Holiday Edition — Happy New Year!
December 30, 2020
The mutated strain of the coronavirus spreading in Britain is 56% more contagious and is likely to boost hospitalizations and deaths next year(see story below)
“I don’t believe we have the evidence on any of the vaccines to be confident that it’s going to prevent people from actually getting the infection and therefore passing it on.”Dr. Soumya Swaminathan, WHO Chief Scientist
“The virus will stay with us for the next 10 years. We need to get used to the fact that there’ll be more outbreaks.”Ugur Sahin, CEO of Germany’s BioNTech – which partnered with Pfizer to develop a C19 vaccine in less than a year
“The science is clear that more lockdowns lead to much more non-COVID morbidity and mortality. Public policy is being based on erroneous assumptions.”Dr. Michael deBoisblanc, former trauma medical director for John Muir Health in Contra Costa County in California, who was fired for expressing his opinion on lockdowns
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 & Positivity
- In South and West, C19 Hospitalizations Keep Rising
- New strain of coronavirus far more contagious and likely will cause more hospitalizations and deaths (!)
- What are the main drivers of household transmission? (!) (*)
- How much coronavirus a person carries could predict how sick they’ll get
- C19 Severity Affected by Proportion of Antibodies in Immune Response Targeting Crucial Viral Protein
- Two studies find that C19 antibodies last 8 months
- Israeli Man Dies After Receiving COVID Vaccine As 5,000+ “Health Impact Events” Reported In US
- WHO Chief Scientist Warns “No Evidence COVID Vaccine Prevents Viral Transmission” (!)
- Moderna vaccine may cause side effects for those with cosmetic facial fillers
- The drug that gives ‘instant immunity’ to coronavirus? (!)
- Existing FDA Approved Drug Shown to Prevent Lung Damage in COVID Patients (!)
- Lung Ultrasounds Could Help Predict if C19 Will Worsen
- Highly Touted Monoclonal Antibody Therapies Sit Unused in Hospitals (!)
- Common diabetes drug may trigger rare complications for C19 patients
- I’m a consultant in infectious diseases. ‘Long Covid’ is anything but a mild illness
- Small Number of Covid Patients Develop Severe Psychotic Symptoms
- A Frightening New Explanation for Silent Hypoxemia
- Secondary Bloodstream Infections Associated With Severe C19 and Worse Health Outcomes
- Could the virus be mutating in immunocompromised patients?
- Skyrocketing Suicides Were Predicted During First Wave of the C19 Pandemic – Here’s What Johns Hopkins Researchers Actually Found
- Model used to evaluate lockdowns was flawed (!)
- Hospital and case numbers in England surpass the first peak, despite lockdowns
- Are two phases of quarantine better than one?
- Twelve Times The ‘Lockdowners’ Were Wrong
N. Linked Stories
- Disposable surgical masks best for being heard clearly when speaking (*)
- With C19 Exacerbating the Threat of Superbugs, Researchers ID New Chemical Weapon
- First Global Atlas of How the Coronavirus Interacts With Human Cells
- Rechargeable N95 Mask With a Custom Fit
- Pneumolysis: High Altitude Specialists Explain C19 Lung Destruction
- 3-year-old Missouri boy had stroke after C19 diagnosis
- Doctor reportedly has severe allergic reaction to Moderna C19 vaccine
- Gross Droplet Test Shows Masks Are Highly Effective at Limiting Your Flying Spit
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A. Pandemic Headlines
(In no particular order)
- Dr. Gottlieb joins Dr. Fauci, others in warning of “grim month ahead”
- Hospitals in Los Angeles County are treating C19 patients in gift shops
- Healthcare workers have 7 times the risk of severe COVID-19
- Red states prioritize elderly and vulnerable in vaccine distribution, bucking federal guidance
- Novavax COVID vaccine enters Phase 3 trial
- A Chinese Covid-19 vaccine has proved effective, its maker said
- China is set to vaccinate millions, but without much proof that its vaccines work
- Man Behind Pfizer Vaccine Warns COVID-19 ‘Will Be With Us For The Next 10 Years’
- Scientists Scramble to Identify Culprit Behind Covid Vaccine Allergic Reactions
- UK’s faster spreading COVID strain, found in Japan, Canada and possibly US
- First case of UK COVID-19 mutation found in US
- WHO says UK study shows no differences in deaths between normal, mutant strain
- Study finds that mutual UK strain of virus far more contagious than original virus
- AstraZeneca CEO latest to reassure public vaccine will work for mutant strain
- Major Covid Vaccine Glitch Emerges: Most Europeans, Including Hospital Staff, Refuse To Take It
- World’s First COVID ‘Human Challenge’ Begins As UK Prepares To Infect 2,500 Volunteers
- Biden COVID Advisor Urges More “Genomic Surveillance” Necessary To Stop Mutant COVID Strains
- US cases decline as states see holiday-related reporting delays
- Two million children in the U.S. have tested positive
- LA County is Running “Dangerously” Low on Oxygen to Treat COVID-19
- UK to approve AstraZeneca vaccine in coming days
- Spain Plans a Registry for those who Refuse COVID Vaccine
- California extends stay-at-home orders in two regions into 2021
- NY Gov. Cuomo eyes reactivating Javits Center hospital for COVID-19 surge
- Kansas counties drop mask rules
- US Requires All UK Travelers To Test Negative For COVID, CDC Rules
- More than 186,000 Russians have died due to coronavirus, three times more than previously reported
- Putin changes mind, will now get Russia’s COVID vaccine
- Japan Issues Complete Ban On Non-Nationals Entry To Battle ‘Super COVID’ Strain
- Singapore confirms first case of UK virus strain
- US hospitalizations hit new record
- Brazil study shows China vaccine 50% effective
- India confirms 24,000+ new cases
- China confirms 17 new cases
- NY extends eviction moratorium
- Sydney residents asked to “limit mobility”
- Spain deaths top 50,000
- The Netherlands sees its highest number of excess deaths since World War II
- Finland latest to confirm presence of UK mutant strain
- Erdogan says will receive COVID vaccine Thurs
- Russia extends UK travel halt
- Indonesia imposes temporary ban on all foreign visitors
- Norway shortens traveler quarantine
- First Japanese lawmaker dies of COVID
- Beijing tightens travel curbs
- Colorado finds first confirmed case of British variant in the US
- Biden warns vaccinations falling behind, pandemic will get worse
- California extends stay-at-home order as LA outbreak worsens
- Premier League mulls 2-week shutdown after worst rash of COVID outbreaks
- Russia strikes deals to sell more vaccines to Argentina, Venezuela
- Dr. Fauci complains about lagging vaccinations in US
- Parts of Beijing locked down for first time since July
- Wuhan’s COVID-19 cases may have been 10 times higher
- Arizona sees record daily deaths
- Ireland weighs even tighter restrictions
- Netherlands outbreak slows
- Germany alarmed by threat posed by coronavirus deniers
- “Limited” vaccine doses allocated to House members
- US Troops In S. Korea First To Receive Mass Vaccination As Host Country Cases Soar
- US Senator Rubio: Elites “Tricking” Americans Into Taking Vaccine
- Cuomo Says Addicts In State-Run Rehabs Next To Receive COVID Vaccine
- CDC reports record-low positive flu tests
- Mysterious Disappearance Of Flu In San Diego Prompted Call For Audit Of COVID Records
- Coronavirus ‘long haulers’ experiencing fishy, sulfur smells
- “A Direct And Severe Violation”: Court Strikes Down Cuomo’s COVID-19 Orders On Churches, Synagogues
- How much coronavirus a person carries could predict how sick they’ll get
- WHO: Bigger Pandemic Than COVID Is Coming
- Santa The Super-Spreader, Kills 18 In Belgian Nursing Home
- 12,000 NYC Students Banned From School For Not Consenting To Random Covid Testing
- “Jab & Go!” Airline Pushes Vaccine Gimmick To Promote Summer Flights
- ‘Tis The Season For Bankruptcies, Store Closings, & Tent Cities…
- Travel Insurers Likely To Make Vaccination A Requirement, New Report Finds
- New Jersey Women Arrested For Hosting COVID Speakeasy Where Hundreds Showed Up
- UK Journalist Hounded After Pointing Out That Only Old And Sick Die From COVID
- For 55% Of Americans, 2020 Has Been “A Personal Financial Disaster”
- “It Doesn’t Look Pretty”: COVID’s Harsh Financial Reality Continues Across The U.S.
- Inventory Soars As Companies Dump Record Volume Of Office Space
- A Billion Unsold Room-Nights And “It’s Going To Get Worse” As America’s Hotel Occupancy Rate Re-Plunges
- Shark Tank’s Kevin O’Leary Warns: 100 Million Americans Have No Retirement
- Wheels Come Off For Bus Companies, Closing Down Travel Options For Poor Americans
- The “New World Of Retail” Employment Is Now Working In A Warehouse
- Consumer brands invest in the work-from-home economy
- 2020: The Year We Lost Our Common Sense, Courage, & Civil Liberties
- “People Are Fed Up”: California Out Of Excuses As Coronavirus Defies Militant Lockdowns
- You may need a ‘COVID-19 passport’ to travel or gather in 2021
- US airports set another single-day pandemic travel record
- Bulgaria uses hot dog trucks to deliver its first shipment of the vaccine
- Hundreds of British tourists flee Swiss ski resort to avoid COVID quarantine – Switzerland furious
- Mask overboard! COVID-19 fuels ocean pollution
- COVID-weary NYC diners flee out of state to eat indoors
- “I’m Not Crazy!” – This American Has Had Enough
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.
Note: Reporting during the holidays may be lower than actual numbers due to delays in reporting, which could result in higher than actual numbers in the future as the reporting catches up.
1. Cases & Tests
- Total Cases = 82,306,863
- New Cases (7 day average) = 562,705
- Since 12/22, the 7 day average of new cases has declined from 648,018 (record high) to 562,705, a decline of approx. 13.3%
- Lowest 7 day average since 11/7
US Cases & Positivity:
- Total Cases = 19,977,704
- New Cases (7 day average) = 184,221
- Percentage of New Global Cases = 32.7%
- Percentage of positive tests (7 day average) =
- Since 12/18, the 7 day average of new cases has declined from 223,902 (record high) to 184,221, a decline of approx. 17.7%
- Lowest 7 day average since 12/3
- Total Deaths = 1,795,230
- New Deaths (7 day average) = 10,260
- Since 12/22, the 7 day average of new deaths has declined from 11,677 (record high) to 10,260, a decline of approx. 12.1%
- Lowest 7 day average since 11/28
- Total Deaths = 346,579
- New Deaths (7 day average) = 2,250
- Percentage of Global New Deaths = 21.9%
- Since 12/22, the 7 day average of new deaths has declined from 2,756 (record high) to 2,250, a decline of approx. 18.4%
- Lowest 7 day average since 12/5
3. Top 5 States in Cases, Deaths, Hospitalizations, Patients in ICU & Positivity
December 29, 2020
- After reaching 12.6% on 12/27, the lowest level since 12/4/20, the US Positivity Rate climbed for the 2nd straight day to 13.5% on 12/29. We expect the rate to continue climbing following the Christmas holiday.
- Overall, only 17 states reported lower positivity rates over the last seven days (-15 states since 12/22).
- Idaho is the current hotspot state with positivity of 50.9%.
- Five states: 7-day positivity rates greater than 40%. (+5 since 12/22)
- Eight states: 7-day positivity rates greater than 30%. (-7 since 12/22)
- Eleven states: 7-day positivity rates greater than 20%. (+5 since 12/22)
- Three states: 7-day positivity rates less than 5%. (-2 since 12/22)
- In total, 47 states have 7-day positivity rates greater than 5% (+2 since 12/22)
- Hospitalizations in the US reached an all-time high of 124,686, up 5.9% since a week ago. Hospitalizations are increasing, and after trending down in prior weeks, the growth rate has increased. The growth rate on 12/22 was 4.4%.
- Twelve states have had increases of hospitalized patients of more than 10% in the past week. (+3 since 12/22)
- CA hospitalizations reached an all-time high of 21,240 (+12.0% since 12/22)
- 30 states have more than 1,000 hospitalized patients (-1 since 12/22)
- 28 states saw decreases in the number of hospitalized patients over the past week. (+2 since 12/22)
Patients in ICU Trends
- ICU Patients in the US reached an all-time high of 22,838, up 2.8% since a week ago. The number of ICU patients is increasing, and after trending down in prior weeks, the growth rate has increased. The growth rate on 12/22 was 1.5%.
- Six states have seen the number of ICU patients increase by more than 10% since a week ago (+1 since 12/22)
- 30 states have more than 100 patients in ICU, (-unch since 12/22)
- 25 states saw decreases in the number of ICU patients over the past week (+2 since 12/22).
4. In South and West, C19 Hospitalizations Keep Rising
- The South accounts for nearly 40% of the 121,235 Americans currently hospitalized, according to data from the Covid Tracking Project. Coronavirus-related hospitalizations in the region have tripled since the beginning of October, rising to 46,240 on Monday from over 14,800 on Oct. 1. Over that same time period, the number of people hospitalized out West has increased more than fivefold, to 32,111.
- Holiday gatherings are expected to throw more fuel on the fire.
- Arkansas hit a record number of hospitalizations last week, according to the state’s health department, while the number of hospitalizations in North Carolina increased by over 70% in a month, according to an analysis of data from the state’s Department of Health and Human Services. In Texas, the second most populous state, hospitalizations have doubled since late October. Intensive-care units are more than 80% full in both North Carolina and Texas, according to data from CovidActNow, a tracking system run by a group of public-health and crisis experts.
- “It’s certainly possible that within a week we can run out of ICU beds,” Mark Escott, interim medical director and health authority for Austin Public Health, said Monday.
- Dr. Escott said the issue isn’t about hospital space, but rather the limited number of qualified staff to handle more patients.
- Dr. Roh said Christmas and New Year’s would likely lead to record-high numbers in all categories: cases, deaths and hospitalizations.
- Some areas of the U.S. appear to be getting a respite from climbing hospitalizations. Data from the Covid Tracking Project shows hospitalizations in the Northeast, which had been steadily climbing, hovering around 20,000 since Dec. 16. In the Midwest, that figure has been drifting downward since the beginning of December.
C. New Scientific Findings & Research
1. New strain of coronavirus far more contagious and likely will cause more hospitalizations and deaths
- A mutated coronavirus strain spreading in Britain is on average 56% more contagious than the original version, scientists have warned in a study, urging a fast vaccine rollout to help prevent more deaths.
- The new variant, which emerged in southeast England in November and is spreading fast, is likely to boost hospitalizations and deaths from COVID next year, according to the study published Wednesday by the Centre for Mathematical Modelling of Infectious Diseases at the London School of Hygiene and Tropical Medicine.
- Researchers, focusing on the English south east, east and London, said it was still uncertain whether the mutated strain was more or less deadly than its predecessor.
- “Nevertheless, the increase in transmissibility is likely to lead to a large increase in incidence, with C19 hospitalizations and deaths projected to reach higher levels in 2021 than were observed in 2020, even if regional tiered restrictions implemented before 19 December are maintained,” they said.
- The authors warned that a national lockdown imposed in England in November was unlikely to prevent an increase of infections “unless primary schools, secondary schools, and universities are also closed”.
- Any easing of control measures, meanwhile, would likely prompt “a large resurgence of the virus”.
2. What are the main drivers of household transmission?
- In this meta-analysis of 54 studies, the estimated overall household secondary attack rate was 16.6%, which was higher than observed secondary attack rates for SARS and MERS.
- Controlling for differences across studies, secondary attack rates were higher
(i) in households from symptomatic index cases than asymptomatic index cases,
(ii) to adult contacts than to child contacts,
(iii) to spouses than to other family contacts, and
(iv) in households with 1 other contact than households with 2 or more other contacts.
- The findings of this study suggest that given that individuals with suspected or confirmed infections are being referred to isolate at home, households will continue to be a significant venue for transmission of the coronavirus.
3. How much coronavirus a person carries could predict how sick they’ll get
- Dozens of research papers published over the past few months have found that people whose bodies were teeming with the coronavirus more often became seriously ill and were more likely to die, compared with those who carried much less virus and were more likely to emerge relatively unscathed. Now that information could help hospitals.
- The results suggest that knowing the so-called viral load — the amount of virus in the body — could help doctors distinguish those who may need an oxygen check just once a day, for example, from those who need to be monitored more closely, said Dr. Daniel Griffin, an infectious disease physician at Columbia University in New York.
- Tracking viral loads “can actually help us stratify risk,” Dr. Griffin said. The idea is not new: Managing viral load has long formed the basis of care for people with H.I.V., for example, and for tamping down transmission of that virus.
- Little effort has been made to track viral loads in C19 patients. This month, however, the FSA said clinical labs might report not just whether a person is infected with the coronavirus, but also an estimate of how much virus is in their body.
- This is not a change in policy. Labs could have reported this information all along, according to two senior F.D.A. officials who spoke on condition of anonymity because they were not authorized to speak publicly about the matter.
- Still, the news came as a welcome surprise to some experts, who have for months pushed labs to record this information.
- “This is a very important move by the F.D.A.,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. “I think it’s a step in the right direction to making the most use of one of the only pieces of data we have for many positive individuals.”
Source: New York Times Coronavirus Updates
4. C19 Severity Affected by Proportion of Antibodies in Immune Response Targeting Crucial Viral Protein
- C19 antibodies preferentially target a different part of the virus in mild cases of C19 than they do in severe cases, and wane significantly within several months of infection, according to a new study by researchers at Stanford Medicine.
- The findings identify new links between the course of the disease and a patient’s immune response. They also raise concerns about whether people can be re-infected, whether antibody tests to detect prior infection may underestimate the breadth of the pandemic and whether vaccinations may need to be repeated at regular intervals to maintain a protective immune response.
- “This is one of the most comprehensive studies to date of the antibody immune response to the coronavirus (SARS-CoV-2) in people across the entire spectrum of disease severity, from asymptomatic to fatal,” said Scott Boyd, MD, PhD, associate professor of pathology. “We assessed multiple time points and sample types, and also analyzed levels of viral RNA in patient nasopharyngeal swabs and blood samples. It’s one of the first big-picture looks at this illness.”
- The study found that people with severe C19 have low proportions of antibodies targeting the spike protein used by the virus to enter human cells compared with the number of antibodies targeting proteins of the virus’s inner shell.
Virus binds to ACE2 receptor
- SARS-CoV-2 binds to human cells via a structure on its surface called the spike protein. This protein binds to a receptor on human cells called ACE2. The binding allows the virus to enter and infect the cell. Once inside, the virus sheds its outer coat to reveal an inner shell encasing its genetic material. Soon, the virus co-opts the cell’s protein-making machinery to churn out more viral particles, which are then released to infect other cells.
- Antibodies that recognize and bind to the spike protein block its ability to bind to ACE2, preventing the virus from infecting the cells, whereas antibodies that recognize other viral components are unlikely to prevent viral spread. Current vaccine candidates use portions of the spike protein to stimulate an immune response.
- Boyd and his colleagues analyzed the levels of three types of antibodies — IgG, IgM and IgA — and the proportions that targeted the viral spike protein or the virus’s inner shell as the disease progressed and patients either recovered or grew sicker. They also measured the levels of viral genetic material in nasopharyngeal samples and blood from the patients. Finally, they assessed the effectiveness of the antibodies in preventing the spike protein from binding to ACE2 in a laboratory dish.
- “Although previous studies have assessed the overall antibody response to infection, we compared the viral proteins targeted by these antibodies,” Boyd said. “We found that the severity of the illness correlates with the ratio of antibodies recognizing domains of the spike protein compared with other non-protective viral targets. Those people with mild illness tended to have a higher proportion of anti-spike antibodies, and those who died from their disease had more antibodies that recognized other parts of the virus.”
Substantial variability in immune response
- The researchers caution, however, that although the study identified trends among a group of patients, there is still substantial variability in the immune response mounted by individual patients, particularly those with severe disease.
- “Antibody responses are not likely to be the sole determinant of someone’s outcome,” Boyd said. “Among people with severe disease, some die and some recover. Some of these patients mount a vigorous immune response, and others have a more moderate response. So, there are a lot of other things going on. There are also other branches of the immune system involved. It’s important to note that our results identify correlations but don’t prove causation.”
- As in other studies, the researchers found that people with asymptomatic and mild illness had lower levels of antibodies overall than did those with severe disease. After recovery, the levels of IgM and IgA decreased steadily to low or undetectable levels in most patients over a period of about one to four months after symptom onset or estimated infection date, and IgG levels dropped significantly.
- “This is quite consistent with what has been seen with other coronaviruses that regularly circulate in our communities to cause the common cold,” Boyd said. “It’s not uncommon for someone to get re-infected within a year or sometimes sooner. It remains to be seen whether the immune response to SARS-CoV-2 vaccination is stronger, or persists longer, than that caused by natural infection. It’s quite possible it could be better. But there are a lot of questions that still need to be answered.”
- Boyd is a co-chair of the National Cancer Institute’s SeroNet Serological Sciences Network, one of the nation’s largest coordinated research efforts to study the immune response to C19. He is the principal investigator of Center of Excellence in SeroNet at Stanford, which is tackling critical questions about the mechanisms and duration of immunity to SARS-CoV-2.
- “For example, if someone has already been infected, should they get the vaccine? If so, how should they be prioritized?” Boyd said. “How can we adapt seroprevalence studies in vaccinated populations? How will immunity from vaccination differ from that caused by natural infection? And how long might a vaccine be protective? These are all very interesting, important questions.”
5. Two studies find that C19 antibodies last 8 months
- Two studies demonstrate that C19 immune responses last as long as 8 months, although the authors focus on different reasons.
- The first study, published in Science Immunology, followed a small cohort of Australians from day 4 to day 242 after infection. All patients demonstrated the presence of memory B cells—immune cells that “remember” viral proteins and can trigger rapid production of antibodies when re-exposed to the virus—as long as 8 months after initial infection.
- The second study investigated antibody responses in 58 confirmed C19 patients in South Korea 8 months after asymptomatic or mild SARS-CoV-2 infection, finding high rates of serum antibodies. These results, published in Emerging Infectious Diseases, are contradictory to both the first study’s antibody data and previous research that showed antibodies waning after 20 days, but the authors suggest that variations in immunoassay test characteristics and manufacturing may be responsible for the difference.
- To read the Australian study, click here.
- To read the Korean study, click here.
5. The Science behind how C19 Affects the Brain
- New research could help explain why thousands of C19 survivors are facing debilitating neurological symptoms months after initially getting sick.
- The WSJ breaks down the science behind how the coronavirus affects the brain, and what this could mean for long-haul patients.
- Watch The Science Behind How the Coronavirus Affects the Brain.
D. Vaccines & Testing
1. Israeli Man Dies After Receiving COVID Vaccine As 5,000+ “Health Impact Events” Reported In US
- Following a handful of reports, including one involving a priest from the Philadelphia area who volunteered as a trial participant, about patients who received a vaccine dying in the weeks following the second dose, one man in Israel has died 2 hours after receiving the vaccine.
- According to reports in the Israeli press, a 75 year old man from Beit Shean died Monday morning from a heart attack about 2 hours after receiving the vaccine.
- The patient has received the vaccine at 0830 in the morning, then waited for the customary time at the health clinic before he was released to his home after reportedly feeling well. Sometime after that, the man lost consciousness, then was pronounced dead.
- The Israeli Health Ministry released a statement on the death: “A 75-year-old man from the north of the country suffering from active heart disease and malignant disease, who has undergone a number of heart attacks, was vaccinated this morning against the coronavirus and died at home shortly after the procedure.”
- An investigation into the man’s death has been ordered by the Director General of the Ministry of Health, Prof. Hezi Levy, who has appointed a case investigation committee to be led by the head of the MoH’s Safety and Quality Division.
- News of the man’s death follows reports that 5,000 out of the first 215,000 recipients of the vaccine in the US reported some kind of “adverse health impact event”, which could be anything that seriously limits an individual’s ability to function and/or complete daily tasks. These events should be severe enough to require medical attention, but exact details are unclear.
2. WHO Chief Scientist Warns “No Evidence COVID Vaccine Prevents Viral Transmission”
- Once again, the WHO has stepped in to offer some confusing comments about the coronavirus vaccine, warning that there is “no evidence to be confident shots prevent transmission” and that people who receive the vaccine should continue wearing masks and following all social distancing and travel guidelines.
- The comments were made by WHO chief scientist Soumya Swaminathan during what appears to have been a virtual press conference held Monday.
- “At the moment, I don’t believe we have the evidence on any of the vaccines, to be confident that it’s going to prevent people from getting the infection and passing it on,”
- Of course, a close look at the research released by Pfizer and Moderna shows the studies haven’t actually tested whether the vaccines actually prevent transmission of the virus; the goal of the trials was to see whether vaccinated patients presented with COVID symptoms at a rate that was substantially less frequent than individuals who hadn’t been vaccinated. That’s pretty much it. Though the data might hint at lowering transmission rates, that’s still tbd, apparently.
- The doctor went on to explain that there’s no evidence to suggest that those who have been vaccinated wouldn’t be a risk if they traveled to a foreign country, say Australia, with relatively low COVID rates.
- At this point, it might be helpful for the WHO to produce some kind of clarification that either offers substantially more context to explain this remark.
- But we suspect they won’t.
- Why? Well, perhaps because that context might undermine certain government officials’ insistence that there’s absolutely no reason to question the efficacy, and potential side effects (both long-term, and short) tied to the new C19 vaccines.
3. Moderna vaccine may cause side effects for those with cosmetic facial fillers
- People with cosmetic facial fillers could experience swelling and inflammation with one of the coronavirus vaccines, the FDA advisory committee noted.
- According to the committee, several trial participants with fillers have already experienced side effects. A California-based dermatologist said the reaction was immunological, ABC7 reported on Thursday.
- “So it makes sense that you would see an immune response in certain areas where they see some substance that is not a naturally occurring substance in your body.”
- “In these cases the patients all had swelling and inflammation in the area that was given the filler,” Chi said.
- “A couple of the patients had cheek filler six months prior to their vaccine and one patient had lip filler done two days after the vaccine. All were treated with steroids and anti-histamines and all of their reactions resolved.”
E. Improved & Potential Treatments
1. The drug that gives ‘instant immunity’ to coronavirus?
- A new antibody treatment with the potential to give people instant immunity after being exposed to C19.
- It could be given as an emergency treatment to hospital inpatients, care home residents and university students to help reduce the spread of the virus.
- People who live with someone who has caught COVID or been exposed to them could be injected with the drug to stop them becoming infected, even if they have not had a coronavirus vaccine.
- British scientists from the University College London Hospitals NHS (UCLH) have already injected ten people with the drug as part of the new trial called Storm Chaser, with an aim to trial the new treatment on 1,125 people globally. The participants received two consecutive doses of the drug.
- They hope the treatment would provide protection from C19 for between six months to a year.
- Scientists from the UCLH have also begun a second clinical trial named Provent, to examine the use of the antibody for people who may not benefit from vaccines, such as patients with a compromised immune system, or those at increased risk of C19 infection due to factors such as age and existing conditions.
- The antibody, known as AZD7442, has been developed by pharmaceutical company AstraZeneca.
- UCLH virologist Dr Catherine Houlihan, who is leading the Storm Chaser trial, said: ‘We know that this antibody combination can neutralize the virus, so we hope to find that giving this treatment via injection can lead to immediate protection against the development of C19 in people who have been exposed – when it would be too late to offer a vaccine.’
2. Existing FDA Approved Drug Shown to Prevent Lung Damage in COVID Patients
Under the microscope.
- 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 SARS-CoV-2 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. Lung Ultrasounds Could Help Predict if C19 Will Worsen
Using 14 points in the lungs, researchers looked for abnormalities and assigned each spot a score out of 3 based on its severity. Adding up all the points, they found the total lung ultrasound score was higher for those who had a worsening outcome of C19.
- For some, C19 can result in severe pneumonia or even death, while others remain purely asymptomatic. A diagnostic tool could help physicians predict if a patient with C19 will worsen.
- Researchers at the Policlinico San Matteo, in Pavia, Italy, have developed a method using ultrasound imaging to score a patient’s lung health, which is indicative of their outcome. The ability to predict when a patient might worsen can help physicians be better prepared for caring for patients.
- Umberto Sabatini’s presentation, “Is lung ultrasound a predictor of worsening in C19 patients?” was part of the 179th Meeting of the Acoustical Society of America.
- The researchers tested the tool on 52 patients who had been admitted to San Matteo Hospital between March 15 and April 29. They administered lung ultrasounds to the patients on arrival and before discharge to get a peek into the state of their lungs. Using 14 points in the lungs, the researchers looked for abnormalities, such as pleural irregularities, and assigned each spot a score out of 3 based on its severity.
- Adding up all the points, the researchers found the total lung ultrasound score was higher for those who had a worsening outcome of C19, such as needing supplementary oxygen, admission to intensive care, or death. Patients with at least three spots scoring 3 or with high overall scores were more than six times more likely to have a worsening outcome than other patients.
- From their results, the researchers proposed a graph called a nomogram that can help physicians compute the probability a patient will worsen based on their lung ultrasound score.
- The diagnostic will help physicians rapidly evaluate and predict how a patient will worsen due to C19. The test is also quick to perform. A scan of each spot takes 10 seconds, making the whole exam last only 15 to 20 minutes.
4. Highly Touted Monoclonal Antibody Therapies Sit Unused in Hospitals
- Doses of monoclonal antibodies—C19 therapies authorized for emergency use last month—are sitting unused in hospital pharmacies, even as cases surge across the country.
- Hospitals say the rollout of the therapies has been stunted by a lukewarm response from infectious-disease specialists, who say they want more clinical trial data before using them on a regular basis. Medical centers are also grappling with a lack of awareness and interest from both the primary-care doctors who would normally prescribe the drug and patients who are offered it. And some places are dealing with a shortage of space and staff to administer the therapies.
- When monoclonal antibody therapies from Eli Lilly and Regeneron Pharmaceuticals Inc. were approved for emergency use in November, health agencies were worried there wouldn’t be enough supply to meet demand. Now, health-care providers are administering just 20% of the doses they receive each week.
- Eli Lilly’s bamlanivimab and Regeneron’s casirivimab-and-imdevimab cocktail target the SARS-CoV-2 spike protein and are injected intravenously. Early trial data of the therapies found they could reduce hospitalization or emergency visits among high-risk patients.
- Demand from doctors in the Northwestern system has been relatively low and many patients aren’t all that interested, he said. Although several hospitals have set up spaces for the infusions and have made arrangements for staff to deliver them, some physicians just aren’t comfortable with prescribing the therapy because it is so new and it is hard to discern which patients will benefit from it, Dr. Ison said.
- The FDA recommends the drugs for use in patients with mild or moderate C19 who are at high risk of progressing to severe symptoms or hospitalization. The FDA has a specific definition of what high risk means, which includes people who are 65 years of age or older, or people who are considered obese, with a body-mass index of 35 or more. The therapies are supposed to be administered as soon as possible after a patient receives a positive test result, within 10 days of the onset of symptoms.
- Some patients who meet the high-risk criteria have mild or moderate symptoms that are improving, so they aren’t interested in coming in for an infusion, Dr. Rubin noted. Others aren’t able to spare the two hours required for administration and monitoring. Still others are told of the benefits of the drug according to trial data and decide the benefit is too dubious.
- A recently published interim analysis of Regeneron’s cocktail found that it could reduce viral load in some patients, and an interim analysis of bamlanivimab found that five out of 309 patients who received the therapy required a visit to the emergency department or hospitalization, compared with nine out of 143 of the placebo population.
- The NIH has said there are insufficient data to recommend for or against the use of the Eli Lilly and Regeneron treatments. Neither should be considered the standard of care for treatment of patients with C19, NIH said. The IDSA also recommends against the routine use of bamlanivimab.
- The need for more data doesn’t mean people shouldn’t be treated now, said Rich O’Neal, Regeneron’s vice president of market access. “It’s going to be really challenging if we continue to wait too long for information and data to continue to decrease the impact of the crisis.”
- Administering bamlanivimab is time-intensive, she said, and staff have been urgently needed to care for rising numbers of C19 patients.
- In contrast, health-care system Northwell Health in New York is moving ahead with its monoclonal-antibody rollout, setting up five sites where it can administer the intravenous drugs. Some are located in tents that were used as overflow units during the C19 surge in New York City in the spring, said Warren Licht, vice president of ambulatory operations at Northwell who has been leading the effort. One is located in the emergency room of Northwell’s Cohen Children’s Medical Center, he said.
- States are beginning to expand the availability of infusions outside of the hospital, including in nursing homes and outpatient infusion clinics, and offering to administer the drugs in patients’ homes, said Janet Woodcock, head of drug evaluation and research at the FDA who is on leave to work with Operation Warp Speed.
- In the future, doctors’ offices could also start offering to provide the treatment, which may be particularly helpful in rural areas where there aren’t many nearby health facilities, she said.
F. Concerns & Unknowns
1. Common diabetes drug may trigger rare complications for C19 patients
- Diabetes is a known risk factor for morbidity and mortality related to C19. In diabetes patients, rare but severe complications, like the potentially lethal condition diabetic ketoacidosis (DKA), can arise when illness or certain conditions prevent cells from receiving enough glucose to fuel their functioning.
- An uptick in a particular type of DKA called euDKA at Brigham and Women’s Hospital during the C19 pandemic has led researchers to hypothesize that diabetes patients on glucose-lowering drugs may be at increased risk for euDKA when they contract C19. The observational case series was published in The American Association of Clinical Endocrinologists Clinical Case Reports.
- EuDKA is a subset of the diabetes complication known as DKA, which occurs when the body’s cells fail to absorb enough glucose and compensate by metabolizing fats instead, creating a build-up of acids called ketones. EuDKA differs from DKA in that it is characterized by lower blood sugar levels, making it more difficult to diagnose.
- The FDA has warned that the risk of DKA and euDKA may be increased for individuals who use a popular class of diabetes drugs called sodium-glucose cotransporter 2 inhibitors (SGLT2i), which function by releasing excess glucose in the urine. Underlying nearly all euDKA cases is a state of starvation that can be triggered by illnesses that cause vomiting, diarrhea, and loss of appetite and can be compounded by the diuretic effect of SGLT2i drugs.
- “We have the background knowledge of recognizing that SGLT2 inhibitors can cause DKA and euDKA,” said corresponding author Naomi Fisher of the Division of Endocrinology, Diabetes, and Hypertension. “Our report reinforces that if patients are ill or have loss of appetite or are fasting, they should pause their medication and not resume until they are well and eating properly.”
- The authors of the study also suspect that C19 may particularly exacerbate euDKA risks. When the virus infects a patient, it binds to cells on the pancreas that produce insulin and may exert a toxic effect on them. Studies of the earlier SARS-CoV-1 virus found that many infected patients had increased blood sugar. “It’s been posited through other models that the virus may be preferentially destroying insulin-producing cells,” Fisher said.
- Moreover, the maladaptive inflammatory response associated with C19, which produces high levels of immune-response-related proteins called cytokines, may increase DKA risks. “These high levels of cytokines are also seen in DKA, so these inflammatory pathways may be interacting,” Fisher said. “It’s speculative, but there may be some synergy between them.”
- Though these findings are observational, rather than the results of a randomized controlled trial, similar reports of heightened euDKA incidence have emerged from other institutions. The authors encourage patients and physicians to halt SGLT2i-use in the event of illness, which is already standard practice for the most common diabetes drug, metformin.
- “Patients should continue to monitor their blood sugar, and if the illness is prolonged or if their blood sugar is very high, they can speak to their doctor about other forms of therapy,” Fisher said. “But often it’s a very short course off of the drug. We’re hopeful that with widespread patient and physician education, we will not see another cluster of euDKA cases amid the next surge in C19 infections.”
2. I’m a consultant in infectious diseases. ‘Long Covid’ is anything but a mild illness
By Joanna Herman, a consultant in infectious diseases in London and teaches at the London School of Hygiene & Tropical Medicine
- With the excitement of the Covid vaccine’s arrival, it may be easy to forget and ignore those of us with “long Covid”, who are struggling to reclaim our previous, pre-viral lives and continue to live with debilitating symptoms. Data from a King’s College London study in September suggested as many as 60,000 people in the UK could be affected, but the latest statistics from the Office for National Statistics suggest it could be much higher.
- I was acutely ill in March, though – like many people with long Covid – mine was defined as a “mild” case not requiring admission to hospital. Nine months on, I am seriously debilitated, with crashing post-exertional fatigue, often associated with chest pains. On bad days, my brain feels like it doesn’t want to function, even a conversation can be too much. I have no risk factors, I’m in my 50s, and have always been fit, but remain too unwell to work – ironically as a consultant in infectious diseases. Watching the pandemic unfold from the sidelines when I should have been working in the thick of it has only added to the frustration of my protracted illness.
- My acute symptoms were over within 12 days, and I presumed I’d be back at work the following week. How wrong I was. In the following weeks I developed dramatic hair loss (similar to that post pregnancy) and continued to feel fatigued, usually falling asleep in the afternoon. I tried to steadily increase the amount I was exercising – but suddenly in mid-June I started to experience severe post-exertional fatigue. It could happen on a short walk or it could be while cooking dinner. It was completely unpredictable. When I felt really terrible, I would get chest pains, which I’d not had during my initial illness, and my body seems to need intense rest – and a lot of it. Graded exercise, an approach that has been used to manage patients with other post-viral fatigue, wasn’t working; in fact it seemed to be detrimental and could leave me floored for days. The one thing I realised early on was that pacing was vital.
- In May, with no resource to turn to, I set up a long Covid yoga group (I am also a yoga teacher) for others I knew who were similarly affected. I focused on particular exercises to help them relearn how to access their lungs and breathe again.
- I am yet to be seen by a physiotherapist, but who’d have thought the perching stool sourced by an occupational therapist for my elderly mother would become a necessity for me to cook dinner and brush my teeth?
- It may be enough for some that they are simply listened to, and it is understood that they are not fabricating their symptoms. We also need to cease classifying all cases that were not admitted to hospital as “mild”. Those experiencing long Covid have anything but a mild disease.
3. Small Number of Covid Patients Develop Severe Psychotic Symptoms
- Doctors around the world are reporting a small number of Covid patients who have never experienced mental health problems are developing severe psychotic symptoms weeks after contracting the coronavirus.
- In interviews and scientific articles, doctors described:
- A 36-year-old nursing home employee in North Carolina who became so paranoid that she believed her three children would be kidnapped and, to save them, tried to pass them through a fast-food restaurant’s drive-through window.
- A 30-year-old construction worker in New York City who became so delusional that he imagined his cousin was going to murder him, and, to protect himself, he tried to strangle his cousin in bed.
- A 55-year-old woman in Britain had hallucinations of monkeys and a lion and became convinced a family member had been replaced by an impostor.
- Beyond individual reports, a British study of neurological or psychiatric complications found that 10 people had “new-onset psychosis.” Another study identified 10 such patients in one hospital in Spain. And in Covid-related social media groups, medical professionals discuss seeing patients with similar symptoms in the Midwest, Great Plains and elsewhere.
- Medical experts say they expect that such extreme psychiatric dysfunction will affect only a small proportion of patients. But the cases are considered examples of another way the C19 disease process can affect mental health and brain function.
- Although the coronavirus was initially thought primarily to cause respiratory distress, there is now ample evidence of many other symptoms, including neurological, cognitive and psychological effects, that could emerge even in patients who didn’t develop serious lung, heart or circulatory problems.
- Experts increasingly believe brain-related effects may be linked to the body’s immune system response to the coronavirus and possibly to vascular problems or surges of inflammation caused by the disease process.
- “Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage,” said Dr. Vilma Gabbay, a co-director of the Psychiatry Research Institute at Montefiore Einstein in the Bronx.
- Brain scans, spinal fluid analyses and other tests didn’t find any brain infection, said Dr. Gabbay, whose hospital has treated two patients with post-Covid psychosis: a 49-year-old man who heard voices and believed he was the devil and a 34-year-old woman who began carrying a knife, disrobing in front of strangers and putting hand sanitizer in her food.
- Physically, most of these patients didn’t get very sick from C19, reports indicate. The patients that Dr. Goueli treated experienced no respiratory problems, but they did have subtle neurological symptoms like hand tingling, vertigo, headaches or diminished smell. Then, two weeks to several months later, he said, they “develop this profound psychosis, which is really dangerous and scary to all of the people around them.”
- Also striking is that most patients have been in their 30s, 40s and 50s. “It’s very rare for you to develop this type of psychosis in this age range,” Dr. Goueli said, since such symptoms more typically accompany schizophrenia in young people or dementia in older patients.
- Persistent immune activation is also a leading explanation for brain fog and memory problems bedeviling many Covid survivors, and Emily Severance, a schizophrenia expert at Johns Hopkins, said post-Covid cognitive and psychiatric effects might result from “something similar happening in the brain.”
- It may hinge on which brain region the immune response affects, Dr. Yolken said, adding, “some people have neurological symptoms, some people psychiatric and many people have a combination.”
- Experts don’t know whether genetic makeup or perhaps an undetected predisposition for psychiatric illness put some people at greater risk. Dr. Brian Kincaid, medical director of psychiatric emergency department services at Duke, said the North Carolina woman once had a skin reaction to another virus, which might suggest her immune system responds zealously to viral infections.
4. A Frightening New Explanation for Silent Hypoxemia
- One of the physiopathological characteristics of C19 that has most baffled the scientific and medical community is what is known as “silent hypoxemia” or “happy hypoxia.” Patients suffering this phenomenon, the causes of which are still unknown, have severe pneumonia with markedly decreased arterial blood oxygen levels (known as hypoxemia). However, they do not report dyspnea (subjective feeling of shortness of breath) or increased breathing rates, which are usually characteristic symptoms of people with hypoxemia from pneumonia or any other cause.
- Patients with “silent hypoxemia” often suffer a sudden imbalance, reaching a critical state that can be fatal. Normally, individuals (healthy or sick) with hypoxemia report a feeling of shortness of breath and a higher breathing rate, thus increasing the body’s uptake of oxygen. This reflex mechanism depends on organs known as carotid bodies. These small organs, located on either side of the neck next to the carotid artery, detect the drop in blood oxygen and send signals to the brain to stimulate the respiratory center.
- A group of researchers from the Seville Institute of Biomedicine – IBiS/University Hospitals Virgen del Rocío y Macarena/CSIC/University of Seville, led by Dr. Javier Villadiego, Dr. Juan José Toledo-Aral and Dr. José López-Barneo, specialists in the physiopathological study of the carotid body, have suggested in the journal Function, that “silent hypoxemia” in C19 cases could be caused by carotid bodies being infected by the coronavirus (SARS-CoV-2).
- This hypothesis, which has attracted the interest of the scientific community for its novelty and possible therapeutic significance, comes from experiments that have revealed a high presence of the enzyme ECA2, the protein the coronavirus uses to infect human cells, in the carotid body. In patients with C19, the coronavirus circulates in the blood. Therefore, researchers suggest that infection of carotid bodies by SARS-CoV-2 in the early stages of the disease could alter its ability to detect blood oxygen levels, resulting in an inability to “notice” the drop in oxygen in the arteries.
- If this hypothesis, which is currently being tested in new experimental models, is confirmed, this would justify the use of activators of the carotid body independent of the oxygen sensing mechanism as respiratory stimulants in patients with C19.
5. Secondary Bloodstream Infections Associated With Severe C19 and Worse Health Outcomes
- People with severe C19 and a secondary blood infection were significantly sicker upon hospital admission, had longer hospital stays, and poorer outcomes, according to a Rutgers study.
- The study, published in the journal Clinical Infectious Diseases, is the first to assess the microbiology, risk factors, and outcomes in hospitalized patients with severe C19 and secondary bloodstream infections.
- The researchers looked at 375 patients diagnosed with severe C19 from March to May 2020. Of that group, they sampled 128 cases that had secondary bloodstream infections, 92% of which were bacterial infections.
- “These patients were more likely to have altered mental status, lower percent oxygen saturation, septic shock and to be admitted to the intensive care unit compared to those without bloodstream infections,” said co-lead author Pinki Bhatt, an assistant professor at Rutgers Robert Wood Johnson Medical School’s Division of Allergy, Immunology and Infectious Disease.
- The researchers also found that patients who needed more advanced types of supplemental oxygen upon hospital admission had higher odds of secondary bloodstream infections.
- The in-hospital mortality rate for these patients was more than 50%, but the study reported these deaths were associated with, not caused by, the condition.
- According to the study, infections in C19 patients may have contributed to the severity of illness or it may reflect other underlying physiological and immunological complications of C19.
- The study showed that the most common cause of secondary blood stream infections was unknown or not determined followed by central-line associated bloodstream infection as the most common presumed source.
- The study found that 80% of all the patients in the study received antimicrobials at some point during hospitalization, including those who did not have bloodstream infections. “This likely reflects clinicians’ inclination to administer antimicrobials given the limited information on the natural course of this novel disease,” Bhatt said. She noted that further studies are needed to better understand when to suspect and treat empirically for secondary bloodstream infections in severe C19.
6. Could the virus be mutating in immunocompromised patients?
- The emergence of the UK variant comes at a pivotal moment in the course of the pandemic: Public health officials are just now trying to decide who should be prioritized to receive the first C19 vaccines approved for distribution in the US. Reports that so many mutations have arisen all at once in the new coronavirus—and that these mutations could have epidemiological consequences—add an important, but so far unappreciated, wrinkle to these deliberations.
- The pathogen likely has more opportunity to develop mutations in immunocompromised individuals than in other carriers. As a result, to guard against the emergence of new and more dangerous variants of the coronavirus (SARS-CoV-2), we should consider moving immunocompromised people—who are themselves at higher risk of dying from C19—closer to the front of the vaccination line.
- Since early in the pandemic, doctors have suspected that people who are immunocompromised are particularly prone to just that kind of extended illness. Most people with C19 are thought to stop shedding infectious virus after around 10 days from the time they were infected, but numerous outlier cases have been identified. These tend to involve people with weakened immune systems.
- A 71-year-old woman who became infected with the virus at a Washington nursing home in February, and who had a kind of cancer that limited her antibody production, ended up harboring the coronavirus for at least 105 days and being infectious for at least 70.
- Could the virus mutate rapidly under such conditions? It’s certainly pretty stable over the course of a normal, shorter bout of Covid. A study posted online, which has not yet been formally reviewed and published in a journal, found very little viral mutation occurring in a general sampling of more than 1,000 people with the disease.
- At the same time, studies that have closely followed immunocompromised individuals have been less reassuring. Michigan researchers followed a 60-year-old man with cancer who was on medication to suppress his immune system’s B cells, which normally produce antibodies. Over the four months that they tracked him, the researchers found that SARS-CoV-2’s spike protein, which is the principal target of Covid vaccines, remained unchanged. However they did observe other mutations that popped up elsewhere in the virus, unrelated to the spike protein.
- Meanwhile, scientists who studied the immunocompromised woman from the Washington nursing home “observed marked within-host genomic evolution of SARS-CoV-2 with continuous turnover of dominant viral variants.” In other words, the virus was definitely evolving variants—including those with changes to the spike protein sequence—during the course of her infection.
- Another group, writing in The New England Journal of Medicine earlier this month, detailed the trajectory of the virus in a 45-year-old man with an autoimmune disorder for which he was receiving immunosuppressants. In this case they found there was “accelerated” evolution of the virus in the individual, and many of the mutations were in the spike protein. Most immunocompromised people clear SARS-CoV-2 infections without major complications, they wrote, but “this case highlights the potential for persistent infection and accelerated viral evolution associated with an immunocompromised state.”
- The same phenomenon has been observed in other conditions where the immune system is hampered. HIV attacks immune function, which allows it to evolve at an astoundingly high rate, making it even harder for the body to keep producing antibodies that bind and neutralize the virus. By the same mechanism, HIV infections allow other viruses in the individual to last longer and morph. Herpes simplex virus can evolve unusual drug-resistance in AIDS patients, for example.
- Evidence for the links between immunocompromised individuals and persistent SARS-CoV-2 infections, and between persistent infections and viral evolution, is compelling enough to be considered in discussions about vaccine priority.
- On Sunday, a panel from the CDC recommended that immunocompromised people be placed in “Phase 1c”—the third wave—of vaccine rollout. That means they’re due to receive the injections at the same time as those with cancer, coronary heart disease, or obesity, among other conditions. That decision was meant to address the particular risks posed by C19 to people with immune system issues, but it left out the possibility that vaccinating these individuals could help prevent the development of new SARS-CoV-2 variants that would make this pandemic even worse than it already is. For that reason, even though there are only a handful of directly relevant case reports, public health officials should consult with virologists about whether it might be wise to move immunocompromised people into the earlier Phase 1b group.
G. The Road Back?
1. The Slow Birth of Covid Realism
- Italy, last seen trying to prosecute government scientists for failing to forecast an earthquake, is now pioneering the use of criminal prosecutors to examine the country’s C19 response. Italy as a country ranks low on every index of efficient, accountable governments and effective legal systems. Criminalizing policy disappointments and managerial errors is a symptom of this failure, not its cure.
- Still, the particulars of the indictment being sought by relatives of early victims will ring bells for many Americans: the shipping of infected persons to nursing homes, failure to test patients who couldn’t be connected to China, failing to order lockdowns sooner, worrying about the potential impact on businesses.
- The U.S. remains in a similar phase of denial, with every failure related to testing, mask promotion, etc., spun as a missed chance to extinguish Covid altogether.
- When the reality principle intrudes, here’s suspecting the greatest failure will be the one we are least willing to acknowledge or even understand: It began with our strange reticence to acknowledge the reality of mild (and, as it turned out, asymptomatic) Covid.
- Any alert person knew from the get-go that, amid the exigencies of Wuhan, Chinese doctors were failing to detect mild cases, and that thousands of these cases were likely being exported to the world. Whatever the horrors in Wuhan’s hospitals, they happened not because C19 is an extravagantly deadly respiratory infection. They happened because a flu-like disease had been allowed to spread unrecognized for months in an urban population unprotected by any prior immunity or vaccine.
- Yet it instantly became a U.S. journalistic trope to accuse anyone mentioning the flu of “downplaying” the new disease—downplaying anything being the worst sin in journalism.
- Inexplicably, authorities, including the World Health Organization, insisted on promoting a fatality rate they knew was exaggerated because of the failure to account for mild infections. To this day, U.S. officialdom and the media dwell on a nearly meaningless “confirmed” case count, knowing full well that doing so is innumerate and unstatistical. It’s a mystery and my only explanation is that they are afraid to stop because it portrays the disease as more deadly than it is (supporting the case for urgency) and also less prevalent than it is (supporting the case that it can somehow be contained).
- A parade of conclusive contrary indicators is not so much unreported as simply unintegrated into the picture sold to the American public. To give the latest example, a Johns Hopkins study finds that in late spring in Maryland, when “confirmed” cases were less than 1% of the state’s population, 10% of autopsies showed evidence of Covid infection—a rate that applied equally to auto-accident victims and people who died of natural causes.
- As the pandemic has unfolded, only deeper has become media revilement of anyone who pointed out that the death risk was being exaggerated, that the lockdowns were not sustainable due to the costs they imposed on people who were at low risk, that our efforts would be better invested in shielding those at high risk of a bad medical outcome.
- The hostility is even greater now that these views have been adopted implicitly and unavowedly almost everywhere in obedience to the reality principle. The lockdowns were unsustainable. Low-risk people were unwilling to maintain energetic social distancing through the summer and fall. Vaccines are being rolled out now expressly to protect the most vulnerable first.
- For all their talk that no cost is too great to save a life, the actual behavior of our elected officials has made clear that the one thing they believe their careers can’t tolerate is a breakdown in hospital care for Covid patients and others.
- I’ve informally adopted Brown University’s Ashish Jha as my metric for realism’s gradual unfurling. In his latest media appearances, he invariably now stresses unseen spread, the impracticality of the lockdown solution, a role for herd immunity in supplementing vaccination to end the pandemic—even if he also occasionally utters imprecations against these opinion pages for making the same arguments months ago.
- When it’s over, countries like Germany and Sweden, which have hardly been spared Covid’s ravages, I suspect will be seen as the least-bad models. And for reasons American leaders will be loath to admit: They treated their people like adults. They leveled with their citizens about Covid’s inevitable spread. They skimped on the baby talk, virtue signaling, or any resort (especially prevalent in the U.S.) to trying to mislead a supposedly infantile public for its own good.
- These countries worked no public-health miracles nor any miracles of the self-isolating sort that appealed in the antipodes. Where they succeeded was in eliciting the intelligence of their people, their intelligent adaptations, to make the Covid trial as bearable as possible.
H. Back to School!?
1. How C19 makes teaching reading harder
- The coronavirus pandemic has brought a host of new challenges to teaching the foundational skills of reading and writing. With masks, social distancing and millions of young children nationwide learning online at home—either several days a week or full-time—teachers say they have to find new ways to tackle literacy instruction, so students don’t miss a crucial window in kindergarten through second grade.
- They can no longer rely on read-alouds with kids answering questions as they sit together on a rug. Teachers can’t roam around a room, peering over the shoulders of children trying to write, or put their hands on students’ hands to help them hold a pencil properly.
- Physical constraints come on top of lost class time due to school shutdowns last March, higher absenteeism, and—for many students—waiting months for electronic devices or Wi-Fi for remote lessons. Research has found school disruptions led to slower academic progress nationwide, especially among disadvantaged students, and worry that achievement gaps will widen.
- The share of first-graders nationwide in need of intensive intervention in reading hit 40% this fall, up from 27% last year, according to Amplify Education Inc., a company that provides assessments for more than a million students across the country, mostly in cities. About 35% of second-graders scored significantly below benchmarks, up from 29% last year, it said.
- Ms. Nikci says this year has been her toughest in a decade with first-graders, and the stakes are high. In the early years, students learn to read, and after third grade they need to be able to read to learn other subjects. Studies show students who can’t read by third grade can fall behind at an accelerating clip and are at high risk of eventually dropping out. “First grade is serious business,” she said.
- Her students arrived this fall with a broader range of skills than usual. Some can read books on grade level or above, but others struggle to recognize letters. Masks make it hard for them to hear how words break down into small segments, a key part of learning to read. It is difficult for her to hear them too.
- “I can’t say, ‘Pull your mask down for a second and tell me,’” she said. Some teachers use clear masks for lip-reading but others say they don’t help enough.
- Ms. Nikci tries to give children different exercises according to their needs and encourages independent reading. But a child can’t simply pick a new book anymore: School rules say every book has to be cleaned and quarantined for a few days before another student touches it.
- Some teachers and administrators cite some upsides from this year. They say they got to know some families better, became more tech-savvy and discovered useful digital materials. Children who stay home with a cold can join lessons instead of missing out. And in-person classes are small, which helps them progress after learning loss.
- Read more at the WSJ by clicking the link here.
I. Innovation & Technology
1. 99.9% of Coronavirus dead in 30 seconds with UV LEDs
- Ultraviolet radiation is a common method of killing bacteria and viruses. Now, researchers from Tel Aviv University have proven that the novel coronavirus, SARS-CoV-2, can be killed efficiently, quickly and cheaply using ultraviolet (UV) light-emitting diodes (UV-LEDs) at specific frequencies.
- “We discovered that it is quite simple to kill the coronavirus using LED bulbs that radiate ultraviolet light,” said Prof. Hadas Mamane, head of the Environmental Engineering Program at Tel Aviv University’s School of Mechanical Engineering, who led the study with Prof. Yoram Gerchman and Dr. Michal Mandelboim.
- She said that the UV-LED bulbs require less than half a minute to destroy more than 99.9% of the coronaviruses.
- “We know, for example, that medical staff do not have time to manually disinfect, say, computer keyboards and other surfaces in hospitals – and the result is infection and quarantine,” said Mamane. “The disinfection systems based on LED bulbs, however, can be installed in the ventilation system and air conditioner, for example, and sterilize the air sucked in and then emitted into the room.”
- Mamane believes that this technology is the future, adding that she expects that by 2025, it will be cost effective enough to become mainstream.
- The study is the first of its kind in the world. An article about it was published earlier this month in the Journal of Photochemistry and Photobiology B: Biology.
J. Projections & Our (Possible) Future
1. Skyrocketing Suicides Were Predicted During First Wave of the C19 Pandemic – Here’s What Johns Hopkins Researchers Actually Found
- In a study that looked at suicide deaths during 2020’s first wave of the C19 pandemic in Maryland, Johns Hopkins Medicine researchers found that, contrary to general predictions of suicides skyrocketing, suicides in the overall population actually dropped, relative to previous years. However, the researchers also discovered that suicide deaths increased dramatically among Black Marylanders during the same period.
- The researchers say that their findings, published on December 16, 2020, in JAMA Psychiatry, highlight the importance of timely identification of high-risk groups and vulnerable populations to reduce suicide numbers.
- Black Americans have been disproportionately affected by the C19 pandemic, underlining long-standing health and social inequities. “Looking at suicide trends by race emphasizes the economic divide we’re seeing in America and unfortunately, that divide also is a racial one,” says Paul Nestadt, M.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
- According to Nestadt, the increase in suicides among Black Marylanders — during the period when C19 deaths peaked and the state was locked down — could be reflective of a socioeconomic divide. In comparison, he adds, the unexpected decrease in suicides in white Marylanders could be due to greater capacity for remote work or benefit from economic relief efforts.
- “I think we’re all in this C19 storm together, but not everyone is having the same experience,” says Nestadt. “Folks who are in places of economic privilege have been able to continue working more or less remotely, to take time off for themselves, reconnect with family, start a new hobby and so on, but it’s a very different story for people working in service industry jobs.”
- In their study, the researchers looked at suicide deaths from Jan. 1 through July 7, 2020. The data were divided into three periods: a pre-C19 period 1 (Jan. 1 to March 4, 2020); a “progressive closure” (lockdown) period 2 (March 5 to May 7, 2020); and a “progressive reopening” period 3 (May 8 to July 7, 2020). Daily suicide mortality was divided by race and compared with the same periods, from 2017 through 2019.
- During period 1, daily suicide mortality did not differ from the same period in 2017 through 2019 for either race, and, in period 3, the rates did not differ for Black residents compared with previous years. However, period 2 daily suicide deaths among Blacks increased by 94% and decreased 45% among whites, compared with the same period in 2017 through2019.
- “The implications of our findings are more far-reaching than just suicidology,” says Nestadt. “It should help policymakers recognize the importance of things like economic relief and increasing access to equal care, so that there’s an end to such disproportionate deaths.”
- Nestadt says further research is needed to characterize these trends. As continuing pandemic restrictions drive public health priorities, he says, policy interventions and targeted resource allocation are needed to mitigate disparities affecting Black Americans.
1. Model used to evaluate lockdowns was flawed
- In a recent study, researchers from Imperial College London developed a model to assess the effect of different measures used to curb the spread of the coronavirus. However, the model had fundamental shortcomings and cannot be used to draw the published conclusions, claim Swedish researchers from Lund University, and other institutions, in the journal Nature.
- WATCH: Three reasons why mathematical models failed to predict the spread of the coronavirus – https://www.youtube.com/watch?v=nwT8_CyIcSI
- The results from Imperial indicated that it was almost exclusively the complete societal lockdown that suppressed the wave of infections in Europe during spring.
- The study estimated the effects of different measures such as social distancing, self-isolating, closing schools, banning public events and the lockdown itself.
- “As the measures were introduced at roughly the same time over a few weeks in March, the mortality data used simply does not contain enough information to differentiate their individual effects. We have demonstrated this by conducting a mathematical analysis. Using this as a basis, we then ran simulations using Imperial College’s original code to illustrate how the model’s sensitivity leads to unreliable results,” explains Kristian Soltesz, associate professor in automatic control at Lund University and first author of the article.
- The group’s interest in the Imperial College model was roused by the fact that it explained almost all of the reduction in transmission during the spring via lockdowns in ten of the eleven countries modelled. The exception was Sweden, which never introduced a lockdown.
- “In Sweden the model offered an entirely different measure as an explanation to the reduction – a measure that appeared almost ineffective in the other countries. It seemed almost too good to be true that an effective lockdown was introduced in every country except one, while another measure appeared to be unusually effective in this country”, notes Soltesz.
- Soltesz is careful to point out that it is entirely plausible that individual measures had an effect, but that the model could not be used to determine how effective they were.
- “The various interventions do not appear to work in isolation from one another, but are often dependent upon each other. A change in behavior as a result of one intervention influences the effect of other interventions. How much and in what way is harder to know, and requires different skills and collaboration”, says Anna Jöud, associate professor in epidemiology at Lund University and co-author of the study.
- Analyses of models from Imperial College and others highlight the importance of epidemiological models being reviewed, according to the authors.
- “There is a major focus in the debate on sources of data and their reliability, but an almost total lack of systematic review of the sensitivity of different models in terms of parameters and data. This is just as important, especially when governments across the globe are using dynamic models as a basis for decisions”, Soltesz and Jöud point out.
- The first step is to carry out a correct analysis of the model’s sensitivities. If they pose too great a problem then more reliable data is needed, often combined with a less complex model structure.
- “With a lot at stake, it is wise to be humble when faced with fundamental limitations. Dynamic models are usable as long as they take into account the uncertainty of the assumptions on which they are based and the data they are led by. If this is not the case, the results are on a par with assumptions or guesses“, concludes Soltesz.
2. Hospital and case numbers in England surpass the first peak, despite lockdowns
- Nearly half of England is under the nation’s strictest lockdown measures, and people have been ordered to stay at home, but the coronavirus is still spreading at an alarming rate. Hospitals are treating more patients than at any time during the pandemic, and there is a growing debate about allowing tens of thousands of students to return to classrooms after the holiday break.
- The nation’s scientists have said that a more contagious variant of the virus is driving the rise in cases and, having already imposed severe restrictions on more than 48 million people, it remains unclear what other tools the government has at its disposal to get the outbreak under control.
- There were 53,135 new lab-confirmed cases reported on Tuesday, the highest figure yet on a single day. The National Health Service said there were now over 20,000 people in the hospital there, more than at the peak of the pandemic in April.
- With the government scheduled to meet to evaluate the current restrictions on Wednesday, Prime Minister Boris Johnson is under pressure to impose another national lockdown and shift students — especially older ones in colleges and secondary schools, who may be more easily infected by the new virus variant — to remote learning.
- The government said that it would rely on mass testing to keep the virus from spreading in schools, with military help. Some 1,500 soldiers are being dedicated to providing schools with the “guidance, materials and funding they need to offer rapid testing to their staff and students from the start of term,” according to the education secretary, Gavin Williamson.
- But two teachers’ unions have said that staff has not been given adequate time to set up mass testing and the country’s board of scientific advisers, known as SAGE, has recommended against allowing classrooms to reopen, according to British media reports.
- Even as the country’s health workers find themselves under growing pressure to treat the influx of patients, they are also being asked to speed up the largest mass vaccination program in the nation’s history.
- Around 200,000 people are getting their first shot of the Pfizer-BioNTech vaccine every week. Ursula von der Leyen, the European Commission’s president, wrote on Twitter on Tuesday that the European Union would take an additional 100 million doses of that vaccine, bringing the total to 300 million doses.
- With the approval of a vaccine from AstraZeneca and the University of Oxford expected in coming days, the number of doses available will expand drastically. The AstraZeneca vaccine, which comes without the stringent temperature requirements of Pfizer’s, should also be easier to distribute.
- There is no evidence that the vaccines are any less effective against the variant of the virus spreading in Britain, and they remain the best chance for the country to break the spread of the current wave of infections. [Note: There is also no evidence that the new vaccines will be effective against the variant strain of the virus.]
Source: New York Times Coronavirus Updates
3. Are two phases of quarantine better than one?
- New research into this question shows that the second wave of an epidemic is very different if a population has a homogenous distribution of contacts, compared to the scenario of subpopulations with diverse number of contacts.
- The research, by American authors from Oakland University, Novi High School, and California Polytechnic State University, used a simulation approach to model the progress of an epidemic in a network where the connectivity of each individual changed over time, modelling the effects of political decisions made concerning various degrees of quarantine. It was published on December 23 in Europhysics Letters.
- The authors stated: “Recently, several authors incorporated quarantine into C19 modeling. However, these models were not network-based. In addition, they did not address the question of the optimal strategy for easing the quarantine in order to minimize the net number of infected individuals – one of the central questions in the present paper.”
- The benefits of a network-based model are that it more accurately accounts for a peaked distribution of individual disease durations, which is a problem for continuum models; also, it does not require the assumption of an equal number of contacts for each individual, so it more accurately models the underlying microscopic structure of the social network.
- According to the authors, if a population has a homogeneous distribution of the number of contacts, “the total number of infected people at the end of the epidemic is the same as if no lockdown had been decreed (saturation of the health system aside),” whereas in the case of diverse frequency of contacts, the overall number of infected individuals can be significantly smaller.
- The reason for this effect is simple. After the individuals with a large number of contacts (high-degree nodes) have acquired immunity, they prevent the propagation of the epidemic through them, thus, slowing-down the spread of the epidemic through the network. Therefore, the optimal timing to allow the low-degree nodes to increase connections (by lifting the lockdown) would be after the high-degree nodes have become immune; this will minimize the net number of infected individuals over the course of the epidemic.
- The results suggest an optimal degree-based procedure for lifting the quarantine: “high degrees go first. In practice, when the state lifts the strict quarantine (or moves from one phase of quarantine to the next phase), there is always a choice. One can open smaller stores (where cashiers are high-degree nodes) or/and one can allow gatherings (which typically consist of low-degree nodes). The model suggests that the smaller stores (high degree nodes) need to be opened first: this way we can save many individuals (mostly low-degree nodes) from being infected“.
- The authors continue: “This has two important consequences: first, it stresses the relevance of adopting lockdown measures to stop the first outbreak of an epidemic, and second, it shows that second and further waves may be milder than expected.”
- The results are counterintuitive, as the controversy in the media about the relevance of adopting lockdown measures reveals. This paper points to the importance of a feature that is usually overlooked in the analysis of how epidemics spread: how the heterogeneity of people’s behaviors affects their ability to protect themselves from contagion.
4. Twelve Times The ‘Lockdowners’ Were Wrong
- The errors number in the thousands, so please consider the following little more than a first draft, a mere guide to what will surely be unearthed in the coming months and years. We trusted these people with our lives and liberties and here is what they did with that trust.
1. Anthony Fauci says lockdowns are not possible in the United States (January 24)
- When asked about the mass quarantine containment efforts underway in Wuhan, China back in January, Fauci dismissed the prospect of lockdowns ever coming to the United States:
- “That’s something that I don’t think we could possibly do in the United States, I can’t imagine shutting down New York or Los Angeles, but the judgement on the part of the Chinese health authorities is that given the fact that it’s spreading throughout the provinces… it’s their judgement that this is something that in fact is going to help in containing it. Whether or not it does or does not is really open to question because historically when you shut things down it doesn’t have a major effect.”
- Less than two months later, 43 of 50 US states were under lockdown – a policy advocated by Fauci himself.
2. US government and WHO officials advise against mask use (February and March)
- When mask sales spiked due to widespread individual adoption in the early weeks of the pandemic, numerous US government and WHO officials took to the airwaves to describe masks as ineffective and discourage their use.
- Surgeon General Jerome Adams tweeted against masks on February 29. Anthony Fauci publicly discouraged mask use in a nationally broadcast 60 Minutes interview on March 7. At a March 30 World Health Organization briefing its Director-General supported mask use in medical settings but dissuaded the same in the general public.
- By mid-summer, all had reversed course and encouraged mask-wearing in the general public as an essential tool for halting the pandemic. Fauci essentially conceded that he lied to the public in order to prevent a shortage on masks, whereas other health officials did an about-face on the scientific claims around masking.
- While mainstream epidemiology literature stressed the ambiguous nature of evidence surrounding masks as recently as 2019, these scientists were suddenly certain that masks were something of a magic bullet for Covid. It turns out that both positions are likely wrong. Masks appear to have marginal effects at diminishing spread, especially in highly infectious settings and around the vulnerable. But their effectiveness at combating Covid has also been grossly exaggerated, as illustrated by the fact that mask adoption reached near-universal levels in the US by the summer with little discernible effect on the course of the pandemic.
3. Anthony Fauci’s decimal error in estimating Covid’s fatality rates (March 11)
- Fauci testified before Congress in early March where he was asked to estimate the severity of the disease in comparison to influenza. His testimony that Covid was “10 times more lethal than the seasonal flu” stoked widespread alarm and provided a major impetus for the decision to go into lockdown.
- The problem, as Ronald Brown documented in an epidemiology journal article, is that Fauci based his estimates on a conflation of the Infection Fatality Rate (IFR) and Case Fatality Rate (CFR) for influenza, leading him to exaggerate the comparative danger of Covid by an order of magnitude. Fauci’s error – which he further compounded in a late February article for the New England Journal of Medicine – helped to convince Congress of the need for drastic lockdown measures, while also spreading panic in the media and general public. As of this writing Fauci has not acknowledged the magnitude of his error, nor has the journal corrected his article.
4. “Two weeks to flatten the curve” (March 16)
- The lockdowners settled on a catchy slogan in mid-March to justify their unprecedented shuttering of economic and social life around the globe: two weeks to flatten the curve. The White House Covid task force aggressively promoted this line, as did the news media and much of the epidemiology profession. The logic behind the slogan came from the ubiquitous graph showing (1) a steep caseload that would overwhelm our hospital system, or (2) a mitigated alternative that would spread the caseload out over several weeks, making it manageable.
- To get to graph #2, society would need to buckle up for two weeks of shelter-in-place orders until the capacity issue could be managed. Indeed, we were told that if we did not accept this solution the hospital system would enter into catastrophic failure in only 10 days, as former DHS pandemic adviser Tom Bossert claimed in a widely-circulated interview and Washington Post column on March 11.
- Two weeks came and went, then the rationale on which they were sold to the public shifted. Hospitals were no longer on the verge of being overwhelmed – indeed most hospitals nationwide remained well under capacity, with only a tiny number of exceptions in the worst-hit neighborhoods of New York City.
- A US Navy hospital ship sent to relieve New York departed a month later after serving only 182 patients, and a pop-up hospital in the city’s Javits Convention Center sat mostly empty. But the lockdowns remained in place, as did the emergency orders justifying them. Two weeks became a month, which became two months, which became almost a year. We were no longer “flattening the curve” – a strategy premised on saving the hospital system from a threat than never manifested – but instead refocused on using lockdowns as a general suppression strategy against the disease itself. In short, the epidemiology profession sold us a bill of goods.
5. Neil Ferguson predicts a “best case” US scenario of 1.1 million deaths (March 20)
- The name Neil Ferguson, the lead modeler and chief spokesman for Imperial College London’s pandemic response team, has become synonymous with lockdown alarmism for good reason. Ferguson has a long track record of making grossly exaggerated predictions of catastrophic death tolls for almost every single disease that comes along, and urging aggressive policy responses to the same including lockdowns.
- Covid was no different, and Ferguson assumed center stage when he released a highly influential model of the virus’s death forecasts for the US and UK. Ferguson appeared with UK Prime Minister Boris Johnson on March 16 to announce the shift toward lockdowns (with no small irony, he was coming down with Covid himself at the time and may have been the patient zero of a super-spreader event that ran through Downing Street and infected Johnson himself).
- Across the Atlantic, Anthony Fauci and Deborah Birx cited Ferguson’s model as a direct justification for locking down the US. There was a problem though: Ferguson had a bad habit of dramatically hyping his own predictions to political leaders and the press. The Imperial College paper modeled a broad range of scenarios including death tolls that ranged from tens of thousands to over 2 million, but Ferguson’s public statements only stressed the latter – even though the paper itself conceded that such an extreme “worst case” scenario was highly unrealistic. A telling example came on March 20th when the New York Times’s Nicholas Kristof contacted the Imperial College modeler to ask about the most likely scenario for the United States. As Kristof related to his readers, “I asked Ferguson for his best case. “About 1.1 million deaths,” he said.”
6. Researchers in Sweden use the Imperial College model to predict 95,000 deaths (April 10)
- After Neil Ferguson’s shocking death toll predictions for the US and UK captivated policymaker attention and drove both governments into lockdown, researchers in other countries began adapting the Imperial College model to their own circumstances. Usually, these models sought to reaffirm the decisions of each country to lock down. The government of Sweden, however, had decided to buck the trend, setting the stage for a natural experiment to test the Imperial model’s performance.
- In early April a team of researchers at Uppsala University adapted the Imperial model to Sweden’s population and demographics and ran its projections. Their result? If Sweden stayed the course and did not lock down, it could expect a catastrophic 96,000 deaths by early summer. The authors of the study recommended going into immediate lockdown, but since Sweden lagged behind Europe in adopting such measures they also predicted that this “best case” option would reduce deaths to “only” 30,000.
- By early June when the 96,000 prediction was supposed to come true, Sweden had recorded 4,600 deaths. Six months later, Sweden has about 8,000 deaths – a severe pandemic to be sure, but an order of magnitude smaller than what the modelers predicted. Facing embarrassment from these results, Ferguson and Imperial College attempted to distance themselves from the Swedish adaptation of their model in early May. Yet the Uppsala team’s projections closely matched Imperial’s own UK and US predictions when scaled to reflect their population sizes. In short, the Imperial model catastrophically failed one of the few clear natural experiment tests of its predictive ability.
7. Scientists suggest that ocean spray spreads Covid (April 2)
- In the second week of the lockdowns several newspapers in California promoted a bizarre theory: Covid could spread by ocean spray (although the paper later walked back the headline-grabbing claim, it is outlined here in the Los Angeles Times). According to this theory – initially promoted by a group of biologists who study bacterial infection connected to storm runoff – the Covid virus washed down storm gutters and into the ocean, where the ocean breeze would kick it up into the air and infect people on the nearby beaches. As silly as this theory now sounds, it helped to inform California’s initially draconian enforcement of lockdowns on its public beaches.
- The same week that this modern-day miasmic drift theory appeared, police in Malibu even arrested a lone paddleboarder for going into the ocean during the lockdown – all while citing the possibility that the ocean breeze carried Covid with it.
8. Neil Ferguson predicts catastrophic death tolls in US states that reopen (May 24)
- Fresh off of their exaggerated predictions from March, the Imperial College team led by Neil Ferguson doubled down on alarmist modeling. As several US states started to reopen in late April and May, Ferguson and his colleagues published a new model predicting another catastrophic wave of deaths by the mid-summer. Their model focused on 5 states with both moderate and severe outbreaks during the first wave. If they reopened, according to the Imperial team’s model, New York could face up to 3,000 deaths per day by July.
- Florida could hit as high as 4,000, and California could hit 5,000 daily deaths. Keeping in mind that these projections were for each state alone, they exceed the daily death toll peaks for the entire country in both the fall and spring. Showing just how bad the Imperial model was, the actual death toll by mid-July in several of the examined states even fell below the lower confidence boundary of its projected count. While Covid remains a threat in all 5 states, the post-reopening explosion of deaths predicted by Imperial College and used to argue for keeping the lockdowns in place never happened.
9. Anthony Fauci credits lockdowns for beating the virus in Europe (July 31)
- In late July Anthony Fauci offered additional testimony to Congress. His message credited Europe’s heavy lockdowns with defeating the virus, whereas he blamed the United States for reopening too early and for insufficient aggressiveness in the initial lockdowns. As Fauci stated at the time, “If you look at what happened in Europe, when they shut down or locked down or went to shelter in place — however you want to describe it — they really did it to the tune of about 95% plus of the country did that.”
- The message was clear: the United States should have followed Europe, but failed to do so and got a summer wave of Covid instead. Fauci’s entire argument however was based on a string of falsehoods and errors.
- Mobility data from the US clearly showed that most Americans were staying home during the spring outbreak, with a recorded decline that matched Germany, the Netherlands, and several other European countries. Contrary to Fauci’s claim, the US was actually slower than most of Europe to reopen. Furthermore, his praise of Europe collapsed in the early fall when almost all of the lockdown countries in Europe experienced severe second waves – just like the locked down regions of the United States.
10. New Zealand and Australia declare themselves Covid-free (August-present)
- New Zealand and Australia have thus far weathered the pandemic with extremely low case counts, leading many epidemiologists and journalists to conflate these results with evidence of their successful and replicable mitigation policies. In reality, New Zealand and Australia opted for the medieval ‘Prince Prospero’ strategy of attempting to wall themselves from the world until the pandemic passes – an approach that is highly dependent on their unique geographies.
- As island nations with comparatively lower international travel than North America and Europe, both countries shut down their borders before the as-of-yet undetected virus became widespread and have remained closed ever since. It’s a costly strategy in terms of its economic impact and personal displacement, but it kept the virus out – mostly.
- The problem with New Zealand and Australia’s Prince Prospero strategy is that it’s inherently fragile. All it takes to throw it into chaos is for the virus to slip past the border – including by accident or human error. Then heavy-handed lockdowns ensue, imposed with maximum disruption at the spur of the moment in a frantic attempt to contain the breach.
- The most famous example happened on August 9 when New Zealand’s Prime Minister Jacinda Ardern declared that New Zealand had reached 100 days of being Covid-free. Then just two days later a breach happened, sending Auckland into heavy lockdown. It’s a pattern that has repeated itself every few weeks in both countries.
- In early December, we saw a similar flurry of stories from Australia announcing that the country had beaten Covid. Two weeks later, another breach occurred in the suburbs around Sydney, prompting a regional lockdown. There have been embarrassing missteps as well. In November the entire state of South Australia went into heavy lockdown over a single misreported case of Covid that was mistakenly attributed to a pizza purchase that did not exist. While both countries continue to celebrate their low fatality rates, they’ve also incurred some of the harshest and most disruptive restrictions in the world – all the result of premature declarations of being “Covid-free” followed by an unexpected breach and another frantic lockdown.
11. “Renewed lockdowns are just a strawman” (October)
- In early October a group of scientists met at AIER where they drafted and signed the Great Barrington Declaration, a statement calling attention to the severe social and economic harms of lockdowns and urging the world to adopt alternative strategies for ensuring the protection of the most vulnerable. Although the statement quickly gathered tens of thousands of co-signers from health science and medical professionals, it also left the lockdown supporters incensed. They responded not by scientific debate over the merits of their policies, but with a vilification campaign.
- They answered by flooding the petition with hoax signatures and juvenile name-calling, and by peddling wildly false conspiracy theories about AIER’s funding (the primary instigator of both tactics, ironically, was a UK blogger known for promoting 9/11 Truther conspiracies). But the lockdowners also adopted another narrative: they began to deny that lockdowns were even on the table.
- Nobody was considering bringing back the lockdowns from the spring, they insisted. Arguing against the politically unpopular shelter-in-place orders in the fall only served the purpose of undermining public support for narrower and more temperate restrictions. The Great Barrington authors, we were told, were arguing with a “strawman” from the past.
- Over the next several weeks in October a dozen or more prominent epidemiologists, public health experts, and journalists peddled the “lockdowns are a strawman” line. The “strawman” claim saw promotion in top outlets including the New York Times, and in an op-ed by two principle co-signers of the John Snow Memorandum, a competing petition that lockdown supporters drafted as a response to the Great Barrington Declaration.
- The message was clear: the GBD was sounding a false alarm against policies from the past that the lockdowners “reluctantly” supported in the spring as an emergency measure but had no intention of reviving. By early November, the “strawman” of renewed lockdowns became a reality in dozens of countries across the globe – often cheered on by the very same people who used the “strawman” canard in October.
- Several US states followed suit including California, which imposed severe restrictions on private gatherings up to and including meeting your own family for Thanksgiving and Christmas. And a few weeks after that, some of the very same epidemiologists who used the “strawman” line in October revised their own positions after the fact. They started claiming they had supported a second lockdown all along, and began blaming the GBD for impeding their efforts to impose them at an earlier date. In short, the entire “lockdowns are a strawman” narrative was false. And it now appears that more than a few of the scientists who used it were actively lying about their own intentions in October.
12. Anthony Fauci touts New York as a model for Covid containment (June-December)
- By all indicators, New York state has suffered one of the worst coronavirus outbreaks in the world. Its year-end mortality rate of almost 1,900 deaths per million residents exceeds every single country in the world. The state famously bungled its nursing home response when Governor Andrew Cuomo forced these facilities to readmit Covid-positive patients as a way to relieve strains on hospitals. The policy backfired as most hospitals never reached capacity, but the readmissions introduced the virus into vulnerable nursing home populations resulting in widespread fatalities (to this day New York intentionally undercounts nursing home fatalities by excluding residents who are moved to a hospital from its reported numbers, further obscuring the true toll of Cuomo’s order).
- New York has also fared poorly during the fall “second wave” despite reimposing harsh restrictions and regional lockdown measures. By mid-December, its death rate shot far above the mostly-open state of Florida, which has the closest comparable population size to New York. All things considered, New York’s weathering of the pandemic is an exemplar of what not to do.
- Cuomo’s policies not only failed to contain the virus – they likely made it far more deadly to vulnerable populations. Enter Anthony Fauci, who has been asked multiple times in the press what a model Covid response policy would look like. He gave his first answer on July 20th: “We know that, when you do it properly, you bring down those cases. We have done it. We have done it in New York.”
- Fauci was operating under the assumption that New York, despite its bad run in the spring, had successfully brought the pandemic under control through its aggressive lockdowns and slow reopening. One might think that the fall rebound in New York, despite locking down again, would call this conclusion into question. Not so much for Dr. Fauci, who told the Wall Street Journal on December 8: “New York got hit really badly in the beginning” but they did “a really good job of keeping things down, and still, their level is low compared to the rest of the country.”
L. Practical Tips & Other Useful Information
1. Using a Humidifier Might Reduce Your Chances of Contracting C19
- “When cold outdoor air with little moisture is heated indoors, the air’s relative humidity drops to about 20%,” Akiko Iwasaki, an immunobiologist at Yale University, said in a statement.
- “This dry air provides a clear pathway for airborne viruses.”
- Relative humidity (RH) is a measure of how saturated the air is with water vapour. So in a room with 40 percent relative humidity, the air holds 40 percent of the total amount of moisture it could hold in total.
- That’s why Linsey Marr, an aerosol researcher from Virginia Tech University who studies coronavirus transmission, recommends using a humidifier in your home.
- “You could invest in a humidifier and set it to keep the humidity above 40 percent but below 60 percent in the wintertime,” she told Business Insider. “The virus doesn’t survive as well under these conditions, and your immune response works better than when the air is dry.”
Humidity and temperature affect how the coronavirus spreads
- Research shows that the coronavirus spreads more easily when temperatures and humidity are low.
- That’s because coronavirus particles in drier, less humid air absorb less moisture and therefore remain aloft longer. That makes them more likely to be inhaled and infect someone new.
- What’s more, like the flu, the coronavirus is ensconced in a fatty layer called a lipid envelope that helps it survive the journey from one person to the next. This sheath dries out more quickly in higher temperatures.
- This fall, Iwasaki helped launch a petition calling on the World Health Organisation to set guidelines for indoor humidity levels. It calls 40-60 percent RH “a sweet spot,” since indoor air in that range “allows our nose and throat to maintain robust immune responses” against many viruses.
- Our immune systems’ built-in protections – such as the mucus in our noses – work better when the air is wetter.
- “Be very careful to avoid getting above 65 percent, because that can promote mold growth,” Marr said. The resulting mold can trigger asthma, and many people are allergic to mold spores.
M. Johns Hopkins COVID-19 Update
December 29, 2020
1. Last 6 Months In Review
- In late December 2019, the initial reports emerged about 27 cases of an unidentified viral pneumonia in Wuhan, China. At that time, nobody imagined that 12 months later, the WHO would report 80 million cases and 1.8 million deaths worldwide.
- In July, we took a look back at the first 6 months of COVID-19 and generated a timeline and overview to highlight some of the major events, benchmarks, and themes. At times over the past year, it has felt like we faced the same issues day after day without moving forward, and in some instances, we seemed to face the same challenges repeatedly.
- However, we as a global community have made a lot of progress in critical areas over the past 6 months, including numerous advancements in testing and vaccines. We are far from the end of this global disaster, and there is considerable disruption, pain, and work remaining; however, it now feels like there is finally a light at the end of the tunnel.
- Below, we have compiled a timeline of select events from the past 6 months of the pandemic:
July 7: Brazilian President Jair Bolsonaro tests positive for SARS-CoV-2
July 20: The WHO reports 600,000 cumulative deaths globally
July 22: China initiates vaccination of essential workers under an emergency authorization
July 23: The WHO reports 15 million cumulative cases globally
July 24: The US summer surge peaks at 67,187 new cases per day
July 28: The US surpasses Brazil as #1 globally in terms of daily mortality
July 29: The US surpasses 150,000 cumulative deaths
August 6: India surpasses the US as #1 globally in terms of daily incidence
August 7: 700,000 global deaths
August 9: The US surpasses 5 million cumulative cases
August 9: New Zealand reports 100 consecutive days without a documented case of domestic transmission
August 12: 20 million global cases
August 15: South America’s first surge peaks at 75,932 new cases per day
August 22: Brazil surpasses the US to regain #1 globally in terms of daily mortality
August 23: 800,000 global deaths
August 26: India surpasses Brazil as #1 globally in terms of daily mortality
September 10: 900,000 global deaths
September 18: 30 million global cases
September 22: The US surpasses 200,000 deaths
September 29: 1 million global deaths
October 1: US President Donald Trump tests positive for SARS-CoV-2
October 4: The Great Barrington Declaration is published, calling for policies to achieve “herd immunity” through natural infection
October 19: 40 million global cases
October 20: The US surpasses India to regain #1 globally in terms of daily incidence
October 21: the US surpasses India to regain #1 globally in terms of daily mortality
October 29: The WHO reports more than 500,000 new cases in a single day for the first time
October 30: The US becomes the first country to report more than 100,000 new cases in a single day
November 8: 1.25 million global deaths
November 8: Europe’s “second wave” peaks at 287,101 new cases per day
November 9: 50 million global cases
November 9: The US surpasses 10 million cases
November 17: The US FDA issues an Emergency Use Authorization (EUA) for the first fully at-home SARS-CoV-2 test kit
November 18: Pfizer announces the completion of the Phase 3 clinical trials for its SARS-CoV-2 vaccine, developed in collaboration with BioNTech
November 26: 60 million global cases
November 30: Moderna announces the completion of the Phase 3 clinical trials for its SARS-CoV-2 vaccine
December 2: The UK issues emergency authorization for the Pfizer/BioNTech vaccine
December 3: The US becomes the first country to report more than 200,000 new cases in a single day
December 4: 1.50 million global deaths
December 5: Russia opens vaccination to the public, using its Sputnik V vaccine
December 8: The US surpasses 15 million cases
December 8: The UK administers its first vaccinations to the public, using the Pfizer/BioNTech vaccine
December 11: US FDA issues an EUA for the Pfizer/BioNTech SARS-CoV-2 vaccine
December 13: 70 million global cases
December 14: The US surpasses 300,000 deaths
December 14: The US administers its first vaccinations to the public, using the Pfizer/BioNTech vaccine
December 15: The US FDA issues an EUA for the first fully at-home SARS-CoV-2 diagnostic test available without a prescription
December 17: French President Emmanuel Macron tests positive for SARS-CoV-2
December 18: US FDA issues an EUA for the Moderna SARS-CoV-2 vaccine
December 21: The first COVID-19 cases are reported in Antarctica, the last of the 7 continents to report a case
December 23: The US reports 1 million vaccine doses administered
December 26: European countries administer the first vaccinations to the public, using the Pfizer/BioNTech vaccine
December 27: 1.75 million global deaths
December 29: The UK begins administering the the second doses of the Pfizer/BioNTech vaccine
- The first 6 months of the pandemic were dominated by news of C19 spreading to new continents and countries and national, state, and local governments implementing highly restrictive measures to prevent the introduction of the virus or bring national epidemics under control.
- However, the second half of 2020 had a very different storyline. Much of the global attention over the past 6 months was divided between progress in developing and testing various medical countermeasures and adapting C19 control measures to ease the economic and social impacts of the pandemic while still slowing the spread.
- And while the main focus remains on identifying and tracking new cases and providing clinical care for active patients, attention is shifting toward recovery, whether in terms of patients recovering from the disease or societies and economies recovering from the pandemic.
2. EPIDEMIOLOGY & CONTROL MEASURES
- The pandemic and the associated policies needed to curb transmission had a wide range of severe downstream impacts, wreaking havoc on national, regional, and local economies. The entertainment, service, and travel and tourism sectors bore the large brunt of the financial losses, and an unimaginable number of businesses around the world have closed, temporarily or permanently, and countless individuals were forced out of work. This has resulted in the loss of hundreds of millions of jobs and trillions of dollars in income globally.
- Additionally, tax revenue from businesses fell sharply, decreasing government revenue at a time when they need to increase spending in order to implement response operations and provide emergency financial support to individuals and businesses. Even healthcare systems have faced significant financial challenges, as many hospitals and health systems pared back non-essential or non-emergent procedures and patients delayed screenings and procedures due to concerns about infection risk.
- In an effort to mitigate these economic losses, national, state, and local governments around the world eased C19 restrictions once transmission decreased—or in some instances, regardless of the current transmission risk—which allowed individuals to resume some social and economic activities. The speed and degree to which these policies were relaxed varied by location, but it appeared that many governments erred on the side of supporting economic recovery over maintaining control of transmission. The increased social interaction provided opportunity for individuals, particularly those with mild or no symptoms, to transmit the infection in community settings, which inevitably led to increased incidence, hospitalizations, and mortality.
- As a result, many countries faced a resurgence in SARS-CoV-2 transmission, in many cases more severe than the first wave or surge. But unlike during the “first wave” of transmission, many governments were reluctant to reinstate highly restrictive C19 policies when incidence increased—in some instances, higher than the initial surge—which permitted community transmission to continue and accelerate, often setting new records for daily incidence and mortality.
- While each country’s epidemic is unique, this trend was evident in countries around the world, in virtually every region. Perhaps the most notable were European countries and the US due to the magnitude of their respective epidemics. In Europe, most countries—including France, Germany, Italy, Spain, and the UK, all of which were severely affected early in the pandemic—were able to bring daily incidence to very low levels and maintain them for several weeks or months.
- Following efforts to relax travel restrictions and social distancing measures in order to revive local and national economies, particularly those reliant on tourism, European countries soon faced increasing incidence. But rather than reimpose highly restrictive control measures like they did earlier in the pandemic, most countries elected to use modified or relaxed social distancing policies in order to maintain some level of economic activity, which resulted in continued transmission that eventually grew into a much larger “second wave” across the continent. In contrast to Europe, the US never really gained control of its “first wave” before state governments began to relax C19 control measures.
- Many of these efforts occurred in states that were not severely affected during the initial surge, and the increase in social activity coincided with geographic spread of the US epidemic across the country. Daily incidence in the US decreased approximately 40% from its initial peak—down to approximately 19,000 new cases per day—before it rebounded, reaching 66,000 per day during the summer surge and more than 220,000 during the ongoing autumn/winter surge.
- Similar trends are evident in a number of countries in other parts of the world as well, many of which were severely affected early in the pandemic. Other notable examples include Japan and South Korea, both of which gained control of transmission following their first wave before easing restrictions and facing larger second and/or third waves. Russia exhibited a trajectory similar to that of the US, decreasing transmission to about half of its first peak before facing a much larger second surge.
- While much of the world continues to struggle with the pandemic, a number of countries and territories have demonstrated the ability to contain SARS-CoV-2 transmission. Most notable is New Zealand, which successfully interrupted domestic transmission in June and reported zero new domestic cases for more than 100 consecutive days. Following an outbreak in Auckland in August and September, which was brought under control relatively quickly, New Zealand has maintained daily incidence below 10 new cases per day. As an island nation, New Zealand has the advantage of being able to more tightly control inbound travel compared to most countries, implementing strict limitations on arriving travelers and mandating quarantine for those permitted to enter the country; however, the country’s strict adherence to evidence-based policies has helped it maintain control over its epidemic.
- After bringing domestic transmission under control through a tiered system of national-level “lockdowns,” New Zealand was able to relax the vast majority of restrictions, which allowed the country to resume most normal social and economic activities without resulting in dramatic increases in transmission. National officials continually evaluated epidemiological data and reintroduced control measures as necessary in response to emerging outbreaks or other incidents, enabling the country to quickly regain control and then slowly ease restrictions again.
- Other examples of success include Australia, Brunei, Cambodia, China, Singapore, Taiwan, and Vietnam as well as many countries in Africa. Many experts around the world originally forecast that African nations would face major C19 epidemics, due in part to weak health systems, limited testing and reporting capacity, and few government resources to support response activities, but this has largely not come to fruition.
- With a few exceptions, including Egypt and South Africa, African nations have generally maintained low levels of reported incidence since the onset of the pandemic. National leaders in many African countries were quick to implement social distancing restrictions, which helped contain community transmission. While African countries have been successful in terms of limiting transmission, many expect to face significant barriers to accessing SARS-CoV-2 vaccines as they become available.
- While cases in the areas most severely affected early in the pandemic skewed heavily toward older, more vulnerable individuals, transmission during subsequent waves and surges tended to begin among younger adults. Limited testing capacity early in the pandemic necessitated allocating the available tests to those who sought care for their disease and those at the highest risk for progressing to severe disease, which included a high proportion of older adults. Younger individuals typically experience milder disease than older or high-risk patients; however, these milder symptoms (including asymptomatic infection) allow individuals to unknowingly continue social activities or essential work while infectious, which provides further opportunity to spread the disease.
- A number of people, including elected officials, have called for younger, healthier adults to continue social activity while protecting the most vulnerable. They viewed this as a way to spread the infection widely among those at the lowest risk for severe disease and death, with the goal of moving toward “herd immunity” that would, in turn, protect the most vulnerable. One notable example was the Great Barrington Declaration, which encouraged lower-risk individuals to “resume life as normal.”
- Experts around the world, spanning health care and public health, criticized this strategy as “scientifically and ethically problematic.” In addition to placing younger adults at risk, including for both acute C19 disease and a variety of potential longer-term health effects, increased community transmission would inevitably spill over to high-risk settings, even if they were largely separated from the community.
- In response to the Barrington Declaration, experts published several high-profile responses, including the John Snow Memorandum, outlining the many shortcomings of approaches that aim to achieve herd immunity through natural infection. As most experts expected, increasing incidence in countries around the world tended to be followed several weeks later by increasing mortality, resulting from both mortality among the younger, healthier population who were driving community transmission and the spread from these individuals to higher-risk individuals, even those who remained relatively isolated.
3. LONG-TERM HEALTH EFFECTS
- The global C19 response has understandably focused heavily on combating community transmission and treating acute disease, but as more C19 patients recover, evidence increasingly illustrates the longer-term health effects stemming from SARS-CoV-2 infection. Now colloquially referred to as “long COVID”—and affected individuals as “long-haulers”—persistent symptoms associated with SARS-CoV-2 infection have been reported in recovered individuals for months after recovery from acute infection or disease. The symptoms vary widely in terms of affected organ systems, duration, and severity, which poses challenges in identifying and classifying the longer-term condition.
- Difficulty breathing and fatigue are among the most commonly reported symptoms, but some recovered C19 patients also report gastrointestinal distress; joint and muscle pain; cardiovascular effects, such as erratic heartbeat; and neurological symptoms, including light sensitivity, memory loss, and “brain fog.” The longer-term symptoms have been documented in individuals across the spectrum of acute C19 disease severity as well as those who did not report symptoms during the acute stage of their infection, and individuals who were younger and healthier prior to infection (ie, those who would be expected to be at lower risk for severe C19 disease and death) have also reported lasting effects from SARS-CoV-2 infection. The impact on lower-risk individuals is concerning, particularly as the age distribution of reported C19 cases continues to shift toward younger portions of the population, and the diverse clinical presentation can make it difficult for clinicians to identify “long COVID,” particularly in patients that did not previously experience acute C19 disease or test positive for SARS-CoV-2 infection.
- Attention on the long-term health effects of C19 is growing, but much uncertainty remains. Numerous research efforts are ongoing to better characterize the various health conditions affecting recovered C19 patients, and it is becoming more clear that the C19 pandemic could have effects that last beyond the completion of vaccination efforts.
- While progress has been made on many fronts relative to medical countermeasures, the most important news pertains to vaccine development. Since the onset of the pandemic, vaccine development efforts around the world have yielded dozens of candidate products, currently in various phases of development, trials, and authorization. Russia initiated vaccination of the public in Moscow on December 5, using its Sputnik V vaccine, which is still undergoing Phase 3 clinical trials.
- China has developed multiple candidate vaccines, which are also at various stages of development and testing. The vaccine developed by Sinopharm is still completing Phase 3 clinical trials, but Bahrain and the United Arab Emirates authorized the vaccine for use. Doses of the Sinopharm vaccine have already been distributed to other countries as well. Several Chinese vaccines were issued emergency authorizations in China early in the clinical trial process, and vaccinations began for essential workers in July, despite not having Phase 3 clinical trial data available.
- Perhaps the biggest news is the formal regulatory authorization of multiple vaccines in the UK, US, Canada, Europe, and numerous other countries. Following announcements of Phase 3 clinical trial results for the vaccines developed by Pfizer/BioNTech and Moderna, regulatory agencies began convening to review safety and efficacy data and determine whether the products warranted emergency authorization for use among the general public. On December 2, the UK was the first to authorize the use of a vaccine that had completed Phase 3 clinical trials, the product developed by Pfizer and BioNTech, and it initiated vaccination efforts on December 8.
- The US soon followed, with Emergency Use Authorizations (EUAs) for both the Pfizer/BioNTech vaccine (December 11) and the Moderna vaccine (December 18), and it began vaccinating individuals on December 14. European countries initiated their vaccination programs starting December 26. In the UK, the US, and Europe, the first vaccinations were administered to high-risk older adults, including long-term care facility residents, and frontline healthcare workers. Eligibility will expand as vaccine availability in each country increases. Phase 3 clinical trial data have not yet been released for the vaccines developed in China or Russia or for the AstraZeneca/Oxford University vaccine, another leading candidate. A number of other candidate vaccines developed in countries around the world are spread across the research and development pipeline, and work will continue on those products as vaccination efforts begin with those that have already received authorization from regulatory agencies.
- But just having a vaccine will not end this pandemic. Production, logistics, and vaccination operations will be critical over the coming months and years, and everyone must remain vigilant and dedicated in order to combat the virus until we are able to deploy the vaccine globally. While vaccination has commenced in a number of high-income countries, principally in Europe and North America, many countries do not yet have access to any vaccines.
- It could be months before they receive their first doses, and it could take years to complete a global mass vaccination effort. Most low- and middle-income countries cannot compete financially against high-income countries, which puts them at a disadvantage in terms of securing vaccine doses as production is scaled up. Many low- and middle-income countries, including in Africa, have banded together under the WHO’s C19 Vaccine Global Access Facility (COVAX), in partnership with Gavi and UNICEF, to pool funding—including donations from other countries and organizations—to support the purchase of early vaccine doses. As of December 18, 92 countries are eligible to receive vaccines under COVAX, and the WHO anticipates being able to distribute 1.3 billion doses of the vaccine in 2021, enough to cover 20% of the population in eligible countries.
- In addition to production and allocation concerns, a number of questions remain about the vaccines’ impact. While efficacy has been demonstrated in Phase 3 clinical trials for 2 vaccines, it remains unclear how long the immunity conferred by the vaccines will last. Further, the vaccines have largely been trialed in adults, and additional data are required to assess their safety and efficacy in children.
- And while the vaccines have been shown to be efficacious in terms of preventing C19 disease, including severe disease, researchers are still evaluating whether they are capable of preventing infection or mitigating the ability of vaccinated individuals to transmit the infection to others. As these questions and others are evaluated over the coming months and years, social distancing, mask use, and other C19 risk mitigation measures will be critical to containing transmission.
- Wear your mask, maintain physical distance, wash your hands, and stay home when you are sick. And remember, we are all in this together, even if we are 6 feet apart.