October 9, 2020
Without reliable information, we rely on fear or luck.
“Going out to eat with members of your household this weekend? Don’t forget to keep your mask on in between bites. Do your part to keep those around you healthy.”Tweet from California Governor’s office
“Coronavirus outbreaks are not going to be stopped by shutting workplaces down.”Dr. Birx
“They negatively impact fundamental rights and freedoms.”Madrid court order striking down partial lockdown regulations issued by government officials
“We hoped this day wouldn’t come, but unfortunately, Wisconsin is in a much different, more dire place today and our healthcare systems are beginning to become overwhelmed by the surge of COVID-19 cases. This alternative care facility will take some of the pressure off our healthcare facilities while expanding the continuum of care for folks who have COVID-19.”Wisconsin Governor Evers in a statement announcing the opening of a field hospital
1. Cases & Tests
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity
4. Cases are surging in America’s breadbasket
6. Simple Algebra Enables Faster, Large-Volume C19 Testing (Link Only)
7. C19 has a prolonged effect for many during pregnancy (Link Only)
8. Urban air pollution may make C19 more severe for some (Link Only)
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A. The Pandemic As Seen Through Headlines
(In no particular order)
- CDC Adds Being Overweight To List Of Potential COVID-19 Risk Factors
- The FDA released updated, stricter guidelines for coronavirus vaccine developers
- HHS secretary lays out timeline for when COVID-19 vaccines might be ready
- Race for Covid-19 vaccine slows as regulators, top Warp Speed official tap the brakes
- COVID-19 vaccine may be ready by year-end, says WHO’s Tedros
- Antibodies are on their way to treat Covid-19, and not a moment too soon
- Regeneron Shares Jump After Trump Calls COVID Treatment “A Cure”
- Regeneron seeks emergency approval for COVID-19 drug that Trump took
- Eli Lilly says its monoclonal antibody cocktail is effective in treating Covid-19
- Eli Lilly asks FDA for emergency approval for antiviral
- China says it will join a global effort to distribute a vaccine
- UCLA’s new $10 COVID test can process thousands of results in a day
- Even Mild Covid-19 Infections Can Make People Sick for Months
- CA Governor’s Office Says To Wear Mask ‘In Between Bites’ At Restaurants
- Home is only place most Americans feel safe amid COVID-19 crisis
- Wisconsin activates field hospital as coronavirus keeps surging
- New COVID-19 outbreaks won’t be stopped by shutting workplaces: Dr. Birx
- In NYC, a virus crackdown by Gov. Cuomo is drawing resentment in the Orthodox Jewish areas that have experienced rising caseloads
- New York City rushes to enact a new targeted lockdown, sowing chaos
- As virus cases spike in rural India, the country may soon outpace the U.S.
- Hospitals in Paris are feeling the strain from a new influx of patients
- Boston will delay the next step in reopening classrooms as virus cases increase
- Bars, restaurants and other businesses in Berlin will be forced to close between 11 p.m. and 6 a.m., starting this weekend, in a bid to slow the accelerating return of the virus
- Italy made masks mandatory across the country, even outdoors, in an effort to stem a second wave
- The prime minister of Malaysia admitted, from quarantine, that a recent election on the island of Borneo had helped spread the virus
- Brazil Becomes 3rd Country To Pass 5 Million Confirmed Cases Of COVID-19
- France suffers nearly 20,000 in latest record jump
- France is toughening restrictions in more big cities as cases rise
- Italy new cases highest since April
- Scotland shuts bars in two biggest cities
- NY sees hospitalizations near 750
- NYC nears threshold for further restrictions as C19 cases continue to rise
- El Paso officials report a single-day record of new cases, and caution against ‘virus fatigue’
- Europe struggles to contain virus with records in Spain and France
- Court strikes down C19’s partial coronavirus lockdown
- New Zealand’s “go hard, go early” strategy seems to have worked in eradicating the virus for a second time
- Boston will delay the next step in reopening classrooms as virus cases increase
- Bars, restaurants and other businesses in Berlin will be forced to close between 11 p.m. and 6 a.m. in a bid to slow the spread of the virus
- Italy made masks mandatory across the country, even outdoors, in an effort to stem a second wave
- The prime minister of Malaysia admitted, from quarantine, that a recent election on the island of Borneo had helped spread the virus
- Brussels, Bucharest join capital cities cracking down on nightlife
- NYC Mayor de Blasio administration has issued zero tickets to maskless New Yorkers
- Poland will make face masks mandatory in public spaces starting Saturday in response to a second day of record-high case numbers
- In Germany, the head of the federal institute responsible for tracking the coronavirus warned on Thursday that the country could soon see an “uncontrolled” spread of the virus
- Portugal sees new cases top 1,000 per day
- Florida posts most new cases in a month
- NJ focuses on hotspots in Monmouth and Ocean Counties
- Texas passes California as state with 2nd highest death toll
- Czech Republic imposes new social distancing restrictions
- Denmark advises against travel to most of Sweden
- Russian health minister asks citizens to stay home
- Sri Lanka bans public gatherings amid COVID-19 spike
- Scotland shutters bars in major cities as COVID-19 cases surge
- Top EU regulator doesn’t expect vaccine approvals before New Year
- Northern England headed for more restrictions
- Hong Kong’s health secretary said the city was considering legal options for mandatory testing as it prepared for a new wave of coronavirus infections
- Global Food Prices Rise As Famine Threat Emerges
- Covid has wiped out the economic dreams of a generation in Asia
- 1 In 5 Americans Could Be “Out Of Money” By Election Day, Survey Finds
- Grounded for good: Dozens of airlines have failed since start of C19 crisis
- Manhattan Apartments Haven’t Been This Cheap to Rent Since 2013
- Retailers Brace for a Black Friday Without Crowds
- Doctor says Trump can have ‘safe return’ to public events on Saturday
- Trump eyeing rallies in Florida and Pennsylvania this weekend
- Dr. Fauci says the treatment Trump called a ‘cure’ may well work, but needs more testing
- Deadline mistakenly publishes story saying Mike Pence has COVID-19
- COVID-19 outbreak kills thousands of minks on Utah fur farms
- Coronavirus cases force changes to NFL schedule
- Strangers now avoid giving CPR, afraid of catching COVID-19
- More parents than ever are quitting their jobs because of the pandemic
- First-year college students settle into a disorienting semester
- Singapore’s Cruises to Nowhere to Start in November
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day.
1. Cases & Tests
- Total Cases = 36,738,698
- New Cases = 348,639
- New Cases (7 day average) = 308,718 (+3,604) (+1.2%)
- Number of new cases is a record high
- 7 day average of new cases is a record high
- 7 day average has recently been rising at a rapid rate
- 1,000,000 new cases every 3.2 days (based on 7 day average)
US Cases & Testing:
- Total Cases = 7,833,763
- New Cases = 56,652
- Percentage of New Global Cases = 16.2%
- New Cases (7 day average) = 46,960 (+1,303) (+2.9%)
- Total Number of Tests = 115,343,815
- Average national percentage of positive tests (7 day average) = 5.2%
- 7 day average of new cases has been steadily increasing since 9/12
- 7 day average has increased by 11,381 since 9/12, an increase of 32%
- The increase in new cases is a significant concern as it could foreshadow an increase in deaths
- 7 day average of percentage of positive tests remains slightly higher than 5%
- Total Deaths = 1,066,412
- New Deaths = 6,424
- New Deaths (7 day average) = 5,245 (+117) (+2.3%)
- 7 day average of new deaths has been steadily increasing since 10/3
- Although increasing recently, the 7 day average is 12.6% (757) less than 2nd peak on 8/11
- Total Deaths = 217,738
- New Deaths = 957
- Percentage of Global New Deaths = 14.9%
- New Deaths (7 day average) = 725 (+5) (-0.7%)
- 7 day average of new deaths has been mostly declining since 2nd peak on 8/4
- 7 day average is 453 less than 2nd peak, a decline of 40%
3. Top 5 States in Cases, Deaths, Hospitalizations & Positivity (10/8)
- A total of 33 states have positivity rates greater than the WHO recommended level of 5%
- Three states: ND, SD, and ID have positivity rates greater than 20%
- Twelve states have positivity rates between 10-20% (WI, IA, NV, KS, MT, UT, WY, IN, AL, MO, NE, and FL)
- Nineteen states have positivity rates between 5-10%
- Seventeen states have positivity rates between the WHO recommended level of 5%
4. Cases are surging in America’s breadbasket
- After savaging the Northeast in the spring and the South and the West this summer, the virus is now devastating another region in the United States — the Midwest and Great Plains.
- From Wisconsin to Montana, states in the nation’s breadbasket had mostly avoided large outbreaks during the initial months of the pandemic. Now, many hospitals in the region are filling to capacity and cases and deaths are on the rise.
- In the past week, North Dakota has reported more new cases per capita than any other state. Hospitalizations have risen so sharply that medical officials have had to send patients miles away for care, even across state lines to Montana and South Dakota. On Monday, across the entire state, just 39 staffed I.C.U. beds were available.
- In Wisconsin, the virus is raging out of control. Three of the four metropolitan areas in the U.S. with the most cases per capita last week were in northeastern Wisconsin, and hospital systems in the state are becoming overwhelmed. Officials opened a field hospital today in Milwaukee.
- Health experts say the recent spike in cases was driven by young adults and the reopening of colleges and K-12 schools. Thousands of cases have been linked to Midwestern universities, and the scale of the outbreaks, given the relatively small populations of states like South and North Dakota, has had outsize effects.
- The virus took its time to reach frightening levels in the region, which is why public health officials say they’re having trouble convincing people that the situation is urgent. There’s a general fatigue over wearing masks and social distancing, and regulations aimed at slowing the spread of the virus in the region have been met with resistance. But as cases and deaths continue to climb, health officials like Vern Dosch, who leads contact tracing efforts for North Dakota, hope that the public will start to take the virus more seriously.
- “If there’s anything that should get our population’s attention, it’s this: how perilously close we are to the edge,” Mr. Dosch said.
Source: New York Times Coronavirus Update
C. New Scientific Findings & Research
1. Decoy Nanoparticles Protect Against C19 by Adsorbing Both Viruses and Inflammatory Cytokines
- Researchers report the development of cell membrane nanovesicles that carry receptors for the coronavirus (SARS-CoV-2) and various inflammatory cytokines on their surfaces, thereby acting as decoys for both SARS-CoV-2 and inflammatory cytokines; the decoy nanoparticles inhibited infection by SARS-CoV-2 and neutralized inflammatory cytokines in vitro, and reduced lung injury in a mouse model of acute lung inflammation, suggesting that they could be a potential therapeutic strategy for C19, according to the authors.
- The decoy nanoparticles were constructed by fusing cell membrane nanovesicles derived from genetically engineered cells, which stably express SARS-CoV-2 receptor ACE2, and human monocytes, which display abundant cytokine receptors. By competing with host cells, these nanodecoys efficiently adsorb viruses and inflammatory cytokines such as IL-6 and GM-CSF. These two functionalities allow effective intervention of viral infection and its associated immune disorder, presenting a promising therapeutic strategy for C19 and other potential epidemics.
- A decoy nanoparticle neutralizes C19 through a powerful two-step approach: virus neutralization in the first step followed by cytokine neutralization in the second step. The nanodecoy, made by fusing cellular membrane nanovesicles derived from human monocytes and genetically engineered cells stably expressing angiotensin converting enzyme II (ACE2) receptors, possesses an antigenic exterior the same as source cells.
- By competing with host cells for virus binding, these nanodecoys effectively protect host cells from the infection of pseudoviruses and authentic SARS-CoV-2. Moreover, relying on abundant cytokine receptors on the surface, the nanodecoys efficiently bind and neutralize inflammatory cytokines including interleukin 6 (IL-6) and granulocyte−macrophage colony-stimulating factor (GM-CSF), and significantly suppress immune disorder and lung injury in an acute pneumonia mouse model. Our work presents a simple, safe, and robust antiviral nanotechnology for ongoing C19 and future potential epidemics.
2. Coronavirus can survive on skin for 9 hours
- The new coronavirus can linger on human skin much longer than flu viruses can, according to a new study from researchers in Japan.
- The coronavirus (SARS-CoV-2) remained viable on samples of human skin for about 9 hours, according to the study. In contrast, a strain of the influenza A virus (IAV) remained viable on human skin for about 2 hours.
- Fortunately, both viruses on skin were rapidly inactivated with hand sanitizer.
- The findings underscore the importance of washing your hands or using sanitizer to prevent the spread of C19.
- “This study shows that SARS-CoV-2 may have a higher risk of contact transmission [i.e. transmission from direct contact] than IAV because the first is much more stable on human skin [than the latter]” the authors wrote in their paper, which was published online Oct. 3 in the journal Clinical Infectious Diseases. “These findings support the hypothesis that proper hand hygiene is important for the prevention of the spread of SARS-CoV-2.”
Survival on skin
- Earlier in the pandemic, researchers in the U.S. analyzed how long SARS-CoV-2 could last on surfaces and found it remained viable on copper surfaces for up to 4 hours, on cardboard for up to 24 hours and on plastic and stainless steel for up to 72 hours, Live Science previously reported. However, for ethical reasons, examining how long the virus can last on human skin is more complicated — you can’t just put samples of a potentially lethal virus on people’s hands.
- So for the new study, the researchers, from Kyoto Prefectural University of Medicine in Japan, created a skin model using samples of human skin obtained from autopsies. The samples were collected approximately one day after death. The authors note that even 24 hours after death, human skin can still be used for skin grafts, meaning that it retains much of its function for some time after death. Thus, the collected samples could be a suitable model for human skin, the authors argued.
- Using their model, the authors found SARS-CoV-2 survived on the human skin samples for 9.04 hours, compared with 1.82 hours for the influenza A virus. When these viruses were mixed with mucus, to mimic the release of viral particles in a cough or sneeze, SARS-CoV-2 lasted an even longer time, about 11 hours.
- However, both viruses were inactivated on skin 15 seconds after using hand sanitizer that was 80% ethanol.
- “Appropriate hand hygiene … leads to the quick viral inactivation [of SARS-CoV-2] and may reduce the high risk of contact infections,” the authors said.
- The authors note that their study did not consider the “infectious dose” of SARS-CoV-2, that is, the quantity of virus particles needed to give someone an infection from contact with contaminated skin, and so future research should also examine this question.
3. Are Potential C19 Vaccines Affected by Recent Mutations in the Virus?
- Vaccines currently being developed for C19 should not be affected by recent mutations in the virus, according to a new study involving a University of York virologist.
- Most vaccines under development worldwide have been modeled on the original ‘D-strain’ of the virus, which were more common amongst sequences published early in the pandemic.
- Since then, the virus has evolved to the globally dominant ‘G-strain’, which now accounts for about 85% of published coronavirus (SARS-CoV-2) genomes.
- There had been fears the G-strain, within the main protein on the surface of the virus, would negatively impact on vaccines under development. But the research by Australia’s national science agency the Commonwealth Scientific and Industrial Research Organisation (CSIRO), found no evidence the change would adversely impact the efficacy of vaccine candidates.
- The study tested blood samples from ferrets given a candidate vaccine against virus strains that either possessed or lacked this mutation (known as ‘D614G’).
- Professor Seshadri Vasan, who holds an honorary chair in Health Sciences at the University of York, is leading the Dangerous Pathogens Team at CSIRO and is senior author of the paper.
- Professor Vasan said: “This is good news for the hundreds of vaccines in development around the world, with the majority targeting the spike protein as this binds to the ACE2 receptors in our lungs and airways, which are the entry point to infect cells.
- “Despite this D614G mutation to the spike protein, we confirmed through experiments and modeling that vaccine candidates are still effective.
- “We’ve also found the G-strain is unlikely to require frequent ‘vaccine matching’ where new vaccines need to be developed seasonally to combat the virus strains in circulation, as is the case with influenza.”
- CSIRO Chief Executive Dr. Larry Marshall said the research was critically important in the race to develop a vaccine.
- Dr. Marshall said: “This brings the world one step closer to a safe and effective vaccine to protect people and save lives.
- “Research like this, at speed, is only possible through collaboration with partners in Australia and globally. We are tackling these challenges head on and delivering solutions through world-leading science.”
D. Vaccines, Testing & Masks
1. C19 vaccine trial participants report aches, fevers and chills
- Some participants for leading C19 vaccine trials have reported experiencing grueling side effects after receiving the shot such as high fever, body aches, headaches and exhaustion.
- Five participants — three in Moderna’s study and two in Pfizer’s late-stage trials — said the uncomfortable side effects usually went away within a day, but some were surprised by how severe they were, CNBC reported.
- “If this proves to work, people are going to have to toughen up,” one of the Moderna participants, a North Carolina woman in her 50s who declined to be identified, told the outlet.
- “The first dose is no big deal. And then the second dose will definitely put you down for the day for sure. … You will need to take a day off after the second dose.”
- She said she didn’t experience a fever but had a bad migraine that left her exhausted and struggling to focus, the outlet reported. But the next day, she woke up feeling better after taking Excedrin.
- While she was uncomfortable, the side effects outweigh the risks of becoming infected with the virus, she said.
- “My hope is that this works but also that the communication [on side effects] is good,” she said, adding that Moderna may need to tell people to take a day off after a second dose.
- Meanwhile, a Maryland participant in his 20s said that he came down with a high fever after receiving the shot.
- “I wasn’t sure if I needed to go to the hospital or not because 104 is pretty high,” he told CNBC. “But other than that, it’s been fine.”
- Luke Hutchison, a 44-year-old from Utah, also participated in the Moderna trials and felt out of sorts for a couple of days after being administered his first shot on Aug. 18, the outlet reported.
- But just hours after receiving the second dose on Sept. 15, he became bedridden with shakes, chills, a terrible headache and shortness of breath, the outlet reported. For five hours, his temperature was above 100 degrees.
- Hutchinson compared the ordeal — which lasted for 12 hours — to “full-on Covid-like symptoms” on Twitter.
- “I’m obviously an isolated case, but since all indications point to this vaccine being approved, I feel like people should know that the side effects may be severe, especially after the second shot,” he wrote.
- Pfizer trial participants have reported similar symptoms.
- One of the participants said he suffered intense flu-like symptoms after his second injection that left him shaking so hard that he cracked part of his tooth.
- “It hurt to even just lay in my bedsheet,” he told CNBC.
- He said he’s still in favor of getting the vaccine but recommends waiting for the weekend to have time to rest.
- “If it gets approved, I still think a lot of people should get the vaccine and I hope that all the side effects are made clear up front,” he said.
- A Baltimore physician who was participating in the study said he experienced a “very mild” reaction to the first injection and still hasn’t received his second, but wouldn’t rule out others experiencing more serious symptoms, the outlet reported.
- Pfizer acknowledged that “short-lived fever, mostly mild to moderate in severity, can be expected in a minority of recipients.”
- “No safety signals have been identified in the study,” spokeswoman Jerica Pitts told the outlet.T ––
- A Moderna spokeswoman said the company doesn’t comment on participants in ongoing trials, but noted that safety committees have given the study the green light to continue at each review, CNBC reported.
2. Race for C19 vaccine slows as regulators, top Warp Speed official tap the brakes
- The race for a C19 vaccine slowed on Tuesday, as both U.S. regulators and the head of the Trump administration’s Operation Warp Speed initiative tapped ever so softly on the brakes.
- The Food and Drug Administration released strengthened rules for authorizing any C19 vaccine on an emergency basis. And Moncef Slaoui, co-chair of Operation Warp Speed, revealed that the government’s vaccine fast-tracking effort has urged manufacturers not to apply for emergency use authorization until they have significant amounts of vaccines to deploy.
- That could push back even the first such authorization — expected to be for a vaccine being made by Pfizer and BioNTech, if it proves to be effective — into sometime in mid- to late November.
- “The one learning message that we came to … was to recommend to the companies that we are supporting that if they achieve efficacy demonstration [of their vaccine] while there are no vaccine doses available at industrial scale … to be able to immunize at least a relevant fraction of the population, that they should refrain or at least consider refraining for filing for an EUA,” Slaoui said during a C19 vaccines symposium on Tuesday.
- Approval of a vaccine that wasn’t actually available to use would be “a major disappointment” to the public, Slaoui said.
- There has been deep concern in the public health world that President Trump would seek to force the FDA to approve C19 vaccines before Election Day — and before large clinical trials currently underway to determine safety and efficacy have reached statistically significant conclusions. Polls suggest many Americans are wary of the vaccines being produced through Operation Warp Speed, and public health experts fear political interference in the approval process would further undermine public confidence.
- The FDA has been attempting to strengthen the rules by which it would agree to issue an emergency use authorization, or EUA, for C19 vaccines, but had been stymied by the White House. On Tuesday, the regulatory agency released the updated safety standards amid a number of guidance documents it posted online in advance of an important meeting on Oct. 22 of the vaccines and related biological products advisory committee, which advises the FDA on vaccine approvals.
- According to the revised rules, the FDA wants vaccine manufacturers to collect safety data on at least half of their clinical trial subjects for two months after they have received their second dose of vaccine, if the candidate vaccine is a two-dose vaccine. (Of the current frontrunners in the vaccine race, only the Johnson & Johnson vaccine, which only recently began its Phase 3 trial, uses a one-dose regimen.)
- Pfizer and BioNTech are viewed as most likely to deliver an early answer from trials of their vaccine, which uses a new technology called mRNA to mount an immune response to the virus. But at Pfizer’s virtual investor day on Sept. 15, the company said that 12,000 of its then-planned 30,000 volunteers had received a second dose — meaning that Pfizer and BioNTech would not have enough data to apply for an EUA until mid-November at the earliest.
- Pfizer and BioNTech have since said they would expand their study to include 44,000 patients. It’s not clear whether the FDA would want two months of data on half the patients on the larger number, or the original 30,000.
- Slaoui also stressed Tuesday that he expected the first efficacy data from C19 vaccines to become available in November or December.
- Peter Marks, the FDA’s top vaccine regulator, insisted Tuesday that the two-month follow-up timeline was guided by data showing that the majority of adverse events occur roughly within two to three months after vaccine administration.
- “There’s something that’s really amazing that you can actually use sometimes … you can sometimes actually use data,” Marks said during the symposium, staged by Johns Hopkins University and the University of Washington. “We picked two months as something that was reasonably aggressive yet also somewhat kind of in the middle — not too aggressive, not too conservative.”
- Former FDA Commissioner Scott Gottlieb groused during the event over how much “political dust” was kicked up by political officials over the FDA’s guidance, for, he said, little gain. Gottlieb, who served in the Trump administration from 2017 to 2019 and now serves on the board of Pfizer, appeared to be referencing reporting that White House officials were blocking release of the FDA’s guidance, although he did not name specific officials nor specific media reports in his comments.
- In addition to the Pfizer-BioNTech vaccine, an mRNA vaccine being produced by Cambridge, Mass.-based Moderna, is expected to have data within that time frame.
- Slaoui told the symposium that though mRNA vaccines have never before been approved, both Moderna and Pfizer-BioNTech are now able to produce vaccine at industrial scale.
- “We are in the process of stockpiling doses in the single-digit million doses in the months of October … and then in the tens of millions of doses in November,” Slaoui said.
3. Diagnosing C19 in just 30 minutes
- For more than 8 months so far, movement between nations has been paralyzed all because there are no means to prevent or treat the virus and the diagnosis takes long.
- In Korea, there are many confirmed cases among those arriving from abroad but diagnosis does not take place at the airport currently. Overseas visitors can enter the country if they show no symptoms and must visit the screening clinic nearest to their site of self-isolation on their own. Even this, when the clinic closes, they have no choice but to visit it the next day. Naturally, there have been concerns of them leaving the isolation facilities. What if there was a way to diagnose and identify the infected patients right at the airport?
- A joint research team comprised of Professor Jeong Wook Lee and Ph.D. candidate Chang Ha Woo and Professor Gyoo Yeol Jung and Dr. Sungho Jang of the Department of Chemical Engineering at POSTECH have developed a SENSR (SENsitive Splint-based one-pot isothermal RNA detection) technology that allows anyone to easily and quickly diagnose C19 based on the RNA sequence of the virus.
- This technology can diagnose infections in just 30 minutes, reducing the stress on one single testing location and avoiding contact with infected patients as much as possible. The biggest benefit is that a diagnostic kit can be developed within week even if a new infectious disease appears other than C19.
- The PCR molecular test currently used for C19 diagnosis has very high accuracy but entails a complex preparation process to extract or refine the virus. It is not suitable for use in small farming or fishing villages, or airport or drive-thru screening clinics as it requires expensive equipment as well as skilled experts.
- RNA is a nucleic acid that mediates genetic information or is involved in controlling the expression of genes. The POSTECH researchers designed the test kit to produce nucleic acid binding reaction to show fluorescence only when C19 RNA is present. Therefore, the virus can be detected immediately without any preparation process with high sensitivity in a short time. And it is as accurate as the current PCR diagnostic method.
- Using this technology, the research team found the coronavirus virus RNA, from an actual patient sample in about 30 minutes. In addition, five pathogenic viruses and bacterial RNAs were detected which proved the kit’s usability in detecting pathogens other than C19.
- Another great advantage of the SENSR technology is the ease of creating the diagnostic device that can be developed into a simple portable and easy-to-use form.
- If this method is introduced, it not only allows onsite diagnosis before going to the screening clinic or being hospitalized, but also allows for a more proactive response to C19 by supplementing the current centralized diagnostic system.
- “This method is a fast and simple diagnostic technology which can accurately analyze the RNA without having to treat a patient’s sample,” commented Professor Jeong Wook Lee. “We can better prepare for future epidemics as we can design and produce a diagnostic kit for new infectious diseases within a week”
- Professor Gyoo Yeol Jung added, “The fact that pathogenic RNAs can be detected with high accuracy and sensitivity, and that it can be diagnosed on the spot is drawing attention from academia as well as industry circles.” He explained, “We hope to contribute to our response to COVID-19 by enhancing the current testing system.
E. Improved & Potential Treatments
1. Remdesivir 25 times more effective when combined with Hepatitis C Drug
- Columbia Engineering researchers report that Sofosbuvir-terminated RNA is more resistant to the proofreader of the coronavirus (SARS-CoV-2), than Remdesivir-terminated RNA. The results of the new study, published today by the Nature Research journal Scientific Reports, support the use of the FDA-approved hepatitis C drug EPCLUSA–Sofosbuvir/Velpatasvir–in combination with other drugs in C19 clinical trials.
- The SARS-CoV-2 exonuclease-based proofreader maintains the accuracy of viral RNA genome replication to sustain virulence. Any effective antiviral targeting the SARS-CoV-2 polymerase must therefore display a certain level of resistance to this proofreading activity.
- “We found that the RNA terminated by Sofosbuvir resists removal by the exonuclease to a substantially higher extent than RNA terminated by Remdesivir, another drug being used as a C19 therapeutic,” says the team’s lead PI Jingyue Ju, Samuel Ruben-Peter G. Viele Professor of Engineering; professor of Chemical Engineering and Pharmacology; director, Center for Genome Technology & Biomolecular Engineering.
- The new study builds upon earlier work the researchers have conducted. Last January, before C19 reached pandemic status, the team posited that EPCLUSA might inhibit SARS-CoV-2. Their reasoning was based on the analysis of the molecular structures and activities of hepatitis C viral inhibitors and a comparison of hepatitis C virus and coronavirus replication.
- In a subsequent study, the researchers demonstrated that the active drug Sofosbuvir triphosphate is incorporated by SARS-CoV and SARS-CoV-2 polymerases, shutting down the polymerase reaction. Other investigators have since demonstrated the ability of Sofosbuvir to inhibit SARS-CoV-2 replication in lung and brain cells; currently, C19 clinical trials with a number of hepatitis C drugs such as EPCLUSA and the combination of Sofosbuvir and Daclatasvir (which is similar to Velpatasvir) are ongoing in several countries.
- Ju notes that a recent preprint from UC Berkeley indicates that a combination of Remdesivir and EPCLUSA increases Remdesivir’s efficacy 25-fold in inhibiting SARS-CoV-2: “These results offer a molecular basis supporting the study of EPCLUSA in combination with Remdesivir for C19 clinical trials.”
2. Liquid gel in COVID patients’ lungs makes way for new treatment
- In some patients who died with severe C19 and respiratory failure, a jelly was formed in the lungs. Researchers have now established what the active agent in the jelly is and thanks to that, this new discovery can now be the key to new effective therapies.
- “There are already therapies that either slow down the body’s production of this jelly or breaks down the jelly through an enzyme. Our findings can also explain why cortisone seems to have an effect on C19,” says Urban Hellman, researcher at Umeå University.
- When performing lung scans on critically ill patients with C19 infection, medical professionals have been able to see white patches. Additionally, the autopsies of some deceased C19 patients have shown that the lungs were filled with a clear liquid jelly, much resembling the lungs of someone who has drowned. It was previously unknown where this jelly originated from.
- Now though, a group of researchers at the Translational Research Centre at Umeå University have shown that the jelly consists of the substance hyaluronan, which is a polysaccharide in the glycosaminoglycan group.
- The presence of hyaluronan is normal in the human body, with various functions in different tissues, but it generally acts as a useful characteristic in the connective tissue. Not least, hyaluronan is involved in the early stages of wound healing. Hyaluronan is also produced synthetically in the beauty industry for lip augmentation and anti-wrinkle treatments.
- Since hyaluronan can bind large amounts of water in its web of long molecules, it forms a jelly-like substance. And it is this process that runs riot in the alveoli of C19 patients’ lungs resulting in the patient needing ventilator care and, in worst case, dies from respiratory failure.
- Currently, a drug called Hymecromone is used to slow down the production of hyaluronan in other diseases such as gallbladder attacks. There is also an enzyme that can effectively break down hyaluronan. As an example, this enzyme can be used in the event that an unsuccessful beauty treatment needs to be terminated abruptly.
- Even cortisone reduces the production of hyaluronan. In a British study, preliminary data shows positive effects on treatments with the cortisone drug Dexamethasone in severely ill C19 patients.
- “It has previously been assumed that the promising preliminary results would be linked to the general anti-inflammatory properties of cortisone, but in addition to those beliefs, cortisone may also reduce the production of hyaluronan, which may reduce the amount of jelly in the lungs,” says Urban Hellman.
3. NIH trial testing hyperimmune intravenous immunoglobulin and remdesivir to treat C19
- A clinical trial to test the safety, tolerability and efficacy of a combination treatment regimen for coronavirus disease 2019 (C19) consisting of the antiviral remdesivir plus a highly concentrated solution of antibodies that neutralize the coronavirus (SARS-CoV-2) has begun. The study is taking place in hospitalized adults with C19 in the United States, Mexico and 16 other countries on five continents. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is sponsoring and funding the Phase 3 trial, called Inpatient Treatment with Anti-Coronavirus Immunoglobulin, or ITAC.
- The antibody solution being tested in the ITAC trial is anti-coronavirus hyperimmune intravenous immunoglobulin, or hIVIG. The antibodies in anti-coronavirus hIVIG come from the liquid portion of blood, or plasma, donated by healthy people who have recovered from C19. These antibodies are highly purified and concentrated so that the anti-coronavirus hIVIG consistently contains several times more SARS-CoV-2 neutralizing antibodies than typically found in the plasma of people who have recovered from C19.
- The ITAC investigators hypothesize that giving people anti-coronavirus hIVIG at the onset of C19 symptoms, before the body makes a protective immune response on its own, could augment the natural antibody response to SARS-CoV-2, thereby reducing the risk of more serious illness and death.
- “Finding safe and effective treatments for C19 is absolutely critical,” said NIAID Director Anthony S. Fauci, M.D. “The ITAC trial will examine whether adding anti-coronavirus hIVIG to a remdesivir regimen can give the immune system a needed boost to suppress SARS-CoV-2 early in the course of illness, nipping the infection in the bud.”
- Leading the ITAC trial is Protocol Chair Mark Polizzotto, M.D., Ph.D., head of the Therapeutic and Vaccine Research Program at The Kirby Institute in the University of New South Wales, Sydney. The University of Minnesota is the coordinating center for the trial, which is being conducted by the NIAID-funded International Network for Strategic Initiatives in Global HIV Trials (INSIGHT). While INSIGHT was established to conduct clinical studies on HIV, it also has been involved in clinical trials related to influenza-like illness and the role of anti-influenza hIVIG since 2009. The ITAC trial also is known as INSIGHT 013.
- Four companies are collaborating to provide anti-coronavirus hIVIG for the trial: Emergent BioSolutions of Gaithersburg, Maryland; Grifols S.A. of Barcelona; CSL Behring of King of Prussia, Pennsylvania; and Takeda Pharmaceuticals of Tokyo. The hIVIG from Emergent BioSolutions and Grifols S.A. was developed with support from the Biomedical Advanced Research and Development Authority, part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services. CSL Behring and Takeda Pharmaceuticals are providing anti-coronavirus hIVIG on behalf of a partnership of plasma companies called the CoVIg-19 Plasma Alliance.
- Remdesivir is currently recommended for treating certain hospitalized patients with C19, based on an analysis of available data from the NIAID-sponsored Adaptive C19 Treatment Trial (ACTT). ACTT found that hospitalized patients with C19 and lower respiratory tract involvement who received remdesivir had a statistically significant shorter time to recovery compared to patients who received placebo. Remdesivir is an investigational broad-spectrum antiviral discovered and developed by Gilead Sciences, Inc. of Foster City, California.
- The ITAC study team will enroll 500 hospitalized adults ages 18 or older who provide informed consent, have had C19 symptoms for 12 days or fewer, and do not have life-threatening organ dysfunction or organ failure. Enrollment will occur at up to 58 sites in Africa, Asia, Europe, North America and South America. Study participants will be assigned at random to receive infusions of either anti-coronavirus hIVIG and remdesivir or a placebo and remdesivir. Neither the participants nor the study team will know who is receiving which treatment regimen.
- hIVIG will be given as a single infusion of 400 milligrams (mg) per kilogram of current body weight. Remdesivir infusions will be administered as a 200-mg loading dose followed by a 100-mg once-daily intravenous maintenance dose during hospitalization for up to 10 days in total.
- The main goal of the ITAC trial is to compare the health status of participants in the combination treatment group with participants in the remdesivir-only group on day 7. Health status will be based on an ordinal outcome with seven mutually exclusive categories ranging from no limiting symptoms due to C19, to death. These categories capture the full range of severity experienced by hospitalized patients with C19, according to the study investigators.
- ITAC study participants will be followed for 28 days. If the trial goes to completion, the primary analysis will be completed after all participants finish 28 days of follow-up.
- An independent data and safety monitoring board (DSMB) will review interim safety and efficacy data to ensure patient well-being and safety as well as study integrity.
- The ITAC trial is associated with the Accelerating C19 Therapeutic Interventions and Vaccines (ACTIV) public-private partnership. NIH and the Foundation for the NIH created ACTIV to develop a coordinated research strategy for prioritizing and speeding development of the most promising treatments and vaccines for C19. ACTIV-associated trials are sponsored by NIH and have one or more industry partners. Both Gilead Sciences and Takeda Pharmaceuticals are ACTIV members.
F. Concerns & Unknowns
1. Certain pre-existing conditions may double, triple mortality risk for C19
- A large, international study of C19 patients confirmed that cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease, stroke and cancer can increase a patient’s risk of dying from the virus. Penn State College of Medicine researchers say their findings may help public health officials improve patient care and develop interventions that can target these high-risk populations.
- The researchers found that cardiovascular disease may double a patient’s risk of dying from C19. They also discovered that other pre-existing conditions may increase a C19 patient’s risk of death by one-and-a-half to three times. The results were recently published in PLOS ONE.
- “This study suggests that these chronic conditions are not just common in patients with C19, but their presence is a warning sign to a higher risk of death,” said Dr. Paddy Ssentongo, a doctoral student in epidemiology at the College of Medicine and research assistant professor in Penn State’s Department of Engineering Science and Mechanics. “There is a high prevalence of cardiovascular disease and hypertension around the world and in particular, the U.S. With the persistence of C19 in the U.S., this connection becomes crucially important.”
- The research team conducted a systematic review and meta-analysis of studies published from December 2019 through early July 2020, to determine which chronic conditions put hospitalized patients at risk of dying from C19. They explored 11 co-existing conditions that pose a risk of severe disease and death among C19 patients, including cardiovascular disease, diabetes, high blood pressure, cancer, chronic kidney disease, chronic obstructive pulmonary disease, stroke, congestive heart failure, asthma, chronic liver disease and HIV/AIDS.
- Ssentongo and colleagues analyzed data from more than 65,000 patients from 25 studies worldwide. Patients in the selected studies had an average age of 61 years. They found that certain pre-existing health conditions affected survival rates more than others. When compared to hospitalized C19 patients without pre-existing conditions, researchers determined that patients with diabetes and cancer are 1.5 times more likely to die, patients with cardiovascular disease, hypertension and congestive heart failure are twice as likely to die, and patients with chronic kidney disease are three times more likely to die.
- “Although the health care community has circulated anecdotal information about the impact of these risk factors in C19 mortality, our systematic review and meta-analysis is the most comprehensive to date that attempts to quantify the risk,” said Vernon Chinchilli, distinguished professor and chair of public health sciences, and senior author of this research. “As the C19 pandemic continues through 2020 and likely into 2021, we expect that other researchers will build on our work.”
- The researchers said that prior studies exploring the association of pre-existing chronic conditions and C19 mortality had limitations in the number of countries included, the number of studies included and the number of conditions explored. They also said these studies had unaddressed sources of bias that limited the conclusions that can be drawn from them.
- “We took an all-inclusive, global approach for this study by examining 11 chronic conditions and including patients from four continents: Asia, Europe, North America and Africa,” Ssentongo adds. “Research suggests that SARS-CoV-2, the virus that causes C19, may become seasonal and require annual vaccination. Once an approved and effective vaccine is available, high-risk individuals with these pre-existing conditions should receive vaccination priority to prevent high mortality rates.”
- Even though additional research is needed to fully understand health risks and implications, particularly in understanding the effects of race and ethnicity on C19 survival rates, Ssentongo said these findings can help inform global prevention and treatment strategies.
2. Severe C19 infection linked to overactive immune cells Severe C19 infection linked to overactive immune cells
- Samples from the lungs of patients show a runaway immune system reaction could be one mechanism behind severe C19 cases.
- When infected with the coronavirus (SARS-CoV-2), many people experience mild and moderate symptoms, but for some people infection can be severe or fatal. Scientists are urgently seeking to understand how C19 can become severe.
- Now, a study led by Imperial College London researchers has revealed how an overreaction of part of the immune system could be linked to severe cases of C19.
- When we are infected with pathogens like bacteria and viruses, our bodies mount several types of immune system response. One of the major components are T cells, which come in several different forms that coordinate the immune response, from killing infected cells to recruiting more T cells to the fight.
- Sometimes, our immune system overreacts to invaders, for example during an allergic reaction, resulting in T cells killing normal, healthy cells and causing tissue damage. However, there is a ‘brake mechanism’ that should kick in, causing T cells to reduce their activity and calming inflammation.
- The new research, published today in Frontiers in Immunology, shows how this brake mechanism does not appear to kick in in severe C19 cases.
- Lead researcher Dr Masahiro Ono, from the Department of Life Sciences at Imperial, said: “We desperately need new ways to reduce the impact of C19 in severely affected patients. This starts with understanding exactly what is going wrong and causing them damage. We hope this study will go some way to answering this question, and lead to new tools to fight the disease.”
- The researchers tested samples from the lungs of six C19 patients in China with severe symptoms and compared them to samples from three moderate C19 patients and three healthy individuals.
- Although the samples were from relatively few patients, the team investigated gene usage in single cells, gaining fine detail on the immune system response. This method allowed them to analyse rare cells and their dynamics, which cannot be achieved with conventional methods.
- The found that the lungs of severe C19 patients had accumulated a broad range of ‘hyperactivated’ T cells, suggesting the brake mechanism had failed. This overreaction ‘paralyses’ the overall T cell system, causing it to fail at fighting the virus, as well as causing more damage to the lungs through severe inflammation and tissue destruction.
- On closer inspection of the mechanism, the researchers found that the protein ‘Foxp3’, which usually induced the brake mechanism, is inhibited in lungs of severe C19 patients. They are unsure why Foxp3 is inhibited, but further study could reveal this, and potentially lead to a way to put the brakes back on the T cell response, reducing the severity of the disease.
- First author Dr Bahire Kalfaoglu, from the Department of Life Sciences at Imperial, said: “Our study looked at just a few patients, but analysed thousands of their cells in great detail, revealing a new mechanism of C19 worsening. With more study, we hope to further understand the mechanism of Foxp3 inhibition, and potentially, how to reverse it.”
3. Vitamin D deficiency increased risk of COVID in healthcare workers
- Healthcare workers who self-isolated after developing symptoms of C19 were more likely to have a vitamin D deficiency, with workers from Black, Asian or ethnic minority backgrounds particularly affected, a new study by experts at the University of Birmingham has found.
- The study, an extension of previous work to establish convalescent immunity in NHS staff at University Hospitals Birmingham NHS Foundation Trust, analyzed blood samples from 392 healthcare workers recruited in May 2020 towards the end of the first surge of the C19 pandemic. Samples were first tested for the presence of SARS-Cov-2 antibodies using a unique in-house assay developed by the University’s Clinical Immunology Service in partnership with The Binding Site before undergoing testing to establish the concentration of vitamin D
- Of the 392 workers, over half (55%) had SARS-Cov-2 antibodies, showing that they had been infected with the virus. A total of 61 (or 15.6%) were deficient in vitamin-D with significantly more of these staff coming from from BAME backgrounds or in junior doctor roles. Vitamin D levels were lower in younger and male staff, and those who had a high BMI.
- Results also showed that staff who were vitamin D deficient were more likely to report symptoms of body aches and pains, but interestingly, not respiratory symptoms including breathlessness or a continuous cough. Vitamin levels were also lower in staff who reported symptoms of fever. Within the cohort as a whole, there was an increase in seroconversion (or the development of detectable SARS-Cov-2 antibodies) in staff with vitamin D deficiency (72%) compared to those without a deficiency (51%) suggesting that lower vitamin D levels could increase susceptibility to the virus. This was particularly prevalent in the proportion of BAME males who were vitamin D deficient (94%) compared to non-vitamin D deficient BAME males (52%).
- Author Professor David Thickett, from the University of Birmingham’s Institute of Inflammation and Aging said: “Our study has shown that there is an increased risk of C19 infection in healthcare workers who are deficient in vitamin D. Our data adds to the emerging evidence from studies in the UK and globally that individuals with severe C19 are more vitamin D deficient than those with mild disease. Finally, our results, combined with existing evidence further demonstrates the potential benefits of vitamin D supplementation in individuals at risk of vitamin D deficiency or who are shown to be deficient as a way to potentially alleviate the impact of C19.”
- The full pre-print paper “Vitamin D status and seroconversion for C19 in UK healthcare workers who isolated for C19 like symptoms during the 2020 pandemic” is available on MedRxiv.
4. ‘Brain fog’ following C19 recovery may indicate PTSD
- A new report suggests that lingering “brain fog” and other neurological symptoms after C19 recovery may be due to post-traumatic stress disorder (PTSD), an effect observed in past human coronavirus outbreaks such as SARS and MERS.
- People who have recovered from C19 sometimes experience lingering difficulties in concentration, as well as headaches, anxiety, fatigue or sleep disruptions. Patients may fear that the infection has permanently damaged their brains, but researchers say that’s not necessarily the case.
- A paper co-authored by clinical professor and neuropsychologist Andrew Levine, MD, of the David Geffen School of Medicine at UCLA, and graduate student Erin Kaseda, of Rosalind Franklin University of Medicine and Science, in Chicago, explores the historical data on survivors of previous coronaviruses, which caused severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
- The paper was published in The Clinical Neuropsychologist.
- “The idea is to raise awareness among neuropsychologists that PTSD is something you might want to consider when evaluating persistent cognitive and emotional difficulties among C19 survivors,” said Dr. Levine.
- “When we see someone for neuropsychological testing, we expect them to be at their best, relatively speaking,” Dr. Levine said. “If we identify a psychiatric illness during our evaluation, and if we believe that condition’s symptoms are interfering with their ability to perform at their best, we would want that treated first, and then retest them once it’s under control.”
- If the symptoms are due, even partially, to a psychiatric condition such as PTSD, treatment will help manage those symptoms, and provide a clearer view of any underlying brain issues.
- “Once they have treatment, and hopefully have some remission of their psychiatric symptoms, if the cognitive complaints and the deficits on neuropsychological tests are still there, then that’s more evidence that something else is going on,” Kaseda said. “It’s going to be important for clinicians across the board to be keeping up with the literature that’s coming out, to make sure they have the most up to date information as these survivors are starting to present for neuropsychological testing.”
- Kaseda began pursuing this question based on her experience working with patients with mild traumatic brain injury, such as concussion. “When these symptoms persist for months or years after the original injury, it’s much more likely to be due to the presence of a psychiatric disorder,” she said.
- A review of data from the SARS and MERS outbreaks showed that those survivors had heightened risk for PTSD. In the case of C19, the symptoms of PTSD may arise in response to the invasive measures needed to treat the patients, including intubation and ventilation, which can be traumatic for fearful patients. Other times, delirium causes patients with C19 to suffer hallucinations, and the memory of these terrifying sensations continues to plague the recovered patient.
- In addition to patients who have been hospitalized, frontline health-care providers can be similarly affected due to the constant stress and fear they face at work. And for some people, the anxiety of living through a pandemic, being isolated from friends, and battling the constant fear of an invisible threat can deliver a similar blow to thinking and memory skills.
- While a PTSD diagnosis might not sound like good news, there are many available treatments for the disorder, including psychotherapy and medications. By comparison, researchers are still working to understand the direct neurological effects of C19. “Treatment options (for C19) are still quite a way’s out, because it’s still an evolving situation,” Kaseda said.
- “We don’t actually know anything yet from survivors of C19,” Kaseda said. “Until we have that data, it’s very hard to say what actual percentage of patients are going to have cognitive complaints because of direct effects of the virus, because of medical intervention, or because of psychiatric concerns.”
5. C19 transmission rebounds quickly after physical distancing rules are relaxed
- Across the U.S., the relaxation of statewide physical distancing measures that are designed to control the C19 pandemic frequently resulted in an immediate reversal of public health gains against the coronavirus (SARS-CoV-2), researchers from Massachusetts General Hospital (MGH) and colleagues reported.
- Looking at data from all 50 states and the District of Columbia, the researchers found a gradual but steady decline in viral transmission rates during the eight weeks immediately preceding relaxation of physical distancing rules. But almost immediately after those rules were relaxed, most states reversed course. Eight weeks after restrictions were lifted or loosened, only nine of 51 still had low rates of transmission.
- “Premature relaxation of social distancing measures undermined the country’s ability to control the disease burden associated with C19,” writes Alexander C. Tsai, MD, investigator in the Department of Psychiatry at MGH and associate professor of Psychiatry at Harvard Medical School, and colleagues in the journal Clinical Infectious Diseases.
- Tsai continues: “C19 is disproportionately killing so-called essential workers, poorer people, and racialized minorities. In the absence of public health leadership at the federal level, these lockdowns are the best tool we have to slow transmission. But there are real costs to these lockdowns, costs that are again inequitably borne by so-called essential workers, poorer people, and racialized minorities, as well as children in public school programs who disproportionately miss out on school. So local governments need to continue to weigh the risks and benefits of these policies, and not be convinced that once you relax, there is no turning back.”
- The investigators previously reported that statewide physical distancing measures were associated with a reduction in the growth rate of C19 cases in the U.S. and a short-term reduction in C19 related deaths. Results of that study were published August 11, 2020 in the open-access journal PLOS Medicine.
- “Essentially the moment those restrictions were released, those trends reversed,” says Mark J. Siedner, MD, MPH, an investigator in the Division of Infectious Diseases at MGH, an associate professor of Medicine at Harvard Medical School (HMS), and senior author of the study.
- The team found that this reversal occurred regardless of the type of restriction: school closings, restaurant/bar closings, workplace rules, limiting public events, closing of outdoor recreational facilities, and limits on in-state travel.
- Tsai and colleagues used data from state governments and third-party sources and regression modeling to estimate the extent to which relaxation of physical distancing measures affected control of C19, expressed as a value represented by the number Rt.
- “Rt is the average number of people each person with C19 will infect,” Siedner says. “The goal of every public health intervention should be to get the Rt down to less than one, because if each person on average infects less than one other person, ultimately the epidemic will be extinguished.”
- The data showed that the Rt, averaged across jurisdictions, declined by 0.012 units per day in the eight weeks leading up to relaxation of restrictions, with 46 of the 51 jurisdictions studied achieving an Rt below one while the measures were in place.
- After physical distancing regulations were relaxed, the transmission rate increased by an average of 0.007 units per day. Eight weeks into the relaxation period, the average Rt was 1.16, and only nine of the 51 jurisdictions had Rt rates that remained below one.
- Siedner adds: “The hope was that lockdowns would lead to sustained changes in behavior: mask wearing and physical distancing. These data do not give us hope. Until a vaccine is available, lockdowns are proving to be the most effective solutions to contain epidemic hotspots.”
6. Symptoms of C19 are a poor marker of infection
- 86% of UK residents who tested positive for C19 during lockdown did not have the specific virus symptoms (cough, and/or fever, and/or loss of taste/smell), finds a new study by UCL researchers. The authors say a more widespread testing program is needed to catch ‘silent’ transmission and reduce future outbreaks.
- The paper, which is published today in Clinical Epidemiology, used data from the Office for National Statistics Coronavirus (C19) Infection Survey pilot study – a large population based survey looking at the association between C19 symptoms and C19 test results.
- The research included data from a representative population sample of 36,061 people who were tested between 26 April and the 27 June 2020 and provided information of whether they had any symptoms.
- The data showed 115 (0.32%) people out of the total 36,061 people in the pilot study had a positive test result. Focusing on those with C19 specific symptoms (cough, and/or fever, and/or loss of taste/smell), there were 158 (0.43%) with such symptoms on the day of the test.
- Of the 115 with a positive result, there were 16 (13.9%) reporting symptoms and in contrast, 99 (86.1%) did not report any specific symptoms on the day of the test.
- The study also includes data on people reporting a wider range of symptoms such as fatigue and shortness of breath. Of the sample who tested positive, 27 (23.5%) were symptomatic and 88 (76.5%) were asymptomatic on the day of the test.
- The authors say the findings have significant implications for ongoing and future testing programs.
- Professor Irene Petersen (UCL Epidemiology & Health Care) explained: “The fact that so many people who tested positive were asymptomatic on the day of a positive test result calls for a change to future testing strategies. More widespread testing will help to capture “silent” transmission and potentially prevent future outbreaks.
- “Future testing programs should involve frequent testing of a wider group of individuals, not just symptomatic cases, especially in high-risk settings or places where many people work or live close together such as meat factories or university halls. In the case of university halls, it may be particularly relevant to test all students before they go home for Christmas.
- “Pooled testing could be one way to help implement a widespread testing strategy where several tests are pooled together in one analysis to save time and resources on individual testing. This strategy would be an efficient way to test when the overall prevalence is low as negative pooled samples can quickly show a large group of people are not infectious.”
- The authors did note that several studies have highlighted a lower proportion of individuals testing positive for C19 are asymptomatic, however, the prevalence of asymptomatic cases varies substantially, possibly due to the sampling and the settings of the study. For example, the study references how among 262 confirmed cases admitted to hospitals in Beijing 13 (5%) were asymptomatic. In contrast, reports from a small village in Italy suggest that up to 40-75% were asymptomatic. A study of 13,000 residents in Iceland found 43 out of 100 with a positive C19 test were asymptomatic.
G. The Road Back?
1. Over 6,000 Scientists, Doctors Sign Anti-lockdown Petition
- Over 6,000 scientists and doctors have signed a petition against coronavirus lockdown measures, urging that those not in the at risk category should be able to get on with their lives as normal, and that lockdown rules in both the US and UK are causing ‘irreparable damage’.
- Those who have signed include professors from the world’s leading universities. Oxford University professor Dr Sunetra Gupta was one of the authors of the open letter that was sent with the petition, along with Harvard University’s Dr Martin Kulldorff and Stanford’s Dr Jay Bhattacharya.
- It declares that social distancing and mask mandates are causing ‘damaging physical and mental health impacts.’
- The petition, dubbed the Great Barrington Declaration after the town in Massachusetts where it was written, has been signed by close to 54,000 members of the public at time of writing, as well as over 2600 medical and public health scientists and around 3500 medical practitioners.
- “Those who are not vulnerable should immediately be allowed to resume life as normal,” it notes, adding “Keeping these [lockdown] measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.”
- “Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration also declares.
- It continues, “The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular [heart] 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,” the declaration adds.
- “Those who are not vulnerable should immediately be allowed to resume life as normal, it concludes, explaining that “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,” it emphasises.
- Finally, the declaration demands that normal life should resume, stating that “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.”
- The declaration dovetails with other research that has concluded lockdowns will conservatively “destroy at least seven times more years of human life” than they save.
- Germany’s Minister of Economic Cooperation and Development, Gerd Muller, has warned that lockdown measures throughout the globe will end up killing more people than the Coronavirus itself.
- In an interview with German newspaper Handelsblatt, Muller warned that the response to the global pandemic has resulted in “one of the biggest” hunger and poverty crises in history.
- Muller’s comments come five months after a leaked study from inside the German Ministry of the Interior revealed that the impact of the country’s lockdown could end up killing more people than the coronavirus due to victims of other serious illnesses not receiving treatment.
- As we have previously highlighted, in the UK there have already been up to 10,000 excess deaths as a result of seriously ill people avoiding hospitals due to C19 or not having their hospital treatments cancelled.
- Professor Richard Sullivan also warned that there will be more excess cancer deaths in the UK than total coronavirus deaths due to people’s access to screenings and treatment being restricted as a result of the lockdown.
- His comments were echoed by Peter Nilsson, a Swedish professor of internal medicine and epidemiology at Lund University, who said, “It’s so important to understand that the deaths of C19 will be far less than the deaths caused by societal lockdown when the economy is ruined.”
- According to Professor Karol Sikora, an NHS consultant oncologist, there could be 50,000 excess deaths from cancer as a result of routine screenings being suspended during the lockdown in the UK.
- In addition, a study published in The Lancet that notes “physical distancing, school closures, trade restrictions, and country lockdowns” are worsening global child malnutrition.
- Experts have also warned that there will be 1.4 million deaths globally from untreated TB infections due to the lockdown.
- As we further previously highlighted, a data analyst consortium in South Africa found that the economic consequences of the country’s lockdown will lead to 29 times more people dying than the coronavirus itself.
- Hundreds of doctors are also on record as opposing lockdown measures, warning that they will cause more death than the coronavirus itself.
- Despite citizens across the world being told to observe the lockdown to “save lives,” numerous experts who are now warning that the lockdown could end up costing more lives are being ignored or smeared by the media.
2. In Dense Cities Like Boston, Coronavirus Epidemics Last Longer
- An analysis by Northeastern University researchers and colleagues finds that in crowded cities — like Boston — coronavirus epidemics not only grow bigger, they also tend to last longer.
- The paper, based on data from Italy and China, looks at how quickly an epidemic peaks depending on how crowded a location is.
- “In urban areas, we tend to see long, broad epidemics — for example, Boston,” says lead co-author Samuel Scarpino from the Network Science Institute at Northeastern. “And in comparatively more suburban or rural areas we tend to see sharp, quick, burst-y epidemics.”
- Scarpino says it’s key for Massachusetts to have uniform rules across the state, because movement from one area to another — say, from a town where restaurants are closed to one where they’re open — can help spread the virus. Here are some edited excerpts of our conversation, beginning with how he sums up the research just out in the journal Nature Medicine:
- Scarpino: What we report in the paper is that the structure of communities affects both the height and the duration of C19 epidemics.
- Carey Goldberg: So more dense areas will have not just more cases, but a more prolonged course?
- Right. In urban areas, we’re likely to have larger outbreaks — in terms of total number, even in terms of percentage of the population — and they will be much longer, lasting weeks and weeks or months, as we’ve seen in Boston, New York City, London and many places around the world.
- However, in rural areas, or areas that have population structures that are much more tightly knit — as opposed to a looser collection of households in neighborhoods, as we have spread out across Boston — you get sharp, intense outbreaks. They can be overwhelming in terms of the resources available for caring for patients, and quite dramatic in terms of their effects on the population.
- Think about the outbreak in rural Maine that was sparked by a super-spreading event at a wedding, and how it quickly swept through the population.
Why do these insights about community structure and its effect on transmission matter?
- In many rural areas that are at risk of these intense outbreaks, there’s much lower health care coverage and often, especially in the United States, a lot more complacency around mask-wearing and physical distancing. These areas are largely protected because they’re isolated. However, if cases show up — as we’ve seen in places like rural Maine — the outbreaks can be quite severe and rapid.
- Also, in the more dense areas, you’re going to have cases that move around throughout the population, throughout the different neighborhoods of the city. You’re going to have outbreaks go quiet in some areas, and then become louder in other areas.
- And this process can be very, very prolonged, and can make the types of intervention measures that you need to deploy either quite severe or quite complicated, because they have to be very specifically tailored to what’s happening at the really local level within the larger cities.
So what does this mean for policy?
- Well, in related work we show that having policies that are different across a city can lead people to move out of their neighborhoods, to go to parks or to go to restaurants with different dining restrictions, or to go to venues with different limits on capacity. And that interacts with the structure of the city to spread the outbreak much more rapidly, kind of accelerating the pace and tempo of cases.
- So that really suggests that because the outbreak is going to be so long-lasting, you really either need to focus on driving it completely out or you need to have policies that will protect all of the places with lower rates of cases while intervening in a targeted way in the places with much higher rates of cases.
- So what you don’t want to do is put in tougher measures in hot-spots, because then you’re just going to drive people out to other places where they’re going to spread it even more.
- Exactly. In the state of Massachusetts, where we have the governor relaxing measures in a fairly extreme fashion in some areas and not in other areas, you are likely to have a situation where you’re just moving the infection around and putting other communities at risk.
- So having a more intermediate level of control that’s more uniformly distributed across space is much better epidemiologically.
But that’s not what the state is doing
- The state in many ways is really doing almost the opposite of what our paper suggests in terms of the ways in which you need to focus on controlling C19, and also related work that shows this sort of patchwork of different policies really creates quite a bit of risk.
- It seems incredibly important to have hyper-local information, because in the structure you describe, the spread happens at the level of households or neighborhoods, and then you have just a bit of crossover to other places, and that’s how it just keeps going.
- That is the implication of our work and many other studies that show that C19, from an epidemiological perspective, is an amalgamation of local transmission that’s happening in households, in restaurants, in occasional longer-distance transmission that moves it into new areas. So you need to have really hyper-localized information around where the cases are occurring and to find out where the cases are coming from.
- And that, unfortunately, is one of the things that we’re still not getting clear guidance on from the state: Where are the cases coming from? So that we can understand how we need to intervene.
- Without that data, we really aren’t armed with the right kinds of information to both stop the spread and to try and implement measures that will maximally control C19 while having the least possible effects on our economic health, mental health and societal health.
3. Fear of the Indoors. Can we really trust our fellow diners enough to head back inside?
- It’s been more than six months since anyone in New York City was allowed to eat food inside a dining room. Most New Yorkers, understandably, miss the joy that comes from a great meal, a joy that is impossible to fully replicate with takeout, delivery, or even the occasional outdoor dinner. But as of today, New York City’s restaurants join the rest of the state in being able to welcome some guests inside — and the available evidence suggests that the public will not exactly rush back into even the most socially distanced of dining rooms.
- The well-publicized state-mandated safety precautions, reduced maximum capacity, and even the experts who have offered solemn, thoughtful advice on dining out cannot really assuage lingering concerns, because more than any single restaurant, one major concern must be the unpredictability of fellow diners.
- Yesterday, the New York Times published a handy guide to details that diners will want to watch for when deciding for themselves whether it is safe to eat inside. Ostensibly, the list is meant to be helpful, but it is also a preview of the anxiety that will accompany any indoor meal right now. How can anyone fully relax if they are also busy trying to determine whether the windows are open enough, or if the dining room’s ACH is adequate? Do the servers seem to be lingering together a bit too long? Is it safe to use the restroom?
- In truth, it’s easy enough to believe responsible operators who say they will follow all safety regulations to a T — the stakes are simply too high, and no owner wants their business to become the epicenter of a new outbreak. The thing is, it is also very easy to believe all of the people who work in restaurants who have told us, time and time again, that it is the customers who are most likely to ignore safety protocols, that a sense of entitlement creates an atmosphere where some diners not only openly flout mask-wearing rules, but also push back when asked to take basic precautions.
- It is not difficult to imagine a scenario where someone at another table — even one that’s 6 feet away — is yelling and chewing and spitting droplets into the shared air. A mask-wearing mandate similar to Chicago’s, where diners must now wear masks unless they are “actively” eating or drinking, might help. But how vigilant will people be about the noses that inevitably peek out over the mask? You just know that somewhere, tonight, someone will try to walk into a New York City restaurant doing that thing where the mask is pulled down under their chin, rendering it totally useless.
- Even setting aside for a moment the fact that parts of the city have seen an alarming rise in positive cases just this week, the only thing that will truly convince on-the-fence indoor diners to take a chance is time. If it continues to work, if there is no resulting rise in infections, if workers are kept safe — it will be far easier to feel okay about sitting in an enclosed space with strangers.
- On a personal note, I hope that my own concerns about indoor dining are unfounded. I am, it probably goes without saying, rooting for an industry that desperately needs a win. I’ve seen firsthand how hard people are working simply to keep their businesses open. I’ve talked to the owners who say that opening their dining rooms at 25% capacity means operating at a guaranteed loss, but also feeling as though they have no other choice.
- For now, I’m going to support those restaurants by continuing to take advantage of the city’s now-permanent outdoor dining situation. If I’m going to be uncomfortable while I eat dinner, I’d rather it be because I’m a little too cold than because some dude at the next table over won’t wear a mask.
H. Back to School!?
1. Texas colleges offer free coronavirus tests. Why aren’t more students getting tested?
- Texas colleges and universities spent the summer months bulking up their testing capacity to catch C19 outbreaks fueled by students who are infected but don’t show symptoms.
- The University of Texas at Austin said it could test up to 5,000 asymptomatic students, faculty and staff weekly. Texas A&M University trumpeted a similar goal of testing more than 5,000 students each week — about 7% of the student body. And the University of Texas at El Paso, with about 25,000 students, said it had the capacity to test up to 2,500 campus members weekly.
- But halfway through the semester, schools are reporting participation rates far below their goals, prompting at least one school to go so far as to offer prizes to students who volunteer to get a coronavirus test.
- UT-Austin, which has more than 50,000 students, has only required students to be tested before attending football games. During the first five weeks of the semester, the school had the capacity to test 25,000 community members but tested only 8,870 — an average of about 1,770 per week. That included the 1,198 students tested for the first home football game on Sept. 12.
- “Why aren’t we testing 5,000 people per week? The answer, in part, is that we have fewer than 5,000 people a week who have been willing to take the tests,” reads a Sept. 28 memo from the UT-Austin Faculty Council.
- Texas A&M conducted 6,195 tests in its first two rounds of random testing through Sept. 12. Meanwhile UT-El Paso, which tested 6,691 campus members from Aug. 17 to Sept. 18, has yet to break 2,000 weekly tests, the El Paso Times reports.
- Experts say routine testing is crucial to stomping out “silent spread” on college campuses, as the Centers for Disease Control and Prevention estimates 40% of C19 infections are asymptomatic. And school officials rely on the results to get an accurate snapshot of the community’s health.
- Major Texas universities have already mandated rigorous testing regimens for athletes, and some schools in other parts of the country require students and employees to get tested multiple times a week. But if the goal is to identify people who might trigger an outbreak on campus, waiting for students and staff to volunteer to get tested “doesn’t make a whole lot of sense,” said David Paltiel, a professor at the Yale School of Public Health.
- “Frankly, I think the whole idea is flawed from the get-go,” Paltiel said. “Unless you’re going to have a routine program that you require the entire population to adhere to, I just don’t know what you’re doing.”
- School officials are stopping short of calling testing participation a problem, even as they work to increase it.
- Shawn Gibbs, dean of the School of Public Health at Texas A&M, said participation is “pretty much what we expected it to be.”
- “Our participation rate isn’t low,” he said. “We always would like higher participation, and we’re in the process, like everyone else, of taking a look at the students who aren’t participating and trying to figure out ways to incentivize participation.”
- At Texas A&M, that means appealing to “selfless service,” one of the Aggie core values, and emphasizing that the saliva-based tests are free, quick and easy, Gibbs said. The flagship College Station campus reported 144 active cases as of Sept. 29.
- UT-Austin’s goal is to test 1,000 asymptomatic people per day, and participation is gradually building in that direction, said Michael Godwin, program director of the university’s proactive community testing. Monday was “a really great day,” he said, with close to 700 people coming out. The flagship reported 67 estimated active cases as of Sept. 30.
- To boost participation, the school is launching an incentive program, with raffle prizes for students including $50 gift cards to local and national vendors, Godwin said. The university has also enlisted professors to make class-wide announcements and deployed ads on Canvas, its online learning platform.
- UT-Austin faculty participation in the testing has been “very low,” according to the Sept. 28 Faculty Council memo.
- “I don’t think anyone expected to see 5,000 people in the first week,” Godwin said. “It takes a little bit of time to get the word out, to get the process set up and working well, and … we’ll continue to build on what we have and get more people in the door to get tested regularly.”
Mandatory testing at Baylor
- Students might dodge invitations to test for a number of reasons — especially if they don’t feel sick, said Diana Cervantes, an epidemiologist at the University of North Texas Health Science Center. Students may also be avoiding the inconvenience of quarantines in the event they do test positive.
- “Let’s say I think I had a high-risk exposure and I think that testing positive is going to mean something detrimental to me, maybe I’d decide not to get tested,” Cervantes said.
- Julia Elder, a UT-Austin master’s student, said she has not taken the university up on its offers to get tested because she worries about being exposed to the virus during her appointment. Elder hasn’t eaten in a restaurant or socially interacted with anyone since March. She takes online classes and only leaves the West Campus apartment she shares with her twin sister to pick up food.
- “I definitely have wanted to get tested … but it seems like more interaction than I do on a daily basis,” Elder said, adding that she recently drove past the health center and saw a line of students wrapped around the building. “It seems like an unnecessary risk to take if I feel fine.”
Some universities are making testing mandatory
- At the University of Illinois Urbana-Champaign, students and employees must get tested twice a week. They’re testing about 10,000 people per day, and reporting positivity rates below a half of a percent. The university feels “very confident” in its plan, in part because it’s mandatory, said Robin Neal Kaler, associate chancellor of public affairs at UIUC.
- “Our data scientists showed if you tested the vast majority of people twice a week … that would be enough to slow the spread, to keep potential outbreaks under control, and to let you know about them quickly enough that you can deal with them,” Kaler said.
- “But that only works if it’s mandatory testing. And it only works if you’re testing basically the entire population, which is what we decided to do,” she added.
- In Texas, Baylor University is one of the only institutions to require testing. The private Christian university chooses 5% of students and 5% of employees for mandatory testing each week; failure to comply may result in disciplinary action.
- Unlike other Texas universities, Baylor also required a negative test from students and employees before they returned to campus in August. The school reported 62 active cases as of Oct. 1.
- “We felt … we needed to make it mandatory partly because there was some concern if people were left on their own, they would not want to be tested,” said Jim Marsh, dean for student health and wellness at Baylor. He added that even though the testing is mandatory, the school gives students raffle prizes such as meal vouchers, football tickets and scholarships for participating.
2. Eight Tricks for Making Remote School Easier
- Now that many families are well into the fall semester’s remote-learning program, I wanted to know if anyone had advice for managing the school-from-home hassle. I’ve developed a few hacks of my own, but I reached out to dozens of parents, students and education experts to compare notes.
- Besides sharing some very useful tech tips, they also had some good non-tech suggestions to make life easier on you and your kids. Here you go:
- This was the No. 1 tip. No one wants to have to constantly nudge their kids to get online for class every day, multiple times a day. And no one has to, when technology can do it for you. You can go as fancy as setting Google Assistant’s new “family bells” to ding from a Nest Hub when it’s time to log in, or as simple as setting and labeling alarms on your phone. A physical timer or a timer app that counts down is also useful in helping students keep track of time during breaks.
- Leiza McArter, an Irving, Texas, mom of an elementary student, a middle schooler and a high-schooler with varying remote school schedules, has her kids use the alarms on their iPhones, labeled according to activity, such as “Log in to Zoom” or “Lunch.”
Use dual screens
- For students who are attending video calls with their class while also trying to do school work in an online classroom, switching between tabs can get confusing and result in inadvertently exiting out of calls. Toggling back and forth between windows became so frustrating for my older kids that we set up second monitors for them. (Good thing I’d stopped bugging my husband to get rid of his old electronics!) Secondary devices, such as iPads, can achieve the same goal. If your kid is using a tablet as either a primary or secondary screen, it’s wise to get a stand for one—or you can make your own. My colleague Joanna Stern shows you how in this video.
- One caveat is that extra devices—or even second screens—can make it easier for kids to surf or play games while they should be paying attention. Roxy Shapiro, a 14-year-old in New York City, says she was getting distracted by the notifications on her phone during class, so she now keeps it far from where she’s working on her laptop. “It’s very hard to just ignore it,” she said.
Maintain a central calendar
- For kids who have multiple video calls and a schedule that changes daily, keeping a calendar with all meeting links is a sanity-saver. Some school districts have calendars with links built into the virtual-school platform. But if you have more than one child, that’s still a lot to manage. Combine everything into one shared family calendar, whether it’s a Gmail or Microsoft Outlook calendar, a specialized app like Cozi or Any.do or the calendar on your iPhone, where you can set up multiple calendars for different purposes.
- Danni Johnson, a marketing consultant in Boca Raton, Fla., uses the Apple calendar on her iPhone and Mac to manage her 4-year-old’s pre-K classes. “She has to log in for each class, so that was a challenge for us.” She created an iCloud account for her daughter, and set up a calendar with 5-minute-warning alerts. “She just clicks the link when it pops up and logs herself into Zoom.”
Create bookmarks and save passwords
- Not only do my kids have a password to log into their school-issued Chromebooks, but they also have passwords for their virtual classrooms and still more for numerous external educational apps required for schoolwork. Typing up a list and posting it somewhere works, but you can also save them in the browser so your kids can automatically log in. If you don’t like having browsers remember passwords, create a memo on your child’s device with all of them and keep it open. Be sure to bookmark frequently visited school webpages so you or your kids don’t have to search for them.
- One entrepreneur that I profiled recently is developing Modern Village, an app where all things related to family management—from calendar items to school emails—can be housed in one place. Parents can now sign up for early access to the app.
Put your virtual assistant to work
- That’s what Alexa is for, after all. You can tell Alexa to create reminders through a speaker or from the Alexa app on your phone. Those reminders can now be broadcast through all Alexa-enabled devices, so if your children aren’t in the same room as their Echo Dots, they can hear or see a reminder through the Echo Show in the kitchen. Later this year, people will be able to join a video call on certain Echo Show devices simply by saying, “Alexa, join my Zoom meeting.” You can also have Google Assistant set reminders through compatible smart-home devices.
- Not all the ways to make virtual school better require technology. Here are some other tips I picked up during my chats with families:
Let them fidget
- It’s hard for many kids to sit still and pay attention behind a screen, and many parents said it helps to give children a small toy they can hold. Maybe they’d prefer some slime or putty to squeeze, or a pad of paper to doodle on. My editor said his son plays with a tiny music keyboard when he’s on mute, so he manages to get in a little piano practice while supposedly paying attention. One dad suggested getting a ButtOn chair, which allows kids to move around while seated.
Get them moving
- It can get tiring for kids to spend hours each day in front of screens, so encourage them to spend their breaks outside, like they would if it were regular recess. If weather doesn’t allow that, encourage some indoor stretching or jumping jacks between classes.
- My kids’ workspaces are a mess each day after school. It might seem obvious, but having them (or helping them) clean up afterward and set out the materials needed for the next day makes life a lot easier. It’s especially important for younger kids who have a hard time quickly finding what they need—or who tend to walk off with headphones or art supplies that you might not see again for days.
3. Air purifiers remove 90% of aerosols in school classrooms
- The most dangerous route to an infection with the coronavirus (SARS-CoV-2) is via the air: For example, when infected persons sneeze or cough, they catapult relatively large droplets which, however, sink to the ground within a radius of two meters. Important are also aerosols, much smaller droplets, which we emit when speaking or breathing. Studies show that infectious SARS-CoV-2 pathogens can still be detected in such aerosols over three hours after emission and several meters away from an infected person. The fluid in such aerosol particles evaporates quickly, making them smaller and able to disperse in a room within a few minutes.
- Together with his team, Joachim Curtius, professor for experimental atmospheric research at Goethe University, tested four air purifiers in a classroom with 27 students and their teachers over a period of a week. The purifiers had a simple prefilter for coarse dust particles and fluff as well as HEPA and active carbon filters. Together, the filters processed between 760 and 1,460 m3 of air per hour. Apart from aerosol load, the researchers also measured the volume of fine dust particles and CO2 concentration and analyzed the noise levels caused by the device. The result: Half an hour after switching it on, the air purifiers had removed 90% of the aerosols from the air.
- Professor Curtius explains: “On the basis of our measurement data, we’ve calculated a model that allows the following estimate: An air purifier lowers the amount of aerosols to such a considerable degree that the risk of being infected by a highly contagious person, a superspreader, is greatly reduced. That’s why we’re recommending that schools use HEPA air purifiers this winter with a sufficiently high air flow rate.”
- Noise measurements and a survey among students and teachers revealed that in most cases the noise made by the air purifier was not considered disturbing, provided that the appliance was not running at the highest level.
- The researchers also measured that the air purifier—apart from lowering the risk of infection –additionally reduced allergens and fine dust particles (PM10). Joachim Curtius: “An air filter does not, however, replace opening the window at regular intervals, which is important for decreasing CO2 concentration in the room. Our measurements in the classrooms showed that levels often exceeded the recommended limits. Here, we recommend installing CO2 sensors so that students and teachers can monitor this themselves.”
I. Projections & Our (Possible) Future
1. Winter will make the pandemic worse. Here’s what you need to know.
- As we head into the Northern Hemisphere fall with C19 still raging in the US and a number of other parts of the world, two data points provide cause for extra concern.
- One is that the seasonal flu—a respiratory viral infection like C19—is much more active in the winter. Last year in the US, there were 40 times as many flu cases in the fall and winter months as in the previous spring and summer. Historically, those cooler months see tens of times as many seasonal flu infections in temperate regions. (In tropical regions, the flu tends to peak during the rainy season, though not as strongly.)
- The other is that the death toll from the 1918 influenza outbreak—the only pandemic to have killed more Americans than this one so far, and one of the deadliest in global history—was five times as high in the US during the late fall and winter as during the summer.
- If the covid pandemic follows those patterns and blows up as we head into winter, the result could easily top 300,000 additional US deaths on top of the more than 200,000 so far, conservatively assuming (based on the 1918 outbreak) four times the rate of C19 deaths that we saw this summer.
- How likely is that? “We just don’t have the evidence yet with this virus,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm notes that some of the key variables defy scientific analysis and prediction. It’s difficult to calculate whether government policy will shift, whether the public will comply with guidelines, when a vaccine may become available, or how effective and well accepted it will be if it does.
- Nonetheless, scientists are pulling together a picture of how the pandemic is likely to play out this winter. They are drawing on lab studies and a rapidly growing body of epidemiological data. In particular, they now better understand how lower temperatures and humidity affect the virus, and how different indoor conditions affect its transmission.
- The results are not encouraging. “All the factors we associate with colder weather are looking like they will potentially accelerate the virus’s transmission,” says Richard Neher, a computational biologist at the University of Basel in Switzerland, who is developing simulations of how coronavirus spreads through a room.
- The better news is that the research is also revealing steps people and institutions can take to limit transmission during the colder weather. But whether enough people will take these steps—and whether that will be enough to head off a second wave—is far from sure.
What happens to the virus in the winter?
- It’s actually not typical for a new respiratory virus that becomes a pandemic to have a deadly second wave in winter. All 10 respiratory pandemics of the past 250 years had a second wave six months after the first, but in only three of those cases did it come during winter. The 1918 flu was one of those exceptions.
- Could C19 turn out to be another? It’s hard to say. Scientists had hoped any weather-related patterns in its spread would be discernible as the months dragged on. It was early winter when the disease first broke out in China at the end of 2019, so there is now detailed data on how the virus behaves through three seasons, in both temperate and tropical climates, and through a complete summer in the Northern Hemisphere and a complete winter in the Southern Hemisphere.
- No such patterns have emerged. The infection spread wildly in parts of northern Italy in March, when temperatures were already in the 70s Fahrenheit (low to mid-20s Celsius); it peaked in some US cities, such as Boston, when temperatures were in the 40s (below 10 °C) and in others, such as Houston, when they were in the 90s (above 32 °C). South Africa and Australia were among the Southern Hemisphere nations that saw surges during their winters, while the US was among the northern countries with summer surges. And while there’s general scientific agreement that tropical climates tend to mitigate the virus’s spread, many nations in tropical regions, including India and Brazil, have had severe outbreaks.
- It would help if science had a solid, proven understanding of why the so-called seasonal flu is, well, seasonal. But it doesn’t. Linsey Marr, an environmental engineering researcher at Virginia Tech who studies viral transmission, notes that influenza viruses tend to hit hardest during the winter only after they become endemic—that is, continue to circulate year after year. That suggests seasonality may have something to do with the buildup of temporary immunity among much of the population to at least some strains of the flu. “You just don’t see that seasonality among new viruses,” she says.
- Even if C19 turns out to show some seasonality in its first year, other factors will play a much bigger role in its spread—namely, whether people socially distance, wear masks, and avoid congregating indoors. Failure to follow these practices could explain why C19 infection rates skyrocketed across much of the US during the warm summer weather, when people expected it to die down. “It doesn’t mean this virus doesn’t have some sensitivity to weather,” says Benjamin Zaitchik, a Johns Hopkins University climate scientist currently studying coronavirus transmission patterns. “It may be that the effect can’t be detected against the background of policy and behavior.”
- Any seasonality in C19 might contribute to a winter surge, however. And that could wreak havoc, because it would almost certainly coincide with the flu season. One study in the Journal of the American Medical Association found that a fifth of C19 patients had a second respiratory illness. Not surprisingly, they tended to be sicker on average.
- An even bigger danger, says Zaitchik, is simply the combined number of C19 and seasonal flu cases. “It’s a health-care capacity and case management issue,” he says. “Not only will the sheer number of cases be a problem for hospitals, but doctors will have more trouble guessing which infection they’re treating when a patient first walks in.”
- The good news is that the flu season in the Southern Hemisphere, May through September, was shockingly mild, almost nonexistent in many countries. The likely explanation is that masks and social distancing to protect against covid also largely prevented flu. That bodes well for the Northern Hemisphere if people continue taking those precautions.
- Yet even in a mild flu year, just a small winter bump in C19 could have a huge impact, says Jose-Luis Jimenez, an environmental chemist at the University of Colorado. The single most important measure of whether an infectious disease can be brought under control is the so-called reproduction number, R, which indicates how many people on average will be infected by each infected person. When R is less than 1, the disease is slowing down; when it’s greater than 1, the spread is still accelerating.
- If C19’s R is hovering at or just below 1 heading into winter, then even a small seasonal increase could push it over. “Just an extra 10% transmission during an under-control situation can blow it up out of control,” says Jimenez.
- And the winter transmission boost is likely to be a lot larger than 10%, says Jimenez, because of the one factor on which virtually all experts agree: in most parts of the country people will be spending more time indoors, where the coronavirus is transmitted far more efficiently. (In the warmest parts of the country, such as Florida and Texas, it’s possible that cooler weather will encourage some people to spend less time indoors.)
- A study from researchers in Japan, based on contact tracing, found that infected people were 19 times more likely to pass on the infection when they were indoors than outdoors. A database compiled by the London School of Hygiene and Tropical Medicine of about 1,500 so-called superspreader events—where a single infected person ends up infecting several other people at about the same time, in the same place—indicates that only three took place outdoors.
- In fact, most respiratory viruses are more easily transmitted indoors. The most likely culprit is the big drop in relative humidity—the amount of water in a given volume of air compared with the maximum it could hold at that temperature—when already-dry cold outside air enters a home and is heated. The rise in indoor temperature raises the amount of water the air could hold, but the moisture level remains constant, lowering the relative humidity. A March epidemiological metastudy from researchers at Yale and in Switzerland, combined with laboratory work on mice at Yale, suggests that dry indoor air helps preserve the flu virus, and at the same time impairs the immune system’s ability to fight it off when it first takes hold in the nose or elsewhere in the airway.
- Epidemiological research from MIT, Harvard, Virginia Tech, and the University of Connecticut suggests the coronavirus likewise is more infectious in low relative humidity—anything below 40% will help the virus thrive. That’s bad news for most of the US, where relative humidity routinely drops as low as 15% on the coldest days, compared with typical indoor relative humidity of 50% to 70% in the summer.
Preparations to take
- One of the biggest shifts in our understanding of the coronavirus has been about how it’s transmitted. Early on, it was thought to travel in droplets of moisture from someone’s nose or mouth that would fall to the ground relatively fast. It’s now increasingly clear that tiny particles carrying the virus can remain airborne, possibly for hours, meaning they can accumulate in a room until someone breathes them in. It’s not enough to simply avoid standing too close to an infected, unmasked person indoors. People can be infected by someone who’s standing 20 or more feet away, even if they’re wearing a mask—and even if the infected person has left the room. That’s because the virus can travel farther and linger for a longer period of time, building up throughout the space.
- The coronavirus does this more than most respiratory viruses—which is why many public health officials were slow to emphasize airborne transmission as C19’s main route of infection. Even the World Health Organization was downplaying the risk as late as July, and the Centers for Disease Control finally posted an update about airborne transmission to its website only this week, after posting and then hurriedly taking down a version last month.
- Low humidity makes the risk worse, says Neher: “One of the main reasons I think we’ll see a seasonal surge in this virus is that the water in the droplets will quickly evaporate in the dry air indoors, leaving the virus in tiny nuclei that can spend more time floating around.”
- Even so, many scientists doubt humidifiers will help. “To make a meaningful difference you have to add as much as five kilograms of water per hour to a room,” says Jimenez. “You’d need multiple humidifiers and you’d be refilling them often.”
- Experts say a better way to lower the risk of indoor transmission is to boost air circulation, which can disperse the plumes of virus-contaminated air from an infected person and reduce the buildup of virus in a room.
- But not all air circulation is equal, warns Robert Bean, an HVAC (heating, ventilation, and air conditioning) engineer. There are several documented cases of fans or air conditioners pushing contaminated air toward people who were then infected. Moreover, the coronavirus can easily survive the ride through the heating and air-conditioning systems found in most homes.
What should I do?
- Should I get an air purifier for my house? I’ve read the virus is too small for such filters to help.
- If you don’t already have effective filters in your heating and air-conditioning systems, it’s probably a good idea. Get a HEPA filter or one with a MERV rating of 12 or 13. Though a naked virus will sneak past these filters, the viruses are typically found in water droplets, which will be caught.
- I understand the virus thrives in low humidity. Should I buy a room humidifier for my home?
- Probably not worth it. To be effective it would need to add to up to five kilograms of water per hour for a typical room in a home. That’s beyond the capabilities of most room humidifiers. Plus the extra moisture can lead to respiratory problems and mold.
- Our office recirculates and filters air. Should we still wear masks?
- Yes! Air circulation and filtration won’t offer much protection from “ballistic” transmission—the ejection of droplets from a non-mask-wearing infected person who coughs, sneezes, or talks loudly.
How bad will the flu season be this year?
- It’s largely unknown. There has been no rise in flu cases in the US, but it’s too early to expect such an increase. There’s little insight into the likely effectiveness of the flu vaccine this year compared with other years. The good news is that the flu season in the Southern Hemisphere (May through September) was almost nonexistent in many countries. The same precautions that work to prevent C19—such as wearing a mask and social distancing—are also effective against the flu.
- Bringing in more air from outside can help. Homes vary quite a bit in the amount of air that comes into them, says Bean, whether via leaks or through ducting designed to mix outside air into an HVAC system. But though some modern buildings allow adjusting the outside air mix to as high as 100%, a more typical maximum level is 20% or less, and Osterholm at the University of Minnesota says that won’t help much if there’s an infected person inside. “Without larger air exchanges, you can see the level of virus concentration increasing minute by minute,” he says. The simplest solution is to open windows, but in cold weather that might not be practical, and in many office and school buildings it can’t be done.
- Moreover, the air must not only be circulated, but also properly filtered. Most HVAC filters aren’t effective at blocking airborne viruses: you need one with a HEPA rating, or a MERV rating of at least 11 and preferably 13 or above, says Marr, the Virginia Tech researcher.
- For buildings that don’t have a central HVAC system with a good filter and strong airflow throughout the entire space, a portable HEPA air purifier capable of recirculating all the air in an average-sized room at least twice every hour can be had for a few hundred dollars, says Jimenez, and it can go a long way to reducing the level of virus in the air.
- But filters of any sort are unlikely to make a huge dent in a winter surge, says Neher. “It’s going to be logistically challenging to retrofit every place we live and work on this time scale,” he says. Meanwhile, air circulation and filtration won’t offer much protection from “ballistic” transmission—the ejection of droplets from someone who coughs, sneezes, or talks loudly. Those droplets can shoot directly at anyone within several feet, which is why masks and social distancing will remain important.
What to expect
- So how bad will it get? Scientists lack one crucial piece of the puzzle for predicting how easily C19 will spread when winter drives more people indoors: how much virus it takes to get sick.
- Virologists define the “infectious dose” as the number of virus particles someone needs to inhale to have a 50% chance of getting infected. Knowledge of flu viruses, along with a coronavirus study by Japanese researchers that relied on animal research and an analysis of a spreading event in a building in China, suggests the infectious dose for the coronavirus may be 300 or so inhaled particles. (The study didn’t specify over what time period.) That figure needs to be validated, though, and even then is likely to vary from person to person.
- Until those numbers are better understood, estimates of how likely transmission is in different indoor situations will be extremely rough. And even then, they’ll depend on things like where people are standing relative to the airflow. “The airflow in a room is Rubik’s cube,” says Bean. He adds that the only way to be sure what the air is doing is to light up a “smoke pen” and observe the trail. He strongly recommends doing that in classrooms, offices, restaurants, and other places where lots of people will be mingling.
- Eventually, says Bean, a better knowledge of the virus and its infectious dose will allow HVAC experts and environmental engineers to modify spaces. For now, though, it’s largely guesswork, and that doesn’t bode well for this winter. “Nobody’s putting all the formulas together yet,” he says. You can reduce the risk by using air filters where they’re available, finding ways to bring in more outside air, and simply not spending time in confined spaces with people who might be infectious—which is to say, pretty much anyone outside your own household. But given how ready many people have been to flout health guidelines in the US and many other countries, a big winter surge may be inevitable.
1. C19 lockdowns were a risky experiment — and one that failed
- Lockdowns are typically portrayed as prudent precautions against C19, but they are surely the most risky experiment ever conducted on the public. From the start, researchers have warned that lockdowns could prove far deadlier than the virus. People who lose their jobs or businesses are more prone to fatal drug overdoses and suicide, and evidence already exists that many more will die from cancer, heart disease, pneumonia, tuberculosis and other diseases because the lockdown prevented their ailments from being diagnosed early and treated properly.
- No ethical scientist would conduct such a risky experiment without carefully considering the dangers and monitoring the results, which have turned out to be dismal. While the economic and social harms have been enormous, it isn’t clear that the lockdowns have brought significant health benefits beyond what was achieved by people’s voluntary social distancing and other actions.
- In a comparison of 50 countries, a team led by Rabail Chaudhry of the University of Toronto found that C19 was deadlier in places with older populations and higher rates of obesity (like the United States), but the mortality rate was no lower in countries that closed their borders or enforced full lockdowns.
- After analyzing 23 countries and 25 US states with widely varying policies, Andrew Atkeson of UCLA and fellow economists found that the mortality trend was similar everywhere once the disease took hold: The number of daily deaths rose rapidly for 20 to 30 days, then fell rapidly.
- Similar conclusions were reached in analyses of C19 deaths in Europe. Simon Wood of the University of Edinburgh concluded that infections in Britain were already declining before the nation’s lockdown began in late March. In Germany, Thomas Wieland of the Karlsruhe Institute of Technology found that infections were waning in most of the country before the national lockdown began and that the additional curfews imposed in Bavaria and other states had no effect.
- Wieland hasn’t published any work on New York City’s pandemic, but he says that the city’s trend looks similar to Germany’s. If, as some studies have shown, a C19 death typically occurs between 21 days and 26 days after infection, the peak of infections would have occurred at least three weeks prior to the peak in deaths on April 7. That would mean that infections in the city had already begun to decline by March 17 — five days before the lockdown began.
- What experimental drug would ever be approved if there were so much doubt about its efficacy and so much solid evidence of its harmful side effects? The cost-benefit rationale becomes even bleaker if you use the standard metric for determining whether a drug or other intervention is worthwhile: How much money will society spend for each year of life being saved?
- By that metric, the lockdowns must be the most cost-ineffective intervention in the history of public health, because so many of the intended beneficiaries are near the end of life. In America, nearly 80% of C19 victims have been over 65, and more than 40% were living in nursing homes, where the median life expectancy after admission is just five months. In Britain, a study led by the Imperial College economist David Miles concluded that even if you gave the lockdown full credit for averting the most unrealistic worst-case scenario (500,000 British deaths, more than 10 times the current toll), it would still flunk even the most lenient cost-benefit test.
- No one wants to hasten the demise of the elderly, but they and other vulnerable people can be shielded without shutting down the rest of the society, as Sweden and other countries have demonstrated.
- Sweden was denounced early in the pandemic by lockdown proponents because of its relatively high death rate — and it did initially flounder in protecting nursing homes — but its overall mortality rate is now lower than that of the United States and some other European countries. The rate is higher than that of its Nordic neighbors, but mainly because of demographic differences and other factors not related to its failure to shut down.
- Early in the pandemic, Scott Atlas at the Hoover Institution and researchers at Swansea University independently calculated that the lockdowns would ultimately cost more years of life than C19 in the United States and Britain, and the toll seems certain to be worse in poor countries. The World Bank estimates that the coronavirus recession could push 60 million people into extreme poverty, which inevitably means more disease and death.
- The lockdowns may have been justified in the spring, when so little was known about the virus and the ways to contain it. But now that we know more, there’s no ethical justification for continuing this failed experiment.
2. C19 Debate Infected By Fallacy Of Averages
- Can you walk across a river with an average depth of five feet?
- Put in terms that simple, the fallacy of relying on an average should be obvious. Knowing the average doesn’t help. It depends where you cross and how tall you are.
- But that same fallacy constantly appears in discussion about C19 and policies to fight it. Averages that mean little have been overdone, nationally and here in Illinois.
- Most recently, the COVID debate is moving in a new direction that demands better awareness of the fallacy of averages.
- This is important not only to the coronavirus debate, but provides a broader lesson why primary schools ought to be requiring students to read books like Innumeracy: Mathematical Illiteracy and Its Consequences, How to Lie With Statistics and Thinking Fast, Thinking Slow. Too many people, including much of the media and government, seem unaware of the fallacy.
- The fallacy most commonly appears in discussion about fatality rates. From the start of the pandemic, the average mortality rate from an infection has understandably been central to perceptions about the virus, and initial estimates almost always were provided as a single average. They were scary. Headlines were common in the spring with words like “staggering death tolls” of 1.3%. In March, Dr. Anthony Fauci estimated the mortality rate at about 2% and the World Health Organization pegged it at about 3.4%.
- Estimates gradually dropped for a number of reasons, but a single, average number continued to be the focus. Until last month the Center for Disease Control published only one average number, which it put at 0.65% in July.
- Hold on, many scientists are now saying. Focus on what’s inside those averages. Thousands of scientists and medical practitioners are now signing on to what’s called the Great Barrington Declaration, asking for what they call “focused protection.” Signers include what the Wall Street Journal calls “dozens of esteemed medical experts with blue-chip academic credentials.” Their statement says,
- 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.
- Underpinning their approach is the starkness of the age variance within the “average” fatality rate. Below is the breakdown newly provided by the CDC. This is its “current best estimate” of chances of dying if you get infected. Death rates are clearly far, far lower than originally said for most of the population. The averages were distorted up largely because most of the deaths are older people. In Illinois, 86% of deaths have been over age 60.
- Stay laser-focused just on those at risk and leave younger people alone because they face no material risk – that’s what’s behind the new declaration. Since April, that’s the approach we’ve often said makes sense.
- Instead of that focused protection, however, policy in Illinois and much of the nation would be better described as carpet bombing – flatten the entire economy by restricting behavior of the entire population. In fact, Illinois’ approach might be considered the opposite of focused protection since its policies toward retirement facilities were so poor, as reported by the Chicago Tribune. Over half of Illinois C19 fatalities have been in those facilities.
- The fallacy was first evident in a different way in Governor JB Pritzker’s initial shutdown order and reopening plan, which lumped the entire state into one unit. Regions with no COVID problem howled, and Pritzker gradually switched over to a more regionalized approach instead of state-wide averages.
- But the state is still struggling under an inconsistent approach to the fallacy of averages.
- St. Clair County’s positivity rates are better than the rest of its region, it insists, so it should stand alone in how restrictions are imposed. But the state is refusing to allow the county to be counted separately from Region 4. The county emergency management director says he sometimes feels like he is “in a war” with the Illinois health department, according to the Belleville News-Democrat.
- And that’s inconsistent with how the state is dealing with Region 6. There, positivity rates are pulled way down by heavy testing at the University of Illinois – over 10,000 per day according to the News-Gazette. Heavy testing gets lots of negative results. So, the state decided to exclude the U of I county from Region 6 numbers. That has the rest of Region 6 squealing about the tougher restrictions it will face because of the exclusion.
- That whole dust-up with excluding U of I, by the way, illustrates the silliness of focusing on positivity rates at all. They are heavily distorted by how much testing is being done and who is getting tested.
- If all that is too much math for you, flunk with dignity and at least remember the main lesson: Don’t let anybody tell you whether it’s safe to walk across a river based on its average depth.
K. Practical Tips & Other Perspectives
1. Inside Trump’s supplement regimen — and what experts say you can try too
- Since his coronavirus diagnosis last week, President Trump has received a variety of cutting-edge treatments, including an experimental polyclonal antibody infusion administered at the White House last Friday.
- But the president, who returned to the White House on Monday after being treated at Walter Reed National Military Medical Center and reported no symptoms Tuesday, is also taking a cocktail of seemingly routine over-the-counter supplements and medications.
- A recent memorandum from Trump physician Sean Conley noted that “the President has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin.”
- As the C19 pandemic rages on, can Trump’s drugstore-available meds aid others in the treatment of C19?
- That’s still unclear, according to Dr. Bruce Farber, the chief of infectious diseases at Northwell Health’s North Shore University Hospital and Long Island Jewish Medical Center.
- “There’s no evidence that any over-the-counter medication is active in treating or preventing COVID,” Farber told The Post, adding that patients should always contact their doctors before taking any new supplements.
- “I think this [regimen] is somewhat unique to [Trump],” Farber added.
- Here’s what we know so far about these supplements and how they might help treat the potentially deadly bug.
- If there’s one pill that stands out to Farber, it’s aspirin. The painkiller and blood thinner has long been part of treatment plans for those with histories of heart attacks or strokes.
- Coronavirus “dramatically increases the risk of spontaneous blood clots,” said Farber. “That’s part of COVID’s MO.
- “People with COVID who are sick should be on some [anti-clotting] medication, and that could be aspirin,” he added.
- A COVID-related aspirin trial at Xijing Hospital in China earlier this year hypothesized that early use of aspirin would “reduce the incidence of severe and critical patients”; however, that study’s results have not yet been posted.
- Famotidine, more commonly known as the over-the-counter heartburn medication Pepcid, has also been the subject of recent research.
- According to a September hospital study from Connecticut’s Hartford HealthCare, COVID patients who took famotidine were 45 percent less likely to die in the hospital, as well as 48 percent less likely to require a ventilator to breathe.
- “Current thoughts are that it may lessen the hyperimmune inflammatory response,” said cardiologist Dr. Raymond McKay, the study’s primary investigator, who added that the results ought to be considered preliminary and that the specific reasons for these positive outcomes were still theoretical.
- Zinc, an over-the-counter mineral, is known to regulate the immune system and metabolism.
- According to preliminary research from doctors working in a Barcelona hospital, patients with lower zinc levels were more likely to die from the coronavirus.
- Older people and others more susceptible to COVID, such as those with a heart condition or diabetes, may also have lower zinc levels due to diet or lower absorption levels, according to a recent Wall Street Journal column, “Trump Takes Zinc. Maybe You Should Too.”
- But Farber warns that there is too much of a good thing.
- “It can cause toxicity,” he said. Symptoms of too much zinc can include nausea and vomiting, as well as flu-like symptoms of fever, chills or fatigue.
- “Zinc is not totally benign … particularly if taken in large quantities for long periods of time,” he added.
- A recent study from the University of Chicago Medicine found a link between vitamin D deficiency and testing positive for C19.
- “Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections,” said David Meltzer, lead author of the study.
- Last month, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recommended vitamin D supplements, which he himself takes, noting that it has “an impact on your susceptibility to infection.”
- The hormone melatonin, known to regulate sleep and produced by the brain’s pineal gland, can also be taken as an oral supplement.
- “It’s usually used for sleep and sleep health,” said Farber.
- Additionally, the hormone has anti-inflammatory and antioxidant qualities.
- Researchers at the State University of New York at Buffalo recently began a yearlong trial to determine whether melatonin can reduce the severity and halt the progression of C19 when taken while symptoms are mild.
L. Johns Hopkins C19 Update
October 7, 2020
1. Cases & Trends
- The WHO C19 Dashboard reports 35.66 million cases and 1.04 million deaths as of 10:30am EDT on October 7.
- The US CDC reported 7.45 million total cases and 209,560 deaths. The US is averaging 43,852 new cases and 708 deaths per day. The daily mortality increased for the second consecutive day, after falling below 700 for the first time since mid-July. In total, 24 states (no change) 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, North Carolina, and Tennessee with more than 200,000. We expect Oklahoma to surpass 100,000 cases in the coming days. The CDC is reporting 98,244 total cases and 87,444 confirmed cases for Oklahoma, but the Oklahoma State Department of Health is reporting 93,346 cases. The reason for the discrepancy between the CDC and state health department data is unclear.
- C19 daily incidence continues to increase in most of the US. In addition to the Midwest, which we have addressed previously, a number of other states are also reporting concerning trends. The COVID Exit Strategy website categorizes all but 9 states and Washington, DC, as either Trending Poorly or Uncontrolled Spread. Among these 41 states, 13 are reporting test positivity greater than 10%, including 3—Idaho, South Dakota, and Wyoming—at 20% or greater. Notably, several of these states are reporting per capita incidence on par with or greater than the spring and summer peaks in other parts of the country—and still increasing (changes in testing availability make this an imperfect comparison). In fact, North Dakota is currently reporting more than 555 daily cases per million population, breaking the record set by Florida in mid-July.
- The Johns Hopkins CSSE dashboard reported 7.52 million US cases and 211,343 deaths as of 1:30pm EDT on October 7.
2. AIRBORNE TRANSMISSION
- The CDC published new guidance on the potential for airborne transmission of SARS-CoV-2 earlier this week. The updated guidance distinguishes between droplet and airborne transmission (as well as contact transmission); however, it emphasizes that respiratory droplets exist in a spectrum of sizes, ranging from large droplets “that fall out of the air rapidly” to smaller droplets or particles “that can remain suspended for many minutes to hours and travel far from the source.” The guidance also describes aerosols—referring both to smaller droplets and particles and the “clouds of these respiratory droplets in the air”—and clarifies the public health definition of “airborne transmission”—specifically, transmission via “infectious, pathogen-containing, small droplets and particles suspended in the air over long distances and that persist in the air for long times.”
- The guidance goes on to state that most SARS-CoV-2 infections are principally spread through “close contact,” primarily through respiratory droplet transmission within a short range of 6 feet or less, rather than airborne transmission. The guidance highlights certain conditions that can facilitate airborne transmission—including enclosed spaces, inadequate ventilation, and prolonged exposure (e.g., greater than 30 minutes)—due to the accumulation of suspended respiratory droplets that could increase exposure. The CDC emphasizes that certain protective measures can mitigate airborne transmission risk in enclosed spaces, such as increased ventilation, avoiding crowded indoor spaces, mask use, and enhanced hand hygiene and disinfection practices.
3. US ECONOMY
- The US has managed to recover only about half of the jobs lost due to C19, and recent data, including the latest employment date published by the Bureau of Labor Statistics, indicate that the pace of this recovery has slowed. While there are still millions of Americans out of work, hiring has slowed over the past month. According to the most recent BLS jobs report, employers added 661,000 new jobs in September, compared to 1.5 million added in August. Federal Reserve Chairman Jerome Powell recently argued that the federal government should focus on providing more economic stimulus funding in order to support the struggling economy. Negotiations on proposed stimulus packages stalled recently when President Donald Trump announced his intention to suspend efforts to finalize a new stimulus package until after the election.
4. CDC DEPLOYMENTS
- The CDC C19 Emergency Response Team and Division of Emergency Operations published an article in the CDC’s MMWR describing the deployment of CDC field teams to support state, tribal, local, and territorial health officials. As of July 25, the CDC deployed 208 teams involving more than 700 staff across 55 jurisdictions nationwide. Among these deployments, 26% were to long-term care facilities, 12% were to food processing facilities, 6% were to correctional facilities, and 5% were to homeless shelters. For those teams that completed their deployment by July 25, the mean deployment length was 20 days, with durations ranging up to 89 days. A total of 85% of the total deployments were to state health departments, and the remaining were distributed relatively equally between tribal, local, and territorial health departments. A total of 69% of deployments provided epidemiologic support, 37% provided infection prevention and control support in healthcare settings, 18% provided health communications support, 17% supported community mitigation efforts, and 15% supported occupational safety and health. The deployments were cited as informative for the development of epidemiologic publications describing key outbreaks in the US, characteristics of outbreaks and epidemics, and guidance on testing in long-term care facilities, homeless shelters, and food processing and meat packing facilities, and other settings.
5. WHITE HOUSE OUTBREAK
- Following the announcement that President Trump and other White House and elected officials tested positive for SARS-CoV-2, New Jersey state health officials are working to contact at least 206 individuals who attended a fundraiser event over concerns that they could have been exposed to confirmed C19 cases, including President Trump. Similar events, including the presidential debate, were held in multiple other states and at the White House during the period in which President Trump and other known cases may have been infectious.
- Without explicit detailed information on the results of contact tracing efforts for the White House outbreak, multiple efforts outside the White House are attempting to identify and track new cases and possible exposures, based on data available through official White House statements, media reports, personal accounts, and other publicly available sources. Among these efforts are The New York Times, Axios, and Tableau Public. To date, confirmed cases have been reported among a wide variety of individuals, including several who may be secondary cases with no direct exposure at the White House or other recent events (e.g., presidential debate).
- Washington, DC, has faced a surge in demand for testing following news of the White House outbreak. Tests performed on Monday of this week represented an 81% increase from the previous week.
6. PRESIDENTIAL & VP DEBATES
- As the US moves closer to the general election on November 3, the candidates for president and vice-president have 3 more scheduled debates. The vice-presidential debate will be held tonight, and the final 2 presidential debates are scheduled for each of the next 2 weeks. In response to emerging information regarding the ongoing White House C19 outbreak, particularly concern regarding Vice President Pence’s exposure to known cases, additional precautions are being implemented for tonight’s vice-presidential debate. Notably, plexiglass barriers will be erected between the candidates in an effort to better protect against droplet transmission. The candidates will maintain a 12-foot separation, and Vice President Pence has reported negative SARS-CoV-2 tests to date. Additionally, all attendees at the debate, with the exception of the moderator and candidates, will be required to wear a mask throughout the event.
7. VACCINE CLINICAL EUA STANDARDS
- The FDA published a guidance document to vaccine manufacturers regarding the process and standards to receive an Emergency Use Authorization (EUA) for SARS-CoV-2 vaccines. The document, which contains nonbinding recommendations, specifies at a high level some of the key information that manufacturers need to provide to the FDA in seeking an EUA for their vaccine candidates. Notably, the data from Phase 3 clinical trials should include a “median follow-up duration of at least  months” to assess both safety and efficacy. The document specifies that the “FDA does not intend to make a favorable determination” unless “well over 3,000 vaccine recipients” are monitored for serious adverse events or adverse events of special interest for at least 1 month after vaccination. Additionally, a total of 5 or more severe C19 cases in the placebo group would “generally be sufficient” to evaluate the vaccine’s efficacy.
- The guidance was welcomed by public health authorities and other stakeholders, but it was met with some opposition. According to a report published by The Washington Post, senior White House officials delayed approval of the document. Of particular concern was the duration of follow-up, which would likely prevent a vaccine from receiving an EUA prior to the November election. Releasing the guidance publicly provides transparency into the metrics by which the FDA will review candidate vaccines and the standards required to move forward with an EUA. This transparency will be critical to establishing public support for future vaccines.
8. ANTIGEN TESTING
- A pilot program involving the US Department of Health and Human Services and The Rockefeller Foundation aims to assess approaches for using rapid point-of-care antigen testing to screen for SARS-CoV-2 infection. The program will involve multiple study sites across the US and will use at least 120,000 Abbott BinaxNOW SARS-CoV-2 antigen tests. On-site antigen testing could provide support for screening at schools, businesses, and other settings.
- As we covered previously, the US government recently purchased 150 million of these tests, which will be distributed to states for use in schools, long-term care facilities, and other priority settings. The BinaxNOW test is currently the only rapid point-of-care antigen test with an EUA issued by the FDA. The pilot study will support efforts to operationalize these screening programs, including at “laboratories, retail pharmacies, and other community entities.”
9. MONOCLONAL ANTIBODY TREATMENT EUA
- Pharmaceutical manufacturer Eli Lilly submitted an EUA request to the FDA for its monoclonal antibody cocktail as a C19 treatment after clinical trials for the drugs met the target clinical endpoints. Results from a Phase 2 clinical trial indicate that a combination of two of Eli Lilly’s monoclonal antibodies reduced viral load in C19 patients mitigated symptoms and resulted in fewer hospitalizations and emergency department visits. The study included 268 total participants with mild-to-moderate C19 symptoms, 112 of whom received the treatment and 156 who received a placebo. Additionally, a press release issued by the company indicates that no serious adverse events were reported. The company stated that it aims to make 100,000 doses of a single antibody available by the end of October and 1 million by the end of 2020. For the combination therapy, the company hopes to produce 50,000 doses by the end of 2020, and it is collaborating with various external partners to ensure availability for lower-income countries.
10. LONG-TERM HEALTH EFFECTS
- Nine months into the C19 pandemic, clinicians are observing more well-defined patterns of long-term health consequences for C19 patients. A commentary published in JAMA describes some of the frequently reported manifestations in recovered patients. Although long-term health effects are more likely to be exhibited by patients with more severe disease (e.g., admitted to an intensive care unit), these effects are also being observed in persons with milder illnesses. General fatigue and dyspnea were the most commonly reported long-term sequelae, in addition to general joint and chest pain.
- The authors also describe organ-specific manifestations in 3 specific organ systems: cardiovascular, pulmonary, and neurological. In the cardiovascular system, myocarditis and myocardial injury are being reported in patients with a range of disease severity, including individuals who were younger and healthier prior to infection. The presence of myocardial injury in previously healthy student athletes, for example, suggests that damage to the heart is a potentially serious complication of SARS-CoV-2 infection. I
- In the lungs, one study found more than 60% of patients had persistent symptoms or other indication of pulmonary dysfunction 3 months after discharge from the hospital. Another study found decreased pulmonary muscle strength in nearly 50% of patients 30 days after discharge. Neurological sequelae such as anosmia and ageusia have been commonly reported, but encephalitis, seizures, mood swings, and “brain fog” have been identified in recovered C19 patients as well, although less frequently. While larger studies on these long-term sequelae are still forthcoming, preliminary reports of serious health effects in major organ systems are sufficiently concerning to encourage adherence to prevention measures.