Holiday Edition — Merry Christmas!
December 23, 2020
New strain of coronavirus discovered in UK, which is likely in the US, appears to be more contagious and may be more infectious to children, and it is not yet known to what extent the new vaccines will be effective against it, but it does not appear to be more lethal[See stories below for more details]
“I’m not sure we know what we’re doing. The new restrictions were imposed without evidence that the activities they target are major drivers of transmission. Yet they will mean more job loss, more hunger, more despair and desperation . . . and more death from causes other than COVID.”San Mateo County Health Officer Scott Morrow, referring to the myriad puzzling restrictions that state and local governments have imposed in the name of fighting C19
“I will be helpful in any role that people think I can be helpful in and then I will retire. I will have to say, this experience has been a bit overwhelming. It has been very difficult on my family … I think what was done over the last week to my family.”Dr. Brix, White House coronavirus task force coordinator, announcing her retirement after she and some of her family members were outed for not following her own holiday travel guidance
Navigational Tips: Except for the stories listed under Linked Stories, all of the stories listed below are included in this update. And to the extent available, we have embedded links in the title of the stories to the extent available so that you can quickly jump to the original story on the internet if you want by clicking on the title. If you reading the Word document, you can jump to a section by holding down the control key+clicking on the title of the section.]
Highlighted stories includes information we found interesting. An (!) indicates a story that includes new, promising/breakthrough or unexpected/surprising information. A (*) indicates information that may be useful in connection with your plans and preparations regarding the coronavirus and C19. And © indicates that a story contains information that may contradict or be inconsistent with other information.
- Cases & Tests
- Top 5 States in Cases, Deaths, Hospitalizations, ICU Patients and Positivity Percentage
- Hospitalizations Shoot Back Up As Total Number of U.S. Infections Crosses 18 Million
- Could melatonin be the key to ending the pandemic? (!)
- Promising clinical data for fenofibrate’s ability to prevent lung damage in C19 patients (!)
- COVID immunity lasts up to 8 months ©
- Suspicions grow that nanoparticles in Pfizer’s vaccine trigger rare allergic reactions (!) (*)
- Can you choose your C19 vaccine? The answer may depend on your location
- The Moderna Vaccine’s Antibodies May Not Last As Long As We Hoped
- Antibody drugs could cut C19 hospitalizations by half. Why aren’t they being used? (!) (!)
- Prostate cancer regulator plays role in C19, providing a promising treatment lead
- Mini Antibodies Produced by a Llama and Isolated by Neuroscientists Could Prevent C19 Infection
- How dangerous is the Covid mutation? (!)
- UK C19 strain may infect kids more than other variants (!)
- What Are the Greatest Risk Factors of Dying From C19?
- Long-Haul Covid Patients Put Hope in Experimental Drugs
- C19 is 10 times deadlier to people with Down Syndrome
- Hospitals Retreat From Early Covid Treatment and Return to Basics (!)
- Does C19 Spread on Buses, Subways? NYC aims to find out
- Experts say this is what children need to survive the C19 pandemic (*)
- Mitigation efforts can prevent most college campus COVID cases
- Nanomaterial System Detects C19 Antibodies In Just Seconds
- Hand-held device measures aerosols for coronavirus risk assessment
- Lockdowns have become the default Covid policy – but do they actually work? (!)
- Polticians ordering senseless lockdown rules so they can ‘do something’
- There’s No Trade-Off Between Lives and the Economy
- A dire time for restaurants
- When is it not safe to wear a mask? (*)
- Covid Guide: How to Get Through the Pandemic (*)
- Tips on How to Get Through this Dark Pandemic Winter (*)
N. Linked Stories
- New Testing Shows Masks Not Enough to Stop C19’s Spread Without Social Distancing (*)
- Mayo Clinic Model of Care and Research leads to favorable outcomes for patients with C19
- UCLA Scientists Discover How the C19 Virus Causes Multiple Organ Failure
- Potential Weakness in Coronavirus Discovered – Single Protein Needed for C19 Virus to Reproduce and Spread
- C19 isolation hurting women more than men
- Researchers investigate at-home ‘scratch-and-sniff’ tests for C19
- Trials of blood thinners in critically ill C19 patients pause due to futility
- Pregnant women with C19 pass no virus but fewer-than-expected antibodies to newborns
- Traditional model for disease spread may not work in C19
- C19: avoiding hospital caused heart disease death rise
- Antibody Responses 8 Months after Asymptomatic or Mild SARS-CoV-2 Infection
- The looming questions scientists need to answer about the new variant of the coronavirus
- Study finds 27% of patients hospitalized for C19 were readmitted or died within 60 days
- Threat Assessment Brief: Rapid Increase of a New Coronavirus Variant with Multiple Spike Protein Mutations Observed in the United Kingdom
- CDC issues guidelines on C19 vaccination after allergic reactions
- Who are you again? Face masks significantly reduce brain’s ability to recognize people
- A guide to vaccinology: from basic principles to new developments
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A. Pandemic Headlines
(In no particular order)
- US deaths in 2020 top 3 million, by far most ever counted
- Dr. Fauci: New COVID-19 strain from UK is likely in US now
- US Surgeon General pick says new UK COVID-19 strain does not appear to be deadlier
- CDC says ‘no evidence’ new COVID strain causes ‘increased risk of death’
- German virologist downplays fears about new mutation of COVID-19
- New UK strain of coronavirus does not appear to increase the virus’s lethality or resistance to vaccines
- Pfizer, Moderna testing COVID-19 vaccines against new UK strain
- CEO ‘confident’ vaccine will work against new COVID-19 strain
- Countries across Europe and beyond barred travelers from Britain, citing concerns about a new variant of the virus that may spread more easily
- Governors impose new restrictions on travelers from Britain as holiday travel ratchets up
- As the world tries to contain a new strain of the virus, questions arise about how far it has already spread
- More than 2.1 million have been vaccinated
- Third COVID-19 vaccine may be approved in January
- US close on deal with Pfizer for millions more vaccine doses
- US Surgeon General pick predicts all Americans will have C19 vaccine access by fall
- President Trump deserves gratitude of all Americans for Warp Speed vaccines
- Shame of young, healthy Congress members jumping the vaccine line
- Ilhan Omar slams lawmakers like AOC for ‘shameful’ COVID vaccination
- Fauci, Azar receive Moderna COVID-19 vaccine
- President Elect Biden and incoming first lady Jill Biden receive vaccine on live television
- US to study allergic reactions from Pfizer’s COVID-19 vaccine
- Americans’ readiness to immediately receive COVID-19 vaccine jumps to 46%
- CDC says people over 75, frontline workers should get COVID-19 vaccine next
- The arrival of the Moderna vaccine brings hope to rural areas
- Bank Of America Expects 1.1 Billion People Will Be Vaccinated For COVID By Late 2021
- Hospital Workers Turn Down COVID Vaccine: “There’s Too Much Mistrust”
- Black Pastors Refuse To Push COVID Vaccine, Turn Congregants Into ‘Guinea Pigs’
- Moderna COVID-19 vaccine begins hitting New York arms
- China aims to vaccinate 50 million people by mid-February
- As vaccines arrive in the U.S., health care workers warn of P.P.E. shortages
- California desperately seeks more nurses and doctors amid COVID-19
- California builds field hospitals and considers rationing care as virus spreads unabated
- Doctors put us under ‘do not resuscitate’ orders without our permission during pandemic
- COVID-19 spikes follow in prisons after inmate transfers
- E.U. regulator authorizes Pfizer-BioNTech vaccine, with hopes to speed doses to all 27 member countries
- U.S. officials debate travel bans as coronavirus variant spreads in Britain
- COVID-19 Christmas lockdown leads to chaos, mass exodus out of London
- Mexico Misled Citizens About the Severity of Coronavirus in its Capital
- South Korea to curb social gatherings, close tourist spots nationwide
- Japanese Citizens Urged to Wear Masks at Home as Cases Swell
- Kenyan doctors strike in protest at inadequate benefits, PPE
- New strain of COVID-19 is driving South Africa’s resurgence of coronavirus infections
- Pandemic Now Reaches Every Continent After Major Outbreak At Antarctic Research Base
- Ontario announces sweeping new restrictions ahead of Boxing Day
- Gatherings of more than five people will be banned in South Korea’s capital region
- French Law Would Ban People Who Don’t Get COVID Vaccine From Using Public Transport
- UK Retailers Urge Government To Ensure Food Supplies As French Border Shut
- Number of countries banning travel from UK tops 30
- Israel bars all international travel on new mutation fears
- California Gov. quarantines after COVID exposure; hints at lockdown extension
- Mutation announced last week stokes fears worldwide
- US hospitalizations decline, led by Midwest
- Sweden imposes travel ban
- Ireland warns extension likely
- Colombia capital lifts some restrictions
- Tokyo mayor urges residents to stay home
- Canada suspends flights to UK
- In Afghanistan, a place mired in war, the virus is an afterthought
- Jakarta extends restrictions for another week
- British Travellers “Held Against Their Will” At German Airports
- Anti-lockdown protestors kick in door at Oregon statehouse
- United passenger who died after collapsing on crowded plane had COVID-19
- United passengers gave dying man CPR despite COVID-19 risk
- British Airways to test JFK-bound passengers for COVID-19 at Cuomo’s request
- U.S. Economy Showing Strains From Virus, Business Restrictions
- Apple closes all California locations amid rising COVID-19 cases
- Mobile Home Frenzy: RV Shipments Soar 43% In November
- Millions are traveling in the U.S., despite warnings
- Waffle House CEO: No Evidence Of COVID-19 Spread Across 2,100 Locations
- New COVID-19 relief bill designates $15 billion for movie theaters, live event venues
- Amazon warehouse in NJ closed over asymptomatic COVID-19 cases
- Governor Kristi Noem invites Minnesota bar owners to move to South Dakota
- Millions of Christmas presents may arrive late because of Postal Service delays
- London is a ghost town after city goes into strict COVID-19 lockdown
- Overuse of antibiotics for COVID-19 to blame in ‘super gonorrhea’ spike
- The Vatican says it is ‘morally acceptable’ to get a vaccine tied to fetal tissue
- Virus-weary Americans less festive this year, poll finds
- NYC’s uber-rich are dragging nannies to COVID hot spots for Christmas vacation
- Thousands flock to Rio’s famed beaches even as COVID-19 cases rise in Brazil
- UK couple arranges wedding in 2 hours to avoid COVID-19 lockdown
- In a locked-down Germany, animal advocates worry that city pigeons will starve
- College Football Playoff semifinal moved from Rose Bowl to Texas due to COVID-19
- Sex-crazed ‘roaring ’20s’ awaits post-pandemic: Yale prof
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day.
1. Cases & Tests
- Total Cases = 78,346,451
- New Cases (7 day average) = 647,722
- Record high 7 day average of new cases
- Rate of growth of new cases has been slowing for the last 10 days (to early to tell if new cases are nearing a peak of if this is a temporary slowdown)
US Cases & Positivity Rates:
- Total Cases = 18,684,628
- New Cases (7 day average) = 219,171
- Percentage of New Global Cases = 33.8%
- Percentage of positive tests (7 day average) = 14.1%
- 7 day average of new cases is approx. 2% less than the peak on 12/18 (but it is too early to tell if we have passed a peak or whether the decline is temporary)
- Although US has approx. 4% of world population, it has almost 34% of new cases
- Positivity rate is approx. 5% less than the record high set or tied multiple times during the last 2 weeks
- Total Deaths = 1,722,897
- New Deaths (7 day average) = 11,624
- Record high 7 day average of new deaths
- 7 day average continues to grow at a rapid rate (over the last 30 days, the 7 day average has increases from 9,844 to 11,624, an increase of 18.1% (which translates into an annualized rate of 217.1%)
- Total Deaths = 339,824
- New Deaths (7 day average) = 2,781
- Percentage of Global New Deaths = 23.9%
- Record high 7 day average of new deaths
- 7 day average is increasing at a rapid rate (during the last 30 days, the 7 day average has increased from 1,548 to 2,781, an increase of 79.7% (which translates into an annualized rate of 956.4%) (!)
- Increases in new cases suggest that deaths may continue to increase for another week or 2
- Although US has approx. 4% of world population, it has almost 24% of new cases
3. Top 5 States in Cases, Deaths, Hospitalizations, ICU Patients and Positivity Percentage as of (12/22)
- While hospitalizations and Patients in ICU continue to increase, the overall growth rates are slowing.
- Positivity rates, while still high, continue to show signs of moderation.
- After reaching an all-time high 0f 14.9% on 12/18, the US Positivity Rate declined to 14.1%.
- Overall, 32 states reported lower positivity rates over the last seven days (unch states since 12/17).
- After falling to 35.0% on 12/20, its lowest level since 10/14, ND returns to a positivity % above 50% (50.2%). [This rapid increase may be due to data reporting anomalies.]
- Zero states 7-day positivity rates greater than 40%. (-4 since 12/17)
- Fifteen states 7-day positivity rates greater than 30%. (+4 since 12/17)
- Six states had 7-day positivity rates greater than 20%. (-3 since 12/17)
- Five states had 7-day positivity rates less than 5%. (+2 since 12/17)
- In total, 45 states have 7-day positivity rates greater than 5% (-2 since 12/17)
- Hospitalizations in the US reached an all-time high of 117,177, up 4.4% since a week ago. Hospitalizations are increasing, but the rate of growth is slowing. The growth rate on 12/17 was 6.5%.
- Nine states have had increases of hospitalized patients of more than 10% in the past week. (-14 since 12/17)
- CA hospitalizations reached an all-time high of 18,961 (+24.8% since 12/17)
- 31 states have more than 1,000 hospitalized patients (-unch since 12/17)
- 26 states saw decreases in the number of hospitalized patients over the past week. (+2 since 12/17)
- Nine states have had increases of hospitalized patients of more than 10% in the past week. (-14 since 12/17)
Patients in ICU Trends
- ICU Patients in the US reached an all-time high of 22,213, up 1.5% since a week ago. The number of ICU patients is increasing, but the rate of growth is slowing. The growth rate on 12/17 was 4.2%.
- Five states have seen the number of ICU patients increase by more than 10% since a week ago (-10 since 12/17)
- 30 states have more than 100 patients in ICU, (-1 since 12/17)
- 23 states saw decreases in the number of ICU patients over the past week (+7 since 12/17).
4. Hospitalizations Shoot Back Up As Total Number of U.S. Infections Crosses 18 Million
What to Know
- The U.S. reported more than 190,000 new cases for Monday.
- Hospitalizations hit a new record of 115,351. ICU capacity has hit critical levels in parts of Southern California.
- In parts of California, intensive-care units have hit capacity.
- U.S. life expectancy could decline by the largest amount since World War II, as Covid-19 is set to become the third-leading cause of death.
- Hospitalizations hit a new record of 115,351 Monday, according to the Covid Tracking Project, after hovering below 114,000 for three days, as the total number of U.S. coronavirus infections since the pandemic began topped 18 million.
- Hospital capacity in some states has been stretched as admissions have surged over the past week, in states including California, South Carolina and Georgia.
- The nation reported more than 190,000 new cases for Monday, up from 189,099 a day earlier, according to data compiled by Johns Hopkins University. It was the third day in a row that newly reported cases were below 200,000, following a three-day streak in which they were above 230,000. The number of newly reported cases each day tends to be lower toward the beginning of the week, as fewer people are tested over the weekend.
- The new cases put the nation’s total at more than 18.04 million, according to Johns Hopkins data, an increase of more than a million in about five days.
C. New Scientific Findings & Research
1. Could melatonin be the key to ending the pandemic?
- The newly discovered coronavirus had killed only a few dozen people when Feixiong Cheng started looking for a treatment. He knew time was of the essence: Cheng, a data analyst at the Cleveland Clinic, had seen similar coronaviruses tear through China and Saudi Arabia before, sickening thousands and shaking the global economy. So, in January, his lab used artificial intelligence to search for hidden clues in the structure of the virus to predict how it invaded human cells, and what might stop it. One observation stood out: The virus could potentially be blocked by melatonin.
- Melatonin, best known as the sleep hormone, wasn’t an obvious factor in halting a pandemic. Its most familiar role is in the regulation of our circadian rhythms. Each night, as darkness falls, it shoots out of our brain’s pineal glands and into our blood, inducing sleep. Cheng took the finding as a curiosity. “It was very preliminary,” he told me recently—a small study in the early days before C19 even had a name, when anything that might help was deemed worth sharing.
- After he published his research, though, Cheng heard from scientists around the world who thought there might be something to it. They noted that, in addition to melatonin’s well-known effects on sleep, it plays a part in calibrating the immune system. Essentially, it acts as a moderator to help keep our self-protective responses from going haywire—which happens to be the basic problem that can quickly turn a mild case of C19 into a life-threatening scenario.
- Cheng decided to dig deeper. For months, he and colleagues pieced together the data from thousands of patients who were seen at his medical center. In results published last month, melatonin continued to stand out. People taking it had significantly lower odds of developing C19, much less dying of it. Other researchers noticed similar patterns. In October, a study at Columbia University found that intubated patients had better rates of survival if they received melatonin. When President Donald Trump was flown to Walter Reed National Military Medical Center for C19 treatment, his doctors prescribed—in addition to a plethora of other experimental therapies—melatonin.
- Eight clinical trials are currently ongoing, around the world, to see if these melatonin correlations bear out. Few other treatments are receiving so much research attention. If melatonin actually proves to help people, it would be the cheapest and most readily accessible medicine to counter C19. Unlike experimental drugs such as remdesivir and antibody cocktails, melatonin is widely available in the United States as an over-the-counter dietary supplement. People could start taking it immediately.
- Yet Cheng emphasizes that he’s not recommending that. Like any substance capable of slowing the central nervous system, melatonin is not a trifling addition to the body’s chemistry. Its apparent benefit to C19 patients could simply be a spurious correlation—or, perhaps, a signal alerting us to something else that is actually improving people’s outcomes. Cheng thinks that might be the case. He and others suggest that the real issue at play may not be melatonin at all, but the function it most famously controls: sleep.
- Continue reading the story on the Atlantic here.
2. Promising clinical data for fenofibrate’s ability to prevent lung damage in C19 patients
- In what has the potential to significantly change how Corona patients are being treated and the severity of the disease, research spearheaded at Jerusalem’s Hebrew University gathered early clinical evidence demonstrating the efficacy of an existing drug in treating C19.
- The study was presented at the recent SPARK Conference on Generic Drug Repurposing for C19 by Professor Yaakov Nahmias, Director of the Center for Bioengineering at Hebrew University. Nahmias applied a well-established existing drug to address the buildup of fats in human lung cells caused by the coronavirus (SARS-CoV-2). Initial lab-based results and new data from 1,500 Israel-based Corona patients have been extremely promising and clinical studies are scheduled to begin this week at Barzilai Hospital in Ashkelon, Israel, joining other clinical centers across the United States, South America and Europe.
- The study began in July 2020 when Professor Nahmias demonstrated that the SARS-CoV-2 virus was inhibiting the effective breakdown of fat within the lungs. His research then identified the efficacy of Fenofibrate (Tricor), an FDA approved drug that has been on the market since 1975 to address this deficiency in Corona patients. The drug is traditionally designed to address high levels of triglycerides (fats) in the blood. When applied to Corona patients, the study proposes that it will stop the progression of the disease.
- “We knew that the system we had developed for Tissue Dynamics provided us with a unique vantage point to understand how the virus operates in the lungs,” Professor Nahmias explained. After discovering the efficacy of the drug in the lab-setting, Professor Nahmias, together with Professor Oren Shiboleth of Ichilov Medical Center in Tel Aviv and Dr. Sigal Shafram-Tikva at Hadassah Medical Center in Jerusalem, worked to gather data from 1,500 Corona patients who were on a regiment of drugs designed to reduce the fatty buildup in lung cells.
- The results were abundantly clear. Patients who were taking the drugs to speed up the breakdown of fats were recovering from the Corona-caused lung infections in a matter of days. The evidence even showed that there was zero mortality among these patients.
- “We showed that the human lungs responded to the SARS-CoV-2 virus by completely changing their metabolism, causing a major buildup of fats in lung cells. Our findings show that this unhealthy fat buildup is a critical factor in C19 patient’s deterioration. Patients taking fibrates that work directly to breakdown fats recovered fast from the disease, while those taking medications that build fats like thiazolidinediones, showed greater lung damage and mortality,” Professor Nahmias explains.
- According to the research team, applying the use of this established drug, which is widely available, inexpensive and has a proven safety record, could alter the effects of C19 from a devastating disease to a far more manageable form of a respiratory cold.
- In the coming days, the team will begin an investigator-led Phase 3a clinical study, with financial support from Abbott. Taking place at Barzilai Hospital in Ashkelon, this phase will be led by Professor Shlomo Maayan, Director of the Department of Infectious Diseases.
- Other clinical studies intended to corroborate Professor Nahmias’s findings are also taking place in the US, Europe and South America. “Even as we see the introduction of numerous vaccines intended to reduce the transmission of the disease and protect vulnerable populations, this drug can help the direct treatment of the virus and reduce its severity and mortality. We hope to see the first results of the clinical phase of this study in the coming months,” Professor Maayan said.
3. COVID immunity lasts up to 8 months
- Australian researchers have revealed – for the first time – that people who have been infected with the C19 virus have immune memory to protect against reinfection for at least 8 months.
- The research is the strongest evidence for the likelihood that vaccines against the coronavirus (SARS-CoV-2) will work for long periods. Previously, many studies have shown that the first wave of antibodies to coronavirus wane after the first few months, raising concerns that people may lose immunity quickly. This new work allays these concerns.
- As with other studies – looking only at the antibody response – the researchers found that antibodies against the virus started to drop off after 20 days post infection.
- However – importantly – all patients continued to have memory B cells that recognised one of two components of the SARS-CoV-2 virus, the spike and nucleocapsid proteins. These virus-specific memory B cells were stably present as far as 8 months after infection.
- According to Associate Professor van Zelm, the results give hope to the efficacy of any vaccine against the virus and also explains why there have been so few examples of genuine reinfection across the millions of those who have tested positive for the virus globally.
- “These results are important because they show, definitively, that patients infected with the C19 virus do in fact retain immunity against the virus and the disease,” he said.
- “This has been a black cloud hanging over the potential protection that could be provided by any C19 vaccine and gives real hope that, once a vaccine or vaccines are developed, they will provide long-term protection.”
D. Vaccines & Testing
1. Suspicions grow that nanoparticles in Pfizer’s vaccine trigger rare allergic reactions
- Severe allergy-like reactions in at least eight people who received the C19 vaccine produced by Pfizer and BioNTech over the past 2 weeks may be due to a compound in the packaging of the messenger RNA (mRNA) that forms the vaccine’s main ingredient, scientists say. A similar mRNA vaccine developed by Moderna, which was authorized for emergency use in the United States on Friday, also contains the compound, polyethylene glycol (PEG).
- PEG has never been used before in an approved vaccine, but it is found in many drugs that have occasionally triggered anaphylaxis—a potentially life-threatening reaction that can cause rashes, a plummeting blood pressure, shortness of breath, and a fast heartbeat. Some allergists and immunologists believe a small number of people previously exposed to PEG may have high levels of antibodies against PEG, putting them at risk of an anaphylactic reaction to the vaccine.
- Others are skeptical of the link. Still, the U.S. National Institute of Allergy and Infectious Diseases (NIAID) was concerned enough to convene several meetings last week to discuss the allergic reactions with representatives of Pfizer and Moderna, independent scientists and physicians, and the Food and Drug Administration (FDA).
- NIAID is also setting up a study in collaboration with FDA to analyze the response to the vaccine in people who have high levels of anti-PEG antibodies or have experienced severe allergic responses to drugs or vaccines before. “Until we know there is truly a PEG story, we need to be very careful in talking about that as a done deal,” says Alkis Togias, branch chief of allergy, asthma and airway biology at NIAID.
- Pfizer, too, says it is “actively seeking follow-up.” A statement emailed to Science noted it already recommends that “appropriate medical treatment and supervision should always be readily available” in case a vaccinee develops anaphylaxis.
- Anaphylactic reactions can occur with any vaccine, but are usually extremely rare—about one per 1 million doses. As of 19 December, the United States had seen six cases of anaphylaxis among 272,001 people who received the C19 vaccine, according to a recent presentation by Thomas Clark of the U.S. Centers for Disease Control and Prevention (CDC); the United Kingdom has recorded two. Because the Pfizer and Moderna mRNA vaccines use a new platform, the reactions call for careful scrutiny, says Elizabeth Phillips, a drug hypersensitivity researcher at Vanderbilt University Medical Center who attended an NIAID meeting on 16 December. “This is new.”
- News reports about the allergic reactions have already created anxiety. “Patients with severe allergies in the US are getting nervous about the possibility that they may not be able to get vaccinated, at least with those two vaccines,” Togias wrote in an invitation to meeting participants. “Allergies in general are so common in the population that this could create a resistance against the vaccines in the population,” adds Janos Szebeni, an immunologist at Semmelweis University in Budapest, Hungary, who has long studied hypersensitivity reactions to PEG and who also attended the 16 December gathering.
- Scientists who believe PEG may be the culprit stress that vaccination should continue. “We need to get vaccinated,” Phillips says. “We need to try and curtail this pandemic.” But more data are urgently needed, she adds: “These next couple of weeks in the U.S. are going to be extremely important for defining what to do next.”
Toothpaste and shampoo
- Pfizer’s and Moderna’s clinical trials of the vaccines, which involved tens of thousands of people, did not find serious adverse events caused by the vaccine. But both studies excluded people with a history of allergies to components of the C19 vaccines; Pfizer also excluded those who previously had a severe adverse reaction from any vaccine. People with previous allergic reactions to food or drugs were not excluded, but may have been underrepresented.
- The two vaccines both contain mRNA wrapped in lipid nanoparticles (LNPs) that help carry it to human cells but also act as an adjuvant, a vaccine ingredient that bolsters the immune response. The LNPs are “PEGylated”—chemically attached to PEG molecules that cover the outside of the particles and increase their stability and life span.
- PEGs are also used in everyday products such as toothpaste and shampoo as thickeners, solvents, softeners, and moisture carriers, and they’ve been used as a laxative for decades. An increasing number of biopharmaceuticals include PEGylated compounds as well.
- PEGs were long thought to be biologically inert, but a growing body of evidence suggests they are not. As much as 72% of people have at least some antibodies against PEGs, according to a 2016 study led by Samuel Lai, a pharmaco-engineer at the University of North Carolina, Chapel Hill, presumably as a result of exposure to cosmetics and pharmaceuticals. About 7% have a level that may be high enough to predispose them to anaphylactic reactions, he found. Other studies have also found antibodies against PEG, but at lower levels.
- “Some companies have dropped PEGylated products from their pipeline as a result,” Lai says. But he notes that the safety record of many PEGylated drugs has persuaded others that “concerns about anti-PEG antibodies are overstated.”
- Other scientists, meanwhile, are not convinced PEG is involved at all. “There is a lot of exaggeration when it comes to the risk of PEGs and CARPA,” says Moein Moghimi, a nanomedicine researcher at Newcastle University who suspects a more conventional mechanism is causing the reactions. “You are technically delivering an adjuvant at the injection site to excite the local immune system. It happens that some people get too much excitement, because they have a relatively high number of local immune cells.”
- Others note the amount of PEG in the mRNA vaccines is orders of magnitude lower than in most PEGylated drugs. And whereas those drugs are often given intravenously, the two C19 vaccines are injected into a muscle, which leads to a delayed exposure and a much lower level of PEG in the blood, where most anti-PEG antibodies are.
Stay for 30 minutes
- To understand the risk, Phillips says, it’s crucial to unravel the mechanisms underlying the immune reactions and find out how often they are likely to occur. The known U.S. cases are currently under study, but key clues may have vanished: Anaphylactic reactions produce biomarkers that only remain in the blood for a few hours. At the NIAID meeting, participants discussed ways to ensure that blood samples from future cases are taken immediately and tested for those markers.
- If PEG does turn out to be the culprit, the question is, what can be done? Screening millions of people for anti-PEG antibodies before they are vaccinated is not feasible. Instead, CDC guidelines recommend not giving the Pfizer or Moderna vaccines to anyone with a history of severe allergic reaction to any component of the vaccine. For people who have had a severe reaction to another vaccine or injectable medication, the risks and benefits of vaccination should be carefully weighed, CDC says. And people who might be at high risk of an anaphylactic reaction should stay at the vaccination site for 30 minutes after their shot so they can be treated if necessary.
- “At least [anaphylaxis] is something that happens quickly,” Philips says. “So, it’s something that you can be very much alerted to, prepared to recognize early and be prepared to treat early.”
2. Can you choose your C19 vaccine? The answer may depend on your location
- So the question is: Will you get to choose which one you get?
- The answer is not really — at least, not anytime soon.
- As long as vaccines remain in short supply, most people will not have a choice of which vaccine they receive, says William Schaffner, an infectious disease expert at Vanderbilt University Medical Center. It’s not a sure thing that every facility will have both vaccines on hand at all, let alone both at the same time.
- Decisions made by the federal government will determine how much of each vaccine every state gets, but at the local level, transportation and storage requirements will dictate what specific facilities get what vaccine.
- “The main thing is the cold storage,” Schaffner continues. “That’s far and away what accounts for 99% of who’s getting what.”
3. The Moderna Vaccine’s Antibodies May Not Last As Long As We Hoped
- With the rollout of C19 vaccines finally underway across the United States, data on the vaccines’ effectiveness is starting to become more available. But one key piece of information is still relatively unknown: how long the vaccines’ effectiveness will last.
- While only a preliminary analysis, a new study by the New England Journal of Medicine (NEJM) suggests that the long-term efficacy of Moderna’s mRNA-1273 vaccine, specifically the neutralizing antibody count, may be less than we were hoping for.
- The NEJM study followed a group of 34 patients who had taken both doses of mRNA-1273 and analyzed their antibody counts from the administration of the first dose for 119 days. Neutralizing antibodies were monitored in subgroups of 18-55 years of age, 56-70, and 71+, as shown below.
- For those 18-55 years old, the majority only show a slight decrease in neutralizing antibodies in the three months following their second vaccine dose.
- However, sustained antibody counts are not the case in the 56-70 and 71+ age groups. In these subsets, the neutralizing antibody counts fall anywhere between 50 and 75%. This suggests that in these age groups, the duration of neutralizing antibodies from the Moderna vaccine will be relatively short, potentially less than a year.
- Read the full study in the NEJM here.
E. Improved & Potential Treatments
1. Antibody drugs could cut C19 hospitalizations by half. Why aren’t they being used?
- Antibody drugs from Regeneron and Eli Lilly could reduce hospitalizations from C19 by 50-70%.
- About 65,000 doses are distributed to states by the U.S. government every week.
- Only 5-20% of the doses are actually getting used, Operation Warp Speed’s Moncef Slaoui said.
- When President Donald Trump got sick with C19 in October, he credited an antibody drug from Regeneron with making him feel better “immediately.”
- “I felt as good three days ago as I do now,” he said in a video shot in front of the White House after he left Walter Reed National Military Medical Center, promising medicines from Regeneron and Eli Lilly would soon be available to the American public to help stop the terrible effects of C19.
- The concern, as these drugs were cleared through the FDA and made it to market last month, was that there wouldn’t be enough supply. They’re complicated to manufacture, and Regeneron said there were only enough doses for 80,000 Americans by the end of November. Lilly has 250,000 doses available.
- But a month into their distribution, the opposite problem has emerged: the drugs are not getting used.
- “We have a surplus of these monoclonal antibodies right now,” Health Secretary Alex Azar told CNBC’s Shepard Smith Tuesday night. “What’s happening is people are waiting too long to seek out the treatments.”
- Moncef Slaoui, chief scientific adviser to the U.S. government’s Operation Warp Speed, told CNBC Tuesday that the federal government is distributing about 65,000 doses of the antibody drugs every week to states.
- But, he said, only 5% to 20% of the doses are getting administered to patients.
- “It should be used much more,” Slaoui said in a telephone interview, noting the drugs — which are indicated for patients at high risk for severe C19 — could cut down on hospitalizations by 50% to 70%.
- The drugs are not simple to administer. For one thing, they’re given by intravenous infusion, so patients must go to health centers where this can be done. But since they’re likely contagious, existing IV facilities, like where patients receive chemotherapy, can’t be used.
- Another issue is that the drugs need to be given early in the course of the disease. The FDA’s guidance for health-care providers says they should be administered as soon as possible after diagnosis, and within 10 days of symptom onset. It recommends against use of the drugs once patients are so sick they’re hospitalized.
- But many patients don’t feel sick right away, so the idea of an IV-infused drug doesn’t occur to them immediately after diagnosis, Slaoui and Azar suggested.
- “If you are over 65 or at risk of serious complications or hospitalization due to co-morbidities, what have you, and you test positive, you need to seek out and get the Lilly or Regeneron monoclonal antibody,” Azar said on the “News With Shepard Smith.” “It can dramatically reduce the risk for us of hospitalizations at a time when hospitals are getting very crowded with people with Covid.”
- But it’s a challenge for some health systems to set up the infrastructure to deliver these drugs. Some states are using 100% of their allocation, Slaoui said. Others, like in Georgia and Illinois, may not be using any, according to former FDA Commissioner Dr. Scott Gottlieb.
- Georgia’s public health department didn’t immediately respond to questions about their antibody usage. A spokeswoman for Illinois’ Department of Public Health said providers aren’t yet required to report use of monoclonal antibodies, but that the U.S. Department of Health and Human Services will require hospitals to report the information starting Jan. 8.
- “Trying to get in place the infusion centers that you need, it’s not an easy task,” Gottlieb told CNBC’s Squawk Box Wednesday morning. “Some states like Maryland have set up special sites and done a really good job, and other states didn’t plan for this.”
- He also said funding is an issue.
- “States are resource-constrained on their own,” Gottlieb noted. “There’s probably more the federal government can do to be back-stopping the states.”
- Gottlieb also warned the stunted antibody rollout is a bad harbinger for the massive C19 vaccine distribution campaign just beginning in the U.S.
- “It might be challenging for the states to distribute the vaccines if they can’t distribute the antibody drugs,” Gottlieb said.
- He noted the data behind the medicines suggest “the number needed to treat in terms of keeping one patient out of the hospital … is 10.” Lilly has said it will have 950,000 doses available by the end of January, Gottlieb cited the effects if 900,000 doses were used: “That means if all of the drugs got distributed, we could avoid 90,000 hospitalizations or emergency room visits. That would be substantial.”
- Lilly noted the IV administration of the antibody drugs “presents unique challenges to the healthcare system,” and said it’s working to address the challenges to ensure patients who need the drug can get it. The company is running a number of pilot programs through Operation Warp Speed, including one with CVS for in-home infusions, a company spokeswoman said.
- Slaoui said Operation Warp Speed would provide help, but “I really think it’s the various centers that would need to do it themselves mostly.”
- “If there is a need of help that can be consolidated at the level of the state, of course tell us what you need and we’ll work that out,” Slaoui said Tuesday. But he also noted that if some states can’t figure out how to use the medicines, the federal government would direct the doses to the places that could.
- “If there are places that don’t use them,” Slaoui said, “why send them?”
- NOTE: You can find more information about Eli Lilly’s drug, Bamlanivimab, here: https://www.covid19.lilly.com/bamlanivimab]
2. Prostate cancer regulator plays role in C19, providing a promising treatment lead
- By taking a lesson from prostate cancer, researchers now have a promising lead on a treatment for C19.
- Two proteins, ACE2 and TMPRSS2, help the coronavirus gain entry and replicate within cells. TMPRSS2 is well-known to Arul Chinnaiyan, M.D., Ph.D. His lab discovered that TMPRSS2 fuses with the ETS gene to drive more than half of all prostate cancers. They also knew that TMPRSS2 was regulated by the androgen receptor.
- So when cancer research shut down in the spring, Chinnaiyan’s lab turned its attention to the coronavirus. With a grant from the National Cancer Institute, the team used its existing knowledge and resources to determine how TMPRSS2 was regulated in the lungs.
- They found that, just like in prostate cancer, TMPRSS2 is regulated by the androgen receptor in the lungs. And notably, blocking the androgen receptor led to lower expression of TMPRSS2 as well as ACE2, which led to decreased coronavirus infection in mice and cellular models. Results are published in PNAS.
- “What’s especially appealing about this is that anti-androgen treatments are already FDA-approved. This opens the door to look at these drugs, which we know work in prostate cancer, as potential C19 treatments,” says Chinnaiyan, director of the Michigan Center for Translational Pathology.
- Using cell lines infected with the coronavirus (SARS-CoV-2), researchers found that inhibitors of androgen receptor, including enzalutamide, apalutamide and darolutamide, inhibited the coronavirus infection.
- They also tested a class of drugs designed to inhibit or degrade BET proteins. BET protein activity is essential for androgen signaling and these drugs are being looked at for prostate cancer. In cell lines infected with coronavirus, the BET inhibitors decreased androgen signaling and inhibited viral infection.
- The findings also provide some explanation for observations that C19 affects men more than women. Researchers looked at human lung tissue and found higher androgen receptor signaling in men than women. They also found androgen signaling was highest in men over 70 and in smokers.
- “This explains why elderly men who are smokers are more vulnerable to C19 infection. High androgen receptor signaling allows the virus to gain entry and replicate more easily. This may explain why the disease is often particularly severe in older men,” Chinnaiyan says.
- Several clinical trials are underway testing androgen receptor inhibitors as a treatment for C19, and additional trials are being developed to look at BET inhibitors.
3. Mini Antibodies Produced by a Llama and Isolated by Neuroscientists Could Prevent C19 Infection
NIH scientists showed that nanobodies isolated from a llama may prevent C19 infections. Infections happen when SARS-CoV-2 virus spike proteins (yellow) latch onto ACE2 receptors (blue) that line the outside of a cell. The NIH nanobodies (grey) may prevent infections by covering spike proteins, which blocks binding to the ACE2 receptor.
- National Institutes of Health researchers have isolated a set of promising, tiny antibodies, or “nanobodies,” against the coronavirus (SARS-CoV-2) that were produced by a llama named Cormac. Preliminary results published in Scientific Reports suggest that at least one of these nanobodies, called NIH-CoVnb-112, could prevent infections and detect virus particles by grabbing hold of SARS-CoV-2 spike proteins. In addition, the nanobody appeared to work equally well in either liquid or aerosol form, suggesting it could remain effective after inhalation.
- A nanobody is a special type of antibody naturally produced by the immune systems of camelids, a group of animals that includes camels, llamas, and alpacas. On average, these proteins are about a tenth the weight of most human antibodies. This is because nanobodies isolated in the lab are essentially free-floating versions of the tips of the arms of heavy chain proteins, which form the backbone of a typical Y-shaped human IgG antibody. These tips play a critical role in the immune system’s defenses by recognizing proteins on viruses, bacteria, and other invaders, also known as antigens.
- Because nanobodies are more stable, less expensive to produce, and easier to engineer than typical antibodies, a growing body of researchers, including Mr. Esparza and Dr. Brody, have been using them for medical research. For instance, a few years ago scientists showed that humanized nanobodies may be more effective at treating an autoimmune form of thrombotic thrombocytopenic purpura, a rare blood disorder, than current therapies.
- Since the pandemic broke, several researchers have produced llama nanobodies against the SARS-CoV-2 spike protein that may be effective at preventing infections. In the current study, the researchers used a slightly different strategy than others to find nanobodies that may work especially well.
- “The SARS-CoV-2 spike protein acts like a key. It does this by opening the door to infections when it binds to a protein called the angiotensin converting enzyme 2 (ACE2) receptor, found on the surface of some cells,” said Mr. Esparza, the lead author of the study. “We developed a method that would isolate nanobodies that block infections by covering the teeth of the spike protein that bind to and unlock the ACE2 receptor.”
- To do this, the researchers immunized Cormac five times over 28 days with a purified version of the SARS-CoV-2 spike protein. After testing hundreds of nanobodies they found that Cormac produced 13 nanobodies that might be strong candidates.
- Initial experiments suggested that one candidate, called NIH-CoVnb-112, could work very well. Test tube studies showed that this nanobody bound to the ACE2 receptor 2 to 10 times stronger than nanobodies produced by other labs. Other experiments suggested that the NIH nanobody stuck directly to the ACE2 receptor binding portion of the spike protein.
- Then the team showed that the NIH-CoVnB-112 nanobody could be effective at preventing coronavirus infections. To mimic the SARS-CoV-2 virus, the researchers genetically mutated a harmless “pseudovirus” so that it could use the spike protein to infect cells that have human ACE2 receptors. The researchers saw that relatively low levels of the NIH-CoVnb-112 nanobodies prevented the pseudovirus from infecting these cells in petri dishes.
- Importantly, the researchers showed that the nanobody was equally effective in preventing the infections in petri dishes when it was sprayed through the kind of nebulizer, or inhaler, often used to help treat patients with asthma.
- “One of the exciting things about nanobodies is that, unlike most regular antibodies, they can be aerosolized and inhaled to coat the lungs and airways,” said Dr. Brody.
- The team has applied for a patent on the NIH-CoVnB-112 nanobody.
- “Although we have a lot more work ahead of us, these results represent a promising first step,” said Mr. Esparza. “With support from the NIH we are quickly moving forward to test whether these nanobodies could be safe and effective preventative treatments for C19. Collaborators are also working to find out whether they could be used for inexpensive and accurate testing.”
F. Concerns & Unknowns
1. How dangerous is the Covid mutation?
- For a deeper review of the new UK variant, known as B.1.1.7, read more here: https://unherd.com/2020/12/how-dangerous-is-the-covid-mutation/
- In short: it’s real; we need to take it seriously, and watch it closely, and it will likely make life harder; but it’s not panic stations, and there’s no major reason as yet to think it will, for instance, stop vaccines from working. Also, we’ve been oddly lucky with the testing.
- There really is a new, noticeably different strain. The new strain, though, really has mutated significantly more. Here is a useful chart (below), from a preprint study released over the weekend. Each blob on the chart represents one time a coronavirus (SARS-Cov2) was sequenced, so that scientists could see its genome. The higher up it is, the more it has mutated away from the original version detected in January. The further right it is, the later the date it was collected.
- The lighter grey blobs represent the familiar SARS-Cov2 virus, slowly changing at a fairly steady, predictable rate. But the darker blobs are the new strain, B.1.1.7, which was first detected in September. You can see that although it too is changing at a steady rate, at some point before it was detected, it diverged from its parent strain significantly: it has roughly twice as many mutations per location on its genome.
- Of course, we don’t care about mutations for their own sake, so it might be worth talking about what this means. A “mutation” is simply a copying error. The virus gets into your cells and commandeers them to make new copies of itself. Sometimes, as it does so, it gets it slightly wrong: random errors appear in the RNA, its equivalent to our DNA. Those errors may slightly change, for instance, the shape of a protein that it makes.
- It’s wrong to think of viruses as mutating “for” something: the errors are random. Most will do nothing, or have a negative effect, like randomly adding or deleting words in a recipe. But every so often, one might do something that is useful for the virus. Perhaps it might make its protein spike a little more suited to opening up cell membranes, or help the virus evade antibodies a little more effectively. Then that version of the virus will tend to spread a bit better than the older one, and copies with that mutation will become more common in the population.
- With viruses that have recently jumped from another species, such as SARS-Cov2, says Birney, there are usually two main pressures driving change. One is obvious: viruses that can jump more easily between hosts will tend to spread better, so viruses tend to become more efficient at transmission. Another is perhaps less so: viruses tend to become less deadly, because if your disease kills your host in two hours, you won’t have much time to get to the next one. “Viruses when they jump, usually do two things,” says Birney. “They end up mutating to transmit faster, and often to cause less disease. That’s the pathway to becoming an endemic virus.”
- So the question is whether either of these things has happened in the B.1.1.7 strain, and the answer is: it’s hard to know, but probably, at least on the transmissibility point.
- It’s not that you can look at a viral genome and say “Ah yes, that one’s better at spreading.” And if you notice that a particular variant is spreading faster, that may be because the variant is better at spreading, or it may just be, for instance, that it happens to be prevalent in an area where there’s a lot of transmission. There’s a lot of regional variation in what strains are where; if a new strain happens to arise in a place where, say, fewer people can work from home, then it will look like it’s good at transmission when in fact it’s just lucky. That happened early on, says Birney: the D614G mutation became the dominant one in Europe after it arose in May. It may have had a slight growth advantage, he says, although “the jury is very much still out” on that; “it’s hard to work out if it was just random chance that got it to the top or not”.
- In this case, though, there are reasons to think that it probably is more effective at spreading. The New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) looked at four strands of evidence and they all centred on the B.1.1.7 strain being around 70% more effective at transmission, although there is a lot of uncertainty around that figure.
- There is a theoretical reason to think it’s more transmissible, as well. The new strain had 17 “non-synonymous” mutations when it was first detected — that is, mutations which actually affect its output (there are a further six “synonymous” ones, which don’t). It’s not clear, by the way, how B.1.1.7 ended up with so many mutations. But often, multiple mutations are seen when a virus infects someone with a compromised immune system. In those patients, the virus can stay in the system for weeks and months, rather than a few days; they are often then treated with convalescent plasma. The preprint speculates that something like that may have happened here.
- Birney, and Babak Javid, an immunology lab director at the University of California San Francisco, all think that is plausible, although there is no direct evidence for it. Adam Kucharski, a mathematical epidemiologist at the London School of Hygiene and Tropical Medicine, draws an analogy with antibiotic resistance: if you nuke a microbe with a full course of antibiotics, it will just die, so it won’t mutate into a resistant form. If you don’t give it antibiotics at all, it will have no pressure to mutate. But when you use antibiotics for a bit, those microbes which are a bit more resistant will tend to survive, and resistance will emerge. It’s where there are half-measures, weak selection pressures over a long time, that pathogens mutate into new forms: a virus that lives for a while in someone with a weak immune system and treated with partially effective treatments will throw out new, experimental mutations. It’s well documented.
- Whether or not that’s exactly what happened, B.1.1.7 definitely has several mutations, and the most notable one is a deletion: two RNA “letters” found in the main SARS-Cov2 strain have been removed.
- That same mutation, 69-70del, has cropped up in a few other places. One was the Danish mink outbreak that was reported a few weeks ago; it has also been spotted in Lyon. But they are different lineages: the same mutation has happened independently. That is, says Javid, reason to think that the mutation is making the virus more transmissible. “I was sceptical,” he says, “but the same mutation has arisen in several places. If it’s random mutation it’d be less likely to keep appearing, so that’s strong evidence.” Another mutation found in B.1.17 has also cropped up in another new variant seen in South Africa.
- Javid’s suspicion, and it’s only a suspicion, is that the mutations make the virus a bit harder for your immune system to kill, so it survives a little longer in the bloodstream. If you have the virus for 10% longer, then, all else being equal, you’ll be 10% more likely to pass it on. “My gut instinct is that this increases the contagious window by six hours, or 24 hours, or something,” he says. “I’m trying to think of biological ways this might result in more contagiousness, and my working hypothesis is if it’s very slightly more resistant to neutralisation by antibodies.”
- For the vaccines, we can be reasonably hopeful, I think. Birney points out that there were already many strains in circulation when the vaccines were being tested; the fact that they were so effective is reason to think that they must have worked against the large majority of them. It’s not definitive — “that argument is not fully watertight,” says Birney, “because currently other strains are rare”, but it’s reassuring.
- Regarding the question of whether the new strain is more deadly, or less deadly. The evidence is weak either way; as I said at the beginning, often you get selection pressure for viruses to become less virulent, but in the case of C19 it’s in an awful sweet spot where it isn’t very deadly for most people and can spread via presymptomatic and asymptomatic people, so the selection pressure isn’t great, but it’s still very deadly among vulnerable people.
- Birney says that “hospitalisation rates in the South-East [where the new strain is widespread] are not a million miles away from what you’d expect given the infection rate”, so at the moment we can only say that it’s probably not loads more or loads less dangerous. Javid says that one mutation is similar to one found in a Singapore strain which seemed to cause less deadly disease in animal trials, but again, he says, that’s speculative.
2. UK C19 strain may infect kids more than other variants
- The new mutation of C19 found in the UK may be infecting more children than earlier strains, according to a government advisory group of scientists.
- Until now, C19 has mostly affected adults, but children appear just as susceptible to the new strain, which is also thought to be more contagious, members of the New and Emerging Respiratory Virus Threats Advisory Group told reporters.
- “There is a hint that it is has a higher propensity to infect children,” NERVTAG member Neil Ferguson, a professor from Imperial College London, said Monday of the mutation that forced London into lockdown.
- Studies from the last few weeks show that “cases for the variant in under-15s was statistically significantly higher than the non-variant virus,” he said, according to the Independent.
- Wendy Barclay, another NERVTAG professor and a specialist in virology, said the mutations in the new variant include changes to the way it enters human cells, which may mean “that children are, perhaps, equally susceptible to this virus as adults” are.
- “We’re not saying that this is a virus which specifically targets children,” she said, saying it instead puts them “on a more level playing field” with adults in terms of getting infected, The Independent said.
- The mutation — VUI 202012/01 — is being blamed for a huge spike in cases in the wider London area, forcing the government to effectively “cancel Christmas” there and leading to a slew of nations slamming shut their borders with the UK.
- NERVTAG’s chairman, Peter Horby, a professor of emerging infectious diseases at Oxford University, confirmed experts there “now have high confidence that this variant does have a transmission advantage over other virus variants that are currently in the UK.”
- Barclay, meanwhile, said they were not yet “completely confident” that the vaccines that have just been rolled out would be effective against the new variant.
- That work is “underway in several laboratories around the UK at the moment,” she said of urgent studies, with others being carried out in the US as well as by the vaccine makers themselves.
3. What Are the Greatest Risk Factors of Dying From C19?
- Hospitalized C19 patients have a greater risk of dying if they are men or if they are obese or have complications from diabetes or hypertension, according to a new study conducted by University of Maryland School of Medicine (UMSOM) researchers. In a study published in the journal Clinical Infectious Diseases, the researchers evaluated nearly 67,000 hospitalized C19 patients in 613 hospitals across the country to determine the link between certain common patient characteristics and the risk of dying from C19.
- Their analysis found that men had a 30% higher risk of dying compared to women of the same age and health status. Hospitalized patients who were obese, had hypertension or poorly managed diabetes had a higher risk of dying compared to those who did not have these conditions. Those aged 20 to 39 with these conditions had the biggest difference in their risk of dying compared to their healthier peers.
- “Knowledge is power in many ways, so I think understanding which hospitalized C19 patients are at highest risk of mortality can help guide difficult treatment decisions,” said study corresponding author Anthony D. Harris, MD, MPH, Professor of Epidemiology and Public Health at UMSOM.
- For example, higher-risk patients may be given the drug remdesivir earlier in their hospitalization to help prevent severe complications or may be considered for closer monitoring or ICU admission. Healthcare providers may also want to consider these risks when determining which C19 patients could benefit the most from the new monoclonal antibody therapies that, if given in the first few days of the infection, can reduce the risk of hospitalization.
- Age remained the strongest predictor of mortality from C19. Overall, nearly 19% of hospitalized C19 patients died from their infection with the lowest mortality among pediatric patients, which was less than 2%. Mortality rates increased with each decade of life with the highest mortality, 34 percent, among those aged 80 and older.
- “Older patients still have the highest risk of dying, but younger patients with obesity or hypertension have the highest risk of dying relative to other patients their age without these conditions,” said study lead author Katherine E. Goodman, JD, PhD, a postdoctoral fellow in the Department of Epidemiology and Public Health at UMSOM. “Doctors may want to be paying extra attention to these younger patients when they’re hospitalized to ensure they detect any complications quickly.”
- The researchers also found some good news in their study findings. Death rates among hospitalized patients have fallen dramatically since the early weeks of the pandemic in April. This is likely due to the availability of new treatments and more knowledge in the medical community on how to properly manage and care for hospitalized patients.
4. Long-Haul Covid Patients Put Hope in Experimental Drugs
People suffering from debilitating symptoms for months after getting sick with Covid are searching for relief
- There are an estimated tens of thousands of Covid patients suffering from debilitating long-term symptoms. For months, they have gotten few answers—and even fewer treatments—from the medical community. Now, some pharmaceutical companies and researchers are moving to launch the first clinical trials for drugs intended to treat long-term Covid.
- Months later, many are experiencing life-altering symptoms including brain fog, extreme fatigue and shortness of breath, often making normal daily activities nearly impossible.
- Research suggests at least 10% to 20% of Covid patients experience long-term symptoms. A recent survey from the U.K.’s Office for National Statistics, for instance, reported that at least 10% of Covid patients have symptoms lasting for three or more months.
- Companies are repurposing experimental drugs being tested for other diseases, filing applications or launching clinical trials. Some are using the treatments on patients who apply for compassionate use when possible.
- The list of repurposed drugs discussed in the WSJ article include the following:
- Leronlimab, a monoclonal antibody administered through subcutaneous injections, was developed as an HIV drug. It hasn’t been FDA approved for HIV or for Covid.
- Zofin, an experimental drug tested for chronic obstructive pulmonary disease, or COPD, on long Covid patients. Zofin uses nanoparticles to reduce inflammation and microRNA to target different genes.
- LYT-100, an experimental drug that treats lung-scarring in post-acute Covid patients.
- Ampligen, an experimental antiviral drug administered as an IV infusion that is often used to treat patients suffering from myalgic encephalomyelitis, or chronic fatigue syndrome (CFS), a post-viral condition.
- Click here to read the full article.
5. C19 is 10 times deadlier to people with Down Syndrome
- When the C19 pandemic descended last winter, Catherine Ross was filled with dread. Her 36-year-old sister, Amanda Ross, has Down syndrome (DS), which makes her especially vulnerable to respiratory viruses. Amanda Ross had been hospitalized repeatedly with pneumonia. In 2017, she ended up on a ventilator and nearly died.
- In April, she was back on a ventilator. She lives in a group home in Somers, New York and was diagnosed with C19 on 31 March. The doctor told her close-knit family that, given her history, they needed to prepare for the worst. “It shook us,” Catherine Ross says. Her sister and others with DS, also known as trisomy 21, “are dealing with a stacked deck against them in terms of dealing with the virus,” she says.
- Among groups at higher risk of dying from C19, such as people with diabetes, people with DS stand out: If infected, they are five times more likely to be hospitalized and 10 times more likely to die than the general population, according to a large U.K. study published in October. Other recent studies back up the high risk.
- Researchers suspect background immune abnormalities, combined with extra copies of key genes in people with DS—who have three copies of chromosome 21 rather than the usual two—make them more vulnerable to severe C19. “This is a vulnerable population that may need protective policies put in place,” says Julia Hippisley-Cox, a clinical epidemiologist at the University of Oxford’s medical school and senior author on the U.K. study.
- On 2 December, the United Kingdom’s Joint Committee on Vaccination and Immunisation recommended prioritizing people with DS for speedy vaccination. But the more than 200,000 Americans with DS so far are not slated for early vaccination. Nor has the U.S. Centers for Disease Control and Prevention (CDC) included DS in its list of conditions that it says boost the risk for severe C19.
- Hippisley-Cox and her colleagues analyzed a database of 8.26 million people in the United Kingdom for their paper, published in the Annals of Internal Medicine. The extraordinary risk they found emerged even after they corrected for many other factors including obesity, heart disease, diabetes, and living in a group home. Another recent preprint that includes findings from a large international survey found that people with DS hospitalized with C19 who are 40 and older bear most of the increased risk, with a mortality of 51% versus 7% for those under 40. “At about the age of 40, things are getting really bad … [with] a mortality rate comparable with those older than 80 in the general population,” says first author Anke Huels, a biostatistician at the Rollins School of Public Health at Emory University.
- Experts say the typical anatomy of people with trisomy 21, including large tongues, small jaws, and relatively large tonsils and adenoids, along with lax throat muscle tone, helps explain their higher rate of respiratory infections in general. But genetics may also make them particularly susceptible to SARS-CoV-2, the pandemic coronavirus. They have three copies of a gene on chromosome 21, TMPRSS2, which codes for an enzyme that the virus hijacks to help it enter human cells. The TMPRSS2 enzyme cleaves the spike protein that studs the virus’ surface, launching a series of steps that allows the virus to invade the host cell.
- Cells from people with DS typically express 1.6 times more TMPRSS2 than those from people without the condition, according to an analysis posted as a preprint in June by Mara Dierssen, a systems biologist at the Centre for Genomic Regulation in Barcelona, Spain, and her postdoc Ilario De Toma. “Down syndrome individuals might be more susceptible to infection due to triplication of TMPRSS2,” Dierssen says.
- Immune system abnormalities likely add additional risk, experts say. In people with DS, T cells don’t develop properly, and levels of circulating B cells are low. So are levels of a key protein that prevents immune cells from attacking the body’s own tissues. In contrast, levels of potent, inflammation-inducing signaling proteins are high, contributing to a state of chronic inflammation even in the absence of infection.
- “The cells of people with Down syndrome are constantly fighting a viral infection that does not exist,” says Joaquin Espinosa, a genomicist at the University of Colorado’s Linda Crnic Institute for Down Syndrome. That reflects a revved-up immune system that may tip people with trisomy 21 into the hyperinflammatory state that typifies severe and fatal C19, he suggests.
- His group showed in 2016 that the interferon response, a first line of defense against viruses, is constantly activated in DS. Four genes for crucial interferon receptors are located on chromosome 21, likely leading to an “overdose” of receptors and thus of interferon activity, he says, noting there’s plenty of interferon available to bind to those receptors. In August, a team led by geneticist Jean-Laurent Casanova of Rockefeller University buttressed this hypothesis with a paper showing that certain white blood cells from DS patients display extra interferon receptors on their surfaces.
- A powerful interferon response may be helpful early in the course of C19 infection. But the elevated interferon activity seen in people with DS isn’t necessarily protective. Chronic background stimulation can make interferon receptors unresponsive to still more stimulation, says Louise Malle, an M.D./Ph.D. candidate at the Icahn School of Medicine at Mount Sinai. She was lead author on yet another recent study in New York City hospitals that found that patients with DS were on average 10 years younger and had significantly more severe C19 than age-matched controls. Interferon hyperactivity may feed the immune storm that can turn C19 fatal 1 week or more after symptoms appear, adds Andre Strydom, an expert in the neurobiology of DS at King’s College London who was senior author on the preprint.
- The picture is complicated and not fully understood, Strydom says. But, he adds, “What is clear … is that the immune differences in people with Down syndrome probably do put them at a disadvantage for fighting infection with C19. And for the consequences.”
- Public health experts in some countries agree. Within days of the Annals publication, the United Kingdom’s chief medical officers added people with DS to a list of “clinically extremely vulnerable” people who should be shielded from exposure.
- The international Trisomy 21 Research Society has since issued a pointed statement strongly calling for people with DS, especially those 40 and over, to be prioritized for early vaccination. In the United States, however, a panel advising CDC on vaccine prioritization has not yet defined the medically vulnerable groups that may be included in a second wave of vaccinations. Despite the new studies, a CDC spokesperson said: “At this time, there is not enough evidence to determine if adults with Down syndrome are at increased risk of severe illness from C19.” They added that the agency’s list of those at risk for severe C19 “is not exhaustive and … may not include every condition,” and noted that CDC can update its list as the science evolves.
- Because the prognosis for older C19 patients with DS can be so poor, they should have high priority for monoclonal antibody treatments, which are in short supply, says Beau Ances, a neurologist at Washington University in St. Louis who takes care of patients with DS. “A 40-year-old with Down syndrome who develops C19 … that’s the kind of individual that physicians should be thinking about for early antibody treatment,” he says.
- Physicians should also consider a drug called baricitinib, Espinosa says, because it blocks a signaling pathway essential to the interferon response. In a study described last month in Cell Reports, his group showed it prevented otherwise-lethal immune hypersensitivity in mice with trisomy 21. That suggests baricitinib could help tame an out-of-control immune response in DS patients with C19, he says. The Food and Drug Administration last month authorized baricitinib, in combination with remdesivir, for emergency use in hospitalized, severely ill C19 patients.
G. The Road Back?
1. Hospitals Retreat From Early Covid Treatment and Return to Basics
- Doctors are treating a new flood of critically ill coronavirus patients with treatments from before the pandemic, to keep more patients alive and send them home sooner.
- Last spring, with less known about the disease, doctors often pre-emptively put patients on ventilators or gave powerful sedatives largely abandoned in recent years. The aim was to save the seriously ill and protect hospital staff from C19.
- Now hospital treatment for the most critically ill looks more like it did before the pandemic. Doctors hold off longer before placing patients on ventilators. Patients get less powerful sedatives, with doctors checking more frequently to see if they can halt the drugs entirely and dialing back how much air ventilators push into patients’ lungs with each breath.
- Advances also include new drugs, most notably steroids, for severely ill patients.
- Read more in the Wall Street Journal here.
2. Does C19 Spread on Buses, Subways? NYC aims to find out
- Transit officials in New York are teaming up with the Department of Homeland Security and Massachusetts Institute of Technology to study how to reduce the spread of the new coronavirus on buses and trains.
- If—and how much—the virus spreads on mass transit is a stubborn question. Ridership is down in cities around the world largely due to people working from home and businesses closing, but also because of fear of contracting the virus.
- Studies and reports this year have drawn conflicting conclusions about the extent to which the virus spreads on mass transit. Some of the studies have been conducted by economists and transit specialists who don’t have expertise in the spread of viruses and other pathogens.
- Researchers plan to release different types of water-based aerosols, including those that mimic respiratory droplets which can be inhaled by people within 6 feet of each other as well as tiny particles that can travel further and linger in the air for hours. The studies will be conducted on transit vehicles that are empty and not in service. They will be carried out on vehicles in their normal state as well as on those with doors and windows open and with enhancements to ventilation and air-filtration systems. The study will be led by MIT’s Lincoln Laboratory.
- Don Bansleben, a program manager at the DHS Science and Technology Directorate, said it is clear that mass transit riders in the U.S. might have been exposed to the virus by fellow riders. However, Mr. Bansleben said, “I don’t believe there’s any definitive evidence that has shown that public transportation is really a source of spreading the virus, especially in large clusters of people.”
- New York’s Metropolitan Transportation Authority, the largest transit agency in the nation, carried about 8 million riders daily on the subway, buses and two commuter rail systems before the pandemic. Its operations are focused on New York City, which bore the brunt of the coronavirus in the spring when tens of thousands of people died. Weekday subway ridership is currently down about 70% compared with pre-pandemic levels. Weekday commuter rail ridership is down between 75% and 80%.
- Meghan Ramsey, a researcher at the Lincoln Laboratory who is leading the study, said the idea is to measure contamination in the air and on surfaces to understand the relative risk of contracting the virus and the efficacy of mitigation methods.
- Mark Dowd, the MTA’s chief innovation officer, said the agency asked DHS to conduct the study to determine scientifically whether the virus can be transmitted on transit and how to mitigate any risks.
- The emphasis in combating the virus that causes Covid-19 has shifted during this year from surfaces to air quality. The shift came as the U.S. Centers for Disease Control and Prevention said in the early summer that person-to-person interactions for extended periods, not surfaces, are the leading cause of infections.
- The project team says the tests are safe. The mock viral droplets being released contain ingredients common in household products, such as glycerol, which is found in soap, and fluorescent dye found in laundry detergent. Nevertheless, the study is subject to an environmental assessment and public comment period which begins Tuesday. Researchers hope to start the study in late January or early February and to have results by early spring.
- A DHS spokeswoman, Anne Cutler, noted that the mitigation measures being tested such as improvements to ventilation systems or opening windows are simple and cheap. Ms. Cutler said the agency hopes lessons learned from the study can be applied nationwide.
H. Back to School!?
1. Experts say this is what children need to survive the C19 pandemic
- Nine months after C19 changed everything, parents are asking the same question they asked at the start: Will my children be OK?
- “Children can go through divorce, they can go through death, they can go through just an amazing array of things and come out looking pretty good, if they’ve got somebody who can support them,” said Mary Dozier, a psychology professor at the University of Delaware who studies children who have experienced adversity.
- USA TODAY asked parents for their most pressing questions. Experts in child development and education answer below.
How do I know if my child is OK?
- Experts say there is no universal “normal.” To know how well your child is coping, look for differences in behavior.
- Brenda Jones Harden, the Alison Richman professor of children and families at the University of Maryland School of Social Work, said “normal” is different for every child. Parents should be concerned if their child appears more sad, hopeless or angry.
- Teens, for example, are volatile and moody, but if those mood swings become more extreme, that’s worth attention. Similarly, a child who starts having accidents after being fully toilet-trained might be struggling.
- Phil Fisher, a psychology professor at the University of Oregon, said even those signs aren’t necessarily red flags, but they are changes parents should monitor.
Is adversity good for kids?
- It depends on the kind of adversity and whether they have support to cope with it.
- Nat Kendall-Taylor, chief executive officer at the FrameWorks Institute and a senior fellow at the Center on the Developing Child at Harvard University, said people typically think of adversity in two ways: Either kids are unbreakable – impossibly resilient – or adverse experiences damage them beyond repair.
- There are different classes of stress, he says, and outcomes depend on the kind of stress a child is experiencing.
- Positive stress is being challenged and pushed mildly out of your comfort zone, which leads to growth and development. That could be taking a difficult test or forming a new relationship with a safe, unfamiliar person.
- Tolerable stress is when bad stuff happens, but it happens in the presence of a buffering, supportive relationship, like the one a child has with a parent.
- Toxic stress is severe in its strength and chronic in its duration and happens without that buffering relationship. That’s the kind of stress that can damage development.
- “A key variable or mediator is the buffer,” he said.
How worried should I be about my kids’ use of screens?
- If there’s one thing parents can let go of their guilt about, experts say it’s this.
- A Pew Research Center survey this summer found more than 71% of parents in the U.S. with children under 12 were concerned their child was spending too much time in front of a screen.
- Worried about your kid’s screen time?: Parenting issues arise due to social media, tech
- The American Academy of Pediatrics recommends no screen time for children younger than 18 months (outside of video chatting), one hour of high-quality programming for children 2 to 5, and consistent limits for children 6 and older.
- Now, children are learning virtually, and screens have in many cases become de facto babysitters. That isn’t ideal, experts say, but it is reality.
- “As a parent myself, I am not following those rules, and I’m trying to be kind to myself for never following those rules,” said Natalie Renew, director at Home Grown, a national collaborative of funders that works to improve access to home-based child care.
- Kendall-Taylor says that while the way children are engaging with screens now isn’t optimal, children are incredibly adaptive.
- “These biological systems are plastic,” Kendall-Taylor said. “When kids go back to school and resume the kind of social relationships that they had with peers, that will have an effect on their development. Development is this open and contingent process. And that’s to me the hopeful part.”
How much does my well-being impact my child?
- A caregiver’s well-being is directly tied to their child’s. Experts underscore a child’s best buffer during the pandemic is a supportive parent.
- But staying mentally well can be difficult in the midst of so many stressors, and financial hardships add to the burden. Fisher, who is also director of the Rapid Assessment of Pandemic Impact on Development Early Childhood Household Survey Project (RAPID-EC Project), which is studying the effect of the pandemic on children 5 years old and younger, said the survey has found caregivers in lower-income households report experiencing more depression and anxiety. Those stressors affect a parent’s ability to be available.
- Becoming a mother in and of itself can be challenging. Throw a pandemic into the mix and you instantly have to go into survival mode which in my case, I believe, has taken some of the emotion out of this process. I haven’t cried since having Bowie Iman
- RAPID’s surveys show caregivers of young children are experiencing distress, financial hardship and loss of emotional support. Because the project’s data is sequential, it’s able to show a chain reaction. When a family is stressed about meeting basic needs, the next week they report more emotional distress, and the week after they report increases in their child’s emotional distress.
- “There’s no question that if you can’t buy food or you can’t pay your rent, that you are experiencing the kind of stress that is going to be toxic to your children,” Fisher said.
How can I react to my child in a calm and loving way when I’m stretched so thin?
- The question’s premise is heartbreaking, Renew said, but it shows the kind of emotional sensitivity that’s paramount for parents and their children to weather this time.
- Stressed parents can be distant and distracted, but children need emotional and physical closeness. Communication is key.
- “We know that talking builds young children’s brains. This is also a good way to help your child understand why you may be frustrated or irritable or rushing or overwhelmed,” she said. “I find that bedtime is a great time to reflect with my child and sometimes to apologize if I have been snappy or crabby that day. I am a big believer in saying sorry.”
Is the pandemic causing my child permanent damage?
- “There is no molecule that we can assay, or questionnaire that we can administer, that will say a hundred percent we can guarantee this shows you’d better get help, or a hundred percent this shows that things are going to be fine, no matter what,” Fisher said.
- But experts say that unless a child is experiencing toxic stress, they probably will recover well and may build resiliency that will serve them in the long run.
- “Even in the midst of all of this adversity, no child is lost,” said Myra Jones-Taylor, chief policy officer at nonprofit Zero to Three. “We never speak about children being irreparably damaged.”
- My biggest concern for our daughter is how to keep her engaged with her friends in ways that are safe. It is so important for her social and emotional health to maintain relationships in the era of social distancing.
- If you feel your child is doing OK, your gut is probably right. If you feel something is off, seeking support from a professional makes sense.
- “Parents know their children, and parents have a sense of the vulnerability of their children,” Fisher said. “If people have serious concerns about this, then seeking support makes total sense. If for no other reason, then for reassurance.”
I’m working from home and I don’t have child care. How can I do my work and not neglect my child?
- Quality matters more than quantity, experts say. Even if you can’t give your child all the attention they crave, showing you are still present and available for important things can go a long way.
- That can mean taking a moment to talk about the picture your child just drew, or breaking from work to help with a question about school.
- “I work with mothers who are full-time employees and who have their children doing their work right beside them. And right in the middle of our conversation, the child comes up and says something and these moms turn and are responsive to them, and say, ‘Oh yeah, here’s what you need to do to get to that next step on your Zoom call.’ Or, ‘Yes, Molly, I love your hair like that,'” Dozier said.
How much does missing in-person school matter?
- That depends on a few variables. In-person school is optimal, but children who have supportive caregivers at home and access to technology will likely fare well.
- Experts are, however, worried about certain populations – especially low-income kids. Fisher pointed to data showing that during a normal school year, students of all income groups progress at a relatively similar rate. But achievement gaps widen over the summer, in part because poorer children have less access to enrichment opportunities and are more likely to experience instability.
- The pandemic is exacerbating those structural inequalities.
- “It’s different if you can’t get access to a WiFi hotspot. It’s different if you have six kids or three kids or two kids who are fighting over one tablet and a parent who needs it as well,” Fisher said.
I’ve always thought educational milestones were crucial. How concerned should I be about my child’s proficiency in math and reading?
- Early findings based on three separate assessments suggest students have fallen behind more in math than in reading.
- One assessment, by the Northwest Education Association (NWEA) among roughly 5 million students in grades 1-8, analyzed how those children’s growth from the past school year compared with kids in 2018 and 2019. The data excludes the many students who are not engaging with school right now, but it shows learning losses aren’t as pronounced in reading as they are in math: The average student lost 5 to 10 percentile points in the latter and lost little in the former. Results from the other assessments reveal similar trends.
- Now we have to be the teacher, the parent, the friend. We have to do all these roles. … It’s hard to know if we’re doing the right thing. You want to make sure your kids are getting the attention that they deserve
- These findings, while imperfect, show parents are doing a relatively good job of helping keep their kids on track when it comes to reading. Helping children make their way through a book – versus, say, teaching them long division – may come more naturally to caregivers.
- Research also shows children better understand what they’re reading when they are interested in its subject. The pandemic, experts say, is an opportunity to get to know your children’s interests, to help them develop their passion for a variety of subjects.
- As for the math losses, experts suggest they’re concerning but ultimately less of a priority than kids’ mental health. Children, as Harden indicates, won’t have a shot at catching up if they’re not “psychologically and physically safe.”
How can I best support my child’s virtual learning?
- With little data on what works best for kids and teachers, parents may find themselves especially confused as they seek to keep their kids connected and engaged.
- Experts say every child has different virtual learning needs. Be patient.
- Some general guidance, according to experts:
- While this might not be possible for all families, try to dedicate a specific location in the home that can be free of clutter and distractions to support their ability to focus.
- Understand the need for ‘brain breaks,’ which can consist of short bursts of physical activity – such as a brief walk or snack.
- If your school allows for flexibility, encourage your child to focus on content that interests them most.
- “Encourage your child to build independence,” said Thomas Murray, director of innovation at Future Ready Schools, Alliance for Excellent Education, “but don’t hesitate to check in and verify their progress.”
- If you feel as if your child is falling behind, bring those concerns to their teacher.
- “You do not have to go at this alone,” Murray said.
How can I help my teen who has missed out on so much?
- The pandemic has been an especially rough time for adolescents. Young kids want to be around their parents. Teenagers, however, gravitate toward their peers. They want to be more independent. Instead, many are cooped up at home, separated from friends and missing milestones.
- Jennifer Pfeifer, a psychology professor at the University of Oregon who studies the transition from childhood through adolescence, says that while it’s developmentally appropriate for teens to break from their parents, family support is essential at any age. It’s stressful not to see your friends or to miss out on experiences you would otherwise be having, but parents can help their children navigate these losses.
- Validating your teen’s feelings is important, as is encouraging them to think outside themselves. Adolescence, Pfeifer said, is marked by an awakening to the wider world.
- One of my … concerns has been everything my child has missed out on this year. Not being able to participate in Special Olympics, summer camp, sports teams, cooking classes. We tried to do a few things virtually but that is really not the best engagement style for my son. This has been a hard year for families raising children with disabilities.
- “If you are able to help them channel what would otherwise be sort of a derailment experience … into finding new purpose or ways to contribute, that is so critical with adolescents,” she said. “They have a need to contribute and a burgeoning ability to contribute.”
- That can include volunteering in their community or getting involved with an organization they’re passionate about.
Is this normal adolescent angst or something more serious?
- Pfeifer says that when clinical psychologists assess adolescents for depression and anxiety, they recognize that some of those symptoms increase normally around this time.
- Concern is appropriate, she said, if those changes start to affect a teen’s normal functioning. That can mean a child so depressed they aren’t going to their Zoom classes, or who can’t get out of bed.
- The good thing is that during the pandemic, most parents are seeing their children more often, which allows them to observe their children more closely.
- “Adolescents might be hiding some of that from you, but maybe that was a little easier when adolescents and their parents were not typically in the same space all of the time. So you might have this greater insight or at least exposure to adolescents than you would under normal circumstances,” she said.
- Parents should also create an environment where children feel comfortable disclosing, she said. That means listening to their feelings and concerns and being responsive by validating them and not judging them. Don’t try to manipulate or control them; a parent needs to earn their child’s trust.
- “Building that relationship will serve you well even after the pandemic,” she said.
What is one thing I can do every day to help my child?
- Check in, Harden said. Children need space to open up. Put away the screens, put away the distractions, and talk to your child.
- “Say, ‘How are you doing?’ With little people, you show them faces. ‘Are you happy today?’ Are you sad today?’ And older children, you can have more sort of longer-term conversations, richer conversations about their emotional well-being,” she said.
- Routine is also important. Experts acknowledge this might sound tone-deaf in the middle of a pandemic, but science shows predictability is valuable across the entire span of development.
How do I deal with her being afraid of going into a building other than her home?. I worry about all of the experiences she isn’t having.
- Experts also stress the importance of self-care, since data shows parents’ stress can trickle down to kids.
- “Being responsive means that you need to be well,” Renew said. “Responsivity is not just an endless bank of resource that you have. I mean, we all know that, right? When you’re stressed out, do you think you’re responsive? You’re responsive probably in the ways that you shouldn’t be.”
- Lastly, try to integrate something new and unique into your routine. The pandemic has been marked by sudden subtraction. It’s worth using this moment to add something new.
- “In the midst of all of this chaos, carve out something that will be a positive,” Jones-Taylor said.
What is the most important thing for parents to remember?
- Almost all of the experts we spoke with said parents need to care for themselves so they can care for their children. Part of doing that is letting go of unproductive guilt and worry that their families will not recover.
- “To the extent that you’re OK, you can make it OK for your child,” Fisher said. “Let go of all of the worrying. … The science doesn’t suggest that just some of these things – like the interruption in school – are going to necessarily leave a lasting footprint.”
- One of the most difficult tasks as parents is to separate what matters from what doesn’t. Parents want to know what will ripple and what will stick, what children can come back from and what they never will. Experts don’t have every answer, but there is one thing they can say for certain.
- “Parents have done amazing things. They educate their kids, they do their full-time jobs,” Renew said. “What parents have been able to keep together under incredible adversity, it’s really remarkable.”
2. Mitigation efforts can prevent most college campus COVID cases
- As colleges and universities consider strategies for the spring semester to keep C19 cases down, a study conducted by experts in epidemic modeling may help shed light on what mitigation strategies may be most effective, both in terms of infections prevented and cost.
- Investigators from Brigham and Women’s Hospital, Massachusetts General Hospital and Case Western Reserve University used the Clinical and Economic Analysis of C19 interventions (CEACOV) model to perform their study, finding that combining a mandatory mask-wearing policy with extensive social distancing would prevent 87% of infections among students and faculty. Routine testing was also highly effective at preventing infections, but may be cost prohibitive for many colleges and universities. The team also reports that, even if campuses remain closed, there would likely be infections among faculty acquired from the surrounding community, as well as infections among students who return to live off campus in and around college towns. Results are published in Annals of Internal Medicine.
- “This next semester represents a critical time in the pandemic. While the vaccine rollout has begun, it is unlikely that most college students will be eligible for the vaccine until late in the spring semester,” said lead author Elena Losina, PhD, Director of the Policy and Innovation eValuations in Orthopedic Treatments (PIVOT) Center at the Brigham. “However, our modeling shows that colleges and universities can put effective programs in place to mitigate infections. This analysis is designed to help individuals and institutions make decisions using a formal, data-driven approach.”
- The team evaluated 24 mitigation strategies based on four approaches: social distancing, mask-wearing policies, isolation, and laboratory testing. The team compared results from a minimal social distancing program, in which only large gatherings such as sporting events or concerts were cancelled, and an extensive social distancing program, where all large classes and 50% of smaller classes were delivered online. Laboratory testing ranged from no testing of asymptomatic students and faculty to routine testing at 14-, 7-, or 3-day intervals.
- The team’s modeling predicted that:
- No mitigation: Without any mitigation efforts, approximately 75% of students and 16% of faculty would become infected on a college campus.
- Campus closed: Closing the campus would reduce student infections by 63% with most infections coming from those students living off campus.
- Minimum social distancing: Student infections would be reduced by only 16%.
- Mandatory masking: Universal masking would be more effective in preventing infections than either minimum or extensive social distancing.
- Combining social distancing and masking: A mask-wearing policy with extensive social distancing would prevent 87% of infections among students and faculty and would cost $170/infection prevented.
- Routine testing: Adding routine laboratory testing to a policy involving extensive social distancing and mask-wearing reduced infections the most, but at a high cost/infection prevented.
- “If colleges put less effort into social distancing and mask-wearing policies, they need to rely more on routine laboratory testing at higher cost to reduce the spread of C19. If less costly tests were available, then routine testing would be feasible in more college settings,” said co-senior author Kenneth A. Freedberg, director of the Medical Practice Evaluation Center at Massachusetts General Hospital and a professor of Medicine at Harvard Medical School.
- While the researchers tried to capture the major C19 mitigation strategies colleges are considering, the study could not examine all strategies and the analysis was restricted to one semester.
I. Innovation & Technology
1. Nanomaterial System Detects C19 Antibodies In Just Seconds
- A new biosensor can examine the tiniest drop of blood and tell whether someone has antibodies for the coronavirus — in about ten seconds.
- The nanomaterial system can identify two separate antibodies generated in response to the coronavirus (SARS-CoV-2) and send results to a phone, according to research published Tuesday in the journal Advanced Materials. If adopted, the test stands to vastly enhance the speed at which immunological testing could be conducted.
- The technology uses an advanced nanomaterial‐based biosensing platform that detects C19 antibodies within seconds. The biosensing platform is created by 3D nanoprinting of three‐dimensional electrodes, coating the electrodes by nanoflakes of reduced‐graphene‐oxide (rGO), and immobilizing specific viral antigens on the rGO nanoflakes.
- And it could reveal more than whether someone’s had C19, the Carnegie Mellon University engineers behind the research suggest. It could also be used to determine whether or not a coronavirus vaccine is actually protecting a patient by measuring their immune system’s response.
- “Because our technique can quantify the immune response to vaccination, it is very relevant in the current environment,” study coauthor Rahul Panat, a Carnegie Mellon University mechanical engineer, said in a press release.
- And the team has its sights set beyond the coronavirus pandemic as well. The system’s current form contains antigens that respond to coronavirus-specific antibodies, so it’s likely that it could also rapidly detect other viruses with the right modifications.
- The team believes the biosensor platform may work just as well for Ebola, HIV, and Zika, making it a valuable tool for other viral outbreaks around the world.
- Read more about the research here.
2. Hand-held device measures aerosols for coronavirus risk assessment
- Because of the role they play in coronavirus transmission, understanding aerosol concentrations and persistence in public spaces can help determine infection risks. However, measuring these concentrations is difficult, requiring specialized personnel and equipment.
- That is, until now.
- Researchers from the Cardiology Centers of the Netherlands and the University of Amsterdam demonstrate that a commercial hand-held particle counter can be used for this purpose and help determine the impacts of risk-reducing measures, like ventilation improvements. They describe the quick and easy, portable process in the journal Physics of Fluids, from AIP Publishing.
- The key challenge with using hand-held particle counters is dealing with the background dust prevalent in public spaces. The question then becomes, can you distinguish these dust particles from aerosols that arise from breathing, speaking, sneezing, and coughing?
- Because dust and aerosols inhaled into human lungs differ in size, the researchers developed a way to subtract the dust signal in the particle counter by measuring the dust for some time, and watching how the signal changes after aerosols are added to the mix.
- “There’s a lot of fine dust, so we can’t really measure aerosols in that range, but there’s a reasonable sized range where you can detect the aerosols,” said Daniel Bonn, one of the authors.
- They compared the aerosol concentration determined by this method to laboratory-based techniques and found the results match up perfectly. Though this work reports on one specific hand-held particle counter — the Fluke 985, which is used to monitor the dust and air quality in clean rooms — Bonn noted the results aren’t unique to this device and can be extended to other particle counters as well.
- Though the method does not directly measure the presence of viral particles, the detected aerosol concentration can be combined with virus data from other studies to obtain a practical risk assessment for a specific type of public space. The findings suggest well-ventilated areas can have aerosol concentrations more than 100 times lower than poorly ventilated areas, such as public elevators or restrooms.
- “There are people worried about going to the gym, coming to the office, taking the train. All that can at least be evaluated,” Bonn said. “The motto remains ventilation, ventilation, ventilation.”
- He said while ventilation plays a large role in indoor spaces, aerosols are not the only route to infection, and social distancing and hand-washing remain vital.
J. Projections & Our (Possible) Future
1. Particle Testing Has Scientists Expecting a New Surge of C19 Infections
- Winter is coming in the northern hemisphere on Monday, December 21, 2020, and public health officials are asking how the seasonal shift will impact the spread of the coronavirus (SARS-CoV-2).
- A new study tested how temperatures and humidity affect the structure of individual SARS-Cov-2 virus-like particles on surfaces. They found that just moderate temperature increases broke down the virus’ structure, while humidity had very little impact. In order to remain infectious, the SARS-Cov-2 membrane needs a specific web of proteins arranged in a particular order. When that structure falls apart, it becomes less infectious. The findings suggest that as temperatures begin to drop, particles on surfaces will remain infectious longer.
- This is the first study to analyze the mechanics of the virus on an individual particle level, but the findings agree with large-scale observations of other coronaviruses that appear to infect more people during the winter months.
- “You would expect that temperature makes a huge difference, and that’s what we saw. To the point where the packaging of the virus was completely destroyed by even moderate temperature increases,” said Michael Vershinin, assistant professor in the Department of Physics & Astronomy at the University of Utah and co-senior author of the paper. “What’s surprising is how little heat was needed to break them down—surfaces that are warm to the touch, but not hot. The packaging of this virus is very sensitive to temperature.
A group of SARS-CoV-2 virus-like particles is shown in panel (A) on a glass surface in room temperature. The color scale describes the height of each particle–red is the tallest and dark blue is the flattest. (B) Virus-like particles imaged at about 93 degrees F (34 degrees C) under dry conditions. There are no discernable features of the particles in panel A, indicating the particle structure degraded. (C) The virus-like particles that were incubated at about 93 degrees F (34 degrees C) in a buffer solution, and imaged at room temperature. The particles are more consistent with A, but still reveal widespread structural degradation.
- The SARS-CoV-2 is commonly spread by exhaling sharply, (e.g. sneezing or coughing), which ejects droplets of tiny aerosols from the lungs. These mucus-y droplets have a high surface to volume ratio and dry out quickly, so both wet and dry virus particles come into contact with a surface or travel directly into a new host. The researchers mimicked these conditions in their experiments.
- They tested the virus-like particles on glass surfaces under both dry and humid conditions. Using atomic force microscopy they observed how, if at all, the structures changed. The scientists exposed samples to various temperatures under two conditions: with the particles inside a liquid buffer solution, and with the particles dried out in the open. In both liquid and bare conditions, elevating the temperature to about 93 degrees F for 30 minutes degraded the outer structure. The effect was stronger on the dry particles than on the liquid-protected ones. In contrast, surfaces at about 71 degrees F caused little to no damage, suggesting that particles in room temperature conditions or outside in cooler weather will remain infectious longer.
- They saw very little difference under levels of humidity on surfaces, however, the scientists stress that humidity likely does matter when the particles are in the air by affecting how fast the aerosols dry out. The research team is continuing to study the molecular details of virus-like particle degradation.
- “When it comes to fighting the spread of this virus, you kind of have to fight every particle individually. And so you need to understand what makes each individual particle degrade,” Vershinin said. “People are also working on vaccines and are trying to understand how the virus is recognized. All of these questions are single-particle questions. And if you understand that, then that enables you to fight a hoard of them.”
1. Lockdowns have become the default Covid policy – but do they actually work?
- We have heard it often enough: Christmas will be quite different this year, in the same way that this year has been quite different. Europe is now almost entirely locked down. Restaurants and pubs, recreational places, and retail stores are closed. Gatherings have been drastically capped to a handful of people. This is well known, of course, to over 16 million people in the UK now chafing under the most severe restrictions as we approach the end of the year.
- But do lockdowns of this kind even work? It is a question that is rarely asked in the hurly-burly of panicky doom-mongering in the mainstream media and out-of-whack conspiracy theorising on the wilder fringes of the internet.
- The assumption from the beginning of this crisis has been that the only appropriate response to a pandemic running out of control is to lock down – and the worse the situation gets, the more people have to be locked down.
- Though the precise measures may differ from country to country, and even within countries (such as in England’s tiers 3 and 4), the goal is the same: to avoid becoming another Bergamo, with overwhelmed health systems and spiralling death rates. So, what happened in northern Italy earlier this year became a near-universal response, regardless of the dimensions of the pandemic being different from country to country.
- Indeed, when looking at the question of whether lockdowns work, one will quickly find that there is no clear answer.
- There are no past experiences to gather information from – not only that lockdowns on today’s scale have never been implemented, but governmental organisations have recommended in the past not to do so. Take the Council of Europe, which warned in 2010 not to repeat the “unjustified scare” in response to the swine flu.
- When looking at C19 lockdowns, the picture remains pretty opaque. A Bloomberg analysis based on the spring lockdowns showed “little correlation between the severity of a nation’s restrictions and whether it managed to curb excess fatalities”. A study published in Frontiers in Public Health in November concluded that the stringency of measures “did not appear to be linked with death rate” and further research in the UK and Germany showed that infections were already declining before lockdowns had been implemented.
- In the absence of decent information about the effectiveness of lockdowns, we get different horror – or fantasy – scenarios presented in an often pedantic attempt to justify one’s pre-conceived opinion. This is true for both sides of the lockdown debate.
- Those in favor of lockdowns will point to countries like the US or Brazil – or US states like Florida, the Dakotas, and Tennessee – to show the grave consequences of reacting too late. Those opposed to lockdowns will point to Italy and France – or US states like New York or California – arguing that the strictest lockdowns have failed to prevent mass fatalities.
- In some cases, the same country can occupy a totemic role for both sides of the debate. Sweden is a prime example of how lockdowns are not needed, argue lockdown opponents, but it is also a prime example of how we have to have lockdowns, argue lockdown proponents. While both sides instrumentalize the Nordic outlier, the fact remains that little is known beyond the fact that Sweden has had fewer restrictions than many other countries, that they are doing better so far than some countries with lockdowns and worse than others.
- Similarly, lockdown-free Switzerland is currently depicted as close to Sodom and Gomorrah, a full-on war zone, in the eyes of lockdown proponents. The sceptics might ignore the national picture and point to individual cantons that fit their narrative, like “the miracle of Schwyz,” which steered clear of a lockdown despite soaring infections and saw numbers decline nonetheless. Like Sweden, Switzerland has been doing better than some and worse than others. They will enter a lockdown today – but one much lighter than in most of Europe. Spain, meanwhile, had harsh restrictions in spring. This time around, restaurants and bars are packed and nobody seems to understand why there hasn’t been another crisis.
- A generally held principle in politics is that of evidence-based policymaking, which states that policies should only be introduced if there is clear evidence, based on rigorous analysis, that they work. Many popular C19 policies have already failed that test by the urge of political leaders to simply “do something,” regardless of what.
- For instance, EU agencies have concluded that quarantines after flying are pointless – yet they continue to exist. Germany’s Robert Koch Institut explained that only 0.5% of total infections arise in restaurants – yet the country’s restaurants were first in line for closure. The virus spreads the same regardless of which hour of the day – yet still we see night-time curfews.
- More concerning still is how little many political leaders seem to care about the enormous intrusions on our hard-fought liberties entailed by these measures. It has become axiomatic that whenever infection numbers rise, restrictions must as well, with little regard to the economic costs or the misery that creates. Whether there is actual evidence that this works is not relevant. We simply have to do something – or anything.
- Shop, restaurant, and hotel owners standing in front their closed businesses and financial ruin, cancer patients not being treated as fast as they otherwise would, those wanting to travel or move to another country, the 135 million people who are close to dying from hunger, and those sitting along by their Christmas tree will all think differently.
- They will wonder if it’s all worth it. And there will be no answer other than a threatening “if you don’t follow the rules, it’ll be Bergamo all over again”.
2. Pols ordering senseless lockdown rules so they can ‘do something’
- “I’m not sure we know what we’re doing,” San Mateo County Health Officer Scott Morrow recently confessed, referring to the myriad puzzling restrictions state and local governments have imposed in the name of fighting C19. Morrow’s doubts are striking, because last spring, he joined other San Francisco Bay Area officials in imposing the nation’s first lockdowns, which he still thinks were justified.
- Morrow’s remarkable statement, which he posted on his department’s Web site this month, shows that politicians and bureaucrats are still struggling to justify edicts that are often arbitrary and scientifically dubious. A year into the C19 pandemic, many of them have yet to digest the dangers of carelessly exercising their public-health powers.
- Although research in other countries has shown that K-12 schools aren’t an important source of viral transmission, they remain closed in California and many other jurisdictions, largely because of resistance from teachers unions. “The adverse effects for some of our kids will likely last for generations,” Morrow warned.
- Morrow, who has served as San Mateo County’s health officer since 1992, also criticized the stay-at-home order that California Gov. Gavin Newsom issued on Dec. 3, which he said is “rife with inconsistencies.” The new restrictions, Morrow said, were imposed without evidence that the activities they target are “major drivers of transmission.” Yet they will mean “more job loss, more hunger, more despair and desperation . . . and more death from causes other than COVID.”
- A conspicuous example is Newsom’s ban on outdoor restaurant dining, which applies in regions where the available ICU capacity drops below 15%. This month, a Los Angeles County judge said such bans are “not grounded in science, evidence or logic.”
- California Health and Human Services Secretary Mark Ghaly has admitted the state ban wasn’t based on evidence that outdoor dining plays a significant role in spreading C19. Ghaly said the policy, a grave threat to businesses that were already barely surviving, is “not a comment on the relative safety of outdoor dining” but is instead aimed at discouraging Californians from leaving home.
- Ghaly assumes that giving people fewer things to do outside their homes will push them toward safer behavior. But as Morrow noted, “these greater restrictions are likely to drive more activity indoors” — a “much riskier” setting.
- New Mexico Gov. Michelle Lujan Grisham apparently didn’t consider that possibility when she imposed a two-week “pause” last month that shut down golf courses and state parks. Although many parks remain open in California, camping is banned in restricted regions, and the state says residents “should not travel significant distances for recreation.”
- C19 restrictions are equally capricious in other states. New York Gov. Cuomo last week banned indoor dining in Gotham, even though his own data showed that restaurants accounted for just 1.4% of infections, while Minnesota Gov. Tim Walz banned both indoor and outdoor dining at a time when 1.7% of cases were linked to restaurants.
- Another Walz decree was so sweeping and invasive that even The New York Times, usually a big fan of C19 restrictions, was taken aback. Walz “took the extraordinary step of banning people from different households from meeting indoors or outdoors, even though evidence has consistently shown the outdoors to be relatively safe,” the paper reported.
- Cuomo’s eagerness to show he was doing something about the epidemic led him to impose onerous limits on “houses of worship,” a policy so blatantly discriminatory, it was overturned by the Supreme Court. Even when ill-advised restrictions don’t violate the Constitution, they provoke resentment and resistance, which undermine compliance with the sensible precautions that are crucial to containing the virus until vaccines are widely available.
- “Just because one has the legal authority to do something doesn’t mean one has to use it, or that using it is the best course of action,” Morrow noted. “The power and authority to control this pandemic lie primarily in your hands, not mine.”
3. There’s No Trade-Off Between Lives and the Economy
Some countries saved both this year – while others saved neither
- As the plague year of 2020 lurches to a close, it’s worthwhile revisiting one of the biggest policy mistakes of the pandemic: the attempt to preserve economic growth by minimizing restrictions that might hurt the economy.
- I wrote about that in May in a Bloomberg Businessweek cover story focusing on President Trump. “Will some people be affected? Yes. Will some people be affected badly? Yes,” Trump told reporters during a factory visit on May 5. “But we have to get our country open, and we have to get it open soon.”
- By now it’s clear there’s no necessary trade-off between lives and livelihoods. A country can have both. Two economists for Bloomberg Economics, Scott Johnson and Tom Orlik, hit that point in a graph that plots C19 deaths per million population vs. the level of gross domestic product in the fourth quarter in comparison to its pre-pandemic trend.
- China, South Korea, and Japan are in the top left of the graph. They’re on the left because they have a minuscule number of virus deaths per million, and they’re near the top because their economies are running almost as fast as they did before C19. China is the best in both respects, with the lowest death rate and the least harm to growth of any major economy.
- In the loser’s corner at bottom right sit the U.K., Mexico, Spain, and Argentina, with high death rates and lots of economic damage.
- If there really were a strong trade-off between lives and the economy, neither the good cluster nor the bad cluster would exist. Of course, not every country fits into one of the clusters.
- The U.S., France, and Italy are intermediate cases, with far more lives lost than China but not as much economic damage as the U.K.
- Australia, India, and Indonesia are a different type of intermediate case: fairly low death rates, fairly serious economic damage.
- Johnson and Orlik write: “Governments acting on the false hope that a little more growth could be purchased at the expense of a few more virus cases often ended up with precious few more jobs but a lot more contagion.”
- Among democracies, ones the World Bank rate highly for “government effectiveness” tended to do the best job in simultaneously fighting the pandemic and preserving growth, the Bloomberg economists found. South Korea, Japan, Germany, Australia, and Canada are highly rated in government effectiveness and have a high score on Bloomberg’s composite rating for saving lives and livelihoods. Mexico and Argentina are weak on both measures. The U.S. is in between.
- “Worryingly,” the authors write, some of the best performances were recorded by countries that rate low in democracy: China, Russia, Turkey, and Saudi Arabia.
- They have three explanations: Some of the countries, particularly Russia, might be misreporting data; China learned from its brush with SARS in 2003; and all four countries “have relatively small service sectors—helping shield them from the virus’ impact.”
4. A dire time for restaurants
- No matter how you slice it, the restaurant industry is in trouble. By some estimates, nearly 110,000 restaurants have permanently closed.
- “People in the industry I’ve talked to seem to be in despair,” Pete Wells, a New York Times restaurant critic, told me.
- Everyone has struggled, small and large. Independent restaurants have closed and reopened (and then closed again), built outdoor dining areas and bolstered takeout menus, along with other creative solutions.
- Dine-in chains have a different set of problems. Outposts in cities with more relaxed regulations can tide over those that are under lockdown. But large restaurant companies have struggled to develop a coordinated approach. Several dining chains — including Chuck E. Cheese, California Pizza Kitchen and some Il Mulino restaurants — were compelled to file for bankruptcy.
- The pressure is on now that we’ve officially entered the holiday season, usually the industry’s busiest time of year. But big company dinners and intimate family meals will be largely absent in 2020.
- Diners were already hesitant to eat out, but indoor bans have dealt another blow. And temperatures have dropped, shortchanging outdoor options.
- “It’s just so brutal right now,” Pete said. “We can see the light at the end of the tunnel, finally. All of these vaccines are flooding in. And at the same time, things in restaurants are worse than they’ve been at anytime since April.”
- The government could still take steps to bail out restaurants, as has happened in many other countries. And the CARES Act did keep many unemployed restaurant workers afloat. But Pete says that within the industry, “no one really expects to see a bill that specifically addresses the industry’s needs, at least not until after the inauguration.”
- If you want to help, or if you’re tired of cooking, it’s always good to order in from a favorite spot. Pete suggested focusing on one or two neighborhood places that you really want to support. And please, if you can, tip as if you had remarkable in-person service all meal long.
Source: New York Times Coronavirus Briefing
L. Practical Tips & Other Useful Information
1. When is it not safe to wear a mask?
- Wearing a used mask could be more dangerous than not wearing one at all when it comes to warding off C19, a new study has found.
- A new three-layer surgical mask is 65% efficient in filtering particles in the air — but when used, that number drops to 25%, according to the study published Tuesday in the Physics of Fluids.
- Researchers from the University of Massachusetts Lowell and California Baptist University say that masks slow down airflow, making people more susceptible to breathing in particles — and a dirty face mask can’t effectively filter out the tiniest of droplets.
- “It is natural to think that wearing a mask, no matter new or old, should always be better than nothing,” said author Jinxiang Xi.
- “Our results show that this belief is only true for particles larger than 5 micrometers, but not for fine particles smaller than 2.5 micrometers.”
- To reach their findings, researchers used a computer model of a person wearing a pleated three-layer surgical mask to track how the face covering affected airflow and how particles passed through. They also looked at how the tiny droplets settled onto the face, in the airway and where they land in the nose, pharynx or deep lung.
- They found that wearing a mask “significantly slows down” airflow, reducing a mask’s efficacy and making a person more susceptible to inhaling aerosols into the nose — where SARS-CoV-2 likes to lurk.
- “In this study, we found that the protective efficacy of a mask for the nasal airway decreases at lower inhalation flow rates,” the study said.
- The pleats of a face mask also significantly affect airflow patterns and their efficacy changes with more use, the researchers found. The team plans to study how mask shapes affect protection from C19.
- “We hope public health authorities strengthen the current preventative measures to curb C19 transmission, like choosing a more effective mask, wearing it properly for the highest protection, and avoid using an excessively used or expired surgical mask,” said Xi.
2. Covid Guide: How to Get Through the Pandemic
- The NY Times offers a guide to getting through the pandemic:
A guide to the last months (we hope) of the pandemic
- The pandemic is surging, but as bad as things are, the end is in sight. By doubling down on precautions, we can slow the virus and save lives. Read more here: Hunker Down for a Little Bit Longer
- How and when the pandemic ends will depend on the choices we make this winter, particularly around Christmas and New Year’s Eve. Read more here: Scale Back Your Holiday Plans
- C19 can be scary, but we’ve learned a lot about how to monitor the illness at home — and when to seek hospital care. Read more here: Take Care of Yourself at Home
- With the rollout of the vaccine, an end to the pandemic is in sight. Life will start to feel more normal in mid- to late 2021, depending on how many people get vaccinated. Read more here: Look for Better Days This Spring
3. Tips on How to Get Through this Dark Pandemic Winter
- The stresses are taking a terrible toll on our country’s mental health. In June researchers at the CDC found that 25.5% had symptoms of anxiety and 24.3% had symptoms of depression—a threefold and fourfold increase, respectively, from 2019.
- We can now glimpse, with the advent of vaccines, that there will be an end to this pandemic. But to get there, we have to somehow keep going through months of trauma and strain. How do we do that? How do we endure more and more of the isolation, the deaths, the flare-ups, the economic wreckage, the fear and the uncertainty?
- There are ways—not perfect solutions but methods that can help. Psychologists who specialize in trauma and disaster recovery, as well as those who work with patients who have chronic injuries or disabilities, say that although it feels impossible and although there will be losses, most of us will get through this disaster. And they point to strategies for coping born of experience and science. When people in devastating situations can spot warning signs of mental trouble, acknowledge and express their distress, focus on the present moment and the small things they can control, and find ways to connect with others, they can get through the darkest of moments and show resilience.
- Read the article in Scientific American here to learn more ways to cope.
M. Johns Hopkins COVID-19 Update
December 22, 2020
1. Cases & Trends
- The WHO C19 Dashboard reports 76.25 million cases and 1.70 million deaths as of 10:15am EST on December 22. The WHO again reported a new record for global weekly incidence with 4.59 million cases last week, an increase of more than 5% from the previous week. The global cumulative incidence surpassed 75 million cases on December 20, and it could reach 80 million in the next 5-6 days. The WHO also reported a new record for weekly mortality. Last week’s 78,611 deaths surpassed the previous week by more than 3.5%.
- This week we get the opportunity to start monitoring vaccination progress. Our World in Data has started compiling reports of SARS-CoV-2 vaccination from countries that have initiated their vaccination campaigns. Currently, there is no official comprehensive or aggregated source for national-level vaccination data, so the data presented here are drawn from individual national reports and announcements. To date, this site includes quantitative data from Canada, China, Israel, Russia, the UK, and the US. It notes that other countries have initiated vaccination, and they will be added as soon as reports can be verified.
- To date, the UK leads globally in terms of doses per capita, with 0.74 doses per 100 population. The remaining countries, in order, are the US (0.17), Russia (0.14), Israel (0.12), China (0.07), and Canada (0.05). In terms of total vaccination, China is #1, with 1 million doses administered, followed by the US (556,208), the UK (500,000), Russia (200,000), Canada (17,633), and Israel (10,000). Our World in Data also displays vaccination policies by country, mapping countries by what proportion of their population is eligible for vaccination: nobody/none, 1 or 2 vulnerable groups, all vulnerable groups, vulnerable groups and others, and universal. At this time, only 4 countries are included in this dataset: United Arab Emirates (vulnerable populations and some others), the UK (all vulnerable groups), Canada (2 vulnerable groups), and the US (1 vulnerable group).
- The US CDC added a vaccination tab to its C19 data tracker. Currently, the tab shows only national totals for doses distributed and administered, as opposed to state-level data. The CDC reports more than 4.6 million doses have been distributed nationwide and 614,117 doses have been administered. Additionally, the Johns Hopkins Coronavirus Resource Center has added a vaccine tracker, which will provide updates from US states as they report vaccination data. Currently, the tracker includes data from 23 states.
- The US CDC reported 17.79 million total cases and 316,844 deaths. On December 18, the US reported 403,359 new cases, far exceeding the previous single-day record; however, this included 171,505 previously unreported probable cases in Texas. Without this addition of historical cases, the US would have reported 231,854 new cases on that day, which would have been the third highest single-day total to date. Texas jumped from 1.37 million cumulative cases on December 17 to 1.56 million on December 18.
- The US is currently averaging 239,604 new cases per day, but this is inflated due to the data from December 18. We expect that the actual average is closer to 215,000. Following the US Thanksgiving holiday weekend, C19 reporting recovered from holiday delays and resumed its previous trend. It appears as though the US is reaching a peak or plateau in terms of daily incidence. The US reported its highest daily incidence to date on December 17, with 216,159 new cases per day. Omitting the probable cases reported by Texas, the expected daily incidence fell slightly December 18 and 19 before increasing again yesterday to 215,104.
- The US is averaging more than 2,600 deaths per day. While this is still the highest mortality since April 20-21, it does appear that the US is approaching or has passed an inflection point in terms of C19 mortality. Daily mortality was increasing exponentially leading up to Thanksgiving, and it appears to be increasing approximately linearly since then. This could be a sign that US mortality is starting to taper off; however, if incidence increases again as a result of holiday travel and gatherings, we would expect mortality to increase again as well. As we have observed throughout the pandemic, C19 mortality tends to lag 3-4 weeks behind incidence, so it could be mid-late January before such a trend becomes evident. Even if there is no effect from Thanksgiving, it would likely be 3-4 more weeks before mortality peaks.
- It could be difficult to track national-level epidemiological trends in the US over the coming weeks. Between Texas’ probable cases reported over the weekend, expected reporting delays over the Christmas and New Year’s holidays, and potential effects of holiday travel and gatherings over the coming weeks, it could potentially be mid-January or later before we have a clear picture of US C19 trends.
- The Johns Hopkins CSSE dashboard reported 18.06 million US cases and 319,827 deaths as of 10:30am EST on December 22.
2. US FDA AUTHORIZES MODERNA VACCINE
- On Friday, the US FDA issued an Emergency Use Authorization (EUA) for Moderna’s SARS-CoV-2 vaccine, the second vaccine authorized for use in the US. This development follows positive findings from FDA’s analysis as well as unanimous recommendation from the Vaccines and Related Biological Products Advisory Committee (with one abstention). The vaccine is authorized for use for adults aged 18 years or older and will be administered in 2 doses spaced one month apart. The Moderna vaccine demonstrated nearly 95% efficacy in Phase 3 clinical trials, on par with the Pfizer/BionNTech vaccine that received an EUA the previous week. Moderna is currently prepared to deliver enough doses to vaccinate 10 million individuals by the end of December. While this additional supply is exciting in and of itself, officials arranging for vaccine distribution are also no doubt relieved that the Moderna vaccine does not require the same extremely cold storage conditions that are needed for the Pfizer vaccine.
3. EU AUTHORIZES PFIZER VACCINE
- On Monday, the European Commission issued a conditional marketing authorization for the Pfizer/BioNTech SARS-CoV-2 vaccine, based in part on the recommendation of the European Medicines Agency. The vaccine is authorized for individuals aged 16 years and older. This authorization will allow for use of the vaccine within the 27 EU member states, and the first vaccines are expected to be administered on December 27. The EMA published information on its safety monitoring program, which will be implemented as vaccination efforts commence. In addition to EU countries, Switzerland’s Swissmedic also authorized the use of the Pfizer/BioNTech vaccine. The European Commission President assured the public that the vaccine will be available in all member states at once. The EU has already secured 200 million doses from Pfizer, which are scheduled to be delivered by September 2021, and it is working to purchase an additional 100 million doses.
4. UK SARS-CoV-2 VARIANT
- A new SARS-CoV-2 variant has come to prominence in the UK, and there are concerns that it has increased transmissibility compared to other variants. The new variant was originally labeled as VUI-202012/01—variant under investigation; the first VUI in December 2020— and subsequently updated to VOC-202012/01—variant of concern. Other analysis labels the variant B.1.1.7.
- The variant is characterized by at least 17 specific mutations, including 8 for the spike protein, which attaches to the ACE2 receptor and allows the virus to enter cells. Preliminary research indicates that the change could make the virus more transmissible. UK researchers identified the mutations in specimens from as far back as September based on analysis of genetic sequencing data, and the variant “circulated at very low levels…until mid-November.”
- UK health officials began investigating the new variant in November, after increasing social distancing restrictions were not having the intended effect in Kent County in southeast England. Health officials subsequently identified widespread community transmission of the variant in nearby London and Essex County.
- UK officials, including Prime Minister Johnson and Secretary of State for Health and Social Care Matt Hancock as well as officials from Public Health England and researchers from Imperial College London, indicate that the new variant could be substantially more transmissible. Notably, Dr. Susan Hopkins from Public Health England indicated that the new variant could potentially be 70% more transmissible, and Prime Minister Johnson noted that it could increase the reproductive number (R) by as much as 0.4. At this time, there is an absence of evidence that the strain results in more severe disease. Preliminary assessments suggest that the Pfizer/BioNTech vaccine will still be effective against the variant, but additional research is ongoing. The UK has issued guidance to laboratories to enable them to update existing PCR-based diagnostic tests to ensure that tests can effectively detect infection with the new variant.
- Researchers from the C19 Genomics Consortium UK (CoG-UK) published (preprint) preliminary analysis of the variant’s genome. The researchers note that this variant exhibits a large number of mutations that appeared over a very short period of time. They theorize that the variant could have, in part, evolved in a chronically infected patient; however, it is not possible to determine the exact cause at this point. Additionally, the UK government published its own investigation of the variant, conducted by Public Health England (PHE). PHE analysis indicates, among other findings, that the variant has increased in prevalence since at least the week of October 12. Dr. Chris Witty, England’s Chief Medical Officer, estimated that the variant is responsible for 60% of recent infections in London.
- This is not the first SARS-CoV-2 variant to gain widespread attention, particularly in the context of transmissibility. As we covered previously, the D614G spike protein mutation was found to have spread more efficiently in Europe and the US, and researchers determined that the mutation enabled the virus to spread more rapidly in nasal epithelial cells and the upper respiratory tract, which could make that variant more transmissible.
5. VARIANT, POLICY RESPONSE
- In response to increasing daily incidence, UK Prime Minister Boris Johnson announced that C19 restrictions would increase to Tier 4 for much of Southeast England, including London and numerous surrounding cities and counties. The enhanced restrictions prohibit households from mixing over the Christmas holiday and prohibit individuals from traveling to or from Tier 4 areas. Individuals and families in parts of the country currently in Tiers 1-3 will still be permitted to form “Christmas bubbles,” but only for December 25, Christmas Day. Previous iterations of the Christmas bubble guidance permitted the bubbles from December 23-27. In addition to restrictions on gatherings, Tier 4 will require all non-essential businesses to close. The UK also issued guidance for “clinically extremely vulnerable” individuals in Tier 4 areas, including individuals with compromised immune systems or those with severe respiratory conditions, which recommends remaining at home except for exercise and attending medical appointments.
- In addition to increased restrictions in England, numerous European countries have instituted travel restrictions for the UK, interrupting air, rail, automobile, and maritime travel between the UK and mainland Europe. In total, more than 40 countries—including many in Europe as well as Canada and India—have cancelled air travel from the UK. Reportedly, France prohibited all travel from the UK for a period of 48 hours, including freight, in order to provide time to develop appropriate measures to ensure safe transit of passengers and goods to and from the UK.
- In the US, New York Governor Andrew Cuomo coordinated with 3 airlines that offer flights between the UK and New York City in order to implement mandatory testing for passengers before departing. Governor Cuomo called on the US government to strengthen restrictions for travelers arriving from the UK in response to the emerging variant. Dr. Anthony Fauci argued that travel restrictions are not necessary at this time, and Admiral Brett Giroir, the Trump administration’s “testing czar,” indicated that the US government, including the CDC, is monitoring the situation closely and evaluating potential response options. Other experts suggest that the UK’s high volume of sequencing simply enabled it to identify the variant earlier than other countries and that the variant is likely already more widespread globally than currently evident. A similar set of mutations is reportedly emerging in South Africa, which has been identified in nearly 90% of sequenced specimens in South Africa since mid-November.
6. US VACCINATION PRIORITY GROUPS
- On Sunday, the US CDC’s Advisory Committee on Immunization Practices (ACIP) debated and voted on vaccine priority groups for Phases 1b and 1c, following the initiation of vaccination for healthcare workers and long-term care facility residents in Phase 1a. ACIP recommended that Phase 1b include adults aged 75 years and older as well as frontline essential workers. Frontline essential workers were defined as “first responders, teachers and other education workers including day care workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores”who have direct contact with the public as part of their job. Some essential workers who are able to work remotely or do not interact with the public may not be eligible under this designation. ACIP recommended that Phase 1c include adults aged 65-74 as well as individuals aged 16-64 who have high-risk medical conditions.
- The priority populations included in Phases 1b and 1c attempt to balance the committee’s goals of protecting both those who are most at risk of severe outcomes from C19 disease and those who have the highest risk of exposure in their essential work environment. The decision to designate adults aged 65-74 as lower priority as adults aged 75 and older has drawn criticism, in light of analysis showing that the 65-74 age group has similar risk of severe disease and death as adults aged 75 and older. In total, 202 million Americans could be included in the 3 tiers of Phase 1: 24 million in Phase 1a, 49 million in Phase 1b, and 129 million in Phase 1c.
- US CDC Director Dr. Robert Redfield must review and approve the ACIP recommendations before they will become official CDC guidance. State governments may draw on that guidance, but will be responsible for establishing protocols for their own vaccination efforts. Additionally, as vaccination campaigns move forward nationwide, it is likely that Phases and tiers will overlap chronologically, rather than one Phase reaching completion before beginning the next Phase, and it is possible that states will progress through the tiers at different speeds, which could pose operational, logistical, and communication challenges.
7. CALIFORNIA HOSPITAL CAPACITY
- In California, hospitals are beginning to exceed their capacity, with no signs of slowing incidence or hospitalization rates. Reports show that ICU capacity is at 0% in the Southern California region. Analysis published by The Los Angeles Times found that intensive care unit (ICU) capacity across 11 counties in Southern California, including Los Angeles and San Diego, fell to 0% on December 17. California continues to set new records in terms of C19 incidence, averaging approximately 45,000 new cases per day and reporting 62,661 new cases on Monday.
- When faced with shortages of ICU capacity, hospitals are forced to implement surge plans to increase the number of available beds. This can involve converting other beds to support ICU patients, transferring patients to other facilities, or using ICU-trained personnel from other parts of the hospital. But when every hospital is facing the same challenge, it is difficult to expand capacity enough to meet demand. St. Mary Medical Center, a hospital in Apple Valley, is currently caring for patients at double its capacity, including placing patients in hallways and parking lot triage tents. Normally, the hospital would send overflow patients to another hospital with more capacity, but no nearby hospitals have excess capacity to handle transferred patients.
- In order to combat the increasing hospitalizations and preserve hospital function, California Governor Gavin Newsom extended “stay at home” orders and ordered other enhanced social distancing measures. Approximately 98% of California’s population is currently under a 3-week “stay at home” order, which covers the entire state with the exception of the Northern California region. The California government has used ICU capacity below 15% as a metric to signal the need to impose “stay at home” orders. While many areas of California currently meet this definition, some areas of northern California are above 15% ICU capacity and therefore have been subject to more lenient policies.
8. CDC DATA REPORTING
- Last Friday, the Department of Health and Human Services (HHS) unveiled the C19 Community Profile Report, which shows the history of various key indicators at the local, state, and regional level. The report format highlights week-by-week changes, visualizations of meaningful data trends, and additional contextual information specific to the geographic area of interest. One notable benefit is standardizing state-level reporting across the country. States report data in different ways, which can make it challenging to compare states directly, and the C19 Community Profile Report presents data that have been harmonized across all states to facilitate analysis. The data are aggregated, as opposed to broken down by demographics. The report is generated and updated daily by the Data Strategy and Execution Workgroup under the supervision of the White House C19 Task Force, and the data are managed by an interagency team with members from CDC, HHS, the Assistant Secretary for Preparedness and Response, and the Indian Health Service.
9. LONG-TERM HEALTH EFFECTS
- Since the early months of the pandemic, evidence has steadily emerged about long-term C19 symptoms and syndromes following recovery from acute infection. According to the UK’s Office for National Statistics, 1 in 5 C19 patients experience symptoms for longer than 5 weeks after the initial recovery, and 1 in 10 experience symptoms for longer than 12 weeks. Now commonly referred to as “long COVID,” long-term C19 effects can manifest in a variety of ways, including organ inflammation or damage, new-onset diabetes or thyroid conditions, and cardiac conditions. Even young, previously healthy patients have experienced severe “long COVID” symptoms, such as heart failure and severe organ damage. Some doctors are recommending that athletes who had moderate-to-severe C19 be screened for heart conditions before returning to exercise as a precaution. The existing medical literature and guidance for “long COVID” patients is expanding, but more work needs to be done to better educate C19 survivors and physicians in order to more quickly and accurately recognize and respond to potentially severe “long COVID” manifestations.
10. US ECONOMIC STIMULUS
- US legislators reached an agreement on a new round of C19 economic stimulus funding. The bill, passed yesterday by both the House of Representatives and the Senate, totals nearly US$900 billion, including funding for expanded unemployment benefits (US$300 per week), US$600 direct payments to most individuals, US$284 billion in Paycheck Protection Program support for small businesses, US$25 billion for rental assistance and an extended moratorium on evictions, and US$82 billion to support schools and colleges. Several high-profile priorities for Democrats and Republicans were omitted from the C19 funding package, including support for state and local governments, suspension of student loan payments, and liability protections for businesses. The C19 economic stimulus funding is tied to a larger US government funding bill that US President Donald Trump is expected to sign in the coming days.
- C19 cases have now been reported on every continent on Earth. Reportedly, 36 individuals tested positive for SARS-CoV-2 at a Chilean research facility in Antarctica, likely among the most remote and isolated places on the planet. The individuals have been evacuated to Punta Arenas, Chile, for treatment and isolation. An additional 3 cases have been reported among the crew of a support ship, all of whom tested negative prior to getting underway en route to Antarctica. According to a tweet by The Antarctica Report, personnel at the base recently conducted their annual rotation, which could have provided an opportunity to import the virus. Notably, there were no known cases in Antarctica during the 1918 influenza pandemic.