Coronavirus Update

Without reliable information, we rely on fear or luck.

Coronavirus Update 10-6

Special Edition

October 6, 2020

Without reliable information, we rely on fear or luck.

“I will be leaving the great Walter Reed Medical Center today at 6:30 p.m.  Feeling really good!  Don’t be afraid of Covid.  Don’t let it dominate your life.  We have developed some really great drugs & knowledge.”  

President Trump

Index

A. CDC (Finally!) Acknowledges C19 Can Spread Via Tiny Air Particles  (!)  (*)

B. CDC: Emergency Warning Signs of C19  (*)

C. Covid experts: there is another way (Focused Protection)

D. Pandemic pushes start of holiday shopping earlier than ever  (*)

E. Johns Hopkins COVID-19 Update

Featured Stories:

A. CDC (Finally!) Acknowledges C19 Can Spread Via Tiny Air Particles

Key Takeaways:
  • Coronavirus can be transmitted through air particles
  • Airborne particles can travel more than 6 feet, with some research indicating the clouds of airborne particles from a sneeze can travel 26 feet
  • The virus is primarily transmitted via respiratory droplets by people in close contact, including those who are physically near, or within about 6 feet of, each other  
  • The U.S. Centers for Disease Control and Prevention said tiny particles that linger in the air can spread the coronavirus, revising its guidelines on the matter just a few weeks after the health agency had acknowledged a role for the particles and then abruptly removed it.
  • The guidelines on how the coronavirus spreads were initially updated last month to acknowledge a role, and possibly the primary one, played by tiny aerosol particles in spreading the virus. But the agency removed the changes only days later, saying a draft version of the proposed changes had been posted in error.
  • In its latest revisions to the guidelines Monday, the CDC acknowledged that tiny airborne particles that can travel beyond 6 feet can be infectious, though the latest wording says they aren’t the main way the virus spreads.
  • The virus is primarily transmitted via respiratory droplets by people in close contact, including those who are physically near, or within about 6 feet of, each other, the CDC said. Those droplets, the agency added, cause infection when they are inhaled or deposited in the nose and mouth.
  • The agency also recognized, however, that some infections can be spread by exposure to the virus in small droplets and particles that can linger in the air for minutes to hours. Evidence indicates that under certain conditions people with C19 seem to have infected others who were more than 6 feet away, the CDC said.
  • “These transmissions occurred within enclosed spaces that had inadequate ventilation,” the CDC said. “Sometimes the person was breathing heavily, for example while singing or exercising.”
  • In such situations, infectious smaller droplets and particles became concentrated enough to spread the virus to others, the CDC said. People who became infected from airborne particles were in the space at the same time as the person who was transmitting the virus, or shortly after the person with C19 had left, the agency said.
  • “CDC continues to believe, based on current science, that people are more likely to become infected the longer and closer they are to a person with C19,” the agency said in a news release that accompanied its updated guidelines. “Today’s update acknowledges the existence of some published reports showing limited, uncommon circumstances where people with C19 infected others who were more than 6 feet away or shortly after the C19-positive person left an area.”
  • At the heart of the back and forth is continued debate about how the virus spreads and the infectiousness of the various-sized droplets and tiny particles known as aerosols that are emitted when a person coughs, talks, sneezes, sings or breathes.
How Droplets Move
  • Droplets of all sizes are emitted when a person coughs, talks or sneezes. How they travel depends on many factors. Some research has found that droplets will be carried by a moist gas cloud, which a Massachusetts Institute of Technology researcher has said can travel up to about 26 feet after a sneeze. 
  • Some of the droplets will fall as the cloud moves. Others ultimately evaporate, producing aerosols that can linger in the air and travel with airflow patterns, a March article by the researcher published in the Journal of the American Medical Association said.
  • From the start of the pandemic, some scientists and infectious-disease experts, as well as the CDC and the World Health Organization, said the virus is transmitted primarily between people in close contact, through respiratory droplets, which the CDC said can land in the mouths or noses of people nearby, or possibly be inhaled into the lungs.
  • Those droplets, studies have shown, typically travel only a few feet before falling to the ground.
  • But as more studies began to show that people were also contracting the virus even when avoiding close contact with an infected person, many scientists began to conclude that tiny aerosols are playing a key role in spread.
  • Those minuscule aerosols, research shows, can suspend in the air, traveling for minutes or hours on air currents, far beyond 6 feet. They can be inhaled by people, especially those who are unmasked, in rooms with poor ventilation and exposed for a prolonged period.
  • After the guidelines on how C19 spreads were updated last month to include airborne transmission, many scientists cheered the CDC’s decision, saying it was a necessary and long overdue acknowledgment of the role played by the tiny particles.
  • Scientists applauded the renewed acknowledgment, though some said they wished the airborne-transmission language was stronger.
  • “Airborne transmission is happening in normal situations—it doesn’t just have to be a choir practice or while someone is exercising,” said Joseph Allen, director of Harvard University’s Healthy Buildings program, which studies how buildings affect human health. “We’ve seen this in a restaurant, on a school bus, at a camp.”
  • “If you look at all of these outbreaks, they have a common thread: time spent indoors, no mask and low ventilation,” Dr. Allen added.
  • Whether and how much airborne transmission plays a role in the virus’s spread has become fiercely debated, in part because decisions on reopening schools, businesses and other establishments hinge on the matter.
  • A full endorsement of airborne transmission would likely call for more stringent precautions for reopening businesses and schools, health and ventilation experts say. Everyone would need to wear masks, crowd sizes would have to be small and many buildings would require better ventilation systems, according to the experts.
  • Such steps could make it harder and more expensive for schools, businesses and other establishments to reopen, potentially impeding the economy’s ability to recover.
  • In its new guidelines, the CDC acknowledged the need to ensure proper ventilation of indoor spaces, saying that “being outdoors and in spaces with good ventilation reduces the risk of exposure to infectious respiratory droplets.”
  • The agency recommended that people stay at least 6 feet away from others, wash their hands and routinely clean and disinfect surfaces. It also advised wearing a mask, saying it helps reduce the risk of spread both by close contact and airborne transmission.
  • The CDC’s C19 guidelines, available on the agency’s website, effectively provide the federal government’s view on how the new coronavirus spreads and what people, schools and businesses can do to reduce their risk of infection.
  • Their recommendations have become a flashpoint in the partisan debate over the appropriate response to the virus, including whether people should wear masks, if schools should reopen and who should get tested.
  • The administration’s critics, including many scientists, say it is ignoring scientific evidence for political gain, and risking the health of Americans.
  • Caught in the back-and-forth is the CDC, the country’s pre-eminent public-health agency. It has now reversed course on a number of C19 guidelines.
  • Under pressure from the Trump administration, the CDC in July added to its guidelines language stressing the importance of children returning to schools, and saying C19 poses lower risks for children than for adults.
  • Then, in August, the CDC dialed back its testing recommendations, saying that close contacts of confirmed cases don’t need to undergo testing if they don’t have symptoms. The agency recently walked that back, saying close contacts should get tested, even if they don’t have any symptoms.
  • The latest problem with the CDC’s guidelines stemmed from confusion inside the agency, not interference from the White House or the Health and Human Services department, people familiar with the matter said.
  • Some staff posted an update, when it was still in draft form and hadn’t been vetted by senior agency scientists and approved, the people said.

Source: CDC Acknowledges Covid-19 Can Spread Via Tiny Air Particles

B. CDC: Emergency Warning Signs of C19

  • If you notice any of these emergency warning signs for COVID-19, seek emergency medical care immediately:
  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face.
  • This list doesn’t include all possible symptoms. Call your medical provider for any other symptoms that are severe or concerning to you.

Source: CDC Symptoms of Coronavirus

C. Covid experts: there is another way (Focused Protection)

  • As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical, and mental health impacts of the prevailing C19 policies and recommend an approach we call Focused Protection. 
  • Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. 
  • Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.
  • Fortunately, our understanding of the virus is growing. We know that vulnerability to death from C19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, C19 is less dangerous than many other harms, including influenza. 
  • As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e.  the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity. 
  • The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection. 
  • Adopting measures to protect the vulnerable should be the central aim of public health responses to C19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals. 
  • Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.

Source: Covid experts: there is another way

D. Pandemic pushes start of holiday shopping earlier than ever

  • Add last-minute holiday shopping to the list of time-honored traditions being upended by the coronavirus pandemic. Retailers are kicking off the holiday season earlier than ever this year in hopes of avoiding big in-store crowds and shipping bottlenecks in November and December.
  • Stores like Best Buy, Macy’s, and Target typically offer their biggest Black Friday deals over Thanksgiving weekend, but now they’re starting them in October so people don’t crowd their stores later, creating a potentially dangerous situation during a pandemic.
  • And with more people expected to shop online, retailers are trying to avoid a rush of orders closer to Christmas, which could lead to late packages and more expensive shipping. Many had a hard time keeping up with the surge in buying when shoppers were locked down in their homes during the early days of the pandemic. Even Amazon, which has spent 25 years building warehouses and a delivery network, had to hire an additional 175,000 workers to meet demand.
  • Black Friday has long been the unofficial start to the U.S. holiday season, though retailers have been pushing holiday shopping earlier for the last decade or so.
  • This year there’s more urgency. With the coronavirus still spreading in the U.S., stores have had to rethink their usual holiday plans. Thanksgiving Day doorbusters are canceled. There will still be in-store sales the day after Thanksgiving, but companies are expected to try to steer many shoppers to their websites to avoid crowds and chaos.
  • “We’re preparing for a holiday season unlike any we’ve seen before,” said Target CEO Brian Cornell.
  • With many people out of work and even more uncertain about their economic futures, this isn’t expected to be a banner year for holiday sales. Shoppers will likely buy fewer gifts because they won’t be traveling to big family holiday gatherings. And they’ll be focused on gifts related to activities around the home, from workout wear to home goods and gaming consoles. One bright spot: People are spending less on experiences like travel and eating out, which have siphoned away holiday sales over the past few years.
  • “Shoppers are going to be very selective in what they buy,‴ said Ken Perkins, president of Retail Metrics, a retail research firm. “Retailers, particularly department stores and specialty clothing chains, need to get it right in terms of inventory and customer traffic. They’re fighting for their lives.”
  • The first big holiday push will come from Amazon, which is positioning its mid-October Prime Day as a kickoff to the holiday shopping season. This is the first time Amazon has held Prime Day so close to the holidays. It’s usually in July, but was postponed this year.
  • That will put pressure on stores to offer deals around the same time, too. Target and Walmart have already said they will hold their own sales during the same time as Amazon’s. Best Buy will offer deals in October, earlier than it ever has.
  • Even with the early start to the season, holiday sales are expected to deliver smaller gains than in recent years. But no one really knows what’s going to happen.
  • Joel Bines, who runs the retail practice at AlixPartners, thinks the earlier shopping will stick even when the pandemic is over. He likens it to when most major stores started opening on Thanksgiving Day after one or two stores did it for the first time a decade ago as a way to jumpstart Black Friday sales.
  • “This is here to stay,” Bines said. “The new holiday season is October through January.”
  • There are already signs of early shopping. Kohl’s said shoppers have started searching for stocking stuffers and matching family pajamas on its website.
  • Retailers will try their hardest to woo procrastinators. In October, TV and online ads paid for by trade group National Retail Federation will push people to buy early.
  • MadaLuxe, which has three stores and distributes luxury goods to discount chains, is bringing in holiday items like blankets, pillows and picture frames in mid-October, a month earlier than usual.
  • ″I don’t think our customers are looking at holiday, but we want them to,” said MadaLuxe CEO and president Adam Freede.
  • Sasha Vuillaume has already bought Disney Princess figurines for her 5-year-old daughter as a Christmas gift. And if Amazon has a Prime Day deal on the Barbie camper her daughter wants, the veterinary receptionist from Lakewood, Ohio, will probably buy it then.
  • But Vuillaume expects much of her holiday shopping to be at Target, ordering online and picking up at the store. She wants to spend as little time inside as possible. Before COVID-19, she would grab a drink at Starbucks and wander around the aisles of Target.
  • “That was kind of my downtime,” she said. “Now I can’t really do that.”
  • Stores like Best Buy and Kohl’s know that many shoppers like Vuillaume want to avoid being inside for long and are expanding services that allow them to buy items online and pick them up at the store. Some small businesses are joining in. E-commerce platform Shopify, for example, started offering a way for its merchants with physical shops to add curbside pickup.
  • Retailers are also making plans for people who don’t want to go to a store at all.
  • Expecting to sell more of its rings and diamond bracelets online, Signet Jewelers, the owner of the Zales and Kay Jewelers chains, made tweaks at its Ohio warehouse so it can ship five times as many packages as last year.
  • Meanwhile, delivery company DHL is advising retailers to avoid holding big sales in December, since delivery could be delayed, said Kraig Foreman, the company’s president of e-commerce in North America, who works with nearly 30 retail chains.
  • Some are already seeing shipping delays.
  • Balsam Hill, which sells high-end artificial Christmas trees online, is warning shoppers on its website that shipping could take twice as long than the typical three to four days.
  • People seem to be in the holiday spirit already. Mac Harman, CEO of parent company Balsam Brands, said sales rose in July and continue to be so high that he’s worried the company could run out of faux trees by Black Friday.
  • ″I don’t want to let customers down in a year where we need more joy than ever,” he said.

Source: Pandemic pushes start of holiday shopping earlier than ever

E. Johns Hopkins COVID-19 Update

October 5, 2020

1. Cases & Trends

  • The WHO COVID-19 Dashboard reports 35.11 million cases and 1.04 million deaths as of 10:00am EDT on October 5. The global weekly incidence remained slightly above 2 million for the third consecutive week. These are the 3 highest weekly totals since the onset of the pandemic. The weekly mortality increased by nearly 7% from the previous week to more than 39,000 deaths.
  • Total Daily Incidence (change in average incidence; change in rank, if applicable)

1. India: 78,445 new cases per day (-5,430)

2. USA: 43,257 (-1,062)

3. Brazil: 26,140 (-671)

4. Argentina: 12,452 (-178)

5. France: 11,514 (-601) 

6. Spain: 10,493* (-478)

7. United Kingdom: 9,716 (+3,900; new)  

8. Russia: 9,084 (+2,218; ↓ 1) 

9. Colombia: 5,999 (-855; ↓ 1) 

10. Israel: 5,307 (-779; ↓ 1)

1. Israel: 613 daily cases per million population (-90)

2.  Andorra: 507 (+4)  

3.  Montenegro: 413 (+26) 

4.  Bahrain: 326 (-33)

5. Argentina: 276 (-4)

6.  Czech Republic: 238 (+33; ↑ 2)

7.  Bahamas: 225 (+72; new) 

8. Spain: 224 (-10)

9.  Netherlands: 202 (+53; new)

10.  Moldova: 202 (+50; new)

  • India’s daily incidence continues to decline from its peak in mid-September (93,198 new cases per day), now reporting fewer than 80,000 new cases per day for the first time since September 5. Indonesia fell out of the top 10 in terms of total daily incidence, and it was replaced by the United Kingdom, which jumped to #7. After reporting a slow, steady decline in daily incidence for several months, Russia’s C19 incidence appears to be increasing quickly. If it continues on this trajectory, Russia could surpass its first peak in the next several days. Israel’s daily incidence decreased sharply from its record peak; however, it remains above 600 daily cases per million population. Costa Rica, France (entered the top 10 the previous week), and Peru fell out of the top 10 in terms of per capita daily incidence, and they were replaced by the Bahamas (fell out of the top 10 the previous week), the Netherlands, and Moldova.
United States
  • The US CDC reported 7.36 million total cases and 208,821 deaths. The US is averaging 42,980 new cases and 684 deaths per day. This is the first time that US mortality is fewer than 700 deaths per day since July 11. In total, 24 states (increase of 2) are reporting more than 100,000 cases, including California with more than 800,000 cases; Texas and Florida with more than 700,000; New York with more than 400,000; Georgia and Illinois with more than 300,000; and Arizona, New Jersey, and North Carolina with more than 200,000. The Tennessee C19 dashboard is currently reporting more than 200,000 cases, and we expect that to be reflected in the CDC data soon. We also expect Oklahoma to surpass 100,000 cases in the next week or so.
  • The Johns Hopkins CSSE dashboard reported 7.42 million US cases and 209,857 deaths as of 11:30pm EDT on October 5.

2. US PRESIDENT 

  • Last week, US President Donald Trump tested positive for SARS-CoV-2, and on Friday, he was admitted to Walter Reed National Military Medical Center for treatment and monitoring. The exact timing of his SARS-CoV-2 tests and the onset of symptoms remain unclear, and limited information has been provided regarding the severity of his symptoms and his exact course of treatment. 
  • Based on official statements from the White House, including the President’s physician and other physicians who treated the President at Walter Reed, and multiple media reports, President Trump received supplemental oxygen, remdesivir, monoclonal antibodies, convalescent plasma, dexamethasone, and vitamin D, some of which were provided under Emergency Use Authorization or compassionate use protocols. President Trump remains in the hospital, but White House officials anticipate that he could be discharged as early as today. Over the weekend, the President posted several videos to his Twitter account and took a short ride in the Presidential motorcade to see supporters gathered near the hospital.
  • In addition to President Trump, a number of close advisers and Republican officials have tested positive for SARS-CoV-2 over the past several days. As far as we know, health officials have not definitively identified the index patient/s for this outbreak nor the site/s of exposure. Many of the cases associated with this outbreak attended the ceremony at which President Trump announced Amy Coney Barrett as his nomination to the US Supreme Court, fueling speculation that it could have served as a superspreader event. 
  • Notably, images and video of the event show that most attendees were not adhering to social or physical distancing recommendations, including mask use. There is concern that some of the people recently identified as infected participated in large-scale events, including fundraisers and rallies, while infectious. In addition to high-profile elected and appointed officials, exposures at the White House could include a number of support staff—such as custodial workers, valets and cooks, administrative staff and aides, the media, and the Secret Service (including those that escorted President Trump in the motorcade).

3. YOUNG ADULTS 

  • Last week, US CDC’s MMWR published a study that describes trends in SARS-CoV-2 transmission among young adults, including college and university students. C19 cases among young adults increased by 55% during August and early September, with the greatest increases occurring in the Northeast and Midwest regions, where cases more than doubled. The researchers determined that the increased incidence was “not solely attributable to increased testing.” 
  • Notably, incidence among non-Hispanic White young adults increased by nearly 150% from August 2 to September (and even higher in the Midwest and Northeast), while incidence among racial and ethnic minorities remained steady or decreased over that time. Considering the timing of the increase among this age group, the researchers speculate that it could have been related to students returning to school; however, there are likely a myriad of factors that require further investigation.
  • US universities continue to face increased scrutiny regarding their campus-related outbreaks, such as at Appalachian State University, where more than 700 confirmed cases have been reported since early June. Additional epidemiological investigations and studies are needed to further understand and address risk factors for outbreaks at US colleges. One study, published in the US CDC’s MMWR, aimed to fill in some outstanding gaps. 
  • The authors documented the reopening process and subsequent C19 outbreak for an unnamed university in North Carolina. The school implemented various preventive measures, including reduced capacity in classrooms and dining halls, reduced occupancy in residence halls, increased take-out options at dining halls, daily symptom monitoring, mandatory mask use in indoor spaces, physical distancing, and prohibitions on gatherings or more than 10 people indoors and 25 people outdoors. Adherence data was not available for any of these measures. Despite the social and physical distancing measures implemented at the university, the school reported 18 clusters of 5 or more linked cases, which accounted for 201 of 670 total confirmed cases from August 3-25. Of these clusters, 8 were in residence halls, 5 were linked to fraternities or sororities, 4 were among athletic teams, and 1 was in an off-campus apartment. After reporting 334 cases, the school transitioned all classes to remote, and it implemented measures to further limit residency in on-campus student housing. Student gatherings and congregate living were identified as contributing factors to the campus outbreak.

4. MULTISYSTEM INFLAMMATORY SYNDROME 

  • Multisystem inflammatory syndrome in children (MIS-C), is a rare, severe complication of SARS-CoV-2 infection in pediatric patients that can lead to hospital admission or death. A similar condition has not been well documented in adults, but researchers from the CDC C19 Response Team published a study in the CDC’s MMWR provides analysis of 27 adult patients determined to have a related condition, MIS-A. The patients exhibited cardiovascular, gastrointestinal, dermatologic and neurological symptoms without severe respiratory presentation, similar to what has been observed in children experiencing MIS-C. The researchers used a case definition requiring 5 criteria: (1) severe illness requiring hospitalization in a patient aged 21 years or older; (2) current or recent SARS-CoV-2 infection; (3) severe impairment of one or more non-respiratory organ system; (4) evidence of severe inflammation, indicated by various laboratory analyses; and (5) absence of moderate or severe respiratory illness. The authors recommended that clinicians consider a MIS-A diagnosis for relevant clinical manifestations and use serological testing, if needed, to confirm current or recent SARS-CoV-2 infection. Notably, 8 of the 27% patients included in this study did not have any documented positive SARS-CoV-2 diagnostic test, although all had positive serological tests. Further study is needed to better characterize MIS-A, including whether it is associated with acute C19 disease or if it is “an entirely post-acute phenomenon.” 

5. CARDIAC ARREST & CPR 

  • Researcher from a number of US medical institutions published findings from a study on the use of cardiopulmonary resuscitation (CPR) in C19 patients who experience cardiac arrest. The researchers note that “anecdotal reports of poor outcomes in critically ill patients with C19 who have had in-hospital cardiac arrest have prompted discussions on the futility of [CPR] in this patient population.” The study, published in BMJ, included more than 5,000 C19 patients who were admitted to intensive care units at 68 hospitals across the US. 
  • Among these patients, 701 participants (14%) experienced cardiac arrest while hospitalized, and 400 (57.1%) of those individuals received CPR. Among the 400 patients who received CPR, 48 (12%) survived to discharge, and 28 (7%) exhibited normal neurological function or only mild neurological impairment. These percentages are relatively consistent with studies of CPR among non-C19 patients, which indicates that CPR does provide benefit to C19 patients. Additionally, the study illustrates the high rate of cardiac arrest among C19 patients, and hospitals and health systems should be prepared for the increased demand among severe C19 patients.

6. NEW YORK CITY 

  • Yesterday, New York City Mayor Bill de Blasio announced the upcoming implementation of new restrictions for 20 neighborhoods in the New York City boroughs of Brooklyn and Queens in response to the increase in C19 incidence and test positivity since late September. Nine (9) of the neighborhoods will face closure of public and private schools as well as all non-essential businesses, including the suspension of indoor and outdoor dining. The other 11 neighborhoods will be subject to more limited restrictions, such as the suspension of indoor dining and the closure of gyms and pools. The newly-announced policies are expected to be in place for 2-4 weeks, depending on the impact on local C19 transmission. New York Governor Andrew Cuomo will reportedly need to approve the new measures before they are allowed to take effect. Increased transmission has been identified in some Orthodox or Hasidic Jewish communities. A variety of city government agencies are engaging with these communities to promote social and physical distancing measures and increase testing to contain the outbreaks. Some affected neighborhoods are reporting test positivity as high as 7-8%, which is higher than the city average but still much lower than some parts of the country. 

7. MENTAL HEALTH 

  • Today, the WHO released the results of a survey describing the impact of C19 on “mental, neurological, and substance use services” in 130 countries. Notably, 93% of countries surveyed faced disruption or suspension of critical mental health services due to the pandemic, with outpatient services in hospitals and community-based services being the most affected. One-third of countries responding noted disruption in at least 75% of these services. Among responding countries, 35% of reported disruption in emergency or life-saving services, and 30% experienced disruption in supply of medicines for conditions related to mental, neurological, or substance use disorders. Disruptions in provision of services were mainly attributed to decreases in patients seeking outpatient care, travel restrictions, and decreases in inpatient volume due to suspension of elective procedures. These findings come in advance of the WHO’s Big Event for Mental Health, a virtual event on World Mental Health Day that aims to increase awareness and advocacy for mental health during the pandemic. 

8. REMDESIVIR 

  • On Friday, the European Medicines Agency announced a safety review regarding reports of acute kidney injury in C19 patients treated with remdesivir. Remdesivir is currently being used in the US under an Emergency Use Authorization issued by the US FDA and a conditional marketing authorisation in the EU. Enhanced safety monitoring has been in place for the therapeutic due to animal studies that previously documented renal toxicity, but a causal relationship between use of remdesivir and kidney injury has not yet been established. For now, recommendations regarding use of the therapeutic have not changed.

9. BLEACH-BASED CLEANING SUPPLIES 

  • More than 9 months into the C19 pandemic, some supplies are still difficult to come by. In addition to surgical masks, N95 respirators, and other supplies and equipment for healthcare workers, some cleaning products are still hard for shoppers to find. Toilet paper and paper towels have generally returned to store shelves, as have hand sanitizer and hand soap; however, bleach-based disinfecting wipes and sprays are still a relatively rare commodity. Cleaning products capable of killing coronaviruses became increasingly popular as the attention to enhanced hygiene and disinfection grew. Companies like Clorox and Lysol have been unable to scale up production to meet the demand, which reportedly “surged 500 percent in the last few months.” Manufacturers and retail stores went through several months’ worth of inventory in 1 or 2 weeks. These supplies have been critical to industries such as air travel, as companies are relying on them as convenient and effective ways to disinfect high-touch surfaces. 

10. NFL GAMES POSTPONED 

  • This weekend, the NFL postponed multiple Week 4 games due to positive SARS-CoV-2 tests. The first postponement followed multiple positive tests among players and staff for the Tennessee Titans. At least 18 individuals associated with the team tested positive, starting on Tuesday, September 29. Today was the first day since then that the team has reported no new positive tests, which is the first step in reopening team facilities and resuming team activities. The Titans’ game against the Pittsburgh Steelers will now be played in Week 7, and the NFL also moved the Steelers’ game against the Baltimore Ravens to Week 8 and the Ravens’ bye week to Week 7 to accommodate the schedule change. Later in the week, New England Patriots quarterback Cam Newton tested positive shortly before the team departed for its game against the Kansas City Chiefs. The Patriots vs Chiefs game will still be played this week, but it was rescheduled for tonight, although the Patriots will be without their starting quarterback. 
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