September 2, 2020
“Coronavirus lockdowns are 10 times more deadly than the actual virus in terms of years of life lost by American citizens.”Conclusion of study commissioned by Revolver News
1. Cases & Tests
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (9/1)
1. The dangers of rushing a coronavirus vaccine
I. Links to Other Stories
U.S. advisory group lays out detailed recommendations on how to prioritize C19 vaccine A new report that aims to prioritize groups to receive C19 vaccine focuses on who is at risk, rather than using job categories or ethnic groups to determine who should be at the front of the line.
C19 patients in earlier stages exhaled millions of coronavirus per hour Exhaled breath samples had the highest positive rate (26.9%, n=52), followed by surface swabs (5.4%, n=242), and air samples (3.8%, n=26). C19 patients recruited in Beijing exhaled millions of coronavirus RNA copies into the air per hour. Exhaled breath emission may play an important role in the C19 transmission.
A coronavirus vaccine candidate would likely match all currently circulating variants The rapid spread of the coronavirus raises questions about the possibility of a universally effective vaccine. The virus can mutate in a given individual, and these variants can be propagated across populations and time. To understand this process, we analyze 18,514 coronavirus sequences sampled since December 2019. We find that neutral evolution, rather than adaptive selection, can explain the rare mutations seen across coronavirus genomes.
Development and Evaluation of a Rapid CRISPR-based Diagnostic for C19 Metagenomic next-generation sequencing and reverse-transcription PCR have been the most commonly used molecular methodologies. However, each has their own limitations. In this study, authors developed an isothermal, CRISPR-based diagnostic for C19 with near single-copy sensitivity.
How WeChat Censored the Coronavirus Pandemic When the coronavirus was first discovered in China last winter, the country responded aggressively, placing tens of millions of people into strict lockdown. As C19 spread from Wuhan to the rest of the world, the Chinese government was just as forceful in controlling how the health crisis was portrayed and discussed among its own people.
Acedia: the lost name for the emotion we’re all feeling right now We get distracted by social media, yet have a pile of books unread. We keep meaning to go outside but somehow never find the time. We’re bored, listless, afraid and uncertain. What is this feeling? John Cassian, a monk and theologian wrote in the early 5th century about an ancient Greek emotion called acedia. A mind “seized” by this emotion is “horrified at where he is, disgusted with his room … It does not allow him to stay still in his cell or to devote any effort to reading”. He feels: such bodily listlessness and yawning hunger as though he were worn by a long journey or a prolonged fast … Next he glances about and sighs that no one is coming to see him. Constantly in and out of his cell, he looks at the sun as if it were too slow in setting. This sounds eerily familiar. Yet, the name that so aptly describes our current state was lost to time and translation.
Some Covid-19 infections among health care workers may be going undetected C19 among health care providers treating infected individuals may be higher than reported, according to new CDC data. An analysis of more than 3,200 health workers at 13 academic medical centers across the U.S. found that approximately 6% of them tested positive for coronavirus antibodies, suggesting they had previously been infected. Yet, almost a third of these individuals did not recall having any symptoms consistent with C19 infection, nearly 1 in 2 didn’t suspect having infection, and two-thirds did not have a previous positive test result for C19. Those who said they wore PPE during all interactions with patients were less likely to have coronavirus antibodies than those who reported inconsistent PPE use.
Boosting early immune defenses called interferons might be a way to fight C19 An improved understanding how the virus disarms some of the body’s immune fighters, called interferons, is creating excitement among scientists who theorize they might be able to counter that process and prevent infections from developing into severe disease.
These Scientists Are Giving Themselves D.I.Y. Coronavirus Vaccines Impatient for a coronavirus vaccine, dozens of scientists around the world are giving themselves — and sometimes, friends and family — their own unproven versions.
Coronavirus can cause men’s testicles to swell up – and leave them infertile Medics in the US are warning that C19 could cause the bizarre side-effect after treating a previously healthy 37-year-old man. The doctors, from the San Antonio Uniformed Services Health Education Consortium in Texas, said the patient went to A&E with swelling and discomfort in his scrotum.
A. The Pandemic As Seen Through Headlines
(In no particular order)
- CDC: 94% of Americans who died from C19 had contributing conditions
- Face shields, masks with valves ineffective against C19 spread
- FDA Broadens Emergency Use Authorization for Remdesivir to Include All Hospitalized Patients for Treatment of C19
- Experts call for independent commission separate from FDA to review C19 vaccines
- Infectious Diseases Specialists to FDA: Don’t Cut Corners in C19 Vaccine Approval
- Poll: Most Americans Believe the C19 Vaccine Approval Process is Driven by Politics, Not Science
- US facing primate shortage for COVID vaccine research
- Anti-Trump hysterics now look to block … a vaccine
- US will not join WHO’s coronavirus vaccine effort, White House says
- Dozens of scientists around the world are working on, and giving themselves, family and friends, D.I.Y. vaccines, with wildly varying methods, affiliations and claims
- Man who lost 7 relatives to C19 first to try experimental vaccine in US
- An N.I.H. panel says there is a lack of data to support the efficacy of using plasma to treat coronavirus patients
- In Unprecedented Move, CDC Halts Most Rental Evictions Until End Of 2020
- The numbers are clear: COVID is no real threat to kids
- Maryland moves to reopen all businesses Friday
- Roche plans launch of rapid test in Europe
- Texas could reopen businesses next week
- Florida Gov. DeSantis: ‘We Will Never Do Any of These Lockdowns Again’
- An isolated community in Washington State has avoided the virus, but at what cost?
- Brazil slides back into recession as COVID rages
- Argentina’s positivity rate surges
- NYC Mayor de Blasio strikes deal with teachers unions
- De Blasio Suggests Return of Indoor Dining Depends on Coronavirus Vaccine
- De Blasio Says NYC Indoor Dining May Not Happen Until June 2021 (that is, if anyone is left in New York City by then….)
- NY Gov. Cuomo admits ban on NYC indoor restaurant dining may send people to NJ
- Russia cases top 1 million, 4th country to do so
- New hotspots emerge in Iowa, North Dakota, South Dakota and Alabama
- India new cases slow after week of record gains as country enters new phase of reopening
- Indonesia’s outbreak takes a heavy toll on its medical workers
- Sweden considers new local restrictions
- WHO warns countries can’t just abandon COVID protections
- Obese people at much higher risk of death, study shows
- Many Illegal Immigrants with C19 Face A Long Recovery, Largely On Their Own
- Pandemic brings hard times for farmers, worsening hunger
- Florida’s schools reopened this week, with many students attending classes in person
- Students in many countries are returning to their classrooms this week after months of virus-related closures
- China’s Wuhan says all schools to reopen on Tuesday
- A Quick Virus Test? Sure, If You Can Afford It
- Millions Of Americans Had Their Emergency Savings Wiped Out By Downturn
- One In Four Workers Say They Are Working Entirely From Home
- Nevada Lab Confirms First Case Of COVID-19 Reinfection Documented In US
- ‘Here We Go Again’: A Second Virus Wave Grips Spain
- Germany’s Lockdowns Have Fostered Resentment & Violence Among The Nation’s Youth
- Germany institutes rule that requires masks at demonstrations with more than 100 participants
- Sweden’s Conservatives Warn Surging Violent Crime Has Become A “Second Pandemic”
- N. Korea reportedly orders police to shoot citizens who approach border
- Putin Says Worst Of Russia’s Virus-Induced Recession Over As Recovery Nears
- New York City’s MTA Crisis Could Be “Catastrophic” For Housing Market
- Recent Wave Of Job Losses Casts Shadow On Recovery
- Australia Plunges Into First Recession In 29 Years Following Biggest GDP Drop On Record
- Surgical backlog in Ontario from C19 will take 84 weeks to clear
- Bhutan’s government has started to sell tobacco to fight the virus.
- Philadelphia Mayor Shamed After Eating Indoors In Maryland While His City Remains Shut Down
- Fancy Nancy: Pelosi breaks local COVID rules to get her hair done
- “The Smell Of Rotten Meat”: Garbage Is Piling Up Across Major US Cities As COVID Hits Sanitation Workers
- Colleges Are Testing Dorm Sewage To Detect Early COVID-19 Outbreaks
- ‘Children Are Better Off In Class’: Europe Sending Children Back To School Despite COVID-19
- ‘Empty Highways’ – About 61 Million Americans Have Stopped Commuting In Post-Covid World
- Pregnant teacher dies of C19 after co-workers throw surprise baby shower
- Twitter account of late Herman Cain deletes post downplaying C19
- Too much open road? Car crash deaths spiking with fewer people driving
- UN chief says coronavirus reversed fragile progress on gender equality
- New viruses among humans are accelerating. The reason is ecological disturbance, caused by us.
- Mass testing at a Tennessee prison finds that nearly 2 out of 3 inmates have the virus
- Children of color are infected and hospitalized at higher rates than white children, new U.S. research shows
- Aspirated consonants may promote the spread of C19
- “The Most Dramatic Shift In The History Of Food Service” – Restaurants Suddenly Can’t Find Enough Workers
- Wearing Face Masks Makes People Act Careless And Ignore Social Distancing, UK Study Finds
- Hotels reeling six months into coronavirus pandemic, analysis finds
- Google, Apple unveil built-in C19 exposure notifications
- Your smartphone may soon let you know you’ve been exposed
- Uber to crack down on passengers not wearing masks with new requirement
- In sickness and health? US divorce rates skyrocket amid C19
- Massive New Jersey pool party with pricey cover fee busted by cops
- Movie theaters in NJ can reopen Friday at reduced capacity
- White House set to resume public tours after 6-month hiatus
- 5-year-old Arizona boy with autism booted from school bus for not wearing mask
- UFO sightings on rise amid coronavirus pandemic
- Pet owners are relying on their pets to keep their spirits high now more than ever
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day. Green highlights indicate a decrease or no change and yellow highlights indicate an increase.
1. Cases & Tests
- Total Cases = 25,892,091
- New Cases = 263,951
- New Cases (7 day average) = 260,076 (+1,660) (+0.6%)
- Number of new cases is 11,625 higher than last week
- 7 day average of new cases has been trending higher since 8/26
- 7 day average of new cases is 1.6% below record high on 8/14
- 1,000,000+ cases every 4 days (based on 7 day average)
US Cases & Testing:
- Total Cases = 6,257,571
- New Cases = 45,775
- Percentage of New Global Cases = 17.3%
- New Cases (7 day average) = 42,543 (+258) (+0.6%)
- Total Number of Tests = 83,850,119
- Percentage of positive tests (7 day average) = 5.8%
- Number of new cases is 1,809 higher than one week ago
- Although the 7 day average of cases has been declining since 7/25, the rate of decline has slowed down since 8/23
- 7 day average of new cases has only declined 1.4% since 8/23
- 7 day average of the percentage of positive tests continues to decline
- Total Deaths = 860,323
- New Deaths = 5,899
- New Deaths (7 day average) = 5,394 (-23) (-0.4%)
- New cases are 161 lower than last week
- 7 day average of new deaths have been declining since 8/13
- 7 day average of new deaths as declined from 5,890 on 8/13 to 5,394 on 9/1, a decrease of 8.4%
- Although the 7 day average of new deaths has been declining since 8/13, it can be expected to begin increasing over the next few weeks if the 7 day average of new cases continue to increase
- Total Deaths = 158,929
- New Deaths = 1,164
- Percentage of Global New Deaths = 9.6%
- New Deaths (7 day average) = 960 (-18) (-1.9%)
- Number of new deaths is 126 less than last week
- 7 day average has been steadily (but slowly) declining since 8/15
- 7 day average has been under 1,000 since 8/23
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (9/1)
- While the Sunbelt states (CA, FL, GA, and TX) still lead in the number of new daily cases, there has been a changing of the guard in terms of positivity. The Midwest and Plains states (IA, KS, ND and SD) are have seen rising positivity rates
|Cases (8/1)||Cases (9/1)||% Change|
Source: Worldometer and The Covid Tracking Project
C. New Scientific Findings & Research
1. Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be.
- Some of the nation’s leading public health experts are raising a new concern in the endless debate over coronavirus testing in the United States: The standard tests are diagnosing huge numbers of people who may be carrying relatively insignificant amounts of the virus.
- Most of these people are not likely to be contagious, and identifying them may contribute to bottlenecks that prevent those who are contagious from being found in time. But researchers say the solution is not to test less, or to skip testing people without symptoms, as recently suggested by the CDC.
- Instead, new data underscore the need for more widespread use of rapid tests, even if they are less sensitive.
- “The decision not to test asymptomatic people is just really backward,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, referring to the CDC recommendation.
- “In fact, we should be ramping up testing of all different people,” he said, “but we have to do it through whole different mechanisms.”
- In what may be a step in this direction, the Trump administration announced on Thursday that it would purchase 150 million rapid tests.
- The most widely used diagnostic test for the new coronavirus, called a PCR test, provides a simple yes-no answer to the question of whether a patient is infected.
- But similar PCR tests for other viruses do offer some sense of how contagious an infected patient may be: The results may include a rough estimate of the amount of virus in the patient’s body.
- “We’ve been using one type of data for everything, and that is just plus or minus — that’s all,” Dr. Mina said. “We’re using that for clinical diagnostics, for public health, for policy decision-making.”
- But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.
- The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.
- This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.
- In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90% of people testing positive carried barely any virus, a review by The Times found.
- On Thursday, the United States recorded 45,604 new coronavirus cases, according to a database maintained by The Times. If the rates of contagiousness in Massachusetts and New York were to apply nationwide, then perhaps only 4,500 of those people may actually need to isolate and submit to contact tracing.
- One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.
- Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.
- Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.
- A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.
- The FDA said in an emailed statement that it does not specify the cycle threshold ranges used to determine who is positive, and that “commercial manufacturers and laboratories set their own.”
- The CDC said it is examining the use of cycle threshold measures “for policy decisions.” The agency said it would need to collaborate with the FDA and with device manufacturers to ensure the measures “can be used properly and with assurance that we know what they mean.”
- The CDC own calculations suggest that it is extremely difficult to detect any live virus in a sample above a threshold of 33 cycles. Officials at some state labs said the CDC had not asked them to note threshold values or to share them with contact-tracing organizations.
- For example, North Carolina’s state lab uses the Thermo Fisher coronavirus test, which automatically classifies results based on a cutoff of 37 cycles. A spokeswoman for the lab said testers did not have access to the precise numbers.
- This amounts to an enormous missed opportunity to learn more about the disease, some experts said.
- “It’s just kind of mind-blowing to me that people are not recording the C.T. values from all these tests — that they’re just returning a positive or a negative,” said Angela Rasmussen, a virologist at Columbia University in New York.
- “It would be useful information to know if somebody’s positive, whether they have a high viral load or a low viral load,” she added.
- Officials at the Wadsworth Center, New York’s state lab, have access to C.T. values from tests they have processed, and analyzed their numbers at The Times’s request. In July, the lab identified 794 positive tests, based on a threshold of 40 cycles.
- With a cutoff of 35, about half of those tests would no longer qualify as positive. About 70% would no longer be judged positive if the cycles were limited to 30.
- In Massachusetts, from 85 to 90% of people who tested positive in July with a cycle threshold of 40 would have been deemed negative if the threshold were 30 cycles, Dr. Mina said. “I would say that none of those people should be contact-traced, not one,” he said.
- Other experts informed of these numbers were stunned.
- “I’m really shocked that it could be that high — the proportion of people with high C.T. value results,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “Boy, does it really change the way we need to be thinking about testing.”
- Dr. Jha said he had thought of the PCR test as a problem because it cannot scale to the volume, frequency or speed of tests needed. “But what I am realizing is that a really substantial part of the problem is that we’re not even testing the people who we need to be testing,” he said.
- The number of people with positive results who aren’t infectious is particularly concerning, said Scott Becker, executive director of the Association of Public Health Laboratories. “That worries me a lot, just because it’s so high,” he said, adding that the organization intended to meet with Dr. Mina to discuss the issue.
- The FDA noted that people may have a low viral load when they are newly infected. A test with less sensitivity would miss these infections.
- But that problem is easily solved, Dr. Mina said: “Test them again, six hours later or 15 hours later or whatever,” he said. A rapid test would find these patients quickly, even if it were less sensitive, because their viral loads would quickly rise.
- PCR tests still have a role, he and other experts said. For example, their sensitivity is an asset when identifying newly infected people to enroll in clinical trials of drugs.
- But with 20% or more of people testing positive for the virus in some parts of the country, Dr. Mina and other researchers are questioning the use of PCR tests as a frontline diagnostic tool.
- People infected with the virus are most infectious from a day or two before symptoms appear till about five days after. But at the current testing rates, “you’re not going to be doing it frequently enough to have any chance of really capturing somebody in that window,” Dr. Mina added.
- Highly sensitive PCR tests seemed like the best option for tracking the coronavirus at the start of the pandemic. But for the outbreaks raging now, he said, what’s needed are coronavirus tests that are fast, cheap and abundant enough to frequently test everyone who needs it — even if the tests are less sensitive.
- “It might not catch every last one of the transmitting people, but it sure will catch the most transmissible people, including the superspreaders,” Dr. Mina said. “That alone would drive epidemics practically to zero.”
2. Key to Preventing C19 Indoors: Ventilation
- Add this to the C19 prevention toolbox: strong ventilation.
- After urging steps like handwashing, masking and social distancing, researchers say proper ventilation indoors should join the list of necessary measures. Health scientists and mechanical engineers have started issuing recommendations to schools and businesses that wish to reopen for how often indoor air needs to be replaced, as well as guidelines for the fans, filters and other equipment needed to meet the goals.
- “We didn’t focus on it enough initially,” said Abraar Karan, a doctor at Brigham and Women’s Hospital in Boston who treated C19 patients. “We told everyone to stay home. We weren’t thinking about people congregating in public spaces.”
- Driving the thinking is mounting evidence that the new coronavirus is transmitted through the air among people with prolonged exposure to the pathogen. Especially troublesome, epidemiologists and other scientists say, is evidence from numerous indoor outbreaks suggesting the virus’s ability to spread to others even when close contact is avoided.
- The precise role that airborne transmission plays is still being debated by parts of the scientific community. Yet proponents of aerosol transmission say the evidence so far argues for the need to keep clean air flowing in indoor spaces where people gather.
- Ideally, they say, public spaces like a standard classroom should aim to have air replaced with clean air between four to six times an hour to dilute C19 particles that might accumulate.
- That can be done, aerosol scientists and building engineers say, through strategies that introduce outdoor air and filter indoor contaminants. Those include opening windows and doors, installing window fans, using portable air purifiers with high-efficiency particulate air, or HEPAfilters and upgrading heating, ventilation and air-conditioning systems to meet certain standards.
Keeping Classroom Air Clean
- Scientists say schools and businesses should focus on improving ventilation to help prevent C19’s spread. Spaces such as a typical classroom should aim to have air replaced with clean air four to six times an hour, though recommendations can vary by room size and occupancy. That can be done by introducing more outdoor air and enhancing filtration.
- Some businesses have begun taking such steps, including malls and gyms in New York, where reopening guidelines list enhanced air filtration as mandatory for the spaces. But in aging schools nationwide, strengthening ventilation may be difficult.
- About 41% of U.S. public-school districts need to update or replace their HVAC systems in at least half their schools, representing about 36,000 schools nationwide, according to a report published in June by the U.S. Government Accountability Office, a federal watchdog.
- Repairs can be costly. Denver Public Schools plans to spend nearly $5 million before students return to improve HVAC systems across roughly 185 buildings, including upgrading filters, repairing broken parts and increasing the amount of outdoor air in the systems, it said.
- Public health officials and scientists studying the virus are still working to better understand how C19 is transmitted. Some argue it is predominantly spread by large droplets, transmitted by coughing, talking or sneezing, which people nearby can inhale. The droplets, which tend to fall to the ground quickly, can also splatter on surfaces that bystanders touch and transfer to their mouths, noses and eyes.
- Other scientists argue a significant role is played by smaller particles invisible to the naked eye, called aerosols, that linger in the air and travel. A recent study—which found that particles extracted almost 16 feet from hospitalized C19 patients could infect cells in a lab—suggests aerosols as a potential source of spread, aerosol scientists say. The study, posted on the preprint server medRxiv, hasn’t been peer reviewed.
How Droplets Move
- Droplets of all sizes are emitted when a person coughs, talks or sneezes. How they travel depends on many factors. Some research has found that droplets will be carried by a moist gas cloud, which a Massachusetts Institute of Technology researcher has said can travel up to about 26 feet after a sneeze. Some of the droplets will fall as the cloud moves. Others ultimately evaporate, producing aerosols that can linger in the air and travel with airflow patterns, a March article by the researcher published in the Journal of the American Medical Association said.
- “Based on the evidence we have on hand, it seems wildly irresponsible to me not to recommend strategies” for ensuring strong ventilation, said Joseph Allen, director of Harvard University’s Healthy Buildings program, which studies how buildings affect human health.
- He and other health-science and mechanical engineering experts recently released a tool to help schools determine how to attain several air changes an hour. Currently, he said, some schools may only be achieving one or two.
- Poor ventilation may have played an important role in several indoor C19 cases, researchers said.
- Five people sitting at tables adjacent to an infected but presymptomatic diner inside a Guangzhou, China, restaurant in January later tested positive for C19, despite video that indicates the separate parties didn’t have close contact, according to an April study published on a preprint server. Some patrons who contracted the virus, the authors said, were seated as far as 15 feet away from the infected diner.
- The third floor of the restaurant, where the patrons were seated, had no outdoor air supply, exhaust fans in the walls weren’t running and ventilation was mostly provided by an occasionally opened door, the study found.
- Likewise, a coronavirus outbreak at a choir rehearsal in Washington state was likely exacerbated by poor ventilation, a study showed. Some 53 of 61 attendees were confirmed or strongly suspected to have C19, including two who died.
- Doors were closed at the church’s fellowship hall where the March rehearsal took place, the study, published on a preprint server in June, found. One of the authors said the research team believes that a furnace wasn’t likely operating for most of the rehearsal, providing no filtration or outdoor air supply through the system when it was off.
Students at Pine Grove Area High School in Pine Grove, Pa., were spaced 6 feet apart in class last week.
- The studies demonstrate the importance of introducing outdoor air and having HVAC systems equipped with filters that can remove viral particles, according to scientists who have examined indoor outbreaks of C19. Mechanical engineers recommend increasing a HVAC system’s outdoor air supply and installing a MERV13 filter if the system can handle it. That filter, they say, can trap and remove a substantial number of small and large particles before recirculating air back into a room.
- Absent a well-functioning HVAC system—or if no HVAC system exists—researchers who have studied ventilation say there are relatively inexpensive strategies that schools and businesses can implement to dilute virus-laden air, such as opening windows and doors.
- Installing fans in windows, so long as they aren’t positioned to directly blow air from one person to another, can also increase airflow.
- Both strategies, however, may be difficult to rely on during the winter. As a result, researchers proposed using portable air purifiers with HEPA filters.
- HEPA filters, which trap contaminants pulled in by purifiers before pushing clean air back out, are almost 100% efficient at capturing all airborne particles, including the very smallest sizes.
3. Yet more data support C19 aerosol transmission
- Two studies published late last week in Clinical Infectious Diseases highlight the role of airborne spread of C19 and the importance of efficient ventilation systems. One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak affecting 81% of residents and 50% of healthcare workers at a Dutch nursing home to inadequate ventilation.
- In the first study, researchers in China analyzed exhaled breath samples from 49 C19 patients from 10 countries, 4 hospitalized patients without C19, and 15 healthy people from Beijing using reverse transcription polymerase chain reaction. They also tested 26 air samples and 242 surface swabs from quarantine hotels, hospitals, and personal belongings.
- Of the exhaled breath samples, 26.9% were positive for RNA from coronavirus, the virus that causes C19, while 3.8% of air samples and 5.4% of surface swabs tested positive. The viral RNA breath emission rate was highest in the first stages of disease.
- Breath samples from two patients were positive for coronavirus RNA, but surface swabs of their cell phones, hands, and toilets were negative. Viral RNA was also detected on an air ventilation duct below another patient’s bed.
- Among the 242 surface swabs, viral RNA was found most often on toilet bowls (16.7%); floors (12.5%); patient hands, pillowcases, mobile phones, and computer keyboards (4.0%); and surfaces that healthcare staff touched (2.6%). But only 2 of 22 mobile phone surface samples tested positive for viral RNA, and all object handles were negative.
- The authors said that the viral RNA breath emission rate appears to vary based on factors such as patient activity level and disease stage and may be affected by age. Viral RNA emission was sporadic in at least one patient, whose samples generated different test results on different days.
- The findings support previous studies that concluded that C19 is mostly likely spread by aerosols rather than large respiratory droplets or contaminated surfaces, the researchers said. Such studies have documented airborne spread in semi-enclosed environments such as a choir practice in Washington state and a restaurant in Guangzhou, China.
- “Though we did not study infectivity or transmission probability and other virus releasing activities such as talking and singing, our study demonstrates that exhaled breath emission plays an important role in SARS-CoV-2 emission into the air, which could have contributed greatly to the observed airborne cluster infections and the ongoing pandemic,” the authors wrote.
Stale indoor air
- In the second study, researchers in Rotterdam and Utrecht, the Netherlands, wrote a research letter documenting a C19 outbreak that sickened 17 residents and 17 healthcare staff in one of seven wards in a nursing home for people with psychiatric or behavioral conditions. None of the 95 residents or 106 healthcare staff in the other six wards tested positive.
- The authors noted that the Netherlands was experiencing a low prevalence of C19 the week of the outbreak, with only 493 of that country’s residents testing positive, compared with 8,391 cases during the most intense week of the outbreak in April.
- To prevent coronavirus transmission, all healthcare workers were assigned to specific wards and required to wear surgical masks during patient care starting Apr 26. Residents lived in individual rooms and spent part of each day in shared living rooms; some residents were mobile.
- Suspecting that the ventilation system of the affected ward could have contributed to the outbreak, investigators found that an energy-efficient system had been installed in which indoor air was refreshed only when indoor carbon dioxide (CO2) concentrations detected elevated levels. If CO2 levels didn’t exceed a certain threshold, unfiltered indoor air was simply recirculated throughout the ward. In contrast, the six unaffected wards were refreshed regularly with outside air.
- The researchers noted that low CO2 levels produced by inactive patients may have led to stale air in the affected ward, which was cooled by two air conditioning units that also recirculated the air in the shared living areas. Coronavirus RNA was found in dust on the mesh dust filter of living room air conditioners and in four filters from three of eight ventilation units.
- The research letter was written in support of findings of a study published in the same journal on Jul 6 warning of the hazards of airborne C19 transmission in poorly ventilated environments.
- “We advise that prevention of C19 transmission should take into account the possibility of aerosol transmission in healthcare facilities and other buildings where ventilation systems recirculate unfiltered inside air,” the authors of the Aug 28 study wrote.
4. Coronavirus may survive on outdoor surfaces for longer in autumn
- As the northern hemisphere heads into autumn, the coronavirus may be able to survive on outdoor surfaces for much longer, according to a new US study.
- Researchers found that in lower temperatures and humidity, the virus could, for example, remain on a hiker’s jacket if it was outside for a week – and remain infectious for that time – whereas in summer its lifespan was estimated to be one to three days.
- The prolonged survival of the virus on surfaces in autumn could “potentially contribute to new outbreaks”, the team led by Juergen Richt, professor of veterinary microbiology at Kansas State University, wrote in a non-peer-reviewed paper posted on preprint bioRxiv.org on Monday.
- They believed the virus would also survive for longer indoors in colder and less humid conditions. The study found it had an average half-life – or rate of decay – of nearly eight hours on a stainless steel doorknob, or nearly 10 hours on a window, which was about to twice the duration in summer.
- The pathogen is believed to prefer lower temperatures and humidity.
- For the study, Richt’s team used climate data from America’s Midwest to recreate artificial seasons in biosafety chambers. Temperature was controlled at 13 degrees Celsius and 66 per cent relative humidity for spring and autumn, while for summer it was kept at 25 degrees and 70%.
- The virus was then applied to the surface of 12 materials people come into contact with every day, such as cardboard, concrete, rubber, gloves and N95 masks. The aim was to find out if the viability of the virus changed with the season.
- Earlier in the pandemic, the research community had hoped the spread of the virus would slow in summer, believing it would be less likely to stay in the air in warmer weather.
- But the resurgence of infections in many areas – especially the United States, the worst-hit country where nearly 80,000 cases per day were recorded at the peak of summer – raised the question of whether there was any seasonal impact at all.
- The result of the Midwest study “clearly demonstrates that the virus survives longer under spring/fall not summer conditions”, the researchers said in the paper.
- That trend was observed on all materials tested, to varying degrees. Out of all of them, the virus survived longest on Tyvek, a synthetic material used in everything from home insulation to personal protective equipment and outdoor wear, with a half-life of up to 45 hours.
- Autumn could also see a rise in other infectious diseases such as flu, which might further stretch health care systems. It could also result in patients having multiple infections that make their symptoms worse, recent studies have warned.
- Richt and his colleagues urged people to maintain the “practice of good personal hygiene and regular disinfection of potentially contaminated surfaces” to prevent the spread of the virus.
- The study follows a warning earlier this month from the US Centres for Disease Control and Prevention of the potential for the situation to get worse in autumn. Director Robert Redfield said people needed to do four things: “wear a mask, social distance, wash your hands and be smart about crowds”. Otherwise, he said, it could be “the worst fall, from a public health perspective, we’ve ever had”.
5. Are Bradykinin Storms the Cause of Severe C19 Symptoms?
- Earlier this summer, the Summit supercomputer at Oak Ridge National Lab in Tennessee set about crunching data on more than 40,000 genes from 17,000 genetic samples in an effort to better understand C19. Summit is the second-fastest computer in the world, but the process — which involved analyzing 2.5 billion genetic combinations — still took more than a week.
- When Summit was done, researchers analyzed the results. It was, in the words of Dr. Daniel Jacobson, lead researcher and chief scientist for computational systems biology at Oak Ridge, a “eureka moment.” The computer had revealed a new theory about how C19 impacts the body: the bradykinin hypothesis. The hypothesis provides a model that explains many aspects of C19, including some of its most bizarre symptoms. It also suggests 10-plus potential treatments, many of which are already FDA approved. Jacobson’s group published their results in a paper in the journal eLife in early July.
- According to the team’s findings, a C19 infection generally begins when the virus enters the body through ACE2 receptors in the nose, (The receptors, which the virus is known to target, are abundant there.) The virus then proceeds through the body, entering cells in other places where ACE2 is also present: the intestines, kidneys, and heart. This likely accounts for at least some of the disease’s cardiac and GI symptoms.
- But once C19 has established itself in the body, things start to get really interesting. According to Jacobson’s group, the data Summit analyzed shows that C19 isn’t content to simply infect cells that already express lots of ACE2 receptors. Instead, it actively hijacks the body’s own systems, tricking it into upregulating ACE2 receptors in places where they’re usually expressed at low or medium levels, including the lungs.
- In this sense, C19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house. Once inside, though, they don’t just take your stuff — they also throw open all your doors and windows so their accomplices can rush in and help pillage more efficiently.
- The Renin Angiotensin System (RAS) controls many aspects of the circulatory system, including the body’s levels of a chemical called bradykinin, which normally helps to regulate blood pressure. According to the team’s analysis, when the virus tweaks the RAS, it causes the body’s mechanisms for regulating bradykinin to go haywire. Bradykinin receptors are resensitized, and the body also stops effectively breaking down bradykinin. (ACE normally degrades bradykinin, but when the virus downregulates it, it can’t do this as effectively.)
- The end result, the researchers say, is to release a bradykinin storm — a massive, runaway buildup of bradykinin in the body. According to the bradykinin hypothesis, it’s this storm that is ultimately responsible for many of C19’s deadly effects. Jacobson’s team says in their paper that “the pathology of C19 is likely the result of Bradykinin Storms rather than cytokine storms,” which had been previously identified in C19 patients, but that “the two may be intricately linked.” Other papers had previously identified bradykinin storms as a possible cause of C19’s pathologies.
- As bradykinin builds up in the body, it dramatically increases vascular permeability. In short, it makes your blood vessels leaky. This aligns with recent clinical data, which increasingly views C19 primarily as a vascular disease, rather than a respiratory one. But C19 still has a massive effect on the lungs. As blood vessels start to leak due to a bradykinin storm, the researchers say, the lungs can fill with fluid. Immune cells also leak out into the lungs, Jacobson’s team found, causing inflammation.
- And C19 has another especially insidious trick. Through another pathway, the team’s data shows, it increases production of hyaluronic acid (HLA) in the lungs. HLA is often used in soaps and lotions for its ability to absorb more than 1,000 times its weight in fluid. When it combines with fluid leaking into the lungs, the results are disastrous: It forms a hydrogel, which can fill the lungs in some patients. According to Jacobson, once this happens, “it’s like trying to breathe through Jell-O.”
- This may explain why ventilators have proven less effective in treating advanced C19 than doctors originally expected, based on experiences with other viruses. “It reaches a point where regardless of how much oxygen you pump in, it doesn’t matter, because the alveoli in the lungs are filled with this hydrogel,” Jacobson says. “The lungs become like a water balloon.” Patients can suffocate even while receiving full breathing support.
- The bradykinin hypothesis also extends to many of C19’s effects on the heart. About one in five hospitalized C19 patients have damage to their hearts, even if they never had cardiac issues before. Some of this is likely due to the virus infecting the heart directly through its ACE2 receptors. But the RAS also controls aspects of cardiac contractions and blood pressure. According to the researchers, bradykinin storms could create arrhythmias and low blood pressure, which are often seen in C19 patients.
- The bradykinin hypothesis also accounts for C19’s neurological effects, which are some of the most surprising and concerning elements of the disease. These symptoms (which include dizziness, seizures, delirium, and stroke) are present in as many as half of hospitalized C19 patients. According to Jacobson and his team, MRI studies in France revealed that many C19 patients have evidence of leaky blood vessels in their brains.
- Bradykinin — especially at high doses — can also lead to a breakdown of the blood-brain barrier. Under normal circumstances, this barrier acts as a filter between your brain and the rest of your circulatory system. It lets in the nutrients and small molecules that the brain needs to function, while keeping out toxins and pathogens and keeping the brain’s internal environment tightly regulated.
- If bradykinin storms cause the blood-brain barrier to break down, this could allow harmful cells and compounds into the brain, leading to inflammation, potential brain damage, and many of the neurological symptoms C19 patients experience. Jacobson told me, “It is a reasonable hypothesis that many of the neurological symptoms in C19 could be due to an excess of bradykinin. It has been reported that bradykinin would indeed be likely to increase the permeability of the blood-brain barrier. In addition, similar neurological symptoms have been observed in other diseases that result from an excess of bradykinin.”
- Increased bradykinin levels could also account for other common C19 symptoms. ACE inhibitors — a class of drugs used to treat high blood pressure — have a similar effect on the RAS system as C19, increasing bradykinin levels. In fact, Jacobson and his team note in their paper that “the virus… acts pharmacologically as an ACE inhibitor” — almost directly mirroring the actions of these drugs.
- By acting like a natural ACE inhibitor, C19 may be causing the same effects that hypertensive patients sometimes get when they take blood pressure–lowering drugs. ACE inhibitors are known to cause a dry cough and fatigue, two textbook symptoms of C19. And they can potentially increase blood potassium levels, which has also been observed in C19 patients. The similarities between ACE inhibitor side effects and C19 symptoms strengthen the bradykinin hypothesis, the researchers say.
- ACE inhibitors are also known to cause a loss of taste and smell. Jacobson stresses, though, that this symptom is more likely due to the virus “affecting the cells surrounding olfactory nerve cells” than the direct effects of bradykinin.
- Though still an emerging theory, the bradykinin hypothesis explains several other of C19’s seemingly bizarre symptoms. Jacobson and his team speculate that leaky vasculature caused by bradykinin storms could be responsible for “Covid toes,” a condition involving swollen, bruised toes that some C19 patients experience. Bradykinin can also mess with the thyroid gland, which could produce the thyroid symptoms recently observed in some patients.
- The bradykinin hypothesis could also explain some of the broader demographic patterns of the disease’s spread. The researchers note that some aspects of the RAS system are sex-linked, with proteins for several receptors (such as one called TMSB4X) located on the X chromosome. This means that “women… would have twice the levels of this protein than men,” a result borne out by the researchers’ data. In their paper, Jacobson’s team concludes that this “could explain the lower incidence of C19 induced mortality in women.” A genetic quirk of the RAS could be giving women extra protection against the disease.
- The bradykinin hypothesis provides a model that “contributes to a better understanding of C19” and “adds novelty to the existing literature,” according to scientists Frank van de Veerdonk, Jos WM van der Meer, and Roger Little, who peer-reviewed the team’s paper. It predicts nearly all the disease’s symptoms, even ones (like bruises on the toes) that at first appear random, and further suggests new treatments for the disease.
- As Jacobson and team point out, several drugs target aspects of the RAS and are already FDA approved to treat other conditions. They could arguably be applied to treating C19 as well. Several, like danazol, stanozolol, and ecallantide, reduce bradykinin production and could potentially stop a deadly bradykinin storm. Others, like icatibant, reduce bradykinin signaling and could blunt its effects once it’s already in the body.
- Interestingly, Jacobson’s team also suggests vitamin D as a potentially useful C19 drug. The vitamin is involved in the RAS system and could prove helpful by reducing levels of another compound, known as REN. Again, this could stop potentially deadly bradykinin storms from forming. The researchers note that vitamin D has already been shown to help those with C19. The vitamin is readily available over the counter, and around 20% of the population is deficient. If indeed the vitamin proves effective at reducing the severity of bradykinin storms, it could be an easy, relatively safe way to reduce the severity of the virus.
- Other compounds could treat symptoms associated with bradykinin storms. Hymecromone, for example, could reduce hyaluronic acid levels, potentially stopping deadly hydrogels from forming in the lungs. And timbetasin could mimic the mechanism that the researchers believe protects women from more severe C19 infections. All of these potential treatments are speculative, of course, and would need to be studied in a rigorous, controlled environment before their effectiveness could be determined and they could be used more broadly.
- C19 stands out for both the scale of its global impact and the apparent randomness of its many symptoms. Physicians have struggled to understand the disease and come up with a unified theory for how it works. Though as of yet unproven, the bradykinin hypothesis provides such a theory. And like all good hypotheses, it also provides specific, testable predictions — in this case, actual drugs that could provide relief to real patients.
- The researchers are quick to point out that “the testing of any of these pharmaceutical interventions should be done in well-designed clinical trials.” As to the next step in the process, Jacobson is clear: “We have to get this message out.” His team’s finding won’t cure C19. But if the treatments it points to pan out in the clinic, interventions guided by the bradykinin hypothesis could greatly reduce patients’ suffering — and potentially save lives.
6. Large study shows C19 antibodies last 4 months, bolstering vaccine hopes
- Coronavirus antibodies could last for at least four months and fade more slowly than previously reported, according to a new study.
- The findings come from a large-scale survey published Tuesday involving more than 30,500 people in Iceland. Billed as the most comprehensive look at the body’s response to the virus, scientists believe it gives hope to achieve immunity through a vaccine.
- If a vaccine generates antibodies that are as long-lasting, there is “hope that host immunity to this unpredictable and highly contagious virus may not be fleeting and may be similar to that elicited by most other viral infections,” wrote scientists in an editorial on the study, published in the New England Journal of Medicine.
- Researchers are still trying to decipher built immunity to the virus. Previous smaller studies had suggested antibodies potentially protecting from re-infection faded over weeks, lasting no more than three months.
- But researchers involved in the Iceland report, conducted by the Reykjavik-based deCODE Genetics, said previous studies typically observed subjects 28 days after diagnosis, while they looked at patients for four months.
- They found the body produces a second collection of antibodies a month or two after infection that could provide more long-lasting protection.
- “Infections and vaccines generate two waves of antibodies: The first wave is generated by early short-lived plasma cells, poised to populate the systemic circulation, but this wave subsides rapidly after resolution of acute infection,” wrote scientists Galit Alter and Robert Seder in the commentary.
- “The second wave is generated by a smaller number of longer-lived plasma cells that provide long-lived immunity,” they went on.
- The scientists behind the study stressed that more research was still needed and that not everyone had the same response to the virus. And it’s still unclear if antibody production will prevent reinfections.
- Several reports have surfaced recently of patients who were re-infected after just several months from their first diagnosis.
- The researchers also found that almost a third of Iceland infections were in people who reported no symptoms and that the infection fatality rate was 0.3 percent, or about three times as deadly as the seasonal flu.
7. Visualization shows face shields may not protect against C19 spread
- A new visualization shows why face shields and masks with exhalation valves may not be the best barriers for preventing the spread of C19.
- Although face shields initially block droplets from a simulated cough, small droplets can easily move around the sides of the visor and eventually spread over a large area, according to the visualization, which is detailed in a study published Tuesday (Sept. 1) in the journal Physics of Fluids.
- For masks with exhalation valves, a stream of droplets passes, unfiltered, through the valve, meaning the mask would in theory do little to hinder the spread of potentially infectious droplets.
- In contrast, the researchers previously showed that some cotton face masks reduce the spread of droplets to only a few inches from the face during a simulated cough, Live Science previously reported.
- The simulations in the new study “indicate that face shields and masks with exhale valves may not be as effective as regular face masks in restricting the spread of aerosolized droplets,” the authors wrote.
- Face masks have become a part of everyday life during the C19 pandemic. But some people are turning to plastic face shields or masks with exhalation values because they find these alternatives more comfortable to wear for long periods of time. Face shields also have the advantage of allowing users to show facial expressions.
- However, the CDC does not recommend either of these as alternatives to cloth masks. Masks with one-way valves, which are intended for use in construction work, allow users to breathe in filtered air and exhale warm, moist (and unfiltered) air through the valve, Live Science previously reported. But because respiratory droplets from the wearer are expelled into the air, the CDC says people should not wear these masks to prevent C19 spread.
- The CDC also does not recommend face shields as a substitute for cloth masks because evidence is lacking to show their effectiveness, the agency says.
- “As students return to schools and universities, some have wondered if it is better to use face shields, as they are more comfortable and easier to wear for longer periods of time,” study lead author Siddhartha Verma, an assistant professor at Florida Atlantic University’s College of Engineering and Computer Science, said in a statement. “But what if these shields are not as effective? You would be essentially putting everyone in a tight space with droplets accumulating over time, which could potentially lead to infections.”
- In the new study, the researchers simulated coughing by connecting a mannequin’s head to a fog machine — which creates a vapor from water and glycerin — and using a pump to expel the vapor through the mannequin’s mouth. They then visualized the vapor droplets using a “laser sheet” created by passing a green laser pointer through a cylindrical rod. In this setup, simulated cough droplets appear as a glowing green vapor flowing from the mannequin’s mouth.
- For the face shield simulation, the shield initially deflected droplets toward the ground after a cough. But small droplets remained suspended at the bottom of the shield and then floated around the sides, eventually spreading about 3 feet (0.9 meters) to the front and sides of the mannequin. In some cases, the droplets spread backward, behind the mannequin, instead of forward.
- For the mask with a valve, a jet of droplets passed through the valve in the front of the masks during coughing. Initially, this jet of droplets traveled toward the ground, but eventually the droplets dispersed over a wide area.
- The researchers also tested two different brands of commercially available surgical masks. Both of these masks were not recommended for medical use by the manufacturers. Although the masks looked similar, one brand was effective at stopping the forward spread of aerosolized droplets, while the other allowed a high number of droplets to leak through the mask.
- “This indicates that even among commercially available masks which may appear to be similar superficially, there can be significant underlying differences in the quality and type of materials used for manufacturing the masks,” the authors said.
- Since the study was a simulation, it doesn’t provide data on the exact conditions that would result in the spread of an infection. For example, with the coronavirus, it’s unclear exactly how long the virus remains infectious in the air, and how far infectious particles can travel, or how much virus is needed to make a person sick.
- The authors also noted that “even the very best masks have some degree of leakage,” Verma said. So “it’s still important to maintain physical distance while wearing [masks] to mitigate transmission.”
D. Vaccines & Testing
1. The dangers of rushing a coronavirus vaccine
- Flattening the curve was just the first step in responding to the pandemic (and for many countries, it’s still a work in progress). Much of the world is now waiting eagerly for a covid vaccine that could let us lift travel restrictions and get economic activity back to full speed. But it has to be done right—rushing out a vaccine that isn’t effective or safe could be disastrous. Here’s what you need to need to know.
What happens if people get a faulty vaccine
- Health experts worry most about two things. First, if a vaccine hasn’t been properly vetted for safety, a lot of people may experience side-effects that aren’t worth whatever kind of protection the vaccine confers. Second, if the vaccine isn’t effective in reducing C19 infection, cases will almost certainly rise as authorities lift covid-related restrictions and people resume activities like gathering in restaurants and other public spaces under the mistaken belief that they’re protected from the virus.
Distinguishing “efficacy” from “worthwhile efficacy”:
- In a paper published in the Lancet last week, the WHO’s Solidarity Vaccines Trial Expert Group wrote that there’s considerable debate over whether current vaccine trials must show “not only proof of some vaccine efficacy but also proof of worthwhile efficacy.” A vaccine that shows, say, reduction in C19 incidence by only 20% would not put much of a dent in stopping the spread of the virus, especially if those people stopped wearing masks and adhering to social distance rules.
- What’s effective enough? WHO recommends that a vaccine should show an estimated risk reduction of at least one-half, and that the true vaccine efficacy is proven to be greater than 30%. This is just a starting point, and ideally researchers would continue to work on developing something that could prove more effective.
Long-term vs. short-term efficacy:
- Even if a vaccine proves safe and can protect well enough against infection in the short term, researchers still need to establish how long immunity lasts. If immunity disappears fairly quickly, pharmaceutical groups would want to continue working on developing something that delivers long-term efficacy.
Organization and preparation:
- Developing an effective vaccine will only be half the battle. After one is produced, the biggest obstacles will be logistical and organizational in nature—it takes a lot of time and resources to manufacture a vaccine and prepare enough doses that can be shipped and administered to a wide population. This kind of preparation can take up to several months. And roughly 35% of Americans say they would forgo a vaccine, even if it was free, which would hurt efforts to reach a level of herd immunity that could stop the spread of the virus.
E. Concerns & Unknowns
1. As Child Covid Cases Rise, Doctors Watch for Potential Long-Term Effects
- As more children become infected with C19, doctors are paying closer attention to potential long-term effects.
- In adults, one of Covid’s most troubling effects has been so-called long-haul cases, in which people whose illness initially seemed moderate end up having symptoms for months, sometimes getting worse over time. Now as doctors warn that children may be more vulnerable to the virus than initially believed, researchers are looking more closely at longer-term symptoms in kids, too.
- Children now represent about 9% of all C19 cases in the U.S., up from 2% in March, according to the most recent weekly report issued from Children’s Hospital Association and the American Academy of Pediatrics. The number of child C19 cases has doubled since July 9, totaling 406,109 as of Aug. 13, according to cases reported from 49 states.
- The majority of children experience mild illness or even no symptoms from C19, doctors say. But some are reporting symptoms that persist for weeks, or the development of post-viral syndromes. Symptoms reported include fever, cough, headaches, shortness of breath and gastrointestinal problems.
- “It’s an important area for study because certainly we’re still learning a lot about the virus, particularly about its impact on children,” says Sean O’Leary, vice-chair of the American Academy of Pediatrics Committee on Infectious Diseases, who himself is experiencing long-term symptoms from C19. “At least acutely it’s less severe in children, but we also need to understand whether there are potentially consequences of long-term effects.”
- One challenge with tracking longer-term symptoms in children is that testing has been inconsistent. C19 tests were difficult to get for children in the early weeks of the pandemic. The number of tests done in children has increased over the past five months, though declined in recent weeks. So far, discussion of children and Covid—around school reopening, for instance—has focused more on risks for community transmission than potential longer-term effects.
- Matthew Kelly, an assistant professor of pediatric infectious diseases at Duke University Medical Center, oversees a registry of more than 400 children in North Carolina who tested positive for Covid or who had a close contact test positive.
- So far, children under age 14 appear to recover quickly and have fewer symptoms, according to preliminary results from the registry published Saturday on the preprint server medRxiv which haven’t yet been reviewed by other researchers.
- Patients 14- to 20-years-old had a range of symptoms similar to what adults have experienced, with respiratory and flu-like symptoms, such as headache and muscle aches. And while most teens had symptoms that resolved in a week, 25% still reported symptoms after 12 days, and 10% still had symptoms after 17 days, such as cough, fever and shortness of breath.
- So far the main complication in children with Covid is multisystem inflammatory syndrome (MIS-C), a serious inflammatory syndrome where different body parts—including the heart and brain—can become inflamed, causing a fever, stomach pain, rash and gastrointestinal symptoms. There have been at least 570 cases of MIS-C, according to the CDC. Children usually present with the syndrome two to four weeks after having C19 and are often hospitalized.
- Dr. Kelly speculates that MIS-C is likely the extreme end of a spectrum of post-infectious inflammatory syndromes children may experience after C19. “That’s the severest form…but there seems to be a larger group of children who develop inflammatory illnesses less severe than what is seen in MIS-C,” says Dr. Kelly.
- Gabriela Maron, an associate faculty member in the infectious diseases department at St. Jude Children’s Research Hospital in Memphis, Tenn., and Ronald Dallas, a clinical research scientist in the infectious diseases department at St. Jude’s, oversee and manage another pediatric C19 registry. So far it includes about 4,000 cases of children and adolescents under age 21 with lab-confirmed Covid.
- For most, symptoms resolved on average three days later. But between days eight and 28, about 199 kids out of roughly 2,500 whose long-term information has been entered were still reporting symptoms.
- Tania Dempsey is an internist and integrative medicine doctor in Purchase, N.Y., who specializes in autoimmune disorders. She has a couple of teenage patients who she has diagnosed with mast cell activation syndrome, a disorder of the immune system that she believes was triggered by a C19 infection.
- “I think it’s becoming clearer as more kids are getting sick that there’s a cohort of children whose immune systems are going to react inappropriately and set off an escalating degree of inflammation,” says Dr. Dempsey.
- Mary Pflum Peterson, a writer and television producer in New York City, has had persistent symptoms after being diagnosed with Covid in March. Her son Roman Peterson, 13, was diagnosed with Covid in April based on his symptoms and exposure to her, Ms. Peterson said. Two of her other children were also sick but recovered within days.
- Roman had a fever for four weeks, chest pain, no appetite, a sore throat, and severe headaches. For months, he experienced a racing heartbeat. He’s feeling better now, but he still gets periodic headaches, has nausea, and gets dizzy. “They’re really irritating headaches,” he says. “I have them like once every two or three days.”
- “I feel like people think [Covid] is just bad for the elderly and those with conditions,” he adds. “It actually really takes all the energy out of you.”
- “Could this cause long-term or permanent damage? Nobody knows yet,” says Ms. Peterson. “It’s not as simplistic as some of us want to think.
- Because cases in children are rarer and tests have often been conducted less frequently, they can be difficult to untangle. Casey Whiston-Hodnett says her 13-year-old daughter, Joeyanna, first became very sick in March and then started to feel a little better in May. She began regressing in June and was hospitalized at Boston Children’s Hospital in early July.
- Joeyanna wasn’t able to get tested for Covid until June—more than three months after first getting sick, which is generally too late to detect the virus’ genetic material. Esra Meidan, her pediatric rheumatologist at Boston Children’s, says antibody tests have come up negative, but experts say antibody tests can also have reliability problems.
- Dr. Meidan has diagnosed her with several conditions that she believes were triggered by two separate viral infections, the first of which may have been C19. One of the conditions is a neurological one called dysautonomia, which occurs when the autonomic nervous system is out of balance. The condition can be triggered by viruses and is being seen in many adult C19 patients with long-term symptoms.
- “I’m always tired and then I have really bad joint pain and muscle aches and chest pain and stomach pain,” says Joeyanna.
- She’s lost more than 10 pounds and can barely eat because of intense stomach pain, says her mom. “This has just totally changed her, she can’t even get off the couch,” says Mrs. Whiston-Hodnett. “They’re telling me she’s going to recover but you look at her and you wonder how much longer?”
2. How many people has the coronavirus killed?
- At the beginning of March, Andrew Noymer felt a familiar twinge of doubt. He was watching countries across Europe and North America begin to record their first deaths from C19, and he knew there could be problems with the data. Even in a normal winter, some deaths caused by influenza get misclassified as pneumonia. If that can happen with a well-known disease, there were bound to be deaths from C19 going unreported, thought Noymer, a demographer at the University of California, Irvine. “I just remember thinking, ‘this is going to be really difficult to explain to people’,” he recalls.
- And in March and April, when national statistics offices began to release tallies of the number of deaths, it confirmed his suspicions: the pandemic was killing a lot more people than the C19 figures alone would suggest.
- In times of upheaval — wars, natural disasters, outbreaks of disease — researchers need to tally deaths rapidly, and usually turn to a blunt but reliable metric: excess mortality. It’s a comparison of expected deaths with ones that actually happened, and, to many scientists, it’s the most robust way to gauge the impact of the pandemic. It can help epidemiologists to draw comparisons between countries, and, because it can be calculated quickly, it can identify C19 hotspots that would otherwise have gone undetected. According to data from more than 30 countries for which estimates of excess deaths are available (see ‘Terrible toll’), there were nearly 600,000 more deaths than would normally be predicted in these nations for the period between the onset of the pandemic and the end of July (413,041 of those were officially attributed to C19).
- But this high-level metric has several flaws. It cannot distinguish between those who are dying of the disease and those who succumb to other factors related to the pandemic, such as disruptions to regular health care, which can delay treatments or mean that people do not seek medical care. It relies on accurate, timely reporting of deaths, which can be limited owing to underdeveloped death-registration systems, or might even be intentionally suppressed. And as with so many other aspects of the pandemic, the statistic has become politicized — a way for countries to claim superiority over one another.
- Experts worry that simple reports of excess deaths have led to premature or faulty comparisons of countries’ pandemic responses, and have largely ignored the situation in low- and middle-income countries owing to a lack of data.
- There are more sophisticated ways to categorize mortality to find out how many people were killed as a direct result of infection with SARS-CoV-2, and how many deaths happened because of other factors associated with the pandemic. Eventually, demographers and public-health researchers will have enough granular information from death certificates to do this. They will then be able to assess which interventions worked best, to inform future pandemic responses.
- Several media outlets are already crunching the data and drawing such conclusions. Some statisticians argue that, as the first wave of the pandemic recedes in many places, comparisons can — and should — be made between government policies to see how they might have affected mortality. But many experts say that it’s still too early in the pandemic to do this with rigour. The process can be skewed by the random way that some early outbreaks spread and others fizzle out, making analysis complicated until the pandemic has run its course, says Jennifer Dowd, a demographer and epidemiologist at the University of Oxford, UK. “It’s going to be a very long road.”
- When deaths began creeping up in Europe, Lasse Vestergaard was one of the first to notice. Vestergaard, an epidemiologist at the Statens Serum Institut in Copenhagen, leads the European Mortality Monitoring Project (EuroMOMO), which aggregates weekly all-cause death data from 24 European countries or regions. Between March and April, EuroMOMO’s tracker showed tens of thousands more deaths than expected — about 25% higher than the official C19 deaths figure. Infections were slipping under the radar because of a lack of testing, and because different countries counted deaths in different ways — excluding deaths occurring in care homes, for instance. It was nearly impossible to get a true sense of how countries were faring.
- So researchers, journalists and politicians turned to calculations of excess deaths. Rather than getting bogged down by cause, the metric compares all deaths in a given week or month with the deaths that statisticians predict would have happened in the absence of the pandemic, usually as an average over the previous five years. More-sophisticated versions model how a population is ageing, or how it is changing as a result of immigration and emigration, although these additions can make it tricky to compare countries. Some analyses of excess deaths, such as a 30 July report released by the UK Office for National Statistics, standardize their mortality rates to control for differences in the age structure of populations between different countries (see go.nature.com/3hxa14m). Because officials can register the occurrence of a death relatively quickly if they are not logging the cause at the same time, these statistics can be compiled much faster than can cause-specific data.
- Nature gathered figures from several databases maintained by demographers, as well as from trackers run by The Financial Times and The Economist, two of the most comprehensive data sets on excess deaths. Although the coverage is not universal — it lists 32 countries (largely in Europe) and 4 major world cities — it includes many nations with major outbreaks and comprises about two-thirds of the official C19 death toll up to the end of July.
- The Nature analysis shows that there are huge variations in excess deaths between countries (see ‘More than expected’). In the United States and Spain — two of the hardest-hit countries so far — about 25% and 35%, respectively, of the excess death toll is not reflected in official C19 death statistics. But in other places, the mismatch is much greater, such as in Peru, where 74% of the excess deaths are not explained by reported C19 deaths. And some countries, such as Bulgaria, have even experienced negative excess deaths during the pandemic so far — meaning that, despite the virus, fewer people have died this year than expected.
Digging into data
- The blunt tool of excess mortality is the best one to use during the pandemic, say most demographers. But as time goes on, they will be able to use hindsight and more-granular data to improve understanding of the pandemic’s toll. They will eventually be able to parse the deaths into three categories: direct deaths, for which C19 is recorded as the cause; direct-but-uncounted deaths, in which the virus was responsible but wasn’t officially noted; and indirect deaths, which occur because of other changes wrought by the pandemic.
- Direct deaths feature on pandemic trackers showing numbers of cases and deaths, which are generally updated daily by local and national health authorities. But even this count isn’t as clear-cut as it might seem, warns Maimuna Majumder, a computational epidemiologist at Harvard Medical School in Boston, Massachusetts.
- It can be challenging to differentiate between people who died of C19 and those who were infected but died from unrelated causes. “That’s going to be a very critical piece of all this,” she says. “If you have two concurrent conditions, what does it get classified as?” Parsing those deaths, Majumder says, will require a death-classification system that accounts for the underlying conditions that make C19 more likely to kill. Such a system would mean waiting for cause-of-death data, which take around a year to compile in full.
- Researchers are already looking back at the first six months of the pandemic and adding in those deaths that were misclassified at the time. Several major outbreaks, including in Wuhan, China, and in New York City, had their death tolls revised upwards in April to account for deaths that were suspected to have been miscoded.
- Then there are the direct-but-uncounted deaths — those that were missed because the individual presented with symptoms not recognized as C19. “We’re still figuring out exactly how the disease manifests,” says Natalie Dean, a biostatistician at the University of Florida in Gainesville. Strokes and pulmonary embolisms are two potentially deadly complications of the virus that might have been overlooked initially, she says.
- A small proportion of excess deaths are indirect — a result of the conditions created by the impact of the pandemic, rather than because of the virus itself (see ‘Deaths from other causes’). Some hospitals report that people with cancer and chronic conditions are skipping their regular check-ups, which could put their health in jeopardy. Reports of domestic violence have increased in some places, and researchers who study mental health worry about the toll on front-line workers and those living under lockdown measures — although it’s not yet clear whether there has been a rise in the number of deaths as a result.
- Visits to emergency departments in the United States declined by more than 40% in the early days of the pandemic, according to a report from the Centers for Disease Control and Prevention (CDC), suggesting that many people were reluctant to attend (K. P. Hartnett et al. Morb. Mortal. Wkly Rep. 69, 699–704; 2020). And even if they did seek care, hospitals were severely overstretched, Majumder says. “You died from something else, but the reason you died from something else is because the systems that were initially in place to take care of you are no longer strong enough.” Preliminary, incomplete data from the CDC offer a glimpse of these indirect deaths: in April, US recorded deaths from diabetes were 20–45% higher than the 5-year average; deaths from ischaemic heart disease were anywhere from 6% to 29% higher than the norm.
- One silver lining is that lockdowns and behaviour changes such as mask wearing and hand washing might have prevented deaths from other causes — particularly other infectious diseases, such as flu. And with large swathes of people staying at home worldwide, deaths from traffic accidents and certain types of interpersonal violence are likely to have diminished. These reductions could be hiding some of the increase in deaths driven by C19.
- Some of these effects are already beginning to show up in the data. The global surveillance system FluNet found that this year’s flu season was truncated by more than a month, probably because of strict lockdowns and increased hygiene practices. In South Africa, the death-tracking system put in place during the height of the country’s AIDS epidemic is allowing epidemiologists to distinguish between deaths that are occurring as a result of natural causes, such as disease, and non-natural causes, such as interpersonal violence. A team led by Debbie Bradshaw at the South African Medical Research Council in Cape Town showed that, by the end of March, with strict lockdown measures in place, non-natural deaths had dropped to half their usual number. And when lockdown rules began to lift in late May, these deaths returned to around their expected level.
- Demographers will probably never know the pandemic’s final toll with certainty, Noymer says. “You don’t get to scratch off the lottery ticket and find out the actual values underneath the grey plastic coating.” Once the pandemic subsides, disentangling the three types of death — and determining how many would have occurred in the absence of the virus — will be a process that will take months or even years. “We haven’t even settled on how many people died in the 1918 flu,” he says. “And we’ve had 100 years to sort out the numbers.”
- Right now, statistics on excess deaths are helping to chart the path of the outbreak in different places. In the future, with full cause-of-death data, researchers will be able to analyse the impacts of lockdowns and other interventions by looking at the levels of direct and indirect deaths from country to country. But it’s risky to do that now, says Noymer, while the pandemic rages on and the final toll is unknown. “We just don’t have much perspective yet, because we’re still in the rising tide,” he says. “It’s like trying to predict rainfall totals in the middle of a hurricane.”
- Even after the storm, these analyses will be possible only in high-income countries with robust systems that register births and deaths — known as civil registration and vital statistics (CRVS). In low- and middle-income countries, counting deaths is much less straightforward, says Irina Dincu, a programme specialist in CRVS at the International Development Research Centre in Ottawa. “Across the world, about 50% of the deaths occurring in a given year are registered,” she says. “The other 50% do not exist at all. They are invisible.”
- CRVS adviser Gloria Mathenge can think of lots of reasons why these deaths are hidden. In her role at Pacific Community, an international development organization in Nouméa, New Caledonia, Mathenge helps to strengthen data systems in Pacific island countries such as Kiribati and Tonga. Although the situation is improving, about 20% of deaths in the region go unregistered, on average.
- Many existing systems are rooted in their countries’ colonial pasts. As a result, Mathenge says, they do not reflect contemporary cultural and social norms — such as the fact that many people in low- and middle-income countries do not die in hospitals. So, in addition to missing C19 deaths, there is no reliable way to establish a baseline from which to calculate an excess.
- To estimate the death toll in these countries, demographers will have to rely on less-precise methods such as door-to-door surveys, says Stéphane Helleringer, a demographer at New York University in Abu Dhabi. But these happen infrequently, he says. “By the time we do them, they’re already way outdated.”
- For some demographers, it doesn’t necessarily matter whether someone died of the disease itself or because the health-care system was stretched beyond its capacity — all of the deaths can be attributed, in some way, to the pandemic. “At some point you have to say, ‘well that’s COVID-related, somehow, because COVID disrupted the health-care system’,” says Noymer. “To me, the thought experiment is, ‘what does 2020 look like if this thing had never, ever happened?’”
- Other researchers are keen to separate deaths caused by the virus from those resulting from circumstance, so that they can build an accurate picture of how lethal the virus itself actually is.
- But there’s little time for such analyses right now. The pandemic has drastically increased the strain on death-registration systems as well as the scrutiny they face. Politicians, the media and the public are demanding daily or weekly statistics that would usually take months to compile. That makes some demographers uneasy. “We understand mortality best in retrospect,” Noymer says, because of the time and labour required to compile and analyse death certificates. “Everyone all of a sudden wants to know about it in real time.”
F. Back to School!?
1. Looking to Reopen, Colleges Become Labs for Coronavirus Tests and Tracking Apps
- Thousands of students returning to the Rochester Institute of Technology in New York this month are being asked to wear masks in public, register their health status online each day and electronically log classroom visits for contact tracing if a coronavirus outbreak occurs.
- But the most novel effort at the school to measure and limit virus spread will require little effort and come quite naturally. Students need only use the bathroom.
- At more than 15 dormitories and on-campus apartment buildings, sewage is being tested twice weekly for genetic evidence of virus shed in feces. This provides a kind of early-warning system of an outbreak, limiting the need to test every student for C19. If the disease is found in sewage, individual tests can be administered to identify the source.
- “It’s noninvasive,” said Enid Cardinal, senior adviser to the president for strategic planning and sustainability at R.I.T. The school is among a half-dozen colleges in upstate New York adopting similar technology, which was first introduced by Syracuse University. At the University of Arizona, officials said such tests led to the discovery that several students in a dorm were infected.
- “Wastewater,” Ms. Cardinal quipped. “My new favorite topic.”
- The fall of 2020 will go down as a period of profound experimentation at colleges and universities transformed into hothouse laboratories. They are trying out wastewater tests, dozens of health-check apps and versions of homegrown contact technologies that log student movement and exposure risk. And they are experimenting with different testing methods that might yield faster results and be easier to administer, such as using saliva instead of nasal swabs.
- Like small island nations with discrete populations, many universities are using methods that cities, states and nations often cannot. The colleges have some authority over relatively captive communities, which are made up of students largely at ease with new technology. Plus, the schools have profound motivation: Their very economic survival depends on people coming to campus safely.
- College officials are also hoping that students will be motivated to make it work. Excessive risky behavior (partying, casual sex, the inevitable let-your-mask-down moments) that leads to a rise in new cases might cause campuses to close, sending students home to their parents’ basements and couches.
- Thousands of positive cases have already been reported on scores of newly reopened campuses. The danger may be less to the students themselves and more to vulnerable people in their families, among college work forces and in surrounding communities.
- “The third wave is going to be these kids,” said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco, who advises universities and other major institutions about the coronavirus. The first wave, he said, centered on New York City and the second on the South and the Southwest.
- Dr. Rutherford said schools would nonetheless be able to consider their experiments a success if they managed to keep their case prevalence below those of their surrounding communities.
- The schools argue that their efforts will potentially have a much broader impact: These trial-and-error experiments could seed technologies to help the rest of society cope with the pandemic.
A system at U.N.C. Charlotte will automatically take wastewater samples from residence hall basements.
- “There’s an analogy to Facebook’s rollout,” said Joanna Masel, a mathematical biologist and professor in the department of ecology and evolutionary biology at the University of Arizona. “We’re starting on college campuses. It is useful to focus on these communities and on places where there is trust, achieve high uptake and spread from there.”
- To that end, the cdc and the Massachusetts Institute of Technology have shown interest in Dr. Masel’s pioneering contribution to the contact tracing and exposure app being deployed at the University of Arizona. The app, known as Covid Watch and developed on a platform built by Apple and Google, anonymously tracks students’ movements using Bluetooth technology; those who download the app will be notified if they have been in proximity to someone who has tested positive.
- Dr. Masel built in an algorithm that seeks to gauge how infectious a student was at the time contact was made with others — a determination made by looking at when symptoms first appeared. Using that data, the algorithm can calculate how much risk was posed to other students depending on when they were exposed to the infected student and for how long. Students at the highest risk of exposure will be asked to quarantine and get tested.
- To grapple with the privacy implications, the university has made use of the app voluntary. The information is kept on personal devices — phones or watches or other Bluetooth-enabled technology — and the users are the ones who would permit a positive test to be shared, with their identities kept secret.
- The more students who sign up, the more the university, which has also bought 27,000 thermometers and many thousands of masks, hopes it will be able to head off outbreaks.
- “If we have outbreaks of Covid, we will have to shut down and go digital,” said Joyce Schroeder, a professor who heads the molecular and cellular biology department and helps lead the university’s contract tracing effort. “They need to understand they want to be here and they can only do that if we don’t have full outbreaks.”
- Melanie Furman, 19, a sophomore, said she was willing to sign on. “I’m a rule follower,” she said, “and I don’t like getting sick.” She said it was hard to predict how people would behave at parties “that aren’t supposed to be happening anyway.”
- Versions of the app that do not bake in Dr. Masel’s extra algorithm have been introduced at the University of Alabama and the University of Virginia. Other colleges are exploring related technology developed by the M.I.T. Media Lab, said Ramesh Raskar, an associate professor at the lab.
- “We’ve talked to about 50 colleges and universities,” Dr. Raskar said, adding that the M.I.T. technology, called PathCheck, is being pilot tested by at least three schools: Vassar College, Southern Methodist University and Texas Christian University.
- Dr. Raskar said colleges and universities were far ahead of local and state governments in adopting or experimenting with exposure-notification technology and other advanced tactics to fight the coronavirus.
- “All of them are trying different innovations, different ideas, home-brew solutions,” he said.
- He also cautioned that many well-intentioned experiments would probably not work. Some colleges are using systems that track and record the movement history of students through the badges that let them enter buildings. But if there is an outbreak, he said, that data might not sufficiently detail how close students were to a sick person, forcing the school to risk having to test too broadly.
- Dr. Raskar said a more general concern he had was whether any technology at all, no matter how viable, can truly constrain free-range, freethinking students. In that sense, some part of these experiments is for show. “It’s about Covid theater,” he said.
- A key to limiting outbreaks is knowing who is sick in the first place. To that end, the University of Illinois is using a saliva test it developed that can give results within five hours. The test was recently approved by the FDA for emergency use, and a preliminary green light was also given to a saliva test developed by Yale University that the National Basketball Association is using in its playoff bubble.
- At R.I.T., students, faculty and staff are reporting their health by app on a daily basis. The school has built its own contact tracing technology: When students enter classes and other high-traffic public areas, they are being asked to take photos of QR codes displayed on posters. That information will be sent to and stored on a campus-controlled computer server, creating a digital log that will be used to see who might have been exposed when someone tests positive.
- The school has high hopes for its wastewater experiment, an outgrowth of technology that had previously been used at the level of the sewage-treatment plant — to look for polio at the community level in Israel, for example — not for samples taken from small populations like dorms.
- “They’re desperate for new tools,” Krista Wigginton, an associate professor of environmental engineering at the University of Michigan, said of the schools’ efforts to avoid outbreaks.
- The University of North Carolina at Charlotte is waiting for the delivery of technology that will automatically dip into sewage for samples at roughly 20 residence halls. The university has delayed in-person classes until Oct. 1, with students returning to campus in late September.
- In the meantime, a campus research scientist is jury-rigging hand pumps to allow manual sewage checks from the pipes in the basement of each residence hall.
- “He’s one of those guys who can build cars in his own garage,” said Cynthia Gibas, professor of bioinformatics and genomics at UNC Charlotte, where she has participated in the school’s reopening process.
- “It is important we get in and get the samples,” Dr. Gibas said. “It is not something we do routinely. We’re kind of building this for a special occasion.”
2. Colleges With Covid Outbreaks Advised to Keep Students on Campus
- A consensus is building among public health experts that it’s better to keep university students on campus after a C19 outbreak rather than send them home as many are doing.
- It’s easier to isolate sick or exposed students and trace their contacts if they stay put, said Ravina Kullar, epidemiologist and spokesperson for Infectious Diseases Society of America. Sending students home risks exposing other people there as well as along the way, and makes contact tracing all but impossible.
- “There’s just inevitably going to be an outbreak,” she said. “Colleges need to take on the burden of having these students kept at their campus and taking care of them.”
- The University of North Carolina at Chapel Hill was one of the first to reverse in-person learning, sending students home to complete the semester remotely after the school had an outbreak. Colleges including Towson University and East Carolina University have done the same.
- New York Governor Andrew Cuomo announced Aug. 27 that schools in the state would switch to online learning for two weeks if they record 100 cases or 5% of the population gets infected, keeping students in place while tamping the virus’s spread. The University of Notre Dame adopted the same strategy, and announced Friday that it will resume in-person classes on Sept. 2.
- U.S. President Donald Trump spoke of the risk this month while urging campuses to reopen, saying that sending students home after an outbreak could put relatives at risk. “Instead of saving lives, a decision to close universities could cost lives,” he said.
- Notre Dame President John Jenkins had initially leaned toward clearing the campus when cases shot up to 147 less than two weeks after the first person was diagnosed. The county’s deputy health officer, Mark Fox, persuaded him to make classes remote and clamp down on interactions first to see if that could slow the spread.
- Notre Dame had a solid plan for reopening its campus, Fox said. The challenge was the magnitude and the velocity of cases, he said. When it hit, the school ramped up testing, added more isolation beds and expanded contact tracing. Together with tight restrictions on interactions between those living on and off campus, Notre Dame slowed cases from jumping to communities surrounding the school.
- For schools that send students home, contact tracing to help ensure they and their communities stay safe gets harder, especially for out-of-state students.
- If students live relatively nearby or are in-state, tracers can do their job, said Howard Koh, former assistant secretary for health for the U.S. Department of Health and Human Services and Harvard T.H. Chan School of Public Health professor. If students leave the state to go home, it’s less effective.
- “That will make the job very difficult, if not impossible,” he said.
- Contact tracing can help manage outbreaks when done correctly. The U.S. has struggled with it for many reasons, including getting people to answer the phone and respond truthfully. That’s even harder at college, when students worry about being disciplined for violating rules: Many schools have limited parties and other gatherings to reduce Covid-19 risks. Young people also relish finally being back with their friends.
- “The more contacts a person has, the harder contact tracing can be,” said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security. “People may not even know who they’re in contact with, especially if they are drinking.”
- Effective programs interview a patient as soon as possible after a diagnosis to find out where they went while contagious, then contact anyone they encountered about their possible exposure. It’s usually recommended those contacts quarantine and monitor for symptoms.
- In Chapel Hill, sick Tar Heels were isolated, and UNC quarantined anyone who was exposed when it announced it was sending students home on Aug. 17.
- Those who went home were advised to self-isolate for 14 days, according to Ken Pittman, campus health executive director. Contact tracers have been effective in mitigating further spread, he said. Still, the UNC Covid dashboard showed another 26 new cases on Aug. 28.
Out of State
- East Carolina reported 370 total positive cases from students as of Aug. 24. ECU’s contact tracing coordinator, Kelli Russell, said although they’ve run into issues with voice mailboxes that are full or not set up, students are answering their phones and speaking with the trained contact tracers, and have been transparent about where they have been and whom they have been in contact with.
- UNC’s staff and student health services work with county officials to locate cases on campus or nearby and traces close contacts of students testing positive even if they’ve left campus, Pittman said. They’ll coordinate with local health departments when a close contact who isn’t a student is identified, even out of state.
3. Welcome to college! Please stay in your room. Alone.
- On a hot and sticky night last week, a first-year student at Wellesley College sat alone in her dorm room, gazing at the empty blue mattress where her roommate was supposed to be.
- Laura Umana’s unfaltering optimism had helped her weather many disappointments this year. Her prom was canceled, her high school graduation was canceled, she had a roommate picked out, but then the college said everyone would be housed one to a room.
- Still, nothing quite prepared her for the strangeness of spending her first days of college alone in quarantine.
- “I was literally with my family two hours ago, and now it feels like I’m in a completely different world. I’m completely isolated,” she said in a phone interview from her new dorm room on the night she moved in. “I think normally I’d be at an orientation right now, meeting all my friends, exploring the campus.”
- Umana, who is from Queens, is one of tens of thousands of college students moving into Greater Boston this month to begin what will be the most unusual academic year in modern history. Most colleges are requiring arriving students to stay alone in their dorm rooms for some period of time until they test negative for C19. It’s a necessary precaution that runs counter to everything the first days of college are supposed to be about: spontaneous gatherings, unexpected conversations, exploring a new city.
- The quarantine rules are designed to prevent large campus outbreaks like the ones that have already occurred elsewhere. Skyrocketing cases at the University of North Carolina forced the school to revert to online learning a week after the campus reopened. There are now more than 26,000 cases at more than 750 colleges and universities nationwide, according to a New York Times survey, including more than 500 positive cases at the University of Alabama, one of the largest outbreaks so far. [NOTE: 1201 as of Aug 27] Many of these outbreaks are in places where students have openly ignored social distancing and mask protocols. So far the number of cases reported by local schools is minimal.
- The length of quarantine varies by institution; some schools release students after one negative test, while others have differing rules depending on the infection rate in the state a student comes from. At Boston University, students who come from high-risk states are advised to stay in isolation until they have three negative tests, which normally takes about a week. At Northeastern, students will also be tested three times but will be able to leave their room if the first test comes back negative.
- Penalties also vary. At BU, students who violate quarantine rules will be kicked out of campus housing.
- Some unlucky students have to isolate for as long as 14 days. Draken Garfinkel, a 19-year-old Brandeis student from Arlington, was startled when university contact tracers called to inform him that a friend of his he’d spent time with recently had tested positive. Even though the friend eventually tested negative, Garfinkel was required to stay in his room for two weeks.
- It’s a long time to be in a room by yourself, especially with no time to prepare. He’s tried to use the time productively by devising plans for two student organizations he helps lead, and exercising using a mortar and pestle he put in a bag as a weight. But little things have begun to grate: the trash nobody’s picked up in the hallway outside his room; the difficulty of getting clean clothes and ordering his books.
- “I was trying to talk to people and nobody was really responding, and I felt abandoned, and like I didn’t matter,” Garfinkel said.
- At Emerson College, Tristen Pon had to isolate longer than he’d expected because the school’s testing operation wasn’t yet open when he arrived from San Francisco. Pon, an RA this year, worries about how he’ll help his younger charges endure their first days at college.
- “I definitely had a complete mental breakdown being here,” he said about his quarantine. “I can’t imagine what it’s like to be a freshman right now.”
- Pon said the cereal, sandwich, and salad delivered daily to his room left him feeling hungry most days. He passed the time working out on the floor of his bedroom, which only made him hungrier.
- “I want to be the most positive person ever, but it’s hard to be positive when you only get two meals and the meals are pretty much the same,” he said.
- Arriving at college normally means a whirl of formal and impromptu gatherings, often till all hours of the night. The afternoon that Umana arrived on the Wellesley campus she had little to do, and couldn’t meet the other women on her floor. The dining hall is closed except to pick up food and students must stay in their rooms until they test negative.
- She unpacked some boxes and hung a few clothes in the closet, but she saved her large suitcase to unpack the next day, while she waited for her test results, to give her something to pass the time.
- Umana is glad Wellesley has strong safety measures; perhaps more than many of her peers, she understands the ruthlessness of the virus. At home in New York this spring, she lived just four blocks from Elmhurst Hospital, a public institution that was overloaded with C19 patients. Her mother contracted the virus, but Umana escaped it.
- Wellesley, like many colleges, has reconfigured its academic year. Classes begin Monday and will be a mix of in-person and remote. For the first semester, only first- and second-years are on campus, taking two classes at a time over two quarters. Students are discouraged from leaving campus and asked not to return home for Thanksgiving. In the spring, third- and fourth-years will come to campus and Umana will complete the year at home.
- The Wellesley administration has worked to make the beginning of college this year as welcoming as possible, given the circumstances.
- During move-in, the school created virtual activities students can participate in from their rooms, including a remote version of bingo, a Wellesley tradition, and online tours of the school’s art museum. Staff check in with students to help them with any concerns or even just bring them a cup of tea, according to Sheilah Shaw Horton, vice president and dean of students.
- The college has added extra counseling services this year, including virtual groups where students can meet and talk together about the stresses and anxieties of the pandemic.
- Over the summer Umana watched orientation videos that showed the campus brimming with cheerful young women, waving and smiling as new students arrived. When she and her family arrived, it was mostly empty, save for three students holding signs and wearing masks.
- Her parents and younger brother were allowed to drive onto campus to drop her off, but not allowed inside. They hugged and took a photo as RAs wheeled her belongings into the dorm. Five minutes later, they were gone.
- “It was really quick, but at least I got to hug them all at the same time,” she said.
- Umana lucked out, getting a room larger than most. She plans to turn the extra bed into a couch, even though she probably won’t be allowed to have other students come hang out.
- “At first I was like, ’Oh, my God, this feels like a jail, what can I do? I’m literally stuck inside,’ ” she said. “But now I’ve come to peace with it because I think it’s going to make all of us closer as a class.”
- Mental health specialists have said it’s imperative that institutions focus extra attention on students’ emotional well-being this semester.
- “During COVID, we are so focused on the physical . . . there is often this worry that we forget about how important the mental is here,” said Sian Leah Beilock, a cognitive scientist and president of Barnard College in New York City, which is all remote this semester.
- Today’s youth already experience increased levels of depression and anxiety, and now they are also coping with a public health crisis, economic disaster, and a season of social justice reckoning, Beilock said. Nevertheless, she said, she has been impressed by students’ resilience.
- “The young people give me hope,” she said, “and we should give them credit for what they are doing.”
- Umana has tried to stay upbeat. On Wednesday night, her first night in the dorm, the dining staff lost her quarantine food order, but an RA found her an extra meal: a hamburger, fries, fruit, and salad.
- Her dorm windows span an entire wall, and light filters in through tall trees. She occasionally sees people walking along the wooded trail outside, which somehow makes her feel less alone.
- It would be another two days before Umana’s test results came back negative, allowing her to leave the dorm. She spent the first night of quarantine watching Netflix and applying to campus jobs. She had thought about attending a virtual game night the school organized.
- “It feels completely bizarre that I’m in this room right now,” Umana said. “I expected to have this feeling that I’m starting something new, but it feels like it’s an extension of something — an extension of quarantine.”
4. When Tuberculosis Struck the World, Schools Went Outside
An open-air school in the Netherlands shows how the concept spread throughout Europe. (National Archief via Wikimedia Commons under CC BY-SA 3.0)
- In 1905, when tuberculosis plagued the United States, and Americans lived in deadly fear of the disease, a New York City health official addressed the American Academy of Medicine, pleading for changes at the nation’s schools. “To remove all possible causes which might render a child susceptible to the invasion of tuberculosis during school life, we must appeal to school boards, superintendents teachers, and school physicians to do all in their power.” Alarmed, the speaker noted that windows in American classrooms only opened halfway, and should be immediately replaced with French-style windows to “permit twice the amount of foul air to go out, and of good air to come in.” Every school must have a large playground, he continued, and classroom ventilation “of the most improved kind.” Schoolrooms were to be washed daily, and a “judicious curriculum” was to include “as much outdoor instruction as possible.”
- The speaker was S. Adolphus Knopf, a German-born expert on tuberculosis and the founder of the National Tuberculosis Association, which became the American Lung Association. Like many leading minds of his generation, Knopf took an approach to science that was informed by the racist tenets of eugenics. For Knopf, slowing the spread of tuberculosis—an infectious disease second only to influenza in its deadliness—required investing in healthy, young bodies to prevent racial, national and even military decline. By 1915, Knopf argued that “open-air schools and as much open-air instruction as possible in kindergarten, school and college should be the rule.”
- Today, as parents struggle with school closures and the prospect of many months of distance learning, some are asking why school can’t be held outside, where transmission risk of C19 is lower. There are currently no large-scale plans in the U.S. to move classrooms into the open, but it’s not for lack of precedent. In the early 20th century, when tuberculosis killed one in seven people in Europe and in the United States, outdoor schools proliferated, first in Germany and then around the world. Physicians and public health officials worried that overcrowded cities and cramped apartments were unnatural and unhealthy, given the lack of fresh air and sunlight, and that children—cooped up indoors for much of the day—were especially vulnerable to the ravages of tuberculosis. The solution was to move school outdoors, where children would “learn to love fresh air,” according to Knopf. There, “the tuberculous child” would not “be a danger to his comrades.”
In Charlottenburg, near Berlin, students with tuberculosis attended the Waldschule für kränkliche Kinder (translated: Forest school for sickly children). (via Wikimedia Commons)
- On August 1, 1904, the world’s first open-air school held lessons for the “delicate children of needy families” in a pine forest in Charlottenburg, a prosperous town near Berlin. The idea for a Waldschule, or forest school, came from Bernhard Bendix, a pediatrician at Berlin’s Charité Hospital, and Hermann Neufert, a local school inspector. The men worked with Adolf Gottstein, an epidemiologist and Charlottenburg’s chief medical officer, to plan the school and secure municipal funding. The state welcomed the idea. Tuberculosis threatened German society and its devastating effects turned child health into a national priority.
- In 1904, Germany recorded a staggering 193.8 tuberculosis deaths for every 100,000 people. (For comparison’s sake, the United States is currently recording about 52 deaths for every 100,000 people during the C19 pandemic.) According to public health experts, inadequate ventilation and poor hygiene were to blame: crowded tenements, stuffy rooms, dirty linens, bed-sharing in working-class families and too many sedentary hours spent indoors. “Both physicians and the public were very concerned about tuberculosis,” says Paul Weindling, the Wellcome Trust research professor in the history of medicine at England’s Oxford Brookes University. “There were many social distancing guidelines in diverse social contexts, as well as efforts to regulate personal behavior.”
- Lacking medicines to treat the disease, let alone a vaccine, health professionals focused their energies on reforming personal behavior and the environment. Public placards and posters warned against spitting on the ground, a common practice. Health officials crusaded for fresh air and exercise, demanded reductions in housing density, and called for the construction of playgrounds and parks to serve as the “lungs” of the city. “Air, light, and space became the priorities of architects, municipal officials, and public health experts,” writes Weindling in his book Health, Race and Politics between German Unification and Nazism.
- Child deaths from tuberculosis remained relatively rare, but German physician Robert Koch’s discovery of the tubercle bacillus in 1882 led to a “tuberculin test” that uncovered large numbers of infected children, even if they didn’t show symptoms. This finding was made even more troubling by another in 1903: Childhood tuberculosis infection could become latent or dormant, only to reactivate in adulthood, causing illness and death. In his Nobel Prize acceptance speech in 1905, Koch confirmed that tuberculosis was an airborne disease: “Even the smallest drops of mucus expelled into the air by the patient when he coughs, clears his throat, and even speaks, contain bacilli and can cause infection.” Koch’s words served as a call to action. Tuberculosis couldn’t be vanquished, but its spread could be contained in the streets, public places and schools.
A student studies in an open-air seating area on the campus of the University of North Carolina at Chapel Hill on August 18, 2020 in Chapel Hill, North Carolina. (Melissa Sue Gerrits / Getty Images)
- On a plot designated by officials for the open-air school, builders installed a pavilion, gardens, activity areas and open sheds, some fitted with tables and benches for lessons. The school grounds also included a larger shed for meals, an enclosed shelter for rainy days and rest periods, a teacher’s room, a kitchen, toilets and a “cure gallery,” a special structure designed to maximize sun exposure. In a departure from prevailing norms and in keeping with the goals of progressive educators, boys and girls were never separated. Whereas the average school in Prussia—Germany’s largest and most populous state—counted two square meters per pupil, students at Charlottenburg’s forest school enjoyed 40.
- The forest school in Charlottenburg isolated children who were “tuberculosis contacts,” at risk of catching the disease at home, or “anemic and undernourished,” a preexisting condition that was believed to raise the risk of infection. Bendix and Neufert targeted working-class city children who were shown in studies to be “tuberculized” at higher rates. Since 1899, when the International Congress on Tuberculosis met in Berlin and discussed, among other things, the plight of workers, public health experts worried that the chain of contagion would never be broken without access to “open air” at home or at a sanatorium, the spa-like retreat for those who could afford it. The forest school ensured a steady supply of fresh air to the children of workers. Half the school’s teachers were former patients at sanatoria, where they had already recovered from tuberculosis.
- The small school was soon swamped with so many applicants that it expanded to accommodate 250 students. What began as a local experiment attracted dozens of foreign visitors in just a few months and became an international sensation. By 1908, open-air schools were up and running in Britain, France, Belgium, Switzerland, Spain and Italy. That same year, the first outdoor school opened in the United States, in Providence, Rhode Island, in the dead of winter no less. The work of two women doctors—Mary Packard, the first woman graduate of the Johns Hopkins School of Medicine, and Ellen Stone, the founder of Providence’s League for the Suppression of Tuberculosis—the Providence Open-Air School was housed in an old school building, where a brick wall had been removed and replaced with large windows that always remained open. To protect the school’s 25 “delicate children” from the cold, wool mittens, hats, overshoes and “sitting-out bags,” the equivalent of today’s sleeping bags, were provided. Between 1910 and 1925, hundreds of outdoor schools “rooted in different cultural contexts,” while hewing to the German model, opened around the world, according to Anne-Marie Châtelet, a historian of architecture at the University of Strasbourg.
- On the eve of World War I, the U.S. counted some 150 open-air institutions in 86 cities. Behind every outdoor school was an anti-tuberculosis association that included physicians and laypeople. These voluntary groups were a diffuse but growing presence in American life—there were 20 anti-tuberculosis associations in 1905 and 1,500 in 1920. Scholars have attributed a number of the strategies deployed in modern public health campaigns to their efforts.
- As with many things education-related, the founders of the Providence school looked to Germany. Since the 1840s, when Horace Mann, then secretary of the Massachusetts Board of Education, traveled to Prussia to report on the world’s first free and compulsory schools, generations of American educators flocked to the German lands to study everything from curriculum and instruction to school architecture and classroom ventilation. The open-air school was no exception.
- Open-air schools in Boston, New York, Chicago, Hartford, Rochester and Pittsburgh followed, each shepherded into existence by a local anti-tuberculosis group. Unlike the Waldschule and its counterparts found in parks on the outskirts of European cities, these schools were located in dense urban areas. For American educators scrambling to meet the challenges of skyrocketing enrollments—the result of rapid urbanization, immigration and the enforcement of compulsory schooling laws—the outdoor schools promised some relief. At least it would remove at-risk children “from what many health experts considered the overheated and noxious atmosphere of the typical school room,” writes Richard Meckel, a professor of American Studies at Brown University, in an article on the early history of the schools, “and provide them with sustained exposure to cold air, which was widely believed to promote strength and vigor by stimulating the appetite and increasing respiratory and vascular activity.” It was this line of thinking that drew support from the eugenics movement. “Eugenicists prioritized the wider society and future generations,” says Weindling, “and many thought that promoting fitness could prevent infections, which justified open-air schools.”
- On both sides of the Atlantic, health experts viewed the city as a breeding ground for disease, where tuberculosis would continue its deadly rampage if conditions for workers and their families weren’t ameliorated. Open-air prophylaxis was available to paying clients at a sanatorium, but not the families of workers or the poor. Today, as public health experts emphasize the importance of ventilation and outside air, concerns over essential workers who face the highest risk of exposure to C19, are back.
- So, too, is interest in outdoor schools. According to recent reporting, more than 250 “nature-based preschools and kindergartens” are operating in the U.S., most of them barely a decade old. The Natural Start Alliance was created in 2013 to address “dramatic growth in nature-based early childhood education,” and a national survey conducted in 2017 found that eight out of 10 programs had started a waitlist in the previous 12 months. Like early 20th-century fears that city children were dangerously disconnected from nature, today’s worry is that screen time has eclipsed outdoor play.
- And while the open-air schools of a century ago were conceived for the families of workers—for the purposes of public health and nationalist ideals—outdoor schools and outdoor learning pods, now cropping up across the country, cater to a different demographic. “Nature schools in the United States tend to be filled with white, upper class kids,” the Oregon Association for the Education of Young Children observed in 2018. Change is unlikely, since the shuttering of schools has only accelerated gaps in educational opportunity.
- As more white Americans reckon with a long history of racial injustice, it’s worth acknowledging that these open-air schools were a product of their time, with its hierarchies of race and class permeating ideas about public health and the nation. Just as the modern pandemic has laid bare the inequities of the health care system, so too could a return to mass outdoor schooling, where proper supplies must be secured, warm clothing worn and wide open spaces made available.
- After World War II, new antibiotics dispelled the deadliness of tuberculosis, and open-air schools faded into irrelevance. Today their history is a reminder of what was once possible, as others have noted. But that only came to fruition when Americans were willing to look abroad for new ideas and when the nation viewed its own health and vitality as inextricably bound up with its schools.
5. C19 cases are spiking in these college towns—even as the U.S. trends downward
- The return of students to campuses across the U.S. is changing the landscape of pandemic America.
- As new cases of coronavirus across the country trend downward, college towns dominate the list of places—accounting for the top 16 spots—where new cases of C19 have increased the most in the past two-week period, according to a Fortune analysis of New York Times data.
- Johnson County, Iowa, home to Iowa City and the University of Iowa where classes began last Monday, saw the biggest jump in new cases—up from an average of 17 per day two weeks ago to 184 per day in the week ending Aug. 30. After the reports of fast-rising cases and publication by the local media of photos of mask-less students teeming Iowa City’s bars last week, Iowa governor Kim Reynolds ordered all bars, night clubs, and other drinking venues in six counties—including those where Iowa, Iowa State, and Drake Universities are located—to close. (All three of those institutions are in counties that are among the 16 with the biggest increase in new coronavirus cases). The University of Iowa Health Care reported positivity rates well above 30% for multiple days last week.
- Lee County, Alabama, where Auburn University is located—and where classes began Aug. 17—experienced the second largest increase in new cases—up from an average of 8 per day two weeks ago to 54 per day in the week ending Aug. 30. Sixteen players on the college’s football team are among those to have reportedly tested positive.
- In total, counties with 113 colleges had reported at least 25 more coronavirus cases per day in the week ending Aug. 30 than two weeks prior.
- In less populated areas, the return of students to campus has had an even greater impact in terms of overall coronavirus case numbers. The city of Radford, Virginia—the location of Radford University and roughly 9,400 students—had recorded just 68 cases as of Aug. 17; two weeks later, with students back on campus, the figure has increased by 465% to 348 cases for the year. The total number of cases reported year-to-date in Dawes County, Nebraska (population 8,700) have increased 329% in the two weeks ending Aug. 30. That’s the location of Chadron State College, a 3,000-student institution that has reported 27 positive cases among its student and faculty since Aug. 12. Whitman County, Washington has seen its case numbers soar by 258% in the past two weeks, reportedly due to the area’s student population. While the university has gone to remote classes this fall, many students have reportedly returned to off-campus housing nearby. Some of South Dakota’s college towns have also become hotspots, though case numbers remain relatively small.
- Institutions in counties with largest increase of daily new cases
- Additional new cases per day based on a seven-day average, Aug 17 – Aug. 30
|Institution name||County||City||State||Increase in county|
|University of Iowa||Johnson||Iowa City||Iowa||170|
|University of Texas Rio Grande Valley||Hidalgo||Edinburg||Texas||141|
|South Texas College||Hidalgo||McAllen||Texas||141|
|University of Houston||Harris||Houston||Texas||124|
|University of Houston-Downtown||Harris||Houston||Texas||124|
|Houston Baptist University||Harris||Houston||Texas||124|
|Texas Southern University||Harris||Houston||Texas||124|
|University of Houston-Clear Lake||Harris||Houston||Texas||124|
|University of St Thomas||Harris||Houston||Texas||124|
|University of Texas Health Science Center at Houston||Harris||Houston||Texas||124|
|University of Texas MD Anderson Cancer Center||Harris||Houston||Texas||124|
|Drake University||Polk||Des Moines||Iowa||122|
|Texas A&M University||Brazos||College Station||Texas||90|
|University of Massachusetts Boston||Suffolk||Boston||Mass.||87|
|Massachusetts College of Art and Design||Suffolk||Boston||Mass.||87|
|Pine Manor College||Suffolk||Chestnut Hill||Mass.||87|
|Wentworth Institute of Technology||Suffolk||Boston||Mass.||87|
|University of Alabama||Tuscaloosa||Tuscaloosa||Ala.||83|
|East Carolina University||Pitt||Greenville||N.C.||78|
|Iowa State University||Story||Ames||Iowa||78|
|University of Notre Dame||St. Joseph||Notre Dame||Ind.||76|
|Saint Mary’s College||St. Joseph||Notre Dame||Ind.||76|
|Indiana University South Bend||St. Joseph||South Bend||Ind.||76|
|Purdue University – Purdue Polytechnic South Bend||St. Joseph||South Bend||Ind.||76|
|North Carolina State University||Wake||Raleigh||N.C.||75|
|William Peace University||Wake||Raleigh||N.C.||75|
|Saint Augustine’s University||Wake||Raleigh||N.C.||75|
|University of South Carolina||Richland||Columbia||S.C.||71|
|Illinois State University||McLean||Normal||Ill.||66|
|Illinois Wesleyan University||McLean||Bloomington||Ill.||66|
|University of Alabama at Birmingham||Jefferson||Birmingham||Ala.||64|
|Boston College||Middlesex||Chestnut Hill||Mass.||63|
|Massachusetts Institute of Technology||Middlesex||Cambridge||Mass.||63|
|University of Massachusetts Lowell||Middlesex||Lowell||Mass.||63|
|Framingham State University||Middlesex||Framingham||Mass.||63|
G. Cost of Lockdowns
1. C19 Lockdowns Over 10 Times More Deadly Than Pandemic Itself
- A groundbreaking new study commissioned by Revolver News concludes that C19 lockdowns are ten times more deadly than the actual C19 virus in terms of years of life lost by American citizens.
- Up until this point there had been no simple, rigorous analysis that accurately and definitively conveys the true costs of the C19 lockdowns. Accordingly, Revolver News set out to commission a study to do precisely that: to finally quantify the net damage of the lockdowns in terms of a metric known as “life-years.”
- Simply put, we have drawn upon existing economic studies on the health effects of unemployment to calculate an estimate of how many years of life will have been lost due to the lockdowns in the United States, and have weighed this against an estimate of how many years of life will have been saved by the lockdowns. The results are nothing short of staggering, and suggest that the lockdowns will end up costing Americans over 10 times as many years of life as they will save from the virus itself.
- The C19 lockdown measures that Americans have had to endure for the greater part of 2020 represent one of the most dramatic, consequential, and damaging policy measures undertaken in this nation’s history. For the first time in its history, America has experienced a situation so crippling and perilous that long term financial and social stability have been legitimately threatened.
C19 “Cure” Is Worse Than Disease
- Standard approaches to evaluating epidemic policy responses, involving the Value of a Statistical Life, have conceptual problems and are biased towards the elderly and rich.
- Using a life-years criterion as an alternative shows that the lockdowns cost an order of magnitude more life-years than they saved.
- Most of the publicized cost-benefit analyses of C19 lockdowns have used coarse measures like lives as units rather than life-years, which misleads politicians and the general public. C19 deaths disproportionately impact the oldest members of the population, whereas the economic impacts of lockdowns disproportionately harm the youngest of the working population, who have far greater life expectancies at the time of impact.
- Using prior research on workforce entrants and recent graduates entering into a market marred by an economic recession, empirical estimates of life-years lost can be determined. Extensive research on job displacement can be used to estimate the economic impact in life-years of starkly increased unemployment for mid-to-late career workers.
- Combining these analyses, we found that an estimated 18.7 million life-years will be lost in the United States due to the C19 lockdowns. Comparative data analysis between nations shows that the lockdowns in the United States likely had a minimal effect in saving life-years. Using two different comparison groups, we estimate that the C19 lockdowns in the U.S. saved between a quarter to three quarters of a million life-years.
- Every broad age category lost life-years from the lockdowns including those 55 and older.
- The media and state and local governments contributed to the panic by selectively presenting evidence on C19 and shutdowns of dubious benefit.
- Public health researchers and health economists gave poor policy advice and made selective use of the prior research literature. They will likely be rewarded, not punished, by academia for their failure because of academia’s biases.
- Public health in general is so biased and vulnerable to motivated cognition that it is not “not yet ready for policy analysis.”
- On March 11, 2020, the World Health Organization officially classified C19 as a global pandemic. In the following weeks, the countries of the world began implementing previously unthinkable measures to prevent the spread of the virus. In the United States, some states quickly locked down nearly all physical businesses, venues, and public areas. As a short quarantine rapidly grew into an indefinite lockdown, some lawmakers and economists began asking if the lockdowns would cause more damage than the virus itself. Using empirical research, first-pass estimates can be made about the impact of the unprecedented lockdown in life-years lost. This can then be compared to the number to the estimated life-years lost to C19 in the United States.
- Why life-years? It is well-known that socioeconomic status (SES) appears to be linked to life expectancy and some of that association is causal, with higher SESes causing longer life expectancies through a number of channels. Most government policy analysts make decisions using the Value of a Statistical Life (VSLs) — which is about $10 million. If a regulation can save 1 life and costs $9 million, for instance, then it’s worth imposing to save a life. If it costs $11 million, then it’s not worth imposing to save a life. A problem with this approach is how coarse it is. Because SES is linked to life expectancies, actions by the government that do not result in direct loss of life are liable to being simply unaccounted for in this approach. For example, why not set the VSL at $100 million? Or $1? If you set the VSL too low, you will fail to impose many very cheap lifesaving regulations. Something perhaps more subtle is that if you set the VSL too high, then regulations you impose will reduce income so much by retarding economic activity that you will wind up reducing life expectancies through the SES-life expectancy channel. There are actually more fundamental issues with the use of a single VSL for all citizens (see Sunstein’s Valuing Life for a good overview), but many find the general equilibrium problems with it very intuitive.
- Surprisingly, the C19 conversation among public health analysts, bio-statisticians, economists, and policymakers who are otherwise sensitive to the problems with VSL has been dominated by the standard “coarse” VSL calculation above. We have seen no full policy analyses utilizing life-year approaches, although various studies have tried to estimate the average life-year losses per C19 death. Controversy over estimating the correct value of a statistical life, problems with actually applying it in analysis as described above, and perhaps a certain odiousness associated with the rendering of human lives in dollar terms have pushed some health economists and public health analysts toward use of a life-years approach. This approach is simple, and in principle, involves no explicit conversion of human lives into money terms — although such a trade-off is implicit in any policy analysis. From the life-years’ perspective, a policymaker can compute the life-years lost and gained if they take a specific action. For instance, a new airline safety regulation may make users of airlines so safe that they save an average of 0.1 life-years per traveler, but the higher cost of air travel may induce potential passengers to switch to less safe car travel, costing the switchers an average of 0.3 life-years. If enough people switch to car travel, then the airline safety regulation will actually reduce the total life-years lived from the perspective of the transportation system as a whole.
- A life-year maximizer would say that the regulation should not be adopted. An advantage of the life-year approach is that it values all people’s life-years equally in principle. The life-year of an 80 year old is of equal value to that of a 20 year old. The life-year of a poor person is worth the same as the life-year of a rich person. The VSL method, by incorrectly estimating the amount that heterogenous consumers and workers are willing to pay for safety, may privilege the wealthy (who place a higher premium on safety) and the elderly (who will not have to face the “general equilibrium” costs of more safety regulations) over the poor and the young, who might prefer less safe but much cheaper goods and services or higher paying, but unsafe jobs over lower paying, but safe jobs. With life-years now established as our operational metric, we shall proceed with our analysis of the life-year impacts of Covid lockdown policies.
- The C19 lockdowns have resulted in a massive global recession, which has spared almost no country, firm, or economic sector. Job displacement in America has occurred at a scale nearly rivaling that of the Great Depression in the 1930s, with unemployment as high as 14.7% in April of 2020. Using a back-of-the envelope calculation, we can lower-bound the medium-term increase in unemployment, which can reasonably be estimated at around 8.5%. It is important to note that even medium-term unemployment will result in permanent job separations, as employees who are unemployed for over a year are unlikely to return to their previous position.
- Previous research on job displacement and mortality has found that displaced workers face a significant increase in mortality rates, from which lost years of life can be estimated. Job losses and permanent job separations have been shown to correlate directly with increases in heart disease, drug overdoses, lung cancer, and liver disease, among other factors of increased mortality risk. Sullivan and Von Watcher’s paper on job displacement and mortality estimated that job separation results in about 1.5 lost life-years per individual.
- The Organization for Economic Co-operation and Development (OECD) estimates that U.S. unemployment in 2021 will range between 8.5% in a single-wave scenario and 11.5% in a double-wave scenario. Assuming that a single-wave scenario occurs, U.S. unemployment next year will increase by about 5% over pre-C19 2020 levels. Based on pre-C19 payrolls, total job displacements in 2021 will likely be around 8.2 million. Increases in 2020 unemployment by age group between February and July can be used to estimate the distribution of additional unemployment for each age group. Taking the 8.2 million job displacements and multiplying them by Sullivan and Von Watcher’s lost life-year coefficients for each age group provides a total estimate of over 8,000,000 life-years lost due to job displacement.
- Beyond direct job displacements, additional research has shown that labor market recessions have significant but lagged effects on the future mortality rates of those entering the labor market. Based on Hannes Schwandt and Till von Wachter’s linear model of increased mortality due to entering the job market during a recession, a figure of 0.629 life-years are lost per individual in this classification. This number can be multiplied by 13 million workers in the 16-24 age group in 2020 and then multiplied separately by the 3.9 million college graduates of 2020. This methodology is also used by Till von Wachter in his working paper on the long-term effects of the C19 crisis on workers. By these estimates, long-term life-years lost due to the C19 recession in the U.S. total around 18.7 million.
- Table 1 contains a breakdown of total life-years lost as a result of economic conditions created by the lockdowns by all estimation methods.
|Group||Estimated life-years lost|
|2020 Displaced Workers||8,071,000|
|New Workforce Entrants||8,180,000|
- Having established the amount of life-years lost due to C19 lockdown policies, it remains to consider how many lives these may have saved.
- With over 170,000 confirmed C19 deaths at the time of writing, the virus has proven to be a clear public health threat in America. Table 2 (below) contains CDC data for C19 deaths by age group in the United States, and life expectancies of those age groups.
- Multiplying the expected years of life remaining by the number of deaths in each age group provides a number for life-years lost by age group. The total calculated life-years lost from C19 in the United States adds up to 1.88 million. It is important to note that this is a high-end estimate. This calculation assumes that those dying from coronavirus have an average life expectancy and would have otherwise likely lived out the remaining years, had they not contracted the virus. Recent medical research has shown that coronavirus deaths are more likely to occur in patients with underlying health conditions. This implies that an estimate of life-years lost due to C19 may be slightly inflated.
|Age Group||US C19 Deaths||Expectation of Life||Estimated Life-Years Lost|
|Under 1 year||15||78.61||1,179|
|85 years and over||45,842||6.58||301,848|
- To better contextualize the effect of the lockdown, it is important to estimate C19 deaths in the United States in a scenario where a lockdown was not enacted. While much is still unknown about the virus, data from other countries illustrates the effect of varying degrees of lockdowns.
- Sweden faced controversy for not enacting lockdown measures, unlike most other nations. Data from Johns Hopkins University shows that Sweden had a C19 fatality rate of 56.62 per 100,000 people. The United States, with full lockdown measures, had a C19 fatality rate of 50 per 100,000 people [note all data valid up to the time of writing]. The United Kingdom provides yet another perspective, as it initially took an approach closer to Sweden and then changed course during the pandemic, resulting in a C19 death rate of 70 per 100,000 people.
- An estimate of U.S. C19 deaths had the lockdowns not been enacted can be estimated by using either Sweden’s per-capita death rate or the United Kingdom’s rate as counterfactual estimates of the “least economically costly-possible policy.” For simplicity, we hold the distribution of age at death constant. Figure 2 and Table 3 show these estimates by age group. Table 4 shows differences between counterfactual and actual C19 deaths. For simplicity, we assume that the “age structure of death” in the United States for C19 would have continued to apply and apply a simple multiplier (based on the ratio of per capita deaths in the U.S. and UK/Sweden) to construct our counterfactual estimates.
|Age Group||C19 Deaths||Est. Life-years lost|
|Under 1 year||17||21||1,336||1,653|
|Age Group||Excess C19 Deaths||Excess Life-Years Lost|
|Under 1 year||2||6||157||474|
- Based on the estimations in Table 4 (directly above), the U.S. lockdowns may have saved anywhere between a quarter of a million to three quarters of a million life-years. This estimate range is staggeringly low compared to the life-years that will be lost as a result of the lockdown.
- Figure 3 (below) shows the breakdown with the Swedish and U.K. models. In the Figure, the blue bars represent life-years saved from the lockdown, which are estimated by comparing the U.S.’s performance with Sweden and the U.K. The red bars represent life-years lost from the lockdown, which are estimated using the estimated reductions in life expectancy from unemployment and separations using U.S. data described above.
- An intuition policymakers should develop is that that the death of someone aged 20 to 25 will “cost” a little over 50 life-years. Similarly, a permanent employment separation today will “cost” between 0.5 and 1.5 lost life-years, as a small fraction of permanent separations will yield permanently unemployed workers, who have shorter life expectancies in general (think stress-induced increases in cancer, heart attacks, homicide, and deaths of despair [alcohol, suicide, pills]). On the other hand, a typical C19 death will cost between 7 and 17 years — simply because of the age and comorbidity structure of those typically dying already tilts them towards an early death.
- A second key assumption, more debatable, is that absent the lockdowns unemployment would not have dramatically increased. Krugman and other economists make the case that the consumption cuts driving unemployment would have happened without the stay-at-home orders based on the experience of contiguous countries e.g. Sweden and Denmark both suffered similar GDP losses. This logic ignores the fact that huge fractions of the Nordics’ collective GDP are linked through trade and so a straightforward difference-in-difference exercise ignores the negative externalities Finnish, Danish, and Norwegian lockdowns imposed on their neighbors. Even if it was not lockdowns causing the consumption cutbacks, mainstream media did little to push back on catastrophe narratives and, through selective coverage, actively misled citizens’ about the actual (small) risks of C19.
- The fact of the matter is that once C19 hit, there were going to be economic and life-year losses compared to the world where C19 did not hit. However, the ultimate size of those income and life-year losses, and the geographic and age-allocation of those life-year losses, amount to a policy choice.
- Some pedants may quibble that we have constructed our unemployment counterfactual using a time series analysis of U.S. data while we constructed our “no lockdown” C19 life-year losses counterfactual using foreign country experience, effectively mixing two different designs.
- We encourage the fair reader to consult the title of this piece. The correct counterfactual is impossible to know. Real results from a country like Sweden or the UK are better than results from an epidemiological model with extremely limited out of sample validity and fundamentally unidentifiable parameters. The point of this quantitative thought experiment is mostly qualitative and aimed at making the single point to citizens and policymakers: small permanent or cohort-level increases in unemployment induced by the lockdowns easily wipe out the small documented benefits of lockdowns.
- The actual increases in unemployment in the United States are massive — exceeding the scale of the Great Recession. The long-run increase in unemployment cannot easily be constructed from contemporaneous cross-country data for the simple reason that those countries long-run employment evolutions haven’t happened yet, but it is reasonable to assume that C19 has run its course in say, New York or Sweden — which now has around 1-2 C19 deaths per day. Revolver.news would be honored if someone stole these insights for Lancet, which has a quick turnaround, the CDC’s in-house journals, or the NBER working paper series on epidemics/C19.
- The economic devastation of the lockdowns will last for decades after the virus is brought under control, and it may lead to far worse ripple effects down the road. For the first time in its history, America has experienced what could be almost likened to a sudden stop in an emerging nation — a situation so crippling and perilous that long term financial and social stability have been legitimately threatened.
- How did this happen? It is worth reflecting for a moment on the institutional incentives in academia that led to the pandemic pandemonium and the U.S.’s almost assured future fiscal collapse. Our calculations imply that — from a lost life-years’ perspective — the C19 lockdowns in the U.S. objectively caused far more harm than good to every age category. The life year losses are so large that it is difficult to see any kind of refinement justifying the current American policy combination. Indeed, one would need to argue that — without elite panic — a disease only about two to four times as virulent as the flu would have induced a depression, which itself would indict the macrofinancial policymaking community.
2. 4 Life-Threatening Unintended Consequences of the Lockdowns
- When policymakers across the country decided to “lock down” in response to the March outbreak of the novel coronavirus, they took a leap into the unknown. Not only did we know little about C19 itself at that time, but we knew almost nothing about how shutting down nearly all of society would affect people.
- Policymakers focused on their models predicting how lockdowns could help limit the spread of C19; an important factor, to be sure. So, too, many acknowledged the negative economic ramifications of lockdowns. But in the months since, we’ve seen many other dire consequences stem from the unprecedented shutdown of society.
- Future public health policy should take these four life-threatening unintended consequences of C19 lockdowns into account.
1. Massive Spikes in Suicide Rates and Mental Health Crises
- Even the most fortunate among us felt the emotional strain from months behind closed doors. Being cut off from friends, family, and many of the other things that give life meaning has proved too much for many of those who were already struggling.
- As FEE.org Managing Editor Jon Militmore has detailed, the CDC found that one in four young people have had suicidal thoughts during the pandemic to date. (For comparison, less than six percent of young people harbored similar thoughts in 2008-2009 according to older CDC data). And more than 40% of respondents said the crisis had prompted mental health or behavioral problems. Anecdotal evidence also suggests that suicidality increased during lockdown.
- Given that young people without preconditions are at almost zero risk of death from C19 and the well-documented deleterious effects of social isolation, it’s fair to largely attribute this disturbing trend in mental health to lockdowns.
2. Uptick in Drug Overdoses and Substance Abuse
- Naturally, social isolation and despair are key triggers for substance abuse relapse. So it’s no surprise to see the emotional and mental consequences of C19 lockdowns have exacerbated an already-severe drug crisis in the US.
- This has played out in my backyard, the Washington, DC metro area.
- “In April, the most recent month for which statistics are available, the city [of Washington DC] saw its largest monthly number of opioid overdoses in five years,” the Washington Post reports. “[This] is part of a national trend of overdose increases that health experts say has accelerated in recent months.”
- Meanwhile, Maryland saw more than double the opioid overdose fatalities in the first quarter of this year compared to the previous year. And in Virginia, state officials estimate that they will “record almost 1,700 such fatalities by year’s end—the highest annual toll since at least 2007.”
- This is a country-wide trend. NPR reports that overdoses nationally have spiked by about 18%. For comparison, in 2018, more than 67,300 Americans died from drug overdoses. An 18% increase undoubtedly means thousands of additional tragic overdose deaths.
3. Economic Devastation Leads to Hunger
- The US Census Bureau recently surveyed Americans on how the C19 crisis has affected their ability to feed their families, and the results are chilling.
- “The number of Americans who say they can’t afford enough food for themselves or their children is growing,” the Wall Street Journal reports. “As of late last month, about 12.1% of adults lived in households that didn’t have enough to eat at some point in the previous week, up from 9.8% in early May, Census figures show. And almost 20% of Americans with kids at home couldn’t afford to give their children enough food, up from almost 17% in early June.”
- Meanwhile, food banks report unprecedented, surging levels of demand for their charitable services.
- Closing down businesses and schools might have limited the spread of C19. But it’s also clear the economic consequences of the lockdowns caused mass malnutrition and even pushed many American families to the brink of starvation. (Globally, the C19 lockdowns could push up to 100 million people into extreme poverty.)
4. Surge in Domestic Violence Under C19 Lockdowns
- Tragically, trapping people at home and cutting them off from outside support is a recipe for domestic violence. This has played out on a global level, with reports of skyrocketing domestic violence amid tension and home confinement in India, Mexico City, the United Kingdom, and other nations around the world.
- There’s reason to believe the US has experienced a similar trend. One study published in the journal Radiology found greatly increased levels of injuries consistent with domestic violence wounds at a Massachusetts hospital during the state’s stay-at-home emergency order.
- “This data confirms what we suspected,” the study’s co-author told US News and World Report. “Being confined to home for a period of time would increase the possibility for violence between intimate partners.”
- A separate study analyzing data from police precincts in several major US cities also showed increases in domestic violence during the lockdown period, with the increases ranging from 10% to 27%.
Unintended Consequences Necessitate Humble Policymaking
- These dire unintended consequences of C19 lockdowns are tragic, but frankly, they aren’t so shocking. We have long known that sweeping government interventions have ripple effects that extend far beyond their intended goals.
- Why? Because of what economic philosopher Friedrich Hayek called the “knowledge problem.”
- “If we can agree that the economic problem of society is mainly one of rapid adaptation to changes in the particular circumstances of time and place,” Hayek wrote. “It would seem to follow that the ultimate decisions must be left to the people who are familiar with these circumstances, who know directly of the relevant changes and of the resources immediately available to meet them.”
- Simply, the knowledge problem means that central planning efforts are doomed to fail. Only those closest to a problem know the ins and outs of it.
- For example, can you imagine planning a birthday party for a person you’ve never met? You don’t know what kind of cake they like. You don’t know if they prefer pepperoni pizza or Hawaiian pizza. You don’t even know who to invite. Now, what are the odds you can plan a party that won’t go horribly?
- This is the Herculean task that awaits government officials who try to dictate the every behavior of millions of individuals.
- So, when it comes to sweeping, nation-wide pandemic lockdowns, central planners will never be able to adequately assess all the deadly unintended consequences that correspond with their drastic actions. This doesn’t mean the government should do nothing at all in the public health arena, but that elected officials ought to be far more humble in the extent of their actions. The deadly unintended consequences of sweeping C19 lockdowns remind us why.
H. Johns Hopkins COVID-19 Update
August 31, 2020
1. Cases & Trends
- Total Daily Incidence (change in average incidence; change in rank, if applicable)
- Per Capita Daily Incidence (change in average incidence; change in rank, if applicable)
- India has surpassed the US for the global record for average daily incidence. At 73,557 new cases per day, India is already nearly 10% higher than the previous record, and case counts are still accelerating. The Philippines fell out of the top 10 in terms of total daily incidence, and it was replaced by France. The Bahamas fell out of the top 10 in terms of per capita daily incidence, and it was replaced by Spain. No countries are currently reporting more than 250 daily cases per million population.
- The US CDC reported 5.93 million total cases (44,292 new) and 182,149 deaths (1,006 new). In total, 19 states (no change) are reporting more than 100,000 cases, including California, Florida, and Texas with more than 600,000 cases; New York with more than 400,000; and Arizona, Georgia, and Illinois with more than 200,000. We expect California to surpass 700,000 cases in its next update. The US continues to average fewer than 1,000 deaths per day; however, the daily total is decreasing very slowly. The US is currently averaging 928 deaths per day, still nearly double the national low of 484 deaths per day on July 6.
- Several US territories continue to report extremely high per capita daily incidence. Guam is reporting 446 daily cases per million population, which would be #1 globally—nearly 90% greater than the Maldives, the actual #1. Guam’s daily incidence has held relatively steady since August 27. The US Virgin Islands is reporting 205 daily cases per million population, which would be #4, falling between Bahrain and Argentina. Puerto Rico would have fallen out of the top 10, but it is still reporting 147 daily cases per million population—more than 15% greater than the rest of the US.
2. Prevalence & Transmission in Children
- New research published in JAMA Pediatrics describes the prevalence of asymptomatic SARS-CoV-2 infection in children. The study included pediatric patients who sought care at 25 US children’s hospitals who were tested for SARS-CoV-2 prior to receiving care for other conditions (e.g., surgery). Out of 33,041 children tested in April and May, 250 asymptomatic infections were detected. The prevalence at individuals facilities ranged from 0%-2.2%, and the overall prevalence was estimated to be 0.65%. Increases in asymptomatic pediatric infections within the hospitals was significantly associated with increases in incidence among the surrounding general population.
- Two case studies published in the US CDC’s Morbidity and Mortality Weekly Report (MMWR) address SARS-CoV-2 transmission among children in non-school congregate settings. One article describes the reopening of 4 overnight summer camps in Maine (US). The camps had a total of 1,022 attendees from 41 states, and they were successful in preventing secondary transmission of SARS-CoV-2 in the camp setting. The camps implemented multiple preventative measures, including quarantine, symptom screening, testing, and enhanced hygiene measures. All campers and staff were instructed to quarantine for 10-14 days with their family prior to arriving at the camp, and the camp provided additional guidance for campers during travel to the site. All attendees either tested negative within 5-7 days prior to arriving at the camp or had documented SARS-CoV-2 infection in the previous 2 months. Four asymptomatic individuals tested positive during the pre-arrival testing, and they were required to complete isolation before joining the group. The attendees were placed in a “bubble” with a designated cohort of attendees, and cohorts remained separate from each other for 14 days after arrival. Testing was repeated 4-9 days after arrival, and 3 additional asymptomatic cases were identified and isolated. Symptom screenings were conducted for all campers and staff daily. No secondary transmission by symptomatic individuals was detected at any of the 4 camps, but the possibility of additional asymptomatic cases cannot be ruled out.
- The second MMWR article describes the reopening of 666 childcare programs—approximately 18,945 children—in Rhode Island (US) in June and July. The Rhode Island Department of Human Services initially limited capacity at childcare centers to 12 total individuals initially and then later expanded to 20. The programs were also required to implement universal mask use for staff, daily symptom screenings for staff and children, and enhanced hygiene and cleaning practices. Compliance with regulations was enforced through unannounced visits by state officials. If anyone developed symptoms, the centers were required to close for 14 days, or until a negative test ruled out SARS-CoV-2 infection. Throughout the study period, 101 individuals were identified as a possible SARS-CoV-2 infections, of which 33 tested positive and 19 were symptomatic but not tested—30 children, 20 teachers, and 2 parents. In total, 29 childcare programs, and health officials were able to rule out secondary transmission in all but 4 programs.
- Two recent studies provide further analysis of the immune response to SARS-CoV-2 infection. The first study, published in the US CDC’s Emerging Infectious Diseases, included 28 participants with severe C19 disease and 15 participants who recently recovered from mild C19. Participants with mild C19 exhibited a delayed increase in IgG and neutralizing antibodies compared to patients with severe C19; however, the IgM response reactive toward S1 and E proteins increased early for both groups. The researchers suggest that mild cases of C19 may “not necessarily represent an intermediate stage between severe and asymptomatic C19,” but further research is required to better characterize the human immune response and any associations with disease severity.
- The second study, published in Nature, explored differences in viral load, antibody titers, and plasma cytokines in female and male C19 patients. The study included 98 total participants treated at Yale-New Haven hospital in Connecticut (US). The researchers found that female patients exhibited a more robust T cell activation than male patients, whereas male patients had higher levels of innate immune response, including IL-8 and IL-18 cytokines. They also found that poor T cell response was “associated with worse disease outcomes in male patients, but not female patients” and that elevated innate cytokine response was associated with more severe disease in females but not males. These differences could potentially inform variations in treatment courses for female and male C19 patients.
- After researchers in Hong Kong published details of a C19 patient who appears to have been infected twice, with different strains of the virus, a team of US researchers report evidence that a C19 patient in Nevada was also reinfected. The patient, a 25-year-old male, tested positive for SARS-CoV-2 in late April and was discharged following 2 negative diagnostic tests. He then tested positive again approximately 1 month later. The researchers indicate (preprint) that, like the patient in Hong Kong, genetic analysis of the specimens from the Nevada patient indicated that he was infected with 2 different strains of SARS-CoV-2.
- This is the first documented instance of SARS-CoV-2 reinfection in the US. One notable difference between the Hong Kong patient and Nevada patient is the severity of their second infection. The Hong Kong patient was asymptomatic when he was identified via screening upon arrival in Hong Kong, whereas the Nevada patient experienced much more severe disease during his second infection. While it still appears that reinfection is relatively rare, researchers will inevitably identify more cases. With tens of millions of cases, many of whom recovered from their initial infection months ago, we will certainly hear about more reinfections in the coming months. As more examples of reinfection are identified, researchers will aim to answer critical questions, some of which could provide critical insight into the efficacy of future vaccines.
5. Influenza Vaccine Mandate
- Health experts continue to warn about the risks associated with simultaneous epidemics of C19 and seasonal influenza, and governments are scaling up efforts to increase access and participation in seasonal influenza vaccination. While the US government has purchased an increased volume of seasonal influenza vaccine this year, state governments, many of which are already overburdened with the C19 response, will be responsible for coordinating the distribution and administration of the vaccine to the public. Some states are also purchasing their own vaccine and initiating campaigns to educate the public and promote seasonal influenza vaccination. While many Southern Hemisphere countries reported much lower seasonal influenza incidence compared to previous years, many of those countries have had greater success in limiting SARS-CoV-2 transmission than the US, including through social distancing and mask use. It remains unclear whether C19 measures will have any meaningful impact on the Northern Hemisphere influenza season or if simultaneous epidemics in some countries could compound the burden on health systems.
- In Massachusetts (US), the Department of Public Health is requiring seasonal influenza vaccination for all children age 6 months and older in order to attend child care, preschool, K-12, and colleges and universities. Exemptions will be available for medical and religious reasons. Vaccination will not be required for college and university students participating in all-remote classes; however, K-12 students in school districts that are conducting classes remotely will not be exempt. The addition of the seasonal influenza vaccine to the Massachusetts vaccination schedule appears to be a permanent change, extending beyond the C19 pandemic, but the health department’s Medical Director, Dr. Larry Madoff, emphasized that seasonal influenza vaccination is even more important during the C19 response. In response to the announcement, hundreds of protesters gathered at the Massachusetts State House. The protesters included both anti-vaccine advocates and parents concerned about the state eliminating their ability to make choices for their children’s health.
6. Rapid Test in Asymptomatic Infections
- Following the announcement of an Emergency Use Authorization (EUA) for its new SARS-CoV-2 rapid antigen test, the CEO of Abbott Laboratories, Robert Ford, announced that the company is currently conducting a clinical trial to collect data on the test’s accuracy for asymptomatic infection. The EUA limits the test’s use to individuals within 7 days of developing C19 symptoms, but it is generally understood that transmission by asymptomatic or presymptomatic individuals plays a major role in driving the pandemic.
- The ability to rapidly screen asymptomatic individuals for infection would further increase the test’s utility during the pandemic. The test does not require specialized or proprietary equipment or supplies beyond the test kit itself. The test is capable of providing results in approximately 15 minutes, much faster than traditional PCR-based diagnostic tests. The widespread availability of a rapid point-of-care diagnostic test that works on asymptomatic individuals could improve the ability to identify and isolate infectious individuals or screen larger groups of people for possible infection, which could facilitate efforts to resume some social and economic activities.
7. Burial Rituals
- In addition to the threat of C19 itself, many communities are working to adapt funerary and burial practices for C19 victims. Traditional practices, including large gatherings and washing the deceased’s body, are common in many cultures, but these activities could pose transmission risk. Many countries and state/regional governments have implemented restrictions on funerals, including prohibitions on washing the body and limitations on the number of attendees, and domestic and international travel restrictions can make it difficult or impossible for family and friends who live elsewhere to attend the service. As we have seen in previous epidemics, such as the 2014-16 West Africa Ebola epidemic, communities are adapting to new burial processes, which likely do not conform to long-standing traditions.
- These changes can put additional stress on affected families and communities, compounding challenges in dealing with social distancing, economic damage, and other disruptions associated with the pandemic. Communities are working to balance the importance of providing a dignified burial for C19 victims with the need to protect the health of families and communities, as well as the religious leaders, morticians, and others who participate in funerary services.