September 15, 2020
Without reliable information, we rely on fear or luck.
“If you’re talking about getting back to a degree of normality which resembles where we were prior to COVID, it’s going to be well into 2021, maybe even towards the end of 2021.”Dr. Fauci
“Once again, I’m not very fond of easy solutions to complex problems and to believe that once the vaccine is here, we can go back and live as we always have done. I think that’s a dangerous message to send because it’s not going to be that easy.”Anders Tegnell, chief epidemiologist of Sweden
1. Cases & Tests
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity
9. Seasonal coronavirus protective immunity is short-lasting (Link Only)
11. Seasonal coronavirus protective immunity is short-lasting (Link Only)
5. AstraZeneca resumes C19 vaccine trials in the U.K. (Link Only)
6. C19 Ventilator Patients Can Have Permanent Nerve Damage (Link Only)
7. Loneliness Doubled Among Older Adults in First Months of C19 (Link Only)
A. The Pandemic As Seen Through Headlines
(In no particular order)
- WHO reports highest one-day increase in global coronavirus cases since pandemic began
- Chinese virologist posts report claiming COVID-19 was made in Wuhan lab
- PA Governor’s COVID-19 Restrictions Ruled Unconstitutional By Federal Judge
- Trump says striking down Pennsylvania’s pandemic restrictions is ‘good news’
- US halts COVID-19 symptom checks, screenings for high-risk countries
- India reported 92,071 new cases on Monday, the fifth consecutive day that new cases exceeded 90,000 in the country.
- AstraZeneca Resumes C19 Trials After Halt Over Adverse Reaction
- Pfizer says it should know if COVID-19 vaccine works by end of October
- Pfizer CEO: Coronavirus vaccine could be distributed in U.S. by end of year
- UK testing if COVID-19 vaccines work better inhaled
- Russia Recruits 55,000 Volunteers For COVID-19 Vaccine Trials
- Russia and China have already started vaccinating under emergency use measures, and are making international deals to sell their experimental vaccines
- Bill Gates is pushing Congress to spend $4 billion on vaccinations for poor countries
- Health officials in India—which is on track to outpace the U.S. as the world’s worst-hit country—may approve a vaccine on an emergency basis
- Indonesia enacts strict coronavirus precautions with hospitals nearly full
- Israel becomes first country in the world to impose second national lockdown
- France’s Hospitalizations Rise as Virus Spread ‘Won’t Stop’
- Czech Republic sees another daily record
- Austria sees most new cases since March
- Florida sees just 8 deaths, lowest since June 15
- Italy cases climb for 6th week
- Wuhan domestic air traffic back to pre-pandemic levels
- Nebraska to end nearly all social distancing restrictions
- Lessons learned in early days on COVID-19 front lines are now saving lives
- Wisconsin is facing its highest level of new daily cases during the pandemic, averaging more than 1,000 new cases a day in the past week. College towns are driving the troubling surge
- Los Angeles began a sweeping initiative to test and screen all 700,000 students and 75,000 employees in the city’s public schools
- Several school districts in Massachusetts and New York delayed the start of in-person classes in recent days after learning that their high school students had attended large parties
- Principals blast NYC Department of Eduction for supplying ‘cheap black-market crap’ PPE
- College students throw party despite testing positive for COVID-19
- Schools reopen across Europe
- Victoria state sees lowest case count in 3 months
- New Zealand to lift all COVID restrictions next week
- Mexico cases, deaths climb
- Austria is entering the second wave of the pandemic. Other European countries, including the U.K. and the Czech Republic, are also experiencing alarming new outbreaks.
- Britain lowered limit on the number of people allowed to meet to 6 from 30
- UK Prime Minister Pledges Millions of Covid Tests But Labs Can’t Cope
- The French cities of Marseille and Bordeaux significantly tightened restrictions on public gatherings after the authorities pointed to a concerning surge of infections in both cities and their surrounding areas
- The Spikes in Central Europe Worsen
- Massive Lines Form Outside Virginia Food Bank As Demand Hits One Million Meals Per Month
- Wisconsin Food Bank Warns: “We’re Not Going Back To Normal Anytime Soon”
- The global economic hit from the virus has been more than four times worse than the financial crisis, an international economic organization said
- Amazon Hires 100,000 Workers Ahead Of Holiday Season Amid Pandemic-Inspired E-Commerce Boom
- Futures Surge On Monday Merger Mania, Fresh Vaccine Hopes
- Internet searches for gastrointestinal symptoms predicted COVID-19 hot spots
- Majority of the Washington region’s workers unlikely to return to the office before summer, survey says
- ‘Cuomo killed my mother!’: Protesters rally at Cuomo’s NYC office over nursing homes
- It’s Not Time to Let Our Guard Down
- It’s the Worst Time Possible to Lose Interest in the Pandemic
- Is the U.S. on the verge of a third wave?
- Couple held hands as they died moments apart from coronavirus
- It may be more than a year before we can safely go to theaters, Fauci says
- I was pro-lockdown for NYC — but now there’s no excuse for continuing it
- Texas county offering $100 for plasma donations from COVID-19 survivors
- Anti-maskers forced to dig graves for COVID-19 victims in Indonesia
- US woman that refused to quarantine accused of sparking COVID-19 outbreak in German ski town
- Peru’s Indigenous turn to ancestral remedies to fight virus
- Wearing masks could become part of troops’ standard post-COVID operating procedure
- Study finds severe COVID-19 more deadly than heart attacks among young adults
- Amid coronavirus pandemic, Americans in ‘denial’ over poor mental health: survey
- Coronavirus can survive on chilled salmon for eight days, study claims
- Big Ten to vote on football returning as early as October
- Adults with COVID-19 twice as likely to have dined at a restaurant: study
- Gibraltar has become Europe’s pandemic wedding hot spot
- German prostitutes furious over sex work ban amid COVID-19
- Singapore Airlines Plans Flights to Nowhere
- NYC Cancels Macy’s Thanksgiving Day Parade
- ‘Saturday Night Live’ to resume live shows next month
- Sea ya later! Stranded cruise ship workers finally going home after 6 months
- Maldives Offers $52,000 Remote Office ‘Work From Paradise’ Package
- Could the pandemic finally kill daylight saving time?
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 = 29,435,721
- New Cases = 242,555
- New Cases (7 day average) = 273,753 (+6,371) (+2.4%)
- 7 day average of new cases is a record high
- 7 day average of new cases has increased by 4.9% since 9/9
- 1,000,000+ cases every 4 days (based on 7 day average)
US Cases & Testing:
- Total Cases = 6,749,289
- New Cases = 38,072
- Percentage of New Global Cases = 15.7%
- New Cases (7 day average) = 37,142 (+1,810) (+5.1%)
- Total Number of Tests = 93,242,920
- Percentage of positive tests (7 day average) = 5.1%
- Although the 7 day average of new cases has been trending lower since the 2nd peak on 7/25, the 7 day average has increased 5.5% over the last 2 days
- 7 day average of the percentage of positive tests continues to decline
- Total Deaths = 932,445
- New Deaths = 4,375
- New Deaths (7 day average) = 5,121 (+71) (+1.5%)
- Changes in 7 day average of new deaths since 9/8 have been within a 1.5% range
- Total Deaths = 199,000
- New Deaths = 480
- Percentage of Global New Deaths = 11.0%
- New Deaths (7 day average) = 781 (+28) (+3.7%)
- Although the 7 day average of new deaths has been trending lower since the second peak on 8/4, the 7 day average has increased 6.0% since 9/8
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (9/14)
- Over the last week, a total of 16 States showed an increase in the average number of cases over the last week (and 34 States had decreases in cases).
- States with the highest weekly percentage change in new cases:
|State||# of Cases for week ended 9/7||# of Cases for week ended 9/14||% Change|
- Of the 16 States with increases in their cases, 11 States had increases under 10%
Source: Worldometer and The Covid Tracking Project
C. New Scientific Findings & Research
1. Study shows C19 infection rate was 3x to 20x higher than confirmed cases
- To date, coronavirus testing in the US has been extremely limited. Confirmed C19 case counts underestimate the total number of infections in the population. We estimated the total C19 infections – both symptomatic and asymptomatic – in the US up to April 18, 2020. We used a semi-Bayesian approach to correct for bias due to incomplete testing and imperfect diagnostic accuracy. We estimated that the number of C19 infections in the U.S. was 3 to 20 times higher than the number of confirmed cases, with substantial variability by state.
C19 testing rates vary widely between states
- In March and April, 2020 C19 testing increased from 0.9 to 11 per 1,000 in the U.S. However, there were large discrepancies in testing between states, with state-level testing rates of 6 per 1,000 in Kansas to 31 per 1,000 in Rhode Island.
- We estimated the cumulative population tested in each state by date by dividing the number of tests performed by 2019 population projections from the U.S. 2010 Census. Line and text colors are based on quintiles of the distribution of testing per 1,000 population on April 18, 2020 across all states. Quality of daily estimates of the number of tests performed varied by state; see the (About page) for details.
Current confirmed C19 case counts vastly underestimate total infection burden.
- Correcting for incomplete testing and imperfect diagnostic accuracy, we estimated that the total number of C19 infections was 6,454,951 (19 per 1,000) by April 18, 2020. This number vastly exceeds the 721,245 confirmed cases (2 per 1,000) C19 cases reported during that period.
- Below, estimated total C19 infections – including symptomatic and asymptomatic infections – are shown. Accounting for uncertainty in our model, the number of estimated infections in the U.S. was 3 to 20 times higher than the number of confirmed cases.
- Analyses include cumulative confirmed C19 case counts up to April 18, 2020. Estimated coronavirus infections were from a Bayesian probabilistic bias analysis to correct for incomplete testing and imperfect test accuracy. Estimated infections include both symptomatic and asymptomatic infections. Horizontal black lines indicate the simulation interval for estimated infections (2.5th and 97.5th percentiles of the distribution of estimated infections for each state). Rows are sorted by the number of confirmed cases per state. Quality of daily estimates of the number of tests performed varied by state; see the (About page) for details.
Disparities between confirmed case counts and estimated infections varied by state.
- The ratio of estimated infections to confirmed C19 cases can be interpreted as the multiplication factor for a given state. For example, in Kansas, the number of estimated infections is 19 times the number of confirmed C19 cases. The states with the highest discrepancy – shown at the top of the graph – between estimated infections and confirmed case counts tended to have lower testing rates per capita.
- Analyses include cumulative confirmed C19 case counts up to April 18, 2020. Estimated infections were estimated using Bayesian probabilistic bias analysis to correct for incomplete testing and imperfect diagnostic accuracy. Estimated infections include both symptomatic and asymptomatic infections. Ratios in each state are colored by quintile, with the darkest shade of blue indicating the largest quintile, and the lightest shade of green indicating the lowest quintile. Horizontal black lines indicate the simulation interval for estimated infections (2.5th and 97.5th percentiles of the distribution of estimated infections for each state). Rows are sorted by the ratio of estimated infections to confirmed cases. Quality of daily estimates of the number of tests performed varied by state; see the (About page) for details.
Geographic disparities in testing contribute to larger underestimates in certain regions.
- Underestimation of coronavirus infections was more common in Puerto Rico, California, the Midwest, and certain states in the south southern states.
- Analyses include cumulative confirmed C19 case counts up to April 18, 2020. Estimated infections were estimated using Bayesian probabilistic bias analysis to correct for incomplete testing and imperfect diagnostic accuracy. Estimated infections include both symptomatic and asymptomatic infections. Colors were defined by quintiles of the distribution of the ratio of estimated infections to confirmed C19 cases.Quality of daily estimates of the number of tests performed varied by state; see the (About page) for details.
- We used a probabilistic bias analysis to correct confirmed C19 case counts for under testing, systematic testing of individuals with moderate-to-severe infection, and imperfect diagnostic accuracy. We used the best available evidence to define prior distributions of the probability of being symptomatic if tested for C19, being symptomatic if not tested, and testing positive among symptomatic and asymptomatic individuals. Using Bayesian melding, we constrained these probabilities by an assumed distribution of the probability that individuals who tested positive were asymptomatic using evidence from populations with more widespread testing. We also corrected for the possibility of false negative test results (imperfect test sensitivity). Prior distributions build in uncertainty given the limited information about C19 testing among symptomatic and asymptomatic individuals to date. Analyses include cumulative confirmed C19 case counts up to April 18, 2020. Disaggregated state-level data prior to February 28, 2020 was not readily available. We will update this site with estimates for April 2020 as additional data becomes available.
- Read more in a Nature Communications article here.
2. A reduction of six decibels in average speech levels can double a room’s ventilation
- Introducing “quiet zones” indoors could help slash the risk of transmitting C19, researchers have said, as mounting evidence suggests that speaking quietly reduces the spread of the virus.
- In an advance paper detailing the results of a new study, a team at the University of California, Davis, said that a reduction of six decibels in average speech levels can have the same effect as doubling a room’s ventilation.
- “The results suggest that public health authorities should consider implementing ‘quiet zones’ in high-risk indoor environments, such as hospital waiting rooms or dining facilities,” wrote the six researchers.
- The paper builds on previous studies, including a report in Nature which concluded that people release up to 10 times more particles from speech than a cough – and talking louder only increases the amount of viral particles we emit.
- In the California study, researchers confirmed that microscopic droplets ejected while speaking evaporate to leave behind aerosol particles big enough to carry viable virus.
- An increase of about 35 decibels in loudness, or the difference between whispering and shouting, boosts the particle emission rate 50 times. Normal conversation is around the 10-decibel range, while ambient noise in restaurants is around 70.
- “Not all indoor environments are equal in terms of aerosol transmission risk,” lead researcher, William Ristenpart, told Reuters. “A crowded but quiet classroom is much less dangerous than an uncrowded karaoke bar where patrons are socially distanced but talking and singing over loud music.”
- Since the World Health Organization updated guidance in July to acknowledge the possibility of aerosol transmission, numerous experts have warned that loud pubs and bars are among the “most dangerous” settings for coronavirus transmission.
- “People are more uninhibited, especially with alcohol involved,” Dr Julian Tang, a consultant virologist at Leicester Royal Infirmary, told The Telegraph. “You talk more, you laugh and tell jokes – you don’t get that atmosphere in an office or an airplane, so that kind of aerosol transmission and exposure is not happening.”
3. Drug Breakthrough: Tiny Antibody Component Completely Neutralizes the Coronavirus
- University of Pittsburgh School of Medicine scientists have isolated the smallest biological molecule to date that completely and specifically neutralizes the coronavirus. This antibody component, which is 10 times smaller than a full-sized antibody, has been used to construct a drug — known as Ab8 — for potential use as a therapeutic and prophylactic against the coronavirus.
- The researchers report in the journal Cell that Ab8 is highly effective in preventing and treating coronavirus infection in mice and hamsters. Its tiny size not only increases its potential for diffusion in tissues to better neutralize the virus, but also makes it possible to administer the drug by alternative routes, including inhalation. Importantly, it does not bind to human cells — a good sign that it won’t have negative side-effects in people.
- Ab8 was evaluated in conjunction with scientists from the University of North Carolina at Chapel Hill (UNC) and University of Texas Medical Branch (UTMB) at Galveston, as well as the University of British Columbia and University of Saskatchewan.
- “Ab8 not only has potential as therapy for C19, but it also could be used to keep people from getting coronavirus infections,” said co-author John Mellors, M.D., chief of the Division of Infectious Diseases at UPMC and Pitt. “Antibodies of larger size have worked against other infectious diseases and have been well tolerated, giving us hope that it could be an effective treatment for patients with C19 and for protection of those who have never had the infection and are not immune.”
- The tiny antibody component is the variable, heavy chain (VH) domain of an immunoglobulin, which is a type of antibody found in the blood. It was found by “fishing” in a pool of more than 100 billion potential candidates using the coronavirus spike protein as bait. Ab8 is created when the VH domain is fused to part of the immunoglobulin tail region, adding the immune functions of a full-size antibody without the bulk.
- Abound Bio, a newly formed UPMC-backed company, has licensed Ab8 for worldwide development.
- Dimiter Dimitrov, Ph.D., senior author of the Cell publication and director of Pitt’s Center for Antibody Therapeutics, was one of the first to discover neutralizing antibodies for the original SARS coronavirus in 2003. In the ensuing years, his team discovered potent antibodies against many other infectious diseases, including those caused by MERS-CoV, dengue, Hendra and Nipah viruses. The antibody against Hendra and Nipah viruses has been evaluated in humans and approved for clinical use on a compassionate basis in Australia.
- Clinical trials are testing convalescent plasma — which contains antibodies from people who already had C19 — as a treatment for those battling the infection, but there isn’t enough plasma for those who might need it, and it isn’t proven to work.
- That’s why Dimitrov and his team set out to isolate the gene for one or more antibodies that block the cornavisur virus, which would allow for mass production. In February, Wei Li, Ph.D., assistant director of Pitt’s Center for Therapeutic Antibodies and co-lead author of the research, began sifting through large libraries of antibody components made using human blood samples and found multiple therapeutic antibody candidates, including Ab8, in record time.
- Then a team at UTMB’s Center for Biodefense and Emerging Diseases and Galveston National Laboratory, led by Chien-Te Kent Tseng, Ph.D., tested Ab8 using live coronavirus. At very low concentrations, Ab8 completely blocked the virus from entering cells. With those results in hand, Ralph Baric, Ph.D., and his UNC colleagues tested Ab8 at varying concentrations in mice using a modified version of the coronavirus. Even at the lowest dose, Ab8 decreased by 10-fold the amount of infectious virus in those mice compared to their untreated counterparts. Ab8 also was effective in treating and preventing coronavirus infection in hamsters, as evaluated by Darryl Falzarano, Ph.D., and colleagues at the University of Saskatchewan. Sriram Subramaniam, Ph.D., and his colleagues at the University of British Columbia uncovered the unique way Ab8 neutralizes the virus so effectively by using sophisticated electron microscopic techniques.
- “The C19 pandemic is a global challenge facing humanity, but biomedical science and human ingenuity are likely to overcome it,” said Mellors, also Distinguished Professor of Medicine, who holds the Endowed Chair for Global Elimination of HIV and AIDS at Pitt. “We hope that the antibodies we have discovered will contribute to that triumph.”
4. Potential C19 Achilles Heel Discovered: MicroRNA Molecules May Repress the Replication of Human Coronaviruses
Smart virus outfoxed: Russian researchers have found MicroRNA molecules potentially capable of repressing the replication of human coronaviruses
- HSE University researchers have found microRNA molecules that are potentially capable of repressing the replication of human coronaviruses, including the coronavirus (SARS-CoV-2). It turns out that the virus uses miRNA hsa-miR-21-3p to inhibit growth in the first stages of infection in order to delay the active immune response. The results of the research will be published in the journal PeerJ (September 14, 2020).
- After the virus gets inside the cell, it starts actively interacting with various in-cell molecules. One such molecule class is microRNAs (miRNAs), which are small RNAs whose main function is to regulate gene expression. When a virus enters, miRNAs start binding certain parts of its genome RNA, which leads to the destruction of virus RNAs. Such an attack can stop virus replication completely. However, in cases when miRNAs are not very “aggressive,” such interactions do not destroy the virus but rather slow down its replication. This scenario is beneficial for the virus since it helps avoid a fast immune response in the cell. And some of the viruses purposefully accumulate host miRNA binding sites. This becomes their advantage: viruses with more binding sites survive and reproduce better, which leads to their evolutionary domination.
- Researchers from the HSE Faculty of Biology and Biotechnology, Stepan Nersisyan, and Alexander Tonevitsky, together with first-year students Narek Engibaryan, Aleksandra Gorbonos, Ksenia Kirdey, and Alexey Makhonin, detected cell miRNAs that are able to bind coronavirus genomes.
The image shows miRNA binding sites hsa-miR-21-3p and hsa-miR-421, which are mutual for six out of seven human coronaviruses.
- There are seven types of human coronaviruses in total. Four of them (HCoV-OC43, HCoV-NL63, HCoV-HKU1 and HCoV-229E) are widespread and cause the common cold, while viruses MERS-CoV, SARS-CoV, and the coronavirus can cause dangerous atypical pneumonia. The researchers found four families of human miRNAs with detected binding sites with all the viruses under consideration.
- The image shows miRNA binding sites hsa-miR-21-3p and hsa-miR-421, which are mutual for 6 out of 7 human coronaviruses.
- To find out how the virus can interact with the detected miRNAs, the researchers analyzed the available data on miRNA sequences in lungs of mice infected with coronavirus. They discovered that the infection leads to an 8-fold increase in the expression of the previously detected miRNA hsa-miR-21-3p.
- ‘MiRNA hsa-miR-21-3p has big potential for binding all human coronaviruses. But after infection with coronavirus, the concentration of this miRNA in the lungs grows a lot. If we assume that this is a mechanism of immune response, it is unclear why the virus does not eliminate the binding sites with cell miRNAs in the process of mutation. On the contrary, we see that the virus ‘accumulates’ them in its genome during the evolution — our research demonstrates that such sites are present in all human coronaviruses and do not mutate considerably. We suppose that this way the virus uses this miRNA to slow down its replication in the early stages of infection in order to delay the active immune response,’ Stepan Nersisyan said.
- The next step of the team’s research will be experimental verification of their discoveries. The researchers are also planning to investigate the possibility of medicinal effect on the virus that targets the discovered miRNAs. In particular, they plan to determine whether their artificial introduction or elimination is able to prevent virus reproduction.
5. Computer Designed Synthetic Antiviral Proteins Inhibit Coronavirus in Human Cells
- Computer-designed small proteins have now been shown to protect lab-grown human cells from the coronavirus. The findings were reported on September 9, 2020, in the journal Science
- In the experiments, the lead antiviral candidate, named LCB1, rivaled the best-known coronavirus neutralizing antibodies in its protective actions. LCB1 is currently being evaluated in rodents.
- Coronaviruses are studded with so-called spike proteins. These latch onto human cells to enable the virus to break in and infect them. The development of drugs that interfere with this entry mechanism could lead to treatment of or even prevention of infection.
- Institute for Protein Design researchers at the University of Washington School of Medicine used computers to originate new proteins that bind tightly to the coronavirus spike protein and obstruct it from infecting cells.
- Beginning in January, more than two million candidate spike-binding proteins were designed on the computer. Over 118,000 were then produced and tested in the lab.
- “Although extensive clinical testing is still needed, we believe the best of these computer-generated antivirals are quite promising,” said lead author Longxing Cao, a postdoctoral scholar at the Institute for Protein Design.
- “They appear to block SARS-CoV-2 infection at least as well as monoclonal antibodies, but are much easier to produce and far more stable, potentially eliminating the need for refrigeration,” he added.
- The researchers created antiviral proteins through two approaches.
- First, a segment of the ACE2 receptor, which coronavirus naturally binds to on the surface of human cells, was incorporated into a series of small protein scaffolds.
- Second, completely synthetic proteins were designed from scratch. The latter method produced the most potent antivirals, including LCB1, which is roughly six times more potent on a per mass basis than the most effective monoclonal antibodies reported thus far.
- Scientists from the University of Washington School of Medicine in Seattle and Washington University School of Medicine in St. Louis collaborated on this work.
- “Our success in designing high-affinity antiviral proteins from scratch is further proof that computational protein design can be used to create promising drug candidates,” said senior author and Howard Hughes Medical Institute Investigator David Baker, professor of biochemistry at the UW School of Medicine and head of the Institute for Protein Design. In 2019, Baker gave a TED talk on how protein design might be used to stop viruses.
- To confirm that the new antiviral proteins attached to the coronavirus spike protein as intended, the team collected snapshots of the two molecules interacting by using cryo-electron microscopy. These experiments were performed by researchers in the laboratories of David Veesler, assistant professor of biochemistry at the UW School of Medicine, and Michael S. Diamond, the Herbert S. Gasser Professor in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis.
- “The hyperstable minibinders provide promising starting points for the new cornavirus therapeutics,” the antiviral research team wrote in their study pre-print, “and illustrate the power of computational protein design for rapidly generating potential therapeutic candidates against pandemic threats.”
6. No evidence of ‘cytokine storm’ in C19
A study of C19 patients in the Netherlands did not find the disease to be associated with cytokine storm, as previously suggested. This may have implications for treatment.
- Sometimes our immune systems can work against us. In the case of autoimmune diseases, for example, the immune system attacks the body’s own tissue to cause the illness.
- Autoimmune involvement has come up in the context of the C19 pandemic, with numerous reports describing so-called cytokine storm in severe cases of the disease.
- Cytokine storm happens when an immune response releases more cytokines than are beneficial. Cytokines play a number of important roles in the immune system, but when too many are released, it can cause a severe inflammatory reaction that can be fatal.
- On the basis of these reports, researchers have suggested that the use of anti-cytokine therapies could be beneficial in the treatment of patients with severe C19.
- However, a study recently appearing in JAMA Network suggests otherwise.
- The new article compares levels of inflammatory cytokines in C19 patients with those in other patient groups, finding no evidence of cytokine storm in patients with C19.
- The authors, therefore, suggest that anti-cytokine therapies may not be beneficial in the treatment of the disease.
- [NOTE: We recently highlighted a new theory, called a Bradykinin Storm. Read more about it here: A Supercomputer’s C19 Analysis Yields a New Way to Understand the Virus]
- The study used data from patients admitted to the intensive care unit (ICU) of Radboud University Medical Center, in the Dutch city of Nijmegen.
- The researchers measured the levels of three inflammatory cytokines, tumor necrosis factor-alpha and interleukins 6 and 8 (IL-6, IL-8), in the blood of 46 C19 patients. All of these patients were seriously ill, having severe acute respiratory infections and receiving mechanical ventilation.
- The team then compared their findings with those of people admitted to the ICU with other conditions: bacterial septic shock, cardiac arrest, or severe trauma, such as that sustained from an accident. These groups collectively contained 156 people.
- The same technician performed all the measurements, using the same equipment and protocol.
No evidence of cytokine storm
- The researchers found significantly lower levels of cytokines in people with C19, compared with those who had septic shock — a condition that causes a surge in cytokine levels.
- “The level of cytokines was significantly less elevated in C19 patients than in patients with septic shock and [acute respiratory distress syndrome (ARDS)]. Compared to patients with septic shock without ARDS, so without severe pulmonary disease, patients with C19 also displayed markedly lower levels of IL-6 and IL-8,” explains the study’s first author, Matthijs Kox, an assistant professor of intensive care medicine.
- Instead, the cytokine levels seen in C19 patients were closer to those in people who had come to the ICU due to trauma or cardiac arrest — issues that are not associated with cytokine storm.
Anti-cytokine therapies unlikely to help
- Based on their results, the researchers did not find C19 to be associated with cytokine storm, in contrast to some previous findings.
- If validated, this means that anti-inflammatory agents targeting cytokines may not be beneficial in treating C19.
- “Critically ill C19 patients likely will not benefit from specific anti-cytokine therapies.” – Peter Pickkers, senior author of the study and professor of intensive care medicine at Radboud University Medical Center
- Although this study is one of the first to directly compare cytokine levels in patients with C19 to those in other patient groups, the sample sizes were relatively small, and the participants all received treatment in a single hospital.
- Additional, larger studies will be necessary to confirm these findings.
7. Adults 10 times more likely to be asymptomatic carriers of C19 than children
- Adults are nearly 10 times more likely to be asymptomatic carriers of C19 than children, according to an analysis published Monday by JAMA Pediatrics.
- Just over 1% of children who had no outward signs or symptoms of infection tested positive for the virus after they were admitted to a hospital in Milan for other reasons, the researchers said.
- Conversely, just over 9% of asymptomatic adults were found to have C19.
- Researchers have estimated that between 50% and 80% of individuals infected with the virus remain asymptomatic.
- Meanwhile, symptomatic children may be up to 15% of those carrying C19, according to an analysis from China published early in the pandemic.
- The new JAMA Pediatrics findings are based on C19 screening results for 214 patients at the Fondazione Ca’Granda Hospital in Milan. Northern Italy was the site of one of the worst outbreaks of the virus.
- All 214 patients — 83 children age 1 to 11 and 131 adults age 57 to 84 — were screened for C19 for precautionary reasons upon admission to the hospital, despite having no symptoms, the researchers said.
- One of the 83 asymptomatic children and 12 of the 131 asymptomatic adults tested positive for the virus, and none of them developed symptoms of infection within 48 hours of admission, the data showed.
- This equates to an infection rate of 1.2% among asymptomatic children and 9.2% among asymptomatic adults, researchers said.
- Eleven of the 12 adults who tested positive for the virus did so on the first test, the analysis said.
- The findings indicate that children may not be not at higher risk than adults as asymptomatic carriers of C19, meaning that they may not play a significant role as “facilitators of the spread” of the virus, the researchers said.
8. Early research from 23andMe strengthens link between blood types and C19
- A forthcoming study from genetic testing giant 23andMe shows that a person’s genetic code could be connected to how likely they are to catch C19 — and how severely they could experience the disease if they catch it. It’s an important confirmation of earlier work on the subject.
- People whose blood group is O seemed to test positive for C19 less often than expected when compared to people with any other blood group, according to 23andMe’s data; people who tested positive and had a specific variant of another gene also seemed to be more likely to have serious respiratory symptoms.
- The study, which was released on a preprint server and which has not yet been peer-reviewed, could extend and confirm earlier work on the subject; 23andMe’s study relied on a larger dataset than earlier work and included a more diverse set of participants, the company said. Experts who aren’t affiliated with 23andMe praised the study design and the work.
- “They clarify further what our data could only vaguely hint at,” said Tom Hemming Karlsen, a physician at Oslo University Hospital who published an article in the New England Journal of Medicine on genetic links with C19 severity in June, and who was not associated with 23andMe’s work.
- But the outside experts also cautioned that the research won’t change treatment decisions.
- “It doesn’t have practical implications. There’s no treatment decisions that will be made from it — it’s just an interesting finding,” said Jennifer Lighter, a pediatrician and epidemiologist at NYU Langone who was not involved in the research.
- Unlike the study Karlsen and his colleagues ran, which only included people with severe C19 symptoms, 23andMe included people who had both mild and severe cases — which allowed them to draw stronger conclusions, Karlsen said.
- The company’s study participants are also more diverse than Karlsen’s, which only studied people in Spain and Italy. However, the 23andMe study’s demographics still don’t fully reflect the population of the United States. A little more than 11% of the people in 23andMe’s studies said they were Latino; less than 3% said they were Black. (Latinos represent about 16% of the U.S. population, while Black people account for about 13% of the population.)
- Both Karlsen and 23andMe’s team found that the genes that code for a person’s blood type seemed to be linked to whether a person would test positive for C19; another section of chromosome 3 — referred to in both papers as chr3p21.31 — seemed to be linked to how severe a person’s response would be to a C19 infection.
- Janie Shelton, a senior scientist at 23andMe and a lead author of the paper, and her colleagues noted that genetic associations did not seem to explain all the differences between populations; public health experts have noticed that people of color seem to be particularly at risk for C19 due to some of the direct and indirect health effects of inequality and discrimination.
- Both studies suggested one gene found in that area on chromosome three — SLC6A20 — might be particularly related to worse outcomes; however, it’s not yet clear how a particular gene could make a meaningful difference in a person’s response to an infection.
- Both 23andMe and Karlsen ran the same kind of genetic analysis — a genome-wide association study. This particular method, which tries to find similar patterns in the genetics of people with a particular condition, has significant limitations. Scientists have suggested that the method is most useful when used to analyze hundreds of thousands of genomes.
- For most scientists, getting that many samples would be difficult and expensive. But 23andMe has an obvious advantage — it has already sequenced more than 12 million people, according to the company’s website; over a million people agreed to participate in the company’s C19 study.
- “I do think that because of the power of our large sample size, we were able to detect that association pretty strongly,” said Shelton.
- Without a clear understanding of which genes matter — and why — the impact of genetic studies on C19 treatment plans will be limited.
- “We’d have to find out why it’s significant — is it significant because it’s affecting blood clotting?” Lighter asked. “Unless we find out why there’s a difference, we wouldn’t target therapies or [adjust] a risk category.”
D. Vaccines & Testing
1. There are 7 coronavirus vaccine candidates being tested in the U.S. — here’s where they stand
- The race to develop a safe and effective C19 vaccine is well under way, setting the stage to bring to market the fastest vaccine in history.
- There are dozens of coronavirus vaccines in development, primarily in the preclinical phase when they are tested on animals. In the U.S., there are seven vaccine candidates that have moved into clinical trials with human participants, including three that have moved into the crucial Phase 3 development phase.
- The first and second phases of clinical studies are primarily conducted to test for safety, while the third and final stage is used to determine whether vaccines are efficacious and can prevent infection among participants. At that point, the vaccine makers will decide when to pursue an emergency-use authorization from the FDA and/or a full approval. The majority of the vaccines in development have received funding from the U.S. government, either to help support clinical development or pay for manufacturing and distribution of the vaccines as part of the Trump administration’s “Operation Warp Speed” program.
Vaccines in Phase 3 trials in the US:
1. AstraZeneca , in partnership with the University of Oxford
- Name: AZD1222.
- Type: Vector-based.
- Phase 1/2: Data from the Phase 1/2 trial, which is being conducted in the U.K., was published July 20 in the Lancet. It reported neutralizing antibody responses in 91% of 35 patients when using one test and 100% of 35 patients when using a different test.
- Phase 3: This trial, which will be held in the US, is expected to enroll up to 30,000 participants. (Late-stage studies are also being conducted in Brazil, South Africa and the UK) Data are expected by the end of the year. Although trials were halted in early September over concerns about a serious adverse event, the trials have been restarted.
- Clinical development and manufacturing funding from the US government: up to $1.2 billion.
- US dose promise: 300 million doses.
- Dosing: 2 doses.
2. BioNTech and Pfizer Inc.
- Name: BNT162b2.
- Type: mRNA.
- Phase 1: The companies published preliminary data on July 1 for BNT162b1 as a preprint. They said then that 24 participants in the study who received two doses of the lower-dose vaccine developed neutralizing antibodies. A second preprint was published on Aug. 28 for BNT162b2 that found this candidate produced similar levels of antibodies but participants reported fewer reactions.
- Phase 2/3: This trial is expected to focus on BNT162b2. It is expected to enroll up to 30,000 participants in Argentina, Brazil and the US
- Manufacturing funding from the U.S. government: $1.95 billion.
- US dose promise: 100 million doses, with option to buy up to 500 million more doses.
- Dosing: 2 doses.
3. Moderna Inc.
- Name: mRNA-1273.
- Type: mRNA.
- Phase 1: Preliminary data were released May 18; more detailed data published July 14 in the New England Journal of Medicine. Moderna’s vaccine candidate elicited neutralizing antibodies in all 45 participants in this trial, which was conducted in the US in partnership with the National Institute of Allergy and Infectious Diseases.
- Phase 2a: This study closed enrollment of 600 participants on July 8. This trial is also focused on the US
- Phase 3: This study is expected to complete enrollment of up to 30,000 people some time in September.
- R&D funding from BARDA: $955 million.
- Supply funding from the U.S. government: Up to $1.525 billion.
- US dose promise: 100 million, with option to acquire up 400 million additional doses.
- Dosing: 2 doses.
Vaccines in Phase 1 and 2 trials in the US
4. Inovio Pharmaceuticals Inc.
- Name: INO-4800.
- Type: DNA.
- Phase 1: The company released some preliminary data on June; it has not yet shared the full data but has submitted the results for publication in a peer-reviewed medical journal. The trial is being conducted in the US
- Phase 2/3: Inovio said on Sept. 8 that it plans to launch this phase of the study in September, if it is given the go-ahead by the FDA.
- US government funding: It received $71 million from the Department of Defense to make and buy the devices that will be used to dispense the company’s vaccine if it is authorized or approved.
5. Johnson & Johnson
- Name: Ad26. COV2. S.
- Type: Vector-based.
- Phase 1/2a: The study began in the second half of July, with a goal of enrolling 1,045 adults in Belgium and the U.S.
- Phase 3: It plans to launch this trial in September.
- R&D funding from BARDA: $456 million
- US government funding for manufacturing and delivery: More than $1 billion (from BARDA and the Department of Defense).
- US dose promise: 100 million doses, with option to buy up to 200 million additional doses.
6. Novavax Inc.
- Name: NVX-CoV2373.
- Type: Protein subunit.
- Phase 1: Preliminary data from a trial conducted in Australia were published Sept. 2 in the New England Journal of Medicine.
- Phase 1/2: The second phase of the Phase 1/2 trial started in August and will be conducted in Australia and the US
- Phase 3: TBD.
- Clinical development and manufacturing funding from the US government: $1.6 billion.
- US dose promise: 100 million doses.
7. Sanofi , in combination with GlaxoSmithKline’s adjuvant technology
- Name: TBD.
- Type: Protein-based.
- Phase 1/2 study: The trial was initiated Sept. 3, with a goal of enrolling 440 adults in the U.S. Results are expected in December.
- Phase 3: This study is expected to launch by the “end of 2020.”
- Clinical development and manufacturing funding from the US government: Up to $2.1 billion.
- US dose promise: Up to 100 million doses, with option to buy up to 500 million doses.
E. Improved & Potential Treatments
1. Rheumatoid arthritis drug helps recovery in coronavirus patients
- Eli Lilly said on Monday its rheumatoid arthritis drug baricitinib shortened the time taken to recover from C19 in hospitalized patients when taken in combination with Gilead Sciences’ antiviral remdesivir.
- Lilly said the drug, which is branded as Olumiant, in combination with remdesivir showed a roughly one-day reduction in median recovery time versus patients treated with remdesivir alone.
- Based on the results from the trial, which tested more than 1,000 patients, Lilly said it plans to discuss the potential for an emergency use authorization (EUA) with the U.S. Food and Drug Administration.
- Remdesivir is at the forefront of the fight against C19 after the drug was granted an EUA in May after trial data showed the antiviral drug helped shorten hospital recovery time.
- The drug, which has been licensed by Lilly from Incyte, could potentially help suppress a potentially lethal immune response to C19 called “cytokine storm.”
F. Concerns & Unknowns
1. Why obesity worsens C19
- This spring, after days of flulike symptoms and fever, a man arrived at the emergency room at the University of Vermont Medical Center. He was young—in his late 30s—and adored his wife and small children. And he had been healthy, logging endless hours running his own small business, except for one thing: He had severe obesity. Now, he had tested positive for C19 and was increasingly short of breath.
- He was admitted directly to the intensive care unit (ICU) and was on a ventilator within hours. Two weeks later, he died.
- “He was a young, healthy, hardworking guy,” recalls MaryEllen Antkowiak, a pulmonary critical care physician who is medical director of the hospital’s ICU. “His major risk factor for getting this sick was obesity.”
- Since the pandemic began, dozens of studies have reported that many of the sickest C19 patients have been people with obesity. In recent weeks, that link has come into sharper focus as large new population studies have cemented the association and demonstrated that even people who are merely overweight are at higher risk. For example, in the first metaanalysis of its kind, published on 26 August in Obesity Reviews, an international team of researchers pooled data from scores of peer-reviewed papers capturing 399,000 patients. They found that people with obesity who contracted the coronavirus were 113% more likely than people of healthy weight to land in the hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die.
- A constellation of physiological and social factors drives those grim numbers. The biology of obesity includes impaired immunity, chronic inflammation, and blood that’s prone to clot, all of which can worsen C19. And because obesity is so stigmatized, people with obesity may avoid medical care.
- “We didn’t understand early on what a major risk factor obesity was. … It’s not until more recently that we’ve realized the devastating impact of obesity, particularly in younger people,” says Anne Dixon, a physician-scientist who studies obesity and lung disease at the University of Vermont. That “may be one reason for the devastating impact of C19 in the United States, where 40% of adults are obese.”
- People with obesity are more likely than normal-weight people to have other diseases that are independent risk factors for severe C19, including heart disease, lung disease, and diabetes. They are also prone to metabolic syndrome, in which blood sugar levels, fat levels, or both are unhealthy and blood pressure may be high. A recent study from Tulane University of 287 hospitalized C19 patients found that metabolic syndrome itself substantially increased the risks of ICU admission, ventilation, and death.
- But on its own, “BMI [body mass index] remains a strong independent risk factor” for severe C19, according to several studies that adjusted for age, sex, social class, diabetes, and heart conditions, says Naveed Sattar, an expert in cardiometabolic disease at the University of Glasgow. “And it seems to be a linear line, straight up.”
- The impact extends to the 32% of people in the United States who are overweight. The largest descriptive study yet of hospitalized U.S. C19 patients, posted as a preprint last month by Genentech researchers, found that 77% of nearly 17,000 patients hospitalized with C19 were overweight (29%) or obese (48%). (The Centers for Disease Control and Prevention defines overweight as having a BMI of 25 to 29.9 kilograms per square meter, and obesity as a BMI of 30 or greater.)
- Another study captured the rate of C19 hospitalizations among more than 334,000 people in England. Published last month in the Proceedings of the National Academy of Sciences, it found that although the rate peaked in people with a BMI of 35 or greater, it began to rise as soon as someone tipped into the overweight category (see graphic, below). “Many people don’t realize they creep into that overweight category,” says first author Mark Hamer, an exercise physiologist at University College London.
- The physical pathologies that render people with obesity vulnerable to severe C19 begin with mechanics: Fat in the abdomen pushes up on the diaphragm, causing that large muscle, which lies below the chest cavity, to impinge on the lungs and restrict airflow. This reduced lung volume leads to collapse of airways in the lower lobes of the lungs, where more blood arrives for oxygenation than in the upper lobes. “If you are already starting [with] this mismatch, you are going to get worse faster” from C19, Dixon says.
- Other issues compound these mechanical problems. For starters, the blood of people with obesity has an increased tendency to clot—an especially grave risk during an infection that, when severe, independently peppers the small vessels of the lungs with clots (Science, 5 June, p. 1039). In healthy people, “the endothelial cells that line the blood vessels are normally saying to the surrounding blood: ‘Don’t clot,’” says Beverley Hunt, a physician-scientist who’s an expert in blood clotting at Guy’s and St. Thomas’ hospitals in London. But “we think that signaling is being changed by COVID,” Hunt says, because the virus injures endothelial cells, which respond to the insult by activating the coagulation system.
- Add obesity to the mix, and the clotting risk shoots up. In C19 patients with obesity, Hunt says, “You’ve got such sticky blood, oh my—the stickiest blood I have ever seen in all my years of practice.”
- Immunity also weakens in people with obesity, in part because fat cells infiltrate the organs where immune cells are produced and stored, such as the spleen, bone marrow, and thymus, says Catherine Andersen, a nutritional scientist at Fairfield University. “We are losing immune tissue in exchange for adipose tissue, making the immune system less effective in either protecting the body from pathogens or responding to a vaccine,” she says.
- The problem is not only fewer immune cells, but less effective ones, adds Melinda Beck, a co-author of the Obesity Reviews metaanalysis who studies obesity and immunity at the University of North Carolina, Chapel Hill. Beck’s studies of how obese mice respond to the influenza virus demonstrated that key immune cells called T cells “don’t function as well in the obese state,” she says. They make fewer molecules that help destroy virus-infected cells, and the corps of “memory” T cells left behind after an infection, which is key to neutralizing future attacks by the same virus, is smaller than in healthy weight mice.
- Beck’s work suggests the same thing happens in people: She found that people with obesity vaccinated against flu had twice the risk of catching it as vaccinated, healthy weight people. That means trials of vaccines for SARS-CoV-2 need to include people with obesity, she says, because “coronavirus vaccines may be less effective in those people.”
- Beyond an impaired response to infections, people with obesity also suffer from chronic, low-grade inflammation. Fat cells secrete several inflammation-triggering chemical messengers called cytokines, and more come from immune cells called macrophages that sweep in to clean up dead and dying fat cells. Those effects may compound the runaway cytokine activity that characterizes severe C19. “You end up causing a lot of tissue damage, recruiting too many immune cells, destroying healthy bystander cells,” says Ilhem Messaoudi, an immunologist who studies host responses to viral infection at the University of California, Irvine. Of the added risk from obesity, she adds: “I would say a lot of it is immune-mediated.”
- The severity of C19 in people with obesity helps explain the pandemic’s disproportionate toll in some groups. In American Indians and Alaska Natives, for example, poverty, lack of access to healthy food, lack of health insurance, and poor exercise opportunities combine to render “rates of obesity … remarkably high,” says Spero Manson, a Pembina Chippewa who is a medical anthropologist at the University of Colorado’s School of Public Health. And obesity “is connected to all these other [illnesses], such as diabetes and cardiovascular disease, rendering us susceptible” to severe C19, Manson says.
- In addition, a large body of literature shows that people with obesity may delay seeking medical care due to fear of being stigmatized, increasing their likelihood of severe disease or death. “Patients that experience weight stigma are less likely to seek care and less likely to seek follow up because they don’t feel welcome in the healthcare environment,” says Fatima Cody Stanford, an obesity medicine physician-scientist at Harvard Medical School and Massachusetts General Hospital.
- C19–specific research on this question is urgently needed, she adds. “We don’t know how many people are dying in the community that are never making it in,” Stanford says. “Maybe that was [due] to their weight or to their race, the two most prevalent forms of stigma in the U.S.”
- For people with obesity, the extra risk adds a psychological burden, says Patty Nece, vice chair of the Obesity Action Coalition. “My anxiety is just totally ramped up,” she says, adding that because of stress eating she’s recently regained 30 of the 100 pounds she lost before the pandemic. “You have the general anxiety of this pandemic … and then you layer on top of it: ‘You in particular, you could get really sick.’”
- Data on how to treat C19 patients with obesity are scant. Published evidence supports giving such patients higher doses of anticoagulants, says Scott Kahan, an obesity medicine physician who directs the National Center for Weight and Wellness. But very little is known about whether and how to adjust other treatments such as remdesivir and dexamethasone, partly because patients with obesity “are often excluded from clinical trials,” he says. He urges that C19 treatment trials include people with high BMIs wherever possible.
- People with obesity should take extra care to avoid getting sick, Messaoudi says. “If you are a person with obesity, be extra, extra cautious,” she says. “Wear your mask. Wash your hands. Avoid large gatherings.”
- In addition, exercising and, separately, losing even a little weight can improve the metabolic health of a person with obesity, and, in doing so, reduce their chances of developing severe C19 if they become infected, says Stephen O’Rahilly, a physician-scientist who directs the MRC Metabolic Diseases Unit at the University of Cambridge. “If you’re 300 pounds, even losing a modest amount is likely to have a disproportionate benefit on how well you do with coronavirus infection. You don’t have to become a slim Jim to benefit.”
2. C19 may dice heart muscle fibers into tiny snippets, remove cells’ DNA
- When scientists mixed the new coronavirus with heart cells in a lab dish, the virus appeared to carve heart muscle fibers into small fragments. On the left, an image of healthy heart muscle cells, which have long fibers that allow them to contract. On the right, an image of heart muscle cells infected with the cornavirus in which the long fibers appeared to be diced into small pieces.
- The new coronavirus seems to slice heart muscle fibers into small, precisely sized fragments — at least when it infects heart cells in a lab dish, a new study reveals.
- This snipping of muscle fibers, which could permanently damage heart cells, is scary enough in a lab dish; but the researchers found evidence that a similar process could be happening in the hearts of C19 patients as well. However, the new finding, which was published to the preprint database bioRXiv on Aug. 25, has not yet been published in a peer-reviewed journal, or proven to happen in people.
- The finding is unlike anything researchers have seen before — no other disease is known to affect heart cells in this way. “What we were seeing was completely abnormal,” study co-author Todd McDevitt, a senior investigator at Gladstone Institutes, a nonprofit research organization in San Francisco, said in a statement.
- The new finding may explain how C19 inflicts damage to the heart. Previous studies have found signs of heart abnormalities in C19 patients, including inflammation of the heart muscle, even in relatively mild cases.
- For the new study, the researchers used special stem cells to create three types of heart cells, known as cardiomyocytes, cardiac fibroblasts and endothelial cells. In lab dishes, these cells were then exposed to SARS-CoV-2, the virus that causes C19. Of the three types of cells, SARS-CoV-2 could infect and make copies of itself only inside cardiomyocytes, or heart muscle cells.
- Cardiomyocytes contain muscle fibers that are made up of units called sarcomeres, which are critical to the muscle contractions that produce a heartbeat. These sarcomeres usually line up in the same direction to form long filaments. But the lab dish studies revealed something bizarre — the sarcomere filaments were chopped up into small fragments.
- “The sarcomere disruptions we discovered [in lab dishes] would make it impossible for the heart muscle cells to beat properly,” study co-author Dr. Bruce Conklin, also a senior investigator at Gladstone Institutes, said in the statement.
- But findings in lab dishes don’t always translate to real life. So the researchers analyzed autopsy samples of heart tissue from three C19 patients. They saw that the sarcomere filaments were disordered and rearranged — a pattern that was similar to, but not exactly the same as, what was seen in the lab dish experiments.
- More studies are needed to see if the sarcomere changes seen in heart cells are permanent. The authors note that scientists need to perform a special process to see the sarcomeres, which isn’t usually done, explaining why this finding in autopsies may have been overlooked until now.
- “I hope our work motivates doctors to review their patients’ samples to start looking for these features,” McDevitt said.
- The researchers also observed another strange finding in both the lab dish experiments and the heart tissue from C19 patients. They saw that, for some heart cells, the DNA inside the cells’ nucleus seemed to be missing. This would render these cells essentially “brain dead” and unable to perform normal functions, the authors said.
- Once scientists understand how SARS-CoV-2 damages heart cells, they could screen for drugs to mitigate these effects. For example, if the virus uses an enzyme to chop up sarcomeres, it may be possible to find a drug that blocks this enzyme. (However, the authors note that it’s still unclear whether the virus directly cuts the sarcomeres, or if the virus triggers cells to cut the fibers through another mechanism.)
- “It will be important to identify a protective therapy, one that safeguards the heart from the damage we’re seeing in our models,” McDevitt said. “Even if you can’t prevent the virus from infecting cells, you could put a patient on a drug to prevent these negative consequences from occurring while the disease is present.”
3. Depression Symptoms 3 Times Higher During C19 Lockdown
- A new study found that depression symptoms are three times higher during the C19 lockdown.
- Experts say the C19 pandemic is a traumatic event of a much larger scale.
- It has caused physical, emotional, and psychological distress, and not just for patients of the virus.
- While we have been so focused on the physical impact of C19 and ways to stop the spread, we may have let another condition in under the radar: depression.
- In a recent study,Trusted Source researchers analyzed survey data from 1,441 participants, all U.S. adults aged 18 years or older.
- It found that depression symptoms were three times higher during C19 lockdown than before the pandemic, up from 8.5 percent before C19 to 27.8% during.
C19 is a large-scale traumatic event
- The C19 pandemic is very much a large-scale traumatic event. It has caused physical, emotional, and psychological distress, and not just for patients of the virus.
- While we have been working tirelessly to keep our faces covered, wash our hands, and stay 6 feet apart from everyone, including our loved ones, we may not have realized how the pandemic and quarantine has chipped away at our mental health.
- Policies put in place to prevent the spread of C19 disrupted daily life for most people in the United States.
- Twenty million people filed for unemployment between the start of the pandemic and mid-April.
- As of mid-April, 42 states were under stay-at-home advisories or shelter-in-place policies, which touched the lives of 316 million people, according to the study.
- “Results suggest that the rates of depression symptomatology are three times higher during the pandemic compared to before the pandemic,” said Dr. Brittany LeMonda, senior neuropsychologist at Lenox Hill Hospital, New York City. “Undoubtedly, there are many factors contributing to this increase in mood symptoms, including increased social isolation, economic hardships, and exposure to other stressors.”
- These are not small disturbances.
- The findings are on par with those from other major traumatic events. For example, after September 11, 2001, 9.6 percent of Manhattan residents had symptoms consistent with depression and post-traumatic stress disorderTrusted Source.
- “Exposure to large-scale traumatic events are associated with increased burden of mental illness in the population affected,” the study reported.
Contributing factors to depression
- The study found among participants that there were fewer people with no symptoms of depression and more people with more symptoms during C19 than before C19. It also found that certain groups were at greater risk of depression symptoms, such as lower income groups and those that have less than $5,000 in household savings. They had a 50% greater risk of depression symptoms than those of higher income.
- But income isn’t the only factor. Isolation and uncertainty contribute to depression symptoms in people of all socioeconomic backgrounds.
- “The rates of depression have significantly increased during the pandemic because people are more socially isolated, have less structure and routine, and more uncertainty about the future, which leads to doubt and negative predictions,” said Dr. Collin Reiff, clinical assistant professor in the Department of Psychiatry at NYU Langone Health.
- Beyond that, he added, there is the change in the “big picture.” “What does this do to the plans people had? What if they were about to start a job and now they have a financial hardship as a result of it being delayed six months? What if they lost a significant other or family member and now have to face life without that person?”
- On top of it all, there is no way to know when it will all end. Needless to say, it is understandable why depression symptoms are on the rise.
How to address depression symptoms during C19
- There are many ways to help ease symptoms of depression even during a pandemic.
- Depression is a common condition that affects millions of people in the United States and around the world. This means that there are verified and trusted methods for dealing with its symptoms so that you can get back to living and enjoying your life.
- “Identifying those at risk for mood symptoms — for example, those with a history of depression or anxiety, substance abuse history, those facing long-term unemployment, or those who feel a sense of isolation from others — is vital for early detection and intervention,” said LeMonda. “Recognizing warning signs in our friends and family members, such as feelings of hopelessness and withdrawal from others, can be a way to connect individuals with the appropriate services before symptoms worsen.”
- For those who may not know if they are struggling with depression, symptoms can include:
- low energy
- weight loss
- low mood
- feeling like a burden to others
- feelings of guilt
- suicidal ideation
- “Based on the symptoms, you can decide how you want to approach it,” Reiff said. “It could be as simple as developing a semblance of structure or routine to your day, or setting a reminder to take time for yourself, even if it’s just an hour.”
- There is also psychotherapy, which is one of the most valued tools when it comes to improving mental health.
- “To suddenly feel like you have someone to listen and understand you and allow you to see things from a different perspective — that’s worth a lot,” said Reiff. “Especially when someone is struggling with depression.”
- Additionally for some people medication such as antidepressants can help.
- LeMonda said in the midst of a pandemic and recession one way to help is simply to reach out to family and friends and check in on their mental health.
- “Everyone is struggling in one way or another during C19. Don’t be afraid to reach out for help or share your experiences with those close to you,” LeMonda said. “Chances are, you’ll find you’re not alone.”
4. Young adults hospitalized with C19 face increased risks
- Older age has consistently been associated with higher mortality in patients with coronavirus disease 2019 (C19). Unfortunately, C19 does not spare young people. Using a national all-payer hospital database, the investigators identified 3,222 nonpregnant adults aged 18 to 34 years who were admitted to US hospitals for C19. Morbidity was substantial: 21% required intensive care, and 2.7% died. Mortality was higher among those who had obesity, hypertension, and male sex, as has been noted in general adult populations.
- Combined with what we know about the greater risk of older persons, what does this study tell us about C19 and young adults? First, while young adults are much less likely than older persons to become seriously ill, if they reach the point of hospitalization, their risks are substantial. Second, obesity, hypertension, and male sex put patients of all ages at greater risk. As obesity and hypertension are preventable and treatable conditions, reducing the risk of serious C19 illness should be added to the already long list of reasons to increase medical and public health efforts in young adults to promote healthful diets and increased exercise. Finally, C19 is a life-threatening disease in people of all ages and that social distancing, facial coverings, and other approaches to prevent transmission are as important in young adults as in older persons.
5. Study shows children can spread C19
What is already known about this topic?
- Children aged ≥10 years have been shown to transmit SARS-CoV-2 in school settings.
What is added by this report?
- Twelve children acquired C19 in child care facilities. Transmission was documented from these children to at least 12 (26%) of 46 non-facility contacts (confirmed or probable cases). One parent was hospitalized. Transmission was observed from two of three children with confirmed, asymptomatic C19.
What are the implications for public health practice?
- Coronavirus infections among young children acquired in child care settings were transmitted to their household members. Testing of contacts of laboratory-confirmed C19 cases in child care settings, including children who might not have symptoms, could improve control of transmission from child care attendees to family members.
1. “It’s Like Using A Hammer To Kill A Fly” – Architect Of Sweden’s C19 Anti-Lockdown Strategy Finally Vindicated
- When the history books are written about 2020 and the great coronavirus pandemic, Anders Tegnell, the humble Swedish state epidemiologist and architect of the global-consensus-defying ‘Sweden strategy’, will inevitably loom large throughout the text. But whether he is portrayed as a hero or villain may – like so many things in this highly polarized era – ultimately depend on who’s writing the piece.
- As the FT explained in its latest in a series of interviews with Tegnell, the American press – thanks in large part to its newfound fanatical devotion to the cause of “science” – including the NYT, has been particularly hard on Tegnell. The Gray Lady has called Sweden a “pariah state” and “the world’s cautionary tale.”
- European papers have been somewhat more forgiving. That’s perhaps because the lockdowns imposed across Europe were far more restrictive than what most, outside NYC, experienced in the US. And despite all that work, new daily cases are back to seeing record highs in France, and post-lockdown highs in Spain, while cases climb in Italy, the UK, Germany and across Central Europe into Ukraine.
- But sure enough, there’s one European nation where cases haven’t been showing a “second wave”: Sweden.
- Instead, cases have continued to fall well into September.
- There’s no denying that Sweden suffered a large tally of preventable deaths in nursing homes and other long-term care facilities early on the in the pandemic. But as more time has passed, Sweden’s outsize death toll is looking more and more reasonable, particularly compared to the UK and Spain and France.
- But even when compared to its well-managed Nordic neighbors, Sweden’s numbers are starting to turn.
- Here’s another view of the respective C19 case data.
- The data could offer some insight into why one Swedish CEO told an FT reporter in hushed tones that he would love to tag along on a meeting to meet Tegnell, who had reportedly been planning to spend 2020 helping Somalia set up a public health agency and sending out surveys to Swedes before COVID hit.
- For many Swedes, their state epidemiologist has embodied a rational approach as other countries have appeared to sacrifice science to emotion. “I wish I were coming with you to see him,” one of Sweden’s leading chief executives confided to me just before I went to see Tegnell. “The way he has stood for what he believes in while the rest of the world does something else is admirable.”
- It’s worth adding that Tegnell’s critics in Sweden, even amid all the furor about the “public opinion polls” that were so widely touted by English-language media outets – polls that of course purportedly reflected growing discontent with Tegnell’s and the government’s approach.
- But the situation in Sweden has changed rapidly. And although Tegnell has been careful to repudiate the notion that Sweden “went herd”, as President Trump might say, there’s little doubt that despite all the setbacks – including the wave of international condemnation that followed the publication of Sweden’s Q2 GDP figures – the ruling party and Tegnell are much more widely respected inside Sweden than elsewhere in Europe.
- For some local experts, Tegnell’s standing alone as the world locked down inspires none of the CEO’s veneration. “Tegnell is known for his stubbornness. You wonder what this would have looked like with a different person in charge,” says a Swedish epidemiologist who has been a critic of Tegnell’s. International media have been harsher still: The New York Times has called Sweden a “pariah state” and “the world’s cautionary tale”.
- In his latest interview with the FT, Tegnell shares his predictions for Sweden, which sound markedly different from Dr. Fauci’s comments about the future of the US outbreak yesterday.
- But if there’s one takeaway from the FT piece that we find particularly interesting, it’s the degree of trust that the Swedish people placed in Tegnell.
- Today, the architect of Sweden’s lighter-touch approach says the country will have “a low level of spread” with occasional local outbreaks.
- “What it will be in other countries, I think that is going to be more critical. They are likely to be more vulnerable to these kind of spikes.
- Those kind of things will most likely be bigger when you don’t have a level of immunity that can sort of put the brake on it,” he adds. Herd immunity is one of the most controversial concepts of the C19 crisis. Tegnell is adamant that it was not Sweden’s goal to allow the virus to run its course until enough of the population had been exposed and the infection rate slowed. But he argues immunity is at least in part responsible for the sharp recent drop in Swedish cases and questions how its neighbors will fare without it.
- “What is protecting Copenhagen today? We will see,” he adds. Sweden’s approach to the pandemic is unusual in large part because its governance is unusual. Unlike in pretty much every other country, it is not politicians who take the big decisions but Sweden’s public health agency, due to its constitution giving big powers to independent authorities. In practice, this means Tegnell. “This whole approach is Tegnell’s. The government has accepted it without questions,” says the critical epidemiologist.
- Asked by the FT about his distaste for lockdowns, and his decision to stand strong against the crowd, even in the face of sometimes incredible vitriol, Tegnell shrugged his head, and noted the backing of all the rest of the 500 or so staff at Sweden’s public health agency.
- That makes his ability to stand alone as the rest of the world locked down seem all the more remarkable. I ask him about it, suggesting it must be easier just to go with the flow. “Yes, of course it is. But I am not alone,” he says, dutifully listing the backing of the 500 staff in the public health agency as well as Sweden’s government and population. The only other country not to lock down in Europe was authoritarian Belarus, I say. He erupts in a burst of nervous laughter: “That’s no comparison.” He looks awkward as I mention strong support for Sweden’s strategy from some US libertarians and UK supporters of a hard Brexit. “Odd bedfellows,” is his sole comment. His dislike of national lockdowns is obvious. “It’s really using a hammer to kill a fly,” he insists. Instead, his approach has been about having a strategy that can work for years if needs be, rather than the constant chopping and changing seen in the rest of Europe. “We don’t see it as viable to have this kind of drastic closing down, opening and closing. You can’t open and close schools. That is going to be a disaster. And you probably can’t open and close restaurants and stuff like that either too many times. Once or twice, yes, but then people will get very tired and businesses will probably suffer more than if you close them down completely,” he says.
- Many Americans have also been guilty of criticizing Sweden without first appreciating how radical its program truly was. Throughout the pandemic, youth sports never even stopped. Now, the return of sports is suddenly becoming a major issue in the US.
- Sweden’s approach was predicated on trying to keep its healthcare system working but also looking at public health in the broadest sense, rather than narrowly trying to minimise C19 deaths. So children’s sports carried on, as did primary school lessons, yoga sessions, drinking and eating out with friends, and shopping. This trip is my first time in Stockholm for six months — I am based in Oslo and had been to Sweden once during the pandemic, to Gothenburg in June — and I soon settle into my usual rhythm. I go record shopping at several of my favourite spots, picking up several bargains, have coffee with a contact nearby, and take the metro to meetings and my hotel. Throughout, I barely see a single person with a mask.
- But would aliens landing in Sweden really not realize that there’s a pandemic going on? Tegnell doubts this. And with good reason.
- I suggest to Tegnell that an alien landing in Sweden would have difficulty knowing there is a pandemic whereas in England or France, with face masks prevalent, they would realise immediately. He argues that while that might be true on the surface, especially with masks — which Sweden is one of the few countries not to recommend wearing in public — the differences elsewhere are exaggerated. Swedes have stopped travelling just as much as neighbours; hotels and restaurants may not have closed but have been severely affected. He points to the markings in supermarkets showing people where to stand and detailed restrictions on restaurants in terms of how many people they can have and how they serve them.
- During the closing lines of the piece, the author includes one last Tegnell soundbite that’s as brilliant as any to end on. And it’s – of course – Tegnell’s “view” on a C19 vaccine, something he believes won’t be a “silver bullet”.
- Our conversation ends with Tegnell again swimming against the tide, and warning that a vaccine – if and when it comes – will not be the “silver bullet”. He adds: “Once again, I’m not very fond of easy solutions to complex problems and to believe that once the vaccine is here, we can go back and live as we always have done. I think that’s a dangerous message to send because it’s not going to be that easy.”
- Looks like Tegnell was ahead of the curve once again.
2. ‘Draconian’ restrictions around C19 condemned by HSE doctor
- C19 is “much less severe” than the average annual flu and current “draconian” restrictions are no longer justified, according to a senior Health Service Executive doctor.
- People at low risk from the virus should be exposed to it so they can develop herd immunity and reduce the risk to vulnerable groups, according to Dr Martin Feeley, clinical director of the Dublin Midlands Hospital Group.
- “That is what is happening and yet the policy seems to be to prevent it,” he says. “This should have been allowed to happen during the summer months before the annual flu season, to reduce the workload on the health service during winter months.”
- Any assessment of Ireland’s strategy to combat the virus should take into account the cost to people’s quality of life, according to the former vascular surgeon, who points out that “you can’t postpone youth”.
- “The financial cost can be seen in any walk or drive through cities, towns and villages. Mortgage repayments and other financial setbacks are virtually all suffered by the young worker or business person and not by the over-65, who are guaranteed their pension, as indeed are the salaries of the individuals who decide to inflict these draconian measures,” the 70 year old told The Irish Times.
- Dr Feeley is critical of the media and public “obsession” with daily case numbers, when so few people are being admitted to hospital or intensive care units. “The number of deaths among recent cases is less than one in a thousand. This data reflects a disease much less severe than the average annual flu.
‘Borders on hysteria’
- “The media reaction to these cases, ie, with the gravity appropriate to reporting deaths from a major catastrophe, borders on hysteria. Opening a newscast with the number of people testing positive for a condition less dangerous than the flu, which many don’t even know they have, is scaremongering.”
- Flu and C19 are both contagious respiratory illnesses, caused by different viruses. Both can be transmitted by a person before they show symptoms. C19 is generally more contagious and more associated with “super-spreader” events. Its effects are most severe among older people and those with underlying conditions. However, young children are at a higher risk of serious illness from flu.
There is a vaccine for flu but none as yet for C1.
- Dr Feeley says that while the initial measures taken by the Government were “totally acceptable and justifiable”, this is no longer the case, given what we now know about the disease.
- C19 is “profoundly different” from the Spanish flu pandemic of a century ago, he maintains, saying that that was “an indiscriminate killer” that largely targeted the young.
- “Experience has taught us that at-risk and vulnerable individuals are identifiable with remarkable accuracy; and protective measures, hygiene, masks, social distancing and cocooning are effective.”
- Dr Feeley notes that virus-related deaths among people aged under 65 who do not have underlying conditions are uncommon, and transmission by children while possible is also uncommon.
- The presence of a “chronic illness” is the “all-important factor” in determining a person’s C19 risk, he points out. “You can identify with amazing accuracy who is at risk, as with no other disease.”
- “The best-kept secret regarding C19 is the vulnerability of individuals who are overweight,” he asserts.
- Separately, another doctor, Alan Farrell, has written to the Taoiseach and the Minister for Health taking issue with the Government’s approach to C19.
- “From a medical perspective I am not seeing an impact from Covid on the ground. What I am seeing is delayed diagnoses for other conditions – breast cancer, skin cancer in young people, an onslaught of anxiety and depression, an increase in loneliness in the elderly, recently a fractured humerus in an elderly lady that has been like that for months as she was afraid to go outside.”
- In a paper written with engineer Ivor Cummins, Dr Farrell argues that excess mortality from C19 is “not very much greater” than the excess mortality observed during the 2018 flu season.
- Most people are already immune to the virus, due to cross-immunity from prior coronaviruses, while the wearing of masks is an ineffective “politically driven endeavour”, they say.
H. Projections & Our (Possible) Future
1. Collision of pandemic and flu could double C19 transmission
- Influenza could more than double the transmission rate of the coronavirus, according to new European research.
- A joint study by the Max Planck Institute in Germany and Pasteur Institute in France showed that on average, a patient infected with the coronavirus could pass C19 to two other persons.
- But if he or she also had the flu, it would help the coronavirus jump to four or five people, it said.
- “The results were unequivocal,” said the researchers, led by German epidemiologist Dr Matthieu Domenech de Celles, in a non-peer-review paper posted on Medrxiv.org on Wednesday.
- There is growing concern that a second wave of the pandemic may hit the northern hemisphere this autumn, possibly making the current coronavirus crisis even worse.
- “I don’t know … nor can anyone know what the fall is going to bring,” said top US infectious disease expert Dr Anthony Fauci in an interview with the American medical publication JAMA last month.
- Domenech de Celles and colleagues developed a model that could simulate the co-circulation of seasonal flu and C19. They analysed the C19 data in European countries, including Belgium, Italy, Spain and Norway to decouple the impact of the two different infectious diseases.
- Debate surrounds how the flu affects the pandemic. Some scientists believe the infection caused by influenza strains would produce a cross-immune response that could provide partial protection against the novel coronavirus.
- But others say it would only make the situation worse, because a co-infected patient has to fight two different viruses at the same time. Furthermore, some typical flu symptoms such as coughing and sneezing would help spread C19.
- The study led by Domenech de Celles found “consistent evidence that, during the period of co-circulation, influenza was associated with an average 2-2.5-fold population-level increase in SARS-CoV-2 transmission”, the French and German researchers said.
- The decline of new cases after the first wave in spring was not only caused by lockdown and social distancing measures, but also the end of flu season, according to their analysis.
- The researchers also found that 30 to 50 per cent of the co-infections were likely not detected. One possible reason, according to Domenech de Celles, was the different time it took for the onset of the two illnesses. The coronavirus usually takes more than five days to start showing symptoms, longer than flu incubation period of one or two days. So when a patient tested for coronavirus, the flu might have already disappeared from the patient.
- A pandemic caused by a variant of the H1N1 virus in 1918 infected about a third of the world’s population and killed 50 million people. It had come in several waves, and some scientists believed these waves were driven and made worse by the seasonal flu.
- A study by Google and Cold Spring Harbor Laboratory in May found that flu infection could significantly increase the amount of angiotensin-converting enzyme 2 (ACE2) in the human body. ACE2 is a main receptor used by the coronavirus to bind with host cells.
- Dr Robert Redfield, director of the US Centres for Disease Control and Prevention, said last month that autumn could “be the worst we’ve seen” if Americans did not follow mitigation guidelines, such as avoiding crowds or wearing face masks.
- Dr Wang Chen, president of the Chinese Academy of Medical Sciences in Beijing and a senior adviser to the Chinese government on pandemic response, said everyone should get a flu shot before the influenza season hits in November.
- The flu vaccination could cut the risk of being infected by different viruses that caused similar symptoms circulating at the same time, he told a national conference of the China Association for Science and Technology last month.
- It “must be done before the end of September, or in October the latest”, he said.
I. Practical Tips & Other Useful Information
1. Flu vs. Covid: Ways to Identify Symptoms and Differences
- As the autumn flu season approaches while the C19 pandemic continues, cold-weather sniffles are likely to provoke even more anxiety than usual. Some symptoms of flu—as well as colds and other autumn ailments—are similar to Covid’s, making it harder to know what’s wrong. Fever, dry cough, fatigue and body aches are common with both the flu and Covid.
- If you’re concerned, call your doctor. And there are some ways to try to recognize the differences. Here’s what doctors say.
Can you differentiate between illnesses by tracking your fever?
- Fever is common in C19, and also likely to appear with the flu and other viruses. But fevers that result from the novel coronavirus tend to come on stronger and cause chills and major discomfort even if they don’t climb far past 100.4 degrees, says Panagis Galiatsatos, a physician in pulmonary and critical care medicine at the Johns Hopkins School of Medicine in Baltimore. “C19 fevers are not subtle,” he says. “Look beyond the number to see how the fever is making you feel.”
Does the speed of onset vary between C19 and flu?
- How quickly you come down with symptoms may be telling for some people, especially for those who can pinpoint their day of exposure. Coronavirus symptoms often come on suddenly around day five to seven, but can appear as long as 14 days after exposure. Those who have the flu tend to experience symptoms one to four days after exposure, says Molly Fleece, an infectious disease specialist at the University of Alabama at Birmingham.
If you’re staying home to monitor your symptoms, what are the signs that might point to C19?
- As the virus progresses, it can be easier to tell whether it’s C19 or another illness, says Ben Singer, pulmonary and critical care specialist at Northwestern Medicine in Chicago. Among the most telltale indications of C19 are shortness of breath, pneumonia and continued fever. “If people are at home monitoring their symptoms, the thing to look out for is that things are generally getting worse,” Dr. Singer says.
Sneezing and a stuffy nose are often associated with a cold. Can nasal congestion be a sign of C19?
- Yes, but it’s less likely. The good news is that most colds start with nasal congestion, but it’s not one of the primary symptoms of C19, says Dr. Fleece. A stuffy nose is also less worrisome if that’s the only symptom you have, she adds. Having C19 with “just a runny nose is probably unlikely,” she adds.
- Another symptom that’s more prevalent with a cold: a wet cough where phlegm is involved. On the other hand, a dry cough or especially a loss of smell or taste can be symptomatic of C19, she adds.
How important is it that I get a flu shot this year?
- It is very important. Even if you do get sick with the flu, the vaccine can lessen the duration and severity of the illness. That helps keep you out of the ER, decreasing the strain on the health care system when doctors are trying to fight Covid. And your getting vaccinated helps prevent the spread to others, including infants and other medically vulnerable people who can’t get a flu shot.
Will this year’s flu shot help boost immunity for C19?
- There’s no evidence that the flu vaccine can help protect you from C19. But generally, “vaccines strengthen, not weaken, the immune system,” says David Beuther, chief medical information officer at National Jewish Health in Denver. “The more you’ve been vaccinated in recent years, the better trained your immune system is.”
Will getting the flu shot make it easier to tell the difference between flu and C19?
- Whether you’ve had your flu shot will be one of the top questions physicians ask in screening for C19 symptoms, helping doctors make a correct diagnosis. “The flu shot is really important this year,” says Dr. Beuther. “It can significantly reduce your chance of influenza, and reduce the chance that you’ll be in this conundrum.”
Does having the flu make you more vulnerable to C19? Can you get them at the same time?
- It’s possible that having a severe case of flu could make you more vulnerable to another illness, including Covid, says Dr. Galiatsatos. But since Covid is so new, not much is known about how one might affect the other.
- If you do happen to get both flu and Covid at the same time, your illness may be more severe. “A second viral infection might warrant closer monitoring of a patient for deterioration,” says Dr. Beuther. During flu season, most people will be tested for multiple viruses, including C19, to help doctors gain a clearer picture, he adds.
What can you glean from local health data to better evaluate your symptoms?
- Local health departments often post data about a variety of illnesses to help medical providers. Along with the flu, looking at increases for other viruses in your area including RSV (Respiratory syncytial virus) and parainfluenza can make it easier to interpret symptoms, says James Cherry, a professor at the David Geffen School of Medicine at University of California Los Angeles. “You have to think about epidemiology and what else is around now,” he says.
J. Johns Hopkins COVID-19 Update
September 14, 2020
1. Cases & Trends
- The WHO COVID-19 Dashboard reports 28.92 million cases and 922,252 deaths as of 9:30am EDT on September 14. The global weekly incidence continues to hold relatively steady at approximately 1.8-1.9 million cases. After 3 consecutive weeks of decreasing global mortality, the weekly total last week increased by 8.4% compared to the previous week, up to 40,720 deaths.
- Total Daily Incidence (change in average incidence; change in rank, if applicable)
1. India: 91,688 new cases per day (+5,887)
2. USA: 34,794 (-1,226)
3. Brazil: 27,562 (-2,601)
4. Argentina: 10,668 (+629)
5. Spain: 9,620* (+502)
6. France: 8,045 (+971; ↑ 1)
7. Colombia: 7,114 (-807; ↓ 1)
8. Peru: 5,663 (+83)
9. Russia: 5,329 (+224; ↑ 1)
10. Mexico: 4,908 (-352; ↓ 1)
- Per Capita Daily Incidence (change in average incidence; change in rank, if applicable)
1. Israel: 428 daily cases per million population (+107; ↑ 1)
2. Bahrain: 404 (+60; ↓ 1)
3. Montenegro: 264 (+46; ↑ 1)
4. Costa Rica: 239 (+23; ↑ 1)
5. Andorra: 239 (+96; new)
6. Argentina: 236 (+14; ↓ 3)
7. Spain: 206 (+11)
8. Kuwait: 173 (-8)
9. Peru: 172 (+3)
10. Panama: 156 (-5)
- India’s epidemic continues to accelerate and set new records for total daily incidence, now exceeding the previous record of 67,374 new cases per day in the US by more than 25%. India is also reporting more than double the current daily incidence in the US, more than 3 times Brazil’s incidence, and more than 8 times that of any other country. Brazil’s daily incidence has decreased by a third since September 5. Bahrain, Israel, and Montenegro continue to report rapidly increasing C19 incidence. Bahrain’s incidence has increased by more than 150% since September 2, Israel’s has increased by nearly 140% since August 31, and Montenegro’s has quadrupled since August 25. The Maldives fell out of the top 10 in terms of per capita daily incidence, and it was replaced by Andorra, which jumped all the way to #5.
- The US CDC reported 6.47 million total cases and 193,195 deaths, and the US is averaging 34,371 new cases and 734 deaths per day. If the US continues at its current pace, it could reach 200,000 cumulative C19 deaths in the next 10 days. In total, 21 states (increase of 2) are reporting more than 100,000 cases, including California with more than 700,000 cases; Florida and Texas with more than 600,000; New York with more than 400,000; and Arizona, Georgia, and Illinois with more than 200,000.
- Guam’s per capita daily incidence remains elevated. It has held relatively steady at approximately 225 daily cases per million population since September 6, which would be #7 globally, if Guam were a country.
- The Johns Hopkins CSSE dashboard reported 6.53 million US cases and 194,238 deaths as of 1:30pm EDT on September 14.
2. GLOBAL ECONOMIC IMPACT
- The Organisation for Economic Co-operation and Development (OECD) published data on national economies for G20 countries in Quarter 2 of 2020. As a whole, the G20 economy contracted by 6.9% from Quarter 1. This contraction is an all-time record and more than 4 times what was observed during the peak of the 2009 global financial crisis. Of the G20 countries, China was the only one to report economic growth (+11.5%), likely in part due to its success in containing its epidemic. Excluding China, the combined economy of the rest of the G20 contracted by 11.8%. Notably, India’s economy contracted by more than 25%, and the UK’s contacted by more than 20%. Across all OECD countries, the combined economy contracted by 10.6%. For many of the listed countries, the contraction compared to Quarter 2 in 2020 was even more severe, since the pandemic had already hindered economic growth in Quarter 1 of this year. Many countries have relaxed social distancing measures in an effort to increase economic activity; however, a number of them have re-instituted or strengthened these restrictions following a resurgence, in some cases worse than their “first wave.” It remains unclear how long the economic effects of C19 will persist and the extent to which subsequent waves of transmission or a future vaccine will affect recovery efforts.
3. VACCINE CLINICAL TRIALS
- Less than a week after suspending Phase 3 clinical trials for its candidate SARS-CoV-2 vaccine due to a serious adverse event, AstraZeneca announced that the trials have resumed in the UK. According to a press release issued by AstraZeneca, the trials resumed after the UK government’s Medicines Health Regulatory Authority (MHRA) evaluated the evidence and determined that it was safe to continue testing the vaccine. The press release states that AstraZeneca and the University of Oxford are not permitted to “disclose further medical information” regarding the adverse event, presumably including the associated safety data reviewed by MHRA or the results of their analysis. It appears that the Phase 3 trials in other countries remain on hold.
- The CEO of Pfizer, Inc., announced that the company could be ready to begin distributing its candidate SARS-CoV-2 vaccine to the American public by the end of 2020. In support of this effort, Pfizer received approval to expand its Phase 3 clinical trial from 30,000 participants to 44,000 in order to more quickly collect necessary safety and efficacy data. A press release published by Pfizer indicates that expanding the study would “further increase trial population diversity” and allow for the inclusion of children aged 16 years and older and those with various pre-existing health conditions. Pfizer (and collaborator BioNTech) expects to have preliminary findings by the end of October.
- Experts have criticized both AstraZeneca and Pfizer for their lack of transparency with respect to their candidate vaccines and associated clinical trials. These experts argue that the companies should publish more information, both in terms of trial study design and data analysis in order to build confidence among the public in advance of future availability. This could be particularly important in light of the recent pause in AstraZeneca’s trials and speculation regarding the nature of the participant’s serious adverse event.
- Remdesivir is one of the few treatments available for C19 with an Emergency Use Authorization (EUA) from the US FDA. Reports during the summer warned of shortages of remdesivir for hospitals in need, but officials from the US Department of Health and Human Services have recently noted that purchases of the antiviral have slowed. State and territory public health systems accepted only 72% of their allocation, and hospitals purchased only two-thirds of that supply. It appears that overall demand for the drug in hospitals has decreased since the US summer resurgence. Additionally, while the FDA expanded the authorization to include any hospitalized patient, some facilities are limiting its use to more severely ill patients. Despite the decreased demand, some hospitals continue to stockpile remdesivir in anticipation of a surge during the fall and winter months.
5. MORTALITY RISK
- It is well understood that increased age and underlying medical conditions elevate the risk of severe disease or death in C19 patients, but health officials continue to struggle with communicating the relative mortality risk posed by C19. One commentary, published in The BMJ, discusses a method of translating C19 risk into an effective analogy by comparing increased mortality risks due to C19 to the normal mortality risks that individuals face at different ages. Based on data published by Imperial College London, the authors determined that the risk of death posed by C19 alone is approximately equal to the normal risk of death for individuals over the age of 20 years. The authors note that this equates to nearly double the normal risk of death for younger individuals (who have a lower baseline risk of death), and the proportional increase tapers off as age (and normal risk of death) increases. Providing a framework to help individuals comprehend the relative risk of C19 to their health and life can help them appreciate the risk and encourage the use of recommended protective measures.
6. C19 vs SEASONAL FLU IN PEDIATRIC PATIENTS
- A study published in JAMA: Network Open compared disease severity among pediatric seasonal influenza and C19 patients. The study analyzed clinical data from 315 pediatric C19 patients and 1,402 pediatric seasonal influenza patients during the Northern Hemisphere 2019-20 influenza season. The researchers found that the two groups did not differ significantly in terms of hospitalization rates, admission to intensive care units, or mechanical ventilator use. In terms of clinical presentation, C19 patients were more likely to report fever, diarrhea or vomiting, headache, body aches, and chest pain than seasonal influenza patients. As the pandemic continues into the Northern Hemisphere 2020-21 influenza season, it will be critical to rapidly distinguish C19 patients from seasonal influenza patients.
- If C19 severity among pediatric patients is similar to seasonal influenza, it can provide additional insight into mortality risk. The US CDC estimates that 7-26,000 children were hospitalized in a given influenza season (since 2010), and as many as 600 may have died in 2017-18. It is well understood that older individuals are at elevated risk for severe disease and death; however, there is certainly still risk of severe disease and death in children.
7. MORTALITY RISK RAPID ASSESSMENT
- A study published in The BMJ describes the development and validation of a rapid risk assessment tool for hospitalized C19 patients. The tool was developed by the International Severe Acute Respiratory and emerging Infections Consortium Coronavirus Clinical Characterisation Consortium (ISARIC-4C). The researchers analyzed clinical data for more than 35,000 hospitalized C19 patients in the UK in order to identify a set of indicators, including both clinical presentation and underlying risk factors, that could be rapidly assessed during hospital admission with the aim of identifying patients who may be at higher risk of death. The researchers identified 8 predictive indicators and developed a tool that yielded a score (4C Mortality Score) that correlates with the patient’s risk of death: age, sex, number of relevant comorbidities, respiratory rate, peripheral oxygen saturation, level of consciousness, urea level, and C reactive protein level. Each patient is scored on a scale of 0-21, with higher scores corresponding to increased risk. Patients with scores of 15 or greater exhibited 62% mortality, compared to only 1% mortality for those with scores of 3 or less. While the tool needs further validation, it could provide rapid assessment capability to enable clinicians to “stratify [C19] patients admitted to [the] hospital…into different management groups,” which could streamline clinical response operations and enable clinicians to more proactively initiate specific treatment protocols for higher-risk patients.
8. GLOBAL PREPAREDNESS MONITORING BOARD
- The Global Preparedness Monitoring Board (GPMB) is an independent body convened by the WHO and the World Ban that focuses on global preparedness for health emergencies. GPMB published its second annual report today, titled “A World in Disorder.” The report delivers a fairly scathing review of the world’s response thus far to the C19 pandemic. In particular, the report notes that the crisis “has revealed a collective failure to take pandemic prevention, preparedness and response seriously and prioritize it accordingly.” The GPMB also notes that the recommendations outlined in its first report were minimally implemented, with insufficient financial and political investment. The report emphasizes the importance of political leadership that prioritizes public health and science, establishing and maintaining community support for preventive measures, and proper response execution in order to mitigate both health effects as well as downstream social and economic impacts.
- The authors outline a series of recommendations to address various aspects of pandemic preparedness and response. Specifically, the report addresses the role of national and global leadership, the broader global public, national and global systems and programs for addressing global health security, investments in preparedness and prevention for large-scale health emergencies like a pandemic, and global governance and coordination for preparedness efforts. The report includes a discussion of both the current C19 pandemic response and a look ahead to future emergencies.
- Israeli Prime Minister Benjamin Netanyahu announced on Sunday that Israel will undergo its second nationwide “lockdown” as C19 incidence continues to surge. The lockdown is scheduled to last at least 3 weeks, starting this Friday. Israel’s epidemic has surged since late August, and Israel is now reporting the highest daily per capita incidence globally. Additionally, Israel is heading into a month of religious festivals and holidays, which could provide opportunity for large gatherings and increased transmission risk. The restrictive measures include closing schools and non-essential businesses (e.g., retail stores, gymnasiums, swimming pools), prohibiting in-person dining at restaurants, restricting individuals’ movement outside their homes to 500m (except for essential activities), and limiting gatherings to 10 people indoors and 20 people outdoors. The Israeli government will evaluate the epidemiologic situation at the end of the lockdown period and determine whether the country can move into the first stage of recovery.
10. WINE WINDOWS
- In the Tuscany region of Italy, residents are reviving a centuries-old architectural feature to support economic activity and social distancing. In the mid-1500s, the Grand Duke of Tuscany permitted noble families in the region to sell wine directly from their palaces. In order to facilitate the sales, “wine windows” were incorporated into city walls to allow the wine to be passed through to patrons. These windows, unique to the region, were particularly useful during the Black Plague in the 1600s, as they allowed the sale of wine, food, and other goods without contact between retailers and customers. The wine windows are once again providing this capability, allowing businesses of all sorts, particularly restaurants, to serve customers via the medieval equivalent of curbside pickup. Even now that “lockdown” restrictions have relaxed, some businesses continue to operate their wine windows to serve customers.