Recent Developments & Headlines
August 27, 2020
“I think that in the coming days that we will see other similar stories. These could be exceptions, but do exist. It’s not good news.”Marc Van Ranst, a Belgian virologist, commenting on confirmation of C19 reinfections
“That someone would pop up with a reinfection, it doesn’t make me nervous. We have to see whether it happens often.”Marion Koopmans, virologist and adviser to the Dutch government
“It’s absolutely vital that pupils get back into school in September,” Johnson said. “It’s vital for their education, its vital for their welfare, it’s vital for their physical and indeed their mental welfare. We have a moral duty to reopen.”Boris Johnson, UK Prime Minister
”I just want to say thank you so very much for making this newsletter available on an ongoing basis. It has been the most comprehensive, least biased way that I know to access information related to Covid 19. I really appreciate your kindness and generosity in sharing this.”Lauren, Coronavirus Update Reader
1. Cases & Tests
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity
4. Case Fatality Rates
5. First Peak vs. Second Peak
K. Links to Other Stories
- A dilemma for ‘long-haulers’: Many can’t prove they ever had C19 As the coronavirus pandemic rolls on, an unknown number of seemingly recovered patients are experiencing what is being called post-Covid syndrome — weeks or months of profound fatigue, fevers, problems with concentration and memory, dizzy spells, hair loss, and many other troubling symptoms. Among these “long-haulers,” as they have become known, a significant number face a very specific challenge: convincing others they had C19 in the first place.
- The coronavirus may shut down the immune system’s vital classrooms In many infections, the immune system builds so-called germinal centers (yellow-brown rings inside the blue) in the spleen or lymph nodes to train cells that make antibodies, but the structures fail to develop in some C19 cases.
- EPA approves a virus-killing coating for American Airlines, studies use by schools The U.S. Environmental Protection Agency said on Monday it has granted emergency approval for American Airlines to use a disinfectant against the coronavirus on certain surfaces that lasts for up to seven days, and is studying whether it could be effective in places like schools.
- How Do You Play Soccer in a Pandemic? Human Foosball Argentines adapt the table-top game popular in bars for the field. “It’s better than not playing.”
- Covid Malaise Poses Economic Drag Long After Virus Abates It’s now known that C19 will leave a portion of the more than 23 million people it’s infected with a litany of physical, cognitive and psychological impairments, like scarred lungs, post-viral fatigue and chronic heart damage. What’s still emerging is the extent to which the enduring disability will weigh on health systems and the labor force. That burden may continue the pandemic’s economic legacy for generations, adding to its unprecedented global cost — predicted by Australian National University scholars to reach as much $35.3 trillion through 2025 as countries try to stop the virus’s spread.
- Why Boys Might Be Weathering the Pandemic Better Than Girls Videogame-playing has soared during the C19 pandemic, fueled largely by boys who socialize while they play—but how much is too much?
- Non-woven masks better to stop C19, says Japanese supercomputer Face masks made from non-woven fabric are more effective at blocking the spread of Covid-19 via airborne respiratory droplets than other types that are commonly available, according to modelling in Japan by the world’s fastest supercomputer. Fugaku, which can perform more than 415 quadrillion computations a second, conducted simulations involving three types of mask, and found that non-woven masks were better than those made of cotton and polyester at blocking spray emitted when the wearer coughs.
- Air Quality Is Safety Focus for New York’s Schools The Department of Education said it has deployed teams to inspect ventilation systems, fans and windows in schools and will post results by Sept. 4.Nanobodies Poised to Revolutionize Antibody Therapeutics Single-domain antibodies, or nanobodies, have recently been thrust into the spotlight as a potential treatment for C19. In fact, a C19 nanobody-based treatment developed by the Beroni Group, an Australian biotechnology company, is currently in preclinical testing. Even though nanobodies are only beginning to realize their therapeutic potential, they have been studied for decades.
A. The Pandemic As Seen Through Headlines
(In no particular order)
- CDC Now Says People Without Covid-19 Symptoms Do Not Need Testing
- A CDC recommendation to test fewer people for the virus raises concerns
- Dr. Fauci concerned new CDC guidelines are being misinterpreted and will give people wrong impression that asymptomatic spread is not a big concern when in fact it is
- Dr. Fauci says rushing out a vaccine could jeopardize testing of others
- FDA approves a compact virus test that gives results in 15 minutes
- FDA chief clarifies remarks about convalescent blood plasma as COVID-19 treatment following criticism
- HHS Azar rejects claims Trump pressured FDA to approve convalescent plasma coronavirus treatment
- New coronavirus cases declining in US, experts credit masks in drop
- GOP Senators Demand FDA Explain Hydroxychloroquine Stance Amid Positive Studies And Physician Advocates
- ‘Half-masking’ may increase coronavirus risk, study finds
- Scientists find that Citriodiol, ingredient in insect repellent, can kill COVID-19
- US Department of Justice probes nursing home deaths in 4 states — including in NY
- Virginia governor’s office downplays vaccine mandate but leaves door open for one
- Al Gore: Burning Fossil Fuels ‘a Precondition for Higher Death Rates from COVID-19’
- UK Prime Minister Boris Johnson: It would be “clearly nonsensical” for students to wear face masks in class
- Long shielded by geography, U.S. islands see cases grow
- At U.S.C., classes are online, but university officials report an ‘alarming increase’ in cases anyway
- A New York Times survey found more than 26,000 cases at more than 750 American colleges and universities over the course of the pandemic
- New York City stopped more than 3,000 vehicles entering the city as part of a move to promote compliance with the state’s 14-day quarantine requirement for many travelers
- NYC’s subway and bus service would be reduced by 40% without federal aid, Metropolitan Transportation Authority warns
- NJ indoor dining and cinemas could resume before mid-September
- New Mexico will allow indoor dining to resume on Saturday at restaurants, bars and similar establishments, at 25% of normal capacity
- NM to allow houses of worship to operate at 40% of capacity, up from 25% now
- A cluster of cases in rural Maine that has been linked to a wedding reception
- Trump blasts Biden over the idea of locking down country again: ‘That’s crazy!’
- As Hurricane Laura slams the U.S., evacuation shelters adjust for the virus
- California makes a deal to more than double testing capacity and get results faster
- Young people are the worst COVID-19 ‘superspreaders’
- Florida reports 9,000 new cases in kids since schools reopened
- Italy sees largest virus toll in 3 months
- Delhi outbreak worsens
- Myanmar suffers record jump as Muslim minority bears brunt
- Myanmar shuts schools after huge spike in coronavirus cases
- Kenya’s president extends a nationwide 9 p.m. curfew for another 30 days.
- India on Thursday surpassed 60,000 deaths and reported 75,760 new cases, its highest daily increase so far.
- For the first time in three months, virus infections in South Africa have fallen below 2,000 per day
- Local authorities have tightened restrictions in Marseille, the second-largest city in France, where the per capita rate of cases is more than four times the national rate
- Almost 500 million schoolchildren have been cut off from learning, a report finds
- ‘Every day is Friday’ mentality during coronavirus lockdowns contributed to increase in alcoholism in the UK, doctor says
- New Hampshire coronavirus restaurant restriction lifted, allowing them to operate at full capacity
- Texas college holds class in parking lot
- ‘I’m paying the price’: Man who thought COVID-19 was hoax loses wife to it
- Economic Rebound Defies U.S. Benefit Cuts and Broadly Holds On
- Day Trips Instead of Destinations: Tourist Hot Spots Brace for Lean Years
- Stress headaches surge during COVID lockdowns, research shows
- Vatican announced that, starting next month, Pope Francis would resume his weekly Wednesday audience in public
- Australian woman gets 6 months in jail for breaking COVID-19 quarantine order
- Google searches for ‘panic attack,’ ‘anxiety attack’ hit all-time high amid coronavirus
- CDC warns workers to avoid arguing with anti-mask customers
- Roku and Netflix surge more than 11 percent after upbeat analyst reports
- MLB proposing bubble-like environments for postseason
- Airbnb says employees can work from home until August 2021
- Dick Sporting Goods sales jump more than 20% on COVID-19 fitness craze
- Researchers say Biogen conference led to 20,000 COVID-19 cases in Boston area
- NYC banquet halls hosting large weddings despite COVID-19 ban
- Illinois mandates masks at bars and restaurants when interacting with staff
- As Summer Wanes in N.Y.C., Anxiety Rises Over What Fall May Bring
- Jail time or a $569,000 fine: The price of breaking quarantine can be steep
- Americans are starting to get sick of cooking at home
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day.
1. Cases & Tests
- Total Cases = 24,323,789 (+1.1%)
- New Cases = 272,519 (+24,121) (+9.7%)
- New Cases (7 day average) = 248,624 (+51) (+0.2%)
- 7 day average of new cases has plateaued during the last 5 days
- Almost 1,000,000 cases every 4 days (based on 7 day average)
US Cases & Testing:
- Total Cases = 6,000,365 (+0.8%)
- New Cases = 44,637 (+4,539) (+11.3%)
- Percentage of New Global Cases = 16.4%
- New Cases (7 day average) = 42,658 (-47) (-0.9%)
- Total Number of Tests = 78,632,566
- Percentage of positive tests (7 day average) = 5.8%
- 7 day average of new case has been generally declining since 7/25, but the decline has slowed down during the last 3 days
- 7 day average of the percentage of positive tests continues to decline, but there are some hotspots (for example, 7 day average of Mississippi and South Dakota are in excess of 20%)
- Total Deaths = 828,906 (+0.8%)
- New Deaths = 6,338 (+344) (+5.7%)
- New Deaths (7 day average) = 5,527 (-52) (-0.9%)
- 7 day average of new deaths has been trending slightly lower since 8/13
- 7 day average of new deaths has decreased from 5,891 on 8/13 to 5,527 on 8/26, a decline of 6.2%
- Total Deaths = 183,653 (+0.7%)
- New Deaths = 1,289 (+39) (+3.1%)
- Percentage of Global New Deaths = 20.3%
- New Deaths (7 day average) = 966 (-14) (-1.4%)
- 2nd peak occurred on 8/4
- 7 day average of new deaths has declined 17.9% since 2nd peak
- 7 day average of new deaths has been steadily declining since 2nd peak
- 7 day average of new deaths has been less than 1,000 for 4 consecutive days
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (8/26)
Current Positivity v Peak Case Day Positivity
- The percentage of positive tests continue to decline in the sunbelt “hotspot” states
|State||Current Positivity||Peak Positivity||Peak Case Day|
Note: Positivity measured as the percentage of daily positive tests of daily total tests. Percentages are based on 7-day averages.
Source: Worldometer and The Covid Tracking Project
4. Comparison of Case Fatality Rates
- Average Global Case Fatality Rate is 3.4%
- US Case Fatality Rate is 3.1%
- In addition to being lower than the average global case fatality rate, the US case fatality rate is lower than Europe, Sweden, Canada, UK and Italy, among others
5. First Peak vs. Second Peak
- New cases have been declining since late July
- New deaths have been declining since early August
- At the 1st peak, the fatality rate was approx. 6.7% of confirmed cases
- At the 2nd peak, the fatality rate as approx. 1.7% of confirmed cases, a decrease in the fatality rate of 74.6%
- If there are 10 unconfirmed cases for every confirmed case as has been estimated by the CDC, then the current fatality rate is approx. 0.15% (the flu fatality rate is approx. 0.1%)
C. New Scientific Findings & Research
1. Risk of Death Is 30% Lower for C19 Patients Treated With Hydroxychloroquine
- An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic. The research, conducted on 3,451 patients treated in 33 hospitals throughout the Italian territory (list of participating centers attached), shows that the use of this drug reduces by 30% the risk of death in hospitalized patients affected by C19.
- Published in the European Journal of Internal Medicine, the study was coordinated by the Department of Epidemiology and Prevention of the I.R.C.C.S. Neuromed, Pozzilli, in collaboration with Mediterranea Cardiocentro, Naples, and the University of Pisa, with the participation of 33 hospitals forming the CORIST collaboration (C19 RISk and Treatments). Researchers analyzed data regarding current and previous diseases, therapies followed before the infection and drugs administered in the hospital specifically for the treatment of C19. All this information was compared with the evolution and the final in-hospital outcome of the infection.
- “We observed — explains Augusto Di Castelnuovo, epidemiologist at the Neuromed Department of Epidemiology and Prevention, currently at Mediterranea Cardiocentro in Naples — that patients treated with hydroxychloroquine had a 30% lower in-hospital mortality rate compared to those not receiving this treatment.”
- “Our data were subjected to extremely rigorous statistical analysis, taking into account all the variables and possible confounding factors that could come into play. The drug efficacy was evaluated in various subgroups of patients. The positive results of hydroxychloroquine treatment remained unchanged, especially in those patients showing a more evident inflammatory state at the moment of admission to hospital.”
- “While waiting for a vaccine — says Licia Iacoviello, Director of the Department of Epidemiology and Prevention at Neuromed and professor of Public Health at the University of Insubria at Varese — identifying effective therapies against C19 is an absolute priority. We hope that our research will make an important contribution to the international debate on the role of hydroxychloroquine in the treatment of hospitalized patients for coronavirus. Further observational studies and ongoing clinical trials will of course be needed to better assess the role of this drug and the most appropriate administration methods. However, data from the CORIST collaboration support the use of hydroxychloroquine. At variance with some studies carried out in other Countries, where efficacy of the drug was not observed, it is interesting to note that the doses of hydroxychloroquine adopted in Italy (200 mg, twice a day) are lower than the ones used in those researches.”
- “In past months — comments Giovanni de Gaetano, President of Neuromed — the World Health Organization recommended a stop to the use of hydroxychloroquine on the basis of an international observational study, subsequently retracted.
- Now the new data from the CORIST study, resulting from a ‘real life’ national collaboration, might help Health Authorities better clarify the role of this drug in the treatment of C19 patients.”
Note: For additional information on hydroxychloroquine studies, see c19study.com (to date, there have been 82 studies, 47 of which have been peer reviewed.
2. Social vulnerabilities and increased C19 infection vary among US counties
- A new study confirms that social vulnerability is associated with increased prevalence of C19 infection in the United States.
- However, the specific vulnerability factors most important in predicting infection — minority status and language, household composition and disability, and transportation and housing — vary among regions and counties. For example, in the Pacific Northwest, minority status and language and household composition and disability were more predictive of C19 case counts. In the Gulf Coast states, housing and transportation were more predictive.
- Lead investigator Ibraheem M. Karaye, MD, DrPH, Epidemiology Program, University of Delaware, Newark, DE, USA, explains, “In the US, social vulnerability to C19 is highly ‘local,’ so while a coordinated Federal response is needed to control C19 nationally, local jurisdictions should, where possible given limited funding and staff, address specific vulnerable groups with interventions designed to mitigate the spread of the pandemic.”
3. Additional C19 reinfections reported in the Netherlands, Belgium
- Two coronavirus patients in Europe have been reinfected with C19 in a confirmed development one scientist called “not good news,” according to a report Wednesday.
- One of the patients, from Belgium, suffered mild symptoms after catching C19 in March and then again in June, health officials said Tuesday, according to Sky News.
- A second patient — an older person from the Netherlands with a weakened immune system — was also reinfected, the outlet reported.
- The new cases, confirmed through rigorous genetic testing, revealed a slightly different strain of the virus in both people the second time around, raising concerns among some scientists about immunity.
- “I think that in the coming days that we will see other similar stories. These could be exceptions, but do exist. It’s not good news,” Marc Van Ranst, a Belgian virologist, told local station VRT.
- The new cases come after researchers on Monday revealed a 33-year-old Hong Kong man was the first patient ever confirmed to be reinfected with the coronavirus.
- The man showed mild symptoms after he contracted C19 in March, then tested positive again at an airport this month, according to University of Hong Kong researchers. He had no symptoms the second time.
- Other scientists said the reinfections were “expected” and shouldn’t cause alarm.
- “That someone would pop up with a reinfection, it doesn’t make me nervous,” said virologist Marion Koopmans, who is an adviser to the Dutch government. “We have to see whether it happens often.”
- Little else is known about the names, ages and situations of the patients from the Netherlands and Belgium.
- Reinfection cases reported earlier this year, including ones in South Korea in May, are believed to be a result of false positives during testing. Reported cases in the US, including ones in LA and New Jersey, were not confirmed via genetic testing.
4. Japan researchers say ozone effective in neutralising coronavirus
- Japanese researchers said on Wednesday that low concentrations of ozone can neutralise coronavirus particles, potentially providing a way for hospitals to disinfect examination rooms and waiting areas.
- Scientists at Fujita Health University told a news conference they had proven that ozone gas in concentrations of 0.05 to 0.1 parts per million (ppm), levels considered harmless to humans, could kill the virus.
- The experiment used an ozone generator in a sealed chamber with a sample of coronavirus. The potency of the virus declined by more than 90% when subjected to low level ozone for 10 hours.
- “Transmission of the novel coronavirus may be reduced by continuous, low-concentration ozone treatment, even in environments where people are present, using this kind of system,” said lead researcher Takayuki Murata.
- “We found it to be particularly effective in high-humidity conditions.”
- Ozone, a type of oxygen molecule, is known to inactivate many pathogens, and previously experiments have shown that high concentrations, between 1-6 ppm, were effective against the coronavirus but potentially toxic to humans.
- A recent study at the Georgia Institute of Technology showed that ozone may be effective in disinfecting gowns, goggles and other medical protective equipment.
- Fujita Medical University Hospital, in Aichi prefecture central Japan, has installed ozone generators to reduce infection in waiting areas and patient rooms.
5. Why Does C19 Impact Some Organs But Not Others
- In severe cases of C19, damage can spread beyond the lungs and into other organs, such as the heart, liver, kidney and parts of the neurological system. Beyond these specific sets of organs, however, the virus seems to lack impact.
- Ernesto Estrada, from the University of Zaragoza and Agencia Aragonesa para la Investigación Foundation in Spain, aimed to uncover an explanation as to how it is possible for these damages to propagate selectively rather than affecting the entire body. He discusses his findings in the journal Chaos, from AIP Publishing.
- In order to enter human cells, the coronavirus relies on interactions with an abundant protein called angiotensin-converting enzyme 2.
- “This receptor is ubiquitous in most human organs, such that if the virus is circulating in the body, it can also enter into other organs and affect them,” Estrada said. “However, the virus affects some organs selectively and not all, as expected from these potential mechanisms.”
- Once inside a human cell, the virus’s proteins interact with those in the body, allowing for its effects to cultivate. C19 damages only a subset of organs, signaling to Estrada that there must be a different pathway for its transmission. To uncover a plausible route, he considered the displacements of proteins prevalent in the lungs and how they interact with proteins in other organs.
- “For two proteins to find each other and form an interaction complex, they need to move inside the cell in a subdiffusive way,” Estrada said.
- He described this subdiffusive motion as resembling a drunkard walking on a crowded street. The crowd presents obstacles to the drunkard, stunting displacement and making it difficult to reach the destination.
- Similarly, proteins in a cell face several crowded obstacles they must overcome in order to interact. Adding to the complexity of the process, some proteins exist within the same cell or organ, but others do not.
- Taking these into account, Estrada developed a mathematical model that allowed him to find a group of 59 proteins within the lungs that act as the primary activators affecting other human organs. A chain of interactions, beginning with this set, triggers changes in proteins down the line, ultimately impacting their health.
- “Targeting some of these proteins in the lungs with existing drugs will prevent the perturbation of the proteins expressed in organs other than the lungs, avoiding multiorgan failure, which, in many cases, conduces the death of the patient,” Estrada said.
- How the affected proteins travel between organs remains an open question that Estrada is dedicating for future studies.
6. Comparing the Flow Fields of Coughs With Various C19 Face Masks/Coverings
- Months into the C19 pandemic, wearing a mask while out in public has become the recommended practice. However, many still question the effectiveness of this.
- To allay these doubts, Padmanabha Prasanna Simha, from the Indian Space Research Organisation, and Prasanna Simha Mohan Rao, from the Sri Jayadeva Institute of Cardiovascular Sciences and Research, experimentally visualized the flow fields of coughs under various common mouth covering scenarios. They present their findings in the journal Physics of Fluids, from AIP Publishing.
- “If a person can reduce the extent of how much they contaminate the environment by mitigating the spread, it’s a far better situation for other healthy individuals who may enter places that have such contaminated areas,” Simha said.
- Density and temperature are intricately related, and coughs tend to be warmer than their surrounding area. Tapping into this connection, Simha and Rao utilized a technique called schlieren imaging, which visualizes changes in density, to capture pictures of voluntary coughs from five test subjects. By tracking the motion of a cough over successive images, the team estimated velocity and spread of the expelled droplets.
- Unsurprisingly, they found N95 masks to be the most effective at reducing the horizontal spread of a cough. The N95 masks reduced a cough’s initial velocity by up to a factor of 10 and limit its spread to between 0.1 and 0.25 meters.
- An uncovered cough, in contrast, can travel up to 3 meters, but even a simple disposable mask can bring this all the way down to 0.5 meters.
- “Even if a mask does not filter out all the particles, if we can prevent clouds of such particles from traveling very far, it’s better than not doing anything,” said Simha. “In situations where sophisticated masks are not available, any mask is better than no mask at all for the general public in slowing the spread of infection.”
- Some of the other comparisons, however, were striking.
- For example, using an elbow to cover up a cough is typically considered a good alternative in a pinch, which is contradictory to what the pair found. Unless covered by a sleeve, a bare arm cannot form the proper seal against the nose necessary to obstruct airflow. A cough is then able to leak through any openings and propagate in many directions.
- Simha and Rao hope their findings will put to rest the argument that regular cloth masks are ineffective, but they emphasize that masks must continue to be used in conjunction with social distancing.
- “Adequate distancing is something that must not be ignored, since masks are not foolproof,” Simha said.
7. Genetic data show how a single superspreading event sent coronavirus across Massachusetts — and the nation
- None of the biotech executives at the meeting noticed the uninvited guest. They had flown to Boston from across the globe for the annual leadership meeting of the drug company Biogen, and they were busy catching up with colleagues and hobnobbing with upper management. For two days they shook hands, kissed cheeks, passed each other the salad tongs at the hotel buffet, never realizing that one among their number carried the coronavirus in their lungs.
- By the meeting’s end on Feb. 27, the infection had infiltrated many more people: a research director, a photographer, the general manager for the company’s east division. They took the virus home with them to the Boston suburbs, Indiana and North Carolina, to Slovakia, Australia and Singapore.
- Over the following two weeks, the virus that circulated among conference attendees was implicated in at least 35 new cases. In April, the same distinctive viral sub-strain swirled through two Boston homeless shelters, where it infected 122 residents.
- Scientists know all this thanks to a mistake made during the coronavirus’s replication process — a simple switch of two letters in the virus’s 30,000-character genetic code. This mutation appeared in two elderly patients in France at almost exactly the same time that genetically matching viruses were sickening dozens of people at the Biogen meeting. After the conference, each time the infection spread, the mutation spread with it.
- Now, a sweeping study of nearly 800 coronavirus genomes, conducted by no less than 54 researchers at the Broad Institute, Massachusetts General Hospital, the Massachusetts Department of Public Health and several other institutions in the state, has found that viruses carrying the conference’s characteristic mutation infected hundreds of people in the Boston area, as well as victims from Alaska to Senegal to Luxembourg. As of mid-July, the variant had been found in about one-third of the cases sequenced in Massachusetts and 3 percent of all genomes studied thus far in the United States.
- The study, which was added Tuesday to the preprint website MedRxiv, is probably the largest genomic analysis of any U.S. outbreak so far and is among the most detailed looks at how coronavirus cases exploded in the pandemic’s first wave.
- It documents the cost of the world’s naivete this spring, when people traveling for events like the Biogen conference unwittingly imported the virus into Massachusetts dozens of times. It reveals the connections between seemingly disparate communities, showing how an outbreak at a gathering of wealthy executives was only a few infections removed from sickening some of Boston’s most vulnerable residents. It highlights the outsize role of indoor “superspreading events” in accelerating and sustaining transmission. With genetic data, said co-author Bronwyn MacInnis, “a record of our poor decisions is being captured in a whole new way.”
- Although the study must undergo the rigors of peer review before it is published in a scientific journal, both outside experts and the scientists involved say it shows the power and promise of an emerging field of research known as genomic epidemiology. The small mutations that accumulate in a virus’s genome are like genetic bar codes; by tracking them, researchers can trace infections to their sources and develop more effective interventions to stop the disease.
- “This is the kind of study that … defines why genomics can be so useful in outbreak reconstruction,” said Vaughn Cooper, a microbiologist at the University of Pittsburgh who was not involved in the Boston research. “It reflects a great deal of coordinating work, and that’s what in part makes this so powerful.”
- But if the new research shows the powerful potential of genomic surveillance to unveil the path of the virus through communities, it’s also an exception in terms of the large volume of data it contains. In the United States, such sophisticated genetic tracking has been “patchy, typically passive, reactive, uncoordinated, and underfunded,” experts at the National Academies of Sciences, Engineering and Medicine wrote in a lengthy report last month. Advocates for the cutting-edge technique say more coordinated and comprehensive sequencing efforts could dramatically improve contact tracing and infection control.
- As the nation flounders ahead of a possible second wave of infections, the study serves as both a portent and an opportunity, MacInnis said. The virus’s genome may continue to record the consequences of the nation’s failures — the too-large gatherings and too-fast reopenings, the testing shortages and lack of protective equipment, and the silent spread.
- Or it may answer lingering questions about how the virus is transmitted. It may provide the insights that finally allow workplaces to reopen and schools to safely resume. The virus’s own genetic instruction manual may be “invaluable” for teaching us to control the pandemic, MacInnis said — but only if we are willing to heed its lessons.
The anatomy of an outbreak
- On the day the Biogen meeting was set to begin, 15 cases of C19 had been diagnosed within the United States, nearly all of them among travelers or their close contacts. The Centers for Disease Control and Prevention had just acknowledged an instance of possible “community spread” — an infection without an obvious source. Vice President Pence was to lead a coronavirus task force, and President Trump declared that the risk to Americans was “very low.”
- Just like organizers of Mardi Gras in New Orleans, the Democratic primary in South Carolina, and the U.S. Mixed Doubles Curling Championship in Bemidji, Minn. — all of which were held the same week — those coordinating the Biogen conference saw no reason to change plans.
- In a statement to The Washington Post, a Biogen spokeswoman pointed out that the company was following all U.S. guidelines at the time and notified health officials as soon as it realized attendees had gotten sick.
- “February 2020 was nearly a half year ago, and was a period when general knowledge about the coronavirus was limited,” said Anna Robinson, the company’s head of U.S. media relations. “We never would have knowingly put anyone at risk.”
- Biogen has since announced a collaboration with the Broad Institute and Partners HealthCare to compile biological data that could help battle the disease.
- The analysis of virus sequences shows that the coronavirus was introduced into Boston and its surrounding area more than 80 separate times by international and domestic travelers — most of whom were probably unaware of the germs they carried.
- “We didn’t know better,” said Jacob Lemieux, a physician and infectious-disease expert at Massachusetts General Hospital and lead author of the study. “The difference now is there is increasing scientific evidence to show what can happen from a single event like that. We do know better. So we need to learn the lesson.”
- The Boston event opened with breakfast at the Marriott Long Wharf hotel’s ballroom overlooking the wintry, gray harbor. Roughly 175 people were there, including guests from Italy, where officials had recently locked down more than a dozen towns in an effort to contain the country’s 400 cases.
- Everything that felt so normal about the meeting seems sinister in retrospect, said Lara Woolfson, a Boston-based photographer who had been hired to document the conference. In a Facebook live video posted in March, Woolfson reflected on all the doorknobs she’d touched, the strangers she’d sat beside.
- In the days that followed, dozens of attendees developed flu-like symptoms, according to the Boston Globe. By March 4, the company was instructing everyone who’d gone to the meeting to self-quarantine. The next day, Biogen confirmed that three out-of-state attendees had been diagnosed with C19; genetic data show that at least 12 others were sick by that point.
- But Woolfson knew nothing about her potential exposure until a friend texted her a news article about the outbreak. Suddenly the dry cough and mild ache she’d been feeling seemed serious enough to call her doctor, who immediately sent her to the ER for testing. She was positive.
- The Massachusetts Department of Public Health ultimately identified 97 coronavirus cases among meeting attendees and people who lived with them. Every individual linked to the conference whose genome was sequenced — 28 people in total — carried the conference’s characteristic mutation. It was dubbed “C2416T” for its location at the 2,416th spot on the genome and the two nucleic acids, cytosine (C) and uracil (T), that got switched.
- Sequencing also revealed how the coronavirus evolved even as the Biogen conference was going on. About a quarter of attendees were sickened by a virus whose genome contained both the C2416T mutation and a second mutation, G26233T. In one case, the scientists found both versions of the virus replicating in a single set of lungs.
- This shows that the G26233T variant is a descendant of the germ that originally arrived at the meeting, Lemieux said, an imperfect clone that wound up giving rise to its own distinct lineage.
- The conference, the new study finds, amplified both variants, turning what might have been just one more introduction of the virus into a “superspreading event.”
- About a month later, more than 600 residents and staff members at two of Boston’s biggest homeless shelters were tested as part of a universal screening effort. Officials were shocked to discover that 230 people were already infected with the coronavirus, the large majority of them asymptomatic.
- Genetic analysis showed that nearly two-thirds of sequenced infections among shelter residents could be traced back to the conference.
- “Our jaws dropped,” said Pardis Sabeti, a computational biologist at the Broad Institute and one of the lead researchers on the study. “It was the realization that these events really affect the most vulnerable among us.”
- Scientists can only speculate as to exactly how the infection among biotech executives made its way into Boston’s homeless community. But that’s precisely the point of genomic epidemiology, Sabeti said. Genetic data can reveal connections no one thought to look for, helping health officials seek out and sever chains of transmission.
- There’s another lesson in the data, said James O’Connell, a professor of medicine at Harvard Medical School and the founder and president of the Boston Health Care for the Homeless Program: Packed shelters, like the conference, provide ideal conditions for superspreading.
- “And by the time we realized how bad it was, so much asymptomatic spread had happened that it was too late,” O’Connell said.
- The findings match what has been observed on a smaller scale in other studies, said Dave O’Connor, a virologist at the University of Wisconsin at Madison. Superspreading events, which provide the virus with huge numbers of hosts in a small amount of time, are driving the global outbreak. Delays in returning test results make it much more difficult to mitigate their effects; by the time those infected in such events know they’re sick, they have probably infected many more people.
- “Right now, there are almost certainly people sparking new transmission clusters‚” O’Connor said.
- If the United States continues to repeat the mistakes of February, he added, the same patterns of transmission will play out over and over again.
‘Just throwing away the crown jewels’
- Of the 5.7 million confirmed coronavirus cases in the United States, scientists have sequenced the genomes for about 19,008, according to the Global Initiative on Sharing All Influenza Data (GISAID), the widely used international genome database. That’s roughly 0.33 percent of the nation’s epidemic.
- Even though most tests work by detecting viral RNA in swabs from patients’ airways, those samples are rarely studied further once doctors get a diagnosis.
- But if it were up to MacInnis, every coronavirus sample collected in the United States would be sent to a genetics lab for sequencing. Each of those sequences would be analyzed and submitted to the GISAID database. The results would be shared with health officials and contact tracers, deepening their understanding of their local outbreaks.
- “If you’re spending whatever money large organizations seem to be putting into large-scale testing,” MacInnis said, “throwing away that very same extracted [RNA] that could tell you about how cases are connected within your organization or within communities is just throwing away the crown jewels of what you really want to know.”
- Genetic insights could be “invaluable” for communities balancing the need to control the virus with the desire to reopen, MacInnis said. Suppose four students at an elementary school became sick. If genetic analysis showed they shared a common strain, the virus was most likely transmitted at school, suggesting the facility should close or at least conduct a thorough review of infection-control procedures. But if the infections were genetically unrelated, it’s likely they independently contracted the illness elsewhere, in which case the students should stay home but the school could remain open.
- “It’s not testing that can answer that question,” MacInnis said. “It’s having genomic data to tell you whether they appear to be connected.”
D. Vaccines & Testing
1. How Effective Does a C19 Vaccine Have to be to Stop the Pandemic?
- New computational model finds that a C19 vaccine will have to be at least 80% effective to achieve a complete “return to normal.”
- Researchers around the world are racing to find a C19 vaccine to eliminate the need for social distancing, mask wearing, and limits on interpersonal gatherings.
- In a new study, a computer simulation model found that if 75% of the population gets vaccinated, the vaccine has to have an efficacy (ability to protect against infection) of at least 70% to prevent an epidemic and at least 80% to extinguish an ongoing epidemic.
- If only 60% of the population gets vaccinated, the thresholds are even higher, around 80% to prevent an epidemic and 100% to extinguish an ongoing epidemic. “Some are pushing for a vaccine to come out as quickly as possible so that life can ‘return to normal.’
- However, we have to set appropriate expectations. Just because a vaccine comes out doesn’t mean you can go back to life as it was before the pandemic,” notes lead investigator Bruce Y. Lee, MD, MBA, Public Health Informatics, Computational and Operations Research, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA. “It is important to remember that a vaccine is like many other products — what matters is not just that a product is available, but also how effective it is.” The investigators say the results of their study can provide targets for vaccine developers as well as shape expectations for policy makers, business leaders, and the general public.
E. Improved & Potential Treatments
1. A Cure For C19 Could Be Right Under Our Noses
- Nobody wants to go back to a national coronavirus lockdown. France’s Emmanuel Macron and Spain’s Pedro Sanchez are ruling out blanket stay-at-home restrictions, even as C19 cases surge higher. Their motives are clear: Another round of widespread lockdowns would tank the economy and split society, and would also be an admission of defeat from politicians and public-health officials who — like Sanchez — insist we are “better prepared” to control the epidemic than we were in the dark days of spring.
- The less draconian strategy of combining preventative measures, while waiting for a vaccine to emerge, is a commendable one. But there are limits here, too. Mask policies are becoming tougher and more complicated, risking confusion and hostility. International travel curbs, which haven’t always proven effective or easy to enforce, are piling up again. And while testing and tracing are vital for improving our ability to catch cases, resource gaps remain. Spain is enlisting the army to help its efforts.
- The tangle of rules will become harder to enforce as time goes on. History suggests citizens eventually chafe at epidemic edicts, from the mask “slackers” of the 1918-19 Spanish flu to the residents of 19th-century Naples who, as historian Frank Snowden tells it, protested anti-cholera rules by eating vast quantities of fruit the authorities might confiscate. There’s a shelf life to such measures.
- New emphasis needs to be put on the curative on top of the purely preventative. While vaccines loom large in the collective imagination, finding a treatment for the virus would be the real game-changer. It would likely be cheaper and quicker to manufacture than a vaccine and lessen risks such as low take-up or a fight over doses. Halting infection or deaths would rob C19 of its most terrifying traits.
- Sadly, seven months into this pandemic, there has been little progress. We are better at treating serious cases, but not by much. A paper last month by the French government’s scientific advisory committee cited low-cost anti-inflammatory drug dexamethasone — found to lower deaths among patients needing breathing assistance — and arthritis drug tocilizumab as showing effectiveness.
- This is no ordinary virus, with multiple possible points of attack including provoking an out-of-control immune response. Finding a treatment requires resources. The Milken Institute counts 316 treatments currently being studied worldwide, alongside 203 vaccines.
- Yet time has been wasted. Rushed clinical trials, intended to produce results quicker, have only sown confusion and stoked hype. So far there have been more disappointments, such as anti-malaria drug hydroxychloroquine or HIV therapies including lopinavir, than successes.
- The result is that hospitals are still ultimately at the virus’s mercy. A predominance of milder symptoms and more experience in treating C19 has seen the estimated global case fatality rate fall, to 3.5%, but suggestions that the virus has mutated into a much less virulent form are still inconclusive. Hospitalizations and deaths, while rising much more slowly than cases, are starting to tick up again in countries such as France and Spain. Julien Carvelli, an intensive-care doctor at La Timone Hospital in Marseille, tells me his concern is a co-mingling of C19 sufferers with other patients as winter draws near.
- There are ways to improve the search for a treatment, such as adaptive clinical trials. More international cooperation would also boost their size and avoid duplication. It’s incredibly dispiriting that multi-country trials in Europe like the France-led “Discovery” have failed to reach critical mass. Getting countries to work together is harder than devising no-fly zones, but the rewards will ultimately be greater.
- The price tag for developing Covid-19 drugs, such as repurposing generics, could come to $200 million per treatment (a fraction of the $1 billion it can cost to produce a single vaccine). That’s all the more enticing given that Covid-19 may end up requiring a cocktail of different therapies. Jeffrey Aronson, a clinical pharmacologist at the Center for Evidence-Based Medicine at Oxford University, last month likened using a mix of drugs to a siege strategy attacking all sides of the virus’s castle: Preventing the virus from entering cells, stopping it from reproducing once it gets inside, and changing the body’s immune response by boosting or suppressing it at relevant times.
- None of this means that more immediate prophylactics such as masks and social distancing should be dropped. But scientific research needs to be supported and coordinated as part of the plan. If we are due a fresh spike in cases this fall, patient trials need to be ready.
- Instead of being trapped in a binary debate about dumb or smart lockdowns, the focus should be on finding a treatment that makes all kinds of lockdown obsolete. And it could be right under our masked noses.
F. Concerns & Unknowns
1. Obesity increases risk of Covid-19 death by 48%
- Obesity increases the risk of dying of C19 by nearly 50% and may make vaccines against the disease less effective, according to a comprehensive study using global data.
- The findings, which the lead researcher described as scary, show that the risks for people with obesity are greater than previously thought.
- The study, commissioned for the World Bank, will increase pressure on governments to tackle obesity, including in the UK where Boris Johnson has put himself at the head of a drive to reduce the nation’s weight.
- Johnson hit out last year at “sin taxes” such as the UK’s sugary drinks levy, but his own spell in intensive care with C19, which he blames on his weight, has convinced him that tough measures are needed to reduce obesity levels. It is understood that even taxes are no longer off the table.
- The US and UK have some of the highest obesity rates in the world. US government data shows that more than 40% of Americans are obese. The figure England is more than 27% of adults.
- The new study from the University of North Carolina at Chapel Hill into the effects of C19 on people with obesity, defined as a BMI over 30, finds they are at greater risk from the virus in every way. Their risk of ending up in hospital with C19 increases by 113%, of needing intensive care 74% and of dying of the virus 48%.
- The study is led by Prof Barry Popkin, of the department of nutrition at the UNC Gillings Global School of Public Health, who said he was shocked by the findings. The risk of dying of C19 for people with obesity was significantly higher than anyone had thought.
- “That’s a pretty big effect for me,” he said. “It is a 50% increase essentially. That’s a pretty high scary number. All of it is actually, much higher than I ever expected.”
- The risk of being admitted to hospital for people with obesity was doubled, he said. “That, ICU admission and mortality are really high. They all shocked me, to be honest.”
- The study, published in the journal Obesity Reviews, is a meta-analysis, bringing together data from many studies carried out around the world, including China, France, Italy, the UK and the US. Obesity is a global problem that no country has yet successfully tackled.
- People with obesity often have underlying medical conditions that put them at greater risk from the coronavirus, such as heart disease and type 2 diabetes. Obesity can also cause metabolic changes, such as insulin resistance and inflammation which make it harder for the body to fight off infections.
- “Individuals with obesity are also more likely to experience physical ailments that make fighting this disease harder, such as sleep apnoea, which increases pulmonary hypertension, or a body mass index that increases difficulties in a hospital setting with intubation,” said the study’s co-author, Prof Melinda Beck.
- Nor may a C19 vaccine work as well in people with obesity, the authors say. “We know a Covid vaccine will have a positive effect on obese people, but we suspect from all our knowledge from tests on the Sars vaccine and the flu vaccine it will have a diminished benefit compared to the others,” Popkin said.
- They had convinced the CDC which oversees public health in the US that people with obesity were not getting the full benefit of standard flu vaccines, he said. “We now have a stronger flu vaccine for overweight people.”
- The recommendation was brought in this year after a long campaign. There is now an extra booster shot for people who are overweight and for elderly people, whose immune systems weaken over time.
- Popkin said vaccine developers should look at the data from their clinical trials for the obesity effect, even where they have an overall benefit. “They might just then have to consider this and do some testing in the vaccine to get it to work better for obese people,” he said.
2. Why Does the Coronavirus Hit Men Harder? A New Clue
- The coronavirus may infect anyone, young or old, but older men are up to twice as likely to become severely sick and to die as women of the same age.
- Why? The first study to look at immune response by sex has turned up a clue: Men produce a weaker immune response to the virus than do women, the researchers concluded.
- The findings, published on Wednesday in Nature, suggest that men, particularly those over age 60, may need to depend more on vaccines to protect against the infection.
- “Natural infection is clearly failing” to spark adequate immune responses in men, said Akiko Iwasaki, an immunologist at Yale University who led the work.
- The results are consistent with what’s known about sex differences following various challenges to the immune system.
- Women mount faster and stronger immune responses, perhaps because their bodies are rigged to fight pathogens that threaten unborn or newborn children.
- But over time, an immune system in a constant state of high alert can be harmful. Most autoimmune diseases — characterized by an overly strong immune response — are much more prevalent in women than in men, for example.
- “We are looking at two sides of the same coin,” said Dr. Marcus Altfeld, an immunologist at the Heinrich Pette Institute and at the University Medical Center Hamburg-Eppendorf in Germany.
- The findings underscore the need for companies pursing coronavirus vaccines to parse their data by sex and may influence decisions about dosing, Dr. Altfeld and other experts said.
- “You could imagine scenarios where a single shot of a vaccine might be sufficient in young individuals or maybe young women, while older men might need to have three shots of vaccine,” Dr. Altfeld said.
- Companies pursuing coronavirus vaccines have not yet released clinical data analyzed by the participants’ sex, but the FDA has asked them to do so, as well as by racial and ethnic background, said Dr. William Gruber, a vice president at Pfizer.
- Dr. Iwasaki’s team analyzed immune responses in 17 men and 22 women who were admitted to the hospital soon after they were infected with the coronavirus. The researchers collected blood, nasopharyngeal swabs, saliva, urine and stool from the patients every three to seven days.
- The analysis excluded patients on ventilators and those taking drugs that affect the immune system “to make sure that we’re measuring natural immune response to the virus,” Dr. Iwasaki said.
- The researchers also analyzed data from an additional 59 men and women who did not meet those criteria.
- Over all, the scientists found, the women’s bodies produced more so-called T cells, which can kill virus-infected cells and stop the infection from spreading.
- Men showed much weaker activation of T cells, and that lag was linked to how sick the men became. The older the men, the weaker their T cell responses.
- “When they age, they lose their ability to stimulate T cells,” Dr. Iwasaki said. “If you look at the ones that really failed to make T cells, they were the ones who did worse with disease.”
- But “women who are older — even very old, like 90 years old — these women are still making pretty good, decent immune response,” she added.
- Compared with health care workers and healthy controls, the patients all had elevated blood levels of cytokines, proteins that rouse the immune system to action. Some types of cytokines, called interleukin-8 and interleukin-18, were elevated in all men but only in some women.
- Women who had high levels of other cytokines became more seriously ill, the researchers found. Those women might do better if given drugs that blunt these proteins, Dr. Iwasaki said.
- The study has limitations. It was small, and the patients were older than 60 on average, making it difficult to assess how the immune response changes with age.
- “We know that age is proving to be a very important factor in C19 outcomes, and the intersection of age and sex must be explored,” said Sabra Klein, a vaccine expert at the Johns Hopkins Bloomberg School of Public Health.
- The study also did not offer a reason for the differences between men and women. Because the women were past menopause, on average, “it is doubtful that sex steroid hormones are involved,” Dr. Klein said.
- Still, the new findings are “exciting” because they begin to explain why men fare so much worse with the coronavirus, she added: “The more robust T cell responses in older women could be an important clue to protection and must be explored further.”
3. Traces Of C19 Found In Abandoned Apartment Bathroom Offer New Clues About How It Spreads
- Still haunted by the memory of SARS, contact tracers in Guangzhou, China, have worked diligently to monitor the outbreak in their community. So, when a group of researchers happened upon an unusual situation – a group of five family members who all tested positive living below an apartment that had been unoccupied for months.
- Researchers decided to do some research, and have published their findings as a case study in Environmental International, which was picked up by Bloomberg.
- In the latest research to support the notion that the virus coronavirus in the bathroom of an unoccupied apartment in Guangzhou, China, suggests the airborne pathogen may have wafted upwards through drain pipes, an echo of a large SARS outbreak in Hong Kong 17 years ago.
- According to the research, traces of coronavirus were detected on the sink, faucet and shower handle of a long-vacant apartment situated near the apartment of the family mentioned above. The contaminated bathroom was located directly above the home of 5 people confirmed a week earlier to have C19. The study was carried out by researchers at the Chinese Center for Disease Control and Prevention.
- The scientists conducted what they described as an “on-site tracer simulation experiment” to see whether the virus could be spread through waste pipes via tiny airborne particles created by the force of a toilet flushing.
- They found evidence of these aerosols in bathrooms 10 and 12 levels above the infected family’s apartment. Two cases were confirmed on each of those floors in early February, raising concern that coronavirus laden particles from the infected family’s stool had drifted into their homes via plumbing and managed to successfully infect others.
- For those who don’t understand the physics behind aerosol particles, the study’s authors offered a visual guide.
- Here’s an abstract from the report.
- As public health teams respond to the pandemic of C19, containment and understanding of the modes of coronavirus transmission is of utmost importance for policy making. During this time, governmental agencies have been instructing the community on handwashing and physical distancing measures. However, there is no agreement on the role of aerosol transmission for coronavirus. To this end, we aimed to review the evidence of aerosol transmission of coronavirus. Several studies support that aerosol transmission of coronavirus is plausible, and the plausibility score (weight of combined evidence) is 8 out of 9. Precautionary control strategies should consider aerosol transmission for effective mitigation of coronavirus.
- It’s just the latest piece of evidence suggesting that the coronavirus is indeed “airborne” – that is, it spreads via tiny particles called “aerosols”. Like the abstract reflects, the data collected in this experiment suggest that the chances of aerosols being a significant means of infection are 8 in 9.
- At one point in the paper, the Chinese researchers take a swipe at organizations like the WHO, which has been slow to recognize the risks surrounding aerosol transmission. This is a dangerous assumption, especially considering the fact that transmission via surface contact and large-droplet transmission (which inspired the mandatory mask orders) has almost no actual evidence to back it up, but rather are the results of early assumptions that have endured for various and sundry reasons.
- Current evidence on coronavirus has limitations, but is strongly indicative of aerosols as one of several routes of C19 transmission. It should be noted that the equivalent evidence for contact and large droplet transmission is not available, but has been an unproven assumption from the outset. Epidemiologic and experimental data continues to be obtained at a rapid pace, and the role of aerosols in C19 transmission should be revisited in light of the emerging evidence.
- The study also attacks another alleged misconception: the notion that coronavirus spreads mainly through respiratory droplets, spatters of saliva or discharge from the nose.
- But since the first weeks of the pandemic, scientists in China have warned that virus in an infected person’s stool can help spread it. Studies in Guangdong province have found evidence of the virus in the stool of the infected.
- This means that bathrooms could be a key breeding ground for coronavirus transmission, because they “may promote fecal-derived aerosol transmission if used improperly, particularly in hospitals,” the China CDC researchers said. They cited a fluid-dynamics simulation that showed a “massive upward transport of virus aerosol particles” during flushing. This creates a “fecal plume” that could be particularly infectious.
- Though, to be sure, the extent to which people are infected by these plumes isn’t known. But readers can find the study in its entirety at 1-s2.0-S0160412020319942-main (1).pdf .
4. Drop in Brazilian C19 cases prompts herd immunity questions
- An unexpectedly positive turn for Brazilian cities once plagued with the coronavirus pandemic is raising fresh questions about herd immunity.
- A new report in the Washington Post described how the impoverished city of Manaus saw hospitalizations plummet even though it had never imposed a lockdown or taken the other drastic containment measures imposed in Asia and Europe. It’s also testing far more residents than it once did.
- Initially, medical experts believed that between 60% and 70% of the population needed to develop antibodies to reach collective immunity, but Manaus never got past 20%. And the Amazonian city of 2 million suffered three times as many deaths as normal in the spring.
- There are too many unknown variables to be sure, however, in the broader debate about virus transmission and the level that must be crossed before the number of those infected begins to taper — especially in large cities like the Amazonas capital.
- Many researchers believe that collective immunity works differently in a live outbreak like coronavirus than in something like the measles. The virus doesn’t vanish at a specific point, but the transmission decelerates until it’s eradicated.
- They report that while stringent restrictions are effective, once the virus infects a critical mass, a resurgence in cases is unlikely.
- While the concept of herd immunity has long been used to explain the purpose of mass vaccination campaigns, now the answer seems to be more complex.
- Scientists have been studying the possibility that individual variations in vulnerability reduce the ratio of infection at which herd immunity may be achieved. Some, scrutinizing data from European cities, theorize that herd immunity could be reached at rates lower than 20%.
- Many other cities around the globe that were once devastated by coronavirus have begun to reopen without second waves, with some speculating that collective immunity has been reached.
- Harvard epidemiologists have hypothesized that parts of London and New York have already achieved “substantial immunity.” The same is said by health officials in highly dense areas like India’s Mumbai, though the first recorded C19 re-infection was just confirmed in Hong Kong.
- Swedish health experts claimed they too had achieved herd immunity while abstaining from recommended procedures like mask-wearing and harsh lockdowns.
- Residents of Manaus, meanwhile, are hoping that infections remain at bay.
- Mayor Arthur Virgílio Neto — who has had the virus himself — has admitted that if a second wave did hit, the city’s capacities would once again be “overwhelmed.”
5. Antisocial traits linked to lower coronavirus safety adherence
- A new study from Brazil found that people with antisocial traits are less likely to follow coronavirus containment measures.
- Traits like callousness, deceitfulness, hostility and risk-taking typically present themselves in people diagnosed with antisocial personality disorder, researchers explained. These traits are associated with rule-breaking behavior like criminality and violence, they wrote.
- The study, by researchers from State University of Londrina and São Francisco University, was recently published in the journal Personality and Individual Differences.
- Researchers hypothesized that those with “higher levels of antisocial traits” and lower empathy would “show more difficulty in adhering to the containment measures.”
- “Exposing oneself and others to risk, even when it can be avoided, is a typical trait for people with antisocial tendencies and with low levels of empathy,” study authors noted.
- The study involved 1,578 Brazilian adults who responded to questions about compliance to containment measures and virus testing.
- “Our findings indicated that antisocial traits, especially lower levels of empathy and higher levels of callousness and risk-taking, are directly associated with lower compliance with containment measures,” study authors wrote.
- They concluded that these traits explain, in part, why people continue to disregard containment measures even amid rising cases and deaths. The findings were said to confirm previous literature on the association between personality traits and adherence to coronavirus containment measures.
- “Our findings can be useful for public health policies [such as] screenings that demonstrate an elevation in these traits, interventions can be carried out aiming at greater awareness and consequent compliance with containment measures,” authors wrote.
6. Partygoers Turn to Virtual Raves and Happy Hours, and Drugs
- People have traded in nightclubs and dance festivals for virtual raves and Zoom happy hours as a result of lockdowns during the C19 pandemic–yet, many are using drugs in these socially distanced settings, according to a new study by researchers at NYU Grossman School of Medicine and the Center for Drug Use and HIV/HCV Research at NYU School of Global Public Health.
- The study, published in the International Journal of Drug Policy, is the first to examine drug use during virtual raves and happy hours.
- “We explored whether stay-at-home orders changed how people use drugs–and it appears that drug use during virtual gatherings is somewhat prevalent among the party-going population we studied,” said Joseph Palamar, PhD, MPH, an associate professor of population health at NYU Langone, an affiliated researcher with the Center for Drug Use and HIV/HCV Research at NYU School of Global Public Health, and the study’s lead author.
- With government regulations to curb the spread of C19 temporarily closing nightclubs and canceling large electronic dance music (EDM) festivals, some forms of nightlife have shifted to online platforms. At virtual raves, attendees experience live DJ performances broadcasted to thousands or even millions of people. For instance, Electric Daisy Carnival, the largest EDM festival in the U.S., held a virtual rave-a-thon featuring many popular DJs in May. Virtual happy hours are social gatherings at which alcohol may or may not be consumed, hosted using video conferencing platforms.
- While nightlife settings are often associated with drug use, not much is known about whether drugs are also used in these newer virtual settings. To investigate, the NYU researchers conducted online surveys in April and May 2020 with 128 people who live in New York, attend EDM parties and reported recent drug use.
- The researchers found that virtual raves and virtual happy hours are popular among these EDM partygoers: 55.5% of those surveyed attended virtual raves and 69.5% attended virtual happy hours during C19 social distancing. Of those who participated in these virtual events, more than a third reported using illegal drugs during them, including 40.8% of virtual rave attendees and 33.7% of virtual happy hour attendees.
- Alcohol was used by the majority of participants (70%) during both types of events, followed by marijuana, which was used by nearly 30% of participants. Other drugs were less prevalent: for virtual raves, the use of ecstasy, also known as MDMA and Molly (8.5%), LSD (7%), and cocaine (4.2%) were reported, while some virtual happy hour attendees used cocaine (3.4%) and ketamine (3.4%).
- While drug prevention and harm reduction efforts have typically focused on clubs and parties, the researchers cite virtual events as an opportunity for outreach and education, given that substance use is also occurring in these settings.
- “Although drug use may be considered ‘safer’ in a home environment, it may also introduce different risks, such as using alone,” said Palamar. “My main concern is potential adverse social effects of using drugs on camera because this could compromise one’s career. This applies to use of weed as well, because this can still compromise one’s relationship with an employer, even in 2020.”
- Palamar notes that the rise of virtual raves and happy hours only tell one part of the story about how substance use has shifted during the pandemic.
- “We’ve conducted another study, also on EDM partygoers, and we’re learning that the use of drugs, such as cocaine, ecstasy, and LSD, has been dropping since the C19 lockdown,” said Palamar. “This shouldn’t be unexpected as many of these drugs are most commonly used in social and party settings, but social distancing measures have certainly changed drug use behaviors.”
G. The Road Back?
1. Your office will never be normal again
- Bosses have a battle on their hands to prove that after months working from home, employees’ physical presence is both necessary and safe. Early indications suggest that the pandemic will have a significant impact upon the mental health of employees for months or even years to come, according to the Chartered Institute of Personnel and Development (CIPD). As early as two weeks into lockdown, employees were reporting a range of health effects including negative impacts on mental health and overall well-being.
- When people who may have experienced anxiety, depression or trauma during the coronavirus lockdown finally return to the office, nothing will feel normal. Hand sanitiser, floor markings, extra laptops so staff don’t share – building inspector Geoff Wilkinson at London-based Wilkinson Construction Consultants decked out his office after the Prime Minister told construction to reopen first in early May.
- Like any other business in the UK, people will have to work alone or in shifts, avoid group meetings, eat by themselves and forget any social interaction with their peers. And that’s without factoring in the risk of exposing themselves to the virus when travelling to and from work.
- “They all understandably have concerns, like caring for elderly relatives”, he says. To ease the return, he has calculated how many hours of work are needed and lets staff set their own schedules.
- And safety-proofing offices without making them feel like prisons will be tricky. Russell Corlett, health and safety director at employment law firm Peninsula, says companies are installing thermal cameras to detect raised temperatures, while losing things that encourage cohesiveness, like the tea round.
- Wilkinson’s team is living through that change. “No one offers to make each other tea or coffee anymore, each preferring to wash their own cup and make their own, just to be sure,” he says, “it is quite a culture change, we have always prided ourselves on everyone, including the managing director, offering to make drinks.”
- His office has grass outside that allows employees to sit and eat socially distanced lunch on warm days, “but how we deal with this in winter if restrictions are still in place will be another matter,” he says.
- Returning to the office as the lockdown eases will affect staff morale. “Employers must get it right to ensure coming back isn’t depressing,” says Kate Palmer, associate director also at Peninsula employment lawyers.
- Crowded tubes, trains and buses will be a big safety issue for office workers in major UK cities, says Heather Bolton of Unmind, a workplace mental health service. Out-of-town staff driving to the outskirts then completing journeys on a folding bike is one solution, but may not be an option for many people.
- “Many employees might find it hard to share their anxieties,” Bolton says. Emotions could run high. “Some employees will feel more anxious and contamination-conscious than others, which could cause conflict within teams,” she says. “Sleep may also suffer, as they try to adapt to stricter office-based routines.”
- Research by Unmind found eight in ten employers had more staff requests for mental health support during lockdown. Companies expect similar figures when they reopen – 70% intend to spend more on mental health services.
- Companies are not only trying to figure out best practice when they unlock offices; they have to convince their workers to come back in the first place. In a mid-May survey of GMB union members 80% feared a return to work could give their family coronavirus. The government message is “work from home if you can’, but in the GMB survey 60% expected that they would be pressured to return because of their company’s culture of presenteeism. Just 18% thought their workplace would be safe, what Wilkinson calls “the biggest issue we face”.
- The use of apps such as Xero, Slack and Google docs have allowed staff at accountancy firm The Wow Company to keep clients happy from home, says co-founder Paul Bulpitt, so he plans to open an office only if staff want it.
- “Some live alone in small flats with no outside space. Many have young children they have had to entertain or educate all day,” he says. “We are seeing if we could open at least one office for them”.
- Bulpitt admits just housing 50% of staff isn’t smart for productivity. “It’s easier for everyone to work from home until it’s safe to reopen completely,” he says.
- Bulpitt says that his staff are included in discussions on how the company will return to work, so they don’t feel like it is being imposed on them top-down.
- Companies should be honest about the change that is coming, says Bolton. “Be clear on how things will operate in the office and manage expectations about what a return to work will look like.”
- Workers may have to quickly learn the jobs of colleagues who aren’t in the office. In his consultancy offices across the South East of England Wilkinson has a rota – employees cover different roles or unfamiliar locations – which he hopes “will mean we emerge with a more multi-disciplinary team and improve teamwork”.
- Being in an 9-5 office routine again will mean losing the autonomy and flexibility of daily routines for some, or more time away from partners and children. Even those eager to return could be in for a shock.
- “With social distancing, altered layouts and fewer employees in the office, those lonely at home and desperate to get back may feel frustrated and disappointed with the reality of it,” says Bolton.
- “Find ways to boost employee morale – like socially distanced team-building exercises or flexibility in working days,” she says.
- Unhappy employees who refuse to return to the office, even in the middle of a pandemic, are on shaky ground legally. “Unless a permanent change to working arrangements was made employees would be expected to return when asked,” says Palmer.
- Workers with at least 26 weeks’ continuous service have a right to request flexible working. But an employer can refuse flexible working (including homeworking) requests, and the company has three months from the initial request to make a final decision: during those three months you will have to go into your workplace anyway.
- More working from home is strongly expected as a legacy of lockdown though and Bolton says employers shouldn’t wait for things to go back to the way they were, or act like they will.
- “This is a ‘new normal’, not a return to normality,” she says. “Remember this when making plans to help staff through this transition”.
2. The 6-foot social-distancing rule is based on nearly 80-year-old science. Scientists at MIT and Oxford have created a traffic-light system to use instead.
- In the late 1800s, the German scientist Carl Flügge had a hunch: Maybe if you maintain enough physical distance between people who are sick and those who are well, you can prevent the spread of pathogens from person to person.
- At the time, it was just a hypothesis, one that scientists like him often tried to test out using glass plates.
- But it would take another four decades for technology to advance enough to confirm the idea, with the advent of high-speed photography.
- In the early 1940s, scientists finally got their first glimpses of people’s sneezes hurtling through the air in real time, at a capture rate of 30,000 frames a second, confirming that indeed, most of the stuff we throw into the air when we sneeze, cough, or yell tends to settle down to the ground within about a wingspan or so (say, 3 to 6 feet).
- Here is one of those (revolting) first images:
- This photo of a sneezer caught in the act was taken by the professor Marshall Jennison from MIT and published in a 1941 research paper.
When ‘the dogma was born’
- Back then, scientists maintained that most of the infectious gunk people expel (say, about 90% of their pathogens) travel less than 6 feet away.
- Their study measurements were never meant to be taken as hard-and-fast rules about how far we should stand from other people during a pandemic, though.
- Nevertheless, these 3-to-6-feet rules of thumb have become easy-to-follow protocols for keeping potentially sick people at arm’s length during the coronavirus outbreak.
- “The dogma was born,” the professor Lidia Morawska, a leading aerosol scientist in Australia, said of the 80-year-old 6-foot rule. “Like any dogma, it’s extremely difficult to change people’s minds and change the dogmas.”
- But as the coronavirus pandemic drags on for months on end, Morawska and other leading air and virus scientists and engineers are starting to lead a charge toward dismantling the old 6-foot rule and taking a more nuanced approach to managing the novel coronavirus’ spread.
- Instead of always being on super-high alert, or assuming that a distance of 6 feet (or wearing masks, or washing hands) keeps us 100% safe all the time, they say, we should be learning how better to assess the situations we’re in every day, letting our guard down now and again when it’s relatively safe and moving back onto high alert when it’s appropriate.
Can we start thinking differently?
- On Tuesday, hoping to inject a little more of such empowerment into the ways people protect themselves from the virus’ spread, researchers from Oxford and MIT released a new traffic-light system that they hope will help people live life to its fullest while still being careful enough during the pandemic.
- “With knowledge and tools that are relatively simple to use, that distill complex information, our hope is that decision makers, local community leaders, school leaders, and everybody that is organizing anything like a barbecue or party or a wedding, is empowered to be more resilient, by having the tools to make the right decisions and to impose the right restrictions,” Lydia Bourouiba, an MIT professor who directs the university’s Fluid Dynamics of Disease Transmission Lab, told Business Insider, shortly before her new tool was released in the BMJ.
- “We equip people with understanding to adapt in various situations so that they know when they need to be absolutely vigilant, and when they can let their guard down,” she said.
- The most important things to keep in mind when assessing the riskiness of any situation include taking a look at the environment you’re in and acknowledging the density of the crowd and the activities people are doing.
- The coronavirus doesn’t follow hard-and-fast rules about infection, and neither should you.
- Environmental scientists like Morawska say when it comes to talking about how the coronavirus spreads, there’s no point in trying to distinguish a droplet from an aerosol or distinguish what happens at 3 feet away versus 10. What matters most is how much virus has a chance to get into your body, regardless of how it gets there.
- “There are three modes of transmission, and all three modes of transmission have to be controlled,” she said.
- Those three modes are people (the most common source of infection), surfaces, and the air.
- “These things happen at the same time, and therefore distinguishing what’s what is very difficult,” Morawska said.
- Life is more dangerous, then, in places where people become animated, excited, or otherwise loud in close confines, with stale air.
- “Breathing out, singing, coughing, and sneezing generate warm, moist, high-momentum gas clouds of exhaled air containing respiratory droplets,” Bourouiba and her coauthors wrote in the BMJ.
- In such instances, a distance of even 20 to 30 feet may not be enough to protect you from an infection.
- Meatpacking plants are then understandably ripe for viral spread because “the combination of high levels of worker contagion, poor ventilation, cramped working conditions, background noise (which leads to shouting), and low compliance with mask wearing” all contribute to viral spread, Bourouiba and her coauthors noted.
- The same issue pops up easily in bars, gyms, indoor music venues, churches, and clubs.
- We need to be able to adapt to environments with different levels of vigilance so we’re not constantly on max alert
- A different risk chart, similar to the one that Bourouiba and her coauthors invented for the BMJ, which weighs the relative risks of different activities during the pandemic, based on various criteria. Dr. Ezekiel Emanuel – University of Pennsylvania, Dr. James Phillips – George Washington University, Saskia Popescu – University of Arizona/George Mason University
- Engineers, virologists, and environmental scientists all stress that learning how to live with the virus can be done.
- “I think everybody understands what traffic lights are in the general public,” Bourouiba said.
- She says it’s important to have such guides in mind as we weigh how to reopen, gather, and socialize during the pandemic, keeping our environment, and our behaviors in it, top of mind.
- “We need to be able to adapt so that we are not constantly at max alert,” she said. “Not just the 6-foot rule or the mask on its own,” she added.
- The simple questions to ask include: How long is the contact? Are people wearing face masks? Is the setting well-ventilated? And will it be quiet or loud?
- “It’s not rocket science to work out what needs to be done to minimize the risk of infection transmission,” Morawska said.
H. Back to School!?
1. College Reopening vs. Reality
We Can Save the Semester
- From the outside, the University of Notre Dame’s return to campus looks like a disaster. And in some aspects—including the number of positive cases of Covid-19, 471 since Aug. 3—it is. When Notre Dame halted in-person classes and shifted everything online last week, the public response seemed to be: “How could they not have seen this coming?” Others conjectured that the return to campus was a scam to buy time for tuition checks to clear.
- I don’t believe that. Students and staff are frustrated and determined to salvage the year. We want to be here. The spike in positive cases was a brutal but necessary wake-up call. The school year is in serious jeopardy only because of a few off-campus parties to which many of the cases were linked. This shows that the virus can be controlled on campus, not that we never should’ve returned. Students still have a responsibility to follow the basic health guidelines that are posted all over.
- As a freshman, being able to get settled on campus was crucial to calming the typical nerves that accompanied the experience. The help and support of the staff to attempt to make this return as safe as possible has been unbelievable, but it’s time for us students to take responsibility. We will.
- —Ryan Peters, University of Notre Dame, marketing
Social Pressure Keeps Us Safe
- Texas Christian University welcomed back students during the week of Aug. 10. A school with almost 10,000 undergraduates, as of Tuesday our active C19 case count is 177, with only 66 cases of students or staff in direct contact with campus. Our success stems from more than the typical reopening plan of mask mandates, optional online courses, reduced gathering sizes and limited dining options. In a short time we’ve created an atmosphere in which choosing not to wear a mask turns you into an outcast. I’ll admit that I was skeptical of how this semester would go. But we’re keeping safe, online instruction has improved and TCU is showing success in all areas of concern. I hope only that we can keep it up.
- —Jillian Verzwyvelt, Texas Christian University, economics and communication studies
The Prohibition Effect
- I’m a resident adviser and it’s clear to me that the Babson College staff have a good-faith desire to keep everyone on campus safe. We have weekly testing and daily symptom reporting, no one is allowed in dorms they don’t live in, all meals are to-go, a large proportion of classes are fully or mostly online, and all indoors social gatherings are limited to six people or fewer. This last one is a good idea, but hardly a reasonable expectation. Our college can’t control students going in and out of campus. Locking down may only set up the conditions that encourage large, off-campus parties. My guess is that these will cause the school to be shut down in a few weeks’ time.
- —Nicholas Leone, Babson College, business
Good or Bad, I Want an Answer
- If any school were going to survive coronavirus, I thought it would be Brown. Christina Paxson, our university president, has been one of the most vocal proponents for reopening higher education, even testifying before Congress on the subject. Throughout the summer, I have received updates about ambitious and comprehensive public-health plans, which gave me hope for a somewhat normal fall.
- But three weeks before I was slated to move back to campus, I had to cancel my plane ticket. The college was changing its plans again. Move-in, if it is to happen, was getting delayed even further, at least until late September.
- Given the country’s condition, I’m not surprised. If anything, it is a wise choice. What frustrates me is the continuing opacity of the administration’s guidance to students. We’ve had to plan for housing, classes and extracurricular activities, not knowing whether we’ll be able to follow through. And instead of providing a clear answer, the school continues to defer its decisions, promising a possible return at a later date.
- At this point, I want certainty more than I want hope. This pandemic has shown me the value of pragmatic pessimism. If returning is unrealistic, simply tell us the truth. Then, at least we can mourn the semester in peace.
Source: College Reopening vs. Reality
2. A Huge C19 Natural Experiment Is Underway—in Classrooms
- For parents and teachers, the reopening of schools has been a chaotic mess. Guidelines and procedures seem to change daily. Classroom policies or even whether in-person learning occurs at all depends on where you live and often the politics of who sits in the governor’s mansion. But for epidemiologists, this fall is proving to be a scientific bonanza of sorts. “The opening of schools is a tremendous opportunity for natural experiments to understand transmission,” says Tina Hartert, a pediatric epidemiologist at Vanderbilt University Medical Center.
- Researchers like Hartert want to know how effectively this coronavirus spreads, how much of a risk children and teenagers pose for transmitting the virus, and whether any of the measures that schools are taking right now—from staggered schedules to new ventilation systems to chemically disinfecting the desks—make a difference.
- While existing studies have examined these questions, most were conducted last spring when schools were closed and children were at home. Those that did look at schools that had reopened, in Germany and Israel for example, had small sample sizes, Hastert says. “We are not confident looking at the whole body of literature in making claims of children’s role in transmission as compared with adults,” says Hartert, who is also coordinating a nationwide National Institutes of Health-funded study examining novel coronavirus spread among households.
- The study, known as Human Epidemiology and Response to SARS-CoV-2 (Heros), also will help determine what percentage of children infected with the virus develop symptoms of the disease, and compare the infection rates among children who have asthma or allergic conditions with those of kids who do not. More than 1,900 households in 12 US cities have been enrolled in the study, and Hartert hopes to have some preliminary data in early 2021.
- Hartert is specifically examining how the virus travels throughout families. She says she wants to see a similar study of how the virus might spread through a school. “It’s not as simple as only studying the school,” Hartert says. “The school building is only one network that students interface with when they leave class, get on buses, and go home.”
- Data experts say that designing studies about school transmission or about mitigation measures isn’t so easy. For one thing, in school districts where most parents are unable to work from home or lack access to a computer and the internet, administrators may have an incentive to keep their schools open despite the risk from the virus, says Zoe McLaren, professor of health policy at the University of Maryland, Baltimore County.
- “In communities where the students are relatively disadvantaged, they are likely to go back to school, because the students will likely fall further behind,” McClaren says. “If there are outbreaks, they are more poorly resourced. If they had money for better ventilation systems and to have smaller class sizes, they would have been able to do it safely.”
- Even if researchers can take into account the economic disparities among school districts, any school study will have to conduct a lot of C19 diagnostic tests among the students, teachers, and staff over a long period of time to track the progress of the virus. They will also have to run a detailed accounting of each person that an infected student or teacher meets, a strategy known as contact tracing, which is both labor-intensive and expensive to do.
- In tracking respiratory diseases like the coronavirus, “you can’t tell as easily what has happened after the fact,” says Dimitri Christakis, a pediatrician at Seattle Children’s Research Institute. “That’s why you need to be testing children, so you know that they came to school without Covid, that five kids now have C19, and then also contact-trace with their families. You have to have the infrastructure in place, otherwise it becomes very difficult or even impossible to trace.”
- That’s more or less the blueprint of an ambitious initiative being launched in Los Angeles, where school officials and medical researchers are teaming up on a $150 million program to administer rapid C19 tests to all 500,000 students and 75,000 teachers and other staff members. Researchers from UC Los Angeles, Stanford University, Johns Hopkins University, Anthem BlueCross, and Microsoft will partner on the testing effort, which will begin before schools open their doors to in-person learning. The study will identify sick students and staff and collect epidemiological data about the background spread of the virus.
- “We don’t know the community prevalence of the disease, and by doing this there will be an idea of the prevalence of the virus in school-age households throughout the county,” says Kristan Staudenmayer, a physician at Stanford University Medical Center who is part of the study team. “You can identify those who are sick and keep them from entering school and putting at risk other students.”
- Staudenmayer says that the primary goal of the Los Angeles testing and contact-tracing program is to slow the spread of the virus while keeping schools open. “We are realizing that Covid is not going away, and that we have to learn to live with it and educate our children,” she says.
- In some parts of the country, where schools reopened earlier, it’s already becoming clear that it’s hard to keep C19 out of schools. In Lincoln, Nebraska, students started school in person earlier this August with extra space between desks, mandatory masks, and reminders about frequent handwashing. But a few weeks later, health officials asked 35 teachers to self-quarantine at home after exposure to C19, while one elementary school switched to online learning after a cluster of positive tests. In suburban Atlanta, nearly 1,200 students and staff members in one district tested positive within a week of reopening. Meanwhile, as of Friday, 21 of the 25 largest school districts in the US had opted for online classes as a way to keep the pandemic in check.
- Some experts note that other countries opened schools by driving down the number of cases in the surrounding community and by prioritizing the opening of schools rather than the opening of businesses and social establishments that could be a high risk for spreading the virus.
- “Schools in the US were first to close and last to open,” says Christakis of Seattle Children’s Research Institute. By contrast, starting around Memorial Day, some US cities and states allowed eateries, bars, gyms, and other social spaces to reopen, leading to a resurgence in infection rates around the country. “Now there are all these hot spots around the country, but no one can blame schools,” Christakis says. “How about we close bars and restaurants and make the first thing to open the schools? If I ruled the world, that’s what we would do.”
3. Extreme measures colleges are taking to limit partying
- Say goodbye to sticky floors, keg stands and dubious punch bowls.
- While college administrators around the country struggle to keep their students safe in class, there’s one, formative part of college that seems to be out of their hands: parties.
- It took just one week after students returned to the University of North Carolina at Chapel Hill before there was an outbreak of 130 coronavirus cases. The cases were traced to four “clusters” — five or more positive people — in UNC dorms and one cluster was centered around an off-campus frat house.
- Meanwhile, in that same amount of time, 19% of more than 400 students tested positive for the virus at the University of Notre Dame. At the famed Indiana school, the outbreak was credited to off-campus parties. There were at least two gatherings where social distancing wasn’t practiced and masks weren’t worn, leading to a large group of mostly male seniors who caught the cough.
- And despite asking students to pledge not to party, at least 20 students raged until 1 a.m. last weekend during an off-campus bash hosted by Holy Cross students in Worcester, Massachusetts. So far, it’s caused at least one confirmed case of C19 and several more potential positive infections.
- For months, anxious students have been cooped up in their parents’ homes, waiting for their chance at freedom — and to go full-on “Animal House” with their long-lost peers. What’s the point of going to college if you can’t get mono after drinking beer from a communal funnel, after all?
- But some students have reluctantly hung up their togas: “I’ve accepted the reality of the situation,” Ruby Reimbold, an incoming freshman at Syracuse University, told The Post.
- “I was most excited to tailgate and go to games, since it was my favorite part of high school and I’ve heard the ‘Cuse football atmosphere is amazing,” she said. Although football games will be held, fans can not attend.
- But now, Reimbold is just nervous about not being able to make friends.
- “I think it will be much harder to meet people and join campus organizations since group gatherings are so limited,” she says.
- And she and other students are bracing for the possibility of being sent home if they break social-distancing rules. After the outbreak at Notre Dame, classes have been temporarily moved online. Off-campus students were asked to not come to campus, and those who live at school were told not to leave unless there is an emergency.
- UNC students also had to head home after coming to campus only two weeks ago. Classes have moved 100-percent online for the semester, and students have the option to cancel their housing without penalty.
- At notorious party school Penn State University, a Change.org petition asking for the freshman class to be sent home has garnered more than 4,000 signatures after videos posted to social media showed many newcomers joining a massive crowd and not wearing masks during a campus bash.
- In many cases, for what could be the first time, young adults are begging their guardians for restrictions.
- “University leadership should have expected students, many of whom are now living on their own for the first time, to be reckless. Reports of parties throughout the weekend come as no surprise,’’ wrote angry college journalists in an editorial for UNC’s campus newspaper, the Daily Tar Heel.
- After the outbreak, student gatherings at Notre Dame of any kind are limited to 10 people, although it’s unclear how that will be enforced.
- Some schools are already taking extreme measures to limit partying. In an attempt to create a “bubble” similar to that of the NBA, Albion College in Michigan is requiring its attendees to download an app that tracks their location and health data to monitor the spread of the virus, reports Newsweek. Called Aura, the smartphone tracker will alert the school if a student leaves the campus’ 4.5-mile wide perimeter. If they step out, students will face suspension.
- At Cornell University, students may be allowed to party — if they sign in first, claimed incoming freshman Ryan Wong, 18.
- “It’s a check-in system,” Wong said. “The reason they have people sign-in is for contact tracing just in case someone tests positive.”
- The university could not confirm to The Post that the sign-in system is officially in place. However, they have asked all students to agree to a behavioral compact — a set of rules urging them to take precautions to prevent the spread of the virus. On- and off-campus gatherings are limited to 30 people, and students must stay 6 feet apart and wear face masks.
- One of the stipulations in the contract includes the agreement “to refrain from organizing, hosting, or attending events, parties, or other social gatherings on- or off-campus that may cause safety risks to me and other members of the community.”
- With so much riding on the decision, Wong, who said he doesn’t use substances, is still conflicted as to whether he should party or not.
- “You don’t want to get yourself COVID and then have to quarantine for a couple of weeks, or give it to your family when you go back,” he said. Because he’s from the Bay Area of California, he plans to follow New York state’s 14-day quarantine before moving to Cornell’s Ithaca campus.
- But after having his senior year of high school cut short, Wong doesn’t have much hope for his first semester.
- “At any point, they can just cancel in-person [classes] and we could be sent home,” he says. “It’s kind of expected.”
4. Virtual learning sites sprout up to help working parents
- A dance studio in Florida. A martial arts center in Missouri. Libraries in San Francisco. These and other places are taking on a somewhat unlikely new role this fall — welcoming children for supervised distance learning while their parents go to work.
- With many schools still closed by the coronavirus pandemic, public and private alternatives are sprouting up across the nation to watch over children as they study.
- The sites provide a lifeline for families that struggled through virtual learning last spring, but organizers acknowledge they are a poor substitute for schools with professional educators. And by inviting students to congregate in new spaces, experts say, the programs risk subjecting caregivers to the same virus dangers that closed schools.
- “It’s creating the same situation as we would for having the children in school,” said Florida International University epidemiologist Dr. Aileen Marty. “So the only way that that works is if you know everybody in that group, a very small group, and everyone is tested and tested negative.”
- When schools in Broward County, Florida, announced plans to begin the new year with remote learning, dance studio owner Katie Goughan recognized immediately the challenges for working parents. Her Dance Explosion Co. in Hollywood, Florida, has hired a substitute teacher who is on site from 7 a.m. to 3 p.m. to keep students on task. The studio is charging $150 a week, or a daily rate of $35.
- “I thought to myself, ‘What would my parents have done with me?’” Goughan said. “I wanted to alleviate any stress that parents might be under right now trying to find somewhere for their kids to do their schoolwork.”
- The studio, which has capacity for 30 students, currently has 10 children during the day, all of them wearing masks, along with temperature checks and lots of hand sanitizer.
- Jennifer Quisenberry, 37, a nurse practitioner, is sending her 6-year-old daughter, Audra, to a “distance learning camp” at Premier Martial Arts in Wildwood, Missouri. Her daughter’s district is beginning the year virtually, and she and her husband, who works for a car dealership, have struggled with child care since schools closed. With no family available to help, she had trouble sleeping before finding the martial arts center, which is owned by a former high school teacher.
- “We can’t not come to work,” she said. “My partners said I could bring Audra to work. But a hospital is not an ideal setting for a 6-year-old in the middle of a pandemic.”
- While affluent parents turn to “learning pods” and private tutors, many of the arrangements set up by nonprofits and local governments are designed with low-income families in mind.
- In Philadelphia, city officials announced Thursday that they would open 31 drop-off sites at community centers, housing authority properties and libraries for parents who need someone to supervise children attending virtual classes. The program will focus on families with the greatest need, including those who cannot afford child care and those who do not have internet access at home.
- San Francisco is creating “community learning hubs” at 40 sites across the city to assist with distance learning for children who are poor, homeless, in foster care or learning English as a second language.
- In Kansas City, Missouri, the parks department is working with the Boys and Girls Club and the group Camp Fire Heartland to offer virtual learning to hundreds of students. For participants from Kansas City Public Schools, the city’s poorest district, the program is free.
- “It is tough for parents with school-aged children who are too old to go to preschool, and hiring a babysitter or nanny is not an option for their finances,” said Roosevelt Lyons, deputy director of operations for the parks department.
- In Orlando, which is hosting distance-learning programs at community centers citywide, families will pay just $5 a day or nothing if they qualify for government-subsidized lunches.
- “Some parents aren’t computer literate, so they are very appreciative,” Orlando Mayor Buddy Dyer said. “Also there is the social aspect. There are eight other students, so you get that social interaction and don’t feel so isolated.”
- Kansas City area daycare owner Megan Huffman has been deluged with calls from parents begging her to enroll their school-aged children. She may be able to add some kindergartners and siblings of students at her Rising Sun Learning Center, which has one facility in Missouri and another in Kansas.
- But she said her own experience offering virtual instruction to staff members’ children this past spring was less than ideal, and she is planning to send her own 6- and 8-year-olds to a private school offering in-person instruction.
- “Trying to get 20 kids from six or seven grade levels from 10 districts on task is damn near impossible,” she said. “Day care has been open every day through the pandemic. If it is that dangerous, it doesn’t make sense that day cares are open and schools can’t open.”
- Carrie Hutchcraft, chief administrative officer with the Magic House, an interactive children’s museum in the St. Louis suburb of Kirkwood, is offering a virtual learning program that can handle about 80 students each day. Her own 9- and 7-year-olds will be among the participants.
- When schools shut down, she made her own job a priority, figuring her children already had most of a year of instruction under their belt. Now five more months have passed.
- “I feel like they already have got behind in learning new things last year, but we can’t do that again,” she said.
I. Projections & Our (Possible) Future
1. We could ‘beat’ C19 before a vaccine is ready
- Is a vaccine the only way to return to normal after C19? New research into the virus suggests not — that the infection rate may drop to tiny levels before then.
- Since the spring, scientists have known the virus’s infection fatality rate — how many people it kills compared to the number it infects — is under 1%, perhaps as low as 0.2%. That lower figure translates into one death for every 500 people infected.
- We have also known that deaths are seriously skewed by age. The media says older people are at “more” risk from the novel coronavirus than younger people. That’s true, but it understates the reality. Most people do not realize that the risks to people over 80 are hundreds or thousands of times higher than those younger people face.
- The fatality rate for children, meanwhile, is very small. In July, Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said it’s about one in a million infected.
- Of course, most of the media simply ignored Redfield’s comment — maybe because it would have made parents less afraid to send their kids to school.
- But the fatality rate is only half the puzzle when scientists try to figure out what the final death toll from the coronavirus might be. And even with a small rate, the numbers are staggering. If the entire nation was infected, it would mean potentially 500,000 or more Americans dead.
- But if the virus runs out of steam more quickly and the epidemic fades before everyone is infected, the number of deaths will be lower.
- Epidemiologists call the level where the epidemic ends the “herd immunity” threshold. Herd immunity does not mean that the virus has completely disappeared, only that it can no longer infect a critical mass of people and become an epidemic again.
- Figuring out when a virus has reached herd immunity is very tricky, even trickier than estimating the death rate. It depends heavily on the virus’s reproduction number, or R — how many people one infected person infects in turn.
- The higher the R, the more quickly a virus will spread, and the more people must be infected before the epidemic breaks. Coronavirus seemed at first to be highly contagious, and most scientists initially believed that 60% to 80% of people might need to be infected before herd immunity was reached.
- But the R for the coronavirus seems to vary wildly at different times and places. Also, some people may have some pre-existing immunity because of their exposure to other coronaviruses.
- A growing number of scientists believe the threshold for herd immunity may be much lower. Some predict it might be 40%. Others say it could be as low as 20% — meaning that the epidemic will burn out after only 1 in 5 people is infected with and recovers from the virus.
- And real-world evidence — from Sweden, from Sunbelt states like Arizona, and now from the Brazilian city of Manaus — provides very encouraging evidence that the immunity threshold may be well below 50%. Sweden, Arizona and Manaus don’t have much in common, but in all of them, the epidemic burned out relatively quickly, without hard lockdowns, and after a relatively low number of people were infected based on antibody tests.
- If we can actually reach herd immunity after 40% or less of the population is infected, far fewer people will die than the early forecasts, even without lockdowns. And if the best-case estimates of 20% or less are correct, we may be closer to the end than the beginning of the coronavirus epidemic. It’s still too early to be certain — but maybe for the first time since March, we have real reason to hope.
- As the world wearies of trying to suppress the coronavirus, many of us are wondering what the future will look like as we try to learn to live with it.
- Will it always have the capacity to make us so sick? Will our immune systems learn — and remember — how to cope with the new threat? Will vaccines be protective and long-lasting?
- These pressing questions gained even greater urgency Monday with the news that scientists in Hong Kong have confirmed a 33-year-old man was reinfected with C19; his second infection as diagnosed — by airport screening — came 4.5 months after his first infection in March.
- “I’ve been thinking about it a lot,” Malik Peiris, a coronavirus expert at the Hong Kong University who was one of the co-discoverers of SARS-1, said when asked about the question of immunity.
- Peiris isn’t alone. STAT asked a number of experts to map out scenarios of how we might come to coexist with this new threat. In a time of uncertainty, the scenarios they sketched were actually hopeful, even if the relief most envisage is not immediately around the corner.
- “I don’t think we’ll be wearing masks in two to three years — for this virus,” said Vineet Menachery, a coronavirus researcher at the University of Texas Medical Branch in Galveston.
- Menachery laid out 4 possible scenarios for how humans might interact with the coronavirus over time — in other words, what kind of immunity we might expect.
- Some of the terms are of his own creation, so they may not be instantly recognizable to people who have studied immunology. They also cover a spectrum, and the lines between some of the scenarios can be blurry in spots. But they provide a useful discussion starter.
- As Menachery sees it, the possibilities for the future when it comes to C19 and human immunity break down as follows: sterilizing immunity, functional immunity, waning immunity, and lost immunity.
- Please remember: These are educated guesses, based on what’s known about the way the immune system works in general, and how it responds to other coronaviruses.
- Sterilizing immunity would be a best-case scenario. It describes an immune system that is armed against a foe, able to fend it off before infection can take hold.
- Diseases that we think of as “one-and-done” infections induce such a robust and durable immune response in a single encounter that we cannot be reinfected. In general terms, measles fits into this category, although there are rare reports of people contracting measles more than once.
- The bad news is that viruses that infect via the mucus membranes of the nose and throat, like the coronavirus, typically don’t induce sterilizing immunity.
- “Sterilizing [immunity] in my view is out of the question, as with any respiratory virus,” said Marion Koopmans, head of virology at Erasmus Medical Center in Rotterdam, the Netherlands. Stanley Perlman, a coronavirus researcher at the University of Iowa, called this option “not so likely.”
- But Florian Krammer, a professor of vaccinology at the Icahn School of Medicine at Mount Sinai Hospital in New York, does believe some people will develop sterilizing immunity after a bout of C19.
- One last observation about sterilizing immunity: If infection doesn’t trigger it, there is reason to be concerned that vaccines may not either. Peiris noted that so far most of the experimental vaccines, when tested in primates, protect the lungs from severe disease but don’t block replication of virus in the upper airways.
- If the primates predict how the vaccines will work in people, these studies would suggest that people may still be able to be infected and they may emit viruses that potentially could infect others, but the type of C19 disease that lands people in ICUs and that sometimes kills them would be prevented.
- “Of course, what we’d all like is immunity that protects the individual — protects from infection and protects from transmission. We may not achieve that,” Peiris said. “Because protecting from infection of the upper respiratory tract and then transmission is quite a challenge.”
- Functional immunity, on the other hand, may be within reach. In fact, it’s the scenario Menachery sees as most likely.
- Under this scenario, people whose immune systems have been primed to recognize and fight the virus — whether through infection or vaccination — could contract it again in the future. But these infections would be cut short as the immune system’s defenses kick into gear. People infected might not develop symptoms or might have a mild, cold-like infection.
- “I’m a believer that if you’ve gotten C19, then your likelihood of dying from a second C19 case is very low, if you maintain immunity,” Menachery said.
- Peiris agreed. “It won’t have the impact it has now. … It becomes manageable.”
- There’s been enormous amounts of debate — and concern — about how long-lasting or “durable” immune responses to this virus will be, based on a few scientific papers that suggest some people don’t develop many antibodies to the virus and others that report that those antibodies appear to decline quickly.
- The experts who spoke with STAT all felt that the immune responses to this virus are exactly what you would expect to see. And the case of the Hong Kong man who appears to have been reinfected underscore that, several said.
- “The fact that somebody may get reinfected is not surprising. But the reinfection didn’t cause disease,” said Peiris, who knows about the case but was not one of the authors reporting it.
- Angela Rasmussen, a virologist at Columbia University in New York who studies human responses to viral infections, said it is hard to be definitive, given the limited human experience with this new coronavirus, but she said she could see no reason to believe the immune system would behave differently to this respiratory virus than to others.
- “So far, anyway, the evidence supports functional immunity, but the only way to see how long that will last is to follow people over time and see if those responses diminish,” she said.
- “The idea there is that, yes, your antibodies might wane, but your memory responses aren’t absent,” said Menachery, noting that when a primed immune system re-encounters the virus, production of antibodies would kick into gear.
- Christian Drosten, who is another co-discoverer of SARS-1, describes a future that fits into this category.
- “I clearly expect lasting and relevant immunity that is almost sterilizing immunity against the coronavirus in almost every person infected with the coronavirus,” Drosten, director of the Institute of Virology at Berlin’s Charité University Hospital, said via email.
- “It may be possible to become infected again, without any change in the virus. The resulting infection will be mild or asymptomatic, with significantly lower levels of virus replication and onward transmission.”
- Drosten’s last point would be a big bonus. If people who are reinfected don’t generate high levels of cornaviruses in their respiratory tracts and therefore don’t contribute much to the spread of the virus, C19 may become, over time, not just less dangerous, but also less common.
- “It may become a rare infection, although that is difficult to foresee given the size of the global population,” Koopmans said.
- Another hopeful part of this scenario relates to young children, who are far less likely than adults to develop severe disease. Krammer expects that children who first encounter the virus when they are very young may end up being infected several times over their lifetimes, but those later infections won’t lead to severe illness, even when they are elderly.
- “I think that’s kind of how, in the long run, it would play out without the intervention of vaccines,” Krammer said. “I think with vaccines, we just basically speed up that process.”
- A big question mark here relates to people who were infected and developed no symptoms, or who had very mild infections. Perlman said it’s not clear if their immune systems were sufficiently “tickled” to induce a long-lasting response, though he said he would guess — and he stressed it was a guess — that they would have enough protection to ward off severe disease.
- While this scenario sounds truly hopeful, Perlman sounded a note of caution. This type of protection, if it comes to pass, will exist on the individual level. There will likely remain pockets of people who have never been infected and who haven’t been vaccinated. If they contract the virus, “we should still see bad disease,” he said.
- Waning infection, the third scenario, is a variation of functional immunity. In this scenario, people who have been infected or vaccinated would lose their protection over time. But even if immunity wanes, reinfections would be less severe, Menachery said.
- “You will never get as sick as you were the first time,” he said.
- The man from Hong Kong may be an example of this phenomenon, though details of his immune responses to his first and second infections are not yet public.
- This is the pattern seen with the four coronaviruses that cause about 15% of what we consider common colds — OC43, 229E, NL63, and HKU1. People can be reinfected with these viruses after a relatively short period of time.
- Thirty years ago, British scientists reported that a year after deliberately infecting a small number of volunteers with 229E, two-thirds became reinfected when again exposed to the virus. “However, the period of virus shedding was shorter than before and none developed a cold,” they wrote.
- In another ambitious study, Dutch researchers followed 10 healthy individuals for decades, measuring antibody levels to the four human coronaviruses at regular intervals. Rises in antibodies were interpreted as evidence of recent infections. Most of the subjects had multiple infections with each of the viruses.
- The shortest period between infections was 6 months, though the median period between reinfections was 30 months. “We saw frequent reinfections at 12 months post‐infection and substantial reduction in antibody levels as soon as six months post‐infection,” they wrote. The paper is a preprint, meaning it has not yet undergone peer review.
- The senior author of the paper, Lia van der Hoek of Amsterdam University Medical Center, said via email that she felt waning immunity was the most likely scenario for what will happen with the coronavirus, but wouldn’t be drawn on what that would mean for people who are reinfected.
- “It is completely unknown what the symptoms will be when reinfection occurs. This could be less, or worse, or equal. We scientists cannot make a prediction on that,” she said.
- Krammer believes the overall picture will be mixed. Some people will have sterilizing immunity, but most will fit into either the functional or waning immunity categories. The net outcome: less of the type of disease that prompted most countries to take the extraordinary steps of locking down this spring.
- “What I think is going to happen with the majority of people who have natural infections, but also the majority of vaccinees, is that they will be protected from disease and might have much less virus if they get infected. They might not know that they’re infected,” he said.
- Lost immunity describes a scenario in which people who have been infected would lose all their immune munitions against the virus within some time frame. A reinfection after that point would be like a first infection — carrying all the same risk of severe disease now seen with C19.
- None of the experts who spoke to STAT felt this was a possibility.
- “I can’t imagine this being a situation where I get infected and then in 10 years, I get infected again and I have zero immunity,” Perlman said.
- “If you generate a response to clear the virus, I think you will maintain that immunity long term,” Menachery added, though he raised a question about people who have had symptom-free or mildly symptomatic infections. “For people with mild or asymptomatic infection, it may not be lost immunity, but rather no immunity generated.”
- If these experts are correct, and the worst-case scenario is off the table, humans can expect to see a waning of the threat coronavirus poses to people over time. Our immune systems will know how to deal with it. It could become the fifth human coronavirus to cause common colds.
- Dan Barouch, director of the Center for Virology and Vaccine Research at Boston’s Beth Israel Deaconess Medical Center, sounded a note of caution, though. The journey from where we are to that more manageable situation won’t be a quick one, he said. Most of the world’s population still has no experience with this virus and even if vaccines work, vaccinating billions of people around the world is the work of years, not months.
- He didn’t agree that what might happen could fit neatly into one of four categories listed above, saying he sees immunity more in terms of shades of gray that shift depending on the person’s immune status and the nature of their exposure to the virus.
- As Barouch sees it, some people’s immune responses might be able to ward off infection entirely in some circumstances, but other types of exposures might result in infection — for instance, if they were exposed to a large amount of the virus.
- “The short answer is we don’t know. So, anyone who gives you a scenario is providing a hypothesis,” he said.
J. Johns Hopkins COVID-19 Update
August 26, 2020
1. Cases & Trends
- The WHO C19 Dashboard reports 23.75 million cases (210,183 new) and 815,038 deaths (4,588 new) as of 9:30am EDT on August 26. The global daily incidence appears as though it may have passed a peak and is now beginning to exhibit a slow decline.
- The US CDC reported 5.72 million total cases (33,076 new) and 176,617 deaths (394 new). In total, 19 states (no change) are reporting more than 100,000 cases, including California with more than 600,000 cases; Florida and Texas with more than 500,000; New York with more than 400,000; and Georgia and Illinois with more than 200,000. The US represents approximately 24% of the total global C19 incidence and 22% of the total global deaths, despite accounting for only 4% of the global population.
- Several US territories continue to exhibit extremely high per capita daily incidence. Guam is reporting 326 new daily cases per million population, which would be #1 globally. It previously appeared as though much of Guam’s increased incidence was due to a large spike of 105 new cases reported on August 21; however, Guam has reported more than 50 new cases on 4 of the 5 days since then. The US Virgin Islands is reporting 320 daily cases per million population, which would also be #1 globally. Puerto Rico’s daily incidence has decreased over the past week or two, but it is still reporting 150 daily cases per million population, which would put it at #8 globally, falling between Israel and the Bahamas.
- As we have covered previously, the US passed its second C19 peak in late July, and we have been closely monitoring for an associated decrease in mortality. Now, approximately 1 month after the peak daily incidence, the US seems to be exhibiting the start of a decline in mortality. A large spike in deaths reported around August 6 makes it a little difficult to identify the beginning of the decline; however, the daily mortality has been slowly decreasing for at least the past week, dipping below 1,000 new deaths per day for the first time since July 27. Additionally, C19 mortality in the South, Southwest, and West regions—the most severely affected regions during the US resurgence over the past several months—appear to have passed their respective peaks as well. Mortality in these regions remains elevated, but it is at least starting to trend downward. Notably, C19 mortality is slowly increasing in the Midwest region, where we have also observed increasing and elevated incidence since mid-June. The Midwest is a mix of states that were severely affected early in the US epidemic, such as Illinois and Michigan; those that recently peaked as part of the summer resurgence, like Ohio and Wisconsin; and those that have not yet passed their peak, including Indiana, Iowa, and Kansas.
- The Johns Hopkins CSSE dashboard reported 5.79 million US cases and 178,819 deaths as of 12:30pm EDT on August 26.
2. US CDC Testing Guidance
- Earlier this week, the US CDC published a major update to its SARS-CoV-2 testing guidance. The biggest change addresses asymptomatic individuals with known exposure to a C19 case. In the previous version of the testing guidance, the CDC recommended diagnostic testing for, among others, “asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2 [in order to] to control transmission.” In the current iteration, the CDC states that asymptomatic individuals who have close contact with a C19 case “do not necessarily need a test unless [they] are a vulnerable individual” or if it is recommended or required by their healthcare provider or local or state public health agency. Notably, testing guidance published on other sections of the CDC website, updated on the same date as the testing guidance described above, continues to include close contact with a known case as a principal consideration for testing, along with exhibiting C19 symptoms and referral by healthcare providers or public health officials.
- The recommendation that asymptomatic individuals with known exposure do not necessarily need to be tested has potentially serious implications for both C19 control and surveillance. The updated guidance does recommend that these individuals monitor for symptoms, but as we have covered previously, it is widely understood that individuals infected with SARS-CoV-2 can transmit the infection without exhibiting symptoms—either in the days prior to the onset of symptoms or without developing symptoms at all. In fact, the CDC’s own “current best estimate” indicates that 50% of SARS-CoV-2 transmission occurs prior to the onset of symptoms (presymptomatic transmission) and that asymptomatic individuals are still 75% as infectious as symptomatic cases. Further down in the new testing guidance, at the bottom of the page, the CDC explicitly notes that infected individuals can spread the virus to others while they are not symptomatic, but the guidance does not provide further information regarding self-quarantine or other measures to mitigate this risk. Without testing, asymptomatic individuals would have no way of knowing that they are infected and potentially placing others at risk. Considering the significant role of asymptomatic and presymptomatic transmission, it is unclear why the testing guidance would de-emphasize testing any individuals with known exposure.
- The new testing guidance also states that asymptomatic individuals with known exposure “should strictly adhere to CDC mitigation protocols”; however, it is not clear exactly to which protocols the guidance is referring. The CDC guidance on community-related exposures recommends that exposed individuals self-quarantine for 14 days, monitor for fever and other symptoms, and avoid higher-risk individuals, but there is no link to this information from the new testing guidance. It is possible that the CDC wholly shifted its focus to self-quarantine following all known exposures, at least for asymptomatic individuals, rather than waiting for or relying on diagnostic test results; however, this is not all that clear from reading the updated testing guidance alone. Individuals seeking information on testing would also need to know where else to look in order to get the full set of recommendations.
- Regardless of whether quarantine without testing would be sufficient to contain the spread of C19—including whether exposed individuals would voluntarily self-quarantine in the absence of both symptoms and a positive test—the change could also impact public health C19 surveillance. The CDC guidance notes that state and local health departments may require testing for asymptomatic individuals with known exposure, but the change in guidance could have a substantial impact on the volume of testing conducted for these individuals, particularly for those not already known to health officials (eg, through contact tracing). A spokesperson for the Department of Health and Human Services argued that the updated guidance functions to support public health surveillance at the state and local levels. Public health officials have struggled since the onset of the pandemic to characterize the scale of infection in their communities, particularly with respect to asymptomatic infections or mild cases. If asymptomatic individuals with known exposure are no longer recommended for testing, this could limit the number of infections reported to public health agencies and prioritize those with more severe disease, much like what occurred early in the pandemic. This has potentially serious implications for our understanding of the level of community transmission as well as disease severity and mortality risk. Notably, the CDC guidance for schools repeatedly emphasizes the need to understand and control community transmission in order to mitigate transmission risk as students return to in-person classes. Without testing asymptomatic individuals with known exposure, it could give the false impression that community transmission is lower than it actually is, which could subsequently increase the risk for school-based transmission, clusters, and outbreaks.
3. Convalescent Plasma EUA
- Following the US FDA’s announcement of the Emergency Use Authorization (EUA) issued for the use of convalescent plasma treatment for C19 patients, some experts questioned the underlying data and statements made by senior government officials—including FDA Commissioner Dr. Stephen Hahn, Secretary of Health and Human Services Dr. Alex Azar, and President Donald Trump—regarding the treatment’s efficacy. In response to the criticism, Commissioner Hahn issued a statement acknowledging that some of the data had been misrepresented. In particular, he clarified that the 35% decrease in mortality touted by President Trump, Secretary Azar, and himself referred to a relative risk reduction rather than absolute, a major issue identified by a number of health experts. He also emphasized that the FDA’s decision was based wholly on the available data and that political considerations played no role in the FDA’s determination. Notably, the clinical trial data from the Mayo Clinic study did not include a control group, so it is not actually possible to draw definitive conclusions about the treatment’s efficacy. The FDA will continue to monitor convalescent plasma data as it becomes available.
4. US CDC: Don’t Argue with Anti-Maskers
- Following increasing reports of violent confrontations with individuals opposed to C19 social distancing policies, including mandatory mask use at some businesses, the US CDC published guidance for retail workers to manage these risks. One of their principal recommendations is not to argue with non-compliant customers if they become aggravated. Reports of threats, assault, and other violent behavior by individuals opposed to C19-related policies have become more commonplace as US businesses continue to reopen and retail employees are put in the position of enforcing new store policies.
- The CDC guidance remains consistent in its recommendations for mask use, social distancing, and other measures while also taking into account the heightened risk of violence for those enforcing these policies. In addition to avoiding confrontations with aggravated individuals, the guidance also recommends that employers implement threat recognition and conflict resolution training, pair workers in teams to provide support in numbers, and provide employees with a safe area to go to if threatened. The guidance seems to take a common sense stance on worker safety: it is not worth the risk of violence for employees to force individuals to comply with store policies. Regardless, it remains concerning that some individuals not only refuse to comply with recommended (or required) protective actions but will raise their opposition to the level of directly endangering the health and safety of others through physical violence.
- A Florida judge granted a temporary injunction to the state’s order requiring schools to open for in-person classes by August 31. The order was issued on July 6 by Florida’s Commissioner of Education, and it included provisions that would withhold state funding for school districts that did not comply. The judge noted that some parts of the order were unconstitutional and that Florida removed school districts’ ability to choose safe reopening plans. The lawsuit, filed by the Florida Education Association (a statewide teacher’s union) and the National Association for the Advancement of Colored People (NAACP), seeks to allow local school districts to develop and implement their own reopening plans, potentially including decisions to suspend in-person classes, without risking a loss of funding. State officials indicated that they intend to appeal the judge’s ruling.
Colleges & Universities
- Several major colleges and universities are reporting concerning C19 data shortly after resuming classes. The University of Alabama has reported more than 550 cases across its 3 universities, including the main campus in Tuscaloosa, in less than a week. Notably, this total does not include cases identified when students underwent “entry testing” prior to returning to campus. The University of North Carolina (UNC) has reported nearly 650 cases since August 10, 218 of which were reported last weekend alone. Additionally, UNC’s test positivity has increased dramatically over the past 2 weeks, jumping from 2.8% the week of August 3-9 to 32.2% the week of August 17-23, an indication that the university’s testing strategy may not be sufficient to fully capture transmission among students and staff. Currently, more than half of the available on-campus isolation and quarantine room capacity is already occupied, and the student census in on-campus residence halls has decreased by approximately 75% since August 17.
- Several colleges and universities have issued warnings to students regarding gatherings that violate the schools’ C19 guidelines, some of which include a variety of associated punishments for violations. Central Michigan University announced that students may be subject to fines or suspension if they attend or host large gatherings. Syracuse University is already enforcing a similar policy, reportedly suspending 23 students following a large gathering prior to the start of classes. Senior university officials described the event “incredibly reckless.” The Ohio State University also reportedly suspended more than 200 students due to large gatherings, and Penn State University reportedly suspended 2 fraternities after hosting large events. Penn State officials stated that no further disciplinary action would be taken against the students as long as they undergo SARS-CoV-2 testing.
- Numerous health experts have noted problems associated with colleges and universities resuming in-person classes but blaming students for issues related to C19. These policies not only aim to direct responsibility for the students’ health and wellbeing away from the school officials who are making the decisions to resume in-person classes, they also increase the risk that students will hide risky activities and avoid testing and contact tracing that would be critical to containing associated clusters and outbreaks.
6. Motorcycle Rally
- The annual Sturgis Motorcycle Rally drew hundreds of thousands of bikers from across the US to a small town in South Dakota for a 10-day festival. Health officials have identified at least 103 cases of C19 across at least 8 states that are believed to be connected with the rally, and that number is expected to grow in the coming weeks. Held August 7-16, the rally drew approximately 460,000 vehicles to the small town of Sturgis, which has a population of 7,000—71 times smaller than its occupancy during the rally. Multiple reports indicate that social distancing and other protective measures, including mask use, were not widely enforced or practiced by the attendees. South Dakota health officials are conducting contact tracing operations to the extent possible, and they have already identified several exposures at the rally, including cases detected among bartenders, tattoo artists, and rally attendees.
- Given the size of the event, contact tracing is a difficult task, and health officials have asked attendees to monitor their symptoms for 14 days. According to cell phone geo-location data, more than 61% of US counties have been visited by someone who attended the Sturgis Motorcycle Rally, which illustrates the potential for widespread geographic transmission of SARS-CoV-2 resulting from the event. Like other large events or gatherings, it could be several weeks before any indication of increased transmission becomes evident. And because the participants dispersed across a wide geographic area (as opposed to remaining concentrated locally), it may be very difficult to identify associated clusters or outbreaks among the broader US epidemic.
7. Physical Distancing
- Many national and international (eg, WHO) guidelines for social distancing and risk mitigation for C19 include a minimum standard for physical distancing. For example, the prevailing guidance in the US recommends maintaining a distance of 6 feet between yourself and others, and the WHO recommends a distance of 1 meter. In reality, the risk of transmission by respiratory droplets or aerosols does not stop at this distance, but rather, they correspond to the point beyond which transmission risk is generally low. They also serve as convenient reminders to the public to maintain physical separation from others in order to mitigate transmission risk. The 6-foot or 1- or 2-meter recommendations stem from historical research on the dispersal of respiratory droplets, but they are not hard and fast rules and do not account for increased risk under a variety of conditions.
- Researchers from the UK and the Massachusetts Institute of Technology (US) published an Analysis article in the journal BMJ that addresses the limitations of these recommendations and proposes an alternative method of communicating transmission risk. The authors note that respiratory droplets exist across a spectrum of sizes, with the smallest transitioning into aerosols, and these particles can travel much farther than 6 feet or 2 meters. Rather than focusing on specific distances in terms or maintaining physical distancing, they argue that guidance should account for other factors as well, including the “force of emission” (eg, breathing vs speaking vs shouting or singing), mask use, ventilation, and duration of exposure. Their proposed transmission risk framework presents the relative transmission risk for various combinations of these factors, which they argue will enable individuals to better assess their risk and take appropriate precautions, such as reducing their exposure time or increasing their physical distance from others.
- While this model certainly offers a more refined and detailed risk analysis, compared to the single recommended separation distance, and more accurately captures the spectrum of risk for different environments and activities, it requires individuals to make their own risk determination and does not necessarily present the user with explicit actions to take under each scenario. In the absence of specific recommended actions, individuals may be less likely or less able to utilize the tool. Additionally, the associated precautions may vary for different environments or activities, which requires individuals to identify appropriate different precautions on their own. The concrete 6-foot or 1-meter recommendations may not sufficiently decrease transmission risk in all scenarios; however, they are simple, consistent, and easy to remember, which could increase their utility and mitigate transmission risk under a variety of scenarios, even if it is not a perfect solution. Individuals should be encouraged to consider a variety of factors in assessing their risk in any given situation, and the use of more detailed risk assessment frameworks and convenient but simplified guidance (eg, minimum recommended physical distancing) are not mutually exclusive.
8. Systemic Racism & C19
- The Johns Hopkins Center for Health Security’s journal, Health Security, issued a call for papers for an upcoming Special Feature on systemic racism in the context of the C19 pandemic. The Special Feature is scheduled to be published in May/June 2021, and all content will be open access. The C19 pandemic’s myriad impacts on health, economies, and social structures have disproportionately impacted racially marginalized populations, in the US and around the world. Racial and ethnic minority communities are experiencing elevated C19 morbidity and mortality, stemming in part from ineffective response efforts and longstanding barriers to accessing healthcare and public health programs and services. Evidence-based and peer-reviewed research is urgently needed to examine the root causes and impacts of systemic and pervasive racial and ethnic inequities in the context of C19. This Special Feature will examine how systemic racism manifests in the practice of health security, including in preparedness for, response to, and recovery from C19. Notably, the journal is actively encouraging submissions from women, underrepresented minority scholars in health security, and scholars with disabilities. Additional information is available here.