October 30, 2020
Without reliable information, we rely on fear or luck.
Roughly 57% of shoppers are considering restocking due to growing fears of a “potential second wave of C19,” which could lead to another round of bare store shelves.(Read the full story below)
“Declining antibody levels after the acute infection has resolved is the sign of a normal healthy immune response. It doesn’t mean that those people no longer have antibodies. It doesn’t mean that they don’t have protection.”Scott Hensley, an immunologist at the University of Pennsylvania
“With the coming of fall and people spending more time inside, an increase in cases was expected. What was not expected is that it would happen so fast. Almost everywhere, we are running after the pandemic.”Josep Jansa, an infectious-diseases expert and senior official at the European Center for Disease Control
“I look forward to each edition of the Coronavirus Update and open it first thing in the morning.”Patricia, an update reader
1. Cases & Tests
5. Strained hospitals and the bet on a vaccine
2. How to make dining out safer (*)
M. Linked Stories
- A room, a bar and a classroom: how the coronavirus is spread through the air
- Study shows hydroxychloroquine may be effective for outpatients with C19
- Some Covid Survivors Have Antibodies That Attack the Body, not Virus
- Amount of COVID viral RNA detected at hospital admission predicts how patients will fare
- New research shows coronavirus spike proteins disrupt the blood-brain barrier
- Some C19 “long haulers” experience lasting skin problems
- In study of 30,000 mild-to-moderate C19 patients, antibody responses can persist for 5 months
- Most people mount a strong antibody response to coronavirus that does not decline rapidly
- Coronavirus outbreak investigation in meat processing plant suggests aerosol transmission in confined
- Models show how C19 cuts a neighborhood path
- Contagion Transmission Model: Estimating Risk of Airborne C19 With Mask Usage, Social Distancing
- Scientific Comparison of C19 Face Mask Materials: T-shirts, Socks, Jeans, Vacuum Bags, N95
- How America Helped Defeat the Coronavirus (Just not in the United States)
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A. The Pandemic As Seen Through Headlines
(In no particular order)
- “A Lot Of Hoarding” – Americans Race To Supermarkets As Second Wave Arrives
- Top UK Scientists Warn “Many, Or All” COVID-19 Vaccine Projects Could Fail, First Gen “Likely To Be Imperfect”
- Amid a pandemic of bad news, there’s a bright spot: Survival rates among Covid-19 patients, even those with severe cases, are improving
- Younger patients, better treatment may be cause of COVID-19 death rate drop
- Remdesivir for COVID-19: FDA approved but still unproven
- Dr. Fauci: U.S. May See ‘Semblance of Normality’ Only in 2022
- Fauci says COVID-19 vaccine could be available by January
- EU won’t see full COVID-19 vaccination until 2022, official reportedly warns
- UK vaccine task force warns: prepare for imperfect vaccines
- 1 in 6 Hospital COVID-19 Cases Are Health Workers or Their Family Members
- Nurses Were 36.3% Of All COVID-19 Healthcare Worker Hospitalizations This Spring
- Almost 800,000 kids have gotten COVID-19 in US, pediatricians say
- New Research Points To The People’s Liberation Army Hospital In Wuhan As Origin For Global Coronavirus Pandemic
- CDC Journal: Cloth Masks ‘May Give Users a False Sense of Protection’ Against Coronavirus
- Utah Restaurant Pushes Back on Mask Mandate…Bans Wearing Masks, Gloves
- Young Adults Are Less Likely to Take Precautions Against COVID-19
- Eli Lilly reached a $375 million deal with the U.S. government to provide Americans with its experimental antibody treatment for Covid-19
- London researchers make breakthrough discovery on antibodies
- ‘Gold Standard’ UK Study Finds COVID-19 Immunity Degrades Within 6 Months
- Death rates among people with severe COVID-19 drop by a half in England
- Illinois Governor Ends Indoor Dining Across 2/3rds Of State As Winter Cold Looms
- US Hospitalizations Soar Almost 40% In One Week
- El Paso Texas imposes second lockdown as local hospitals reach capacity
- Wisconsin reports another record jump in cases, deaths
- Connecticut’s COVID-19 positivity rate soars overnight
- COVID-19 mask use up overall, still lags among young people: CDC
- Seasonal Flu Rates Plunge, Baffling ‘Experts’ Who Predicted Deadly ‘Superbug’
- Germany to go into circuit-break lockdown as coronavirus surges
- France Joins Germany In Reviving Nationwide Lockdown As COVID-19 Cases Soar Across Europe
- Spanish Doctors Stage First Walkout In 25 Years To Protest Government’s New COVID-19 Order
- East Europe Fights Pandemic It Thought Crushed
- Across Europe, hospitals are filling up at an alarming pace, recalling the darkest hours of the pandemic’s first wave
- Europe’s latest wave of restrictions to stop the spread of the virus have largely avoided closing schools
- ‘Massive Traffic Jams’ Across Paris As People Flee Ahead Of Second COVID Lockdown
- Russia Imposes National Mask Mandate
- Czech Republic and Poland suffer new records
- Texas cases see biggest jump in 2 months
- Mainland China reports 42 more cases
- UK Prime Minister Johnson faces pressure for new lockdown
- Flanders closes gyms, pools
- The Netherlands warns of first return to full lockdown in Europe
- Switzerland running out of ICU beds
- Switzerland tightened controls on social gatherings, closing nightclubs and imposing an 11 p.m. closing time for bars, but it will allow restaurants, shops and businesses to remain open, for now
- Russia begins production of a second vaccine
- NY reports 2,499 new cases, hospitalizations top 1,000
- France to re-close Disneyland Paris
- New records in Romania, Poland
- In Greece, the prime minister said he would announce a one-month action of “targeted restrictions” aimed at averting a second nationwide lockdown
- Belgium hospitalizations hit record as nonessential medical patients delayed
- UK rate of spread surges as UK Prime Minister Johnson faces pressure for national lockdown
- India Surpasses 8 Million Coronavirus Cases; 2nd Only To U.S.
- Iran sees another record in new cases
- Singapore lifts travel restrictions with China
- Arizona daily cases back above 1,000
- Pfizer says critical vaccine data won’t be ready before election day
- French officials weigh lockdown as they meet about next steps
- Another German district heads into partial lockdown
- Russia refuses to enter new lockdown as cases continue to climb
- German economy minister warns on rising infections
- Melbourne, Australia’s second-largest city, emerged from a 111-day lockdown with a mix of euphoria and caution
- City Locked Down for 3 Months has Bleak Lessons for the World
- Taiwan has gone 200 days without a locally transmitted case of the virus
- ‘Another piece of populist propaganda’: Critics slam the Brazilian government’s new COVID-19 drug
- South Africa may have achieved COVID-19 herd immunity, expert says
- Health worker’s eye socket broken after asking rail riders to wear masks
- Some college towns that were virus hot spots are beginning to show progress, with new infections at several large universities slowing markedly
- Los Angeles schools will probably stick with remote learning until at least January
- The pandemic has rapidly fueled a new youth unemployment crisis in Europe, and it may be about to get worse
- A new study found that hospitals in Tennessee that served patients from areas without mask requirements had the highest rate of growth in hospitalizations
- CDC: a teenage student who received a false negative result on a virus test infected at least 116 people at a faith-based overnight retreat in Wisconsin this summer
- NBC reports that some elderly people are dying from social isolation brought on by confinement measures meant to protect them from the virus
- S.T.D. rates are falling, and that’s probably bad news
- United Airlines To Rapid Test Passengers For COVID
- Tsunami Of Empty College Dorms Risks Student Housing Market Implosion
- I abandoned NYC amid COVID — and it was the worst decision of my life (?!)
- Netflix Shares Soar As Company Capitalizes On COVID-19, Hikes Prices
- US GDP Soars By A Record 33.1% In Q3, Smashing Expectations
- Americans Plan To Significantly Scale Back Holiday Spending This Year
- Utah restaurant bans customers from wearing masks
- Puerto Rico scraps safe-sex campaign urging people to masturbate during pandemic
- ‘Too Early to Say’ If Christmas Is Cancelled, Says Senior UK Minister
- UK police chiefs warn COVID rule-flouting Christmas parties will be broken up
- Nobody likes lame Zoom birthday parties — so cancel them and move on
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 = 45,312,962
- New Cases = 545,499
- New Cases (7 day average) = 472,984 (+9,916) (+2.1%)
- Record high number of new cases
- Record high 7 day average of new cases
- 7 day average of new cases is rising at a rapid rate
- 1,000,000 cases every 2.1 days (based on 7 day average)
US Cases & Testing:
- Total Cases = 9,212,767
- New Cases = 91,530
- New Cases (7 day average) = 77,733 (+2,406) (+3.2%)
- Percentage of New Global Cases (7 day average) = 16.4%
- Total Number of Tests =
- Percentage of positive tests (7 day average) = 141,669,328
- Record high number of new cases
- Record high 7 day average of new cases
- 7 day average of new cases are increasing at a very rapid rate
- Total Deaths = 1,185,733
- New Deaths = 7,167
- New Deaths (7 day average) = 6,192 (+97) (+1.6%)
- 7 day average has been rising rapidly since 10/15
- 7 day average of new deaths has exceeded the number of new deaths on 2nd peak on 8/11
- Total Deaths = 234,177
- New Deaths = 1,047
- New Deaths (7 day average) = 828 (+11) (+1.4%)
- Percentage of Global New Deaths = 13.4%
- 7 day average of new deaths has been gradually increasing since 10/17
- Confirmed case fatality rate (7 day average) = 1.1%, which is a decrease of 88.2% since the peak on 4/21
3. Covid cases, hospitalizations continue to surge as U.S. reaches ‘critical point’ in pandemic
- Three dozen states reported that the average number of people currently hospitalized with C19 rose by at least 5% over the past week.
- “We are at another critical point in the pandemic response,” said Adm. Brett Giroir, assistant secretary of health who leads the government’s testing effort.
- Giroir went on to emphasize that “we can control the virus” by following public health measures like social distancing, mask wearing, avoiding crowded gatherings and the frequent washing of hands.
- The United States is reporting another record-high average number of new cases of the coronavirus as a top health official warned Wednesday that the country is at a “critical point.”
- The U.S. reported 73,240 new cases on Tuesday, bringing the seven-day average of new cases up to about 71,832, a fresh record and an increase of more than 20% compared with a week ago, according to a CNBC analysis of data collected by Johns Hopkins University.
- Three dozen states reported that the average number of people currently hospitalized with C19 rose by at least 5% over the past week, according to data from the Covid Tracking Project, which tracks testing, hospitalization and other data on the outbreak. Cases are up by at least that amount in 45 states, according to Johns Hopkins data.
- “As the nation did after Memorial Day, we are at another critical point in the pandemic response,” Adm. Brett Giroir, assistant secretary of health who leads the government’s testing effort, said Wednesday on NBC’s “TODAY” show. “Cases are going up in most states across the country. Hospitalizations are up, although we’re still tens of thousands of hospitalizations below where we were in July, but that is rising. And we are starting to see the increase in deaths.”
- Giroir went on to emphasize that “we can control the virus” by following public health measures like social distancing, mask wearing, avoiding crowded gatherings and with the frequent washing of hands.
- The surge in cases and hospitalizations is beginning to overwhelm some hospitals in parts of the country. The Salt Lake Tribune reported over the weekend that the Utah Hospital Association is asking the governor to allow its members to ration care. And in Texas, El Paso County Judge Ricardo Samaniego issued a curfew on Sunday to protect “overwhelmed and exhausted” hospitals and workers.
- Public health specialists and epidemiologists have warned for months that the virus would likely surge as the weather turned colder in the fall and winter. That’s largely because people are more likely to stay indoors in colder weather and because some epidemiologists believe the virus can spread more easily through colder, drier air.
- Dr. Bill Schaffner, an epidemiologist at Vanderbilt University, told CNBC this week that the outbreak will likely worsen this winter.
- Giroir said the administration is “taking this very seriously,” adding that if people fail to abide by public health guidance, “it may force local officials or government officials in the states to have more draconian measures, because cases will go up if we don’t make a change.”
- “We have the tools to combat this,” he said. “We can control it. This is a very important time to do it.”
- Giroir emphasized on Wednesday that the U.S. has more tools to lessen the weight of the virus, such as additional testing that can help catch cases earlier, before people become severely sick. Scientists have also found a number of drugs to be helpful in the treatment of C19, including the antiviral remdesivir and the steroid dexamethasone.
- No vaccine has been authorized by the Food and Drug Administration yet, but Giroir said one is coming this year and it will help end the pandemic. Public health specialists, though, say a vaccine will not bring an abrupt end to the outbreak, especially as it’s not known how effective one might be.
- “There is the sense in the general population that if we get a vaccine and get vaccinated, that’s like putting on a suit of armor,” said Schaffner, the epidemiologist at Vanderbilt. “That’s not going to be the case.”
4. Europe’s C19 Cases and Deaths Are Climbing, a Warning for the U.S.
- Europe is once again at the epicenter of the coronavirus pandemic, with the continent now recording more and faster-rising deaths than the U.S. in an abrupt reversal of fortunes that is leading some governments to reimpose lockdowns they had hoped to avoid.
- The dramatic rise in infections is stretching the capacity of hospitals in the worst-hit cities in France, Belgium, Italy and elsewhere. Around 1,370 C19 patients are dying in the European Union and the U.K. every day on average, compared with 808 in the U.S. Not since March has Europe suffered more recorded deaths than the U.S.
- On a per-capita basis, deaths from C19 in Europe are now rapidly approaching the U.S.’s level, after running significantly below U.S. fatalities since May.
- After a relatively calm summer, Europe now accounts for close to half of the world’s C19 cases.
- Europe’s daily new infections, which averaged 176,400 this past week, have outstripped the U.S.’s seven-day average of 72,300 daily cases, according to data from the European Center for Disease Prevention and Control.
- Until this fall, Europe appeared to have the pandemic under better control than the U.S., where the contagion curve never dropped to a low level.
- But shortcomings accumulated as the first wave became a memory. Most of Europe didn’t manage to develop sufficiently strong alternative tools to keep contagion low after lockdowns had ended. Europe’s programs for testing, tracing and isolating virus-carriers were less effective than in East Asian countries such as South Korea, which never needed a full-blown lockdown.
- Millions of European citizens relaxed their behavior this summer, including young people who wanted to return to their social lives. Vacation travel and nightlife steadily revived infections. As Europeans returned to schools, offices and public transport, fatigue with the pandemic led to patchy compliance with social-distancing and mask-wearing guidelines.
- October’s explosive growth of contagion in Europe, despite many targeted government efforts short of lockdowns, is a sign of faltering popular cooperation and policy lagging behind the curve, health experts say. But many epidemiologists say the speed of the increase is a surprise, and say it shows how quickly the coronavirus can escape from control.
- “With the coming of fall and people spending more time inside, an increase in cases was expected. What was not expected is that it would happen so fast,” said Josep Jansa, an infectious-diseases expert and senior official at the ECDC. “Almost everywhere, we are running after the pandemic.”
- Europe’s sudden loss of control, after months when infections appeared to be stable, is a warning for the U.S. of how fast the situation can deteriorate. U.S. infections are running at the highest levels so far in this pandemic, and hospitalizations are climbing once again, but the pace of growth is currently slower than in Europe.
- “We have to look at the things which are going on in Europe at the moment and think that’s a glimpse of our near future,” said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. “We think that it won’t happen where we are, and people come up with reasons why it’s not going to be there or why it’s not going to be as bad. And then it is.”
- Pressure on hospitals is rising on both sides of the Atlantic.
- In France, over half of the country’s intensive care beds are occupied by C19 patients. In the northern Italian city of Milan, the influx of C19 patients has forced the reopening of a temporary hospital in the city’s trade-fair center, which was built during this spring’s first wave.
- In eastern Belgium, medical personnel have been asked to keep working even if they have the virus, so long as they are asymptomatic.
- “There are just not enough nurses in Belgium,” said Louis Maraite, the communications director of Liege University Hospital Center. Around 10% of the hospital’s nurses have tested positive for the coronavirus. “So it’s either an infected nurse or no nurse at all,” he said.
- In the U.S., there were 45,045 C19 patients in hospitals Wednesday, the highest number since August 14, according to the Covid Tracking Project.
- At St. Luke’s Magic Valley Medical Center in Twin Falls, Idaho, an unprecedented number of hospitalizations have affected capacity, said Joshua Kern, the vice president of medical affairs. Some patients have been transferred to the hospital system’s larger location in Boise, a relief valve for now but one that could be overwhelmed, warned Dr. Kern.
- The rapid increase of pressure on hospitals is pushing European governments to impose tough new restrictions on social and economic life, despite concerns about derailing Europe’s economic recovery.
- France’s announcement of a one-month national lockdown starting Friday, requiring residents to stay at home and nonessential shops to shut, is expected to test its population’s patience with drastic measures.
- Germany’s month long closure of many businesses, including bars, restaurants, gyms and theaters, and Italy’s shutdown of almost all nightlife and entertainment sectors after 6 p.m., show how governments are once again trying to protect health care systems even at the cost of more economic pain.
- Europe is still recording fewer deaths now than in the spring, but daily deaths are climbing rapidly, raising fears among policy makers and their scientific advisers that the second wave could be worse than the first one.
- U.S. deaths are also rising, but at a slower pace than infections, and more slowly than in Europe at present. In the U.S., the virus is still circulating mostly among younger people, whereas European data show that infections are now rising rapidly among people over 65, who are more likely to become seriously ill.
- Coming U.S. holidays, including Halloween and Thanksgiving, pose additional challenges as many American families meet in multigenerational gatherings and college students return home from campus.
- In most of Europe, a high percentage of tests for the virus are coming back positive, an indication that many infected people are going undetected and that testing programs are insufficient. The positivity rate, which the ECDC recommends should stay below 3%, has reached 11% in Spain, 18% in France and 26% in both the Netherlands and the Czech Republic.
- The pandemic has already caused extensive economic damage. The International Monetary Fund projects that the eurozone economy will shrink by 8.3% in 2020, and the U.S. economy by 4.3%. A second round of lockdowns could deepen Europe’s contraction even more.
- Seeking to avoid second lockdowns, European countries including Italy, Spain and the U.K. are hoping more limited measures such as the partial closures of bars and restaurants and restrictions on social gatherings will be enough. But a lot depends on the adherence to social-distancing rules, which has become more lax.
- “No government wants to go back into lockdown, no society wants to go back into lockdown,” said Clare Wenham, assistant professor of global health policy at the London School of Economics. “The problem is that, at the moment, I can’t see a way out of it other than more lockdowns.”
- Not everyone agrees. This time around, many in Europe are prepared to countenance higher contagion as the price of avoiding lockdowns. The government of the Netherlands is among those saying a full lockdown can be avoided if restaurants and bars stay closed and people limit their interactions, despite a more severe outbreak than this spring’s.
- “We want to cause as little damage to the economy and society as possible,” Dutch Prime Minister Mark Rutte said this week.
5. Strained hospitals and the bet on a vaccine
- Hospitals in the U.S. are once again under strain from a resurgent coronavirus. At the same time, it looks like the pandemic could endure long after a vaccine becomes available.
- C19 hospitalizations have risen at least 10% in the past week in 32 states and the nation’s capital, as the month-old viral surge increasingly weighs on America’s health-care system.
- Current hospitalizations soared 68% in New Mexico, 50% in Wyoming and 38% in Connecticut, among other notable increases, according to Covid Tracking Project data. South Dakota, Montana and North Dakota have the most current patients per capita, the data show.
- Nationally, current hospitalizations have climbed 37% to 42,917 in the past three weeks, after months of decline. But they are still about 28% lower than they were during July’s Sun Belt surge, even as cases have risen to a record.
- Those trends are especially troubling given increasing expectations that the effects of the pandemic could linger for several more years.
- While the U.S. has committed more than $10 billion to develop new shots to fight C19, about half of Americans say they are wary of taking them, according to a Gallup poll reported this month. Meanwhile, any shortfalls in the vaccine program could mean the country will struggle with the virus well into 2023, according to the London-based firm Airfinity Ltd.
- Overcoming the logistical, production and public-education challenges of immunizing 60% to 70% of national populations—the level the World Health Organization says is needed to achieve herd immunity—will be a time-consuming and troublesome process. The world will still need masks, social distancing, widespread testing and effective new therapies to keep the virus at bay, public-health specialists say.
- In the U.S., where the of masks and distancing has been slow, the rollout of a vaccine could be accompanied by a crippling strain on the hospital system.
Source: Bloomberg Coronavirus Daily
C. New Scientific Findings & Research
1. Aerosol Microdroplets Not Very Effective at Spreading the C19 Virus
- Aerosol microdroplets, the tiny particles that linger in the air longest after we talk, cough, or sneeze, do not appear to be extremely efficient at spreading the virus that leads to C19.
- Modeling of coronavirus (SARS-CoV-2) transmission in confined spaces suggests aerosol transmission is not a very efficient route. The results were published in Physics of Fluids, by AIP Publishing.
- While the lingering microdroplets are certainly not risk-free, due to their small size they contain less virus than the larger droplets that are produced when someone coughs, speaks, or sneezes directly on us, said Daniel Bonn, one of the authors and institute director.
- “Based on the current insights, we actually see that aerosol-wise, it’s relatively safe to go into well-ventilated modern buildings, such as airports, train stations, modern offices, etc.,” Bonn said. “Modern ventilation makes the aerosol infection risk not very large. The amount of virus in the small droplets is relatively small, meaning that it becomes dangerous if you’re in a badly ventilated room for a relatively long time with an infected person or after an infected person has coughed there.”
- If someone enters a space even a few minutes after a mildly symptomatic carrier of the coronavirus has coughed in that area, the probability of infection is “rather low,” according to the researchers. It is even lower if that person was only talking.
- The findings, Bonn said, support the efficacy of wearing masks, social distancing, and other measures targeting the spread of larger droplets.
- “They are so large that they fall onto the ground roughly within a meter from your mouth,” he said. “If you want to minimize the risk of infection, you need to not only keep the 6 feet, or 1.5 meters, but also make sure the room you are in is well ventilated. And wash your hands.”
- The researchers acknowledge the study’s findings are “necessarily subjective.” But, Bonn said, the authors hope it provides some context as people consider their safety during the pandemic.
2. Understanding ‘aerosol transmission’ could be key to controlling C19
- Imagine you think there are mice in your house. You can see the evidence – mouse droppings; gnawed or damaged skirting boards; holes left in food packaging. You call a local pest control team who confirm that you have mice and advise you on what is needed to remove them. Neither of you have actually had to see a mouse to reach this conclusion.
- The same kind of thinking can be applied to the transmission of coronavirus. We don’t need to see the virus to understand how it spreads. Recent studies from China show that patients infected with C19 in clinical settings exhale large amounts of virus, which remain present in the air and can be sampled and detected.
- Because of this, scientists can reasonably infer that the virus contaminates its surrounding environment. People nearby may inhale it, and as the virus floats through the air, spreading further in poorly ventilated environments, those who are further away could also become infected. Importantly, scientists haven’t yet demonstrated that someone walking through a cloud of exhaled virus would develop C19 from that particular exposure, and research in this area is ongoing. But there is growing evidence that the virus which causes Covid can remain in the air, and therefore pose a risk to people in that airspace.
- The evidence that Covid can spread via aerosol transmission takes one of two different forms. First, many scientists now think that aerosol transmission explained some early outbreaks, such as those in an air-conditioned restaurant in Guangzhou, China, and at a choir practice in the US, where the virus was exhaled by people and may have remained in the surrounding environment before infecting others who inhaled it.
- Second, aerosol transmission partly explains why countries that were early adopters of policies which targeted this kind of transmission have been more successful at controlling the virus. For example, south-east Asian countries were far quicker to adopt face masks, which are shown to reduce the spread of aerosols, than many western countries including the UK.
- I’m not saying that aerosols are the only transmission route. Research suggests there are in fact two main ways the virus can transmit. The first is via contaminated surfaces, also known as “fomites”. The UK government emphasized this transmission route at the beginning of the pandemic, issuing public health messages that focused on hand-washing. Yet as the World Health Organization conceded in a recent C19 brief, “despite consistent evidence as to … the survival of the virus on certain surfaces, there are no specific reports which have directly demonstrated fomite transmission”.
- This doesn’t mean that surfaces don’t play a role in the spread of C19. The WHO still considers them a “likely mode of transmission”, given consistent findings about how the virus contaminates its environment, and the fact that other coronaviruses can transmit this way. But contact with contaminated surfaces may not play as big a role as we initially thought. Indeed, a review of studies by theScientific Advisory Group for Emergencies suggested hand-hygiene policies only led to a 16% reduction in acute respiratory infections.
- The other way that coronavirus spreads is likely through a combination of droplets and aerosols. Droplets are larger than aerosols; too big to remain suspended in the air, they fall more quickly on to surfaces. Aerosols are tiny by comparison and can be spread at far greater distance. Both droplets and aerosols are produced while talking, coughing, sneezing and singing, but where aerosols can remain in the air for minutes or even hours, droplets fall and contaminate surfaces from where they can contribute to transmission.
- In an open letter that I co-authored with many other scientists, we outlined these ideas and cited evidence from various studies suggesting that aerosol transmission is a potentially significant route by which C19 is spread. Surfaces are still important, and people should continue washing their hands, but a growing scientific consensus suggests this may not be the main way that Covid is transmitted.
- Why does this matter? First, because understanding how the virus spreads is key to controlling it. On the basis of what we know about how Covid transmits, a combined approach that targets aerosols, droplets and surfaces, and gives priority to aerosols, is likely the best way to control its spread. This means a combination of policies, such as social distancing, face masks, improving indoor ventilation, reducing contact between households and enforcing the rule of six will all reduce the level of transmission.
- Many countries including Britain have already adopted variations of each of these policies. So why does emphasising aerosols as one of the main routes by which the disease spreads make any difference?
- The reason for recognizing the virus as potentially airborne (as we do with chickenpox, measles and tuberculosis) is that this will release additional funding around the world to combat airborne infections. If C19 is globally recognised as caused by an airborne virus, there will be more of an imperative to fund research and initiatives, such as improving indoor ventilation, that will be crucial to preventing the spread of this virus and others like it.
- Emphasising that C19 can be spread through the air would allow us to add more weapons in our arsenal to fight this virus – which may be with us for some time to come.
3. Over 80% of Hospitalized C19 Patients Have Vitamin D Deficiency, Study Finds
- Over 80% of 200 C19 patients in a hospital in Spain have vitamin D deficiency, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.
- Vitamin D is a hormone the kidneys produce that controls blood calcium concentration and impacts the immune system. Vitamin D deficiency has been linked to a variety of health concerns, although research is still underway into why the hormone impacts other systems of the body. Many studies point to the beneficial effect of vitamin D on the immune system, especially regarding protection against infections.
- “One approach is to identify and treat vitamin D deficiency, especially in high-risk individuals such as the elderly, patients with comorbidities, and nursing home residents, who are the main target population for the C19,” said study co-author José L. Hernández, Ph.D., of the University of Cantabria in Santander, Spain. “Vitamin D treatment should be recommended in C19 patients with low levels of vitamin D circulating in the blood since this approach might have beneficial effects in both the musculoskeletal and the immune system.”
- The researchers found 80% of 216 C19 patients at the Hospital Universitario Marqués de Valdecilla had vitamin D deficiency, and men had lower vitamin D levels than women. C19 patients with lower vitamin D levels also had raised serum levels of inflammatory markers such as ferritin and D-dimer.
4. Why are some C19 infected people asymptomatic?
- Researchers worldwide have been surprised to see that individuals can be infected with the coronavirus (SARS-CoV-2) without showing symptoms. Since these individuals expose others to infection without knowing it, it is important to find an explanation and hopefully a solution to this.
- On the inside of our lungs are specialized immune cells, called alveolar macrophages, which help maintain a healthy environment in the lungs. The lungs contain a large number of alveolar macrophages, so they are probably also the first cell type an invading virus encounters.
- When the body recognizes a viral infection, our immune system initiate the production of interferons. Interferons are a group of cytokines that help shape the immune response and are therefore essential in the fight against a viral infection. Alveolar macrophages have previously been shown to produce large amounts of interferons upon infection with respiratory viruses, such as influenza.
- SARS-CoV-2 is a respiratory virus that typically infects the outermost cell layer of the lungs, the epithelial layer. New research has shown that interferon production in the infected epithelial cells can be inhibited by the SARS-CoV-2 virus. This results in low interferon production and therefore also a limited activation of the immune system to fight against the virus. Although the epithelial layer is the target of the virus, it must be assumed that the first cell type the virus encounters is the alveolar macrophages, and therefore these cells are important for how quickly an immune response to a SARS-CoV-2 infection can be initiated.
- Therefore, a team of researchers from Aarhus University and Aarhus University Hospital in Denmark set out to investigate how these important cells react to the SARS-CoV-2 virus. To answer this, they isolated the alveolar macrophages from lung lavage and examined the activation of the immune system in these cells when they encounter the SARS-CoV-2 virus.
The SARS-CoV-2 virus can hide its genome from being recognized
- The results of their research show that alveolar macrophages effectively produce interferons when infected with known viruses, such as influenza. They have thereby confirmed that they have the potential to produce large amounts of interferons during a viral infection. Contrary to their expectations, the researchers saw no interferon production in the cells when the alveolar macrophages were exposed to the SARS-CoV-2 virus.
- These results therefore suggest that the SARS-CoV-2 virus may hide its genomic material from being recognized in the alveolar macrophages, thereby not inducing the production of interferons.
- This is why there will be no activation of the immune system in the early stages of a SARS-CoV-2 infection, allowing the virus to spread further in the community before symptoms occur. However, more research is needed to understand how SARS-CoV-2 can avoid being recognized by the immune system.
5. Close to 17% of patients recovered from C19 could still carry virus
- A new study in the American Journal of Preventive Medicine, published by Elsevier, presents new data that address important questions pertaining to the containment of the coronavirus pandemic: When should C19 quarantine really end and which continuing symptoms may be more indicative of a positive test in recovered patients?
- Investigators report that close to 17% of patients considered fully recovered from C19 tested positive for the virus in follow-up screening. Patients who continued to have respiratory symptoms, especially sore throat and rhinitis, were more likely to have a new positive test result. This suggests the persistence of these two symptoms should not be underestimated and should be adequately assessed in all patients considered recovered from C19.
- “Clinicians and researchers have focused on the acute phase of C19, but continued monitoring after discharge for long-lasting effects is needed,” explained lead investigator Francesco Landi, MD, PhD, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, and Catholic University of the Sacred Heart, Rome, Italy.
- A new RT-PCR test was administered at the time of post-acute care admission. Demographic, medical, and clinical information was collected, with an emphasis on the persistence of symptoms and signs related to C19 such as cough, fatigue, diarrhea, headache, smelling disorders, loss of appetite, sore throat, and rhinitis.
- Twenty-two (16.7 percent) of the patients tested positive again. There was no significant difference between patients with positive and negative test results in terms of age or sex. None of the patients had fever and all reported improvement in their overall clinical condition. Time since onset of disease, number of days hospitalized, and treatments received while hospitalized were not significant. However, some symptoms such as fatigue (51 percent), labored breathing (44 percent) and coughing (17 percent) were still present in a significant percentage of the patients studied, although there were no significant differences between individuals with a positive or negative test. The only two symptoms that were higher and significantly prevalent in patients with a positive test were sore throat (18 percent vs. 4 percent) and signs of rhinitis (27 percent vs. 2 percent).
- Our findings indicate that a noteworthy rate of recovered patients with C19 could still be asymptomatic carriers of the virus,” Dr. Landi observed. “The main question for the containment of SARS-CoV-2 pandemic infection that still needs to be answered is whether persistent presence of virus fragments means the patients is still contagious. The RT-PCR test looks for small fragments of viral RNA. A positive swab test can reveal if patients are still shedding viral fragments, but it is not able to discern whether they are or aren’t infectious.”
- Importantly, the investigators recommend that for patients who continue to have symptoms potentially related to C19, it is reasonable to be cautious and avoid close contact with others, wear a face mask, and possibly undergo an additional nasopharyngeal swab.
6. Why You Shouldn’t Worry About Studies Showing Waning C19 Antibodies
- The portion of people in Britain with detectable antibodies to the coronavirus fell by roughly 27% over a period of three months this summer, researchers reported Monday, prompting fears that immunity to the virus is short-lived.
- But several experts said these worries were overblown. It is normal for levels of antibodies to drop after the body clears an infection, but immune cells carry a memory of the virus and can churn out fresh antibodies when needed.
- “Some of these headlines are silly,” said Scott Hensley, an immunologist at the University of Pennsylvania.
- Declining antibody levels after the acute infection has resolved “is the sign of a normal healthy immune response,” Dr. Hensley said. “It doesn’t mean that those people no longer have antibodies. It doesn’t mean that they don’t have protection.”
- The research also raised some fears about the ability of vaccines to help populations reach herd immunity, the point at which enough people would be immune to the coronavirus to thwart its spread.
- It’s too early to know how long immunity to the new coronavirus lasts, and whether people can be reinfected many months to a year after a first bout with the virus. Still, experts said worries about vaccines, too, are unwarranted.
- “The vaccine doesn’t have to mimic or mirror the natural infection,” said Shane Crotty, a virologist at the La Jolla Institute for Immunology. “Certainly I wouldn’t be alarmist about these data.”
- The new results indicate the prevalence of coronavirus antibodies in the broader population but not in specific individuals. Several studies looking at antibody levels in individuals have shown that after some initial decline, the levels hold steady for at least four to seven months.
- The British report is based on three rounds of antibody blood tests carried out in 350,000 randomly selected people from June 20 to Sept. 28. The participants tested themselves at home for antibodies using finger-prick assays that deliver a yes-or-no result, much like a pregnancy test.
- Over the three-month period, the proportion of people with detectable antibodies in their blood dropped to 4.8 percent from 6 percent, the researchers reported. The smallest decline was among people ages 18 to 24 and the biggest in those over age 75.
- Looking at the data a different way, about 73% of people who had antibodies early on still produced a positive result months later, noted Dr. Antonio Bertoletti, a virologist at Duke NUS Medical School in Singapore. “That’s not such a dramatic decline.”
- Antibodies also represent only one arm of the immune response, albeit the one that can most easily be measured. There are at least three other branches of the immune system that can fend off illness, so antibody levels don’t present the full picture.
- “It’s not the whole immune response,” said Dr. Paul Elliott, an epidemiologist at Imperial College London who heads the project.
- When the body encounters a pathogen, it rapidly produces antibodies that recognize the invader. Once the acute infection resolves, the levels decline — as they must for purely practical reasons.
- “Our lymphatic system, where immune cells are, only has a finite amount of space,” Dr. Hensley said.
- Depending on the test used, the small amount of antibodies still circulating in the blood may not be enough for a positive signal. The test used in the study has a sensitivity of 84.4 percent, well below that of lab-based tests that hover around 99%. That means it may miss anyone who has low antibody levels.
- For example, people with mild to no symptoms may have produced fewer antibodies than those with severe illness. Most of the people with positive results were ill in March or April, at the peak of the outbreak in Britain, but about 30 percent did not recall having any Covid-19 symptoms. Even a small decrease in the amount of antibodies may drop their levels below the limit of detection.
- “We’re saying the antibody response has declined below the threshold” of detection, Dr. Elliott said. “This is not a surprise to anyone who works in the field.”
- Data from monkeys suggests that even low levels of antibodies can prevent serious illness from the virus, if not a re-infection. Even if circulating antibody levels are undetectable, the body retains the memory of the pathogen. If it crosses paths with the virus again, balloon-like cells that live in the bone marrow can mass-produce antibodies within hours.
- A very small number of people may not make any antibodies. But even those people may have immune cells called T cells that can identify and destroy the virus. The vast majority of people infected with the coronavirus develop lasting cellular responses, according to several recent studies.
- T cells are unlikely to prevent infection, but they may at least prevent serious illness by blunting the attack, Dr. Crotty said. Given all that, he said, interpreting low antibody levels to mean that immunity disappears, or that coronavirus vaccines will not be effective is “wrong.”
- For example, the human papillomavirus “elicits a terrible immune response and lousy antibodies,” he said. “But the vaccine with a single immunization elicits fantastic antibodies that are 99 percent protective in people for 10-plus years, just a complete night-and-day difference.”
- Vaccines can also be designed to provoke much stronger responses than the natural infection, he added.
- Though criticizing many of the interpretations of it, experts said the new study’s results are an interesting glimpse into the prevalence of antibodies at a population level.
- The same research team is also testing hundreds of thousands of people for presence of the virus. Together, Dr. Elliott said, the studies offer a “really powerful tool” for policymakers to gauge the size of a country’s epidemic.
7. Most people mount a strong antibody response to C19 that lasts for months
- The vast majority of individuals infected with mild-to-moderate C19 mount a robust antibody response that is relatively stable for at least five months, according to research conducted at the Icahn School of Medicine at Mount Sinai and published October 28, in the journal Science. Additionally, the research team found that this antibody response correlates with the body’s ability to neutralize (kill) the coronavirus (SARS-CoV-2).
- “While some reports have come out saying antibodies to this virus go away quickly, we have found just the opposite—that more than 90% of people who were mildly or moderately ill produce an antibody response strong enough to neutralize the virus, and the response is maintained for many months,” said Florian Krammer, Ph.D., Professor of Vaccinology at the Icahn School of Medicine at Mount Sinai and a senior author of the paper. “Uncovering the robustness of the antibody response to SARS-CoV-2, including its longevity and neutralizing effects, is critically important to enabling us to effectively monitor seroprevalence in communities and to determining the duration and levels of antibody that protect us from reinfection. This is essential for effective vaccine development.”
- Study findings are based on a dataset of 30,082 individuals, who were screened within the Mount Sinai Health System between March and October, 2020. The antibody test used in this research—an enzyme-linked immunosorbent assay (ELISA)—is based on the virus’s telltale spike protein that contains the machinery that enables it to attach and gain entry into our cells. The ELISA assay was developed, validated, and launched at Mount Sinai by a team of internationally renowned researchers and clinicians. The Mount Sinai antibody test detects the presence or absence of antibodies to SARS-CoV-2 and, importantly, is capable of measuring the titer (level) of antibodies an individual has. The high sensitivity and specificity of this test—meaning that a false negative or false positive is highly unlikely—allowed it to be among the first to receive emergency use authorization from New York State and the U.S. Food and Drug Administration.
- In late March, Mount Sinai began to screen individuals for antibodies to SARS-CoV-2 in order to recruit volunteer donors for its convalescent plasma therapy program—one of the first such programs in the nation. The Clinical Laboratories of The Mount Sinai Hospital set up antibody test results using distinct dilutions set at 1:80, 1:160, 1:320, 1:960 or ≥ 1:2880. The antibody titer score is generated by the number of times the scientist can dilute a patient’s serum and still be able to detect the presence of antibodies. Titers of 1:80 and 1:160 were categorized as low titers; 1:320 moderate; and 1:960 or ≥ 1:2880 were high.
- By early October, Mount Sinai had screened 72,401 individuals with a total of 30,082 being positive (defined as detectible antibodies to the spike protein at a titer of 1:80 or higher). Of the 30,082 positive samples, 690 (2.29 percent) had a titer of 1:80; 1453 (4.83 percent) of 1:160; 6765 (22.49 percent) of 1:320; 9564 (31.79 percent) of 1:960; and 11610 (38.60 percent) of 1:2880. Thus, the vast majority of positive individuals had moderate-to-high titers of anti-spike antibodies.
- “Our microbiology colleagues generated great science and tools that were brought from the research lab into the clinical laboratory, where we were able to implement robust and compliant diagnostic tests at an unprecedented pace,” said Carlos Cordon-Cardo, MD, Ph.D., Irene Heinz Given and John LaPorte Given Professor and Chair of Pathology, Molecular and Cell-Based Medicine and last author of the paper. “The tireless efforts of so many have enabled us to uncover knowledge that can help inform C19 policy and aid in vaccine development.”
- Determining the neutralizing effects of SARS-CoV-2 is critical to understanding the possible protective effects of the immune response. The research team performed a well-established, quantitative microneutralization assay based on authentic SARS-CoV-2 with 120 samples of known ELISA titers ranging from “negative” to ?1:2880. They found that approximately 50 percent of sera in the 1:80-1:160 titer range had neutralizing activity; 90 percent in the 1:320 range had neutralizing activity; and all sera in the 1:960 to 1:2880 range had neutralizing activity.
- Another important and outstanding question in the scientific community is the longevity of the antibody response to the spike protein. To answer that question, the team recalled 121 plasma donors at a variety of titer levels for repeat antibody testing at approximately 3 months and 5 months post-symptom onset. When comparing overall titers, they saw a slight drop from a geometric mean titer (GMT) of 764 to a GMT of 690 from the first to second testing time point and another drop to a GMT of 404 for the last testing time point, indicating that a moderate level of antibody is retained by most people 5 months after symptom-onset. In the higher titer range, they observed a slow decline in titer over time. Interestingly, they saw an initial increase in titer for individuals who had originally tested as having low to moderate titer levels. This is in agreement with earlier observations from their study group that indicate seroconversion in mild C19 cases might take a longer time to mount.
- “The serum antibody titer we measured in individuals initially were likely produced by plasmablasts, cells that act as first responders to an invading virus and come together to produce initial bouts of antibodies whose strength soon wanes,” said Ania Wajnberg, MD, Director of Clinical Antibody Testing at the Mount Sinai Hospital and first author of the paper. “The sustained antibody levels that we subsequently observed are likely produced by long-lived plasma cells in the bone marrow. This is similar to what we see in other viruses and likely means they are here to stay. We will continue to follow this group over time to see if these levels remain stable as we suspect and hope they will.”
- The Mount Sinai data reveals antibody binding titers to the spike protein correlate significantly with neutralization of SARS-CoV-2 and that the vast majority of individuals with antibody titers of 320 or higher show neutralizing activity in their serum that are stable over a period of at least 3 months with only modest declines at the 5-month time point. Correlates of protection have been established for many different viral infections including influenza, measles, hepatitis A, hepatitis B. These correlates are usually based on a specific level of antibody acquired through vaccination or natural infection that significantly reduces the risk of re-infection. The team will continue following this study cohort over longer intervals of time. Although this cannot provide conclusive evidence that these antibody responses protect from re-infection, the team believes it is very likely that the antibodies will decrease the odds of getting reinfected and may attenuate disease in the case of breakthrough infection. To inform policy for the C19 pandemic and for the benefit of vaccine development, it is imperative to swiftly perform studies to investigate and establish a correlate of protection to SARS-CoV-2. Such investigations are currently being carried out by researchers at the Icahn School of Medicine at Mount Sinai.
8. Scientists Say New Wave in Europe is From Mutated Strain of Coronavirus
- Researchers studying the coronavirus and its genetic mutations revealed in a study a genetic mutation that originated in farmworkers in Spain may have contributed to the second wave in Europe, a report said.
- The Financial Times reported scientists are working to determine what role, if any, variant 20A.EU1 could play in disease’s transmission or lethality. Scientists are looking at the mutation’s possible effect on the virus’ “spike protein.” The variant was found in cases across the continent, including more than 80% in Spain, the paper reported.
- The report pointed out the study has not been published in a peer-reviewed journal. Dr. Emma Hodcroft, an evolutionary geneticist at the University of Basel, said there is no evidence the mutation “increases transmission or impacts the clinical outcome,” according to the paper.
- A new wave of lockdowns and business closings swept across France, Germany and other places in Europe as surging coronavirus infections there and in the U.S. wipe out months of progress against the scourge on two continents.
9. Scientist reportedly contracts C19 twice for immunity experiment
- A Russian scientist took two for the team – becoming infected twice with the coronavirus for the sake of an experiment, according to a report.
- Alexander Chepurnov, a professor of virology and expert at the Novosibirsk Federal Research Center of Basic and Translational medicine, decided to become a guinea pig to find out for how long antibodies will protect him from a repeat infection.
- “I spoke to the COVID patients and realized that the exposure happens at certain period. In six months after the first case, I had confirmed COVID once again,” he told the Russian news agency TASS.
- Chepurnov said he first contracted the deadly bug in the early days of the pandemic on a flight from France to Novosibirsk with a stopover in Moscow.
- He developed the characteristic C19 symptoms and also developed pneumonia later.
- After recovering, he took a test that revealed the presence of antibodies, the outlet reported.
- A second test three months later found that the antibodies had disappeared – though another infection did not occur despite his constant close contact with coronavirus patients.
- The scientists decided to administer periodic tests in an effort to determine for how long his immune system would continue to protect him from the virus.
- After six months, he developed symptoms and was confirmed to be infected.
- “My conclusion is that mankind will most likely be unable to obtain a herd immunity to the coronavirus. I was ready to contract the infection for the second time in order to clear the situation this way,” Chepurnov told TASS.
- He said the disappearance of the antibodies will prevent people from developing a collective immunity.
- Chepurnov suggested that a one-time administration of the Russian vaccine may be insufficient to maintain the immunity, saying periodic vaccinations may be much more effective.
1. Nanoparticle Developed to Target “Achilles Heel” of Coronavirus – Could Be Key for Effective C19 Vaccine
- A University at Buffalo-led research team has discovered a technique that could help increase the effectiveness of vaccines against the novel coronavirus (SARS-CoV-2).
- Jonathan F. Lovell, PhD, associate professor in the Department of Biomedical Engineering at UB, is the primary investigator on the research, titled “SARS-CoV-2 RBD Neutralizing Antibody Induction is Enhanced by Particulate Vaccination,” which was published online in Advanced Materials today, October 28, 2020.
- According to Lovell, one answer might lie in designing vaccines that partially mimic the structure of the virus. One of the proteins on the virus — located on the characteristic COVID spike — has a component called the receptor-binding domain, or RBD, which is its “Achilles heel.” That is, he said, antibodies against this part of the virus have the potential to the neutralize the virus.
- It would be “appealing if a vaccine could induce high-levels of antibodies against the RBD,” Lovell said. “One way to achieve this goal is to use the RBD protein itself as an antigen, that is, the component of the vaccine that the immune response will be directed against.”
- The team hypothesized that by converting the RBD into a nanoparticle (similar in size to the virus itself) instead of letting it remain in its natural form as a small protein, it would generate higher levels of neutralizing antibodies and its ability to generate an immune response would increase.
- Lovell’s team had previously developed a technology that makes it easy to convert small, purified proteins into particles through the use of liposomes, or small nanoparticles formed from naturally-occurring fatty components. In the new study, the researchers included within the liposomes a special lipid called cobalt-porphyrin-phospholipid, or CoPoP. That special lipid enables the RBD protein to rapidly bind to the liposomes, forming more nanoparticles that generate an immune response, Lovell said.
- The team observed that when the RBD was converted into nanoparticles, it maintained its correct, three-dimensional shape and the particles were stable in incubation conditions similar to those in the human body. When laboratory mice and rabbits were immunized with the RBD particles, high antibody levels were induced. Compared to other materials that are combined with the RBD to enhance the immune response, only the approach with particles containing CoPoP gave strong responses.
- Other vaccine adjuvant technology does not have the capacity to convert the RBD into particle-form, Lovell said.
- “We think these results provide evidence to the vaccine-development community that the RBD antigen benefits a lot from being in particle format,” Lovell said. “This could help inform future vaccine design that targets this specific antigen.”
2. It may be time to reset expectations on when we’ll get a C19 vaccine
- The ambitious drive to produce C19 vaccine at warp speed seems to be running up against reality. We all probably need to reset our expectations about how quickly we’re going to be able to be vaccinated.
- Pauses in clinical trials to investigate potential safety issues, a slower-than-expected rate of infections among participants in at least one of the trials, and signals that an expert panel advising the FDA may not be comfortable recommending use of vaccines on very limited safety and efficacy data appear to be adding up to a slippage in the estimates of when vaccine will be ready to be deployed.
- Asked Wednesday about when he expects the FDA will greenlight use of the first vaccines, Anthony Fauci moved the administration’s stated goalpost.
- “Could be January, could be later. We don’t know,” Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an online interview with JAMA editor Howard Bauchner.
- On Tuesday, front-runner Pfizer revealed in an earnings call that the first interim analysis in its Phase 3 clinical trial has not yet occurred. That means there hadn’t yet been enough Covid infections among the trial participants to take a first stab at analyzing whether the people randomly assigned to receive vaccine were infected at a lower rate than people who were assigned to get a placebo injection.
- It’s possible that the company will cross that threshold sooner rather than later. But Pfizer, which has been one of the most aggressive players in the vaccine race, had earlier predicted it would know by the end of September if its vaccine worked — an estimate that was later pushed back to late October. The company now projects that it could apply to the FDA for an emergency use authorization for the vaccine, which it is developing with BioNTech, in mid-November.
- It is important to note that, to date, none of the vaccines being developed for the U.S. market has been proven to be effective in preventing C19 disease. Early stage clinical trials have shown what appear to be promising signals; multiple vaccines have triggered production of important antibodies in people who have been immunized.
- But data generated in a few hundred people aren’t enough to determine whether a vaccine will actually fend off illness. That answer comes from large, Phase 3 trials, five of which are now underway in the United States. Their findings will ultimately tell us how soon vaccines may start to be rolled out to the masses.
- The administration has been saying for months that vaccine would be ready for deployment before the end of the year. In fact, President Trump had been hinting vaccine could be pushed out before Election Day, which it will not be; at a campaign rally on Wednesday night, he said vaccine would be ready “momentarily.”
- Other officials have been bullish in their own right. Just last Friday, Paul Mango, deputy chief of staff for policy for Health and Human Services Secretary Alex Azar, reiterated the administration’s projection that all Americans who want to be vaccinated against C19 will have that opportunity by the early spring.
- “We believe before the end of this year we will be able to vaccinate our most vulnerable citizens,” Mango told journalists in an update on the work of Operation Warp Speed, the government’s effort to fast-track C19 vaccines, drugs, and diagnostics.
- “By the end of January, we believe we’ll be able to vaccinate all seniors. By the March and April timeframe, we believe we’ll be able to vaccinate any American who desires a vaccination,” Mango said.
- In reality, that timeline has always been aspirational — probably excessively so. While Warp Speed and vaccine manufacturers and others involved in the effort have moved heaven and earth to accelerate vaccine production, at the end of the day, developing, testing, and manufacturing vaccines takes time. Vaccines are difficult to produce and there are always bumps in the road.
- “While it’s unfortunate, I don’t find it surprising that the timeline is being moved back,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “Clinical trials like this routinely have unexpected occurrences that delay planned timelines. It’s just not unexpected.”
- As for the idea that all Americans will have had a chance to be vaccinated by the early spring, Osterholm suggested it is going to take longer.
- “For many of us, we never thought that that was doable,” he said. “I commend Operation Warp Speed for what it has accomplished in the time it has, but to have vaccinated the U.S. population by March in my mind was never a realistic goal.”
- Two of the vaccines being supported by Operation Warp Speed have seen their Phase 3 trials paused to investigate unexpected illnesses among a small number of trial participants.
- AstraZeneca, which in June projected it could begin to supply up to 2 billion doses of vaccine in September, instead saw its Phase 3 trials in multiple countries put on hold when a participant experienced neurological symptoms that chairman Pascal Soriot said were consistent with transverse myelitis, a serious inflammatory disorder. While regulators in Britain, India, and South Africa quickly cleared Phase 3 trials to resume enrolling volunteers, the U.S. trial was paused for five weeks.
- Johnson & Johnson, the only manufacturer among the major vaccine makers testing a one-dose Covid vaccine, also saw its Phase 3 trial paused for two weeks after a male volunteer in his 20s suffered what the Washington Post reported to be a stroke.
- After an investigation, the FDA allowed J&J to resume the trial.
- Another manufacturer, Novavax, has pushed back the start date for its U.S. Phase 3 trial to the end of November; it had earlier said the trial would start this month.
- Anna Durbin, a vaccine researcher at Johns Hopkins Bloomberg School of Public Health, said the public needs to understand that Covid vaccines may be a bit further off than people have been led to believe.
- “We may see efficacy in one or more trials by the end of 2020, but that doesn’t mean we’re going to have a vaccine available at the end of 2020,” she said.
- “I think what people can take from this is that the process is not being rushed…. That’s a good thing,” Durbin said. “And certainly, I think the other message that has to be heard loud and clear is that even when an [emergency use authorization] is issued, we’re not going to have enough vaccine for everybody [immediately].”
E. Improved & Potential Treatments
1. Antibody drugs seem to work, but the virus is moving faster than we can make them
- The C19 pandemic teaches one lesson, over and over: The virus is moving faster than we are.
- That difficult message was driven home Wednesday evening with news that an antibody cocktail developed by the drug maker Regeneron — the same cocktail used to treat President Trump — reduced infected patients’ need to visit the doctor, virtually or in person, or go to the hospital by 57%.
- Those are encouraging results — and, if authorized, the cocktail could be an important tool in beating back the virus. But right now, there are only 50,000 doses available, a pittance in comparison with the number of infections across the country.
- “It is deeply unfortunate that we head into fall without enough doses of this drug,” Scott Gottlieb, the former commissioner of the FDA, tweeted after Regeneron released its news. “Many of us were talking about this as early as March. Regeneron did extraordinary work to secure their own manufacturing, but we needed a concerted industrial effort to get the supply we needed.”
- Indeed, Gottlieb penned op-eds in the spring and summer calling for a government-backed effort to manufacture the antibodies in large volumes — akin to the massive effort to develop experimental, and still unproven, C19 vaccines. He reiterated that action needs to be taken now to accumulate sufficient supply to treat high-risk patients.
- Most people who get C19 get better on their own, so to make a material difference in the pandemic’s toll, effective antibody therapies need to be given to a lot of people to help a few.
- Elil Lilly has also seen encouraging results for its own antibody cocktail, but here too supply is limited.
- The potential benefit of such treatments is huge if there were more doses — and if the logistics of using them can be managed. Both Regeneron’s drug and Eli Lilly’s need to be given intravenously.
- Regeneron received funding from the U.S. government to ramp up production, and it has announced a partnership with Roche to scale up manufacturing further. The company expects to be able to produce 300,000 doses in the coming months. (The dose is a lot of antibody: 2.4 grams. Many antibody drug doses are measured in milligrams.)
- Lilly has said it anticipates being able to ship 100,000 doses of its single antibody if regulators clear it, and could produce as much as a million doses by the end of the year. But that means using a dosage — 0.7 grams — that is lower than the one that appeared most effective in its single-antibody trial (2.8 grams) or the dose that was used in a trial of a combination antibody, which appeared more effective.
- The companies, in being able to make doses for as many people as they have, have moved mountains. But it will be not enough.
- As with so many efforts to tame this pandemic, every victory is tainted by the approach of the next battle.
2. Flu Vaccine May Provide Some Protection Against C19
- Preliminary research out this month may provide you with a bit more incentive to get the flu vaccine. It found evidence that flu vaccination led to a lowered risk of getting C19 among health care workers in the Netherlands. Though not definitive, the study isn’t the first to suggest that certain vaccines can provide minor, nonspecific protection against infectious diseases not targeted by the vaccine, possibly including C19.
- The research paper was released on the preprint website medRxiv in mid-October by scientists from the Netherlands and Germany. In it, they detail two separate investigations of the theory that the flu vaccine used in the Netherlands last winter—an inactivated vaccine meant to protect against the four main strains of the influenza virus in circulation—could lower the risk of C19. In many countries, including the U.S., this is the primary type of flu vaccine used annually.
- The basic idea is that some vaccines cannot only train the parts of the immune system meant to recognize a specific germ‚ known as the adaptive immune system, but also temporarily boost the effectiveness of our innate immune system. The innate immune system uses a wide array of weapons to repel all sorts of invading germs, making it one of the body’s first lines of defense against unfamiliar microbial threats. A vaccine, it’s thought, can briefly keep the innate immune system more alert and ready to stop the next germ that crosses its way. Scientists call this theoretical boost “trained immunity.”
- In the lab, the researchers found that human immune cells first exposed to the flu vaccine seemed to form a trained immune response to the coronavirus behind C19, compared to a control group of cells. In Dutch hospitals, they found that hospital workers who were vaccinated with last winter’s flu vaccine had a lower risk of being diagnosed with C19 than workers who didn’t get vaccinated.
- “In conclusion, a quadrivalent inactivated influenza vaccine can induce trained immunity responses against SARS-CoV-2, which may result in relative protection against C19,” they wrote.
- The results have yet to go through the peer review process, meaning they should be viewed with some extra caution. And though this study’s authors do provide two lines of evidence for their conclusions, neither is clear proof that a flu vaccine will protect you from C19. There are other possible explanations for why Dutch hospital workers who took a flu shot may have been less likely to get C19, for instance. It could be that these workers are extra cautious about catching any contagious illness—a personality trait that would both nudge them to get vaccinated for the flu and to avoid situations where C19 is likelier to spread.
- This isn’t the first study to find evidence that existing vaccines can meaningfully protect people from C19. But not all of the data has been encouraging, and some experts remain skeptical of the theory. A study published in JAMA this May, for instance, found no evidence that people in Israel who took a BCG vaccine, used to prevent tuberculosis, in childhood were less likely to contract C19 as adults in their 30s and 40s. It’s possible a trained immunity effect created by the BCG vaccine could still exist, just not for that long, but those findings should be a reminder that this theory is not a sure thing. If even trained immunity is the real deal, it almost certainly won’t provide complete protection from the pandemic.
- There are ongoing clinical trials testing out whether the BCG vaccine and others can provide some short-term protection from C19—trials that will hopefully give us a clear answer one way or the other. In the meantime, though, getting vaccinated against the flu is already one of the most helpful things you can do for yourself and your community this winter. If it turns out that it lowers the risk of C19 too, so much the better.
F. Concerns & Unknowns
1. C19 causes ‘chronic’ cognitive deficits equivalent to brain aging 10 years
- Coronavirus can significantly impact brain function, causing mental decline equivalent to the brain aging 10 years, according to an alarming new study.
- A study of more than 84,000 people in the UK found that the virus left even those deemed recovered with “chronic cognitive consequences” that it compared to dropping 8.5 IQ points.
- “People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits,” the study published on MedRxiv said.
- “The deficits were broad, affecting multiple cognitive domains,” the researchers warned in the study, which has yet to be peer-reviewed.
- The study used cognitive tests — such as remembering words or joining dots on a puzzle — that are often used to assess brain performance in diseases like Alzheimer’s.
- The cognitive deficits were “of substantial effect size” and “scaled with symptom severity,” especially those hospitalized, but also “evident amongst those without hospital treatment,” the study said.
- Imperial College London doctor Adam Hampshire, who led the research, told the Times of London that it was a “large enough difference” to “notice an impact on the ability to cope with your normal job and everyday life.”
- “The results align with the ‘brain fog’ reported by many people who, even months after recovery, say they are unable to concentrate on work or focus how they did before,” he told the UK paper.
- The study called the findings a “clarion call for more detailed research.”
- Other experts not involved in the study warned that the results should be viewed with some caution — especially because the study did not record before-and-after cognitive test scores.
- “The cognitive function of the participants was not known pre-COVID, and the results also do not reflect long-term recovery — so any effects on cognition may be short-term,” Joanna Wardlaw, a professor of applied neuroimaging at Edinburgh University, told Reuters.
- Derek Hill, a professor of medical imaging science at University College London, described the results as an “intriguing” but “inconclusive” piece of research into the effect coronavirus can have on the brain.
2. Age and pre-existing conditions increase risk of stroke among C19 patients
- 14 out of every 1,000 C19 patients admitted to hospital experience a stroke, a rate that is even higher in older patients and those with severe infection and pre-existing vascular conditions, according to a report published this week.
- C19 has become a global pandemic, affecting millions of people worldwide. In many cases, the symptoms include fever, persistent dry cough and breathing difficulties, and can lead to low blood oxygen. However, the infection can cause disease in other organs, including the brain, and in more severe cases can lead to stroke and brain haemorrhage.
- A team of researchers at the Stroke Research Group, University of Cambridge, carried out a systematic review and meta-analysis of published research into the link between C19 and stroke. This approach allows researchers to bring together existing – and often contradictory or under-powered – studies to provide more robust conclusions.
- In total, the researchers analysed 61 studies, covering more than 100,000 patients admitted to hospital with C19. The results of their study are published in the International Journal of Stroke.
- The researchers found that stroke occurred in 14 out of every 1,000 cases. The most common manifestation was acute ischemic stroke, which occurred in just over 12 out of every 1,000 cases. Brain haemorrhage was less common, occurring in 1.6 out of every 1,000 cases. Most patients had been admitted with C19 symptoms, with stroke occurring a few days later.
- Age was a risk factor, with C19 patients who developed stroke being on average (median) 4.8 years older than those who did not. C19 patients who experienced a stroke were on average (median) six years younger than non-C19 stroke patients. There was no sex difference and no significant difference in rates of smokers versus non-smokers.
- Pre-existing conditions also increased the risk of stroke. Patients with high blood pressure were more likely to experience stroke than patients with normal blood pressure, while both diabetes and coronary artery disease also increased risk. Patients who had a more severe infection with the coronavirus (SARSCoV2) – the coronavirus that causes C19 – were also more likely to have a stroke.
- The researchers found that C19-associated strokes often followed a characteristic pattern, with stroke caused by blockage of a large cerebral artery, and brain imaging showing strokes in more than one cerebral arterial territory. They argue that this pattern suggests cerebral thrombosis and/or thromboembolism are important factors in causing stroke in C19. C19-associated strokes were also more severe and had a high mortality.
- An important question is whether C19 increases the risk of stroke or whether the association is merely a result of C19 infection being widespread in the community.
- “The picture is complicated,” explained Dr Stefania Nannoni from the Department of Clinical Neurosciences at the University of Cambridge, the study’s first author. “For example, a number C19 patients are already likely to be at increased risk of stroke, and other factors, such as the mental stress of C19, may contribute to stroke risk.
- “On the other hand, we see evidence that C19 may trigger – or at least be a risk factor for – stroke, in some cases. Firstly, SARSCoV2 more so than other coronaviruses – and significantly more so than seasonal flu – appears to be associated with stroke. Secondly, we see a particular pattern of stroke in individuals with C19, which suggests a causal relationship in at least a proportion of patients.”
- The researchers say there may be several possible mechanisms behind the link between C19 and stroke. One mechanism might be that the virus triggers an inflammatory response that causes thickening of the blood, increasing the risk of thrombosis and stroke. Another relates to ACE2 – a protein ‘receptor’ on the surface of cells that SARS-CoV-2 uses to break into the cell. This receptor is commonly found on cells in the lungs, heart, kidneys, and in the lining of blood vessels – if the virus invades the lining of blood vessels, it could cause inflammation, constricting the blood vessels and restricting blood flow.
- A third possible mechanism is the immune system over-reacting to infection, with subsequent excessive release of proteins known as cytokine. This so-called ‘cytokine storm’ could then cause brain damage.
- The team say their results may have important clinical implications.
- “Even though the incidence of stroke among C19 patients is relatively low, the scale of the pandemic means that many thousands of people could potentially be affected worldwide,” said Professor Hugh Markus, who leads the Stroke Research Group at Cambridge.
- “Clinicians will need to look out for signs and symptoms of stroke, particularly among those groups who are at particular risk, while bearing in mind that the profile of an at-risk patient is younger than might be expected.”
- While the majority of strokes occurred after a few days of C19 symptoms onset, neurological symptoms represented the reason for hospital admission in more than one third of people with C19 and stroke.
- Dr Nannoni added: “Given that patients admitted to hospital with symptoms of stroke might have mild C19-related respiratory symptoms, or be completely asymptomatic, we recommend that all patients admitted with stroke be treated as potential C19 cases until the results of screening in the hospital are negative.”
G. Tests & Masks
1. Singapore firm invents coronavirus breathalyzer with results in seconds
- A company in Singapore has developed a breathalyzer test for the new coronavirus which it says will enable people to know whether they are infected in under a minute.
- Breathonix, a startup firm from the National University of Singapore, says its test achieved more than 90% accuracy in a pilot clinical trial of 180 people in the city-state and hopes to get regulatory approval early next year.
- Countries worldwide are looking to develop alternative tests to the Polymerase Chain Reaction (PCR) nasal swab, which is invasive and in short supply in some places where demand has outstripped manufacturers’ production capacity.
- Breathonix is currently expanding its trial in Singapore and hopes to improve accuracy and get the green light to go commercial in the first quarter of next year.
- At US$20, Breathonix says its test would be 70% cheaper than PCR tests, although infected patients would likely still need the more sensitive PCR tests to confirm the diagnosis.
- “The breath test is more like a first level screen device,” said Jia Zhunan, co-founder and CEO of Breathonix, adding it could be deployed at conferences, sports events and concerts.
- The device uses disposable mouthpieces and is designed to ensure there is no cross-contamination.
- After blowing into the device, it assesses the chemical compounds of the breath to determine whether or not a person is infected. Results are generated by a computer within 60 seconds.
- A similar breathalyzer is being tested by a hospital in France, although experts have warned the system may be too costly for widespread distribution.
2. Biomarkers could be used in a quick, inexpensive C19 blood screening tool
- A new study from Lawson Health Research Institute, Western University and University of Alberta suggests that C19 affects the human body’s blood concentration levels of specific metabolites – small molecules broken down in the human body through the process of metabolism.
- Three specific metabolites identified in this study could act as biomarkers and one day be measured through an inexpensive blood test to quickly screen patients for the disease and predict which patients will become most critically ill. The team also suspects those metabolites depleted by the virus could be delivered to patients as dietary supplements, acting as a secondary therapy. Published in Critical Care Explorations, the early findings add to the research team’s growing body of evidence on the bodily changes caused by the coronavirus (SARS-CoV-2).
- “While our findings need to be confirmed in a larger group of patients, they could lead to a rapid, cost-effective screening tool as a first line of testing in the community and in-hospital.”
- “Metabolites are the final breakdown products in the human body and play key roles in cellular activity and physiology. By studying them, we can understand chemical processes that are occurring at any given moment, including those that regulate biological functions related to health and disease,” explains Dr. David Wishart, Codirector of TMIC and Professor of Biological Sciences, Computing Science and Laboratory Medicine & Pathology with the University of Alberta. “Because the human metabolome responds very quickly to environmental factors like pathogens, metabolomics can play an important role in early-stage disease detection, including for C19.”
- The team discovered four metabolites of importance to C19 disease detection. The concentration of one metabolite called kynurenine was elevated in C19 patients while concentrations of the other three metabolites (arginine, sarcosine and lysophosphatidylcholines) were decreased.
- After further analysis, they discovered that by studying the concentrations of only two metabolites – kynurenine and arginine – they could distinguish C19 patients from healthy participants and other critically ill patients with 98% accuracy.
- The team also discovered that concentrations of two metabolites (creatinine and arginine) could be used to predict which critically-ill C19 patients were most at risk of dying. When measured on a patient’s first and third day in ICU, these metabolites predicted C19-associated death with 100% accuracy.
- “It’s our hope these findings can be validated in larger patient populations and then used to develop a simple blood test that shows high likelihood of infection and disease severity, providing rapid results in as little as 20 minutes,” explains Dr. Fraser. “This could ease the demand for current testing methods, perhaps being used as a portable, first-line screening tool in the community and for when undiagnosed patients present to hospital.”
- The team also notes the reduction of key metabolites reflects changes to biochemical pathways or functions in the body which are important to maintaining health and fighting disease. They suggest their findings warrant further study to determine whether certain metabolites could be boosted through dietary supplements. A precision health approach like this could lead to repaired biochemical pathways and improved disease outcomes.
- “Providing dietary supplements could be a simple adjunctive or secondary therapy with meaningful outcomes,” says Dr. Fraser. “For example, the metabolite arginine is essential to tissue repair while the metabolite sarcosine activates a process to remove damaged cells. Knowing that C19 causes hyperinflammation that can damage cells and tissue, particularly in the lungs, supporting these processes may prove critical.”
- In an earlier study, the team was the first to profile the body’s immune response to the SARS-CoV-2 virus and discover six potential therapeutic targets to improve outcomes. In other studies, they have discovered additional biomarkers that could be used to predict how severely ill a C19 patient will become and uncovered a mechanism causing blood clots in C19 patients and potential ways to treat them.
- “We’re working to uncover hard evidence about how the virus invades the body. Ultimately, we hope our combined findings can lead to faster diagnosis, ways to identify patients most at risk of poor outcomes and targets for novel treatments,” notes Dr. Fraser.
3. Masks Are a Distraction From the Pandemic Reality
- A hallmark of C19 pandemic policy has been the failure of political leaders and health officials to anticipate the unintended consequences of their actions. This tendency has haunted many decisions, from lockdowns that triggered enormous unemployment and increased alcohol and drug abuse, to school closures that are widening educational disparities between rich and poor families. Mask mandates may also have unintended consequences that outweigh the benefits.
- First, consider how the debate has evolved and the underlying scientific evidence. Several randomized trials of community or household masking have been completed. Most have shown that wearing a mask has little or no effect on respiratory virus transmission, according to a review published earlier this year in Emerging Infectious Diseases, the Centers for Disease Control and Prevention’s journal. In March, when Anthony Fauci said, “wearing a mask might make people feel a little bit better” but “it’s not providing the perfect protection that people think it is,” his statement reflected scientific consensus, and was consistent with the World Health Organization’s guidance.
- Almost overnight, the recommendations flipped. The reason? The risk of asymptomatic transmission. Health officials said mask mandates were now not only reasonable but critical. This is a weak rationale, given that presymptomatic spread of respiratory viruses isn’t a novel phenomenon in public health. Asymptomatic cases of influenza occur in up to a third of patients, according to a 2016 report in Emerging Infectious Diseases, and even more patients had mild cases that are never diagnosed. Asymptomatic or mild cases appear to contribute more to C19 transmission, but this happens in flu cases, too, though no one has called for mask mandates during flu season.
- The public assumes that research performed since the beginning of the pandemic supports mask mandates. Policy makers and the media point to low-quality evidence, such as a study of C19 positive hairstylists in Missouri or a Georgia summer camp with an outbreak. These anecdotes, while valuable, tell us nothing about the experience of other hairdressers or other summer camps that adopted similar or different masking practices. Also low-quality evidence: Videos of droplets spreading through air as people talk, a well-intended line of research that has stoked fears about regular human interactions.
- Rather, the highest-quality evidence so far is studies like the one published in June in Health Affairs, which found that U.S. states instituting mask mandates had a 2% reduction in growth rates of C19 compared with states without these mandates. Because respiratory virus spread is exponential, modest reductions can translate into large differences over time. But these shifts in trajectory are distinct from the notion that mandating masks will bring the pandemic to an end. Based on evidence around the world, it should be clear that mask mandates won’t extinguish the virus.
- The most reasonable conclusion from the available scientific evidence is that community mask mandates have—at most—a small effect on the course of the pandemic. But you wouldn’t know that from watching cable news or sitting next to a mother being forced off an airplane because her small children aren’t able to keep a mask on.
- While mask-wearing has often been invoked in explanations for rising or falling C19 case counts, the reality is that these trends reflect a basic human need to interact with one another. Claims that low mask compliance is responsible for rising case counts are also not supported by Gallup data, which show that the percentage of Americans reporting wearing masks has been high and relatively stable since June. Health officials and political leaders have assigned mask mandates a gravity unsupported by empirical research.
- On even shakier scientific ground is the promotion of mask use outdoors. One contact-tracing study identified only a single incident of outdoor transmission among 318 outbreaks. Even the Rose Garden nomination ceremony for Justice Amy Coney Barrett, which the media giddily labeled a “superspreader” event, likely wasn’t; transmission more likely occurred during indoor gatherings associated with the ceremony.
- By paying outsize and scientifically unjustified attention to masking, mask mandates have the unintended consequence of delaying public acceptance of the unavoidable truth. In countries with active community transmission and no herd immunity, nothing short of inhumane lockdowns can stop the spread of C19, so the most sensible and sustainable path forward is to learn to live with the virus.
- Shifting focus away from mask mandates and toward the reality of respiratory viral spread will free up time and resources to protect the most vulnerable Americans. There is strong evidence that treating patients early in outpatient settings can be effective, as outlined in a recent American Journal of Medicine paper, but these treatments are underused. Identifying effective treatments for hospitalized patients with C19 is essential, but preventing severe illness before hospitalization will save more lives.
- Until the reality of viral spread in the U.S.—with or without mask mandates—is accepted, political leaders will continue to feel justified in keeping schools and businesses closed, robbing young people of the opportunity to invest in their futures, and restricting activities that make life worthwhile. Policy makers ought to move forward with more wisdom and sensibility to mitigate avoidable costs to human life and well-being.
4. Winter Is Coming: Time for a Mask Mandate
Opinion by Dr Scott Gottlieb, former Commssioner of the FDA
- France set a record for Covid-19 infections this weekend, and Italy has announced new restrictions, such as closing bars and restaurants at 6 p.m. The feared fall coronavirus surge has arrived in Europe and also in the U.S., where cases continue to rise. It’s time to consider a limited and temporary national mask mandate.
- Consider hospitalizations, which reached 42,000 on Saturday, up from 30,000 a month ago. This increase comes even as hospital admission criteria have become more stringent, with more patients managed at home. It’s true that more testing reveals more cases. But most tests are done because people have Covid symptoms or come into contact with someone who is sick. Total hospitalizations, which are on pace to eclipse totals from the spring, are an objective measure of a rampant epidemic.
- As deaths rise this winter, policy makers will have to take new steps to slow the rate of spread. There is no support for reprising this spring’s stay-at-home orders. It will be essential to use standard interventions, including limits on crowded settings such as bars and continuing to test and trace contacts. But on the current trajectory these measures won’t be enough to keep hospitals from being overwhelmed in some areas.
- Masks would help. As a practical matter, it’s easier to wear a mask in the winter than the summer. A mandate can be expressly limited to the next two months. The inconvenience would allow the country to preserve health-care capacity and keep more schools and businesses open. Studies show widespread use of masks can reduce spread. But even if masks are only incrementally helpful, they are among the least economically costly and burdensome options for reducing spread.
- It’s long been known that masks can reduce the spread of flu, and the same logic applies to the coronavirus. People are most contagious before showing symptoms, and many never develop symptoms at all. Data show that masks can trap many droplets that carry infectious particles. Everyone wearing a mask in public would help reduce asymptomatic spread.
- Not all masks are created equal. The quality matters, especially if you are looking for a mask that protects you from others, not just others from you. A cotton mask offers far less protection than a level 2 or level 3 surgical mask. For cotton masks, generally thicker is better, and cotton-and-polyester blends tend to provide more protection. An N95 or equivalent mask offers the best protection from inhaling someone else’s infectious droplets or aerosols. Look up instructions for fit testing if you go this route. A fleece mask is unlikely to do much.
- There’s a presumption that a mask mandate would have to be backed up with fines and set off scuffles with law enforcement. Not necessarily. States should be able to choose how to enforce a mandate, but the goal should be to make masks a social and cultural norm, not a political statement. There are lots of things we do because there is a community expectation of civil behaviors: No shoes, no service. Clean up after your dog. Many of these are even codified in city ordinances.
- Mandating masks has become divisive only because it was framed that way by some politicians and commentators. Some states such as Wisconsin and Utah are setting up field hospitals.
- Deaths are starting to rise again, and vaccines won’t be widely available until next year even in the best-case scenario. Everyone banding together to wear masks, for a limited time, will be the least costly way for society to weather a difficult winter.
5. The Sketchy Claims of the Case for a Mask Mandate
- New coronavirus cases are spiking again as we head into the colder months. While this pattern likely reflects the long-anticipated seasonality of the disease, the lockdown-aligned American news media is currently peddling a different narrative.
- Not enough Americans are doing their duty to defeat the virus by wearing masks, we’re constantly hectored. To this end, the Washington Post ran a flashy visual display purporting to show that high-mask use states are faring better than the rest (conveniently omitting mention that many of those same states were the hardest hit during the first wave last spring, albeit at a time when mask use was less common).
- Anthony Fauci – who publicly discouraged mask use last March – is now claiming that only a national mask-wearing mandate will save us from the months ahead. Further stoking the flames, the modelers of the University of Washington’s IHME team have even published an updated forecast warning of an additional 500,000 deaths unless we all mask up.
- There’s a fundamental problem however with the media’s current mask frenzy: the American public has already adopted mask-wearing at an extraordinarily high rate. In fact, we hit almost 80% mask use back in July according to a survey tracker of behavioral changes in response to the pandemic. Furthermore, the United States has consistently hovered in the 80% mask compliance territory ever since. [NOTE: As noted above, a recent Gallup poll indicated mask usage reached 91%]
- To give you a sense of perspective, the 80% mask use threshold is also where Thailand, Vietnam, and Taiwan have hovered since the beginning of the pandemic. These three Asian countries have thus far weathered the COVID-19 outbreak with only modest case counts – an outcome that is often attributed to their widespread adoption of masks after similar experiences in past regional epidemics such as SARS.
- It took the US from March until mid-July to catch up with these countries – again, but we’ve maintained near-parity with these supposed masking success stories for the last three months now.
- The survey data belie the talking points. Since the start of the pandemic, United States’ mask adoption patterns have consistently outperformed such “socially responsible” nations as Germany, the United Kingdom, and the four Nordic countries.
- American mask usage rates also sit at parity with our northern neighbor Canada, and well exceed the lockdown-addicted dystopia of Australia.
- Mask use in some countries does exceed the United States pattern, but only slightly. Spain, Italy, and France have all hovered around 85 to 90% mask adoption since the late spring.
- Europe is currently undergoing a fall surge and, as of mid-October, has far overtaken the United States in daily new cases. As of this writing the surge appears to be indiscriminate, playing out in both the heavy mask regions of southern Europe and in countries that have lagged in mask adoption such as Germany and the United Kingdom. Widespread mask usage in France, Italy, and Spain clearly did not stop the European second wave, but neither did the European countries that lagged behind on mask adoption.
- What then are we to make of these data on masking patterns? Keep in mind that the most recent epidemiological forecasting, such as the IHME model, places heavy weight upon the effectiveness of masks as a primary tool for COVID mitigation.
- As an interesting aside, the IHME group recently published a new paper in the top science journal Nature where they claim that “the national [US] average for self-reported mask wearing was 49% as of 21 September 2020.” The citation for this figure however goes to the IHME’s own website, where they list a much higher 68% mask compliance rate for September 21st. By all appearances, the IHME paper’s conclusion is based on a simple typographical error that led them to severely understate the level of mask use in the United States.
- The typo is no small matter to their thesis. Citing the erroneous 49% figure, its authors assert that there is “a considerable population health benefit to mask use with great potential for uptake in the United States” and predict that almost a hundred thousand lives could be saved by increasing this number to their target level of 85%.
- It now appears that they undershot their own mask compliance data by almost 20 percentage points, which in turn is another 10 percentage points below the latest survey data for the United States.
- Curiously, the heavy focus on masks as a catch-all “solution” to C19 was not the case only 8 months ago. The now-infamous lockdown forecast from Neil Ferguson of Imperial College even intentionally omitted masks from its equations. As Ferguson explained in his 2006 paper describing the model he then adapted to C19, “We do not present projections of the likely impact of personal protective measures (for example, face masks) on transmission, again due to a lack of data on effectiveness.”
- Some time in the intervening months however, masks became a magic bullet in both the media narrative and the epidemiology literature – and along with it a mythical perception that mask use remains uncommon.
- As we see in the survey data above though, mask adoption is now widespread. It simply isn’t the silver bullet we were promised. Masks do appear to offer some benefit in reducing transmission under specific circumstances. For example, a comprehensive focused protection strategy would likely advise mask use in the presence of vulnerable populations and in certain indoor public settings, or even subsidize the provision of N-95 masks to senior citizens and other high-risk persons.
- But the American population has already widely adopted masks to the tune of 80% usage for the last three months, with no signs of dissipating. Insofar as these practices help, they are likely to reduce exposure in the presence of vulnerable persons in certain settings. That much should be acknowledged and encouraged as part of a new focused protection strategy.
- Yet as we are now seeing in Europe and parts of the United States though, the fall 2020 case surge came many months after the widespread adoption of masks in these regions. Masks are not the next big policy step to take, but rather one that most of the afflicted regions have already taken. They simply weren’t the universal panacea that our media and parts of the epidemiology profession promised.
H. Innovation & Technology
1. AI Can Diagnose C19 Through Cellphone-Recorded Coughs – Even if You Don’t Have Symptoms
- Asymptomatic people who are infected with C19 exhibit, by definition, no discernible physical symptoms of the disease. They are thus less likely to seek out testing for the virus, and could unknowingly spread the infection to others.
- But it seems those who are asymptomatic may not be entirely free of changes wrought by the virus. MIT researchers have now found that people who are asymptomatic may differ from healthy individuals in the way that they cough. These differences are not decipherable to the human ear. But it turns out that they can be picked up by artificial intelligence.
- In a paper published recently in the IEEE Journal of Engineering in Medicine and Biology, the team reports on an AI model that distinguishes asymptomatic people from healthy individuals through forced-cough recordings, which people voluntarily submitted through web browsers and devices such as cellphones and laptops.
- The researchers trained the model on tens of thousands of samples of coughs, as well as spoken words. When they fed the model new cough recordings, it accurately identified 98.5 percent of coughs from people who were confirmed to have C19, including 100 percent of coughs from asymptomatics — who reported they did not have symptoms but had tested positive for the virus.
- The team is working on incorporating the model into a user-friendly app, which if FDA-approved and adopted on a large scale could potentially be a free, convenient, noninvasive prescreening tool to identify people who are likely to be asymptomatic for C19. A user could log in daily, cough into their phone, and instantly get information on whether they might be infected and therefore should confirm with a formal test.
- “The effective implementation of this group diagnostic tool could diminish the spread of the pandemic if everyone uses it before going to a classroom, a factory, or a restaurant,” says co-author Brian Subirana, a research scientist in MIT’s Auto-ID Laboratory.
- Prior to the pandemic’s onset, research groups already had been training algorithms on cellphone recordings of coughs to accurately diagnose conditions such as pneumonia and asthma. In similar fashion, the MIT team was developing AI models to analyze forced-cough recordings to see if they could detect signs of Alzheimer’s, a disease associated with not only memory decline but also neuromuscular degradation such as weakened vocal cords.
- They first trained a general machine-learning algorithm, or neural network, known as ResNet50, to discriminate sounds associated with different degrees of vocal cord strength. Studies have shown that the quality of the sound “mmmm” can be an indication of how weak or strong a person’s vocal cords are. Subirana trained the neural network on an audiobook dataset with more than 1,000 hours of speech, to pick out the word “them” from other words like “the” and “then.”
- The team trained a second neural network to distinguish emotional states evident in speech, because Alzheimer’s patients — and people with neurological decline more generally — have been shown to display certain sentiments such as frustration, or having a flat affect, more frequently than they express happiness or calm. The researchers developed a sentiment speech classifier model by training it on a large dataset of actors intonating emotional states, such as neutral, calm, happy, and sad.
- The researchers then trained a third neural network on a database of coughs in order to discern changes in lung and respiratory performance.
- Finally, the team combined all three models, and overlaid an algorithm to detect muscular degradation. The algorithm does so by essentially simulating an audio mask, or layer of noise, and distinguishing strong coughs — those that can be heard over the noise — over weaker ones.
- With their new AI framework, the team fed in audio recordings, including of Alzheimer’s patients, and found it could identify the Alzheimer’s samples better than existing models. The results showed that, together, vocal cord strength, sentiment, lung and respiratory performance, and muscular degradation were effective biomarkers for diagnosing the disease.
- When the coronavirus pandemic began to unfold, Subirana wondered whether their AI framework for Alzheimer’s might also work for diagnosing C19, as there was growing evidence that infected patients experienced some similar neurological symptoms such as temporary neuromuscular impairment.
- “The sounds of talking and coughing are both influenced by the vocal cords and surrounding organs. This means that when you talk, part of your talking is like coughing, and vice versa. It also means that things we easily derive from fluent speech, AI can pick up simply from coughs, including things like the person’s gender, mother tongue, or even emotional state. There’s in fact sentiment embedded in how you cough,” Subirana says. “So we thought, why don’t we try these Alzheimer’s biomarkers [to see if they’re relevant] for Covid.”
“A striking similarity”
- In April, the team set out to collect as many recordings of coughs as they could, including those from C19 patients. They established a website where people can record a series of coughs, through a cellphone or other web-enabled device. Participants also fill out a survey of symptoms they are experiencing, whether or not they have C19, and whether they were diagnosed through an official test, by a doctor’s assessment of their symptoms, or if they self-diagnosed. They also can note their gender, geographical location, and native language.
- To date, the researchers have collected more than 70,000 recordings, each containing several coughs, amounting to some 200,000 forced-cough audio samples, which Subirana says is “the largest research cough dataset that we know of.” Around 2,500 recordings were submitted by people who were confirmed to have C19, including those who were asymptomatic.
- The team used the 2,500 Covid-associated recordings, along with 2,500 more recordings that they randomly selected from the collection to balance the dataset. They used 4,000 of these samples to train the AI model. The remaining 1,000 recordings were then fed into the model to see if it could accurately discern coughs from Covid patients versus healthy individuals.
- Surprisingly, as the researchers write in their paper, their efforts have revealed “a striking similarity between Alzheimer’s and Covid discrimination.”
- Without much tweaking within the AI framework originally meant for Alzheimer’s, they found it was able to pick up patterns in the four biomarkers — vocal cord strength, sentiment, lung and respiratory performance, and muscular degradation — that are specific to C19. The model identified 98.5% of coughs from people confirmed with C19, and of those, it accurately detected all of the asymptomatic coughs.
- “We think this shows that the way you produce sound, changes when you have Covid, even if you’re asymptomatic,” Subirana says.
- The AI model, Subirana stresses, is not meant to diagnose symptomatic people, as far as whether their symptoms are due to C19 or other conditions like flu or asthma. The tool’s strength lies in its ability to discern asymptomatic coughs from healthy coughs.
- The team is working with a company to develop a free pre-screening app based on their AI model. They are also partnering with several hospitals around the world to collect a larger, more diverse set of cough recordings, which will help to train and strengthen the model’s accuracy.
- As they propose in their paper, “Pandemics could be a thing of the past if pre-screening tools are always on in the background and constantly improved.”
- Ultimately, they envision that audio AI models like the one they’ve developed may be incorporated into smart speakers and other listening devices so that people can conveniently get an initial assessment of their disease risk, perhaps on a daily basis.
2. Early results from DETECT study suggest fitness trackers can predict C19 infections
- Examining data from the first six weeks of their landmark DETECT study, a team of scientists from the Scripps Research Translational Institute sees encouraging signs that wearable fitness devices can improve public health efforts to control C19.
- The DETECT study, launched on March 25, uses a mobile app to collect smartwatch and activity tracker data from consenting participants, and also gathers their self-reported symptoms and diagnostic test results. Any adult living in the United States is eligible to participate in the study by downloading the research app, MyDataHelps.
- In a study that appears today in Nature Medicine, the Scripps Research team reports that wearable devices like Fitbit are capable of identifying cases of C19 by evaluating changes in heart rate, sleep and activity levels, along with self-reported symptom data–and can identify cases with greater success than looking at symptoms alone.
- “What’s exciting here is that we now have a validated digital signal for C19. The next step is to use this to prevent emerging outbreaks from spreading,” says Eric Topol, MD, director and founder of the Scripps Research Translational Institute and executive vice president of Scripps Research. “Roughly 100 million Americans already have a wearable tracker or smartwatch and can help us; all we need is a tiny fraction of them–just 1 percent or 2 percent–to use the app.”
- With data from the app, researchers can see when participants fall out of their normal range for sleep, activity level or resting heart rate; deviations from individual norms are a sign of viral illness or infection.
- But how do they know if the illness causing those changes is C19? To answer that question, the team reviewed data from those who reported developing symptoms and were tested for the novel coronavirus. Knowing the test results enabled them to pinpoint specific changes indicative of C19 versus other illnesses.
- “One of the greatest challenges in stopping C19 from spreading is the ability to quickly identify, trace and isolate infected individuals,” says Giorgio Quer, PhD, director of artificial intelligence at Scripps Research Translational Institute and first author of the study. “Early identification of those who are pre-symptomatic or even asymptomatic would be especially valuable, as people may potentially be even more infectious during this period. That’s the ultimate goal.”
- For the study, the team used health data from fitness wearables and other devices to identify–with roughly 80% prediction accuracy–whether a person who reported symptoms was likely to have C19. This is a significant improvement from other models that only evaluated self-reported symptoms.
- As of June 7, 30,529 individuals had enrolled in the study, with representation from every U.S. state. Of these, 3,811 reported symptoms, 54 tested positive for the coronavirus and 279 tested negative. More sleep and less activity than an individual’s normal levels were significant factors in predicting coronavirus infection.
- The predictive model under development in DETECT might someday help public health officials spot coronavirus hotspots early. It also may encourage people who are potentially infected to immediately seek diagnostic testing and, if necessary, quarantine themselves to avoid spreading the virus.
- “We know that common screening practices for the coronavirus can easily miss pre-symptomatic or asymptomatic cases,” says Jennifer Radin, PhD, an epidemiologist at the Scripps Research Translational Institute who is leading the study. “And infrequent viral tests, with often-delayed results, don’t offer the real-time insights we need to control the spread of the virus.”
- The DETECT team is now actively recruiting more participants for this important research. The goal to enroll more than 100,000 people, which will help the scientists improve their predictions of who will get sick, including those who are asymptomatic. In addition, Radin and her colleagues plan to incorporate data from frontline essential workers who are at an especially high risk of infection.
3. Face Mask With Anti-viral Layer to Deactivate the Coronavirus
- In the pandemic, people wear face masks to respect and protect others — not merely to protect themselves, says a team of Northwestern University researchers.
- With this in mind, the researchers developed a new concept for a mask that aims to make the wearer less infectious. The central idea, which received support from the National Science Foundation through a RAPID grant, is to modify mask fabrics with anti-viral chemicals that can sanitize exhaled, escaped respiratory droplets.
- By simulating inhalation, exhalation, coughs, and sneezes in the laboratory, the researchers found that non-woven fabrics used in most masks work well to demonstrate the concept. A lint-free wipe with just 19% fiber density, for example, sanitized up to 82% of escaped respiratory droplets by volume. Such fabrics do not make breathing more difficult, and the on-mask chemicals did not detach during simulated inhalation experiments.
- The research will be published today (October 29, 2020) in the journal Matter.
Importance of protecting others
- “Masks are perhaps the most important component of the personal protective equipment (PPE) needed to fight a pandemic,” said Northwestern’s Jiaxing Huang, who led the study. “We quickly realized that a mask not only protects the person wearing it, but much more importantly, it protects others from being exposed to the droplets (and germs) released by the wearer.
- “There seems to be quite some confusion about mask wearing, as some people don’t think they need personal protection,” Huang added. “Perhaps we should call it public health equipment (PHE) instead of PPE.”
- “Where there is an outbreak of infectious respiratory disease, controlling the source is most effective in preventing viral spread,” said Haiyue Huang, a 2020 Ryan Fellowship Awardee. “After they leave the source, respiratory droplets become more diffuse and more difficult to control.”
The goal and results
- Although masks can block or reroute exhaled respiratory droplets, many droplets (and their embedded viruses) still escape. From there, virus-laden droplets can infect another person directly or land on surfaces to indirectly infect others. Huang’s team aimed to chemically alter the escape droplets to make the viruses inactivate more quickly.
- To accomplish this, Huang sought to design a mask fabric that: (1) Would not make breathing more difficult, (2) Can load molecular anti-viral agents such as acid and metal ions that can readily dissolve in escaped droplets, and (3) Do not contain volatile chemicals or easily detachable materials that could be inhaled by the wearer.
- After performing multiple experiments, Huang and his team selected two well-known antiviral chemicals: phosphoric acid and copper salt. These non-volatile chemicals were appealing because neither can be vaporized and then potentially inhaled. And both create a local chemical environment that is unfavorable for viruses.
- “Virus structures are actually very delicate and ‘brittle,’” Huang said. “If any part of the virus malfunctions, then it loses the ability to infect.”
- Huang’s team grew a layer of a conducting polymer polyaniline on the surface of the mask fabric fibers. The material adheres strongly to the fibers, acting as reservoirs for acid and copper salts. The researchers found that even loose fabrics with low-fiber packing densities of about 11%, such as medical gauze, still altered 28% of exhaled respiratory droplets by volume. For tighter fabrics, such as lint-free wipes (the type of fabrics typically used in the lab for cleaning), 82% of respiratory droplets were modified.
- Huang hopes the current work provides a scientific foundation for other researchers, particularly in other parts of the world, to develop their own versions of this chemical modulation strategy and test it further with viral samples or even with patients.
- “Our research has become an open knowledge, and we will love to see more people joining this effort to develop tools for strengthening public health responses,” Huang said. “The work is done nearly entirely in lab during campus shutdown. We hope to show researchers in non-biological side of science and engineering and those without many resources or connections that they can also contribute their energy and talent.”
4. A disinfection system that could neutralize C19 in a few minutes is developed
- Cedrión, a company supported by the Universidad Carlos III de Madrid (UC3M), has designed a disinfection system that could neutralize C19 in just over ten minutes. The system uses atmospheric plasma to disinfect spaces and surfaces and neutralizes almost all airborne bacteria and viruses.
- The disinfection system is similar in size to a desktop computer and can be placed in any space, such as a room or car, to disinfect surfaces in the room using cold atmospheric plasma. “We’re developing systems based on our patented cold atmospheric plasma generating technology. Broadly speaking, we subject the surrounding air to a very strong electrical field, pulling electrons from the neutral particles in the air and forming ions. This system can generate up to 70 different types, from ultraviolet rays to peroxides, ozone, or nitrogen oxides. The synergies between these allow bacteria and viruses to be neutralized,” notes Enrique Medina, CEO and co-founder of Cedrión.
- Based on this technology, Cedrión can be used in two ways: it can be used to clean the air and surfaces. The first is a silent system which disinfects rooms that have people inside, it recirculates the air and neutralises bacteria and viruses. The second use cleans any surface in the room when it is empty. To do this, the system releases ions which, once disinfected, are reconnected in neutral particles.
- The testing of this disinfection system will begin in November at the Spanish National Centre for Biotechnology (CNB-CSIC, in its Spanish acronym), testing the neutralization of the strains of Coronavirus that affect humans, including the coronavirus (SARS-COV-2). The start-up, which was housed in the UC3M – ESA BIC Madrid Region node until 2019, plans to have the system tested and certified by the end of this year so that it can be installed in hospitals, schools, and offices, among other spaces.
- “We have tested the system using different types of bacteria, being able to neutralise 99.99% in less than a minute. We’ve also started testing strains of the Coronavirus that do not affect humans, and have had some very promising results,” Medina concludes.
I. Back to School!?
1. Potential impact of C19 school closures on academic achievement
- A study published today in Educational Researcher, a peer-reviewed journal of the American Educational Research Association, provides preliminary projections of the impact of C19-related school closures in spring 2020 on student learning. The study authors found that compared to a typical year, students likely did not gain as much academically during the truncated 2019-20 school year and likely lost more of those gains due to extended time out of school.
- Watch study coauthor Megan Kuhfeld discuss major findings and implications: https://youtu.be/8n4njJXbOqg
- Using a model that assumed that school closures functioned as an extended summer break, the authors estimated that returning students likely started school this fall with approximately 63% to 68% of the typical annual learning gains in reading and 37 to 50% of the typical annual learning gains in math. However, they projected that losing ground during the school closures was not universal, with the top third of students potentially making gains in reading.
- The projections imply that educators and policymakers will need to address that many students are substantially behind academically as a result of extended school closures, particularly if many schools remain disrupted throughout periods of the 2020-21 school year.
- “It will be important to identify students who are struggling and fallen behind academically and provide those students with extra supports, such as high dosage tutoring and additional structural time,” said study coauthor Megan Kuhfeld, senior research scientist at NWEA.
- “Inequalities that have existed in our education system prior to COVID are getting worse at the same time school districts are facing massive budget shortages,” added Kuhfeld. “We need additional investments from the federal government to prevent looming school budget cuts.”
2. The youth sports exodus continues
- Youth sports remain in a moment of crisis, as the health and financial situations brought on by the pandemic continue wreaking havoc.
- By the numbers: The Aspen Institute’s recent survey of 1,103 parents with sport-playing kids aged 6-18 paints a rather bleak picture.
- 29% of parents said their kids are simply not interested in sports, up from 19% when they were last asked in June.
- 64% cite fear of their child contracting COVID as a barrier to resuming sports.
- 28% say they’d spend more money on youth sports now than pre-COVID, but 27% say they’d spend less.
- 6.4 fewer hours: Kids are spending just 7.2 hours per week playing sports, down from 13.6 before the pandemic.
- Solo sports on the rise: Cycling and golf have risen in popularity during the pandemic, as their relative drops in participation are minimal compared to team sports.
- What they’re saying: Kids, parents and coaches alike are feeling the weight of uncertainty and the fear of permanent loss.
- “It’s not enough. It’s not nearly enough,” 17-year-old Aaron Teklu tells the New York Times of the minimal basketball he’s been able to play. “[Basketball] has always helped me deal with my emotions and what is going on in my life.”
- “The time my boys spend playing is down probably 80 percent,” added high school basketball coach Tyrone Riley. “I spend a lot of time wondering how we’re going to get out of this.”
- The bottom line: “This is a moment of historic crisis,” says the Aspen Institute’s Tom Farrey. Unfortunately, its roots are also deep enough that it’s going to take more than the pandemic ending to right the ship.
- Go deeper: Coronavirus puts youth sports on pause
J. Projections & Our (Possible) Future
1. Second coronavirus stockpiling wave may be coming — and it goes beyond toilet paper, cleaning supplies
- As winter encroaches, more than half of U.S. consumers are considering replenishing their assortment of goods and essential products that they had originally stockpiled during the onset of the coronavirus pandemic earlier this year, according to new research from data-driven technology-enabled services company Inmar Intelligence.
- When the pandemic hit the U.S. in March, 64% of shoppers created a stockpile of products as a result, according to Inmar.
- Now, roughly 57% of shoppers are considering restocking due to growing fears of a “potential second wave of C19,” which could lead to another round of bare store shelves.
- Over a quarter of shoppers, roughly 27%, are considering revamping their winter stockpile due to concerns that certain products won’t be in stock when they need them, the firm said. Meanwhile, another 27% are more concerned about the safety of in-store shopping if a second wave were to occur.
- Hygiene products topped shoppers’ stockpile lists again, with 67% grabbing toilet paper and 57% searching for hand sanitizer — both of which were in high demand in the early stages of the pandemic, and left store shelves empty and online retailers charging sky-high prices.
- Canned goods (54%), disinfecting wipes (53%) and paper towels (52%) are also products consumers have stocked up on or plan to stock up on for the upcoming season.
- Unlike their first stockpile, however, 45% of shoppers plan to invest in new items such as frozen dinners, pasta, snacks and cleaning products.
- Overall, about 55% of shoppers are planning to purchase goods in-store, “suggesting that brick and mortar retailers are still crucial for consumers when purchasing everyday items,” the firm said.
- Inmar CEO David Mounts said that during this time of heightened concern, “shoppers will look to their local retailers to deliver consistency and seamless customer service,” especially as the busy shopping season arrives.
- “It will be important for retailers not only to prepare for this new surge in demand but also deliver value to customers during this time of crisis in order to maintain heightened trust and customer loyalty,” Mounts said.
- But it’s not yet clear when — if ever — buying habits will get back to normal.
- Even when the pandemic subsides, about 54% of shoppers plan to keep a stockpile of goods due to fear of another emergency, the firm said.
K. Practical Tips & Other Useful Information
1. Is There a Safe Way to Socialize Indoors This Winter?
- Summer is often the most social season, with backyard barbecues, dips in the lake and walks in the park. Earlier in the pandemic—at least in the northern hemisphere—it was still possible to do these types of outdoor activities safely with other people at a distance. But as temperatures in the U.S. drop and C19 infections rise in nearly every state, the shift from social season to shut-in season feels even more stark.
- “After a summer of seeing friends outside, I’ve been dreading what will happen when the weather gets cold,” says my colleague Jamie Ducharme. “I’ve had many conversations with friends and family about what our social lives will look like this winter—and what we’ll do for the holidays—so I decided to go straight to the experts.”
- Gathering indoors is more dangerous because when an infected person breathes or talks, the virus they expel can linger in the air. Outdoors, natural ventilation blows it away, but indoors, aerosols can build up over time—even when people are spaced six feet apart.
- Knowing this, Jamie wondered if there was a way to socialize safely inside. The answer: not exactly, experts told her—but if you wear masks, pick a large space (think malls and museums over living rooms and restaurants), open windows and keep sessions small and short, you can at least make the experience a little safer.
- Still, outside hangs remain the best choice. “Even more than adults, kids are comfortable being outside,” one infectious disease expert told Jamie. Try to summon the resilience of children by playing in the snow or setting up short outdoor playdates.
- Americans are going to have to make hard choices about how (and whether) to socialize this winter. “Writing this piece confirmed that there’s no easy way to see friends and family inside in the ways we all want to,” says Jamie, who bought a warmer coat to help extend her outdoor hangouts this winter. “There won’t be any risk-free meet-ups or parties for a while.”
2. How to make dining out safer
- It’s a cruel irony that the things that make a restaurant appealing are precisely what currently make it dangerous—the intimacy, the coziness, the groups of people deep in conversation, whiling away the hours over drinks and a meal. Eating in a restaurant is one of the riskiest things you can do during the coronavirus pandemic.
- To understand why, you need to think about the latest science around how C19 passes from person to person. The official line from the World Health Organization from the start of the pandemic has been that the coronavirus is mostly spread by the droplets we generate as we talk, sneeze, or cough. However, the evidence has been mounting for months now that aerosols—which are smaller than droplets and can hang in the air like smoke—are a significant route for infections, if not the main one. This would explain why virtually every recorded coronavirus outbreak has occurred indoors.
- Sadly, the advice to the public still hasn’t caught up. The US Centers for Disease Control and Prevention has only just started to acknowledge the possibility of airborne transmission, and many countries don’t mention it in their official guidance. As a result, many restaurants are still stuck following advice that simply isn’t reflective of the latest science—obsessing over cleaning, wearing visors (which don’t protect you from aerosols), and setting up plastic dividers between tables. Some of these measures might be marginally useful, but they mostly amount to “pandemic theater”—interventions that provide the appearance of safety, but little in the way of real protection.
What to look out for in a restaurant:
- Size matters. A bigger restaurant = one where you can space out more easily.
- If it looks small, busy, loud, or the windows are fogging up—definitely avoid. Also avoid restaurants where any servers aren’t wearing masks.
- If there’s an option to sit outside, take it.
- Failing that, sit as close to an open door or window as possible.
- If you’re meeting people from outside your household, sit diagonally from them.
- – Make sure you or your group stays as far away from other diners as possible.
- Why, exactly, are restaurants so risky? First off, they tend to be noisy spaces. People talk loudly, expelling more air than usual—and thus more potentially virus-laden aerosols. Researchers are yet to work out precisely how much virus you have to breathe in, or how long you have to be exposed to someone shedding viral particles, to get infected. The CDC estimates it’s possible to get infected from just 15 minutes of close proximity, but the reported cases of infections in restaurants “all involve an infected and susceptible person sharing the air for a significant amount of time, often 30 minutes up to a few hours,” says Jose-Luis Jimenez, a chemistry professor at the University of Colorado, Boulder, who has studied aerosols for two decades. It’s also possible, theoretically, to catch C19 through the aerosols left behind by an infected person who has already left the room—but there aren’t any confirmed cases of this occurring, according to Jimenez. The virus loses infectivity with time, “typically in one to two hours,” he says.
- Then there’s the lack of mask-wearing inside restaurants. Diners tend to take them off, because you can’t eat or drink while wearing one. You may have heard that ventilation is pretty important as well—another area in which restaurants typically score poorly. Inadequate ventilation allows tiny virus particles to hang in the air for long periods of time, just waiting to be breathed in.
- And of course, for any restaurant to be successful, it needs to be popular enough to attract people from around a neighborhood, city, or even further afield to come and dine under the same roof. It’s hard to imagine a more inviting setting for an airborne pathogen like SARS-CoV-2 to spread (other than perhaps cruise ships). It’s little wonder, then, that restaurants have shown themselves to be the perfect breeding ground for superspreading events, where one person passes the virus to dozens of others. Virtually every documented case of superspreading has taken place in a noisy, poorly ventilated room—many of them restaurants.
- At the start of October, Public Health England found that for people who’ve tested positive for the coronavirus in the last two months, “eating out was the most commonly reported activity in the two to seven days prior to symptom onset.” Scotland’s government has consistently found that a quarter of people returning positive tests for C19 had been to a restaurant, pub, or cafe in the week before. In September, a CDC study of 802 adults in the US found that people who tested positive for C19 were approximately twice as likely to have reported dining at a restaurant than those who tested negative.
- “Without a doubt, there’s an association there,” says Nathan Shapiro, a professor of emergency medicine at the Beth Israel Deaconess Medical Center, one of the authors of the CDC study.
- With the growing case against dining out, it’s no wonder the pandemic has devastated the restaurant business. While some big-name chain restaurants with drive-through and takeout options have thrived, tens of thousands of dine-in restaurants have been forced to close, potentially taking millions of people’s livelihoods with them.
Making eating out safer
- Despite the dire outlook, there are ways to reopen restaurants while minimizing the risk of infection “Any time there are people indoors there is risk,” says William Bahnfleth, a professor of architectural engineering at Pennsylvania State University. But many of the dangers can be mitigated. The crucial thing to remember is that no one measure is enough on its own; increasing safety is about layering as many different efforts on top of one another as possible.
- First and foremost, people should eat outdoors whenever possible. “The risk of infection is 20 times higher inside than outside,” says Bjorn Birnir, director of UC Santa Barbara’s Center for Complex and Nonlinear Science. However, some restaurants either can’t get the approval for outdoor seating from their local authorities or don’t have the money for outdoor furniture or the patio heaters that will help make diners comfortable as winter rapidly approaches in the Northern Hemisphere.
- If outdoor seating isn’t possible, eateries should focus on simpler stuff. Servers need to wear masks, as should customers while they’re not at their table. Although masks won’t prevent all aerosols from getting through, they will stop some. Tables should be as far away from each other as possible. Again, this isn’t a perfect solution—but the farther away you are from other groups of customers, the less likely you are to inhale a big concentration of their breath. Use the measures you’d take to try to avoid secondhand smoke as an analogy, says Jimenez.
- Some adaptations are more inventive. For example, restaurants should turn the music down to discourage customers from talking loudly, says Sam Harrison, who owns a brasserie called Sam’s Riverside in London. And although it might feel unnatural, it’s a good idea for diners to sit diagonally from anyone who isn’t in their household. Simulations generated by the supercomputer Fugaku in Japan found that about 75% fewer droplets will reach you diagonally than if you sit opposite someone.
- It’s difficult to judge how safe a restaurant is just by looking at it. You can’t tell at a glance how many air changes per hour are taking place. Bahnfleth, the architectural engineer, says you want to aim for about six full replacements of the indoor air volume per hour—perhaps achievable by something as simple as opening a window or a door. It’s tricky to measure the air change rate without hiring expensive air quality consultants, but one shortcut could be to use a carbon dioxide monitor (you can buy these for about $150) as a proxy. If your levels stay below about 800-950 parts per million, ventilation is probably sufficient.
- Restaurateurs who want to get an idea of how well they’re addressing risk can use one of the free online risk estimators from places like Setty, an engineering firm, experts at Oregon University, or the University of Colorado, Boulder. These models let you input details about your space—size, ceiling height, average occupancy, and so on—and then produce a score that tells you roughly how safe it is. The risk scores are based on modeling of relative aerosol risk, and they require a good basic grasp of numeracy and science, but they can be a useful tool. “These are the best things we have, but they’re still based on a fairly uncertain degree of knowledge about how much virus an infected person sheds, and how much you need to inhale to get infected,” Bahnfleth says. Although they’re based on peer-reviewed science, they should be taken as guides rather than immutable truths, because they rely on many unknowns (they can’t know, for example, if people are wearing their masks correctly).
- If open doors aren’t an option, air purifiers can dispose of more than 99% of aerosols in the air stream that passes through them. Some restaurants may already have these installed as part of their overall heating, ventilation, and air conditioning system. For those that don’t, standalone purifiers cost about $100 apiece and can be placed around the dining area.
- Finally, there’s a category of interventions that might be marginally useful but verge on pandemic theater. Temperature checks are widespread and highly visible, and can help to weed out some people with symptoms—but they do nothing to prevent asymptomatic people from entering the premises. Dividers between tables, meanwhile, could stop people from sneezing or coughing on each other, but are useless to stop aerosol transmission.
- The sad truth is that as long as there are high levels of virus circulating in a community, people are going to be justifiably nervous about eating out. That’s something restaurant owners can’t control. All they can do is adapt—more takeout meals, more outdoor seating—and try to survive. Harrison, the owner of Sam’s Riverside, doesn’t see a return to pre-pandemic levels of profit for the foreseeable future. “It won’t kill us, but it’ll get pretty damn close,” he says
M. Johns Hopkins COVID-19 Update
October 28, 2020
1. Cases & Trends
- The WHO C19 Dashboard reports 43.5 confirmed C19 cases and 1.16 million C19 deaths as of 8:30am EDT on October 28.
- The US CDC reported 8.68 million total cases, 225,084 total deaths, and 492,026 new cases in the past 7 days. The daily C19 incidence continues to increase, now up to 63,589 new cases per day, compared to 59,699 new cases reported last Wednesday and almost as high as the peak incidence in late July. Following the previous peak (66,960 new cases per day on July 24), the US daily incidence fell by 48% to its most recent low (34,371 new cases per day on September 12). Since that time, however, the US has climbed about 94% of the way back to this previous peak. The 7 day moving average of mortality was 797 deaths for October 26, compared to increasing numbers of daily deaths in recent weeks, with most recently 815 deaths on October 25th.
- Most US states now have at least 100,000 cumulative cases, including 12 states with more than 200,000 cases:
- >800,000: California, Texas
- >700,000: Florida
- >400,000: New York
- >300,000: Georgia, Illinois
- >200,000: Arizona, New Jersey, North Carolina, Tennessee, Ohio, Wisconsin
- Per capita, states in the West and Midwest – including but not limited to Montana, North and South Dakota, Wisconsin, Wyoming and Idaho – have reported at least 50 new cases per 100,000 population per day within the past 7 days. North and South Dakota have reported 102.7 and 95.6 cases per 100,000 population.
- The Johns Hopkins CSSE dashboard reported 8.78 million US cases and 226,752 deaths as of 10:30 AM EDT on October 28.
2. US HOSPITAL CAPACITY
- Healthcare systems across the United States are feeling the burden of increased C19 incidence. Hospitals in communities across the country are nearing full capacity as the number of currently hospitalized patients exceends 41,000. According to The Atlantic’s COVID Tracking Project, there is an estimated 46% increase in domestic hospitalizations, a continuation of a disconcerting trend.
- Despite this surge in new infections, the mortality rate for C19 has remained relatively stable. This is good news considering the rise in new infections, but the quality of care could be at risk if availability of care becomes more limited. Individual states have taken new actions to accommodate the rise in C19 hospitalizations. Wisconsin has opened a field hospital at their state fair grounds, and other states have begun discussions about rationing care if infections continue to rise. In Utah, Governor Gary Herbet spoke with the president of the Utah Hospital Association about a potential need to decide which patients receive treatment in intensive care units. The state has not had to put these measures into place, but the discussion underscores the severity of the current epidemiological situation.
3. AIR TRAVEL
- The United States Transportation Command released results of a study looking at SARS-CoV-2 exposure on a contracted airline. The test used a Boeing 767-300 and 7770200 aircraft to map particle concentration for passengers in different zones of the aircraft in real time. Over the course of 8 days, the research team conducted over 300 aerosol releases in different situations to get a better picture of the risk of transmission during all aspects of a commercial flight. In total, the researchers found little evidence of aerosol exposure during the tests they performed. They attribute this to the high air exchange rates, and found that aerosol particles remained detectable within the cabin less than 6 minutes on average. The researchers noted that their test conditions only took into account the presence of a single infected passenger.
- This research adds to the growing body of literature examining the safest ways for individuals to conduct air travel during the C19 pandemic. Southwest Airlines cited the study above, as well as studies from IATA and the Harvard T.H. Chan School of Public Health, while announcing the reversal of a policy that blocked individuals from filling the middle seat in their plane’s three-seat passenger rows. The discussion to open the middle seat back to travelers is at odds with an earlier study from MIT that cited a protective value from flying with these seats empty. And a new study from Eurosurveillance describes a C19 outbreak linked to a flight from Ireland this past summer.
4. VACCINE TRIALS
- Vaccine manufacturers Sanofi and GlaxoSmithKline have agreed to provide 200 million doses of their joint SARS-CoV-2 vaccine candidate to the COVAX Facility to foster equitable distribution of the vaccine. The candidate is a recombinant protein-based antigen with an adjuvant developed by GSK. The candidate is currently at the stage of phase I/II trials, with initial results expected by December. Sanofi has also been engaged with Translate Bio to develop a separate mRNA vaccine candidate, but that has not yet reached clinical trials.
- In other news, Pfizer recently announced that they have not yet been able to conduct an analysis of efficacy of their mRNA candidate vaccine. The announcement indicates that the trial is progressing more slowly than initially anticipated, with earlier estimates of the timeline suggesting that an analysis could be conducted as early as September. The news also follows discussions last week from the Vaccines and Related Biological Products Advisory Committee that expressed some hesitancy in prematurely issuing an emergency use authorization (EUA) without longer term assessment of the safety and efficacy of the vaccine, particularly because issuing an EUA would likely impact the ability for the longer trials and more robust analyses to occur.
5. VACCINE ROLLOUT
- Members of the US Advisory Committee on Immunization Practices (ACIP), an independent federal advisory board advising on the use of SARS-CoV-2 vaccines, published guiding principles last week on how vaccines should be allocated within the US population. The JAMA viewpoint focuses on ethical principles and allocation when supplies are limited, noting that more detailed recommendations will be issued once safety data is available following licensure or authorization under EUA. Recommendations from ACIP will be sent to the CDC director, and if approved, will become official CDC recommendations for immunizations in the US.
- Around the same time, stakeholders involved in Operation Warp Speed efforts discussed the preliminary distribution plans and potential challenges that would need to be addressed. Some of the key logistical challenges associated with vaccine distribution include the need for certain vaccine candidates to require -70 degree C freezers, which not all clinics have on hand. This week, the federal government is reportedly announcing a plan to cover out-of-pocket expenditures for SARS-CoV-2 vaccination to people enrolled in Medicare or Medicaid plans. The ruling, which to our knowledge has not yet been officially announced, is expected to determine that Medicare and Medicaid will cover out of pocket costs for vaccines that have an emergency use authorization.
- New publications in CDC’s Morbidity and Mortality Weekly Report are shedding light on the effectiveness of mitigation measures for preventing the spread of C19 among amateur, collegiate and professional sports teams. One article described an outbreak among recreational hockey players in Florida. After the indoor game, nine players of one team and five players of the opposing team, as well as a rink staff member, reported symptoms of C19. Eleven of the 15 individuals reporting symptoms tested positive for SARS-CoV-2 by RT-PCR and two others reported positive antigen tests. The other two symptomatic players and asymptomatic players were not tested. Mask usage and distancing were not adhered to during the game, which may have contributed to spread amongst the players.
- The second article described an outbreak among men’s and women’s collegiate soccer teams. Seventeen of 45 players across both teams tested positive for SARS-CoV-2 with whole genome sequencing, indicating that all cases were linked to the same cluster. While team members were mandated to wear masks during practice, social gatherings without masks or distancing in place and shared accommodations between players were found to be the most likely circumstances where spread occurred.
- The third article described SARS-CoV-2 transmission among 20 players and associated staff on a Major League Baseball team that resulted in no secondary transmission to other teams. Mitigation measures in place included regular diagnostic testing, isolation and quarantine as needed, mask usage, and social distancing. The authors concluded that transmission most likely occurred off-field during interactions that lacked physical distancing and proper mask usage, particularly social interactions occurring indoors. Major League Baseball concluded its 2020 season last night.
7. COLLEGES & UNIVERSITIES
- Colleges and universities across the country have experienced substantial financial and logistical challenges as a result of the pandemic, with some schools eliminating programs, furloughing faculty, and implementing austerity measures. The financial strain preceded the pandemic, but has been exacerbated by reduced enrollment and revenue, paired with substantial expenditures to support expansive testing, contact tracing, and quarantining of students.
- The American Council on Education published a letter last week stating that the pandemic would cost higher education institutions $120 billion. As part of response efforts, some universities are implementing studies to test wastewater and sewage for C19. Testing wastewater is much cheaper than testing individual students, and implementation is more feasible in a dorm environment. The testing approach cannot identify which individuals are infected with SARS-CoV-2, nor how many infections there are. However, the data can indicate potential trends or the occurrence of an outbreak in a setting.
8. POLL WORKERS
- As the US approaches the general election on November 3rd, the CDC has published a study in the Morbidity and Mortality Weekly Report on Delaware’s efforts to protect poll workers and voters during their September 15, 2020 primary election. This study was performed as part of a collaboration between the CDC, the Delaware Department of Health and Social Services, and the Delaware State Election Commission. 522 poll workers were invited to participate in a self-administered survey about their experiences and observations during the 2020 Delaware primary election.
- The survey included questions on training, availability of personal protective equipment, polling location set-up, and mitigation measure compliance. Poll workers reported that personal protective measures, such as mask wearing and physical distancing, were generally well followed by fellow poll workers and voters. Despite personal measures and adjustments to distancing of polling booths, 72% of poll workers reported that they had been in close contact (<6 feet and >15 minutes) with more than 100 people on election through the course of performing their duties. Nearly half (45%) of surveyed poll workers were older than 65 years old, which may put them at higher risk of severe illness.
- The results of this study reinforce the need for strict adherence to mask wearing, handwashing, and physical distancing while voting in-person. The CDC also proposed that recruiting younger poll workers could decrease the overall risk of severe disease within the voluntary workforce. Other recommendations to reduce crowding at polling locations include extending polling hours, reconfiguring polling booths and waiting lines to promote physical distancing, and encouraging greater adoption of voting options that are not in person.