDC reported 4.28 million total cases (54,448 new) and 147,672 deaths (1,126 new). The US once again reported more than 1,000 new deaths, the fifth time in the past 7 days, and the country could potentially reach 150,000 cumulative deaths in tomorrow’s update. California is reporting more than 450,000 cases; Florida and New York are reporting more than 400,000 cases; Texas is reporting more than 375,000 cases; and 8 additional states are reporting more than 100,000 cases. The US fell to #7 globally in terms of per capita daily incidence, but it remains #1 in terms of total daily incidence.
- The Johns Hopkins CSSE dashboard reported 4.38 million US cases and 149,783 deaths as of 12:45pm on July 29.
2. US C19 Stimulus Bill
- Republican leadership in the US Senate unveiled their version of a “Phase 5” C19 economic stimulus package Monday afternoon. The draft bill, titled the HEALS Act, includes approximately US$1 trillion in funding to address a variety of financial and economic needs for both individuals and businesses. There appear to be major differences between the HEALS Act and the HEROES Act that was drafted by Democrat leadership and passed by the House of Representatives several weeks ago. One major area of agreement between the two bills appears to be a second direct stimulus payment to individuals. Both bills include a US$1,200 payment to individuals making up to $75,000 per year (or US$2,400 for married couples making US$150,000 or less). Beyond that measure, however, the rest of the bill will require substantial negotiations to compromise on funding for the Paycheck Protection Program, unemployment insurance, state and local governments, schools and healthcare systems, student loans, and other priorities.
- According to multiple reports, including by The Washington Post, the draft Republican bill includes funding for several major Department of Defense (DOD) programs and a new FBI building. The DOD funding includes ships, aircraft, and other weapons systems—including the Expeditionary Fast Transport amphibious cargo ship and F-35 fighter aircraft—as well as reimbursements for military contractors that kept workers employed while work was suspended due to C19. Reportedly, the weapons systems and programs funded under the bill include some that were defunded when US President Donald Trump repurposed DOD funding to construct portions of a wall along the US-Mexico border. Some Democrats and others have already expressed opposition to including military funding in the C19 bill, particularly to supplement funds used to construct the border wall.
- As we have discussed previously, the provisions included in both the HEROES Act and HEALS Act will inevitably change as negotiations proceed, and the final form and scope of a Phase 5 C19 emergency funding bill remains uncertain.
3. Call for US CDC to Regain Control Over C19 Reporting
- Yesterday, the Attorneys General from 22 states issued a letter to Secretary of Health and Human Services Alex Azar calling on him to rescind a recent directive that shifts the responsibility for C19 reporting from the CDC to the Department of Health and Human Services (HHS). The letter urges Secretary Azar to “restore the CDC to its rightful role as the primary repository for and source of information about the nation’s public health data” and notes that the decision to “bypass the CDC” erodes trust in C19 data, hinders state and local response efforts, and risks millions of lives. The authors argue that any need to improve data reporting and analysis should be addressed by adapting existing CDC systems, including through the use of US$500 million designated by the CARES Act to update CDC data collection and reporting systems. They contend that the new mechanism “circumvent[s] our nation’s top public health experts.” According to the letter, the new data reporting system is operated by private contractors rather than health experts employed by federal health agencies, and it separates data reported by hospitals from other sources, including nursing homes and other long-term care facilities.
4. Malnutrition, C19 and Humanitarian Aid
- The Lancet recently published a call to action co-authored by the directors of UNICEF, the Food and Agriculture Organization, the World Food Programme, and the WHO. The statement addresses the growing threat of childhood malnutrition due to downstream effects of the C19 pandemic and associated response policies and operations, particularly in low- and middle-income countries. The statement listed 5 “urgent actions” to support children’s right to adequate nutrition during the pandemic. Specifically, the authors call on national governments and private donors to support efforts to ensure access to nutritious, safe, and affordable diets; maternal and child health; early detection and treatment for child wasting; nutritious school meals for vulnerable children; and safe access to food and essential services. These priorities must be integrated more completely into the C19 response.
5. Multilateralism in Africa
- The Washington Post published an article outlining multilateral efforts to combat C19 in Africa. African countries have promoted collaborative, multilateral efforts to share physical, educational, and public health resources in an effort to curb the spread of C19 across the continent, in contrast to many other countries around the world that have increased restrictions on travel, immigration, and border control policies. Leaders in Africa quickly recognized that existing public health and healthcare infrastructure and supply limitations in Africa placed many countries at elevated risk for severe C19 epidemics.
- The focus on multilateral approaches “reflects the rise of political ownership and accountability” among national and regional leaders, and the engagement of stakeholders across multiple countries stemmed from the need to quickly identify and mobilize critical resources, particularly at a time when international humanitarian aid and other international assistance dwindled. Additionally, leadership by intergovernmental organizations like the Africa CDC has been critical to organizing coordinating response activities across the continent, including allocating and distributing resources such as medical and testing supplies.
6. Navajo Nation
- As we have covered previously, the Navajo Nation, which spans 4 states in the western US, was severely affected early in the US C19 epidemic. The Navajo Nation is currently reporting 10,364 cumulative cases, which represents a third of all C19 cases reported by the Indian Health Service. With 3,500 cumulative cases per 100,000 population, the Navajo Nation has been more severely affected than any US state, and its cumulative per capita incidence is 50% higher than the leading state (Louisiana with 2,389 cases per 100,000 population). The Navajo Nation was able to flatten the curve, and its epidemic peaked in mid-May.
- The Navajo face a variety of risk factors for severe C19 disease and death, including high rates of underlying health conditions, such as diabetes and heart disease, and limited access to health care and other services. These factors have contributed to elevated mortality among Navajo populations. For example, the Navajo Nation in New Mexico accounts for 57% of the state’s total C19 deaths, despite only representing 9% of the population.
- In response to the early surge in transmission, the Navajo Nation implemented a “lockdown” and mandated mask use on tribal and issued “travel advisories against leaving the Navajo Nation.” Tribal leadership have also encouraged Navajo living outside of reservations to return, particularly in states that have not yet implemented protective measures like mandatory mask use, such as Arizona. These measures have enabled Navajo Nation to bring its C19 epidemic under control, decreasing daily incidence from approximately 220 new cases per day in mid-May to fewer than 45 today. Vox published an interview with Navajo Nation President Jonathan Nez that addresses the Navajo C19 response and ongoing risks and challenges.
- Hospitals in Madagascar are reportedly exceeding capacity due to a recent surge in C19, and some hospitals are only admitting severe patients in order to make the most efficient use of limited beds and supplies. According to several media reports, Madagascar’s Minister of Health recently published an open letter requesting supplies and equipment to support overwhelmed health systems, but the Madagascar government “disavowed” the request. Madagascar’s President Andry Rajoelina, reinstituted a lockdown in central Madagascar in early July in response to increased transmission, but the country’s epidemic continues to accelerate. Madagascar has reported more than 10,000 total C19 cases and nearly 100 deaths, and its daily incidence has doubled since July 8.
- Last week, Science published a letter criticizing the C19 response within Nicaragua. The authors, including one from Nicaragua, described Nicaragua’s response as “disastrous,” following several decisions to forgo recommended policies adopted by other South American countries, including prohibitions on mass gatherings, closing schools and businesses, and robust screening and disease surveillance at border crossings and other points of entry. The authors indicate that neighboring countries have asked PAHO to pressure Nicaragua’s government leadership to more substantively address the disease risk.
- Earlier this week, The Wall Street Journal reported that doctors in the country who have organized to disseminate C19 information to the public have lost their jobs, exacerbating the risk of C19 and damaging the health care system. Nicaraguan President Daniel Ortega has reportedly stated that the C19 epidemic is not as severe as reported and that it has not affected health systems or other sectors. Nicaragua often reports to the WHO weekly instead daily, but it has reported a total of 3,004 total cases and 108 deaths. While these numbers are relatively low, they are among the highest in Central America on a per capita basis. The authors of the Science letter state Nicaragua’s C19 mortality as nearly 350 deaths per million population; however, other sources indicate that it is much lower (17.51 deaths per million population). We were unable to identify an official government report from a Nicaraguan health agency, so it is difficult to determine the actual scale of the country’s epidemic.
9. Crisis Standards of Care Staffing Guidance
- The US National Academies of Sciences, Engineering, and Medicine (NASEM) published a report outlining updated considerations for staffing needs while implementing crisis standards of care during the C19 response. As the US battles a surge in C19, particularly in areas of the country that were not severely affected early in the US epidemic, reports continue of hospitals and health systems struggling to meet C19 patient demand. One option for managing major patient surge is to alter the existing standards of care to allow clinicians to treat more patients with fewer resources.
- This NASEM report specifically addresses staffing issues in order to implement crisis standards of care in a safe and appropriate manner. The report includes recommendations regarding the transfer of staff between facilities and affected geographic areas, adjusting staff-to-patient ratios, utilizing external temporary or contracted personnel to supplement facility staffing, and changing personnel’s duties and responsibilities. Additionally, updated staffing models should address hazard pay or compensation; ensure appropriate leave or other time off for a variety of issues, including healthcare and family needs; and child care services to support increased personnel availability. In particular, the report highlights the demand for personnel with specialized training or skills during the C19 response, including with respect to mechanical ventilation, and the importance of providing guidance and support regarding potential SARS-CoV-2 exposures and infections among healthcare workers and other personnel. This report builds on analysis and recommendations that the committee published in March.
10. Resetting the US Response
- As the US rapidly approaches 5 million C19 cases and 150,000 deaths, it is clear that changes to the national response plan are needed. Researchers at the Johns Hopkins Center for Health Security published a report outlining key steps to “reset” the US response and put the country on a better path toward effectively combating C19. Operational recommendations include encouraging or, “when appropriate,” mandating nonpharmaceutical interventions, including mask use; reinstituting social distancing restrictions in hard-hit areas where health systems are stressed, including “stay at home” orders and prohibitions on large gatherings and other high-risk activities; and conducting and publishing epidemiological analysis, including for case investigations and contact tracing. Additionally, the report outlines recommendations to provide necessary infrastructure and support ongoing research and operational efforts, including scaling up supply chains for personal protective equipment and testing, improving distribution and allocation systems, conducting rapid research to address emerging information needs, and identifying and disseminating best practices for response operations and policies. Finally, the authors highlight the importance of preparing for the production, distribution, and administration of a future vaccine, including effective community engagement efforts.