January 8, 2021
Pfizer C19 vaccine appears to work against UK, South African mutations (see story below)
Amazon selling FDA-approved at-home coronavirus saliva tests
“We believe things will get worse as we get into January.”Dr. Fauci
“The UK variant of the coronavirus is a really big deal.”Marc Lipsitch, an epidemiologist at Harvard’s T.H. Chan School of Public Health
“The antibody decay generated by the vaccine in humans goes down very slowly. We believe there will be protection potentially for a couple of years.”Stéphane Bancel, Moderna CEO
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
- U.S. Deaths, Hospitalizations Set New Records
- The States Leading America’s Vaccination Race
- “A surge on top of a surge”
- Scientists are monitoring a coronavirus mutation that could affect the strength of vaccines (!)
- C19 Vaccines May Be Less Effective Against New Variant of Coronavirus in South Africa (!)
- C19 immunity likely lasts for years (!) ©
- Loss of smell is more likely to occur in mild C19 cases
- C19 effects on the brain appear to be inflammation related
- Pfizer C19 vaccine appears to work against UK, South African mutations (!)
- Moderna C19 vaccine likely to offer up to 2 years of protection (!)
- If you’ve had C19, do you still need a vaccine? (!) (*)
- Rapid virus testing will ramp up, as FDA approves 3 new at-home kits (!) (*)
- New COVID Vaccines Need Absurd Amounts of Material and Labor
- C19 vaccine ‘smart patch’ uses microneedles to deliver immunity
- FDA Admits PCR Tests Give False Results
- Groundbreaking Treatment for Severe C19 Using Stem Cells – “It’s Like Smart Bomb Technology in the Lung” (!)
- C19 unmasked: math model suggests optimal treatment strategies (!)
- Arthritis drugs could help save lives of Covid patients
- Blood Plasma Reduces Risk of Severe C19 if Given Early ©
- Antibody drugs may not be as effective toward South African C19 strain (!)
- C19 infection linked with higher death rate in acute heart failure patients
- Potential Long-Term Effects of C19 on Brain and Nervous System
- Cutting C19 Infectious Period – Even by Just 1 Day – Could Prevent Millions of Cases
- Model estimates more than 50% of Coronavirus is from people without symptoms
- US COVID cases, deaths far higher than reported (!)
- Looking forwards rather than backwards safeguards wellbeing during C19 lockdowns (*)
- How to mitigate the impact of a lockdown on mental health
- Heading outdoors and switching off devices keeps lockdown blues at bay (*)
- Why the C19 Pandemic Has Caused a Widespread Existential Crisis (*)
N. Linked Stories
- C19 VACCINE TRACKER – A guide to the coronavirus vaccination rollout and what you need to know about the authorized vaccines (*)
- Your top resources on the Covid Vaccine (*)
- Study finds commonly used blood pressure medications safe for C19 patients
- C19 outcomes for patients on immunosuppressive drugs on par with non- immunosuppressed patients
- COVID’s Collateral Damage: Germicidal UV Lamps Can Damage Corneas
- Experts tap into behavioral research to promote C19 vaccination in the US
- Black people with type 1 diabetes, C19 are four times more likely to be hospitalized for diabetic ketoacidosis
- Wastewater-based epidemiology: a 20-year journey may pay off for C19
- London will be overwhelmed by covid in a fortnight says leaked NHS England briefing
- The Best Evidence for How to Overcome COVID Vaccine Fears
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- We do not endorse, and may not agree with, any opinion or view included in this update. We include a wide spectrum of opinions and views as we believe that it gives perspective on what people are thinking and may give insights into our future.
A. Pandemic Headlines
(In no particular order)
- US sets new record with over 4,000 COVID-19 deaths in a single day
- Staggering amount of COVID vaccines remain unused in US rollout disaster
- One-third of eligible NY medical workers are refusing COVID vaccine
- Texas hospital offers workers $500 bonus to get COVID-19 vaccine
- FDA Resists Pressure to Tweak Vaccines to Stretch Supply
- FDA Warns Health Officials Not To Mess With COVID-19 Vaccine Doses Schedule
- Most U.S. COVID-19 vaccines go idle as New York, Florida move to penalize hospitals
- Los Angeles is running out of oxygen for patients as covid hospitalizations hit record highs nationwide
- CDC reports over 50 cases of UK coronavirus strain in US
- More states are detecting the highly contagious virus variant
- UK COVID-19 variant most likely to spread among those under 20
- New Variant of Coronavirus Detected in New York Amid Growing Crisis Over Vaccine Rollout
- NY Gov. Cuomo says U.K. variant of virus could be a ‘game-changer’
- ’CDC hopes to double the number of coronavirus samples checked for new mutations
- New strain adds urgency to vaccine push
- California Has the Strictest Lockdown in the US—and the Most Active COVID Cases (by Far)
- Dentists in California can now administer COVID-19 vaccine
- LA County Paramedics Told Not To Transport Some Patients With Low Chance Of Survival
- Despite No Lockdown/Mask-Mandate, Florida Has Same Hospitalization Rate As 2018 Flu Season
- Merck to Repurpose Four U.S. Facilities for COVID-19 Vaccine Manufacturing
- SinoVac vaccine 78% effective in Brazilian trial
- A vaccine made by a Chinese company is said to be effective, and could help fill a gap left by Western countries
- Moderna Vaccine Wins EU Approval in Struggle Against Virus
- Indonesia plans to give working adults COVID-19 vaccine before elderly
- Vaccine rollouts in Europe are off to a shaky start, hampered by slow-moving bureaucracies, a lack of nurses and the shortages of vital equipment
- 29 COVID-19 vaccine recipients had serious allergic reactions: CDC
- 1 in 100,000 Had Severe Allergic Reaction to COVID Shot: CDC
- Israel reaches a deal with Pfizer for enough vaccine to inoculate its adult population by the end of March
- The virus spread faster in counties where large universities held classes in person
- New York Magazine explored the theory that the pandemic may have started after a possible lab accident in China
- Third national lockdown announced in England amid coronavirus surge driven by variant strain
- Russia admits to understating deaths from COVID-19 by more than two thirds
- Chinese city of 11 million stops people leaving to try and contain COVID-19
- Japan declares state of emergency for Tokyo area as COVID cases soar
- First mutant strain cases found in Texas, Penn.
- France confirms 19 cases of variant
- UK pushes to vaccinate 200,000 per day
- New York reports record number of COVID cases
- China locks down city
- WHO urges more European countries to lock down population
- India reports 20,400 new cases
- South Korea reports 870 new cases
- Southeast Asia outbreak worsens
- Swamped Hospitals Expose Depth of Britain’s Unfolding Crisis
- London weeks away from running out of ICU beds
- Officials said that one in 50 people in England had been infected with the virus
- Lebanon begins new lockdown amid surge in coronavirus cases
- Scientists criticize ‘rushed’ approval of Indian COVID-19 vaccine without efficacy data
- WHO’s Tedros ‘very disappointed’ China hasn’t granted entry to coronavirus experts
- Singapore Police Access COVID Tracing App Data For Criminal Investigations
- 79% Of Brits Supported Latest Nationwide Lockdown?!
- UK Lockdown Cops To Stop People In The Street, Issue Fines, Target “Anti-Lockdown, Anti-Vaccine Protesters”
- Manhattan Office Vacancies Hit Record High As Work-At-Home Dominates
- South Carolina Legislation Looks To Ban Mandatory Vaccines
- COVID-19 immunity robust eight months after infection, study says
- NY-NJ region leads nation in residents’ exit amid COVID-19
- COVID-19 vaccine delays could threaten economic recovery
- The US Has Lost More Than 110,000 Restaurants, Setting Stage For Commercial Real Estate Collapse Of Epic Proportions
- World Economy Faces Debt Doom Loop, More Inequity Post Pandemic
- Connecticut private school staffers get COVID-19 vaccine due to CDC error
- As New York City braces for a pandemic winter, many parks, plazas and open spaces have been transformed into cold-weather playgrounds
- Jury trials are being suspended again because of the virus surge
- ‘It’s a train wreck’: Florida uses ticket sales app for COVID vaccine appointments
- Japanese cheerleaders perform outside rail station to lift spirits amid pandemic
- College requiring basketball teams to wear masks during games
- Doctor treks COVID-19 vaccines to rural hospitals hundreds of miles away
B. Numbers & Trends
Note: Unless otherwise noted, (i) all cases/deaths are confirmed cases/deaths that have been reported, (ii) all numbers reported in this update are as of the end of the most recent reporting period, and (iii) all changes reflect changes since the preceding day.
1. Cases & Tests
- Total Cases = 88,480,028
- New Cases (7 day average) = 658,776
- Record high number of new cases (820,796)
- Record high 7 day average of new cases
- US Cases:
- Total Cases = 22,132,045
- New Cases (7 day average) = 233,401
- Percentage of New Global Cases (7 day average) = 35.4%
- Record high number of new cases (274,190)
- Record high 7 day average of new cases
- 7 day average is increasing is at rapid rate
- From 12/29, 7 day average has increased from 185,251 to 233,401, an increase of 26% in 8 days
- Total Deaths = 1,905,542
- New Deaths (7 day average) = 11,336
- 7 day average of new deaths has been rising slightly over the last 4 days
- 7 day average of new deaths is slightly lower than record high on 12/22 (11,725)
- Increase in new cases will likely result in higher new deaths
- Total Deaths = 374,124
- New Deaths (7 day average) = 2,821
- Percentage of Global New Deaths = 24.9%
- Record high number of new deaths (4,134)
- Record high 7 day average of new deaths, which follows a record high of 4,100 on 1/6
3. Top 5 States in Cases, Deaths, Hospitalizations, Patients in ICU & Positivity (1/7)
- After reaching 12.6% on 12/27, the US Positivity Rate climbed for the 11th consecutive day to 17.1% on 1/7.
- Overall, 34 states reported higher positivity rates over the last week (-11 states since 12/29).
- ID leads the US with an average of 48.0% of all tests resulting positive
- Ten states: 7-day positivity rates greater than 40%. (+2 since 12/31)
- Eight states: 7-day positivity rates greater than 30%. (+1 since 12/31)
- Ten states: 7-day positivity rates greater than 20%. (-unc since 12/31)
- Two states (ME, OR): 7-day positivity rates less than 5%. (-1 since 12/31)
- In total, 47 states have 7-day positivity rates greater than 5% (+1 since 12/31)
- Hospitalizations in the US grew to 132,370 patients, up 5.6% over the last week. On 1/7/21, Hospitalizations decreased 94 patients from the prior day.
- Thirteen states have had increases of hospitalized patients of more than 10% in the past week. (-1 since 12/29)
- CA hospitalizations reached an all-time high of 22,851 (+6.5% since 12/31)
- 29 states have more than 1,000 hospitalized patients (-1 since 12/31)
- 19 states saw decreases in the number of hospitalized patients over the past week. (-3 since 12/29)
- Thirteen states have had increases of hospitalized patients of more than 10% in the past week. (-1 since 12/29)
Patients in ICU Trends
- ICU Patients in the US reached an all-time high of 23,821, up 3.1% over the last week.
- Nine states have seen the number of ICU patients increase by more than 10% since a week ago (+3 since 12/29)
- 30 states have more than 100 patients in ICU, (-unch since 12/31)
- 22 states saw decreases in the number of ICU patients over the past week (-unch since 12/29).
4. U.S. Deaths, Hospitalizations Set New Records
What to Know – Worldwide
- The U.S. has so far identified 52 cases of Covid-19 caused by a new, highly contagious variant.
- Texas reported its first case of the variant, as hospitalizations in the state hit new pandemic peaks. Connecticut also detected the variant for the first time.
- U.S. hospitalizations and daily fatalities set new records.
- China’s Sinovac vaccine has shown to be 78% effective in Brazilian late-stage trials.
- Pharmaceuticals giant Bayer and German biotech CureVac are joining forces to develop a Covid-19 vaccine.
- Europe’s vaccination campaign is off to a slow, uneven start.
- Japan declared a state of emergency in Tokyo and surrounding areas.
Key US Trends
- The number of people hospitalized in the U.S. due to Covid-19 hit a record as newly reported coronavirus cases rose to over 250,000 and deaths set a single-day record.
- More than 132,000 people were hospitalized because of the disease as of Wednesday, according to the Covid Tracking Project. Intensive-care units were also stretched, with more than 23,700 patients in ICUs across the country.
- The U.S. daily case total for Wednesday was higher than the nearly 230,000 new coronavirus cases reported Tuesday, according to data compiled by Johns Hopkins University. The nation also reported 3,865 fatalities for Wednesday, a single-day record, according to Johns Hopkins, pushing the overall death toll to more than 361,000. Holiday lags in data reporting may continue to affect case counts and deaths.
5. The States Leading America’s Vaccination Race
- The race to get people vaccinated against Covid-19 is well underway and the United States has administered 5 million doses since it started its rollout on December 14, equating to 1.5 doses per 100 of its inhabitants. That falls considerably short of the 20 million dose goal the CDC states officials set for the end of December, however. Last Thursday, they said that 17 million doses were distributed to states and they acknowledged that the pace of the rollout has proven slow, though they could not explain why. What is certain is that some states have managed to get their doses administered much faster than others, as can be seen on this map which utilizes data from Bloomberg.
- Every state was granted a vaccine allocation roughly proportional to its population. Bloomberg’s data shows that South Dakota and West Virginia have administered the most doses per capita, with both seeing rates higher than 3 jabs per 100 of their inhabitants up to January 0C19, 2021. Currently, Georgia, Alabama, Mississippi and Kansas have proven the states where the effort is slowest and all of them have a current vaccination rate of less than one dose per 100 inhabitants.
6. “A surge on top of a surge”
- The holidays were not kind to California. New infections in the state have skyrocketed — driven by Thanksgiving gatherings and then Christmas festivities — despite weekslong lockdowns in December throughout much of the state. Now, Gov. Gavin Newsom is warning of “a surge on top of a surge” linked to the holidays that will only get worse in the coming weeks.
- The situation is perhaps most dire in Los Angeles County, where it’s estimated that one person becomes infected every six seconds, and one person dies every 10 minutes. The latest crisis has stretched the health care system there so thin that incoming patients at one hospital were told to wait in an outdoor tent. The region is running out of oxygen, and ambulance crews have been instructed to stop transporting people who have little chance of survival.
- California has the second highest rate of new cases per 100,000 people after Arizona. Over the past month, the number of C19 patients in California hospitals has doubled, and many intensive care units are overflowing. In Southern California and the San Joaquin Valley, intensive care units are at zero percent capacity.
- More inoculations would help ease California’s burden, but as with the rest of the country, the vaccine rollout in California has been sluggish, with only about a third of the state’s 1.3 million doses reaching the arms of patients. Worryingly, at least six people in the state have been found to have been infected with the new, more transmissible variant of the virus.
- There has been some progress. Infection rates appear to have stabilized in recent days, but reporting anomalies tied to the holidays mean that it may be another week before we have a solid understand of how much the virus has recently spread.
- Even if infection rates slow, my colleague Shawn Hubler, who covers California, said officials were bracing for a harrowing month, and asking an already exhausted population to hunker down until this latest surge passed.
- “There are many more people who are obeying the law, than not,” Shawn said. “But it’s still not enough.”
Source: New York Times Daily Briefing
C. New Variants (Mutations) of Coronavirus
1. Scientists are monitoring a coronavirus mutation that could affect the strength of vaccines
- As scientists try to track the spread of a new, more infectious coronavirus variant around the world — finding more cases in the United States and elsewhere this week — they are also keeping an eye on a different mutation with potentially greater implications for how well C19 vaccines work.
- The mutation, identified in a variant first seen in South Africa and separately seen in another variant in Brazil, changes a part of the virus that your immune system’s antibodies get trained to recognize after you’ve been infected or vaccinated. Lab studies show that the change could make people’s antibodies less effective at neutralizing the virus. The mutation seems to help the virus disguise part of its signature appearance, so the pathogen might have an easier time slipping past immune protection.
- It’s not that the mutation will render existing vaccines useless, scientists stress. The vaccines authorized so far and those in development produce what’s called a polyclonal response, generating numerous antibodies that home in on different parts of the virus. Changes to any of those target sites raise the possibility that the vaccines would be less effective, not that they won’t work at all.
- “With one mutation or even three mutations, it’s expected the antibodies will still recognize this variant, though they might not recognize it as well as other variants,” said Ramón Lorenzo-Redondo, a molecular virologist at Northwestern University’s Feinberg School of Medicine.
- Essentially, the mutation is getting attention because it appears more likely to have some effect on vaccines than other mutations that have emerged, though scientists are still trying to test that hypothesis. The more contagious variant raising global alarms, which was first seen in the United Kingdom and is referred to as B.1.1.7, is not thought to have mutations that will greatly affect vaccines, the evidence so far indicates.
- “We need to be monitoring for these mutations,” said Jesse Bloom, an evolutionary virologist at Fred Hutchinson Cancer Research Center, who with colleagues published a paper about this specific mutation, known as E484K, this week.
- But Bloom added that he believed the virus would have to pick up multiple mutations — and particular mutations in specific spots, not just any alterations — to have a serious effect on vaccine efficacy, which will likely take some time.
- “I’m quite optimistic that even with these mutations, immunity is not going to suddenly fail on us,” Bloom said. “It might be gradually eroded, but it’s not going to fail on us, at least in the short term.”
- Scientists do think the coronavirus could eventually change so much that the immunity provided by vaccines will be threatened, a process that will pick up as the number of people protected from the virus — either through vaccination or infection — grows and evolutionary pressure in turn increases. But they still anticipate it could take years, and that when it does occur, vaccine makers can tweak their designs to match the newer variant, a process some companies have said would only take weeks.
- The coronavirus (SARS-CoV-2) has been mutating as it spreads, just like other viruses. Many of the mutations do nothing, and some might even impede the virus’s quest to replicate and spread. But every so often, a random mutation gives the virus an evolutionary advantage, and that variant can then become dominant. Early on in the pandemic, a mutation known as D614G helped the coronavirus spread more easily, and variants with that mutation quickly overtook others globally.
- B.1.1.7, which has since spread to other parts of the world, appears to be even more infectious, with some estimates saying it’s 50% more transmissible. One of its mutations, called N501Y, improves how well the virus’ spike protein can attach to a receptor called ACE2 on human cells, making it more likely for the virus to successfully infect cells and for the virus to pass from person to person.
- The same N501Y mutation is also present in the variant identified in South Africa, though the two variants evolved independently. (Public health authorities are trying to steer people away from using terms like the “U.K. variant” or “South African variant,” just as they discourage people from tying SARS-2 by name to China or Wuhan. “We need to use the names appropriately because we don’t want to stigmatize where these variants have been identified,” the World Health Organization’s Maria Van Kerkhove said Tuesday. “That’s true for any virus that’s identified.”)
- The inclusion of N501Y appears to help the variant in South Africa spread faster as well, but the variant also has the E484K mutation, unlike the variant that first appeared in the U.K. Though mutations in the same part of the virus have cropped up previously during the pandemic, the specific E484K mutation is attracting more interest now in part because it’s in this variant that’s spreading across South Africa and, through travelers, has started to appear elsewhere, including Japan, Norway, and the U.K.
- The E484K change occurs on a part of the spike protein called the receptor binding domain, which plays a crucial role as the virus attaches to ACE2 and is a key target for antibodies. As lab studies have shown, antibodies don’t recognize variants with E484K as well as other forms.
- Research from Bloom and colleagues this week further added to that evidence. In their study, which involved mapping how antibodies from people who had recovered from C19 fared against different variants, the scientists found that mutations like E484K had the biggest impact on antibodies’ ability to block the virus, with some people experiencing a more than 10-fold drop in neutralization against the variant. The researchers called the location of the E484K mutation “the site of most concern for viral mutations.” (There was variability among the samples, however; some people were able to neutralize the variant just fine, and mutations in other places had more of an impact than E484K did for certain people.)
- Bloom’s study was focused on people who had recovered from an infection, not those who had been vaccinated; researchers around the world are investigating how well current vaccines stand up to different variants.
- But despite what he and colleagues found about E484K, Bloom noted that the mutation only reduced neutralizing activity, and didn’t eliminate it. Current vaccines, meanwhile, have shown they can generate strong immune responses. “I’m confident current vaccines will be useful for quite a while,” Bloom wrote in a Twitter thread detailing the research.
- The more pressing concern for now, scientists say, remains the spread of B.1.1.7, the variant first seen in the U.K. Though it’s not thought to cause more severe cases of C19, if it causes more cases overall because it spreads more easily, that will lead to more hospitalizations and deaths. It is also likely harder to control than other variants and raises the threshold of the percentage of the population that needs to be protected to reach herd immunity.
- “The variant is a really big deal,” said Marc Lipsitch, an epidemiologist at Harvard’s T.H. Chan School of Public Health.
- Lipsitch said the U.S. should focus its efforts on curtailing the variant, including by sequencing more samples from patients to identify cases and directing its contact tracing and quarantining campaigns to try to hem it in.
- “To the extent that we can find those and preferentially stop the spread, it won’t be perfect, it will be far from perfect, but anything we can do to delay the spread of this new variant virus will make control easier and will help us in the race to get more people vaccinated before this becomes more common,” he said.
2. C19 Vaccines May Be Less Effective Against New Variant of Coronavirus in South Africa
- A new variant of the coronavirus that is surging across South Africa may make the existing C19 vaccines less effective, but is unlikely to be totally resistant to the shots, according to leading researchers who have studied the mutations and the vaccines.
- The variant, which has already shown up in patients in Europe and other African countries, has quickly become the predominant one in South Africa, exacerbating a second wave of infections that is overwhelming hospitals and has driven daily deaths to record highs.
- South African researchers are racing to determine whether it makes patients more seriously ill than other variants of the virus. They are also testing how it responds to antibodies from people who have recovered from C19 and those who have received coronavirus vaccines.
- Their official conclusions are eagerly awaited by researchers around the globe, since one of the variant’s mutations has in earlier laboratory experiments shown increased resistance to some of the antibodies the body uses to fight off C19. U.K. Health Secretary Matt Hancock said earlier this week that he was “incredibly worried about the South African variant.”
- But scientists who worked on the antibody experiments and the lead investigators of several vaccine trials being conducted in South Africa say that—based on their understanding of the virus and the immune response triggered by the shots—the immunizations should still work against the new variant, although perhaps not as effectively.
- “The immune response is a complex part of our body and we know that immune response isn’t just about neutralizing antibodies,” said Glenda Gray, the head of the South African Medical Research Council and one of the lead investigators of the Johnson & Johnson vaccine trial in the country.
- C19 vaccines are designed to trigger an immune response that includes antibodies that shouldn’t be affected by the new mutations as well as blood cells, known as T-cells, which attack the virus more broadly.
- A reduction in a vaccine’s efficacy could mean that a higher percentage of recipients are still susceptible to getting C19 or that they may still get a mild form of the disease. It could also mean that a larger proportion of people need to get vaccinated to produce herd immunity and end the pandemic.
- Dr. Madhi and Dr. Gray said results from the South African trials on the Oxford/AstraZeneca, Novavax and Johnson & Johnson vaccines should be available in the coming weeks. Because participants will have mostly come into contact with the new variant, the results will show how vaccinated people respond to the mutations, rather than just conducting tests with virus cells and antibodies produced in a lab.
- Concern over the South African variant’s impact on the efficacy of vaccines has centered on a mutation dubbed E484K. Researchers believe that mutation has changed the shape of the virus’s spike protein, which it uses to attach to and infect human cells, in a way that makes it harder for some antibodies to get a good grip and neutralize the virus.
- In addition to the E484K mutation, the scientists who sequenced the South African variant’s genome also found a mutation—known as N501—that researchers in the U.K. have said may be responsible for the much faster spread of the virus there. Like in the U.K., the new South African variant has quickly crowded out other versions of the virus in the country, also suggesting that it is more transmissible. Scientists don’t believe that the N501 mutation will affect the efficacy of vaccines.
- In the past two weeks, laboratories in Finland, the U.K., Australia, Switzerland, Japan and South Korea have found the South African variant in coronavirus tests conducted there. Researchers in neighboring Zambia say the South African variant now also appears to be the dominant virus there.
- One reason why the new variant emerged in South Africa may be that the country already suffered through a bad first wave of infections. In some impoverished townships, more than 40% of people visiting clinics for other conditions have been shown to have C19 antibodies in their blood. Those antibodies protect them from older variants of the virus, but new variants could circumvent such immunity.
- Michel Nussenzweig, who heads the Laboratory of Molecular Immunology at the Rockefeller University in New York, leads a team of researchers who implanted the spike protein from the coronavirus into a much-faster-mutating virus. That gave them a kind of time-lapse view of how the virus reacts when it comes under pressure from antibodies cloned from the blood of people who have recovered from C19.
- One of the mutations that appeared during these experiments was E484K, the one that has now shown up in the South African variant. The Rockefeller team found that the E484K mutation knocked out one important class of antibodies, out of a total of four classes.
- But Dr. Nussenzweig said that other elements of a person’s immune response—whether triggered by a vaccine or an earlier infection—could still protect against C19.
- Scientists also said that if the South African variant does indeed have a significant effect on vaccine efficacy, immunizations using messenger RNA, like the BioNTech/Pfizer and Moderna ones, or those relying on other viruses as a vector, such as the Oxford/AstraZeneca vaccine, could quickly be adapted to produce more effective antibodies.
- Because such changes would be relatively minor, regulators may agree to approve adapted vaccines without the full spate of human trials that was necessary for the first round of C19 immunizations. “The flu vaccine (which needs to be adapted every year) is a good example,” said Dr. Madhi.
D. New Scientific Findings & Research
1. C19 immunity likely lasts for years
- C19 patients who recovered from the disease still have robust immunity from the coronavirus eight months after infection, according to a new study. The result is an encouraging sign that the authors interpret to mean immunity to the virus probably lasts for many years, and it should alleviate fears that the C19 vaccine would require repeated booster shots to protect against the disease and finally get the pandemic under control.
- “There was a lot of concern originally that this virus might not induce much memory,” says Shane Crotty, a researcher at the La Jolla Institute for Immunology in California and a coauthor of the new paper. “Instead, the immune memory looks quite good.”
- The study, published January 6 in Science, contrasts with earlier findings that suggested C19 immunity could be short-lived, putting millions who’ve already recovered at risk of reinfection. That predicament wouldn’t have been a total surprise, since infection by other coronaviruses generates antibodies that fade fairly quickly. But the new study suggests reinfection should only be a problem for a very small percentage of people who’ve developed immunity—whether through an initial infection or by vaccination.
- The researchers found that antibodies in the body declined moderately after eight months, although levels varied wildly between individuals. But T-cell numbers declined only modestly, and B-cell numbers held steady and sometimes inexplicably grew. That means that despite decreases in free-flowing antibodies, the components that can restart antibody production and coordinate an attack against the coronavirus stick around at pretty high levels. Crotty adds that the same mechanisms that lead to immune memory after infection also form the basis for immunity after vaccination, so the same trends ought to hold for vaccinated people as well.
- And while immunity to other coronaviruses has been less than stellar, it’s worth looking at what happens in people who recovered from SARS, a close cousin of the virus that causes C19. A study published in August showed that T cells specific to SARS can remain in the blood for at least 17 years, bolstering hopes that C19 immunity could last for decades.
2. Loss of smell is more likely to occur in mild C19 cases
- A reduced sense of smell, or olfactory dysfunction, is one of the most common symptoms of C19. A recent study published the Journal of Internal Medicine has examined it prevalence and recovery in patients with varying degrees of severity of C19.
- In the study of 2,581 patients from 18 European hospitals, the patient-reported prevalence of olfactory dysfunction was 85.9% in mild cases of C19, 4.5% in moderate cases, and 6.9% in severe-to-critical cases. The average duration of olfactory dysfunction reported by patients was 21.6 days, but nearly one-quarter of affected patients reported that they did not recover their sense of smell 60 days after losing it.
- Objective clinical evaluations identified olfactory dysfunction in 54.7% of mild cases of C19 and 36.6% of moderate-to-critical cases of C19. At 60 days and 6 months, 15.3% and 4.7% of these patients did not objectively recover their sense of smell, respectively.
- “Olfactory dysfunction is more prevalent in mild C19 forms than in moderate-to-critical forms, and 95% of patients recover their sense of smell at 6-months post-infection,” said lead author Jerome R. Lechien, MD, PhD, MS, of Paris Saclay University.
3. C19 effects on the brain appear to be inflammation related
- Historically, the great epidemic causes of neurological disease, such as Japanese encephalitis and polio viruses, have directly infected the Central Nervous System (CNS). As the C19 pandemic developed and increasing numbers of patients with neurological disease were reported, the question was, would the coronavirus (SARS-CoV-2) behave in a similar way?
- Initial reports of patients with C19 who exhibited clinical evidence of brain inflammation suggested that SARS-CoV-2 encephalitis can occur1, though the rarity with which the virus was found in the cerebrospinal fluid (CSF) implied that immune-mediated damage is more important than viral replication in neurons. As the numbers of case reports and small series grew, it became clear that anosmia, encephalopathy and stroke were the predominant neurological syndromes associated with C19 (ref.1).
- If the retina is the window on the brain, then for understanding SARS-CoV-2, the nose has perhaps been the front door. For just as SARS-CoV-2 causes disturbance of smell without infecting olfactory neurons, evidence suggests that disturbance of higher mental function occurs predominantly without infection of CNS neurons. Although the virus can enter the brain, it seems to predominantly infect vascular and immune cells. Local inflammation upregulates astrocytes and microglia, perhaps compounding the effects of circulating pro-inflammatory cytokines in severe systemic disease.
- Read more about the results of this analysis by clicking here.
E. Vaccines & Testing
1. Pfizer C19 vaccine appears to work against UK, South African mutations
- Pfizer Inc and BioNTech’s C19 vaccine appeared to work against a key mutation in the highly transmissible new variants of the coronavirus discovered in the UK and South Africa, according to a laboratory study conducted by the US drugmaker.
- The not-yet peer-reviewed study by Pfizer and scientists from the University of Texas Medical Branch indicated the vaccine was effective in neutralizing the virus with the so-called N501Y mutation of the spike protein.
- The mutation could be responsible for greater transmissibility and there had been concern it could also make the virus escape antibody neutralization elicited by the vaccine, said Phil Dormitzer, one of Pfizer’s top viral vaccine scientists.
- The study was conducted on blood taken from people who had been given the vaccine. Its findings are limited, because it does not look at the full set of mutations found in either of the new variants of the rapidly spreading virus.
- Dormitzer said it was encouraging that the vaccine appears effective against the mutation, as well as 15 other mutations the company has previously tested against.
- “So we’ve now tested 16 different mutations, and none of them have really had any significant impact. That’s the good news,” he said. “That doesn’t mean that the 17th won’t.”
- Dormitzer noted another mutation found in the South African variant, called the E484K mutation, is also concerning. The researchers plan to run similar tests to see if the vaccine is effective against other mutations found in the UK and South African variants and hope to have more data within weeks.
- Scientists have expressed concern that vaccines being rolled out may not be able to protect against the new variants, particularly the one that emerged in South Africa.
- Simon Clarke, an associate professor in cellular microbiology at the University of Reading, said this week that while both variants had some new features in common, the one found in South Africa “has a number additional mutations” that included more extensive alterations to the spike protein.
- The Pfizer/BioNTech vaccine and the one from Moderna Inc, which use synthetic messenger RNA technology, can be quickly tweaked to address new mutations of a virus if necessary. Scientists have suggested the changes could be made in as little as six weeks.
2. Moderna C19 vaccine likely to offer up to 2 years of protection
- Moderna’s C19 vaccine will likely protect people from the deadly bug for up to two years, CEO Stéphane Bancel said Thursday.
- While the Massachusetts biotech firm needs to conduct more research to determine how long its shot wards off the coronavirus, Bancel said the “nightmare scenario” of the vaccine only working for a month or two is “out of the window.”
- “The antibody decay generated by the vaccine in humans goes down very slowly,” Bancel said at an event sponsored by Oddo BHF, a financial services group. “We believe there will be protection potentially for a couple of years.”
- The FDA cleared Moderna’s vaccine for emergency use last month along with a similar shot developed by Pfizer and BioNTech.
- FDA officials acknowledged that Moderna’s 30,000-person clinical trial of the shot had not yet produced enough data to determine whether it would remain effective for longer than two months. Companies seeking emergency clearance for C19 vaccines should continue their research “to assess long-term safety and efficacy,” the agency has said.
- Bancel also said Moderna was close to proving that its vaccine would work against new coronavirus variants that have emerged in Britain and South Africa. Both are believed to be highly contagious.
- Both Moderna’s and Pfizer’s vaccines use messenger RNA, genetic material that provokes an immune response to the virus by directing the body to create a tiny amount of coronavirus spike proteins.
3. If you’ve had C19, do you still need a vaccine?
- The United States has just started rolling out the country’s two authorized C19 vaccines, but Vox‘s Brian Resnick writes that some of the more than 20 million Americans who’ve had C19 are wondering: Do I need to get vaccinated?
Why people who’ve had C19 may think they don’t need to be vaccinated
- According to Resnick, some people who’ve had C19 may question whether they need to be vaccinated because their bodies have already mounted an immune response against the novel coronavirus and C19—and that immune response could mean they’ve developed some degree of protection against the virus and the disease. In fact, Resnick writes, scientists in lab studies have found that most people who’ve contracted the novel coronavirus develop neutralizing antibodies that can render the virus “harmless.”
- Nevertheless, immunologists and vaccine experts told Resnick that people who’ve had C19 should get inoculated once vaccines become widely available. Why?
Why experts say people who’ve had C19 should get vaccinated
- One of the main reasons why experts think everyone should receive a C19 vaccination, including those who’ve had C19, is because everyone’s immune system responds differently to the virus, Resnick writes.
- According to experts, documented cases of reinfection from the novel coronavirus suggest some people who’ve contracted the virus may have had a weak or waning immune response to pathogen, meaning their body hasn’t mounted a strong or lasting immunity to the virus. Resnick writes that scientists generally believe when it comes to the novel coronavirus, “the worse the first infection, the stronger the immune response will be.”
- In an email to Resnick, Akiko Iwasaki, a professor of immunology at Yale University School of Medicine, explained that some people who’ve had C19 “develop very high levels of neutralizing antibodies and are likely in no need of vaccines, while others develop undetectable levels of neutralizing antibodies” and therefore may need a vaccine to protect against the coronavirus and C19.
- Alexander Sette, an immunologist at the La Jolla Institute for Immunology, said he and his colleagues have found that about 90% of people will mount a durable immune response against the novel coronavirus—which can last up to eight months—while about 10% of people will not have as strong of an immune response.
- However, Sette explained that it’s not clear which of those categories patients who’ve been infected with the coronavirus fall into. As such, Sette said that not taking any precautions—including wearing a face mask, practicing social distancing, or getting vaccinated—after an initial coronavirus infection is comparable to “driving a car where you’re 90% sure the car has brakes.”
- That’s why experts say people who’ve been infected with the novel coronavirus still should get vaccinated: to “level out the variability” in immune responses, Resnick writes. C19 vaccines offer patients a more consistent level of protection against the pathogen, experts said.
- “During a natural exposure to [the novel coronavirus], there are multiple factors that interfere with a robust immune response,” Iwasaki explained. For example, “[t]he exposure dose may be too little.” In addition, “The virus interferes with our immune system (both innate and adaptive) to block proper antibody induction,” Iwasaki said.
- In contrast, Iwasaki said, “vaccines are formulated to provide just the right dose” of the viral protein needed to generate a robust immune response, resulting in a “much more uniform and higher level of antibodies generated with a vaccine.”
- According to Sette, clinical trial data on the two vaccines currently authorized for use in the United States shows both vaccines have high levels of efficacy, which suggests the inoculations can produce robust immune responses in a majority of people.
- There are some unknowns, however.
- Still, it’s not yet known whether C19 vaccines will boost a person’s natural immune response to the novel coronavirus after an initial infection. Experts say, however, that an inoculation against C19 likely won’t cause harm to people who’ve already been infected with the novel coronavirus—and there may be some potential benefits.
- In an email to Resnick, Helen Chu, an immunologist and physician at the University of Washington, wrote that although scientists haven’t yet determined whether vaccines will offer an immunological boost to people who’ve had a weak immune response to a natural coronavirus infection, she believes getting the vaccine could be beneficial, because “[a]ntibody wanes over time, and it is likely that the vaccine will boost your pre-existing antibody titers.”
- Scientists are still working to definitively prove whether C19 vaccines provide an immunological boost to people who’ve already been infected with the coronavirus, though. According to Resnick, Moderna vaccine scientist Jacqueline Miller recently said the company is “anticipating data in the coming weeks” on whether its C19 vaccine improves the immune response of people who’ve already been infected.
- But in the meantime, experts say that once coronavirus vaccines become widely available, people who’ve been infected with the novel coronavirus should be vaccinated. “To be safe, I recommend getting the vaccine, even after you recover from [C19], when the vaccines become sufficiently available,” Iwasaki said (Resnick, Vox, 12/18).
4. Rapid virus testing will ramp up, as FDA approves 3 new at-home kits
- Amid surging coronavirus cases, the top U.S. testing official on Thursday announced another scale-up in the country’s diagnostic efforts, touting the importance of tests that can run from start to finish outside the lab.
- The government will allocate an additional $550 million to community-based testing programs across all 50 states, said Adm. Brett Giroir, the assistant secretary for health. The government will also put $300 million toward 60 million kits for federal distribution to nursing homes and other vulnerable communities.
- Dr. Giroir projected that the country’s capacity for non-laboratory testing could more than double by June.
- In a video livestream, Dr. Giroir held up three new at-home testing kits, designed by Ellume, Abbott and Lucira Health, that recently received emergency green lights from the Food and Drug Administration. All can deliver results in a matter of minutes after a quick nasal swab, though only Ellume’s product can be purchased without a prescription.
- The Abbott and Ellume tests search for bits of coronavirus proteins called antigens. Lucira’s test, like most laboratory-based tests, hunts for genetic material.
- Dr. Giroir, who will depart his position on Jan. 19 as part of the transition to the Biden administration, praised the tests as “sophisticated” but cautioned that none were yet in widespread use. Production ramp-ups are in progress, he noted, but might not alter the market for a few months.
- Ellume’s test, for example, while it will be sold over the counter in a few weeks, will still be available in only very limited quantities.
- Experts have repeatedly cautioned that rapid tests are not as accurate or consistent as tests that route people’s samples through a laboratory, where they are typically processed with a technique called polymerase chain reaction, or P.C.R.
- Rapid tests, which can run from start to finish in a matter of minutes, may also falter more often when used on people without symptoms. Even so, they are often used — as a way to frequently screen some populations like nursing home residents and schoolchildren.
- But rapid tests typically have cost and convenience on their side — benefits that Dr. Giroir repeatedly underscored in a call with reporters. He noted the slow and bumpy rollout of testing in the United States, where speedy tests results are still a relative rarity.
- Dr. Giroir said it was “not yet obvious” whether widespread at-home testing would be successful.
- Susan Butler-Wu, a clinical microbiologist at the University of Southern California’s Keck School of Medicine, said at-home testing might streamline the testing process. People who feel sick could test themselves and determine whether they need to isolate or seek treatment in a matter of minutes.
- But outsourcing testing to the general public also carries risks.
- Incorrect results, for example, could be tougher to catch, interpret and act on when people test themselves at home. False negatives might embolden people to mingle with others, hastening the spread of the virus, while false positives could unnecessarily keep people out of work or school.
- And both types of errors could erode public trust in testing.
- Dr. Butler-Wu also noted that rapid test results might not make it to the right care providers and to public health officials when collected at home.
- If results aren’t properly reported, she said, “you’re flying blind — you don’t know the prevalence in your community.”
Source: New York Times Coronavirus Updates
5. New COVID Vaccines Need Absurd Amounts of Material and Labor
- Barely a year ago few people outside of a small network of scientists and companies had heard of mRNA vaccines. Today millions are pinning their hopes on these genetics-based immunizations, which have taken center stage in the fight against COVID. But deficiencies in needed supplies and materials for making the vaccines could lead to widespread shortages, some scientists say.
- The first doses of mRNA COVID vaccines began arriving at hospitals in the U.S. and several other countries in December. An overarching question is how fast companies making them can scale up production to meet global demand. This is the first time mRNA vaccines have been authorized for use outside of clinical trials. They work by tricking the body’s own cells into making a viral protein that prompts immune reactions against infection.
- The U.S. has granted emergency authorization to two COVID vaccines so far—made by the pharmaceutical companies Pfizer and BioNTech and the biotechnology firm Moderna, respectively—and both rely on mRNA. A third company called CureVac, headquartered in Tübingen, Germany, currently has an mRNA vaccine in late-stage clinical trials. The Trump administration reached a deal with Pfizer in late December to provide 100 million additional doses to the U.S. by the end of July—resulting in twice the amount the government originally ordered. Together with its partner BioNTech, Pfizer plans to produce and distribute 1.3 billion doses globally next year. And Moderna intends to produce 500 million to one billion doses, of which 200 million have already been allocated to the U.S.
- Meeting these targets will be no easy feat. “There aren’t any facilities in the world that have manufactured mRNA at such a large scale before,” says Maria Elena Bottazzi, a virologist at Baylor College of Medicine and Texas Children’s Hospital in Houston. Pfizer and Moderna have been building supply networks to shift from clinical to large-scale production. But each step in the manufacturing process requires raw materials that, before COVID, were only produced in the amounts needed for clinical research—“not sustained production of billions of doses,” says Patrick Boyle, an executive responsible for research and development at the Boston-based synthetic biology company Ginkgo Bioworks.
- Such mRNA vaccines are created using much faster chemical processes than traditional vaccines made by growing weakened viruses in chicken eggs. Manufacturers start with a digital sequence of genetic building blocks for the novel coronavirus’s “spike” protein, which the pathogen uses to enter and infect cells. Robotic assembly lines transform that sequence first into a DNA template and then into the mRNA vaccine substance. To protect the mRNA, which is highly unstable, vaccine producers pack it within an oily lipid nanoparticle that also facilitates uptake by human cells. Inoculated cells will then make and display the viral spike on their surface so that the immune system learns to recognize and fight off the virus later.
- According to a November report by the U.S. Government Accountability Office (GAO), much of what is needed to produce these vaccines is in short supply. During interviews with GOA staff, manufacturing plant personnel described challenges in obtaining reagents and certain chemicals, as well as glass vials, syringes and other hardware. They also cited a shortage of “fill and finish” facilities where vaccine doses are loaded into sterile containers and a dearth of workers with the specialized skills needed to run mRNA production processes. Such resource scarcities, GAO concluded, could lead to production backlogs.
- Boyle singles out polymerases, a type of enzyme, that convert DNA to mRNA and ingredients used for making lipid nanoparticles as some of the most critical raw materials for the vaccines. He also says manufacturers need better access to a rare substance called vaccinia capping enzyme (VCE), which helps keep the mRNA from degrading and gives it a deceptively human appearance to prevent cells’ protein-making machinery from rejecting it. Boyle’s team has calculated that making the 10 pounds of VCE needed to generate 100 million mRNA vaccine doses would overwhelm the limited capacity of bioreactors (containers used to carry out biochemical reactions) and cost $1.4 billion. VCE prices should fall as manufacturing processes and efforts to increase production improve, however, Boyle says.
- The impact of these shortages was evident in November, when Pfizer and BioNTech halved the number of doses they said could produce globally in 2020 from 100 million to 50 million. Pfizer did not say which shortfalls had affected production. But Tanya Alcorn, vice president of the company’s biopharmaceutical global supply chain, acknowledges there was “a bit of a scale-up issue in early fall” that she says has since been resolved. “When you’re running at this pace, everyone needs to scale up at the same time,” Alcorn says. “We need more from our suppliers, and our sites need to optimize operational performance as well.” The New York Times has reported that Pfizer’s new deal with the U.S. government hinges on better access to specialized materials that were not publicly disclosed by the company. But Alcorn tells Scientific American that the “new and unique components needed for lipid nanoparticles” are a limiting factor. Moderna did not respond to requests for comment.
- A wild card in the needed manufacturing scale-up is how long mRNA vaccine protection lasts. Corey Casper, chief executive officer of the Infectious Disease Research Institute in Seattle, says experts were hoping the vaccines would stimulate antibody levels four to 10 times higher than those induced by natural infections. “That didn’t happen,” he says. “The mRNA vaccines work great: [about] 95 percent protection from disease [in clinical trials]. But if the antibodies drop quickly below a protective threshold, then people might need a booster,” which would require manufacturing more vaccine. It is possible that a broader array of immune cells, including T cells, will prolong and sustain mRNA-induced protection, but that scenario remains an open question.
- Fortunately, mRNA vaccines are not the only game in town. Other companies—such as Johnson & Johnson and AstraZeneca—are taking COVID vaccines made using different approaches through late-stage clinical trials. And ideally, these efforts will contribute millions of additional doses—not just for the richer nations that so far have been hoarding the near-term supply but also for low- and middle-income countries. The latter category includes 67 nations where only one in 10 people may be immunized next year, according to an analysis by the People’s Vaccine Alliance, an organization that includes Amnesty International and Oxfam International. “It’s been said many times before, but we need multiple shots on goal,” Casper says.
6. C19 vaccine ‘smart patch’ uses microneedles to deliver immunity
- The world’s first coronavirus vaccine “smart patch” is being developed in Wales, researchers have said.
- The device, which works like a nicotine patch, is designed to allow patients to self-administer the vaccine before being able to monitor their body’s response to it.
- The small patch will use tiny microneedles, measured in millionths of a metre, to break the skin barrier of a patient and deliver the vaccine in a less invasive way than a traditional hypodermic needle.
- The device simultaneously measures a patient’s inflammatory response to the vaccination by monitoring biomarkers in the skin while being held in place on their arm with tape or a strap.
- Researchers at Swansea University say the devices would be easy to distribute and low-cost to manufacture, with scope to expand the work to apply to other infectious diseases in the future.
- A prototype will be developed by the end of March with the aim of having it put forward for clinical trials and made commercially available within three years.
- Project lead Dr Sanjiv Sharma said the quick measuring of the vaccines’ effectiveness “will address an unmet clinical need and would provide an innovative approach to vaccine development”.
- “The real-time nature of the platform will mean rapid results allowing faster containment of the C19 virus,” said Sharma. “This low-cost vaccine administration device will ensure a safe return to work and management of subsequent C19 outbreak waves.
- “Beyond the pandemic, the scope of this work could be expanded to apply to other infectious diseases as the nature of the platform allows for quick adaptation to different infectious diseases.
7. FDA Admits PCR Tests Give False Results
- The FDA today joined The WHO and Dr.Fauci in admitting there is a notable risk of false results from the standard PCR-Test used to define whether an individual is a COVID “Case” or not.
- As a reminder, “cycle thresholds” (Ct) are the level at which widely used polymerase chain reaction (PCR) test can detect a sample of the C19 virus. The higher the number of cycles, the lower the amount of viral load in the sample; the lower the cycles, the more prevalent the virus was in the original sample.
- Numerous epidemiological experts have argued that cycle thresholds are an important metric by which patients, the public, and policymakers can make more informed decisions about how infectious and/or sick an individual with a positive C19 test might be. However, as JustTheNews reports, health departments across the country are failing to collect that data.
- Here are a few headlines from those experts and scientific studies:
- 1. Experts compiled three datasets with officials from the states of Massachusetts, New York and Nevada that conclude:“Up to 90% of the people who tested positive did not carry a virus.”
- 2. The Wadworth Center, a New York State laboratory, analyzed the results of its July tests at the request of the NYT: 794 positive tests with a Ct of 40: “With a Ct threshold of 35, approximately half of these PCR tests would no longer be considered positive,” said the NYT. “And about 70% would no longer be considered positive with a Ct of 30! “
- 3. An appeals court in Portugal has ruled that the PCR process is not a reliable test for Sars-Cov-2, and therefore any enforced quarantine based on those test results is unlawful.
- 4. A new study from the Infectious Diseases Society of America, found that at 25 cycles of amplification, 70% of PCR test “positives” are not “cases” since the virus cannot be cultured, it’s dead. And by 35: 97% of the positives are non-clinical.
- 5. PCR is not testing for disease, it’s testing for a specific RNA pattern and this is the key pivot. When you crank it up to 25, 70% of the positive results are not really “positives” in any clinical sense, since it cannot make you or anyone else sick
- Positive tests as they are counted today do not indicate a “case” of anything. They indicate that viral RNA was found in a nasal swab. It may be enough to make you sick, but according to the New York Times and their experts, probably won’t. And certainly not sufficient replication of the virus to make anyone else sick.
- In October we first exposed how PCR Tests have misled officials worldwide into insanely authoritative reactions.
- It identifies people who do not have a viral load capable of making them ill or transmitting the disease to someone else as positive for C19.
- The New York Times reported this flaw on August 29 and said that in the samples they reviewed from three states where labs use a Ct of 37-40, up to 90% of tests are essentially false positives. The experts in that article said a Ct of around 30 would be more appropriate for indicating that someone could be contagious – those for whom contact tracing would make sense.
F. Improved & Potential Treatments
1. Groundbreaking Treatment for Severe C19 Using Stem Cells – “It’s Like Smart Bomb Technology in the Lung”
Umbilical cord-derived mesenchymal stem cells naturally migrate directly to the lung where they begin repair to C19 damage.
- University of Miami Miller School of Medicine researchers led a unique and groundbreaking randomized controlled trial showing umbilical cord derived mesenchymal stem cell infusions safely reduce risk of death and quicken time to recovery for the severest C19 patients, according to results published in STEM CELLS Translational Medicine in January 2021.
- The study’s senior author, Camillo Ricordi, M.D., director of the Diabetes Research Institute (DRI) and Cell Transplant Center at the University of Miami Miller School of Medicine, said treating C19 with mesenchymal stem cells makes sense.
Results: treatment group vs. control group
- The paper describes findings from 24 patients hospitalized at University of Miami Tower or Jackson Memorial Hospital with C19 who developed severe acute respiratory distress syndrome. Each received two infusions given days apart of either mesenchymal stem cells or placebo.
- “It was a double-blind study. Doctors and patients didn’t know what was infused,” Dr. Ricordi said. “Two infusions of 100 million stem cells were delivered within three days, for a total of 200 million cells in each subject in the treatment group.”
- Researchers found the treatment was safe, with no infusion-related serious adverse events.
- Patient survival at one month was 91% in the stem cell treated group versus 42% in the control group. Among patients younger than 85 years old, 100% of those treated with mesenchymal stem cells survived at one month.
- Dr. Ricordi and colleagues also found time to recovery was faster among those in the treatment arm. More than half of patients treated with mesenchymal stem cell infusions recovered and went home from the hospital within two weeks after the last treatment. More than 80% of the treatment group recovered by day 30, versus less than 37% in the control group.
- “The umbilical cord contains progenitor stem cells, or mesenchymal stem cells, that can be expanded and provide therapeutic doses for over 10,000 patients from a single umbilical cord. It’s a unique resource of cells that are under investigation for their possible use in cell therapy applications, anytime you have to modulate immune response or inflammatory response,” he said. “We’ve been studying them with our collaborators in China for more than 10 years in Type 1 Diabetes, and there are currently over 260 clinical studies listed in clinicaltrials.gov for treatment of other autoimmune diseases.”
Mesenchymal stem cells potential to restore normal immune response
- Mesenchymal cells not only help correct immune and inflammatory responses that go awry, they also have antimicrobial activity and have been shown to promote tissue regeneration.
- “Our results confirm the powerful anti-inflammatory, immunomodulatory effect of UC-MSC. These cells have clearly inhibited the ‘cytokine storm’, a hallmark of severe C19,” said Giacomo Lanzoni, Ph.D, lead author of the paper and assistant research professor at the Diabetes Research Institute. “The results are critically important not only for C19 but also for other diseases characterized by aberrant and hyperinflammatory immune responses, such as autoimmune Type 1 Diabetes.”
- When given intravenously, mesenchymal stem cells migrate naturally to the lungs. That’s where therapy is needed in C19 patients with acute respiratory distress syndrome, a dangerous complication associated with severe inflammation and fluid buildup in the lungs.
- “It seemed to me that these stem cells could be an ideal treatment option for severe C19,” said Dr. Ricordi, Stacy Joy Goodman Professor of Surgery, Distinguished Professor of Medicine, and professor of biomedical engineering, microbiology and immunology. “It requires only an intravenous (IV) infusion, like a blood transfusion. It’s like smart bomb technology in the lung to restore normal immune response and reverse life-threatening complications.”
Early success with mesenchymal stem cells
- When the pandemic emerged, Dr. Ricordi asked collaborators in China if they had studied mesenchymal stem cell treatment in C19 patients. In fact, they and Israeli researchers reported great success treating C19 patients with the stem cells, in many cases with 100% of treated patients surviving and recovering faster than those without stem cell treatment.
- But there was widespread skepticism about these initial results, because none of the studies had been randomized, where patients randomly received treatment or a control solution (placebo), to compare results in similar groups of patients.
- “We approached the FDA and they approved our proposed randomized controlled trial in one week, and we started as quickly as possible,” Dr. Ricordi said.
- Dr. Ricordi worked with several key collaborators at the Miller School, the University of Miami Health System, Jackson Health System, and collaborated with others in the U.S. and internationally, including Arnold I. Caplan, Ph.D., of Case Western Reserve University, who first described mesenchymal stem cells.
- The next step is to study use of the stem cells in C19 patients who have not yet become severely ill but are at risk of having to be intubated, to determine if the infusions prevent disease progression.
- The findings have implications for studies in other diseases, too, according to Dr. Ricordi.
- Hyper-immune and hyper-inflammatory responses in autoimmune diseases might share a common thread with why some C19 patients transition to severe forms of the disease and others don’t.
- “Autoimmunity is a big challenge for healthcare, as is C19. Autoimmunity affects 20% of the American population and includes over 100 disease conditions, of which Type 1 Diabetes can be considered just the tip of the iceberg. What we are learning is that there may be a common thread and risk factors that can predispose to both an autoimmune disease or to a severe reaction following viral infections, such as the coronavirus (SARS-CoV-2),” he said.
- The DRI Cell Transplant Center is planning to create a large repository of mesenchymal stem cells that are ready to use and can be distributed to hospitals and centers in North America, he said.
- “These could be used not only for C19 but also for clinical trials to treat autoimmune diseases, like Type 1 Diabetes,” Dr. Ricordi said. “If we could infuse these cells at the onset of Type 1 Diabetes, we might be able to block progression of autoimmunity in newly diagnosed subjects, and progression of complications in patients affected by the disease long-term. We are planning such a trial specifically for diabetes nephropathy, a kidney disease that is one of the major causes of dialysis and kidney transplantation. We are also planning to do a study on umbilical cord mesenchymal stem cell transplantation in combination with pancreatic islets to see if you can modulate the immune response to an islet transplant locally.”
- Funding by The Cure Alliance made launching the initial trial possible, while a $3 million grant from North America’s Building Trades Unions (NABTU) allowed Dr. Ricordi and colleagues to complete the clinical trial and expand research with mesenchymal stem cells.
- “North America’s Building Trades Unions (NABTU) has been a major supporter of the Diabetes Research Institute since 1984, when they started a campaign to fund, and build, our state-of-the-art research and treatment facility. NABTU has continued to support our work through the years, including our mesenchymal stem cell research that helped lead the way to this clinical trial,” he said.
2. C19 unmasked: math model suggests optimal treatment strategies
- Getting control of C19 will take more than widespread vaccination; it will also require better understanding of why the disease causes no apparent symptoms in some people but leads to rapid multi-organ failure and death in others, as well as better insight into what treatments work best and for which patients.
- To meet this unprecedented challenge, researchers at Massachusetts General Hospital (MGH), in collaboration with investigators from Brigham and Women’s Hospital and the University of Cyprus, have created a mathematical model based on biology that incorporates information about the known infectious machinery of the coronavirus (SARS-CoV-2) and about the potential mechanisms of action of various treatments that have been tested in patients with C19.
- The model and its important clinical applications are described in the journal Proceedings of the National Academy of Sciences (PNAS).
- “Our model predicts that antiviral and anti-inflammatory drugs that were first employed to treat C19 might have limited efficacy, depending on the stage of the disease progression,” says corresponding author Rakesh K. Jain, PhD, from the Edwin L. Steele Laboratories in the Department of Radiation Oncology at MGH and Harvard Medical School (HMS).
- Jain and colleagues found that in all patients, the viral load (the level of SARS-CoV-2 particles in the bloodstream) increases during early lung infection, but then may go in different directions starting after Day 5, depending on levels of key immune guardian cells, called T cells. T cells are the first responders of the immune system that effectively coordinate other aspects of immunity. The T cell response is known as adaptive immunity because it is flexible and responds to immediate threats.
- In patients younger than 35 who have healthy immune systems, a sustained recruitment of T cells occurs, accompanied by a reduction in viral load and inflammation and a decrease in nonspecific immune cells (so-called “innate” immunity). All of these processes lead to lower risk for blood clot formation and to restoring oxygen levels in lung tissues, and these patients tend to recover.
- In contrast, people who have higher levels of inflammation at the time of infection — such as those with diabetes, obesity or high blood pressure — or whose immune systems are tilted toward more active innate immune responses but less effective adaptive immune responses tend to have poor outcomes.
- The investigators also sought to answer the question of why men tend have more severe C19 compared with women, and found that although the adaptive immune response is not as vigorous in women as in men, women have lower levels of a protein called TMPRSS2 that allows SARS-CoV-2 to enter and infect normal cells.
- Based on their findings, Jain and colleagues propose that optimal treatment for older patients — who are likely to already have inflammation and impaired immune responses compared with younger patients — should include the clot-preventing drug heparin and/or the use of an immune response-modifying drug (checkpoint inhibitor) in early stages of the disease, and the anti-inflammatory drug dexamethasone at later stages.
- In patients with pre-existing conditions such as obesity, diabetes and high blood pressure or immune system abnormalities, treatment might also include drugs specifically targeted against inflammation-promoting substances (cytokines, such as interleukin-6) in the body, as well as drugs that can inhibit the renin-angiotensin system (the body’s main blood pressure control mechanism), thereby preventing activation of abnormal blood pressure and resistance to blood flow that can occur in response to viral infections.
- This work shows how tools originally developed for cancer research can be useful for understanding C19: The model was first created to analyze involvement of the renin angiotensin system in the development of fibrous tissues in tumors, but was modified to include SARS-CoV-2 infection and C19-specific mechanisms. The team is further developing the model and plans to use it to examine the dynamics of the immune system in response to different types of C19 vaccines as well as cancer-specific comorbidities that might require special considerations for treatment.
3. Arthritis drugs could help save lives of Covid patients
- Two drugs used to treat rheumatoid arthritis could help to save the lives of one in 12 intensive care patients with severe Covid, researchers have found.
- The NHS will begin using tocilizumab to treat coronavirus patients from Friday, health officials said after results from about 800 patients confirmed the drug brings benefits, potentially cutting the relative risk of death by 24%.
- Another arthritis drug, sarilumab, appears to do the same, not only saving lives but cutting the length of time patients spent in intensive care.
- Early results from an international trial previously suggested tocilizumab might improve outcomes for those with life-threatening coronavirus infections. However, other trials reported mixed results.
- Both tocilizumab and sarilumab are what are known as IL-6 receptor antagonists, which dampen down the effect of proteins that can cause an overreaction of the immune system. Severe Covid has previously been linked to dangerous levels of inflammation in the body.
- The new results, which have not yet undergone peer review, come from a clinical trial known as Remap-Cap (the randomized embedded multifactorial adaptive platform for community-acquired pneumonia) that involves more than 3,900 Covid patients in 15 countries around the world.
- The results from 792 patients across six countries reveal that tocilizumab and sarilumab reduced the risk of death.
- While hospital mortality stood at 35.8% for patients given standard care, it was 28.0% for tocilizumab and 22.2% for sarilumab. Combining the results for the two drugs gave a hospital mortality of 27.3% – an 8.5 percentage point drop in absolute risk of death, or a 24% relative reduction – compared with the group who had standard care.
- “Treat 12 patients and you save one life,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the trial behind the findings. “[That’s] a big effect.”
- The team also found those given tocilizumab or sarilumab recovered more quickly, leaving intensive care about seven to 10 days earlier than those who had standard care.
- Peter Horby, professor of emerging infectious diseases and global health at Oxford University, who leads the Recovery trial to test drugs for treating Covid patients but was not involved in Ramap-Cap, said the results were good news, noting that until now only the steroids dexamethasone and hydrocortisone have been found to save lives among Covid patients on ventilators. Such drugs also act to suppress inflammation and the immune system.
- With about 80% of the patients in the Remap-Cap trial also given dexamethasone or another steroid, Horby said it appears that tocilizumab and sarilumab provide an additional benefit.
- “We saw an absolute reduction in the risk of death in mechanically ventilated patients of about 12% with dexamethasone [in the Recovery trial], and here you are seeing an absolute reduction of about 8% – that would seem to be on top of the [effect of] dexamethasone,” said Horby.
4. Blood Plasma Reduces Risk of Severe C19 if Given Early
- A small but rigorous clinical trial in Argentina has found that blood plasma from recovered C19 patients can keep older adults from getting seriously sick with the coronavirus — if they get the therapy within days of the onset of the illness.
- The results of the study, here, in the New England Journal of Medicine, are some of the first to conclusively point toward the oft-discussed treatment’s beneficial effects..
- Convalescent plasma, the pale yellow liquid left over after blood is stripped of its red and white cells, teems with disease-fighting molecules called antibodies.
- In 80 people, an infusion of plasma decreased the risk of developing a severe case of Covid by 48 percent, compared with another group of 80 who received a saline solution instead, the study found. But the study’s parameters were strict: Everyone enrolled in the trial was at least 65 years old — a group known to be at higher risk of falling seriously ill. About half of the participants also had health conditions that made them more vulnerable to the virus. And the plasma therapy, which was screened to ensure it contained high levels of antibodies, was always given within three days of when the patients started to feel symptoms.
- “I think it’s becoming clear now that the earlier you catch this infection, the more likely you are to stave off disease,” said Dr. Taia Wang, an immunologist at Stanford University who wasn’t involved in the study.
- Some experts pointed out that the benefits of convalescent plasma may be difficult to study and capitalize on, since most people’s illnesses are too far along by the time they seek medical care.
G. Concerns & Unknowns
1. Antibody drugs may not be as effective toward South African C19 strain
- The former FDA chief is warning Americans that getting the C19 shot is extremely necessary, especially since it appears antibody drugs might not be as effective against the new coronavirus strain that was found in South Africa.
- “The South Africa variant is very concerning right now because it does appear that it may obviate some of our medical countermeasures, particularly the antibody drugs,” Dr. Scott Gottlieb said in an interview on CNBC’s “The News with Shepard Smith” on Tuesday. “Right now that strain does appear to be prevalent in South America and Brazil, the two parts of the world, right now, they are in their summer, but also experiencing a very dense epidemic, and that’s concerning.”
- The South African strain, known as 501.V2, began replacing other strains of the coronavirus as early as November, but the spread was not detected by South African officials until mid-December, The Scientist reported.
- Gottlieb urged to continue vaccinating people in the first-tier category at a faster pace and to expand vaccination sites so more Americans could get the shot.
- “It really is a race against time trying to get more vaccine into people’s arms before these new variants become more prevalent here in the United States,” Gottlieb told CNBC.
- More than 17 million doses of the coronavirus vaccine has been distributed across the country, but, so far, over 5.3 million Americans have been vaccinated, according to the Centers for Disease Control and Prevention.
2. C19 infection linked with higher death rate in acute heart failure patients
- Patients with acute heart failure nearly double their risk of dying if they get C19, according to research published today in ESC Heart Failure, a journal of the European Society of Cardiology (ESC). The small, single centre study highlights the need for patients with heart failure to take extra precautions to avoid catching C19.
- “Our results support prioritizing heart failure patients for C19 vaccination once it is available,” said study lead investigator Dr. Amardeep Dastidar, a consultant interventional cardiologist at North Bristol NHS Trust and Bristol Heart Institute, UK. “In the meantime, heart failure patients of all ages should be considered a high-risk group and be advised to maintain social distance and wear a face mask to prevent infection.”
- Heart failure refers to progressive weakening of the heart’s pump function with symptoms of breathlessness, ankle swelling and fatigue. Sudden and severe worsening of symptoms is called acute heart failure – this is a medical emergency and requires admission to hospital for intravenous medication and intensive monitoring.
- This study examined referral rates for acute heart failure during the pandemic and 30-day mortality. The analysis included 283 patients with acute heart failure admitted to the cardiology department of North Bristol NHS Trust. Two-thirds of the patients had chronic heart failure and presented with an acute deterioration. The date of the first UK coronavirus death, 2 March 2020, was the cut-off to define two groups: before-COVID (7 January to 2 March; eight weeks) and after-COVID (3 March to 27 April; eight weeks; i.e. during the pandemic).
- There was a substantial, but statistically non-significant, drop in admissions for acute heart failure during the pandemic. A total of 164 patients were admitted in the eight weeks before-COVID compared to 119 patients after-COVID – a 27% reduction (p=0.06).
- “This finding may reflect public concerns about social distancing at the start of the national lockdown, delayed reporting of symptoms, and anxiety regarding hospital attendance,” said Dr. Dastidar. “In support of these explanations, our data demonstrate an increase in referrals during the later weeks of lockdown in line with UK media reports encouraging patients to seek medical attention if needed.”
- The 30-day mortality rate of patients with acute heart failure nearly doubled during the pandemic. Some 11% of patients in the before-COVID group died within 30 days compared to 21% of the after-COVID group – a relative risk of 1.9 (95% confidence interval 1.09-3.3).
- The researchers examined what factors may have been responsible for the higher death rate during the pandemic. Older age and admission during the pandemic were linked with death after adjusting for other factors that could influence the relationship, with hazard ratios of 1.04 and 2.1, respectively. When patients with a positive COVID test were removed from the analysis, there was no difference in mortality between the before- and after-COVID groups – indicating that patients with both acute heart failure and C19 had a poorer prognosis.
- “This may suggest a direct interaction or susceptibility to worse outcomes for acute heart failure patients with superimposed COVID infection,” said Dr. Dastidar. “It is noteworthy that our region had very low rates of COVID infection during the study and yet a connection with higher mortality was still apparent.”
- Dr. Dastidar pointed out that routine testing for C19 infection was not in place at the time of the study. He said: “It would be informative to review more recent admissions when COVID testing was more widely implemented to further support our findings. As this was a single centre study, it would be valuable to confirm the findings in a countrywide analysis. Additionally, we are keen to review longer term data to look for patterns of prognosis at later stages in this patient population.”
3. Potential Long-Term Effects of C19 on Brain and Nervous System
- “Since the flu pandemic of 1917 and 1918, many of the flulike diseases have been associated with brain disorders,” said lead author Gabriel A. de Erausquin, MD, PhD, Msc, professor of neurology in the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio. “Those respiratory viruses included H1N1 and SARS-CoV. The coronavirus (SARS-CoV-2), which causes C19, is also known to impact the brain and nervous system.”
- Dr. de Erausquin, an investigator with the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio, said it is becoming clear that the damage done by the pandemic will not be limited to acute effects, such as delirium in the hospital, but will have chronic consequences that impact many individuals’ quality of life and independence.
- The question is to what degree and under what form. Even mild C19 infections may have negative effects on the brain long term, Dr. de Erausquin said.
- “As the Alzheimer’s & Dementia article points out, the under-recognized medical history of these viruses over the last century suggests a strong link to brain diseases that affect memory and behavior,” said Maria C. Carrillo, PhD, Alzheimer’s Association chief science officer and a coauthor on the paper. “In this difficult time, we can create a ‘silver lining’ by capitalizing on the Alzheimer’s Association’s global reach and reputation to bring the research community together to illuminate C19’s long-term impact on the brain.”
Urgently needed international study
- The Alzheimer’s Association is funding the initial work of a consortium of experts from more than 30 countries to understand how C19 increases the risk, severity, pace and progression of neurodegenerative diseases such as Alzheimer’s and psychiatric diseases including depression. Consortium members will enroll study participants selected from a pool of millions of confirmed C19 cases documented in hospitals worldwide. A second group of enrollees will consist of people participating in existing international research studies. Participants will be evaluated on a host of measures at their initial appointment and again at six, nine and 18 months. These measures include cognition, behavior and, when possible, brain volumes measured by magnetic resonance imaging.
Infiltrating the brain
- The coronavirus is known to enter cells via receptors called ACE2. The highest concentration of ACE2 receptors is in the olfactory bulb, the brain structure involved in the sense of smell.
- “The basic idea of our study is that some of the respiratory viruses have affinity for nervous system cells,” said senior author Sudha Seshadri, MD, professor of neurology in the Long School of Medicine at UT Health San Antonio and director of the Glenn Biggs Institute. “Olfactory cells are very susceptible to viral invasion and are particularly targeted by SARS-CoV-2, and that’s why one of the prominent symptoms of C19 is loss of smell.”
- The olfactory bulb connects with the hippocampus, a brain structure primarily responsible for short-term memory.
- “The trail of the virus, when it invades the brain, leads almost straight to the hippocampus,” Dr. de Erausquin said. “That is believed to be one of the sources of the cognitive impairment observed in C19 patients. We suspect it may also be part of the reason why there will be an accelerated cognitive decline over time in susceptible individuals.”
The authors point out that:
- Intranasal administration of SARS-CoV-2 in mice results in rapid invasion of the brain.
- Headache, hypogeusia (reduced ability to taste) and anosmia (loss of smell) appear to precede the onset of respiratory symptoms in the majority of affected patients.
- SARS-CoV-2 can be found in the brain post-mortem.
- Abnormal brain imaging that may be characterized by the appearance of lesions in different brain regions – and the appearance of other abnormal brain changes that may influence clinical presentation – has emerged as a major feature of C19 from all parts of the world.
- Abnormal imaging was seen in an individual whose only symptom was loss of smell.
- The study will collect information over the next two to three years. Initial results are expected in early 2022 for the first set of evaluations. The consortium is aided by technical guidance from the World Health Organization.
H. The Road Back?
1. How to Stop the Next Pandemic
- C19 has reminded the world of the ever-present threat posed by viruses. From universal vaccines to miniature organs that can assess the lethality of a virus, scientists are racing to find new solutions that can prevent future disasters from happening. Here we look at three of the most innovative ideas for stopping the next pandemic before it begins.
A universal coronavirus vaccine
- In May 2020, Matthew Memoli, director of the US National Institutes of Health’s (NIH) Laboratory of Infectious Diseases, published a comment piece in the journal Nature in which he urged the scientific community not to repeat the mistakes of the past.
- While vaccine developers across the globe were racing to develop a vaccine for C19 – as of August 2020, there were more than 170 such vaccines in development – Memoli argued this was not enough. Instead, he outlined a more ambitious target. “We must go further,” he wrote. “We must work towards a universal coronavirus vaccine with broad protection against a diverse number of coronaviruses.”
- Memoli’s reasoning is that history has a habit of repeating itself. From SARS to MERS to the SARS-CoV-2 virus behind C19, the world has now been rocked by three major coronavirus outbreaks of increasing severity. Each time, scientists and policymakers have tended to focus entirely on the problem at hand, at the expense of planning for the future.
- Speaking from his office in Bethesda, Maryland, Memoli says we need to keep the bigger picture in mind. As devastating as C19 has been, future coronaviruses may pose far greater threats. “Just focusing on this individual virus to me is a mistake,” he says. “At the same time we need to be thinking about the future. Even if we come up with a great vaccine for this virus, that doesn’t necessarily mean we’re going to be ready for the next one.”
- The concept of a universal vaccine – one which can protect against many different coronavirus strains – may seem far-fetched, but it isn’t a completely new idea. In the early 1990s, a group of scientists at Norden Laboratories – the Pennsylvania-based animal health division of pharma company SmithKline Beecham, now GSK – came up with the ambitious plan of developing a vaccine that could protect cats from multiple coronaviruses. Back then, the commercial interest in coronaviruses came not from their threat to humans but to animals, as there are various strains which can be harmful to household pets.
- Norden’s team, which dubbed themselves “gene jockeys” due to their expertise in cloning genes from various pathogenic viruses, got as far as filing a patent for the proposed vaccine, but the project nosedived in clinical trials with the vaccine failing to demonstrate any protective ability. However, it left in its wake a key lesson. Achieving effective protection against more than one strain of coronavirus – whether in animals or humans – would be a complex task, likely requiring inducing an immune response broader than neutralising antibodies.
- “We thought we could stimulate an antibody response to a spike protein [a common target of coronavirus vaccines] that would protect against different feline coronaviruses,” says Elaine Jones, one of the original Norden scientists and now an executive who sits on the boards of multiple biotech companies. “But this approach alone was not sufficient to get the right long-lived immunity.”
- Two decades on, the first hints that a universal coronavirus vaccine might be viable came from scientists studying the MERS coronavirus, shortly after it had caused a large outbreak in the Middle East in 2012. Keith Grehan, then a PhD candidate at the University of Kent and now a researcher in molecular biology at the University of Leeds, was intrigued to know whether blood samples taken from survivors of the SARS coronavirus outbreak in the early 2000s exhibited any kind of immune response to this new virus.
- To his surprise, Grehan discovered that approximately a quarter of SARS patients had neutralising antibodies in their blood against MERS. When he compared the protein sequences of the two viruses, he found that there was some overlap. In one particular region of the spike protein, 40 per cent of amino acids were conserved between SARS and MERS. Grehan was even more intrigued when he discovered a further overlap across SARS, MERS and the OC43 and HKU1 coronaviruses which are linked to common colds.
- To him, this suggested that it might be possible to develop a vaccine which could induce an immune response across many coronavirus strains. But by 2016, fears of MERS had waned, and funding for the project had all but disappeared. As he puts it: “Going to a pharma company saying ‘We have a vaccine that potentially protects against some colds, plus if people happen to be near a camel and catch MERS, they’ll also be protected’ wasn’t really a great commercial proposition back then.”
- Four years later, the landscape for such vaccines could not be more different.
The second wave of coronavirus vaccines
- A second wave of coronavirus vaccines, aimed at more than just C19, are in the pipeline, including from Belgian startup myNEO, Canadian pharma company VBI, an initiative led by the Chinese Center for Disease Control and Prevention and an NIH-funded program led by Memoli.
- These will take a little longer to hit the market – all are still in preclinical development with human testing planned for early 2021, while some C19 vaccines are already at the final stage of trials before clinical approval – but, if successful, their broader applicability could make them more useful in the long run.
- “We hope these vaccines will offer added value by protecting against more coronaviruses, including if the current strain causing C19 mutates,and by offering longer-term immunity,” says Cedric Bogaert, co-founder and CEO of myNEO.
- All these programmes are looking to build on what Grehan discovered with SARS and MERS, namely that when you probe the protein sequences of the coronaviruses known to infect humans, there are a number of similarities. The main question is how best to exploit them.
- When Memoli penned his paper in May, he already had an idea in mind, having devoted more than a decade to the ongoing search for a universal influenza vaccine. As the Norden scientists had found in the early 90s, he had learnt that making a successful broad spectrum vaccine likely requires inducing different aspects of immunity, such as training T cells to recognise tell-tale indicators of these viral strains.
- T cells are thought to be particularly vital, as once they have learned to recognise a virus, they generate copies of themselves which remember the pathogen and remain dormant until a future encounter. A vaccine that stimulates this part of the immune system, as well as trying to induce an antibody response, is more likely to offer protection across different coronavirus strains, and in different age groups and populations around the world. Such is the importance of T cell responses that several C19 specific vaccines in development stimulate them.
- “The beauty of the T cell response is that it tends to have benefits in the elderly where their antibody responses and antibody immune memory isn’t as strong,” explains Memoli. “We want to use as many aspects of immunity as we can, so there are lots of ways the virus could be attacked to reduce disease.”
- T cells can be trained to recognise internal components of coronaviruses which mutate less and so are more likely to be similar between different strains.
- These internal proteins are notoriously more difficult to target, but in recent years scientists working on flu vaccines have figured out ways to reach them by injecting parts of a virus’ RNA or DNA into bodily cells, causing them to expose these proteins at their surface where they can be recognised by the immune system.
- Continue reading the article on Wired UK by clicking on the link below.
I. Back to School!?
1. Where Is It Safe To Reopen Schools?
- Since the beginning of this pandemic, experts and educators have feared that opening schools would spread the coronavirus further, which is why so many classrooms remain closed. But a new, nationwide study suggests reopening schools may be safer than previously thought, at least in communities where the virus is not already spreading out of control.
- The study comes from REACH, the National Center for Research on Education Access and Choice, at Tulane University. Up to this point, researchers studying the public health effects of school reopening have focused largely on positivity rates. As in, did the rate of positive coronavirus tests among kids or communities increase after schools reopened?
- The REACH researchers worried that testing in the U.S., especially among children, is still too varied and unpredictable. Instead, Susan Hassig, a Tulane epidemiologist who worked on the study, says they focused on hospitalization rates as a more reliable indicator of virus spread. It’s easy to imagine infections going undetected in communities with spotty testing, Hassig says, but “if you get infected with coronavirus and you become substantially ill, you’re going to become hospitalized.” Mining nationwide data from 2020, she and her colleagues looked to see if more people ended up in the hospital after nearby schools reopened.
- Their findings tell two different stories, says Engy Ziedan, a Tulane economist on the team. First, for communities where hospitalization rates were already relatively low, “when [schools] opened in-person or hybrid mode, we did not see increases in hospitalizations post-re-opening.” This applies to communities with fewer than 36 to 44 hospitalizations per 100,000 people, or, as of mid-December, 58% all U.S. counties, according to the researchers.
- In fact, in many of these communities, hospitalizations appeared to go down after schools reopened — perhaps because of rules and norms around social distancing and wearing masks that kids may not be following at home.
- The other story the researchers found was that it’s harder to know how reopening schools may have impacted communities where hospitalization rates were higher, because the virus was more pervasive. In some cases, school reopenings did appear to make matters worse. In other cases, the opposite was true. In the end, for these harder-hit communities, the researchers say their results were inconclusive.
- The study also comes with a few important caveats. The data analysis was conducted before a new, more contagious strain of the coronavirus had been documented in the U.S. Also, the researchers note that most schools that currently offer in-person education are also offering a remote option, which means many schools that have technically reopened are still operating with far fewer students in their buildings than before the pandemic. That makes it easier for educators to keep students socially distanced in smaller classes and to enforce wearing masks. A return of all students and teachers to school buildings would conceivably be more difficult to accomplish without compromising safety.
- Harris says the public health risks posed by C19 are tangible and have received considerable attention, but communities must also weigh them against the less obvious public health risks of not reopening schools — to kids’ mental health, of child abuse going unreported, not to mention learning loss and caregivers having to drop out of the workforce and falling deeper into poverty. And because the facts vary so wildly from city to city, county to county, town to town, Harris says, this cannot be a one-size-fits-all national reckoning — but a local decision driven by local facts.
- The study can be read here: https://www.reachcentered.org/publications/the-effects-of-school-reopenings-on-C19-hospitalizations
J. Innovation & Technology
1. Hand-Held Particle Detector Measures Aerosols for Coronavirus Risk Assessment
A plot showing how much the aerosol from a sneeze spreads in each direction. Credit: Daniel Bonn, University of Amsterdam
- Because of the role they play in coronavirus transmission, understanding aerosol concentrations and persistence in public spaces can help determine infection risks. However, measuring these concentrations is difficult, requiring specialized personnel and equipment.
- That is, until now.
- Researchers from the Cardiology Centers of the Netherlands and the University of Amsterdam demonstrate that a commercial hand-held particle counter can be used for this purpose and help determine the impacts of risk-reducing measures, like ventilation improvements. They describe the quick and easy, portable process in the journal Physics of Fluids, from AIP Publishing.
- The key challenge with using hand-held particle counters is dealing with the background dust prevalent in public spaces. The question then becomes, can you distinguish these dust particles from aerosols that arise from breathing, speaking, sneezing, and coughing?
- Because dust and aerosols inhaled into human lungs differ in size, the researchers developed a way to subtract the dust signal in the particle counter by measuring the dust for some time, and watching how the signal changes after aerosols are added to the mix.
- “There’s a lot of fine dust, so we can’t really measure aerosols in that range, but there’s a reasonable sized range where you can detect the aerosols,” said Daniel Bonn, one of the authors.
- They compared the aerosol concentration determined by this method to laboratory-based techniques and found the results match up perfectly. Though this work reports on one specific hand-held particle counter — the Fluke 985, which is used to monitor the dust and air quality in clean rooms — Bonn noted the results aren’t unique to this device and can be extended to other particle counters as well.
- Though the method does not directly measure the presence of viral particles, the detected aerosol concentration can be combined with virus data from other studies to obtain a practical risk assessment for a specific type of public space. The findings suggest well-ventilated areas can have aerosol concentrations more than 100 times lower than poorly ventilated areas, such as public elevators or restrooms.
- “There are people worried about going to the gym, coming to the office, taking the train. All that can at least be evaluated,” Bonn said. “The motto remains ventilation, ventilation, ventilation.”
- He said while ventilation plays a large role in indoor spaces, aerosols are not the only route to infection, and social distancing and hand-washing remain vital.
K. Projections & Our (Possible) Future
1. Cutting C19 Infectious Period – Even by Just 1 Day – Could Prevent Millions of Cases
Results from PHICOR’s computational simulation model show reductions in the contagious period of C19 could avert thousands of hospitalizations and millions of cases and save billions of dollars.
- A new computational analysis suggests that a vaccine or medication that could shorten the infectious period of C19 may potentially prevent millions of cases and save billions of dollars. The study was led by Bruce Lee along with colleagues in the Public Health Informatics, Computational, and Operations Research (PHICOR) team headquartered at the CUNY Graduate School of Public Health and Health Policy and the Lundquist Research Institute at Harbor-UCLA Medical Center, and publishes in the open-access journal PLOS Computational Biology.
- While much of the public conversation surrounding C19 vaccines and medications has focused on preventing or curing the infection, the vaccines and medications that may emerge could have subtler effects. Those that can’t necessarily prevent or cure may still reduce how long someone is contagious.
- To clarify the potential value of shortening the infectious period, Lee and colleagues created a computational model that simulates the spread of the coronavirus (SARS-CoV-2). They used the model to explore how a vaccine or medication that can reduce the contagious period might alleviate the clinical and economic impact of the disease.
- The simulations suggest that reducing the contagious period by half a day could avert up to 1.4 million cases and over 99,000 hospitalizations, saving $209.5 billion in direct medical and indirect costs — even if only a quarter of people with symptoms were treated — and incorporating conservative estimates of how contagious the virus may be. Under the same circumstances, cutting the contagious period by 3.5 days could avert up to 7.4 million cases. Expanding such treatment to 75 percent of everyone infected could avert 29.7 million cases and save $856 billion.
- These findings could help guide research and investments into development of vaccines or medications that reduce the infectious period of SARS-CoV-2. They could also help government agencies plan rollout of such products and provide cost insights to guide reimbursement policies for third-party payers.
- “There may be a tendency to overlook vaccines and other treatments that don’t prevent a C19 infection or cure disease,” says Lee. “But this study showed that even relatively small changes in how long people are contagious can significantly affect the transmission and spread of the virus and thus save billions of dollars and avert millions of new cases.”
- “This study shows that vaccine and medication development efforts for C19 should focus on the impact to actually help curb the spread of the C19 pandemic, not just benefits of a single patient,” says James McKinnell, a co-author of the study. “Widespread treatment, in combination with other prevention efforts, could prove to be the tipping point.”
2. Model estimates more than 50% of Coronavirus is from people without symptoms
- Under a range of assumptions of presymptomatic transmission and transmission from individuals with infection who never develop symptoms, the model presented here estimated that more than half of transmission comes from asymptomatic individuals.
- For full study, see https://media.jamanetwork.com/
3. US COVID cases, deaths far higher than reported
- An estimated 14.3% of the US population had antibodies against C19 by mid-November 2020, suggesting that that the virus has infected vastly more people than reported—but still not enough to come close to the proportion needed for herd immunity, according to a study published today in JAMA Network Open.
- In the cross-sectional study, researchers from study sponsors Pfizer and Merck analyzed data from random community seroprevalence surveys and five such regional and national Centers for Disease Control and Prevention (CDC) surveys to estimate infection underreporting multipliers. Seroprevalence surveys reveal the proportion of a population that has antibodies against a certain disease, such as C19.
- After adjusting for underreporting using validated multipliers, the analysis revealed an estimated median 46,910,006 infections with SARS-CoV-2, the virus that causes C19; 28,122,752 symptomatic infections; 956,174 hospitalizations; and 304,915 deaths from April to mid-November.
- According to those numbers, 14.3% of Americans had been infected with the novel coronavirus by Nov 15, 8.6% had symptomatic infections, with an infection-hospitalization ratio of 2.0% and a case-fatality ratio for people with symptoms of 1.1%.
- In contrast, the CDC reported 10,846,373 C19 cases and 244,810 deaths in that same time span, with 1,037,962 cases recorded in just the last 7 days of that period (on average, 148,280 new daily reported cases).
Estimated 35% of COVID deaths unreported
- The authors noted that seroprevalence surveys are essential to monitoring progress toward herd immunity, which occurs when roughly 60% of a population has antibodies that can help slow community transmission. In comparison, reported case numbers are underestimates due to many symptomatic people not seeking testing or medical care and the estimated 40% who have no symptoms.
- “The US population remains a long way from herd immunity even with millions of new infections each week,” the researchers wrote. “The number of estimated C19 deaths is also remarkably more than the reported deaths in the US through November 15, 2020, supporting the conclusion that approximately 35% of C19 deaths are not reported.”
- They added that several methodologic issues need to be considered when using seroprevalence surveys to derive underreporting multipliers for the purpose of adjusting disease surveillance data to estimate the burden of illness. These issues include time from infection to antibody development, antibody waning, and reporting of confirmed infections. The multipliers also shift over time with changes in the proportion of the population who have been tested, diagnosed, and reported.
- “A sensitivity analysis of the CDC seroprevalence surveys suggested that using the number of reported cases at the end of the survey period provides a useful estimate of the underreporting multipliers, particularly early in the pandemic,” the authors said. “Therefore, the number of reported cases on the last day of the seroprevalence survey was used in the C19 disease burden estimation in this study.”
- The researchers concluded that surveillance must continue to measure progress toward herd immunity. “Additional seroprevalence surveys are warranted to monitor the pandemic, including after the development of safe and efficacious vaccines,” they said.
1. Lockdown Measures Catastrophic for Recovering Addicts, Mental Health
- Overseeing sober living homes for newly recovering drug addicts is difficult in the best of times. But the endless shutdowns have created conditions that are challenging for healthy people, let alone those who are fresh out of rehab, vulnerable, and still reeling.
- Matt Royce, 35, oversees seven sober-living homes in Minneapolis. All of his houses, each holding between 9 and 13 people, have been “pretty full the whole time.”
- No overdose deaths had occurred in his homes in almost three years, but last summer he lost two people, while another three were revived from overdoses with opioid-blocker Narcan.
- Depression has “skyrocketed” since the lockdowns began, Royce said. Recovering addicts are struggling even more now due to boredom, inability to see family and friends, and lack of social activities.
- “A lot of these guys, they just need the simple things in life. And when they’re prohibited from being able to get those things, it’s tough,” Royce said.
- “Hopefully this changes sooner rather than later, because I can’t even tell you how many times I was dealing with relapses every single day of the week … heavily, heavily from June all the way until about October. It was non stop. It was definitely more than normal, there’s no doubt about that.”
- Nationally, drug overdose deaths are at historic highs.
- In lockstep with widespread shutdown measures, overdose deaths accelerated, especially between March and May last year, according to an emergency health advisory issued by the Centers for Disease Control and Prevention (CDC) on Dec. 17, 2020.
- More than 81,230 people died from a drug overdose between June 1, 2019, and May 31, 2020, the CDC provisional data shows. The final number, which is up 18 percent over the same period the year prior, is expected to be higher.
- “This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded,” the CDC stated.
- “It’s very, very sad what’s going on,” Royce said. “I wish that I could reach in my pocket and give everybody a little piece of what I was able to grasp onto and let everybody know that ‘You’re not in this alone. Just hold on.’”
- Royce will be four years drug-free on Feb. 20.
- He started smoking pot at age 13 and dabbled in “party drugs” such as cocaine and mushrooms until he discovered opioids.
- “I didn’t try drugs just for the fun of it. I tried drugs because I wanted to escape life. And even at 13 years old, I hated life,” he said.
- At 21, an appendix surgery sent Royce into a 10-year spiral with prescription opioid painkillers.
- “They gave me 160 10-milligram percocets—which is insane. I mean, nobody in this world needs that much for the surgery that I went through. I can literally recall back to only needing maybe two or three [pills],” he said.
- “It was literally within the first 20 or 30 of those pills for sure that I was completely hooked. In just under two weeks, that prescription was out and I was able to refill another 100.
- “I was hooked on those things for … 10 straight, miserable years of my life.”
- It was fairly easy for Royce to get his hands on more pills after the refills ran dry, as his extended family was supplying them. That helped keep him out of jail and conviction-free, which is uncommon for a decade-long opioid addiction. It was also one reason he avoided heroin. 80% of new heroin users begin their addiction with painkillers. Eventually the cost gets too high or it’s hard to source the pills, and users turn to heroin.
- “The No. 1 reason I didn’t branch out to heroin was because I was terrified of it. I thought the only way to do heroin was through a needle. If I’d have known that you could’ve snorted it, it’s sad to say, but I most likely would have went to it,” he said. “And if I would have known that $100 of heroin is equivalent to about $400 in pills, I would have probably went to it.”
- Toward the end of his addiction, Royce was taking opioids and methamphetamines. He was living with his girlfriend, also an addict, and their two little girls, aged 5 and 18 months.
- He said he remembers being unable to get up off the couch to make a bowl of cereal for his daughters.
- “I couldn’t even move. I recall my little 1 1/2-year-old walking over to me and rubbing my kneecap saying, ‘Daddy, it’ll be OK. Daddy, it’ll be OK,’ because I’m sitting there bawling my eyes out. Bawling my eyes out in agony and pain, but also bawling my eyes out because I wanted to die. And then bawling my eyes out because I wanted to die in front of my little girls,” he said.
- Like many opioid addicts, Royce perceived death to be a more favorable option than going through withdrawals.
- “In my withdrawals, I would go into convulsions. I would literally shake nonstop until I was able to finally get my fix,” he said.
- “Each drug has its own anchor, but the opiates, I mean, I’ve never felt anything powerful like that before in my life. The only out I saw was death.”
- Royce’s father provided the impetus he needed to change his life.
- “I’ll never forget that morning. My father knocked on the door and he said, ‘Either you get your [expletive] together right now, or I’m taking your kids and you’ll never see them again,’” Royce said. “And I believed my dad, because he’s not one to just say [expletive] and not do it.”
- That morning, Royce made his decision and was taken to a treatment center where he spent four days detoxing and three months in a residential treatment center.
- “I got tired of the pain, I got tired of the darkness. I got tired of hurting. I got tired of all that selfish stuff for myself. But then I got tired of bringing on a darkness and a pain to my daughters. That’s what really, really helped,” he said.
- Royce knew he had to get sober on the first go, because he had seen so many people cycle through the system, relapse after relapse.
- “I see it all the time where people think that they have another round in them, and they don’t,” he said.
- The treatment center Royce attended was a 16-bed facility.
- “I had 15 other peers in there with me, and six of them are dead right now. And only two of them are doing well. The rest are on drugs or in jail still. That’s how powerful this [expletive] is.”
- Royce doesn’t buy into the well-worn narrative that addicts need to go to rehab many times before finally breaking free of drugs.
- “So many people just fall victim to the statistics … blame the statistics in order to screw up again and into thinking that they have another round out there,” he said.
- “No, we don’t have another round in us. And it’s a miracle if somebody does and makes it to treatment again. It’s a miracle.”
- After successfully completing his treatment, Royce moved to a sober living house and was starting to see his girls again. He got a job in a warehouse and played basketball at the local court. But sober living homes can be precarious places. The house manager relapsed and started shooting up heroin with everyone except Royce and one other person.
- Royce begged the treatment center to step in, and they eventually did, making him the house manager. He cleaned up the house, and over the next few months, he realized he was good at counseling the other residents when they came to him.
- At one-year sober, the mindless warehouse job gave way to a job at the treatment center, and Royce knew he’d found his calling. Then days later, one more incident cemented his drive to help other addicts.
- Royce was called home at 11 a.m. one morning to meet with an inspector. Two of his housemates told him that another housemate had been in the bathroom for two hours. Royce knocked on the door. No response. He banged and yelled. No response. He kicked the door down and found the man slumped over the toilet; his face was purple, and he was foaming at the mouth.
- “I grabbed the Narcan and I proceeded to give him three Narcan [shots] in his thigh. And the third Narcan, all of a sudden, I heard him take a gasp of breath. And that, seeing him come to, it brought this overwhelming sense of relief, sadness, and anger all at the same time,” Royce said. The paramedics arrived, and the man survived.
- “I went into a mild panic attack because I couldn’t believe that there was a life that was literally in my hands.
- “I’d never seen an overdose. I’d never seen almost death like that before in my life. So that was very, very fresh to me. And that was for sure the defining moment for me as far as why I do what I do. Not only for myself and my daughters, but for others as well. Because other people have kids and other people have family members that depend on them and that want to see them succeed.”
- Helping others and dealing with those who relapse solidifies Royce’s resolve to never return to that lifestyle. He sees his girls almost every day and has a close relationship with his father, as well as with the girls’ mother (who also got clean).
- “I get to see firsthand how terrible that life still is for everybody that chooses to go back to it,” he said. “Especially once you’re wrapped up in these sober houses and residential treatment and outpatient services, the rock bottoms that guys hit are so much faster than they’ve ever hit before when they choose to go back to that lifestyle, because they’ve already burnt bridges. They’ve already lost their houses, they’ve already lost their jobs, they’ve already lost their cars, their kids, their best friends, their family members.
- “And I see that all the time, unfortunately.”
- Mental health experts have been warning officials for months about the effects that lockdowns have on drug use and suicide rates.
- During a May 19 Cabinet meeting in the White House, Dr. Elinore McCance-Katz implored officials to consider the impact.
- “To put all of this in perspective, I believe it is important to point out that, pre-pandemic, we lose 120,000 lives a year to drug overdose and suicide. How many more lives are we willing to sacrifice in the name of containing the virus?” said McCance-Katz, assistant secretary for mental health and substance abuse at the Substance Abuse and Mental Health Services Administration (SAMHSA). She’s also a psychiatrist and holds a doctorate in infectious disease epidemiology.
- The number of calls to SAMHSA’s Disaster Distress Helpline increased 1,000% for the month of April 2020, compared to April 2019.
- “As a psychiatrist, I would argue that a life lost to suicide is just as important as a life lost to coronavirus,” McCance-Katz said. “I ask that you take into account whole health, not just one narrow aspect of physical health.”
M. Practical Tips & Other Useful Information
1. Looking forwards rather than backwards safeguards wellbeing during C19 lockdowns
- Practicing gratitude and looking to the future will help safeguard our mental wellbeing during C19 lockdowns, a new study in the Journal of Positive Psychology reports.
- In the first study of its kind, researchers from the University of Surrey investigated the effectiveness of three psychological interventions — nostalgia, a sentimentality for the past; gratitude, recognizing the good things currently in our life; and best possible self, thinking about positive elements of the future — and how they each affect wellbeing during lockdowns.
- Personal characteristics such as emotion regulation (the ability to respond to and manage an emotional experience) and attachment orientations (how a person views their relationships to others) were also examined. It is believed that such traits may be an indicator of how an individual responds to lockdowns.
- Investigating which intervention was the most effective, researchers worked with 216 participants who were each assigned to one of four groups, each one practicing either nostalgia, gratitude or best possible self, plus a control group.
- Those practicing a nostalgic approach were instructed to think of a sentimental memory in their life that occurred before the lockdown; for gratitude, participants were encouraged to list three things that went well in their day and why this was; and for best possible self those involved were asked to think about where they imagine themselves in the future after lockdown has lifted. Those in the control group were each asked to recall the plot of a recent television or film they had viewed. Participants were then asked about their thoughts and feelings.
- Researchers found that those who participated in the best possible self and gratitude interventions reported higher levels of social connectedness than those who practiced nostalgia. Those in the best possible self group were also found to experience significantly more positive emotion than those in the nostalgia group. Researchers believe that gratitude and best possible self direct attention towards positive aspects of a person’s life by giving them hope and prevent individuals from dwelling on their current situation.
- Amelia Dennis, a postgraduate researcher at the University of Surrey, said: “All three interventions have proven beneficial to people experiencing a difficult time in their life. However, as lockdowns have continued people have been presented with unusual challenges and many have struggled. We found that looking to the future and appreciating what is positive in our lives currently is more psychologically beneficial than reminiscing about the past.
- “The current restrictions and any future lockdowns have removed our sense of control of our lives. For the sake of our wellbeing, we need to acknowledge what we do have rather than regretting what we have lost.”
- Participants were also surveyed on their personal characteristics regarding attachment and emotion regulation. Researchers found that those with low attachment anxiety (i.e. believe they are worthy of love) and those with lower attachment avoidance (i.e. inclined to feel others are trustworthy) were most likely to experience greater wellbeing during lockdown. Those with higher emotion regulation were also found to be more resilient to their current circumstances, which protects their overall wellbeing.
- Jane Ogden, Professor of Health Psychology at the University of Surrey, said: “The two lockdowns last year dramatically affected our mental and emotional wellbeing and it is likely any future ones will have the same affect. Reports of increased levels of depression and anxiety are worrying because these can negatively impact upon our physical health. It is important that we understand which psychological techniques can most benefit and support people during unsettling and difficult times.”
2. How to mitigate the impact of a lockdown on mental health
- The C19 pandemic is impacting people’s mental health. But what helps and hinders people in getting through a lockdown? A new study led by researchers at the University of Basel addressed this question using data from 78 countries across the world. The results hint at the pivots and hinges on which the individual’s psyche rests in the pandemic.
- At the outset of the C19 pandemic, little was known about the impact of population-wide governmental lockdowns. What was known was taken from restricted quarantines of small groups of people. “On the one hand, such drastic changes to daily routines can be detrimental to mental health,” explains Professor Andrew Gloster from the University of Basel, co-leader of the study now published in PLOS One. “On the other hand, because the entire population was more or less equally affected during the lockdown, it remained unclear whether this impact would occur.”
- To address this question, Gloster and his international colleagues conducted an online survey in 18 languages. Almost 10,000 people from 78 countries participated, giving information about their mental health and overall situation during the C19 lockdown.
- One in ten respondents reported low levels of mental health – including negative affect, stress, depressive behaviors and a pessimistic view of society. Another 50% had only moderate mental health, which has previously been found to be a risk factor for further complications. These figures are consistent with other studies addressing the impact of the pandemic on mental health.
- Overall, the responses in the different surveyed countries were largely similar. However, although no country emerged as either consistently better or worse across all outcomes, there were some differences. Hong Kong and Turkey reported more stress than other countries; the USA reported more depressive symptoms; and well-being was lowest in Hong Kong and Italy. Participants in Austria, Germany and Switzerland, on the other hand, reported significantly fewer negative emotions (negative affect) than the average level across all countries.
- These differences are likely due to a combination of chance, nation-specific responses to the pandemic, cultural differences and factors such as political unrest. Beyond that, they may in part be explained by factors the researchers found to be connected to outcomes. Loss of financial income compared to pre-lockdown levels and not having access to basic supplies were consistently associated with worse outcomes. Factors that consistently improved outcomes were having social support, higher education levels, and being able to respond and adapt flexibly to the situation.
- “Public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Based on these results, interventions that promote psychological flexibility like acceptance and commitment therapy hold promise when it comes to mitigating the impact of the pandemic and lockdowns,” says Gloster. Given the continued fluid development of the pandemic and its economic consequences, attention to people’s mental health remains important.
3. Heading outdoors and switching off devices keeps lockdown blues at bay
- A new study has found that spending time outdoors and switching off our devices is associated with higher levels of happiness during a period of C19 restrictions.
- Previous academic studies have indicated how being outdoors, particularly in green spaces, can improve mental health by promoting more positive body image, and lowering levels of depression and anxiety.
- Jointly led by academics from Anglia Ruskin University (ARU) in the UK, the Karl Landsteiner University of Health Sciences in Austria, and Perdana University in Malaysia, this new research examined how levels of happiness during a national lockdown were affected by being outdoors, the amount of daily screen time (use of TV, computer and smartphone) and feelings of loneliness.
- Using an experience sampling method (ESM), the researchers measured levels of happiness amongst a group of 286 adults three times a day, at random intervals, over a 21-day period. This allowed the participants to provide data in real-time rather than retrospectively, helping to avoid recall biases.
- The research, published in the Journal of Happiness Studies, was carried out in April 2020, when the Austrian participants were allowed to leave their homes only for specific activities, which included exercise.
- It found that levels of happiness were higher when participants were outdoors rather than indoors. In addition, more daily screen time and higher levels of loneliness were both associated with lower levels of happiness. The impact of loneliness on happiness was also weaker when participants were outdoors.
- Co-lead author Viren Swami, Professor of Social Psychology at Anglia Ruskin University (ARU), said: “While lockdowns can help slow down the transmission of C19, research has also shown that prolonged periods of lockdown take their toll on mental health.
- “Our results are important in this context because they show that being able to spend time outdoors under conditions of lockdown has a beneficial impact on psychological wellbeing. Being outdoors provides opportunities to escape from the stresses of being confined at home, maintain social relationships with others, and engage in physical activity – all of which can improve mental health.
- “Our findings have practical health policy implications. Given that further lockdown restrictions have now become necessary in the UK, public health messages that promote getting some fresh air instead of staying indoors and staring at our screens could really help to lift people’s mood this winter.”
4. Why the C19 Pandemic Has Caused a Widespread Existential Crisis
- “The ‘ol quarantine move-in,” a friend joked a couple months ago, when I told her I’d decided to live with my boyfriend of almost two years.
- I can add all the caveats I want—my lease was up and we probably would have moved in together this year anyway—but I know I’m a statistic. I’m just one of the countless people who have made huge life decisions during this massively chaotic and unsettling pandemic year.
- Of course, there is significant privilege in having the time and ability to choose to make a life shift right now, when many people are facing changes they most certainly did not ask for: losses of jobs, savings, homes, friends, family, security. But among those lucky enough to make them voluntarily, life adjustments are coming fast and frequently.
- My Instagram feed feels like a constant stream of engagements, pandemic weddings, moving trucks, career announcements and newly adopted pets. Three of my closest friends decamped from major cities to houses in the suburbs in 2020; one bought a house, got married and decided to change careers over the course of about six months.
- I’m in my late twenties, so to some degree this comes with the territory. But something about the C19 pandemic, about the unending strangeness of the year 2020, seems to have paved the way for even more change than usual. It’s hard to plan two weeks in the future—who knows what will be open, what we’ll feel safe doing—but, with our previous lifestyles already uprooted, it feels easier than ever to plant new ones. My friends and I joke that when we catch up from our respective quarantines, there is either nothing new, or everything.
- We’re not alone. The U.S. population seems to be making changes to the way it lives, works and relates en masse.
- A Pew Research Center poll found that, as of June, 22% of American adults had either moved because of the pandemic or knew someone who did. That trend apparently continued into the fall: About 20% more houses sold in November 2020 compared to November 2019, according to U.S. Census Bureau data. The reasons for that trend are likely many. Among them, months of indoor time seems to have prompted many people to look for homes that offer more space, and those who can work from home suddenly have more freedom to move beyond the commuting distance of an office.
- Meanwhile, about a quarter of U.S. adults said they’re considering a career shift due to the pandemic, found a November report from HR company Morneau Shepell. That’s not surprising, given that traditional workplaces have been partially replaced (at least for now) by teleworking and many people who cannot work from home must grapple with an entirely new risk-benefit analysis associated with clocking in. The numerous Americans who lost jobs in 2020 also have no choice but to reconsider their employment.
- In the world of relationships, jewelers are reporting double-digit increases in engagement ring sales, the Washington Post reported in December. In the 2020 installment of Match’s annual Singles in America report, more than half of respondents said they’re prioritizing dating and rethinking the qualities they search for in a partner, likely sparked by the complete social upheaval of this year.
- It will take years for researchers to fully understand the effect coronavirus had on the U.S. population, and it’s unlikely there will be one single lifestyle shift that characterizes the pandemic. Right now, the dominant trend seems to be change itself. The COVID-19 pandemic appears to have spurred a collective reckoning with our values, lifestyles and goals—a national existential crisis of sorts.
- Freelance journalist and author Nneka Okona has lived in Atlanta for almost five years, but it often didn’t feel that way. Okona, 34, traveled a total of about 100,000 miles in 2019, so she was rarely home. Even when she vowed to take a month or two off from traveling, she’d get antsy and book a last-minute getaway. To say pandemic lockdowns and social distancing changed her lifestyle would be a massive understatement.
- “It was such a drastic change. I realized maybe a couple months into the pandemic that I actually was not doing well, mental-health-wise,” Okona says. She started seeing a therapist, who helped her realize she was suffering depression after slamming the brakes on her action-oriented life.
- Almost a year into the pandemic, Okona says she’s doing much better mentally and reflecting on her life in ways that weren’t possible when she was constantly on the go. “With the movement I was just so distracted,” she says. “It was easier to ignore a lot of things I needed to focus on because I didn’t have time.” Now, she says, she’s thinking critically about where she wants to live, whether she wants to continue freelancing and in what form she’ll continue her travel habit moving forward.
- Reevaluation is a common reaction to sudden, strange stillness like that brought on by the pandemic, says Dr. Elinore McCance-Katz, who leads the U.S. Substance Abuse and Mental Health Services Administration. “It gives people a lot of time to review their lives and think about what life could look like moving forward,” she says. “For many people, that’s not a bad thing, for them to really spend time taking an inventory of what their life is like currently and what they want it to be like.”
- Quarantine also creates a perfect storm for making big decisions, says Jacqueline Gollan, a psychiatry professor at Northwestern University’s Feinberg School of Medicine who studies decision making. Many people are stuck at home for most of their waking hours, watching one day bleed into the next. When it feels like nothing noteworthy is going on, people may try to make things happen.
- “People have a basic bias toward action,” Gollan says. “People will want to take action on something, whatever it is, rather than delay action [even] when that’s the best option.”
- That natural inclination may be ratcheted up even further when people are trying to relieve negative emotions associated with the pandemic, Gollan says. In addition to a general preference for action over inaction, humans are also likely to seek out situations—new relationships, living situations, jobs—that seem like they’ll relieve stress, sadness or other bad feelings. That’s particularly likely during something as emotionally taxing as a pandemic.
- Coronavirus has also reminded people of their own mortality, Gollan says. “People are realizing that life is short, and they’re reprioritizing,” she says. That’s an expected reaction: Studies show that natural disasters and other traumatic events can prompt people to make big decisions like getting married, often in a search for security or comfort.
- Crises can also make people analyze and change their values. People tend to become more religious after natural disasters, research shows, perhaps out of a desire to understand or cope with difficult and inexplicable situations. Similarly, a Pew Research Center report from October 2020 found that 86% of U.S. adults thought there were lesson(s) humankind should learn from the C19 pandemic. When asked to specify what those lessons were, people gave Pew more than 3,700 answers—some practical (the importance of wearing a mask), some spiritual (“We need to pray more and pray harder”) and some personal (we should “value humankind and intimacy”).
- Relationships are often the first thing to get a makeover when people take a hard look at their lives, says Amanda Gesselman, associate director for research at the Kinsey Institute, a research center that focuses on sex and relationships. Gesselman’s research shows many people, particularly those in their twenties and thirties, are spending more time than usual on dating apps during the pandemic, and report having deeper conversations with the people they meet there, compared to before the pandemic.
- “A big trend right now is really focusing on what kind of connections you want,” she says.
- It’s not all warm and fuzzy, though. Rachel Dack, a Maryland-based psychotherapist and relationship coach, says she is indeed seeing many clients think critically about what they want in a relationship—and that leads to breakups and divorces as well as engagements and cohabitations.
- In Match’s recent survey, about a quarter of singles said stay-at-home orders caused them to end a relationship. Some preliminary data also suggest more couples than normal are divorcing this year, though not all researchers agree with that assessment.
- For every relationship moving forward, Dack says, another seems to be splintering—perhaps not surprising, given pressures like financial stress or the tension of forced 24/7 togetherness. Researchers have observed that phenomenon in the aftermath of other crises; stressful times can both end and promote relationships.
- Mass traumas can force change in other unpleasant ways, too. Both the 1918 flu pandemic and the 2008 recession led to noticeable decreases in the U.S. birth rate.
- National or global crises can also cause or compound mental health and substance abuse issues at the population level, as the C19 pandemic has already done.
- Research shows that rates of depression and anxiety have skyrocketed during the pandemic, which is one reason Gollan says it’s wise to think carefully about making any serious choices right now. “We’re notoriously not very good at predicting the consequences of a future decision,” Gollan says, and we’re also prone to “optimism bias”—the tendency to believe our decisions will work out in the end and that the future will be largely positive. That’s not always the case, though. Decisions can and do backfire, especially when they’re made under duress.
- That’s not to say all change is bad. For many people, the pandemic has kickstarted a genuinely valuable process of reevaluation—it’s been a disruption so jarring it forces introspection. The luxury of extra free time, for those who have it, can also make it easier to define and act upon values and priorities.
- The trick, Gollan says, is leaning into the natural inclination for change without toppling over the edge. Don’t act just because you think you should, and resist the urge to make life-altering changes based solely on temporary factors, she says. (The pandemic will end, though it might not feel like it.) “Stress test” your planned decision by seeking out information or perspectives that challenge it, Gollan suggests—before it’s too late to undo.
- As we spoke, I wondered whether Gollan would approve of my decision to move in with my boyfriend. I haven’t had any regrets so far, but maybe I’ve been blinded by optimism and a desire for comfort amidst all the difficulty of this year. Did I stress test the plan enough? Should we have waited until the pandemic ended and our heads cleared?
- I’m not sure what an expert would say. But if 2020 has taught me anything, it’s that I cannot begin to predict what the future—or even tomorrow—will bring. I’m happy where I am, and that feels like more than enough as a historically awful year comes to a close. Maybe it’s the optimism bias at work. But optimism, psychologically biased or not, feels like a worthy antidote to a year marked by tragedy and sadness and stress. I’m going to hang onto it where I can.