Recent Developments & Information
August 2, 2020
Without reliable information, we rely on fear or luck.
A. Numbers & Trends
B. Airborne Transmission
C. New Scientific Findings & Research
4. Study reveals C19 transmission rate on trains [Note: We believe that the analysis also applies to planes and buses as well]
D. Vaccines & Testing
E. Concerns & Unknowns
F. Effectiveness of Lockdowns
G. Back to School?
H. Different Views
I. Projections & Our (Possible) Future
J. Johns Hopkins COVID-19 Update (7/31)
K. Links to Other Stories
Obese People Are Twice As Likely To Die From Covid The risks of hospitalization, intensive care treatment and death increase progressively with increasing body mass index (BMI) above the healthy weight range even after adjustment for potential confounding factors, including demographic and socioeconomic factors. In other words, the fatter one is, the higher the risk that person may die from covid.
Coronavirus screening strategies for safe reopening of college campuses This study defines the screening performance standards for coronavirus tests that would permit the safe return of students to U.S. residential college campuses this fall
Owners warned not to kiss pets after first cat infected with coronavirus in UK A female Siamese cat has become the first animal in the UK to catch coronavirus, prompting a warning to owners not to kiss their pets or share food with them.
The NBA bubble is a grand experiment in epidemiology We’ll see how technology, policy and human behavior influence an epidemic — and what we can do to stop it
New Yorkers get creative with precious outdoor space during lockdown summer Across the country, home improvement projects have been a quarantine hobby of choice, and most DIYers have focused their efforts on their outdoor spaces — a recent survey by Porch.com found that 61% of renovators made upgrades to their garden, patio or exterior since the start of the C19 pandemic.
One Man’s Quest to Infect People With C19 for Science Inside the movement to launch a human challenge trial for C19
A. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the prior day. Green highlights indicate a decrease or no change and yellow highlights indicate an increase.
1. Cases & Tests (8/1)
- Total Cases = 18,008,487 (+1.4%)
- New Cases = 255,779 (-33,370) (-11.5%)
- New Cases (7 day average) = 259,098 (-873) (-0.3%)
- Number of new cases is 6,107 less than one week ago, a decrease of 2.3%
- 1,000,000+ new cases every 4 days
- 7 day average of new cases has declined for the first time since 5/2
US Cases & Testing:
- Total Cases = 4,764,318 (+1.2%)
- New Cases = 58,429 (-12,475) (-17.6%)
- Percentage of New Global Cases = 22.8%
- New Cases (7 day average) = 63,792 (-1,399) (-2.2%)
- Total Number of Tests = 59,226,909
- Percentage of positive tests (7 day average) = 8.0%
- Number of new cases is 9,786 less than one week ago, a decrease of 14.3%
- 7 day average of new cases has been steadily declining since 7/25, indicating that the increase in cases that began on 6/9 has peaked
- 7 day average of new cases has declined 5,367 since 7/25, a decline of 7.8%
- Total Deaths = 688,022 (0.8%)
- New Deaths = 5,601 (-898) (-13.8%)
- New Deaths (7 day average) = 5,662 (-21) (-0.4%)
- Number of new deaths have declined 140 since last week, a decrease of 2.4%
- 7 day average of new deaths has been moving up and down within a narrow range since 7/25
- Total Deaths = 157,898 (+0.7%)
- New Deaths = 1,123 (-339)
- Percentage of Global New Deaths = 20%
- New Deaths (7 day average) = 1,129 (+28) (+2.5%)
- Number of new deaths are 197 higher than last week, an increase of 21.3%
- 7 day average of new deaths has steadily increased since 7/5, which indicates that the increase in new deaths has not yet peaked
3. Infections & Hospitalizations Appear To Have Peaked, But Deaths Rising
- National C19 incidence and hospitalizations appear to have peaked over the past week, but deaths continue to increase. The US is reporting an average of approximately 65,000 new cases per day, more than double the first peak in mid-April.
- National C19 hospitalizations are at essentially the level reported during the United States’ first peak in mid-April. Analysis by the COVID Tracking Project indicates that more than 56,000 C19 patients are currently hospitalized across the country, based on data reported by individual states. This is a slight decrease from the most recent peak of nearly 60,000 on July 23.
- The US is averaging more than 1,000 deaths per day for the first time since June 3. Multiple states continue to report record high daily deaths, including Arizona, Arkansas, California, Florida, Oregon, and Texas. Notably, Texas is averaging nearly 250 deaths per day, and Florida is reporting more than 150. Arizona is averaging more than 1 death per 100,000 population per day.
Source: Johns Hopkins COVID-19 Updates
B. Airborne Transmission
1. New study explores how coronavirus travels indoors
- A new study from the University of Minnesota College of Science and Engineering analyzes how the coronavirus spreads indoors—information that could help businesses and schools take precautions to reduce the chance of C19 transmission as they reopen.
- Mechanical engineering associate professor Jiarong Hong and assistant professor Suo Yang modeled the airborne virus transmission through aerosols, which are ejected from our mouths when we exhale or speak. The researchers found that when an infected person does this, the coronavirus virus hitches a ride on those aerosols as they land on nearby surfaces or are inhaled by another person.
- Using precise experimental measurements of aerosols released by eight asymptomatic individuals with C19, the researchers were able to numerically model the external flow of the virus through the air in three interior spaces—an elevator, a classroom, and a supermarket. Then, they compared how the virus faired among different levels of ventilation and with different spacing among the rooms’ occupants. The simulations used ventilation systems with inlets and outlets together, side-by-side in the elevator and supermarket cases and on different faces of a box in the classroom case.
- “In general, this is the first quantitative risk assessment of the spatial variation of risks in indoor environments,” Hong said. “You see a lot of people talking about what the risks are of staying in confined spaces, but nobody gives a quantitative number. I think the major contribution we’ve made is combining very accurate measurements and computational fluid dynamics simulation to provide a very quantitative estimate of the risks.”
- The researchers found that in indoor spaces, good ventilation will filter some of the virus out of the air, but may leave more viral particles on surfaces. In the classroom setting, after running a 50-minute simulation with an asymptomatic teacher consistently talking, the researchers found that only 10% of the aerosols were filtered out. The majority of the particles were instead deposited on the walls.
- “Because this is very strong ventilation, we thought it would ventilate out a lot of aerosols. But, 10% is really a small number,” said Yang, who holds the Richard and Barbara Nelson Assistant Professorship in Mechanical Engineering. “The ventilation forms several circulation zones called vortexes, and the aerosols keep rotating in this vortex. When they collide with the wall, they attach to the wall. But, because they are basically trapped in this vortex, and it’s very hard for them to reach the vent and actually go out.”
- In each scenario, the researchers mapped the air flow to find locations of virus “hot” spots, or where the aerosols congregated. With the right combination of ventilation and interior organization, it could be possible to mitigate the disease spread and avoid these hot zones, the researchers said.
- For example, in a classroom setting, the virus aerosols spread significantly less throughout the room when the teacher—who is likely doing the most talking—was placed directly under an air vent. This insight could inform how classrooms are arranged and disinfected, and also help places like theaters and concert venues reopen with the proper precautions.
- Watch a video simulation (here) showing the spread of virus aerosols throughout a classroom with vents placed at two different locations: directly above the instructor and at the back of the room.
- Yang and Hong recently began working with the Minnesota Orchestra to measure aerosol concentrations and flow while instruments are played onstage at Orchestra Hall. Eventually, they hope to provide the nonprofit with a plan to minimize the C19 risk in Orchestra Hall.
- “After our work goes out, I think more people will ask for help because I think many businesses reopening will have this need—movie theaters, drama theaters, any place with large gatherings,” Yang said. “If you do a good job, if you have good ventilation at the right location, and if you scatter the seating of the audience properly, it could be much safer.”
- The researchers recently joined an international work group of experts led by University of Minnesota Professor Michael Osterholm of the Center for Infectious Disease Research and Policy. The task force’s goal is to learn how much of the coronavirus it takes to become infected and provide science-driven policy that will help mitigate the C19 pandemic.
- Read the full paper entitled “Risk assessment of airborne transmission of C19 by asymptomatic individuals under different practical settings” on the ArXiv website.
2. Aboard the Diamond Princess, a Case Study in Aerosol Transmission
- In a year of endless viral outbreaks, the details of the Diamond Princess tragedy seem like ancient history. On Jan. 20, one infected passenger boarded the cruise ship; a month later, more than 700 of the 3,711 passengers and crew members had tested positive, with many falling seriously ill. The invader moved as swiftly and invisibly as the perpetrators on Agatha Christie’s Orient Express, leaving doctors and health officials with only fragmentary evidence to sift through.
- Ever since, scientists have tried to pin down exactly how the coronavirus spread throughout the ship. And for good reason: The Diamond Princess’ outbreak remains perhaps the most valuable case study available of coronavirus transmission — an experiment-in-a-bottle, rich in data, as well as a dark warning for what was to come in much of the world.
- Now, researchers are beginning to use macroscopic tools — computer models, which have revealed patterns in the virus’s global spread — to clarify the much smaller-scale questions that currently dominate public discussions of safety: How, exactly, does the virus move through a community, a building or a small group of people? Which modes of transmission should concern us most, and how might we stop them?
- In a new report, a research team based at Harvard and the Illinois Institute of Technology has tried to tease out the ways in which the virus passed from person to person in the staterooms, corridors and common areas of the Diamond Princess. It found that the virus spread most readily in microscopic droplets that were light enough to float in the air, for several minutes or much longer.
- The new findings add to an escalating debate among doctors, scientists and health officials about the primary routes of coronavirus transmission. Earlier this month, after pressure from more than 200 scientists, the World Health Organization acknowledged that the virus could linger in the air indoors, potentially causing new infections. Previously, it had emphasized only large droplets, as from coughing, and infected surfaces as the primary drivers of transmission. Many clinicians and epidemiologists continue to argue that these routes are central to disease progression.
- The new paper has been posted on a preprint server (here) and submitted to a journal; it has not yet been peer-reviewed, but it was shown by Times reporters to nearly a dozen experts in aerosols and infectious disease. The new findings, if confirmed, would have major implications for making indoor spaces safer and choosing among a panoply of personal protective gear.
- For example, ventilation systems that “turn over” or replace the air in a room or building as often as possible, preferably drawing on external air to do so, should make indoor spaces healthier. But good ventilation is not enough; the Diamond Princess was well ventilated and the air did not recirculate, the researchers noted.
- So wearing good-quality masks — standard surgical masks, or cloth masks with multiple layers rather than just one — will most likely be needed as well, even in well-ventilated spaces where people are keeping their distance.
- The computer modeling adds a new dimension of support to an accumulating body of evidence implicating small, airborne droplets in multiple outbreaks, including at a Chinese restaurant, a choir in Washington State, as well as a recent study of 13 passengers evacuated from the Diamond Princess.
- One researcher not involved in the new work, Julian Tang, an honorary associate professor of respiratory sciences at the University of Leicester in the United Kingdom, said the paper was “the first attempt, as far as I know, to formally compare the different routes of coronavirus transmission, especially of short versus long-range aerosols.”
- He characterized the distances and the kinds of particles involved with a simple analogy from everyday life: “If you can smell what I had for lunch, you’re getting my air, and you can be getting virus particles as well.”
- Another researcher, Linsey Marr, a professor of civil and environmental engineering at Virginia Tech who studies airborne transmission of viruses, had a more vivid description of the finding: the “garlic breath” effect.
- “As you’re close to someone, you smell that garlic breath,” Dr. Marr said. “As you’re farther away, you don’t smell it.”
- The “garlic breath” effect would suggest that powerful ventilation in buildings — primarily using outside air, or very well filtered — could reduce the transmission of the virus. The study found that small particles also had some ability to spread it at longer distances, presumably beyond the range of breath odor.
- From the start of the pandemic, scientists have grappled with the mechanisms of coronavirus spread. Early on, surface transmission was widely emphasized; larger droplets, which travel on more ballistic trajectories, like a stone through the air, and strike mucus membranes directly, are now favored by a number of researchers.
- Other possibilities are candidates as well, said Dr. John Conly, an infectious disease physician and infection control expert with the University of Calgary in Canada who has done consulting with the World Health Organization.
- “We’re getting surprises all the way along,” Dr. Conly said. “This paper I find interesting, but it has a long way to go to be able to get into a line of credibility, in my mind.”
- Dr. George Rutherford, a professor of epidemiology at the University of California, San Francisco, was equally skeptical. He said that, outside of hospital settings, “large droplets in my mind account for the vast majority of cases. Aerosols transmission — if you really run with that, it creates lots of dissonance. Are there situations where it could occur? Yeah maybe, but it’s a tiny amount.”
- Dr. Tang and other scientists strongly disagree. “If I’m talking to an infectious person for 15 or 20 minutes and inhaling some of their air,” Dr. Tang said, “isn’t that a much simpler way to explain transmission than touching an infected surface and touching your eyes? When you’re talking about an outbreak, like at a restaurant, that latter seems like a torturous way to explain transmission.”
- In the new analysis, a team led by Parham Azimi, an indoor-air researcher at Harvard’s T.H. Chan School of Public Health, studied the outbreak on the Diamond Princess, where physical spaces and infections were well documented. It ran more than 20,000 simulations of how the virus might have spread throughout the ship. Each simulation made a variety of assumptions, about factors like patterns of social interaction — how much time people spent in their cabins, on deck or in the cafeteria, on average — and the amount of time the virus can live on surfaces. Each also factored in varying contributions of smaller, floating droplets, broadly defined as 10 microns or smaller; and larger droplets, which fall more quickly and infect surfaces or other people, by landing on their eyes, mouth or nose, say.
- About 130 of those simulations reproduced, to some extent, what actually happened on the Diamond Princess as the outbreak progressed. By analyzing these most “realistic” scenarios, the research team calculated the most likely contributions of each route of transmission. The researchers concluded that the smaller droplets predominated, and accounted for about 60% of new infections over all, both at close range, within a few yards of an infectious person, and at greater distances.
- “Many people have argued that airborne transmission is happening, but no one had numbers for it,” Dr. Azimi said. “What is the contribution from these small droplets — is it 5%, or 90%? In this paper, we provide the first real estimates for what that number could be, at least in the case of this cruise ship.”
- The logic behind such transmission is straightforward, experts said. When a person is speaking, he or she emits a cloud of droplets, the vast majority of which are small enough to remain suspended in the air for a few minutes or longer. Through inhalation, that cloud of small droplets is more likely to reach a mucus membrane than larger ones soaring ballistically.
- The smaller droplets are also more likely to penetrate deeply into the respiratory system, down to the lungs. It may take a much smaller viral load — fewer viruses — to cause infection in the lungs than higher up, such as in the throat. This, at least, is the case for other respiratory viruses, like the flu.
- Brent Stephens, an engineering professor at the Illinois Institute of Technology in Chicago and a co-author on the paper, said the findings were important in shaping, for example, measures that should be taken as college students return to campus.
- The first, he said, should be “really enforcing mask policies.” Another, he said, is to recognize that there is a “huge variability in mask quality,” and material that actually stops small aerosols when someone is breathing, speaking, coughing or sneezing is crucial. Surgical masks are good, he said, but single-ply fabrics often are not.
- As various transmission routes come into clearer focus, they will provide specific guidelines on how to reopen schools, offices, restaurants and other businesses.
- “The value of this model is that it allows for recommendations and guidance to be specific to each unique environment,” said another co-author, Joseph G. Allen, an expert in indoor air quality and an assistant professor at Harvard’s T.H. Chan School of Public Health.
- Dr. Allen said those environments ranged from restaurants to dentist offices. In each case, he said, there are low-cost solutions that sharply improve ventilation and filtration — most buildings fall well short of optimal levels — and in turn reduce the risks of airborne infection.
- “To me, this is an all-in moment,” Dr. Allen said. “We need better ventilation and better filtration, across the board, in all our buildings.”
C. New Scientific Findings & Research
1. Past Infections May Leave behind T Cells That Recognize Coronavirus
- Understanding why some people develop severe symptoms following a coronaviru infection while others remain asymptomatic is one of the most pressing questions in C19 research today. The answer is undoubtedly complicated and multifaceted and will take years of research.
- One potentially crucial factor has now been identified by a team of researchers: prior exposure to other coronaviruses.
- This insight is based on research involving T-helper cells, a specialized white blood cell which is essential to the regulation of our immune response. The researchers found that one in three people with no prior exposure to the coronavirus nonetheless has T-helper cells capable of recognizing the virus. The likely reason for this is that the coronavirus shares certain structural similarities with other coronaviruses.
- The work is published in Nature in the article, “SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19.”
- For their study, the researchers isolated immune cells from the blood of 18 C19 patients. They also isolated immune cells from the blood of 68 healthy individuals who had never been exposed to the novel coronavirus.
- The researchers then stimulated these immune cells using small, synthetic fragments of the coronavirus spike proteins. They then tested whether the T-helper cells would be activated by contact with these protein fragments. They found that this was the case in 15 out of 18 patients with C19 (85%).
- “This was exactly what we had expected. The immune system in these patients was in the process of fighting this novel virus, and therefore showed the same reaction in vitro,” explained one of the study’s three lead authors, Claudia Giesecke-Thiel, PhD, head of the flow cytometry facility at the Max Planck Institute for Molecular Genetics. She added: “The fact that not all patients with C19 showed this T-helper cell response to viral fragments is probably due to the fact that T cells cannot be activated outside the human body during an acute or particularly severe phase of an illness.”
- The team was, however, surprised to find memory T-helper cells capable of recognizing fragments of the coronavirus in the blood of healthy individuals. They were found in a total of 24 out of 68 healthy individuals tested (35%). In fact, the researchers noticed that the immune cells of C19 patients reacted to different fragments of the viral envelope than the immune cells of healthy individuals. While the T-helper cells of patients recognized the spike protein in its full length, the T-helper cells isolated from healthy individuals were primarily activated by sections of the spike protein which showed similarity to corresponding sections found in the spike proteins of harmless “common cold” coronaviruses.
- “This suggests that the T-helper cells of healthy individuals react to the coronavirus because of previous exposure to the endemic ‘common cold’ coronaviruses,” said Giesecke-Thiel. She further explained: “One of the characteristics of T-helper cells is that they are not only activated by a pathogen with an ‘exact fit,’ but also by pathogens with ‘sufficient similarity’.” Notably, the researchers were able to show that the T-helper cells isolated from healthy participants who reacted to the coronavirus were also activated by various “common cold” coronaviruses—displaying what is known as “cross-reactivity.”
- What effects this cross-reactivity might have on a previously healthy person infected with the coronavirus was not addressed in the current study. “Generally speaking, it is possible that cross-reactive T-helper cells have a protective effect, for instance, by helping the immune system speed up its production of antibodies against the novel virus,” explained co-lead author Leif Erik Sander, MD, of Charité’s medical department, division of infectious diseases and respiratory medicine. He added: “In this case, a recent bout of the common cold would probably result in less severe C19 symptoms. However, it is also possible that cross-reactive immunity could lead to a misdirected immune response and potentially negative effects on the clinical course of C19. We know this can occur with dengue fever, for instance.”
- Prospective studies will be needed in order to conclusively determine whether previous “common cold” coronavirus infections confer protection against subsequent infection with the coronavirus—and whether this might explain the high variability in clinical manifestations. One such study, which will be led by Charité and conducted in collaboration with Technische Universität Berlin and the MPIMG, was just launched. Funded by the Federal Ministry of Health (BMG) and the Federal Institute for Drugs and Medical Devices (BfArM), the “Charité Corona Cross Study” will investigate the impact of cross-reactive T-helper cells on the course of C19. The researchers will simultaneously follow C19 risk populations over several months. Ultimately, the study aims to help predict the clinical course of C19, both in people with and without previous C19 infections.
- Coronaviruses are responsible for up to 30% of all seasonal colds.
- “Current estimates suggest that the average adult will contract an infection caused by one of the four endemic coronaviruses approximately every two to three years,” explained Andreas Thiel, PhD, a Charité researcher based at both the Si-M (‘Der Simulierte Mensch) and the BIH Center for Regenerative Therapies (BCRT). “If we assume that these cold viruses are capable of conferring a certain level of immunity against SARS-CoV-2,” he added, “this would mean that people who have had frequent exposure to such infections in the past, and who test positive for cross-reactive T-helper cells, should have better protection.”
- The authors wrote that, “The presence of S-cross-reactive T cells in a sizable fraction of the general population may affect the dynamics of the current pandemic, and has important implications for the design and analysis of upcoming C19 vaccine trials.”
2. Study Indicates That Old Vaccines May Stop the Coronavirus, But Scientists Are Skeptical
- Billions of dollars are being invested in the development of vaccines against the coronavirus. Until one arrives, many scientists have turned to tried-and-true vaccines to see whether they may confer broad protection, and may reduce the risk of coronavirus infection, as well.
- Old standbys like the Bacille Calmette-Guerin (“BCG”) tuberculosis vaccine and the polio vaccine appear to help train the immune system to respond to a broad variety of infections, including from bacteria, viruses and parasites, experts say.
- Now a study suggests that people who have received certain routine vaccines in the recent past — including childhood vaccinations like measles-mumps-rubella and polio, as well as adult flu vaccines — have lower coronavirus infection rates than those not recently vaccinated.
- But many experts greeted the conclusions with skepticism. The paper, an analysis of electronic health records from the Mayo Clinic, was posted online; it has not been through the peer review process and has not been accepted by a medical journal.
- Critics pointed to numerous methodological problems. It is a retrospective study; as such, it points to an association between vaccinations — a marker of overall good health and healthy behaviors — and lower infection risk.
- But the study does not prove a cause-and-effect relationship. While scientists generally consider studies like these useful for generating hypotheses that may be worth exploring further, they are far from definitive.
- The researchers analyzed the immunization records of 137,037 patients who had been tested for infection with the coronavirus, comparing matched pairs of vaccinated and unvaccinated patients who were otherwise similar.
- Patients had lower infection rates if they had recently been given the high-dose flu vaccine or had been vaccinated against polio, measles-mumps-rubella, chickenpox, pneumococcal disease, hepatitis A and hepatitis B, or haemophilus influenzae Type B, compared with those who had not received those vaccines in recent years.
- The level of risk reduction varied, depending on the vaccine and on how recently the individual had been vaccinated. But generally, the childhood vaccinations were linked to a greater reduction in coronavirus infection than the high-dose flu vaccine given to elderly individuals.
- And some vaccines, if received five years before the study began, were tied to higher coronavirus infection rates, including the human papillomavirus vaccine and the one against typhoid, as well as the meningococcal vaccine.
- The researchers went to great pains to account for variables that might have made a difference, including testing rates and geographic variations in coronavirus rates, as well as demographic factors like age, race and ethnicity, though some critics said these efforts fell short.
- “The hypothesis we are testing is that the immune system memory is stimulated by the vaccine,” said one of the authors of the paper, Venky Soundararajan, the founder of nference, a company that uses artificial intelligence to synthesize biomedical information.
- “Then along comes the coronavirus,” he said, “and the immune system is able to get the virus to back off and to clear it, so it can’t invade multiple cells and become a full-blown infection.”
- In one dramatic finding, Black patients who had received the pneumococcal disease vaccine five years before the study had a significantly lower risk of testing positive for the coronavirus, compared with similar patients who had not gotten the vaccine. That vaccine protects against 13 types of bacteria, including some that cause pneumonia.
- But experts said the findings should be interpreted with great caution.
- “Retrospective studies are great and they provide some hints, but there are caveats,” said Dr. Shyam Kottilil, a professor of medicine with the Institute of Human Virology at the University of Maryland School of Medicine. “It’s very difficult to establish causality.”
- Interest in the cross-protective effects of vaccines has led to efforts to repurpose old vaccines that may have potential to provide at least transient protection against the coronavirus until a specific vaccine against the coronavirus is developed and proven safe and effective, he said.
- “But nobody knows whether this approach will work unless we test them,” Dr. Kottilil said. “To endorse this, you need to do really good randomized clinical trials.” There is little incentive for private companies to invest in expensive trials because the old vaccines are cheap and off-patent, he added.
- Dr. Christine Stabell Benn, a professor of global health at the University of Southern Denmark who has studied the potential nonspecific effects of vaccines against infectious diseases, said there is “ample evidence” that live attenuated vaccines can increase resistance to seemingly unrelated infections.
- But the new paper suffers from many limitations, she added, among them that the authors did not do enough to create comparable groups of vaccinated and unvaccinated individuals, and did not disentangle the effects of various vaccines.
- She was particularly concerned about the so-called healthy user effect: People who have the means and are anxious about their health are most likely both to get vaccinations and also to be tested for the coronavirus, even without symptoms.
- That “would lead to strong positive associations between vaccination and having a negative test result,” Dr. Benn said in an email. “The authors acknowledge this and do something to mitigate the impact, but it remains a big concern.”
3. Implementation of social distancing policies correlates with significant reduction in coronavirus transmission
- According to researchers from The University of Texas MD Anderson Cancer Center, the implementation of social distancing policies corresponded with significant reductions in transmission of the coronavirus and reduced community mobility, both in the U.S. and globally, providing evidence that social distancing is a useful tool in preventing further spread of C19.
- The study, published today in PLOS ONE, estimates that social distancing policies enacted nationally in 46 countries prevented an estimated 1.57 million cases of C19 over a two-week period, representing a 65% reduction in new cases. The researchers suggest these data emphasize the significant benefits that can be achieved by individuals practicing social distancing measures.
- “At MD Anderson, we are focused on caring for patients with cancer, and we know that our patients are highly vulnerable to C19,” said senior author Raghu Kalluri, M.D., Ph.D., professor and chair of Cancer Biology. “Therefore, we felt it important to conduct an unbiased analysis of safety measures that could benefit our patients as well as society at large. From our data-driven analysis, it became clear that practicing social distancing can have a huge impact on transmission rates.”
Impact of social distancing policies in the U.S.
- To determine the effectiveness of social distancing policies in the U.S., the researchers analyzed C19 spread across each of the 50 states. Recognizing that many factors contribute to disease spread, they analyzed new cases before and after states enacted social distancing policies.
- Three states did not implement such policies, providing an opportunity for comparisons. These were analyzed over similar time periods relative to other states.
- “We found that states observed significant reductions in transmission rates following the implementation of social distancing policies, compared to states without such policies,” said lead author Daniel McGrail, Ph.D., postdoctoral fellow in Systems Biology. “In fact, two of the smallest reductions in spread were seen in states without social distancing policies.”
- The 47 states with social distancing policies also saw greater reductions in average community mobility compared to states without policies, which measures the movement trends of residents across residential, workplace, retail and other locations. States without social distancing policies also saw decreased mobility, although the change was significantly smaller than states with distancing policies.
Impact of social distancing policies globally
- Understanding that the U.S. analysis was limited by a small number of states without social distancing policies, the researchers analyzed the effects of social distancing policies globally. They were able to obtain sufficient data for 46 countries with national social distancing policies, 74 nations without such policies and 14 with regional policies.
- Following a similar analysis, the data indicate that significantly greater reductions in transmission were seen in countries after implementing a national social distancing policy compared to those with regional policies or a matched time frame in countries without policies. No significant difference was observed between countries with regional policies and those without social distancing policies.
- Countries with any social distancing policies had significantly reduced community mobility relative to nations without policies, and those with national policies saw greater decreases than countries with regional policies. There was a strong correlation between decreased mobility and decreased transmission of the virus, highlighting the importance of individuals practicing social distancing to effectively prevent transmission of the virus.
- “This is clear evidence that social distancing measures can collectively have tremendous impacts on reducing transmission of the coronavirus, and we encourage individuals to practice social distancing to help control spread of infections,” said Kalluri. “We believe these data will provide useful evidence for public health officials and policy makers when considering future measures to reduce the spread of C19 in their communities.”
4. Study reveals C19 transmission rate on trains
- A study by scientists from the University of Southampton has examined the chances of catching C19 in a train carriage carrying an infectious person.
- Based on high-speed routes in China, researchers from WorldPop found that for train passengers sitting within three rows (widthwise) and five columns (lengthwise) of an infected person (index patient) between zero and 10.3% caught the disease. The average rate of transmission for these ‘close contact’ travellers was 0.32%.
- The study, in collaboration with the Chinese Academy of Sciences, China Academy of Electronics and Information Technology, and Chinese Centre for Disease Control and Prevention, also showed that passengers travelling in seats directly adjacent to an index patient suffered the highest level of transmission, with an average of 3.5% contracting the disease. For those sitting on the same row, the figure was 1.5%.
- The ‘attack rate’ for each seat – the number of passengers in a given seat diagnosed with C19, divided by the total number of passengers travelling in the same seat – increased by 0.15% for every hour that a person travelled with an index patient. For those in adjacent seats, this rate of increase was higher at 1.3% per hour.
- Interestingly, the researchers found that only 0.075% of people who used a seat previously occupied by an index patient went on to contract the disease.
- Details are published in the journal Clinical Infectious Diseases.
- The WorldPop team, experts in population mapping, used sophisticated modelling to analyse anonymised itinerary and infection data relating to train passengers on China’s high-speed G train network. This included those who had C19 at the time of travel and their close contacts (who showed symptoms within 14 days of travel). The data, covering a period between 19 December 2019 and 6 March 2020, included 2,334 index patients and 72,093 close contacts. Their travel times ranged from between less than an hour to eight hours.
- Lead investigator, Dr Shengjie Lai, comments: “Our study shows that although there is an increased risk of C19 transmission on trains, a person’s seat location and travel time in relation to an infectious person can make a big difference as to whether it is passed on. The findings suggest that during the C19 epidemic it is important to reduce the density of passengers and promote personal hygiene measures, the use of face coverings and possibly carry-out temperature checks before boarding.”
- The researchers conclude that given the attack rates estimated for passengers in the same row as an index patient, a safe social distance of more than one metre is required for one hour spent travelling together. After two hours of contact, they consider a distance of less than 2.5 metres may be insufficient to prevent transmission.
- Director of WorldPop, Professor Andy Tatem adds: “Our research is the first to quantify the individual risk of C19 transmission on public transport based on data from epidemiological investigations of disease cases and their close contacts on high-speed trains.
- “It shows that the transmission risk not only relates to the distance from an infected person, but also the time in their presence. We hope it can help to inform authorities globally about measures needed to guard against the virus and in-turn help to reduce its spread.”
D. Vaccines & Testing
1. Single-Shot C19 Vaccine Robustly Protects Non-human Primates Against The Coronavirus
- The development of a safe and effective vaccine will likely be required to end the C19 pandemic. A group of scientists, led by Beth Israel Deaconess Medical Center (BIDMC) immunologist Dan H. Barouch, MD, PhD, now report that a leading candidate C19 vaccine developed at BIDMC in collaboration with Johnson & Johnson raised neutralizing antibodies and robustly protected non-human primates (NHPs) against the coronavirus. This study builds on the team’s previous results and is published in the journal Nature.
- “This vaccine led to robust protection against coronavirus in rhesus macaques and is now being evaluated in humans,” said Barouch, who is Director of BIDMC’s Center for Virology and Vaccine Research.
- The vaccine uses a common cold virus, called adenovirus serotype 26 (Ad26), to deliver the coronavirus spike protein into host cells, where it stimulates the body to raise immune responses against the coronavirus. Barouch has been working on the development of a C19 vaccine since January, when Chinese scientists released the coronavirus genome. Barouch’s group, in collaboration with Johnson & Johnson, developed a series of vaccine candidates designed to express different variants of the coronavirus spike protein, which is the major target for neutralizing antibodies.
- Barouch and colleagues conducted a study in 52 NHPs, immunizing 32 adult rhesus macaques with a single dose of one of seven different versions of the Ad26-based vaccine, and giving 20 animals sham vaccines as placebo controls. All vaccinated animals developed neutralizing antibodies following immunization. Six weeks after the immunization, all animals were exposed to the coronavirus. All 20 animals that received the sham vaccine became infected and showed high levels of virus in their lungs and nasal swabs. Of the six animals that received the optimal vaccine candidate, Ad26.COV2.S, none showed virus in their lungs, and only one animal showed low levels of virus in nasal swabs.
- Moreover, neutralizing antibody responses correlated with protection, suggesting that this biomarker will be useful in the clinical development of C19 vaccines for use in humans.
- “Our data show that a single immunization with Ad26.COV2.S robustly protected rhesus macaques against coronavirus challenge,” said Barouch, who is also the William Bosworth Castle Professor of Medicine at Harvard Medical School, a member of the Ragon Institute of MGH, MIT, and Harvard, and a co-leader of the vaccine working group of the Massachusetts Consortium on Pathogen Readiness. “A single-shot immunization has practical and logistical advantages over a two-shot regimen for global deployment and pandemic control, but a two-shot vaccine will likely be more immunogenic, and thus both regimens are being evaluated in clinical trials. We look forward to the results of the clinical trials that will determine the safety and immunogenicity, and ultimately the efficacy, of the Ad26.COV2.S vaccine in humans.”
- Investigators at Beth Israel Deaconess Medical Center (BIDMC) and other institutions have initiated a first-in-human Phase 1/2 clinical trial of the Ad26.COV2.S vaccine in healthy volunteers. Kathryn E. Stephenson, MD, MPH, is the principal investigator for the trial at BIDMC, which is funded by Janssen Vaccines & Prevention, B.V., a pharmaceutical research arm of Johnson & Johnson.
- Pending clinical trial outcomes, the Ad26.COV2.S vaccine is on track to start a phase 3 efficacy trial in 30,000 participants in September.
2. Australian coronavirus vaccine clears first phase of human trials
- A promising Australian coronavirus vaccine has cleared the first phase of human trials — and could be available in as soon as October, according to a report.
- Developed by scientists in Adelaide, the injectable drug known as COVAX-19 is the first vaccine candidate in the country to successfully clear the “phase one” hurdle and could be ready for use in three or four months, according to 7news.com.au
- The drug was shown to safely generate an immune response in 40 people earlier this month, according to Vaxine, the company behind the drug, and researchers from Flinders University.
- COVAX-19 is also one of only a handful of potential vaccines that have progressed beyond phase one of human trials in the world, which one expert called exciting.
- “Safety data from the clinical trials shows the vaccine isn’t showing any problems at all and is inducing the right type of immune response…It’s very exciting,” said Nikolai Petrovsky, a Flinders University Chairman and Research Director of Vaxine.
- “Now we do much bigger clinical trials in a larger number of individuals to prove the vaccine is working.”
- Phase two trials for COVAX-19 will include 400 to 500 volunteers and are scheduled to start in September.
3. Incredible New C19 Testing Technologies
- The National Institutes of Health is investing $248.7 million in new technologies to address challenges associated with C19 testing (which detects the coronavirus). NIH’s Rapid Acceleration of Diagnostics (RADx) initiative has awarded contracts to 7 biomedical diagnostic companies to support a range of new lab-based and point-of-care tests that could significantly increase the number, type and availability of tests by millions per week as early as September 2020. With national demand estimated to be millions more tests per day above current levels, these technologies are expected to make a significant contribution to expanding the nation’s testing capacity.
- “RADx moved incredibly quickly to select promising technologies through its ‘shark tank’ approach, investing in technologies that could boost America’s best-in-the-world C19 testing capacity by millions more tests per day,” said HHS Secretary Alex Azar. “These technologies will help deliver faster results from labs and more and more test results within minutes at the point of care, which is especially important for settings like schools and nursing homes.”
- The 7 technologies use different methods and formats and can be performed in a variety of settings to meet diverse needs.
- Four of the technologies introduce innovations in laboratory-based testing technologies including next generation sequencing, CRISPR and integrated microfluidic chips that could dramatically increase testing capacity and throughput while reducing the time to receive test results.
- Three technologies use platforms to provide nucleic acid and viral antigen tests that can give rapid results at the point of care, such as offices, manufacturing facilities, childcare centers, nursing homes and schools.
- Additionally, some of the tests offer more convenient sampling, such as saliva testing.
- The companies range in scope from small start-ups to large publicly held organizations. The FDA has been working with NIH and RADx external advisors to provide general advice on test validation and is prioritizing the review of emergency use authorization (EUA) for tests supported by RADx. The companies awarded today have either received EUA from the FDA for their C19 test or have applications in process.
- “The RADx initiative has enabled some of the nation’s most creative biomedical device inventors to ramp up development of their testing technologies at unprecedented speed,” said NIH Director Francis S. Collins, M.D., Ph.D. “The innovations selected to date represent the diverse types of promising technologies that will serve the nation’s testing needs.”
- NIH launched RADx on April 29, 2020, just days after receiving an emergency supplemental appropriation of $1.5 billion from Congress to support innovative technologies to make millions of rapid C19 tests per week available to Americans by the fall. At that time, Dr. Collins issued a nationwide call to science and engineering’s most innovative minds. An overwhelming response ensued, culminating in more than 650 applications to date.
- Hundreds of experts from government, academia and industry, including the National Institute of Biomedical Imaging and Bioengineering’s (NIBIB) Point-of-Care Technology Research Network (POCTRN), are contributing to the RADx process by evaluating applications, providing core technical and clinical resources and guiding project teams.
- NIH selected approximately 100 of the best concepts to enter an intense one-week “shark-tank” technology evaluation process. Thirty-one of these projects made the cut and moved to Phase 1, a rigorous four to six-week period of initial technology validation.
- The seven tests announced today are the first to be chosen for scale up, manufacturing and delivery to the marketplace through RADx. More than 20 companies remain actively engaged in meeting Phase 1 milestones and will be considered for Phase 2 awards in the coming weeks.
- In addition, dozens of promising concepts continue to move through the RADx “innovation funnel” and may be selected for Phase 1 and/or Phase 2 funding.
- “This is an exciting milestone,” said Bruce J. Tromberg, Ph.D., director of NIBIB and leader of RADx Tech, one of four components of the NIH RADx initiative. “It will increase U.S. testing capacity exponentially over the next few months. These and other technologies emerging from our RADx pipeline will guide patient care and inform public health measures to stop the spread of the virus and leave us better equipped to address future pathogens and other diseases.”
- The following companies have achieved key RADx milestones and will receive support for manufacturing and scale up.
- Mesa Biotech, San Diego. The company’s Accula coronavirus test employs a hand-held RT-PCR device and a compact, single-use cartridge that detects viral RNA at the point of care. Results can be read from the removable cartridge in 30 minutes.
- Quidel, San Diego. The Quidel Sofia SARS Antigen FIA test kit, a lateral flow immunoassay, is used with Sofia and Sofia 2 Analyzers in point of care settings, such as a doctor’s office or pharmacy. There are currently thousands of Quidel analyzers in place across the United States and HHS has identified this technology for use in nursing homes. The analyzers give electronic results within 15 minutes.
- Talis Biomedical, Menlo Park, California. The Talis One C19 point of care test is a multiplexed cartridge used with the compact Talis One instrument. The test detects SARS-CoV-2 through isothermal amplification of viral RNA and an optical detection system, returning a result in under 30 minutes.
- Ginkgo Bioworks, Boston. Ginkgo Bioworks is scaling up using significant automation for handling samples and high-throughput, next-generation sequencing technologies to process tens of thousands of individual tests at once. Working with universities, schools, public or private companies, and local communities, Ginkgo Bioworks will provide end-to-end sample collection and report results within 24-48 hours from sample receipt. The company is expected scale up to 50,000 tests per day in September 2020 and 100,000 per day by the end of the year.
- Helix OpCo, San Mateo, California. Helix will ship standardized kits in bulk for the collection of nasal swabs to public health departments, health care systems, employers and other customers to collect tens of thousands of samples that can be processed at once and within 24-48 hours, in very high volumes, using a combination of sophisticated automation processes and the use of next generation sequencing technologies. Helix is expected to process up to 50,000 samples a day by end of September 2020 and 100,000 samples per day at the end of the year.
- Fluidigm, San Francisco. Each BioMark HD microfluidics platform has the capacity to process thousands of SARS-CoV-2 PCR tests per day with a primary focus on saliva samples. With many existing Fluidigm instruments in clinical and research labs throughout the United States, scale up and deployment of their advanced integrated fluidic chips can provide tens to hundreds of thousands of new tests per day in fall 2020.
- Mammoth Biosciences, Inc., South San Francisco, California. The Mammoth Biosciences SARS-CoV-2 DETECTR assay uses CRISPR technology, which provides a simpler workflow and significantly faster turnaround time compared to conventional laboratory PCR tests. This high-throughput solution can result in a multi-fold increase in testing capacity in commercial laboratories.
E. Concerns & Unknowns
1. C19 survivors could lose hearing along with sense of smell, taste
- It has already been established that some coronavirus survivors lose their sense of smell and taste — but doctors in Britain now warn that they can also lose their hearing, according to a report.
- Experts at The University of Manchester studied 121 adults who were admitted to Wythenshawe Hospital who were questioned about their lingering symptoms for two months after being discharged, the Mirror reported.
- Eight of them reported a loss of hearing and eight others said they had developed tinnitus, or ringing in the ears, according to the news outlet.
- “We already know that viruses such as measles, mumps and meningitis can cause hearing loss and coronaviruses can damage the nerves that carry information to and from the brain,” said Kevin Munro, a professor of audiology at The University of Manchester.
- “It is possible, in theory, that C19 could cause problems with parts of the auditory system including the middle ear or cochlea,” he added, the Mirror reported.
- “For example, auditory neuropathy, a hearing disorder where the cochlea is functioning but transmission along the auditory nerve to the brain is impaired could be a feature,” Munro said.
- He said the deadly bug also could impact pre-existing hearing loss and tinnitus, adding that there is an “urgent need for high-quality studies to investigate the acute and temporary effects of C19 on hearing and the audiovestibular system”.
- Some people who recover from the illness find that their symptoms persist for months.
- Paul Garner said in a blog post published by the British Medical Journal that his bout with the illness lasted seven weeks, and that his symptoms had waxed and waned.
2. Google searches during pandemic hint at future increase in suicide
- U.S. Google searches for information about financial difficulties and disaster relief increased sharply in March and April compared to pre-pandemic times, while googling related to suicide decreased, researchers at Columbia University Irving Medical Center have found.
- Because previous research has shown that financial distress is strongly linked to suicide mortality, the researchers fear that the increase may predict a future increase in deaths from suicide.
- “The scale of the increase in Google searches related to financial distress and disaster relief during the early months of the pandemic was remarkable, so this finding is concerning,” says Madelyn Gould, PhD, MPH, Irving Philips Professor of Epidemiology in Psychiatry at Columbia University Vagelos College of Physicians and Surgeons and senior author of the study.
Pandemics and suicide
- Researchers in the US and elsewhere have begun studying the effects of the C19 pandemic on mental health, but the impact on suicidal behavior and deaths is difficult to assess due to lag time in the availability of mortality data.
- Previous studies suggest that suicide rates often decrease in the immediate aftermath of national disasters, such as 9/11, but may increase several months later, as seen after the 1918 flu pandemic and the 2003 SARS outbreak in Hong Kong.
- Studies in the U.S. and internationally have linked Google search behavior with suicidal behavior, so in the current study, the researchers evaluated online searches about suicide and suicide risk factors during the early part of the pandemic and potential long-term impact on suicide.
- The researchers used an algorithm to analyze Google trends data from March 3, 2019, to April 18, 2020, and identify proportional changes over time in searches for 18 terms related to suicide and known suicide risk factors.
- “We didn’t have a clear hypothesis about whether there would be an increase in suicide-related queries during this period of time, but we anticipated a national sense of community during the pandemic that might mitigate suicidal behavior in the short term,” says Emily Halford, MPH, data analyst and the study’s first author.
Unemployment, panic attacks, and loneliness may predict future suicide
- The researchers found dramatic relative increases (in the thousands of percentages, in some cases) in Googling search terms related to financial distress — e.g., “I lost my job,” “unemployment,” and “furlough” — and for the national Disaster Distress Helpline.
- The proportion of queries related to depression was slightly higher than the pre-pandemic period, and moderately higher for panic attack.
- “It seems as though individuals are grappling with the immediate stresses of job loss and isolation and are reaching out to crisis services for help, but the impact on suicidal behavior hasn’t yet manifested,” says Gould.
- “Generally, depression can take longer to develop, whereas panic attacks may be a more immediate reaction to job loss and having to deal with emotionally charged events amidst the social isolation of the pandemic.”
- Searches for terms related to loneliness were also meaningfully higher during the early pandemic period versus the prior year.
- Gould adds that social distancing is one of the primary measures implemented to slow the spread of the coronavirus, “but this approach may have detrimental secondary effects, such as loneliness and exacerbation of preexisting mental illnesses, which are known suicide risk factors.”
Meeting the anticipated need for crisis services
- The researchers say that in light of an anticipated increase in suicidal crises, it will be important to ensure continued availability and accessibility of crisis services and other mental health services during the later stages of the pandemic.
- “The current findings give us insight into how people have been dealing with the immediate emotional and financial effects of the pandemic,” says Gould. “Encouragingly, individuals who Google terms related to suicide are directed to the National Suicide Prevention Lifeline. We are hoping that accessing this crisis service may ameliorate suicide risk among the individuals who have Googled suicide-related terms.”
- If you or someone you know is thinking about suicide, contact the National Suicide Prevention Lifeline 24/7 for free, confidential support by calling 1-800-273-8255 (1-800-273-TALK) and through online chats.
3. Children younger than 5 years old who are infected with coronavirus can have as much virus in their nose and throat as infected adults
- Children are susceptible to infection with severe acute respiratory syndrome coronavirus but generally present with mild symptoms compared with adults. Children drive spread of respiratory and gastrointestinal illnesses in the population, but data on children as sources of coronavirus spread are sparse.
- Early reports did not find strong evidence of children as major contributors to coronavirus spread, but school closures early in pandemic responses thwarted larger-scale investigations of schools as a source of community transmission. As public health systems look to reopen schools and day cares, understanding transmission potential in children will be important to guide public health measures. Here, we report that replication of coronavirus in older children leads to similar levels of viral nucleic acid as adults, but significantly greater amounts of viral nucleic acid are detected in children younger than 5 years.
- Our analyses suggest children younger than 5 years with mild to moderate C19 have high amounts of coronavirus viral RNA in their nasopharynx compared with older children and adults.
- Our study is limited to detection of viral nucleic acid, rather than infectious virus, although coronavirus pediatric studies reported a correlation between higher nucleic acid levels and the ability to culture infectious virus.
- Thus, young children can potentially be important drivers of coronavirus spread in the general population, as has been demonstrated with respiratory syncytial virus, where children with high viral loads are more likely to transmit.
- Behavioral habits of young children and close quarters in school and day care settings raise concern for coronavirus amplification in this population as public health restrictions are eased. In addition to public health implications, this population will be important for targeting immunization efforts as coronavirus vaccines become available.
F. Effectiveness of Lockdowns
1. Are Lockdowns Necessary? What Data From 10 Countries Show
- A new Heritage Foundation special report analyzes the C19 responses of 10 countries, with varying levels of economic freedom, to better understand which policies might have been more effective than others.
- The 10 countries we studied have taken vastly different approaches to handling C19 with varying degrees of success.
- The evidence suggests that full lockdowns, such as those implemented in Italy and Norway, are not as effective as the more targeted approaches taken in other countries, such as in South Korea and Iceland.
- In fact, as we discuss, those two countries have fared considerably better than the United States has in handling C19 without shutting down their economies.
- Another key finding is that Australia and New Zealand, two neighboring countries with similar climates, have had similar outcomes regarding C19, even though they took very different approaches to dealing with the virus.
- In particular, New Zealand virtually locked down the entire country in the spring, while Australia took a less restrictive approach.
- Yet, both countries have contained the virus at similar levels.
- Specifically, Australia had 13,595 C19 cases (0.0534% of its population) and 139 deaths (0.000546% of its population), while New Zealand had 1,556 cases (0.0323% of its population) and 22 deaths (0.000457% of its population). However, New Zealand’s unemployment level is forecast to increase to 9.2% by December, while Australia’s is expected to increase to 7.6% over this same time period.
- From a public health perspective, strict lockdowns can cause additional problems.
- As 80% of COVID cases do not require hospitalization, when people isolate at home upon contracting C19, they may infect their family members, including those who are at risk.
- In fact, New York Gov. Andrew Cuomo and Broward County, Florida, Mayor Dale Holness have both noticed this phenomenon. Cuomo was, in fact, quite surprised, noting: “If you notice, 18% of the people came from nursing homes, less than 1% came from jail or prison, 2% came from the homeless population, 2% from other congregate facilities, but 66% of the people were at home, which is shocking to us.”
- Two additional countries that took very different approaches to dealing with C19—and experienced very different outcomes—are South Korea and Italy.
- South Korea permitted much of its economy to remain open, choosing instead to engage in aggressive testing and isolating the infected, either via hospitals or isolation centers. South Korea also engages in extensive digital contact tracing to notify people when they have come in contact with others having C19.
- As of July 22, South Korea (population of more than 51 million) has had13,979 cases and 298 deaths (0.0272% and 0.000579% of its population, respectively.)
- Italy, on the other hand, pursued a strict lockdown policy when the virus was spreading heavily in the spring. The country has a population of 60 million, comparable to South Korea. As of July 22, however, Italy has had 245,590 cases and 35,097 deaths (0.406% and 0.058% of its population, respectively), orders of magnitude higher than South Korea.
- Maintaining a strong economy and protecting public health are not mutually exclusive. And although many states here in the U.S. have pursued strict stay-at-home orders, our country has not done well from either perspective, currently having more than 4 million cases (1.26% of the population) and 148,490 C19-related deaths (0.0449% of the population).
- Thus, although it is impossible to control for all of the differences between countries, these figures rank the United States—despite having instituted stay-at-home orders—behind many of the other developed nations we examined.
- Moreover, as of July 27, with a first quarter gross domestic product loss of 5%, and a June unemployment rate of 11%, the U.S. should develop a better approach.
- For instance, maximum effort here in the U.S. should be concentrated on protecting those at risk, as well as the livelihoods of American families. Among the many countries we examined, our study notes that there are aspects of the South Korean approach that lawmakers can learn from.
- When recently asked about the status of the battle with C19, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said, “We are certainly not at the end of the game, I’m not even sure we’re halfway through.”
- As Heritage Foundation research has discussed, focusing on hot spots, protecting the elderly and most vulnerable, utilizing isolation centers to prevent the virus from spreading, taking advantage of contact tracing, and engaging in appropriate testing are policies lawmakers should consider in the coming months.
- With these and other recommendations also suggested by The Heritage Foundation’s National Coronavirus Recovery Commission, we can be well-equipped to win the fight against this very dangerous enemy.
G. Back to School?
1. Over Half of Colleges On Pace for In-Person Classes
- Colleges and universities across the country are set to reopen for fall semester at the end of August and into September. School officials had hoped the coronavirus would be under control by now, but it continues to sweep through the U.S. with over 60,000 new cases a day and 1,000 new deaths. Despite this, over half of all colleges and universities say they’re still planning to offer in-person classes in the fall.
- In a survey of over 1,000 colleges across the U.S. by the Chronicle of Higher Education, 53% responded that they plan to offer at least some in-person classes for the beginning of the semester. That’s down considerably from the beginning of the month, where the same survey showed 63% of colleges were planning on offering in-person classes.
- A mixture of online-only plans and a hybrid of in-person and online classes have been gaining traction in July, according to the survey. Online-only plans rose from 9% to 12% for the end of July, while hybrid plans nearly doubled from 18% to 32%. Just 3% of colleges surveyed said they were still waiting on making a decision.
2. Reopening Schools Try to Decide When They Should Close Again Due to Coronavirus Cases
- School districts across the country trying to complete their reopening plans are struggling to figure out what to do if a coronavirus outbreak hits—and how bad it would have to be to cause them to shut schools again.
- So far, schools are getting little consensus from federal and state officials on how best to plan. The CDC recommends considering community infection rates, among other factors, in deciding whether to close a school.
- State guidance, meanwhile, is all over the map. California could see school buildings that open in the fall shut down again if multiple clusters of children get sick, or if infection rates in a school hit 5% within a two-week period, a state plan says. In New York, Gov. Andrew Cuomo has said schools would close if a region’s infection rate reaches 9%.
- Schools’ plans for reopening their buildings include measures like requiring students and staff to wear cloth face coverings and having a small group of children stay in the same classroom with the same kids all day, including for lunch. Contingency plans for how to deal with an outbreak consider variables such as rate of transmission, size and layout of a school, and local capacity to test quickly for the virus.
- In New York City, the nation’s largest school district, the chief operating officer of the city Department of Education, Ursulina Ramirez, said the agency is still working to determine how many positive C19 cases in one school would prompt a building’s closure.
- “Is it one? Is it two cases? Is it five?” Ms. Ramirez asked. “We have to really talk to parents and teachers and really see what their comfort level is. If there’s an individual case, we know that is going to cause some panic in our families and we want to make sure that they trust us, that we are both cleaning the buildings diligently and that we have protocols.”
- Summer school has informed some districts’ plans. In Norwalk, Conn., as soon as someone at a summer school program tested positive in July, the building shut for three weekdays of disinfection, plus the weekend. All six people in the infected person’s group quarantined for 14 days.
- “We determined we should err on the side of caution,” said Dr. Frank Costanzo, chief of school operations in Norwalk.
- The CDC’s most recent guidance, released July 24, says that in most instances, a single case of C19 in a school wouldn’t warrant closing the entire building. It says community spread and how much contact the ill person had with others, as well as when such contact took place, need to be considered. It says these variables should also be factors in determining how long a school, or part of a school, stays closed.
- The agency didn’t specify a number of cases or a community infection rate that should trigger closures. Instead, it stressed schools should work with state and local public health officials in making decisions.
- On top of worrying about whether schools will have adequate ventilation, cleaning and space for students to social distance, many parents have expressed concerns about whether schools will handle virus cases properly, and whether they will alert families immediately if anyone on campus gets infected. New York City’s Department of Education, which faced criticism from parents in the spring for insufficient transparency, has pledged to notify families promptly.
- “All parent leaders are concerned, not just that the DOE has protocols but that schools follow them,” said Martha Kessler, who serves on a council of parent representatives of Manhattan high schools and has a daughter entering 12th grade. “The system has enormous autonomy for principals.”
- In Massachusetts, guidance from the state’s Department of Elementary and Secondary Education doesn’t say how many students or staff would need to be C19 positive for a campus to shut down, saying local health officials will determine next steps in cases of suspected in-school transmission “beyond one cohort or a small number of cohorts.” Responses could include closing the entire building, or part of it, for an extensive cleaning that takes one to three days, for example. Or it might close for a 14-day quarantine.
- Michael Simmon, who teaches U.S. history to eighth-graders at IN-Tech Academy in the Bronx, said he would rather stay with distance learning than go into the classroom because it would be hard to prevent infections from entering a large school like his, with more than 1,000 students. He said the school should shut down if a single case pops up, and he trusts his administration and staff to handle any infections responsibly, but “prevention is better than cure.”
- Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security who helped develop a school reopening report for the National Academies of Sciences, Engineering, and Medicine, said it didn’t specify triggers for closure because so much depends on the context. That includes illness rates, a community’s risk tolerance, its ability to test a wide swath of students and staff quickly, and its public health system’s capacity.
- Districts need to have contingency plans ironed out well before school starts, Ms. Rivers said. “It’s important for parent confidence to show these issues have been given due consideration,” she said.
3. More Than 6,600 Coronavirus Cases Have Been Linked to U.S. Colleges
- As college students and professors decide whether to head back to class, and as universities weigh how and whether to reopen, the coronavirus is already on campus.
- A New York Times survey of every public four-year college in the country, as well as every private institution that competes in Division I sports or is a member of an elite group of research universities, revealed at least 6,600 cases tied to about 270 colleges over the course of the pandemic. And the new academic year has not even begun at most schools.
- Outbreaks have emerged on Greek Row this summer at the University of Washington, where at least 136 residents were infected, and at Harris-Stowe State University in St. Louis, where administrators were re-evaluating their plans for fall after eight administrative workers tested positive.
- The virus has turned up in a science building at Western Carolina, on the football team at Clemson and among employees at the University of Denver.
- At Appalachian State in North Carolina, at least 41 construction workers have tested positive while working on campus buildings.
- The Times has identified at least 14 coronavirus-related deaths at colleges [NOTE: 14 deaths equates to a case fatality rate of 0.21%. According to Our World in Data, the CFR for the US is currently at 3.4%].
Search for a school
- The list includes public, four-year universities in the United States, as well as private colleges that compete in Division I sports or are members of an elite group of research universities. Only schools that reported cases are shown. A list of the top schools reporting cases is shown below.
- Note: The charts show the cases per 100,000 residents reported each week in the county where each school is located. The location of a university’s main campus is listed unless otherwise specified. In several instances, colleges noted that some cases were tied to branch campuses or satellite locations. Universities with no case total listed either did not respond to inquiries, declined to provide information or said they had no known infections.
- There is no standardized reporting method for coronavirus cases and deaths at colleges, and the information is not being publicly tracked at a national level. Of nearly 1,000 institutions contacted by The Times, some had already posted case information online, some provided full or partial numbers and others refused to answer basic questions, citing privacy concerns. Hundreds of colleges did not respond at all.
- Still, the Times survey represents the most comprehensive look at the toll the virus has already taken on the country’s colleges and universities.
- Coronavirus infections on campuses might go unnoticed if not for reporting by academic institutions themselves because they do not always show up in official state or countywide tallies, which generally exclude people who have permanent addresses elsewhere, as students often do.
- The Times survey included four-year public schools in the United States, some of which are subject to public records laws, that are members of the Association of American Universities or that compete at the highest level of college sports. It has not yet expanded to include hundreds of other institutions, including most private schools and community colleges, where students, faculty and staff are struggling with the same difficult decisions.
- Among the colleges that provided information, many offered no details about who contracted the virus, when they became ill or whether a case was connected to a larger outbreak. It is possible that some of the cases were identified months ago, in the early days of the outbreak in the United States before in-person learning was cut short, and that others involved students and employees who had not been on campus recently.
Return to Campus
- This data, which is almost certainly an undercount, shows the risks colleges face as they prepare for a school year in the midst of a pandemic. But because universities vary widely in size, and because some refused to provide information, comparing case totals from campus to campus may not provide a full picture of the relative risk.
- What is clear is that despite months of planning for a safe return to class, and despite drastic changes to campus life, the virus is already spreading widely at universities.
- Some institutions, like the California State University system, have moved most fall classes online. Others, including those in the Patriot League and Ivy League, have decided to not hold fall sports. But many institutions still plan to welcome freshmen to campus in the coming days, to hold in-person classes and to host sporting events.
Plans for fall instruction
- The chart shows how schools with reported coronavirus cases plan to offer instruction for the fall semester, according to a database from Davidson College.
- At the University of Texas at Austin, where more than 440 students and employees have tested positive since the spring, in-person classes will be capped at 40% of capacity and final exams will be taken online.
- At Peru State College in Nebraska, where there have been no known cases, classes are expected to resume on schedule, but with stepped-up cleaning procedures and a recommendation for dorm residents to wear masks in common areas.
- The University of Georgia has announced plans for in-person classes despite rising deaths from the virus in the state. The university has recorded at least 390 infections involving students, faculty and staff.
- O’Bryan Moore, a senior at the school, said he was worried about the safety of his classmates and teachers. He said he was skeptical that students would widely follow guidelines to wear masks once they return in August.
- “There is no way I can see this ending without outbreaks on campus,” said Mr. Moore, who is studying to become a park ranger.
- Mr. Moore said that online classes have not been as effective as in-person classes, but that he still hoped the university would change its plans for students to return to campus.
- “I think we should remain online for this semester, even if it’ll hurt my education,” he said. “Because it’s the right thing to do.”
- Case numbers may be larger at some universities with tens of thousands of students, including Central Florida and the University of Texas at Austin, and at others where many university employees work in hospitals where coronavirus patients have been treated, including at the University of Texas Southwestern Medical Center.
- Though hundreds of universities responded to The Times’s request for data — including a mix of public and private colleges, both small and large, in states across the country — others declined to cooperate. Some said they were not tracking such cases. Others invoked privacy concerns, even though The Times asked for aggregate case totals, not a list of individuals who were infected. Others did not respond at all.
- A spokesman at Arizona State, for example, said they “chose months ago to not release data/names/results” on coronavirus cases. A spokesman for Montana State University said the school “does not provide health information on its students, faculty or staff, even on general subgroups.” The United States Naval Academy cited “operational security” concerns. A spokeswoman for Washburn University in Kansas said she believed giving such information would violate privacy laws. And while the University of Missouri’s athletic department confirmed 10 cases, a spokesman at the flagship campus would not provide information about other students and employees.
- As students have started trickling back onto campuses in recent weeks, the early returns have been troubling. After 10 students tested positive this month at West Virginia University, officials pledged to deep-clean the places on campus where they had been. At Kansas State University, off-season football workouts were paused last month after an outbreak on the team.
Athletic Departments at High Risk
- Many of the first arrivals on campus have been athletes hoping to compete this fall. A separate Times survey of the 130 universities that compete at the highest level of Division I football revealed more than 630 cases on 68 campuses among athletes, coaches and other employees.
- As universities make plans for the fall semester — online, in person, or a mix of the two — administrators have had to weigh shifting public health guidance and financial and academic concerns, as well as the difficult reality that some students and faculty members are likely to test positive no matter how classes are held.
- “There is simply no way to completely eliminate risk, whether we are in-person or online,” Martha E. Pollack, the president of Cornell, wrote in a letter explaining the decision to bring students back to campus.
- The college case data is current as of July 28. It is based on reports from colleges and government sources and may lag. Colleges and government agencies report this data differently, so exercise caution when comparing institutions. Some colleges declined to provide data or did not respond to inquiries. At some institutions, cases may be spread across multiple campuses.
- Sources: Case data from a New York Times database of state and local reports; school logos from Clearbit and ESPN.
H. Different Views
1. Dutch Government Won’t Use Mask Mandate; ‘No Proven Effectiveness’
- The Dutch government on Wednesday advised the public that there will be no mask mandate to slow the spread of coronavirus, stating that their effectiveness remains unproven.
- The Minister for Medical Care Tamara van Ark made the decision after a review by the country’s National Institute for Health (RIVM).
- Instead the official advice is for better adherence to social distancing rules after a surge in coronavirus cases over the past seven days, Van Ark said at a press conference in The Hague, Reuters reports.
- “Because from a medical perspective there is no proven effectiveness of masks, the Cabinet has decided that there will be no national obligation for wearing non-medical masks” Van Ark said.
- RIVM chief Jaap van Dissel cited studies that show masks help slow the spread of disease but remained unconvinced they will do anything to counter coronavirus outbreak in the Netherlands.
- He argued wearing masks incorrectly, together with worse adherence to social distancing rules, could increase the risk of transmitting the disease.
- “So we think that if you’re going to use masks (in a public setting) … then you must give good training for it,” he said.
- The decision followed a meeting of health and government officials after new coronavirus cases in the country rose to 1,329 in the past week, an increase of more than a third. The case level has since flattened out.
- As Breitbart News reported, the Dutch have taken a different path in their reaction to the global pandemic almost from the first moment it was discovered.
- Shops have remained open and families cycle along in the sunny summer weather in the Netherlands, which has opted for what it calls an “intelligent lockdown” to meet the coronavirus threat.
- In contrast to most other European countries where people were ordered to remain housebound for months at a time, the Dutch authorities merely advised people to stay home if possible and to keep 1.5 metres (five feet) of social distance.
- The Dutch position — very similar to Sweden’s — also reflects a wider philosophical split in both Europe and the world on how to balance the need to curb the disease against the catastrophic economic and broader societal damage caused by harsh lockdowns.
- The World Health Organization (WHO) has said that wearing masks isn’t enough to protect a person from the virus. Nonetheless, WHO recommends that masks be worn in the following 3 situations:
- “In areas with widespread transmission, the WHO advises medical masks for all people working in clinical areas of a health facility, not only workers dealing with patients with C19,” Tedros said, according to CNN.
- “Second, in areas with community transmission, we advise that people aged 60 years or over, or those with underlying conditions, should wear a medical mask in situations where physical distancing is not possible,” Tedros said.
- Third, he said, “WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments.”
I. Projections & Our (Possible) Future
1. The COVID Crisis Probably Peaked Two Weeks Ago
- On Wednesday, Florida reported a record high 216 deaths and “the grim news comes a day after the state set the record with 186 virus-related deaths,” as NBC Miami put it.
- In fact, the record high for the daily number of deaths in the state appears to have been on July 16, when 123 people in the state were known to have died with the disease.
- As of Wednesday night, Florida’s C19 surveillance dashboard showed only 13 deaths on July 28.
- As we have reported in this space before, the press is using daily reports from states to paint a picture of a runaway virus. (See: Florida Is A Case Study In Media-Induced COVID-19 Panic, and The Big Surge In Coronavirus Deaths Is A Media-Fed Myth)
- What the mainstream press keeps forgetting to tell people is that it can take the government days, if not weeks, to record a C19 death. The daily reports aren’t telling us what’s happening now, but what happened earlier in the month. The chart below shows the impact of this. The gray bars represent when deaths are reported by Florida, and the red bars are when the deaths actually occurred.
- Notice that Florida’s daily reports undercounted actual deaths in the first half of July (by more than 400). That’s when most of the deaths being reported now happened.
- If anything, what the numbers show is that the virus peaked in that state around mid-July.
- There’s more evidence that the crisis is already on the downtrend. Hospital admissions in Florida appear to have peaked more than a week ago. AdventHealth Orlando, for example, reports that the C19 patient count was at 515 on July 19, while this Tuesday the hospital had 406 patients with the illness. And the AdventHealth system across the state is also reporting a decline in admissions from the virus since early July.
- These are the facts that DeSantis pointed to when he talked about “positive trends.”
- In other words, while the virus no doubt has had a big impact on Florida, the worst appears to be over. The same holds true in other states that saw a spike in cases starting in June.
- But instead of looking at these facts and what they mean, the press attacked DeSantis, pointedly asking “how he could square his upbeat assessment with the mounting death toll.”
- Let us state what should be obvious but seems to confuse some people: We are not claiming that the coronavirus isn’t a deadly disease, or that it should not be taken seriously. (We do believe, however, the total death count has been exaggerated nationwide because states are counting deaths with C19, not deaths from C19. And the evidence is mounting that the massively expensive lockdowns were ineffective.)
- But if the crisis is passing in states such as Florida, Texas, Arizona and elsewhere, shouldn’t the public know about that? And why are the media acting as though it’s getting worse?
J. Johns Hopkins COVID-19 Update
July 31, 2020
1. Numbers & Trends
- The WHO C19 Situation Report for July 30 reports 16.81 million cases (253,801 new) and 662,095 deaths (5,999 new). The daily incidence is slightly higher than the corresponding day from the previous week.
South & Central America
- Brazil reported 2 of its 4 highest daily incidence over the past 2 days, including a record high of 69,074 new cases on July 29. Following several weeks in which Brazil’s C19 epidemic appeared to be plateauing, Brazil is reporting significantly elevated daily incidence for the second consecutive week. Brazil remains #3 globally in terms of daily incidence but fell slightly further behind India. Broadly, the Central and South American region remains a major C19 hotspot. Colombia reported 3 of its 4 highest daily incidence over the past 3 days, and its epidemic continues to accelerate. Columbia remains #5 globally in terms of daily incidence. Mexico’s average daily incidence remains relatively steady at approximately 6,600 new cases per day, and it 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 (#3), the US (#5), and Colombia (#9)—and numerous other countries in the region are reporting more than 100 new daily cases per million population.
India & Bangladesh
- After approximately a week of relatively consistent reporting, India’s daily incidence has increased each of the past 3 days, including a new record high of 55,078 new cases today. India remains #2 globally in terms of daily incidence. Bangladesh continues to report slowly decreasing daily incidence, and its test positivity appears to be decreasing slightly over the past week. Bangladesh fell out of the top 10 in terms of daily incidence.
- South Africa reported 11,046 new cases yesterday. South Africa remains among the top countries globally in terms of both per capita (#8) and total daily incidence (#4). South Africa has reported decreasing 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, but countries from several other regions are displacing the Eastern Mediterranean in the top 10. The region still includes 2 of the top 10 countries globally—Bahrain (#2) and Oman (#7)—and several other countries are still reporting more than 100 new daily cases per million population. Nearby Israel (#4), in the WHO’s European region, is among the top countries globally as well. Iraq surpassed Bangladesh in terms of total daily incidence to become #10 globally. Numerous other countries in the region are reporting more than 1,000 new cases per day.
- Montenegro remains in the the global top 10 in terms of per capita daily incidence at #6, and the Maldives climbed to #10, with more than 160 new cases per day per million population.
- The US CDC reported 4.41 million total cases (65,935 new) and 150,283 deaths (1,417 new). The US once again reported more than 1,000 new deaths—now 7 of the past 9 days—and surpassed 150,000 cumulative deaths. The 1,417 deaths is the highest daily total since May 28. California is reporting more than 475,000 cases; Florida, New York, and Texas are reporting more than 400,000; and 10 additional states (increase of 2) are reporting more than 100,000. Additionally, California has surpassed Massachusetts as #3 nationally in terms of C19 deaths; Florida and Texas are #8 and #9, respectively. The US climbed to #5 globally in terms of per capita daily incidence, but it remains #1 in terms of total daily incidence.
- With more than 150,000 cumulative C19 deaths, the US leads the world. The US has reported more than 3 times as many deaths as every country except Brazil. The US represents 22.5% of the global C19 deaths—and 26% of the global cases—despite accounting for only 4.3% of the global population. The US is #9 globally in terms of per capita cumulative deaths—but will likely surpass France as #8 in the coming days.
- The Johns Hopkins CSSE dashboard reported 4.50 million US cases and 152,074 deaths as of 10:30am on July 31.
2. US Schools, Colleges & Universities
- Schools across the country are preparing for the start of the upcoming school year, whether they intend to hold in-person classes, remote classes only, or a hybrid option. A study conducted by The New York Times found that at least 6,600 C19 cases have been linked to colleges and universities across the US, despite most schools suspending in-person in the spring. In total, 12 schools reported at least 100 cases, including among students and staff. The data was collected as part of a nationwide survey and was then combined with other sources to conduct further analysis, including with respect to schools’ plans to resume classes this fall. Participating schools represent a spectrum of plans for fall classes, ranging from wholly or principally in-person classes to entirely online or remote classes. Notably, each of these categories included schools with low reported incidence and schools with high incidence. A number of schools declined to participate in the study for a variety of reasons, including concerns over student privacy with respect to sharing health information and simply not tracking or reporting C19 cases at all. The article also notes that student athletes, particularly (American) football players, are among the first students to return to campus as they begin preparations for seasons scheduled to begin in a few weeks. A separate study of NCAA Division I college football teams identified at least 630 C19 cases among players, coaches, and other personnel at 68 different schools.
- Researchers from Cincinnati, Ohio (US), published their findings regarding the impact of school closures on C19 incidence and mortality in the US. The study, published in JAMA, found that the timing of US school closures was associated with magnitude of declines in C19 incidence and mortality. Schools in all US states were closed in March, and the researchers evaluated the timing of these decisions, relative to the per capita C19 incidence in the state at the time schools were closed, to the reported incidence and mortality during the following several weeks. The researchers found that states that closed schools earlier (ie, when C19 incidence was lower) experienced greater decline in C19 incidence and mortality than those that closed schools later in their epidemic (ie, when C19 was higher). In light of the timing of school closures with respect to other social distancing policies and the complex interaction between these policies, the researchers attempted to adjust for the effects of other policies, testing capacity, nursing home population, and a variety of other factors in order to better isolate the effects of school closures. They estimate that school closures could have prevented 1.37 million cases over a period of 26 days and 40,600 deaths over a period of 16 days.
- Due to the inherent risk associated with holding in-person classes, many schools are evaluating remote/online classes to enable students to continue their education. Some educators are working to improve the quality of remote learning. Many teachers in the US and elsewhere were forced to shift their classes online in the spring, largely without plans in place to do so effectively. Teachers across the US are working to develop best practices and new online platforms to support students in anticipation of the need for remote classes this fall. For example, live instruction may be engaging for students, but it may not be ideal for all students, especially if they are sharing computers or other devices with siblings. Remote classes may not be ideal for many students, particularly those without reliable access to the internet or computers and those whose parents need to remain home rather than return to work, but incorporating lessons and best practices can help mitigate some disadvantages of suspending in-person classes.
3. Coronavirus Viral Load
- Researchers have been attempting to understand the dynamics between viral load and transmissibility since the beginning of the pandemic. Conflicting data, however, have made it difficult to discern key characteristics such as the duration and levels that SARS-CoV-2 can persist in the body and their relationship to the infectious period. In a preprint meta-analysis study, authors from several medical schools and hospitals in the UK and Italy reviewed 79 studies on coronaviruses—specifically, SARS-CoV-2, SARS-CoV-2, and MERS-CoV—that address viral load kinetics in humans. The studies indicate that, while viral RNA can persist in and be shed from the body for long periods of time (more than 80 days in some cases), SARS-CoV-2 only remains viable and infectious for approximately one week after the onset of symptoms. Viral load was at its highest approximately 3-5 days after the onset of symptoms, and there was a positive correlation between prolonged viral shedding and disease severity. Older patients also experienced prolonged viral shedding compared to younger patients, even when accounting for disease severity. While there are fewer studies on the kinetics of viral load for asymptomatic infections, viral shedding appeared to be of a shorter duration, and overall viral load appeared to be lower compared to symptomatic cases. The authors conclude that PCR testing is likely not a good tool for evaluating patient recovery, because viral RNA is detectable long after the end of the infectious period. The authors also emphasize that early case detection and isolation should be prioritized in order to maximize control efforts during the time when patients are the most infectious.
- At #2 globally in terms of cumulative C19 incidence, cumulative deaths, and daily deaths and #3 in terms of daily incidence, Brazil continues to struggle to control its C19 epidemic amid conflicting strategies from President Jair Bolsonaro, regional governors, and public health authorities. President Bolsonaro recently recovered from C19, but he has now reported a lung infection that he describes as “mold in [the] lungs” that he claims he caught while in isolation. His wife, First Lady Michelle Bolsonaro, was also recently diagnosed with C19 and is currently being treated.
- President Bolsonaro credits his recovery to hydroxychloroquine, despite continued evidence that the drug is not an effective treatment, and his continued praise of hydroxychloroquine as a treatment for C19 has been credited for widespread use of the drug in Brazil. For example, a recent survey found that 50% of doctors in the state of São Paulo reportedly felt pressured to prescribe the drug to patients. Additionally, mask wearing remains highly variable among the Brazilian populace, especially in the hard-to-reach interior of the country, which is likely contributing to continued transmission. While deaths and incidence are beginning to slow in highly populated areas, deaths in interior states are starting to increase. These states have relatively little public health or healthcare infrastructure, including few intensive care hospital beds and poor access to oxygen supplies to treat C19 patients.
- Notably, Brazil will participate in two Phase 3 vaccine trials, one involving the Oxford/AstraZeneca vaccine (UK) and one for the Sinovac vaccine (China). Experts say that Brazil’s unique mix of high community transmission and strong scientific institutions make Brazil an ideal study population for candidate C19 drugs. As part of its participation in these trials, Brazil expects to be able to manufacture any vaccines that prove to be effective, which would provide a major benefit in terms of securing access, particularly when initial supplies are limited.
5. Global Vaccine Allocation
- As we look ahead to a future SARS-CoV-2 vaccine—whether later this year, sometime in 2021, or beyond—governments and experts are developing models and principles for equitably and effectively distributing the vaccine to populations around the world. Many experts argue that the most effective use of a vaccine, particularly in the early stages of production when supply is limited, is to prioritize those in the greatest need. Priority populations would include healthcare workers, individuals at elevated risk for severe disease and death, and areas with high levels of community transmission in order to have the largest impact on slowing the spread of the pandemic and reducing mortality. The WHO and other international groups, such as CEPI and GAVI, have established the C19 Vaccines Global Access (COVAX) Facility to encourage and coordinate donations from high-income countries in order to support the distribution of vaccine doses to lower-income countries. Low- and middle-income countries (LMICs) may not be able to purchase sufficient vaccine on their own or compete against wealthier countries to secure access to early doses without external support. Several countries—including the US, UK, and EU—have already contracted directly with pharmaceutical companies to guarantee priority access to early doses. If early vaccine access is limited to high-income countries, it could enable the pandemic to continue devastating LMICs, many of which do not have sufficient public health and healthcare infrastructure to combat health emergencies like C19. International coordination and commitment are needed to ensure that a future vaccine is allocated in a manner that enables it to make the greatest impact.
6. Economic Impact
- The US GDP fell by 9.5% in the second quarter, the worst economic quarter in US history, including the Great Depression. Extrapolated out, this would correspond to a 32.9% decrease in GDP over a full year. While this is severe, it is actually slightly better than 34.7% projection. Consumer spending sharply decreased and supply chains were severely stressed due to C19 and associated social distancing restrictions, including including the closure of many non-essential businesses.
- Last week, 1.43 million Americans filed new unemployment claims, the second consecutive week of increasing new claims following several weeks of consistent decreases. Federal Reserve Chair Jerome Powell stated that emergency funding federal, including under C19 stimulus packages, has successfully kept people in their homes and businesses operating; however, both federal eviction protections and expanded unemployment payments from the previous stimulus package expire this weekend, and Congress has not finalized negotiations for a Phase 5 funding package. Some parts of the US economy are showing signs of a slow recovery, but recent surges in C19 incidence and mortality in some parts of the country have resulted in some states re-instituting various social distancing restrictions, which could hinder economic recovery in the third quarter and beyond.
7. US C19 Reporting
- A private company, TeleTracking, has been responsible for collecting data for the US Department of Health and Human Services (HHS) since April. The agreement has come under increased scrutiny after a directive issued earlier this month that compels hospitals to report important C19 data to HHS through TeleTracking rather than through the longstanding CDC reporting system, the National Health Safety Network. Proponents of the new system have noted that the CDC system was optimized for other diseases, such as pneumonia and other hospital acquired infections, but the new HHS system is specifically designed for C19 in hospitals, which could better serve the data needs for the ongoing response. Critics, however, have voiced concerns that reporting critical data, such as personal protective equipment (PPE) and hospital bed use and availability, to HHS rather than CDC could reduce transparency and access to data. Additionally, hospitals had only a few days to make the transition, which could introduce reporting delays that could impact response operations. Some have also noted that the new requirements for reporting are potentially even more labor intensive and cumbersome for hospitals, despite being designed to streamline the reporting process.
8. US Sports
- Sporting events have already resumed in a number of countries around the world, but the scale of the US epidemic could pose extra challenges as professional sports leagues in the US resume play. The National Women’s Soccer League (NWSL) completed its Challenge Cup tournament with zero reported C19 cases. The league implemented a “bubble” for players, coaches, and other personnel before and during the competition and conducted regular testing (more than 2,000 total tests over the course of the tournament). All games were played at a single site outside Salt Lake City, Utah, over a month-long period. Notably, the Orlando Pride withdrew from the tournament before it started due to at least 10 positive SARS-CoV-2 tests among players and coaching staff.
- The National Hockey League (NHL) is taking a similar approach to salvage its suspended 2019-20 season. The league decided to forgo the remainder of the regular season after it was suspended in March and, instead, resume play with a modified Stanley Cup Playoffs. Teams are playing in 2 “bubble cities” in Canada, one each for the Eastern and Western Conference. Warmup games took place earlier this week, and the opening round of the playoffs begins tomorrow. The NBA also established a bubble at the Disney/ESPN sports complex in Orlando, Florida, to hold a modified playoff tournament, which began yesterday.
- Major League Baseball (MLB) began a shortened season last week, attempting to resume a more traditional schedule, with most games to be played in teams’ home cities. Notable exceptions include the Toronto Blue Jays, who will play all of their games in the US due to travel restrictions between the US and Canada. Less than 2 weeks into the season, an outbreak of at least 17 cases associated with the Miami Marlins has resulted in games for several teams being suspended. Following the outbreak, MLB leadership implemented new C19 policies, including compliance officers for each team to ensure players and staff adhere to the league’s C19 protocols.
- Several other professional sports leagues have also been competing this summer, including NASCAR (auto racing) and the PGA Tour (golf); however, as individual sports, they offer better opportunity to maintain physical and social distancing during play than most team sports. Unlike most other sports, NASCAR has begun to permit fans to attend races, although not at full capacity. The US Golf Association (USGA) announced that the upcoming US Open tournament, one of golf’s 4 major tournaments (and one of only 3 to be played this year), will be held without spectators. Athletes and other personnel associated with both leagues have tested positive for SARS-CoV-2.
- A number of NFL (American football) players have “opted out” of playing in the upcoming season due to C19 concerns. The NFL C19 policy allows players to sit out this season but still receive some pay, even without playing any games. Players determined to be at high risk for severe C19 disease (eg, due to underlying health conditions) can receive US$350,000 for the season, and other players can receive US$150,000.