Limited Weekend Edition
December 12, 2020
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1. Top 5 States in Cases, Deaths, Hospitalizations, Patients in ICU & Positivity
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A. Numbers & Trends
1. Top 5 States in Cases, Deaths, Hospitalizations, ICU Patients and Positivity % as of (12/11)
- Since peaking at 14.0% on 12/8 (12 days after Thanksgiving), the US Positivity Rate fell for the second straight day to 13.6%.
- Overall, 25 states reported lower positivity rates over the last seven days (+18 states since 12/6).
- ND remains stubbornly high at 53.3%, its 44th straight day above 50.0%.
- Two states (NV, SD) 7-day positivity rates greater than 40%. (-5 since 12/6)
- Twelve states (MO, IN, PA, NE, KS, IA, WI, WY, AL, RI, AZ, UT) 7-day positivity rates greater than 30%. (+6 since 12/6)
- Seven states (ID, CO, MN, DE, NH, MA, OH) had 7-day positivity rates greater than 20%. (+1 since 12/6)
- In total, 47 states have 7-day positivity rates greater than 5% (+2 since 12/6)
- Hospitalizations in the US reached an all-time high of 108,108, up 6.75% since a week ago. Hospitalizations are increasing, but the rate of growth is slowing. The growth rate on 12/6 was 8.7%.
- 17 states have had increases of hospitalized patients of more than 10% since 11/29. (-7 since 12/6)
- 32 states have more than 1,000 hospitalized patients (+unch since 12/6)
- 22 states saw decreases in the number of hospitalized patients over the past week. (+10 since 12/6)
Patients in ICU Trends
- ICU Patients in the US reached an all-time high of 21,010, up from 19,858 (+5.8% 9.3%) a week ago. The number of ICU patients is increasing, but the rate of growth is slowing. The growth rate on 12/6 was 9.3%.
- 15 states have seen the number of ICU patients increase by more than 10% since a week ago (-2 since 12/6)
- 30 states have more than 100 patients in ICU, (-2 since 12/6)
- 16 states saw decreases in the number of ICU patients over the past week (+5 since 12/6).
2. U.S. Cases, Deaths Continue to Surge
What to Know
- The FDA granted emergency-use authorization of Pfizer’s Covid-19 vaccine.
- The U.S. reported another record number of new coronavirus cases.
- More than 3,300 deaths from Covid-19 were reported in the U.S. for Friday, a new record.
- Los Angeles County health officials warned a record surge in cases could have “catastrophic consequences.”
- Covid-19 is about as widespread in the U.S. as it has ever been, with new cases and deaths hovering near records.
- The U.S. agreed to purchase an additional 100 million doses of Moderna’s vaccine.
- Indoor dining in New York City will be banned starting Monday.
- The U.S. set records for the number of deaths from Covid-19 in a single day, newly reported coronavirus cases and hospitalizations due to the disease, as the Food and Drug Administration approved a vaccine from Pfizer Inc. and BioNTech SE.
- The U.S. reported more than 231,700 new coronavirus cases for Friday, topping a previous record set earlier this month, according to data compiled by Johns Hopkins University. The country also reported the highest number of fatalities from Covid-19 in one day, with more than 3,300 dead, pushing the overall death toll to more than 295,000.
- Hospitalizations hit another all-time high, with 108,108 people in hospitals across the country because of Covid-19, according to the Covid Tracking Project. The number of patients requiring treatment in intensive-care units fell slightly from a day early, but surpassed 21,000 for the second day in a row on Friday.
- Several states continued to struggle with surging numbers of infections. California reported a record 33,664 new coronavirus cases for Friday, the third day in a row the number exceeded 33,000, according to Johns Hopkins data.
- Pennsylvania, South Carolina and New Hampshire also reported record daily tallies of cases.
3. Many U.S. Hospitals Are Running Critically Short Of ICU Beds
- Department of Health and Human Services data reported by the New York Times has detailed average U.S. hospital and ICU bed occupancy rates for the week ending December 03. It paints an extremely disturbing picture of health system that is buckling under the strain of the pandemic in some parts of the country. Current hospital capacity stands at 59 percent while ICU occupancy is 72 percent, with both figures climbing steadily. The numbers are already significantly higher than that in some parts of the country. 2,200 counties were included in the analysis and the average hospital is 90 percent in 126 of them and well above that in some countries in Kentucky, Georgia, Minnesota, Oklahoma and Texas.
- According to the dataset, ICU bed capacity is already at or above 100 percent in 113 hospital service areas with the highest occupancy rate seen in Cullman, Alabama, at 131 percent. It also looked at how things are developing in areas with a high population, an ominous trend which is illustrated on this map. There are zero ICU beds available in Albuquerque, for example, which has an occupancy rate of 116 percent. In Baton Rouge, that figure is 106 percent while it stands at 107 percent in Ogden, Utah. The New York Times described the situation in El Paso as marginally better with 13 free ICU beds out of 400 in total, which still makes for an occupancy rate of 95 percent.
- More than a third of Americans now live in areas that are running critically short of free ICU beds and that hospitals serving 100 million people reported fewer than 15 available intensive care beds at the end of last week. The situation is worse in some places, however, particularly across a swathe of Midwest, South and Southwest. One in 10 people in those areas live in an area where ICU beds are completely full or 95 percent full. The disturbing hospital-level data comes as the U.S. registered more than 3,000 deaths in 24 hours for the first time. With an FDA panel meeting to consider approving Pfizer’s vaccine, there is some badly needed hope on the horizon.
B. New Scientific Findings & Research
1. Scientists Show How C19 Causes Multiple Organ Failure
- Scientists have created a first-of-its-kind mouse model of the COVID-19 disease, capable of revealing how the SARS-CoV-2 virus wreaks havoc on multiple organ systems in the animal’s body.
- While this experimental model doesn’t directly correspond to human coronavirus cases, it’s a breakthrough in other ways, giving us a potential test system for exploring how the deadly respiratory pathogen extends way beyond the respiratory system in many cases of infection.
- “This mouse model is a really powerful tool for studying SARS-CoV-2 in a living system,” explains cardiologist Arjun Deb from UCLA.
- Mouse models of COVID-19 have been engineered before, but none have gotten us to this point, the researchers say, by demonstrating what extra-pulmonary manifestations of COVID-19 look like.
- Above: Heart muscle cells in an uninfected mouse (left) and a mouse infected with SARS-CoV-2 (right), with mitochondria seen in pink.
- That’s been a significant limitation for animal-based research into the virus’s progression, and it’s due to a couple of reasons. While mouse cells contain an analogue of the ACE2 receptor that the SARS-CoV-2 uses to bind to human cells, the virus doesn’t seem to attach to the mouse version of the molecule.
- Genetically engineering mice with the human version of ACE2 provides a workaround of sorts, but before now, scientists hadn’t succeeded in inducing multiple organ failure in mice, which could mimic the way human cases of extra-pulmonary infection tend to present.
- The shortfall may have been because prior studies used nasal inoculation on mice, infecting the animals with SARS-CoV-2 through the nose, which doesn’t seem to develop into full-blown, system-wide coronavirus infections in mice.
- In the new study, led by first author Shen Li, a cardiologist at UCLA, the team got around this by injecting the virus into the bloodstreams of engineered mice, where it could reach the human version of ACE2 (called hACE2) in the heart and other vital organs.
- Unfortunately for the subjects, the experimental tweaks worked. And while it wasn’t a good outcome for the mice involved, being able to study systemically induced toxicity in SARS-CoV-2-infected mice could significantly expand our knowledge of the virus’s branching capabilities in human cases. Such knowledge is sorely needed.
- “Among COVID-19 patients, those who have organs involved other than the lungs are most at risk of a bad outcome,” Deb says.
- “So we felt it was really important to understand how the virus affects those other organs.”
- In the experiment, systemic administration of the infection provoked rapid results.
- Within seven days, the infected mice “demonstrated profound morbidity, severely restricted activity, and were found huddled at the corner of the cage”, in contrast with a control group of similarly engineered mice who were spared the infection, remaining healthy.
- In the same amount of time, the infected mice lost up to about 25 percent of their body weight due to sharply reduced food consumption, necessitating euthanisation.
- The infected mice also had damaged spleens, irregular heart activity and blood pressure, and altered levels of immune cells – all symptoms resembling human cases of COVID-19.
- After the animals were euthanised, analysis of their organs revealed changes in gene expression in multiple tissues, disrupting cellular processes that generate energy in the body.
- “If a virus snuffs out the energy-generating pathways in multiple organs of the body, that’s going to really wreak havoc,” Deb explains.
- Beyond these effects, the infected mice also bore numerous signs of epigenetic changes, which could explain the altered gene expression evident in multiple organs.
- It’s not known for sure, but the impacts of this could potentially be felt long after an infection has been beaten by the immune system – and, hypothetically speaking, could be the basis of the prolonged symptoms experienced by COVID-19 ‘long haulers’.
- “Although the physiological significance of SARS-CoV-2 altered DNA methylation patterns is not clear from our study, our model provides proof of concept that such epigenetic changes do occur soon after SARS-CoV-2 infection and can potentially led to persistent transcriptional changes affecting tissue homeostasis and organ function,” the authors write in their paper.
- “Such epigenetic changes potentially occurring in humans with COVID-19 could lead to symptoms from persistent changes in dysregulated gene expression in infected tissues even in the absence of tissue viral burden.”
- Again, that’s all depending on how much crossover really exists between artificially induced mouse COVID-19 and all-too-easily caught human COVID-19.
- That relationship is yet another unknown, although thanks to this grisly model, at least now we can start asking the questions.
- The findings are reported in JCI Insight.
2. New cancer patients — especially Black people — are more susceptible to severe Covid-19 infections
- Recently diagnosed cancer patients are more vulnerable to Covid-19 infection and face more severe illness than people without cancer, a risk that is significantly higher for Black people than for white people with both diseases, a large new analysis concludes.
- Deploying artificial intelligence to comb through 73 million Americans’ electronic health records, researchers discovered that people who learned they had leukemia, non-Hodgkin lymphoma, or lung cancer in the past year were at the greatest risk for Covid-19 infection compared to those without cancer or those whose cancers had been diagnosed longer ago. For Black people with cancer, the risk of Covid-19 infection was highest in patients who had breast, prostate, colorectal, or lung cancer.
- “The important differentiating factor was that African Americans with cancer were more susceptible to Covid-19 infection than Caucasians,” said Nathan Berger, a medical oncologist and professor at Case Western Reserve University School of Medicine. He is a co-author of the study published Thursday in JAMA Oncology.
- Black people were more likely than white people to be hospitalized for cancer alone, Covid-19 alone, or both diseases. The difference in death rates did not reach statistical significance — 18.5% for Black patients vs. 13.5% for white patients — but the analysis was limited by small numbers — 100 of 670 patients with Covid-19 and cancer died, 50 Black and 50 white — an editorial appearing with the paper said.
- Recent research has found that death rates inside hospitals are similar, but death rates outside hospitals are disproportionately higher among Black people.
- The combined cancer-Covid-19 risk was higher than adding numbers for the two diseases together. In all patients, “The combination of the virus and cancer is synergistic and leading to mortality. The death rates are much higher than they are for either of the diseases alone,” Berger said.
- The reasons for leukemia, lymphoma, and lung patients being more susceptible to Covid-19 can likely be explained by the biology of those malignancies. Blood cancers such as leukemia and lymphoma arise when immune cells fail to function as they should, so impaired defenses could open the door to a viral infection. While Covid-19 ultimately affects multiple organ systems in the body, it is primarily a pulmonary disease attacking the lungs, so lungs damaged by cancer would be more vulnerable to Covid-19.
- The amount of time since cancer diagnosis may contribute to risk of infection because people with lower immunity beginning cancer treatment have more potential exposures than other cancer patients. Newer cancer patients might see more people in hospitals or doctors’ offices, especially health care workers during the pandemic’s first months, when PPE was not recognized as essential or wasn’t available.
- The reasons why Black people with Covid-19 and cancer had a greater risk of being hospitalized — 55.6% for Black patients vs. 43.2% for white patients — are probably societal, Berger said, although the study was not able to discern those factors. Societal inequities have loomed as large as medical comorbidities since the pandemic began: lower income, less opportunity to work remotely, crowded housing, poorer access to health care.
- The study did account for comorbidities that put people at higher risk for worse Covid-19 illness: obesity, high blood pressure, diabetes, asthma. When those factors were taken out of the equation, Black people still had a higher risk of being infected: 32.5% vs. 19.1% for white people.
- Robert Carlson, chief executive officer of the National Comprehensive Cancer Network, said he was surprised by how much more vulnerable cancer patients were to Covid-19, in contrast to reports from earlier in the pandemic suggesting there was no substantially greater risk.
- “The part that doesn’t surprise me is the disparity in outcomes between African Americans and whites,” said Carlson, who was not involved in the study. “We see that consistently across our health care system. The magnitude of the differences is pretty big. And it’s also consistent.”
- A recent study reinforces the idea that racial disparities in Covid-19 stem from different levels of exposure to the virus. Gbenga Ogedegbe, the director of the division of health and behavior at New York University’s Grossman School of Medicine, led a study analyzing the health records of nearly 12,000 patients admitted to NYU’s Langone Health system during the March pandemic surge. That research, published Dec. 4 in JAMA Network Open, found that Black people had higher rates of infection and hospitalizations but in-hospital death rates were lower or comparable to those in white people. Death rates outside hospitals are disproportionately higher among Black people.
- “The higher rates of mortality in Blacks are not due to inherent immunity or biology or comorbidity like cancer but due to exposure and other factors driven by structural inequities,” Ogedegbe said about the new paper based on national data, saying it confirmed his research and other studies. He was not involved in the new paper.
- “The disparities noted are driven by exposure, access to care, and other social deprivation factors that are pervasive in Black communities,” he said. “I might add that this unfortunate Covid-19 pandemic has again revealed what we have known for a while: that your ZIP code is a better predictor of your life expectancy than your genetic code.”
- Using the AI tool IBM Watson Health Explorys to parse electronic health records allowed the Case Western researchers to cast a wider net and include people who may not be seen in more traditional clinical trials, Berger pointed out.
- “I don’t know if this is systemic racism, but part of the problem of doing clinical studies in this country is that studies are usually underpowered for underrepresented [groups] that for one reason or another, they’re not being included,” Berger said. “So when you’re talking about 73 million patients, you’re talking about a lot of underrepresented minorities.”
- Carslon praised the speed of the AI analysis bringing these results to light now.
- “I think we are quite frustrated by the lack of urgency in terms of addressing disparities,” he said, suggesting the pandemic could be “a tipping point, the crucial moment in history where perhaps we can start addressing this in a meaningful way.”
- For now, Berger suggests doctors treating cancer should redouble their efforts to limit patients’ exposures to potentially infectious people in waiting rooms and consider oral medications that can be taken at home as opposed to drugs that must be infused in hospitals or clinics.
- Doctors also urge patients to seek medical care for themselves or their children without delay, noting safety measures now in place prevent infection in doctors’ offices and hospitals.
- Berger has one other piece of advice:
- “Everybody should get vaccinated.”
- That could be particularly important for cancer patients. Memorial Sloan Kettering Cancer Center, among others, recommends vaccination against Covid-19. “Although cancer treatment may reduce the effectiveness of vaccines, we believe the COVID-19 vaccine is safe and could offer important protection for cancer patients, who may be at higher risk for complications from Covid-19.”
3. COVID-19 patient infected indoors after 5 minutes, 20 feet away
- A South Korean high school student was infected with COVID-19 within five minutes and from a person 20 feet away while dining indoors, according to a new study.
- The case initially stumped contact tracers because North Jeolla province, where the restaurant was located, hadn’t reported any infections in a month, according to the report in the Journal of Korean Medical Science.
- The high school senior hadn’t traveled outside of the region in recent weeks, but cellphone GPS data showed she’d briefly overlapped at a restaurant with a saleswoman who contracted COVID-19 and visited for business.
- Both of the cases were confirmed to have been from the same strain of the virus, researchers said.
- Dr. Lee Ju-hyung, a professor at the Jeonbuk National University Medical School, worked to recreate the restaurant’s setup with his team and was surprised by how far the pair had been sitting from each other.
- Surveillance footage showed the pair never spoke or touched the same cutlery, dishware or any other surfaces — but the movement of a lighting fixture indicated that an air conditioning unit had been on at the time.
- Lee and other researchers measured the airflow throughout the restaurant.
- “Incredibly, despite sitting a far distance away, the airflow came down the wall and created a valley of wind. People who were along that line were infected,” Lee said, according to the Los Angeles Times.
- A schematic diagram of the outbreak restaurant equipped with ceiling-type air conditioners.
- “We concluded this was a droplet transmission, and beyond [6 feet].”
- The findings determined that the student had likely been infected during a five-minute window while sitting 20 feet away from the saleswoman.
- “‘[The student] had to get a large dose in just five minutes, provided by larger aerosols probably about 50 microns,” Linsey Marr, an engineering professor at Virginia Tech who was not involved in the study, told the Los Angeles Times.
- “Large aerosols or small droplets overlapping in that gray area can transmit disease further than one or two meters [3.3 to 6.6 feet] if you have strong airflow.”
- Marr said the study illustrated the risk that comes with dining indoors — and that being the recommended six feet apart from others might not be enough.
- “Eating indoors at a restaurant is one of the riskiest things you can do in a pandemic,” Marr said.
- “Even if there is distancing, as this shows and other studies show, the distancing is not enough.”
4. Scientists spray saliva-like droplets in stadium to study how fans spread aerosols
- Scientists are using the Netherlands’ largest football stadium to model how a cheering football crowd might spread aerosols through the air by spraying fine droplets, made to resemble saliva, over the empty stands.
- Their hope is that by finding out more about the behaviour of aerosols or airborne particles, which could spread the coronavirus within a crowd, they will be able to remove them from the air and get fans back into stadiums and concert halls.
- “There is almost no information in scientific literature about the behaviour of aerosols in this kind of environment”, lead researcher Bert Blocken told Reuters.
- An aerosol generator is seen as Dutch scientists investigate whether football fans can safely return to matches in the experiment which uses hundreds of sensors and aerosols at Johan Cruijff Arena, the stadium of Ajax Amsterdam, in Amsterdam, Netherlands.
- The tests are taking place at the Johan Cruyff Arena in Amsterdam, home of Ajax Amsterdam.
- “We want to get a fundamental insight in the behaviour of aerosols in a stadium filled with football supporters. By air cleaning technologies you can drastically reduce concentrations and make stadiums safe in terms of aerosol transmission of the virus,” he added.
- Researchers check aerosols at Johan Cruijff Arena.
- There is growing consensus among scientists that transmission via aerosols plays a part in the spread of the novel coronavirus, although it is unclear to what extent.
- The research could provide insight in how to minimise the concentration of aerosols and limit their epidemic risk, said Blocken, a professor in aerodynamics at the Technical University of Eindhoven.
- A computer model will extrapolate the data gathered during weeks of testing to show the effects for a full capacity crowd of around 55,000.
- Researchers also hope to get permission soon to experiment with a real crowd of 730 football fans, seated close together.
- The final goal is to get capacity crowds back into stadiums, Blocken said, possibly through the use of large scale COVID-19 testing, face masks and ventilation.
- That would be exactly what the Johan Cruyff Arena needs to survive, its director told Reuters.
- “This is a very costly building, and the income is less than half of what is normal, so we are making a loss every month”, said Henk Markerink.
- “We try to keep the ship afloat, but this shouldn’t take too long because in the end this cannot be financed.”
5. Military-grade camera shows risks of airborne coronavirus spread
- The virus spreads most commonly through close contact, scientists say. But under certain conditions, people farther than six feet apart can become infected by exposure to tiny droplets and particles exhaled by an infected person, the Centers for Disease Control and Prevention said in October. Those droplets and particles can linger in the air for minutes to hours.
- To visually illustrate the risk of airborne transmission in real time, The Washington Post used a military-grade infrared camera capable of detecting exhaled breath. Numerous experts – epidemiologists, virologists and engineers – supported the notion of using exhalation as a conservative proxy to show potential transmission risk in various settings.
- Watch the video here.
6. Gargling Could Slow Covid-19 Spread, Mouthwash Makers Say
- Wash your hands, wear a mask and don’t forget to gargle with mouthwash.
- That’s the message Unilever and Colgate-Palmolive Co. are carefully starting to push after research they commissioned showed that certain types of mouthwash and toothpaste could potentially help deactivate the virus that causes Covid-19.
- Now, Unilever is launching mouthwash brands in new markets, while Colgate has shared the results of its study with dentists.
- Reducing virus particles in the mouth could help fight against the pandemic, the companies said, because Covid-19 can be spread through droplets generated when an infected person coughs, sneezes or speaks. Both companies said the mouthwashes dissolve the outer protective layer of virus particles, preventing them from attaching to cells and infecting them.
- But based on tests so far they can’t definitively say how long the benefit would last or what impact coughing would have. That makes it hard to judge how useful oral-hygiene products could be in curbing transmission.
- Unilever said an October lab-based study it commissioned found mouthwash containing cetylpyridinium chloride, or CPC—an ingredient used by dentists for its antibacterial properties—reduced SARS-CoV-2 particles by 99.9% after 30 seconds of rinsing.
- “While we are clear that this is not a cure or proven way to prevent the transmission of coronavirus, the results are very promising,” said Glyn Roberts, Unilever’s head of research and development for oral care.
- Early in the pandemic, scientists from Cardiff University in Wales and other institutions called for more research into the potential role of mouthwash in fighting Covid-19. Previous studies, they said, had shown that ingredients commonly found in mouthwashes could deactivate other viruses. Mouthwash makers say sales have risen this year amid broader demand for hygiene products.
- Angela Rasmussen, an associate research scientist at Columbia University’s Center of Infection and Immunity who reviewed the results of the study commissioned by Unilever, said that the findings were promising but results from human trials are needed.
- “What happens in a culture dish is not indicative of what would happen in a patient’s actual mouth and throat,” said Ms. Rasmussen. “While it’s great for a short period of time to reduce virus secreted by those cells, what really is going to be important is how long that effect will last.”
- Unilever said it plans to follow its study—in which scientists from Microbac Laboratories used a culture dish to simulate the viral load in the mouth—with a trial in at least 50 people early next year. It will also look into how mouthwashes could impact other viruses.
- In the meantime, Unilever is launching mouthwash with CPC in a string of new markets, from Italy and France to India and Indonesia, under brands including Pepsodent, Mentadent, Signal and Close-Up. The company doesn’t plan to launch these in the U.S., where its oral-care business is smaller and the regional rights to some of the brands are held by other companies.
- Unilever isn’t making any new claims on product packaging, but has been promoting its findings through social media and its website.
- Colgate, the world’s largest toothpaste maker, said its lab tests, conducted by Rutgers New Jersey Medical School, also showed some kinds of toothpaste, mouthwash and mouth spray can virtually eliminate the virus that causes Covid-19. The toothpastes contain zinc or stannous, a mineral that can help fight gum disease, while the mouthwashes contain CPC.
- Colgate said it is sharing its findings with dentists and notes many are now asking patients to rinse before procedures to reduce the possible presence of the virus.
- The company said a separate clinical trial testing mouthwash on 50 hospitalized people suggested the benefit could last between 30 and 60 minutes after rinsing. Full results haven’t yet been shared.
- The company is also funding additional clinical studies in the U.S. and Brazil in which 260 people with Covid-19 are participating.
- “We think oral care has a role to play in fighting the global pandemic, alongside other preventive measures,” said Colgate’s Chief Clinical Officer Maria Ryan.
- Some companies say it is too early to make any virus-related claims about mouthwash or toothpaste.
- Johnson & Johnson, owner of Listerine, said lab-based findings about oral-care products and the virus, while high quality, aren’t sufficient to advocate the use of mouthwash as a prevention measure.
- “Listerine Antiseptic is not intended to prevent or treat Covid-19 and should be used only as directed on the product label,” a spokeswoman said, adding that J&J intends to actively participate in the scientific exchange on this topic.
- In October, J&J said its third-quarter oral-care sales grew 10.8%, partly attributing the rise to “increased demand globally related to the Covid-19.”
- Procter & Gamble Co. isn’t commissioning its own studies and said it is too early to tell how mouthwashes impact the virus. It said its Crest mouthwashes, many of which contain CPC, are being tested by third parties.
C. Vaccines & Testing
1. The chart that shows how we’ll get back to normal
- A covid-19 chart that’s been shared thousands of times is dramatizing just how well vaccines against the disease can work and how we might get out of pandemic hell.
- Today, advisors to the US Food and Drug Administration voted in favor of emergency authorization for Pfizer’s covid-19 shot, and the data in this chart is a big reason why.
- The graphic (below), released by Pfizer and its partner, BioNTech, shows the difference in covid-19 infection rates between the people in their trial who got a novel gene vaccine and those who got a placebo.
- The volunteers who were given a placebo shot appear as the blue line. The ones who got a vaccine are in red. Each time either line jumps up, that’s when a new covid-19 case occurred.
- What the data shows is that during the first week after getting their shots, both groups of people kept getting covid-19 at about the same rate. But after that, the lines start to separate. And they just keep separating and separating.
- That’s the result of the vaccine taking effect, which usually takes a few days and gets boosted by a second dose. After two weeks, hardly anyone with the vaccine was getting covid-19. But the disease kept striking those who got the placebo with clockwork regularity.
- “No comment. This is what vaccines do,” said Florian Krammer, a prominent immunologist, who posted a version of the image to Twitter.
- The triumphalism is justified. This is what the researchers have been working toward all year. And the data in this graphic leaves no room for rumors, politics, or uninformed commentary. It’s as plain as day: this vaccine is one of the best we’ve ever seen.
- Pfizer presented the chart in a paper published on December 10 in the New England Journal of Medicine and earlier in the week as part of its application to the US Food and Drug Administration to begin selling the vaccine. That authorization could be given at any moment now that the agency’s advisors have voted in favor.
2. New Vaccine Data Is Coming: Watch Out for These 3 Claims
Tips on how to read the full results from BNT-Pfizer and Moderna, from an expert in evaluating medical evidence.
- THE LAST FEW weeks have seen dramatic headlines on the efficacy of several new coronavirus vaccines. But coverage to this point has been based on press releases—tiny snippets of results that were trickled out from clinical trials. This week, the real data deluge will begin. The Food and Drug Administration has been analyzing thousands of pages of data for BioNtech-Pfizer’s vaccine, in preparation for an all-day meeting on December 10 to decide whether to authorize its emergency use—and detailed summaries of that data could be released as soon as Tuesday. Then the agency will repeat the process next week for the Moderna vaccine. The first publications of the vaccines’ efficacy data in medical journals should be coming out soon too.
- It’s going to be a lot for experts and the news media to digest. If the past is any guide, there will be plenty of errors, misunderstandings, and communication snafus in coverage, as well as active disinformation campaigns on both sides to boost hype or spread fear. Here are three tricky or misleading claims to keep an eye on:
Misleading Claim 1:
- The trials were so humongous, all the results must be iron-clad. Or else, The trials included so few people who actually got sick, the results must be unreliable.
- We’ve been conditioned to think a study’s size is just about the most important thing about it. That’s how they’re always described to us: “A study of 50,000 people found so-and-so.” But we shouldn’t be so easily impressed by how large a trial sounds! For effectiveness, its power is always about the number of “events” that occur during the study—in this case the number of people who got sick with Covid.
- Take the famous 1954 field trial for the Salk polio vaccine, which included an incredible 1.8 million children! But the number of events used in the most critical analysis—a placebo comparison involving a subset of more than 400,000 children—was just 143. That’s how many children in the study developed paralytic polio, and it was enough to be sure of the all-important finding that the Salk vaccine worked. The BioNTech-Pfizer trial had 43,000 participants and 170 events; the Moderna trial had 30,000 participants and 196 events. Those numbers represent an efficient means of getting urgent answers. They suggest neither overkill nor risky corner-cutting.
- At the same time, it’s important to remember that not every number that’s reported will be based on a full analysis of all the data. The BioNTech-Pfizer vaccine is said to have 95 percent efficacy; Moderna’s, 94.5 percent. These are the most top-level findings. As more data comes out, though, it’s all but certain that more fine-grained—but potentially less reliable—analyses will make the news and be presented as though they are equally strong. We already saw this happen a few weeks ago, when a BioNTech-Pfizer press release reported that “efficacy in adults over 65 years of age was over 94 percent.” Outlets such as ABC News went ahead and passed that finding straight on to their readers. But we can’t be as certain about this as we can about the overall efficacy. When a little more data about the vaccine was released upon its authorization by the UK government last Wednesday, it showed that there weren’t quite enough participants in the study’s oldest age group (over 75) to be as sure about that result. It’s still an important finding; it’s just a more tentative one. The same may apply to other statistics that get reported in the days to come. How effective is the vaccine at preventing infection, for example, or protecting people with chronic diseases from Covid? Don’t assume that secondary findings like these will carry the same degree of confidence as the main ones.
Misleading Claim 2:
- Now we know that claims of “95 percent efficacy” were hype.
- Be prepared to see a bunch of new estimates of effects in the days and weeks to come—and some of these could make the vaccines sound less useful at preventing Covid than did first reports. That’s not a sign that the first analyses are unreliable. Calculations of 95 percent efficacy were based on data from only those participants who took both of two vaccine injections, with some extra time allowed for the fullest possible immunity to kick in. That means a bunch of people were left out: There may be some who got Covid before that point was reached; some who dropped out of the study before getting their second injection; and some who stopped providing the researchers with follow-up, so it won’t be clear whether they ever did get sick. We’ll soon have analyses that take these people into account, and they will show somewhat different levels of efficacy. These may offer some insight into how well the vaccines will perform in practice, when rolled out in our communities.
- That said, the new data may introduce some new problems. Watch out, in particular, for results of analyses that may not have been high-level outcomes planned out by the researchers ahead of time. These are known as “subgroup” or “exploratory” analyses, and they can be more like setups for questions to study in the future than solid answers on their own. We saw a case like this already with some of the Oxford-AstraZeneca results. The efficacy for that vaccine’s standard dosing was 62 percent, according to the press release. But a smaller group of people mistakenly got the wrong dosing, and when their data was separated from the others’, the efficacy was 90 percent. Initial media coverage ran with this finding as if it were a more meaningful, primary result. AstraZeneca has since acknowledged that they “need to do an additional trial” to test this new hypothesis.
Misleading Claim 3:
- The vaccine was well tolerated, and side effects were mostly mild or moderate.
- This is a classic example of what I call “placebo information”: It looks like the real thing, but it tells you nothing. Adverse reactions to vaccines that are designed for widespread distribution are always “mostly mild and moderate.” The vaccine may cause almost no severe effects, or it could cause a lot of them; but either way, mild and moderate reactions will be more numerous.
- For months, we’ve been getting this type of placebo statement for all the Covid-19 vaccines. But that doesn’t mean the experience of taking them will be the same. For example, a press release about the BioNTech-Pfizer vaccine reported that the rates of most severe adverse events were below 2 percent, with only fatigue and headache showing up a bit more often. In contrast, Moderna’s press release reported rates rates higher than 2 percent for about half a dozen severe symptoms, including two—fatigue and myalgia (muscle pain and weakness)—that occurred in up to 9 or 10 percent of those who got the vaccine.
- Even so, The New York Times reported only that participants in trials of both vaccines had no serious effects, but “reported sore arms, fatigue, fever, and joint and muscle aches that last for a day or two.” It’s true that neither study release included evidence of “serious” or “grade 4” side effects, which are defined by the FDA’s grading scale as being those that can be life-threatening, such as a fever over 104.0°F or anything that requires hospitalization, such as a stroke or an acute breathing problem. But the vague New York Times write-up, and many others like it, make no attempt to get across that “severe” or “grade 3” adverse events did occur, and that they were apparently more frequent for Moderna’s vaccine than for BNT-Pfizer’s. These adverse events aren’t life-threatening, but they matter. According to the FDA, a severe one prevents daily activities and requires medical help. It could leave you with a fever between 102.1 and 104.0°F, for example, in need of narcotic pain relievers or on an intravenous drip. In fact, among those who received the Moderna vaccine, severe adverse events could end up being described as “common,” according to the FDA’s threshold definition of that term. Watch out for specific data on these in the coming weeks, and also keep an eye out for what’s revealed about the “moderate” or “grade 2” adverse events, which can be hard-going, too. A full, transparent accounting of these details will only improve public trust in the vaccines.
3. UK trial to mix and match Covid vaccines to try to improve potency
Pilot planned for January will give subjects a shot of both Oxford/AstraZeneca and Pfizer/BioNTech versions
- A trial is likely to go ahead in January to find out whether mixing and matching Covid vaccines gives better protection than two doses of the same one, the head of the British government’s taskforce has said.
- The trial will begin if the University of Oxford/AstraZeneca vaccine is approved in the coming weeks, as is hoped. The treatment can only be administered with licensed vaccines.
- The news comes as the first British patients begin receiving coronavirus vaccinations from Tuesday, a jab made by Pfizer/BioNTech, a week after the UK became the first country in the western world to approve a Covid vaccine.
- Those who take part in January’s trial will get one shot of AstraZeneca’s vaccine and one of the Pfizer injection. A vaccine from US biotech firm Moderna will also be included if it gets approval.
- Pfizer’s and Moderna’s vaccines have both been shown to have 95% efficacy at protecting people against the virus. For AstraZeneca’s, efficacy was 62% among the largest cohort given two doses, but rose to 90% among a smaller group given half a dose initially, followed by a full dose.
- Kate Bingham, outgoing chair of the UK’s vaccine taskforce, said the “mix and match” trials were not about making limited supplies of the vaccines go further. The UK government has ordered 40m doses of the Pfizer vaccine and 100m of Oxford/AstraZeneca’s candidate.
- “It’s not being done because of supplies,” said Bingham. “It’s to do with trying to trigger the immune response and the durability and nothing to do with what vaccines we’ve got.”
- The concept is known as a heterologous prime-boost. “It means mix and matching vaccines,” said Bingham. “So you do a prime with one vaccine and then the second – whether it’s 28 days or two months or whatever the agreed periods would be – would be with a different vaccine.”
- Viral-based vaccines such as the Oxford jab, which is based on a chimp common cold virus, give a much greater cellular response – prompting the T-cells to kill cells infected with the coronavirus. The mRNA vaccines, like Pfizer’s, tend to generate a bigger antibody response. So the idea is to combine them, in whichever order, to help the immune system respond more powerfully to Sars-CoV2.
- “No one’s ever done it live and since we’ll have safe vaccines available we should do that study, because then we have the ability to actually produce better immune responses,” said Clive Dix, deputy chair of the taskforce.
- “There is a slight benefit to it, too, in that if prime and boosting either way around work, it may help with the deployment, because it might just be simpler to deploy that way round, but the main reason is to get a stronger immune response.”
- Bingham and Dix were speaking at the launch of a progress report on the first six months of the taskforce, which has secured deals for seven different vaccines for the UK.
- Three of them – Oxford/AstraZeneca, Valneva and Novavax – are being manufactured in the UK. The first doses of the AstraZeneca vaccine have been made in the Netherlands and Germany, but 4m doses are already in the country and most of the rest of the supply will be UK-manufactured.
- There remain questions over when the Oxford/AstraZeneca vaccine will be approved. The UK regulator has been asked by the government to appraise it following a rolling review, assessing all data and information on safety and efficacy and the quality of the product over recent months as it has become available. But the full data from the late-stage clinical trials, involving 24,000 people, have not yet been published and it is not known how the regulators will view the results.
- Dix said the taskforce had no regrets over backing other types of vaccine over mRNA vaccines like Pfizer’s and Moderna’s, adding: “We certainly wouldn’t have got enough [of the Pfizer vaccine] to vaccinate everybody.”
- They looked at Moderna but realised they could not get any doses until April, so did not sign a contract. On the day Moderna reported its results, a deal was agreed to buy 5m doses, which was later increased to 7m.
4. Tracking the Coronavirus Vaccines That Will End the Pandemic
- The biggest vaccination effort in history has begun. On Dec. 2, the U.K. was first to clear the use of a new shot from Pfizer Inc. and BioNTech SE. The U.S. will likely do the same, and a separate vaccine from Moderna Inc. is close behind. By the end of 2020, tens of millions of people could be inoculated. Next year: billions more.
- Bloomberg is tracking nine of the most promising vaccines around the globe, from national procurement deals to shots in patients’ arms. By our count, 7.95 billion doses have already been allotted.
- It’s enough to cover half the world’s population (most vaccines use two doses), if the shots were distributed evenly. That, however, isn’t likely. Rich countries have hedged their bets with extensive supply deals, and ultra-cold storage requirements make some vaccines difficult to deliver to far-flung places.
- Other countries have struck their own paths: China and Russia authorized their vaccines in July before they’d been fully tested. Including those, a total of five vaccines are now available in limited quantities, in three countries.
- Note: Data are based on interviews, company disclosures, news reports and government data. In many countries, vaccines are first coming to market under emergency measures that let them bypass normal regulatory requirements. Because millions of people will get the vaccines under these rules, they are displayed as “available to the public.” Bloomberg will note when the regulatory status changes in the future.
- Desperate for relief from the worst pandemic in a century, countries have struck deals to secure vaccine access. AstraZeneca’s two-dose shot is the early leader, with pre-purchase agreements to cover 1.49 billion people—more than twice as many as any other candidate.
- Strategies to secure vaccines varied widely. The U.S. struck unilateral deals for all of its supply. Dozens of countries will get vaccines through Covax, a consortium backed by the World Health Organization to ensure equitable vaccine distribution. An arrangement brokered by Mexican billionaire Carlos Slim will deliver cheap vaccines throughout most of Latin America.
- Bloomberg has identified more than 80 agreements. Deals were included only if they had information on what company will make the vaccine, how many doses are covered, and what countries are likely to receive it. Billions of vaccines will likely be manufactured outside of such agreements. India, which has deals to manufacture 2.2 billion doses, plans to send vaccines to other countries.
- Coronavirus vaccines are coming to market at a record pace, shaving years off the typical development time. That speed has been financed in part by rich countries like the U.S., whose Operation Warp Speed program helped subsidize development and manufacturing of half a dozen novel vaccines.
- Wealth has moved those countries to the front of the line. It’s also allowed some to hedge their bets by securing doses from a variety of manufacturers. Canada, with its population of 38 million, has contracts with six companies to supply enough vaccines for 152 million people—and that doesn’t include vaccines it agreed to buy through the Covax consortium.
- Russia and China aren’t striking the same sorts of deals. Instead, they’ll rely on domestically produced vaccines, such as the Sputnik V shots made by Moscow-based Gamaleya Center or those made by China’s state-owned pharmaceutical giant, Sinopharm. While China doesn’t disclose how many doses the government orders from local manufacturers, it’s assumed those companies will provide as much as the population needs.
- Note: Map only shows publicly disclosed allocations for countries with available population data. Some countries, including China, will produce vaccines domestically under terms that haven’t been disclosed. Calculations for population covered take into account the number of doses required by each vaccine.
|No. of people covered (thousands)||No. of people covered as % of population|
- Check back as we continue to track the vaccine rollout, and sign up here to get new updates on the development and access to vaccines emailed to you directly.
5. People with significant allergies should avoid Pfizer COVID-19 vaccine
- The U.K.’s Regulatory Agency is advising people with a history of “significant” allergic reactions to avoid Pfizer’s coronavirus vaccine, after two National Health Service members developed severe allergic reactions to it on Tuesday (Dec. 8).
- “As is common with new vaccines the MHRA (Medicines and Healthcare products Regulatory Agency) have advised on a precautionary basis that people with a significant history of allergic reactions do not receive this vaccination after two people with a history of significant allergic reactions responded adversely yesterday,” Stephen Powis, the national medical director for England’s National Health Service said in a statement on Wednesday (Dec. 9).
- Both workers have a history of severe allergies and carry adrenaline auto injectors (such as EpiPens) around with them, according to The Guardian. Shortly after receiving the vaccine, both NHS workers developed anaphylaxis-like symptoms, or severe allergic reactions, but have recovered after receiving treatment.
- The MHRA will investigate further and Pfizer and BioNTech will support their investigation, according to Reuters.
- “Any person with a history of a significant allergic reaction to a vaccine, medicine or food (such as previous history of anaphylactoid reaction, or those who have been advised to carry an adrenaline autoinjector) should not receive the Pfizer/BioNtech vaccine,” according to the new MHRA guidance. The guidance also notes that “resuscitation facilities” should be available for all vaccinations at all times.
- Pfizer previously said that people with a history of severe adverse allergic reactions weren’t included in late stage trials, according to Reuters.
- Indeed, only 0.63% of people who were given the vaccine and 0.51% of people who were given the placebo reported allergic reactions — some of which were mild — in the trials, according to the first Food and Drug Administration (FDA) review of the vaccine data that was published on Tuesday.
- “Allergic reaction occurs with quite a number of vaccines, and perhaps even more frequently with drugs. So it is not unexpected,” Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine said in remarks to journalists published by Britain’s Science Media Center.
- “What would be wise, as the MHRA have already advised, would be for anyone who has known severe allergic reaction such that they need to carry an EpiPen, to delay having a vaccination until the reason for the allergic reaction has been clarified,” he said.
- For the general population this does not mean that they would need to be anxious about receiving the vaccination, he added. “One has to remember that even things like marmite [a quintessential British food spread] can cause unexpected severe allergic reactions.”
- The very first doses of the Pfizer-BioNTech vaccine were administered to several thousand people in the U.K. on Tuesday, according to the BBC.
D. Concerns & Unknowns
1. FDA warns against wearing masks with metal during MRIs after patient is burned
- A patient wearing a face mask with a metal part was burned while undergoing an MRI exam – prompting the Food and Drug Administration to issue a warning about the potential dangers of using such coverings.
- “The FDA received an injury report for a patient who was wearing a face mask with metal during a 3 Tesla MRI scan of the neck. The report describes burns to the patient’s face consistent with the shape of the face mask,” the FDA said in its alert Tuesday.
- The agency warned that patients should not wear any metal during an MRI, a well-known precaution that was apparently missed during the person’s neck scan.
- “Given the increased use of face masks during the COVID-19 pandemic, the FDA wants patients and health care providers to be aware of the potential risk of face burns related to the use of patient face masks containing metal during an MRI,” the FDA said.
- The agency noted that it is appropriate for a patient to wear a mask for an MRI exam during the coronavirus pandemic.
- ”Before the MRI begins, health care providers who perform MRI exams should confirm the face mask has no metal. Some face masks have metal strips to help shape the mask to the face of the user, nanoparticles, or antimicrobial coating, which may contain metal (for example, silver or copper),” it said.
- “The metal could result in radio frequency (RF)-induced heating. This may represent a hazard for MR imaging during the COVID-19 pandemic.”
2. C19 infection rate exponentially higher than reported 15M, CDC says
- The US topped 15 million cases of COVID-19 this week, but that number is likely exponentially higher — by as much as seven times, a top Centers for Disease Control and Prevention official said Thursday.
- Aron Hall, co-lead of the agency’s epidemiology task force, offered the startling statistic during a virtual hearing over Pfizer/BioNTech’s coronavirus vaccine.
- “The total estimated number of infections is likely two to seven times greater than reported cases,” Hall said, adding that the evidence was based on seroprevalence surveys and models.
- “Though less than 10 percent of the population in most states had evidence of previous infection through September.”
- On Tuesday, the country surpassed 15 million cases of coronavirus as infections and hospitalizations continue to soar into what officials are calling the darkest months of the pandemic.
- More than 289,000 people have died from the virus. Hall said the death toll is also likely higher.
- “We do feel as with hospitalizations and illnesses that the reported number of deaths is likely an underestimate of the true number of deaths,” he said.
E. Back to School!?
1. How to Motivate Teens Struggling With Remote School
Getting boys to engage in virtual instruction doesn’t have to be a battle. Experts offer tips on how to make virtual school more bearable.
- We’re nine months into the pandemic and remote school is wearing on students. Boys, who are at greater risk of falling behind academically than girls, are having an especially tough time with all the hours spent behind screens. The challenges of staying focused and motivated in remote school carry even higher stakes for adolescent and teenage boys, who face more academic pressure than younger ones.
- I reached out to child psychologists and education experts to find out how parents can help their sons—and daughters—remain focused and motivated in virtual school. They all said the first step is for parents to examine their own expectations and reactions to their children’s struggles. Here are some key pieces of advice:
Enlist your child in developing solutions
- “What you need to do as a parent is try to stay away from your own catastrophic thinking and use your foremost consultant, which is your child himself,” said Michael Thompson, a child psychologist and author of “Raising Cain: Protecting the Emotional Life of Boys.” He added, “No one knows more about what he likes and what he hates about school than he does.”
- How do you elicit meaningful feedback from an adolescent or teenager who responds with one-word answers? It’s all about how you ask the question. Dr. Thompson suggests saying something like, “I see you’re struggling with math and English. How can I help you with that?”
- Experts caution parents against being accusatory. If a teacher has alerted you to missing assignments, you can say to your child, “I heard you’re having a hard time turning things in. What’s happening?” suggests Jeffrey Selman, vice president of clinical services at First Children Services, a behavioral health and special-education services provider for children in New Jersey and Pennsylvania.
- Motivation is often tied to success: The harder something is, the less a child wants to do it. But parents sometimes mistake their struggle for feelings of indifference, according to Matthew Cruger, a clinical neuropsychologist and senior director of the Learning and Development Center at the Child Mind Institute.
- By offering to go over homework or helping kids study for a test in the evening, parents can get a better understanding of what the stumbling blocks are. When I noticed that my 10-year-old son didn’t do well on a grammar test, I sat down with him one night and went over sentence structure. Once I explained predicates and conjunctions, he got it.
- I asked him why it was hard to understand this during class and he said the teacher went over everything too quickly. I thought he just wasn’t paying attention, but I discovered that he was getting lost in the cacophony of group Zoom sessions and needed some one-on-one attention.
- Beyond homework help, parents can ask their kids if there are other things that can improve their remote-school experience. Some kids might prefer to work from the couch for part of the day instead of from their desk. And if teens function better in the afternoon or evening, that might be a better time than morning for them to work on independent assignments.
- In his book “Drive: The Surprising Truth About What Motivates Us,” Daniel Pink argues that autonomy over how and when we work is one of the greatest motivating forces for children and adults alike.
Don’t underestimate the power of praise
- Praise isn’t just for little kids—it’s an important motivating factor for adolescents and teenagers, too.
- Multiple experts said it’s best to separate performance from effort when giving praise. Many kids with ADHD and general distractibility spend a lot of time completing their work and then forget to turn it in. Of course, some boys rush through their work to move onto something more rewarding, like playing videogames. Parents should praise the effort that went into the work instead of only focusing on the grade, said Megan Narad, an assistant professor and clinical psychologist at Cincinnati Children’s Hospital.
- While saying “good job” can go a long way, tangible rewards can be helpful, too, if handled carefully. Rewards can be a slippery slope as children come to expect something for everything they do, thus chipping away at their intrinsic motivation.
- Experts say rewards can come in the form of providing kids with more choices, something that’s especially important at a time when children have lost so much control over their daily lives. Even something as simple as letting kids choose what to have for dinner or what movie to watch during a family movie night can help boost their motivation.
- The experts I spoke to were all in agreement that positive reinforcement is far more effective than punishment in fostering motivation.
- “When we use consequences to encourage positive behaviors, it doesn’t work. If you take something away because your child didn’t turn in an assignment or got a bad grade, it’s discouraging and it doesn’t make it more likely for positive behavior to result,” Dr. Cruger said. “If you just keep taking things away, you eventually run out of things to take away.”
- Dr. Cruger advises parents to reserve negative consequences, such as restricting videogames or phones, for more serious behaviors that they want to put an immediate stop to, such as fighting, cheating, lying or stealing.
Create to-do lists and break down tasks
- Since a big part of motivation comes from a sense of achievement, now is a good time to review whether we’re setting our kids up for success. Being successful without the structure of the classroom requires kids to know exactly what to do and when to do it.
- “If you don’t know what to do, you’re more likely to avoid it, and that looks like disengagement,” Dr. Selman said.
- I’ve offered some tips for making remote school easier in a previous column, but there are some structural things parents can do to help with the executive-functioning skills adolescents and teens haven’t fully developed.
- Dr. Narad suggests writing down a list of tasks that need to be completed each day for kids to cross off. Make another list for longer-term projects and break those down into smaller tasks that can be completed each day, so that your child is seeing progress and not scrambling to complete a big assignment right before it’s due.
- Depending on children’s age and maturity, you might need to check for a while to make sure they really have completed their work and turned it in before you can trust that they’re doing it themselves.
Don’t lose sight of the bigger picture
- Kids often don’t see how what they’re doing now matters. It’s important to discuss the purpose of sitting through long video classes and doing the work. “We all do things we don’t want to do, but if we think about why, it can motivate us to do it,” said Julie Kolzet, a clinical psychologist.
- All of the experts said it’s important that parents show their children—and themselves—some grace.
- “Our kids’ whole lives have shifted. They’re dealing with things we never thought they’d have to deal with on a daily basis. Some kids can’t even access the internet,” Dr. Selman said. “We need to be realistic about our expectations of adolescents and teens right now.”
2. Covid-19 Vaccine Makers Turn Toward Testing Children
Moderna, Pfizer now include children in trials, as health experts urge more such research to help curb transmission and reopen schools
- Pharmaceutical companies and health officials are homing in on a key sector of the population that has been largely left out of planning for Covid-19 vaccines: children.
- Pfizer Inc. and BioNTech SE, whose jointly developed vaccine is now being rolled out in the U.K., became the first Covid-19 vaccine developers to include children in U.S. trials in September. Moderna Inc., whose vaccine has also shown to be effective in adults, said Thursday it began a trial for children 12 to 17 years old. AstraZeneca PLC also plans a U.S. trial for children.
- The omission of children in U.S. vaccine trials so far worries public-health experts, who say they don’t know whether the vaccines are safe for children or need changes to dosage levels. While children are less likely than adults to fall gravely ill or die because of Covid-19, researchers say, vaccinating them will help prevent the spread of the virus and achieve herd immunity.
- Yet some experts don’t expect a children’s vaccine will be ready by the 2021 school year because of how long trials take, even on the accelerated timeline for Covid-19 vaccines. “I’m pretty worried that the window’s closing if it hasn’t already closed,” said Evan Anderson, a pediatrics professor at the Emory University School of Medicine. “The timing then becomes a challenge in order to achieve enough data such that you’ve had a vaccine fully tested and evaluated over the spring and summer.”
- The American Academy of Pediatrics recently sent a letter to federal officials urging children to be included in clinical studies. In the letter, AAP noted that more than two-thirds of the children who died from Covid-19 infections were Black or Latino.
- The first vaccine shots in the U.S. are expected to go to high-risk populations such as long-term-care residents and health-care workers. A National Academy of Medicine panel that crafted a plan for prioritizing vaccine distribution included children in its third of four phases, after essential workers such as teachers but before most of the general population.
- The Food and Drug Administration has said it is important for drugmakers to test their shots in children. It has provided few details about how to do so and hasn’t said whether vaccine makers must collect results from thousands of children or merely hundreds.
- Matthew Huang, a 15-year-old from Cleveland’s suburbs who attends school virtually, jumped at the opportunity in October to enroll in Pfizer’s trial when his doctor’s office asked for volunteers. Unable to play cello or piano with friends for months because of the virus, he wanted to help researchers find a solution to the pandemic.
- “I was like, yes, immediately,” said Matthew, an aspiring physical therapist whose 8th-grade school project last year was on vaccine safety. “Participating in this is really important to help others.”
- The fear that children would transmit Covid-19 was initially central in the debate on how to operate schools without them becoming hot spots for the virus. But transmission rates within schools that have reopened since the fall have been much lower than those in the wider population. The coronavirus also appears to cause less harmful effects in children. Through July, just 121 of the approximate 190,000 deaths in the U.S. at the time for Covid-19-related reasons included children under the age of 21, according to the CDC.
- Still, more than one million children in the U.S. have become infected, according to the AAP, and research shows children are more likely to be asymptomatic or have milder symptoms than adults. Health experts note that the number of Covid-related deaths among children has almost surpassed the range of flu-related deaths for children, which has ranged from 37 to 188 since the 2004-05 flu season, according to the CDC.
- “I know there’s a perception that kids are just running around asymptomatic, but there are kids who get really sick from this,” said Grace Lee, a Stanford University professor of pediatrics who sits on the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. “We want to be able to protect as much of the population as possible. Only protecting adults doesn’t make sense as a public-health intervention.”
- Pediatricians and health experts say studies on children should begin because there is sufficient safety data on the most advanced shots. They also point to how childhood vaccines that proved to be effective for measles and polio didn’t have to show efficacy in adults first.
- “For most vaccines there is not much of a reason to think that if they are safe in adults, they wouldn’t be safe in children,” said Sean O’Leary, a professor of pediatrics at the University of Colorado School of Medicine and vice chairman of the American Academy of Pediatrics’ committee on infectious diseases.
- Vaccines are proven to save children’s lives. About 21 million hospitalizations and 732,000 deaths were prevented among children born during a 20-year-period because of vaccines, according to the CDC.
- Vaccine experts say pediatric trials could start with older children before gradually moving down to younger groups and adjusting dosage levels.
- Pfizer, whose vaccine was 95% effective in its late-stage trial, began enrolling children as young as 16 years old in September, and 12 and up the next month, after internal discussions over the challenge education officials faced with school openings, said Kathrin Jansen, who leads Pfizer’s vaccine R&D. Pfizer’s analysis for emergency authorization included some data on 100 children between 12 and 15, and no serious safety concerns arose. A pediatric trial is planned, Pfizer says.
- The vaccine from the University of Oxford and AstraZeneca, which has shown to work in adults, is slated to be tested in children in the U.S., according to the drugmaker. Johnson & Johnson, which hasn’t released data for its vaccine yet, plans to start a trial for children 12 to 18 once regulators sign off, and eventually younger children, too, according to the company.
- Matthew, who enrolled at Senders Pediatrics in South Euclid, Ohio, said he experienced mild side effects after both doses, such as a fever, but he recovered in about two days. He said he hasn’t really changed his behavior, although his mother, Molly, said the family now relies on him to buy groceries since they are convinced he got the vaccine and not a placebo.
- “We give him a list, and we park at the grocery store,” she said. “We let him go in and pick up the groceries instead of me.”
3. We Now Know How Much Children Spread C19
Exclusive: Kids catch and spread coronavirus half as much as adults, Iceland study confirms
- IN THE MIDST of the worst surge of COVID-19 cases in the United States, many state and local officials are again wrestling with the hot-button issue of whether to shut schools down. Now, emerging research confirms that schools aren’t the primary drivers of outbreaks, but cases will seep in and contribute to the disease’s spread whenever a country loses control of containing the pandemic.
- National Geographic was given exclusive access to the results from an Icelandic study that provides definitive evidence of how much children contribute to coronavirus spread. Researchers with the nation’s Directorate of Health and deCODE genetics, a human-genomic company in Reykjavik, monitored every adult and child in the country who was quarantined after potentially being exposed this spring, using contact tracing and genetic sequencing to trace links between various outbreak clusters. This 40,000-person study found that children under 15 were about half as likely as adults to be infected, and only half as likely as adults to transmit the virus to others. Almost all the coronavirus transmissions to children came from adults.
- “They can and do get infected and transmit to others, but they do both less frequently than adults,” says Kári Stefánsson, the chief executive of deCODE.
- This analysis is one in a recent flurry of large-scale studies that support the conclusion that infected adults pose a greater danger to children than kids do to adults. These studies could help inform officials who are struggling to decide when, or if, to close schools, knowing that such shutdowns are harming children. In addition to vital academic lessons, schools provide many critical services to communities, so last week, the U.S. Centers for Disease Control and Prevention recommended that schools should be both “the last settings to close” and “the first to reopen.”
- But even if children are generally less susceptible, when infection surges in a community, the risks in schools can dramatically increase. With the U.S. failing to contain the virus on a national level, American K-12 schools have reported more than 313,000 COVID-19 cases as of December 10.
The kids are alright, unless …
- Whether an infectious disease spreads in schools depends on two factors: how often children get infected with the coronavirus, and how easily they transmit the disease to others. If kids were to be both very susceptible and highly infectious, schools would likely drive new outbreaks of COVID-19, as they do with influenza. But if children are poor catchers and slight spreaders, schools should simply mirror what’s happening in the wider community.
- Before this fall, though, coronavirus data involving children were scarce, mostly because U.S. schools had closed so early in the pandemic. In addition, the research that emerged over the summer often had limitations.
- The best way to understand how transmission might occur between children and adults would be to constantly monitor healthy families with school-age children to see if they get infected. By testing frequently, scientists would catch infections as they occur, making it clear who got sick first.
- Iceland and deCODE put this into practice by conducting comprehensive testing and tracing, screening more than half the country’s population: Anyone who was potentially exposed was quarantined, sealing them off from the community, but often exposing their families. By looking at the difference between adults and children in these quarantines, deCODE found that children play a minor role in transmission.
- Iceland never closed its elementary schools, although it did close its high schools at the peak of its first surge. Data from its wave in September support the idea that younger children are less likely to get sick or to infect others. Stefánsson is in the process of publishing these results in a peer-reviewed journal, but he says the meticulous dataset is conclusive for Icelandic transmission—“and we have turned out to be a reasonable animal model for the human population.”
- Stefánsson cautions that if everything but schools and childcare centers are closed, children would then become one of the primary sources of transmission. He explains that while the individual risk might be low among youths, schools will still have outbreaks.
- That means the question becomes not a scientific one, but rather what level of risk society is prepared to accept to keep children in school: “What are you willing to live with?” he asks.
Don’t treat all ages the same
- In addition to the Iceland study, other research has shown that pre-pubescent kids have a significantly lower likelihood of getting sick. So, school officials need to make a distinction between younger children and adolescents.
- One recent large-scale study on how to stop viral spread cements this conclusion. When the COVID-19 epidemic was just weeks old, thousands of people in China traveled to celebrate the Lunar New Year. In Hunan—a province adjacent to where the coronavirus was first discovered—the government set up travel screenings and contact tracing. Using data from these checkpoints, researchers analyzed 1,178 infected people and their 15,648 close contacts.
- Their results, published in Science in late November, show that children under the age of 12 were less likely to contract the disease after an exposure than adults, says study co-author Kaiyuan Sun, a research fellow at the Fogarty International Center of the U.S. National Institutes of Health. The study also found that the risk of transmission within households, especially during lockdown, was much higher than between more casual contacts, like those made in school. When positive cases were isolated and their contacts quarantined, transmission chains were broken. This suggests that smart interventions could help halt wider outbreaks, including in schools.
- Many other studies agree that age matters. One recent preprint tracked 4,524 people from 2,267 houses in Geneva, Switzerland, from April through June. The researchers found that children from 5 to 9 were up to 22.7 percent less likely to be infected, and that their risk increased with age.
- The takeaway is that a critical shift appears somewhere between the ages of 10 and 12. Around the time of puberty, the risk of teenagers both getting and transmitting the virus increases. The COVID Monitor, a group tracking information from more than 7,000 U.S. school districts, found that high school case rates are nearly three times that of elementary schools.
- It’s still unclear why that might be the case. One theory is that children are more frequently exposed to coronaviruses, conferring some protection. Another is that children have fewer ACE2 receptors, a target of the coronavirus, in their upper airways. Still another theory is that their smaller lungs aren’t as good at projecting droplets or generating aerosols.
- Despite this distinction, children and teenagers often get lumped together in disease reporting, which Alasdair Munro, a clinical research fellow in pediatric infectious diseases at University Hospital Southampton in Britain, says, “is extremely problematic.”
- But transmission is not based only on biology. Behavior plays a role, too. In November, a study in India on half a million people found “patterns of enhanced transmission risk” in children under 14, including many instances in which children were infected by other children.
- “If a school opens, children make contact much more frequently than adults,” Sun says. His analysis also confirmed the CDC’s estimation that presymptomatic transmission accounts for about 50 percent of infections—meaning it’s not always possible to isolate people before they can get others sick. This is why schools will always pose some level of risk.
When do schools need to close?
- Because countries have taken different approaches to schools, the world has inadvertently designed a natural experiment on their exact role in COVID-19 transmission.
- In the U.K., a new paper published in The Lancet found that partial school reopenings this summer were associated with a low risk of cases; out of more than 57,000 schools and nurseries, the study found just 113 cases associated with 55 outbreaks. These cases were correlated strongly with local infection rates, showing how important it is to reduce community transmission to keep schools safe. “Transmission will occur in schools, just as it will anywhere that people mix,” Munro says. “But children aren’t the drivers of disease.” Instead, it’s increasingly clear that in many countries, it’s people in their 20s and 30s who spark outbreaks that then spill over into both older people and children.
- Data from Germany echoes these conclusions. Scientists recently tested thousands of children in Bavaria for antibodies, and found that six times as many children as expected had them—suggesting many children’s cases are being missed. But few of these cases have caused wider outbreaks. The country has also collected data from its 53,000 schools and daycares; even this fall, as community cases surged, an average of 32 schools a week have had more than two positive cases. Susanne Kuger, the director of the Center of Social Monitoring with the German Youth Institute, says that often “it’s adults transmitting disease, even in childcare settings,” as parents drop kids off, or staff mingle in a break room.
- Germany has also taken many additional measures to support parents, like increasing the number of sick leave days so that parents can stay home longer if children get sick. These steps are critical, Kuger says, because “parents transmit fear and worries onto their child. The more stressed parents are, the more stressed the child is.”
- After months of remote learning, it’s abundantly clear to both teachers and parents that closing schools does its own harm. There have been many reports of increased mental health concerns, domestic violence, and possibly even years of life lost due to decreased learning. That’s why Fiona Russell, director of the Child and Adolescent Health Ph.D. Program at the University of Melbourne in Australia, says, “Schools should absolutely be the first priority to open, and the last to close. They need to be prioritized.”
- That doesn’t necessarily mean instantly re-opening schools without first taking other measures to control community spread. The state of Victoria, for example, took a very conservative approach to lockdowns. Home to 6.5 million people, the state didn’t reopen until there were fewer than 10 total COVID-19 infections. Russell says schools were closed not because they’re inherently dangerous, but to prevent the movement of people.
- Brett Sutton, Victoria’s Chief Health Officer also said that in retrospect, the state would not have closed schools. Partly thanks to his advice, Ireland left its schools open during the most recent lockdown while closing gyms, churches, restaurants, and non-essential businesses. Nevertheless, community infections have declined by 80 percent in six weeks.
- “Our priority to keep the virus out of schools,” Russell says, “is to keep it out of the community.”
- Kaliris Salas-Ramirez, a neuroscientist at the CUNY School, is a single mom who has decided to keep her nine-year-old home from his school in New York City’s District 4. “There are so many other things that already put my Black son at risk,” she explains, citing the existential dangers of institutionalized racism. “Black and brown families don’t have the luxury of choosing to put our children’s lives at risk.”
- Government missteps and mixed messaging over the pandemic have already widened racial disparities in education. A recent survey in Massachusetts found that Black, Latino, and lower-income families are far more likely to have a child in remote learning this fall, a trend seen across the country. These choices are intentional and reflect a logical consideration of the disproportionate risk: The majority of children who’ve been infected and killed by the coronavirus fall into these racial and ethnic groups. Meanwhile, private schools are more likely to be open for in-person classes.
- “I don’t want to put myself, my kids, or their teachers in harms’ way,” says Naomi Pena, a woman of color and a member of the Community Education Council for District 1 in New York City. She’s watched multiple friends die from COVID-19. So Pena chose to keep her teenagers home, although one of her children has learning disabilities. Like Pena, around 60 percent of families in District 1 have decided to have their children learn remotely.
- As scientists finally begin to reach consensus on how safe schools are, school boards will need to not only make evidence-based plans, but better communicate what steps they are taking to keep kids and communities safe.
4. How kids’ immune systems evade COVID
- A growing body of evidence suggests why young children account for only a small percentage of COVID-19 infections: their immune systems seem better equipped to eliminate SARS-CoV-2 than are adults’. Some children who do get infected never test positive for the virus on a standard RNA test, even if they develop symptoms and have antibodies specific to SARS-CoV-2. Their immune system sees the virus “and it just mounts this really quick and effective immune response that shuts it down, before it has a chance to replicate to the point that it comes up positive on the swab diagnostic test”, says immunologist Melanie Neeland. The source of children’s immune advantage is thought to arise from one — or several — of these factors:
- Children’s T cells are untrained, so they might have a greater capacity to respond to new viruses.
- Children might have a strong innate immune response from birth, although that raises the question of why it isn’t seen with other viruses that can cause severe disease in children.
- It could be thanks to the protection of antibodies to seasonal common-cold coronaviruses, which run rampant in children.
- Kids might receive a smaller dose when exposed to SARS-CoV-2, because their noses contain fewer of the ACE2 receptors that the virus uses to gain access.
- Click the link below to read the full story.
F. New Technology & Equipment
1. Air purifier company seeks approval for air purifier that rids indoor air of virus
- As the country races to approve and roll out a coronavirus vaccine, one company is seeking federal approval to attack the ongoing coronavirus crisis from a different angle.
- Last week, Dallas-based ActivePure filed an application with the Food and Drug Administration seeking approval to use its range of plug-in air purifiers against SARS-CoV-2, the virus that causes covid-19. The devices are used in homes throughout the United States, utilizing technology shown in studies to kill airborne viruses within enclosed spaces.
- Over the summer, the company’s Aerus Medical Guardian was designated a medical device by the FDA for use in health-care settings. At the time, it was shown to kill 99.98 percent of the live virus on surfaces within seven hours. Now, after further testing, the company says more of its products are effective against the virus. But this time it’s tackling the air.
- Recent lab tests revealed ActivePure’s patented technology can kill airborne covid spores in three minutes, the company says. When turned on, its Aerus Pure and Clean and Vollara Air and Surface Pro devices work continuously to reduce pathogens indoors, even when people are present in the room.
- “We are seeking the (emergency use authorization) for use in all indoor environments so that these areas will be safer for people all over the world in this time of pandemic and beyond,” said Joe Urso, CEO and chairman of ActivePure.
- Hundreds of thousands of ActivePure filtration devices are installed throughout the country, the company says. Its technology is available in free-standing units as well as HVAC systems within hospitals, government buildings, restaurants, office buildings and homes. Prices start at $199 and can go as high as $1,499.
- It offers its line of products through various HVAC contractors and Aerus franchisees. The company says it will sell directly to consumers “soon.”
- While many home-based air purifiers rely on passive HEPA filters or ultraviolet light to kill contaminants, ActivePure uses active, NASA-inspired technology to disinfect the air.
- Standard air purifiers use a fan and filter system that sucks in unclean air, captures contaminants and pushes clean air back into the room. In the filtration company’s system, a fan brings in free oxygen and water molecules and then converts them into special ions that then pass through an internal UV light.
- Those ionized particles are then sent back out into a room to find and destroy microorganisms.
- “Going out on the attack and proactively neutralizing covid-19 viruses is a highly effective way to minimize the amount of virus that reaches your mask or lands on surfaces you may touch,” said Andy Eide, vice president of engineering at ActivePure in a statement.
- The disinfecting method has been shown to work against other RNA viruses, DNA viruses, bacteria, mold and fungi, the company says.
- NASA developed similar technology referred to as an ethylene “scrubber” in the mid-1990s to help with growing plants. The device would draw in ethylene, a gas emitted by plants that speeds up decay, and convert it into water and carbon dioxide, which help plants grow.
- In 2017, the space agency acknowledged the filtration company’s efforts to introduce the technology to people’s homes.
- ActivePure used CDC-approved labs that tested its products against the novel strain of coronavirus.
- Researchers found ActivePure’s air cleaners could reduce the virus’s concentration in the air by more than 99 percent, according to the company. During testing, the air purifiers were turned to their lowest setting of 29-cubic-feet per minute of air movement.
- ActivePure, which is owned by the 96-year-old company Aerus Holdings, isn’t the only air purification firm seeking to combat the ongoing coronavirus outbreak. In September, Hong Kong-based Aurabeat said it received FDA permission to market its device as a medical-grade air purifier under the agency’s modified enforcement policy amid the public health crisis.
- More may be on the way. Study trials found the PYURE Company’s air purifier reduced airborne SARS-CoV-2 below the limit of detection in 80 minutes.
- The air-cleaning technology may serve as one way to reduce exposure to the virus, which health experts say is spread primarily via respiratory droplets. However, it’s far from a cure or vaccine.
- The Environmental Protection Agency warns that disinfecting the air alone is not enough to protect people from the coronavirus. “When used along with other best practices recommended by CDC and others, filtration can be part of a plan to protect people indoors,” the EPA says.
1. MELINDA GATES ADMITS “WE HADN’T REALLY THOUGHT THROUGH THE ECONOMIC IMPACTS”
Authored by Jeffrey Tucker via The American Institute for Economic Research,
- In a wide-ranging interview in the New York Times, Melinda Gates made the following remarkable statement:
- “What did surprise us is we hadn’t really thought through the economic impacts.”
- A cynic might observe that one is disinclined to think much about matters than do not affect one personally.
- It’s a maddening statement, to be sure, as if “economics” is somehow a peripheral concern to the rest of human life and public health. The larger context of the interview reveals the statement to be even more confused. She is somehow under the impression that it is the pandemic and not the lockdowns that are the cause of the economic devastation that includes perhaps 30% of restaurants going under, among many other terrible effects.
- Further, her comments provide a perfect illustration of the core problem all along: most of the people who have been advocating lockdowns in fact have no actual experience in managing pandemics. To many of these, Covid-19 became their new playground to try out an unprecedented experiment in social and economic management: shutting down travel, businesses, schools, churches, and issuing stay-at-home orders that smack of totalitarian impositions.
- Here is what she says:
- You can project out and think about what a pandemic might be like or look like, but until you live through it, it’s pretty hard to know what the reality will be like. So I think we predicted quite well that, depending on what the disease was, it could spread very, very, very quickly. The spread did not surprise us.
- What did surprise us is we hadn’t really thought through the economic impacts. What happens when you have a pandemic that’s running rampant in populations all over the world? The fact that we would all be home, and working from home if we were lucky enough to do that. That was a piece that I think we hadn’t really prepared for.
- There are plenty of specialists who have lived through pandemics in the past and managed them by maintaining essential social and economic functioning. A major case in point is Donald A. Henderson, who as head of the World Health Organization is given primary credit for the eradication of smallpox. He wrote as follows in 2006:
- Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted. Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen to be less than optimal, a manageable epidemic could move toward catastrophe.
- We can look at how this disease traveled around the world and see that the countries who locked down first, they’re doing better. Many African countries saw it coming and locked it down early. Their replication rate just never got as high as many other countries. And that is a good thing.
- While it is true that Africa is an odd outlier, the claim that this is due entirely to early lockdowns has no support. Those who have looked at the anomaly in Africa point to the very young population (just 3% are over 65), cross immunities with other coronaviruses as the main reason for the low death rate, and stronger overall immunities. Indeed, the demographics alone could account for nearly the whole of the mortality difference with Europe and the U.S. In addition, Melinda says here what Bill has said for years: the only solution to a virus is to suppress it and develop a vaccine – the previously untested experiment that has brought poverty, death, and despair to the entire world. Africa in particular was devastated by lockdowns.
- It’s still a good thing that she is opening up to the New York Times so that we can gain a better perspective on her outlook. There will be a reckoning in the coming year concerning why and how all this happened to us. There will be no chance of suppressing the reality of what has happened. Indeed the center-left press is already starting to admit what AIER has been saying since March 2020.
- Consider this roundup from just the last several days:
WHAT HAS LOCKDOWN DONE TO US? BY DREW HOLDEN (NEW YORK TIMES):
- Some researchers worry that the social isolation has inflicted damage to mental health that will outlast even the worst of the pandemic. We may not have a full accounting of the consequences for years to come….There will be significant long term consequences from school closures as well. About half of the country’s school districts held remote classes, either exclusively or partially, at the start of the year. This approach has meaningfully reduced educational quality, particularly for children of color.
- These losses don’t even take into account the direct effects of the lockdowns on the economy. Small businesses have closed their doors at very high rates as the American economy sputtered in response to stay-at-home orders. One study estimates that 60 percent of the millions of jobs lost between January and April were a result of the lockdowns, not the virus itself. The economic uncertainty caused by unemployment comes with its own health risks….
- These tragedies have become an ambient backdrop to everyday life: present but forgotten, real but ignored. Perhaps America has simply gotten comfortable ignoring the quiet suffering of others.
“THE PROBLEM WITH UNDERESTIMATING HOW MUCH PEOPLE WANT TO BE TOGETHER” BY JULIA MARCUS (THE ATLANTIC)
- When a public-health approach isn’t producing the desired outcome, it’s time to try something different. Instead of yelling even louder about Christmas than about Thanksgiving, government officials, health professionals, and ordinary Americans alike might try this: Stop all the chastising. Remember that the public is fraying. And consider the possibility that when huge numbers of people indicate through their actions that seeing loved ones in person is nonnegotiable, they need practical ways to reduce risk that go beyond “Just say no.”
- The state of civil liberties around the world is bleak, according to a new study which found that 87% of the global population were living in nations deemed “closed”, “repressed” or “obstructed”…..A number of governments have used the pandemic as an excuse to curtail rights such as free speech, peaceful assembly and freedom of association, according to Civicus Monitor, an alliance of civil society groups which assessed 196 countries.
THE PARENTAL BURNOUT CRISIS HAS REACHED A TIPPING POINT BY ANNA NORTH (VOX)
- Lack of child care is likely a big reason more than 850,000 women dropped out of the workforce in September — more than in any other month on record except for this April, Covert reports. Overall, moms have borne a bigger share of the pandemic parenting burden than dads, with 80 percent of mothers of kids under 12 saying they are responsible for the majority of distance learning in their homes in one April survey. And single moms have been the hardest-hit of all: The share of unpartnered moms in the workforce dropped from 76.1 percent in September 2019 to 67.4 percent in September 2020, a significantly larger drop than those seen among partnered parents or single dads, according to a Pew analysis.
“MANY AREN’T BUYING PUBLIC OFFICIALS’ ‘STAY-AT-HOME’ MESSAGE. EXPERTS SAY THERE’S A BETTER WAY” (LOS ANGELES TIMES)
- Health officials are up against a fatigued public, as well as a number of people who don’t believe in the danger of the virus, (Dr. Monica) Gandhi said. But she is also part of a growing number of experts who think there’s a better way to engage those who do want to take the pandemic seriously — by taking a lesson from the public health strategy known as harm reduction.
- Finally, it’s tremendously gratifying that the last column of the mighty genius Walter Williams specifically named the Great Barrington Declaration as the answer:
- What about the benefits and costs of dealing with the COVID-19 pandemic? Much of the medical profession and politicians say that lockdowns, social distancing, and mask-wearing are the solutions. CDC data on death rates show if one is under 35, the chances of dying from COVID-19 is much lower than that of being in a bicycle accident. Should we lock down bicycles? Dr. Martin Kulldorff, professor of medicine at Harvard University, biostatistician, and epidemiologist, Dr. Sunetra Gupta, professor at Oxford University and an epidemiologist with expertise in immunology, and Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician and epidemiologist were the initiators of the Great Barrington Declaration. More than 50,000 scientists and doctors, as well as more than 682,000 ordinary people, have signed the Great Barrington Declaration opposing a second COVID-19 lockdown because they see it doing much more harm than good.
- The authors of the Great Barrington Declaration never had any doubt that eventually most everyone would come to see that the traditional principles of public health prevail over the previously untested and now failed policy of lockdowns.
- They spoke out when they did as a means of forcing the issue, and their courage will long echo in the annals of history. Now if we could only get Melinda Gates to see it.
H. Practical Tips & Other Useful Information
1. Exposed to C19 During the Holidays? Here Are Safe Tests and Practices
- The desserts were delicious, the reunions were warm, but you’ve just learned that someone at the holiday gathering you attended had Covid-19. What next? Today’s shorter quarantine guidelines, a variety of tests and newly available therapies call for updated protocols. So what should you do if you feel sick or if you spent time near the fellow guest who has been diagnosed? And is it safer to get tested if you’re considering meeting with family within the next several weeks?
- Here’s what infectious-disease experts at some of the country’s top medical centers advise.
How can you assess your level of exposure?
- Before taking steps to get tested, determine your level of exposure and whether you’ve had close contact. Seeing others outside—with everyone wearing masks—doesn’t warrant a test. If both people were unmasked and within 6 feet for at least 15 minutes, that qualifies as exposure and warrants a test. If you wore a mask and the other person didn’t and was at a greater distance, exposure is less likely and you may not need to get tested, according to Peter Katona, professor of medicine and public health at the David Geffen School of Medicine at the University of California, Los Angeles. If you’re indoors and have had close contact, defined as being within 6 feet of someone for a total of 15 minutes over 24 hours, you’re a good candidate for getting tested. “If somebody is exchanging air with you, then you have a chance of getting infected,” says Dr. Katona.
How long should you quarantine if you’ve had close contact with a confirmed case?
- If you’ve been exposed but don’t have symptoms, you’ll need to quarantine for 10 days, per the latest Centers for Disease Control and Prevention option. People who test negative for Covid can stop the quarantine after seven days past the exposure. A 14-day quarantine remains safest to reduce risk, the CDC says. “There is a false sense of security that if you aren’t symptomatic that you are not putting others at risk,” says Khalilah Gates, a pulmonary and critical care physician at Northwestern Medicine in Chicago.
What if you learn that someone you saw over the holidays is having Covid-19 symptoms but doesn’t have a confirmed case?
- Take a wait-and-see approach and stay away from others as much as possible. Monitoring your own symptoms, including temperature checks, is key. Individuals “can try to limit their contact with other people, but don’t necessarily have to strictly quarantine,” says David Aronoff, director of infectious diseases at Vanderbilt University Medical Center in Nashville, Tenn.
How many days after exposure should you get tested?
- Tests are most accurate about five to seven days after exposure, when your viral load is highest and can be detected more easily. So if you had dinner on Sunday, wait until Friday to do your test. Testing negative within that period “is a pretty good indicator that you don’t have Covid,” says Dr. Gates. Keep in mind: Molecular tests, including PCR tests, are more accurate than rapid antigen tests, but can still render false negatives in roughly 1 in 5 people displaying symptoms, according to Johns Hopkins School of Medicine data published this August in the Annals of Internal Medicine.
Who should you notify of exposure and when?
- If you were around someone with a confirmed case, notify anyone you have seen since exposure, but you do not need to notify local authorities. Companies and schools may have different guidelines on whether or not you need to show up as usual—this also depends on local health-agency rules. But it’s important to let businesses and schools know about confirmed exposure, says Dr. Aronoff. If you’re developing symptoms or awaiting test results, quarantine in addition to telling others. In many areas, it can be challenging to get tested if you’re asymptomatic after confirmed exposure, Dr. Aronoff adds. “This murky area is one of the things that makes this pandemic so difficult,” he says.
When is getting tested a priority?
- Most people can safely isolate at home. But for those at higher risk for complications from coronavirus infection, it’s become increasingly important to get tested. New therapies from Eli Lilly and Regeneron, known as monoclonal antibodies and created in animal populations, are aimed at high-risk patients early on in the disease progression, so having a confirmed diagnosis is critical, says Dr. Gates. “We can offer things that we didn’t have before,” she says.
Is getting tested before a holiday gathering recommended?
- Of course, getting tested and going to a gathering is not as safe as staying home and celebrating holidays with those in your household. But doing a test right before an event can help add a layer of safety on top of other protocols including wearing masks, staying at least 6 feet apart, keeping meetings brief and adding ventilation, says Dr. Aronoff. A rapid molecular-based test is likely to yield the most accurate results, but offerings are limited, he says: “It’s really challenging, because we don’t have ready access to rapid turnaround testing all the time.”