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ANH-Intl Covid-19 information tracker - Week 16
Science |
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Origins |
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Authors: Zhang C et al Publication date: 22 March 2020 Journal: Journal of Proteome Research DOI: 10.1021/acs.jproteome.0c00129 As the infection of 2019-nCoV coronavirus is quickly developing into a global pneumonia epidemic, the careful analysis of its transmission and cellular mechanisms is sorely needed. In this Communication, we first analyzed two recent studies that concluded that snakes are the intermediate hosts of 2019-nCoV and that the 2019-nCoV spike protein insertions share a unique similarity to HIV-1. However, the reimplementation of the analyses, built on larger scale data sets using state-of-the-art bioinformatics methods and databases, presents clear evidence that rebuts these conclusions. Next, using metagenomic samples from Manis javanica, we assembled a draft genome of the 2019-nCoV-like coronavirus, which shows 73% coverage and 91% sequence identity to the 2019-nCoV genome. In particular, the alignments of the spike surface glycoprotein receptor binding domain revealed four times more variations in the bat coronavirus RaTG13 than in the Manis coronavirus compared with 2019-nCoV, suggesting the pangolin as a missing link in the transmission of 2019-nCoV from bats to human. Read more... |
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Genetics |
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Isolation, sequence, infectivity and replication kinetics of SARS-CoV-2 Authors: Banerjee A et al Publication date: 12 April 2020 Journal: bioRxiv preprint DOI: 10.1101/2020.04.11.037382 SARS-CoV-2 emerged in December 2019 in Wuhan, China and has since infected over 1.5 million people, of which over 100,000 have died. As SARS-CoV-2 spreads across the planet, speculations remain about the evolution of the virus and the range of human cells that can be infected by SARS-CoV-2. In this study, we report the isolation of SARS-CoV-2 from two COVID-19 patients in Toronto, Canada. We determined the genomic sequences of the two isolates and identified single nucleotide changes in representative populations of our virus stocks. More importantly, we have tested a wide range of human immune cells for infectivity with SARS-CoV-2. We confirm from our studies that human primary peripheral blood mononuclear cells (PBMCs) are not permissive to SARS-CoV-2. As SARS-CoV-2 continues to spread globally, it is essential to monitor any small nucleotide polymorphisms in the virus and to continue to isolate circulating strains of the virus to determine cell susceptibility and pathogenicity using in vitro and in vivo infection models. The architecture of SARS-CoV-2 transcriptome Authors: Kim D et al Publication date: 11 April 2020 Journal: Cell DOI: 10.1016/j.cell.2020.04.011 SARS-CoV-2 is a betacoronavirus responsible for the COVID-19 pandemic. Although the SARS-CoV-2 genome was reported recently, its transcriptomic architecture is unknown. Utilizing two complementary sequencing techniques, we here present a high-resolution map of the SARS-CoV-2 transcriptome and epitranscriptome. DNA nanoball sequencing shows that the transcriptome is highly complex owing to numerous discontinuous transcription events. In addition to the canonical genomic and 9 subgenomic RNAs, SARS-CoV-2 produces transcripts encoding unknown ORFs with fusion, deletion, and/or frameshift. Using nanopore direct RNA sequencing, we further find at least 41 RNA modification sites on viral transcripts, with the most frequent motif, AAGAA. Modified RNAs have shorter poly(A) tails than unmodified RNAs, suggesting a link between the modification and the 3′ tail. Functional investigation of the unknown transcripts and RNA modifications discovered in this study will open new directions to our understanding of the life cycle and pathogenicity of SARS-CoV-2. Phylogenetic network analysis of SARS-CoV-2 genomes Authors: Peter Forster, Lucy Forster, Colin Renfrew and Michael Forster Publication date: 30 March 2020 Institution: University of Cambridge Journal: PNAS DOI: 10.1073/pnas.2004999117 In a phylogenetic network analysis of 160 complete human severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) genomes, we find three central variants distinguished by amino acid changes, which we have named A, B, and C, with A being the ancestral type according to the bat outgroup coronavirus. The A and C types are found in significant proportions outside East Asia, that is, in Europeans and Americans. In contrast, the B type is the most common type in East Asia, and its ancestral genome appears not to have spread outside East Asia without first mutating into derived B types, pointing to founder effects or immunological or environmental resistance against this type outside Asia. The network faithfully traces routes of infections for documented coronavirus disease 2019 (COVID-19) cases, indicating that phylogenetic networks can likewise be successfully used to help trace undocumented COVID-19 infection sources, which can then be quarantined to prevent recurrent spread of the disease worldwide. |
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Mutations |
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Authors: Farkas C et al Publication date: 12 April 2020 Journal: bioRxiv preprint DOI: 10.1101/2020.04.09.034462 Here we aim to describe early mutational events across samples from publicly available SARS-CoV-2 sequences from the sequence read archive repository. Up until March 27, 2020, we downloaded 53 illumina datasets, mostly from China, USA (Washington DC) and Australia (Victoria). Of 30 high quality datasets, 27 datasets (90%) contain at least a single founder mutation and most of the variants are missense (over 63%). Five-point mutations with clonal (founder) effect were found in USA sequencing samples. Sequencing samples from USA in GenBank present this signature with 50% allele frequencies among samples. Australian mutation signatures were more diverse than USA samples, but still, clonal events were found in those samples. Mutations in the helicase and orf1a coding regions from SARS-CoV-2 were predominant, among others, suggesting that these proteins are prone to evolve by natural selection. Finally, we firmly urge that primer sets for diagnosis be carefully designed, since rapidly occurring variants would affect the performance of the reverse transcribed quantitative PCR (RT-qPCR) based viral testing. Authors: Yong JIA et al Publication date: 11 April 2020 Journal: bioRxiv preprint DOI: 10.1101/2020.04.09.034942 Monitoring the mutation dynamics of SARS-CoV-2 is critical for the development of effective approaches to contain the pathogen. By analyzing 106 SARS-CoV-2 and 39 SARS genome sequences, we provided direct genetic evidence that SARS-CoV-2 has a much lower mutation rate than SARS. Minimum Evolution phylogeny analysis revealed the putative original status of SARS-CoV-2 and the early-stage spread history. The discrepant phylogenies for the spike protein and its receptor binding domain proved a previously reported structural rearrangement prior to the emergence of SARS-CoV-2. Despite that we found the spike glycoprotein of SARS-CoV-2 is particularly more conserved, we identified a mutation that leads to weaker receptor binding capability, which concerns a SARS-CoV-2 sample collected on 27th January 2020 from India. This represents the first report of a significant SARS-CoV-2 mutant, and raises the alarm that the ongoing vaccine development may become futile in future epidemic if more mutations were identified. |
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Pathogenesis |
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Might renin–angiotensin system blockers play a role in the COVID-19 pandemic? Authors: Allegra Battistoni and Massimo Volpe Publication date: 14 April 2020 Journal: European Heart Journal – Cardiovascular Pharmacotherapy DOI: 10.1093/ehjcvp/pvaa030 Since December 2019, a new coronavirus, named SARS-CoV-2, has spread globally, affecting >200 000 people worldwide with the so-called COVID-19 disease. The scientific community is actively and constantly working to identify the mechanisms involved in the diffusion of this virus and the pathogenesis of the infection, with its most frequent and severe complication, namely interstitial pneumonia. To date, SARS-CoV-2 is known to enter the host cells via the angiotensin-converting enzyme 2 protein. For this reason, the hypothesis that drugs capable of increasing the expression of this protein may have a role in the spread of the virus and in the symptomatology of affected patients has taken hold. The purpose of this Editorial is to briefly show the evidence currently available in this regard and to provide ideas for future research. Spread of SARS-CoV-2 in the Icelandic Population Authors: Gudbjartsson DF PhD et al Publication date: 14 April 2020 Journal: The New England Journal of Medicine DOI: 10.1056/NEJMoa2006100 Background: During the current worldwide pandemic, coronavirus disease 2019 (Covid-19) was first diagnosed in Iceland at the end of February. However, data are limited on how SARS-CoV-2, the virus that causes Covid-19, enters and spreads in a population. Conclusions:In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males. The proportion of infected persons identified through population screening did not change substantially during the screening period, which was consistent with a beneficial effect of containment efforts. (Funded by deCODE Genetics–Amgen.) Authors: Yan CH MD et al Publication date: 12 April 2020 Journal: Allergy & Rhinology DOI: 10.1002/alr.22579 Background: Rapid spread of the SARS‐CoV‐2 virus and concern for viral transmission by ambulatory patients with minimal to no symptoms underline the importance of identifying early or subclinical symptoms of Covid‐19 infection. Two such candidate symptoms include anecdotally reported loss of smell and taste. Understanding the timing and association of smell/taste loss in Covid‐19 may help facilitate screening and early isolation of cases. Conclusions: In ambulatory individuals with influenza‐like symptoms, chemosensory dysfunction was strongly associated with Covid‐19 infection and should be considered when screening symptoms. Most will recover chemosensory function within weeks paralleling resolution of other disease‐related symptoms. Presentation of new onset anosmia during the COVID-19 pandemic Authors: Hopkins C, Surda P and Kumar N Publication date: 11 April 2020 Journal: Rhinology DOI: 10.4193/Rhin20.116 Introduction: Anosmia has not been formally recognised as a symptom of COVID-19 infection. Growing anecdotal evidence suggests increasing incidence of cases of anosmia during the current pandemic, suggesting that COVID-19 may cause olfactory dysfunction. The objective was to characterise patients reporting new onset anosmia during the COVID-19 pandemic METHODOLOGY: Design: Survey of 2428 patients reporting new onset anosmia during the COVID-19 pandemic. Conclusions: Anosmia is reported in conjunction with well-reported symptoms of coronas virus, but 1 in 6 patients with recent onset anosmia report this as an isolated symptom. This might help identify otherwise asymptomatic carriers of disease and trigger targeted testing. Further study with COVID-19 testing is required to identify the proportion of patients in whom new onset anosmia can be attributed to COVID-19. Authors: Menni C et al Publication date: 7 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.05.20048421 Importance: A strategy for preventing further spread of the ongoing COVID-19 epidemic is to detect infections and isolate infected individuals without the need of extensive bio-specimen testing. Objectives: Here we investigate the prevalence of loss of smell and taste among COVID-19 diagnosed individuals and we identify the combination of symptoms, besides loss of smell and taste, most likely to correspond to a positive COVID-19 diagnosis in non-severe cases. Design: Community survey. Setting and Participants: Subscribers of RADAR COVID-19, an app that was launched for use among the UK general population asking about COVID-19 symptoms. Main Exposure: Loss of smell and taste. Main Outcome Measures: COVID-19. Results: Between 24 and 29 March 2020, 1,573,103 individuals reported their symptoms via the app; 26% reported suffering from one or more symptoms of COVID-19. Of those, n=1702 reported having had a RT-PCR COVID-19 test and gave full report on symptoms including loss of smell and taste; 579 were positive and 1123 negative. In this subset, we find that loss of smell and taste were present in 59% of COVID-19 positive individuals compared to 18% of those negative to the test, yielding an odds ratio (OR) of COVID-19 diagnosis of OR[95%CI]=6.59[5.25; 8.27], P= 1.90x10-59 . We also find that a combination of loss of smell and taste, fever, persistent cough, fatigue, diarrhoea, abdominal pain and loss of appetite is predictive of COVID-19 positive test with sensitivity 0.54[0.44; 0.63], specificity 0.86[0.80; 0.90], ROC-AUC 0.77[0.72; 0.82] in the test set, and cross-validation ROC-AUC 0.75[0.72; 0.77]. When applied to the 410,598 individuals reporting symptoms but not formally tested, our model predicted that 13.06%[12.97%;13.15] of these might have been already infected by the virus. Conclusions and Relevance: Our study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite. This is particularly relevant to healthcare and other key workers in constant contact with the public who have not yet been tested for COVID-19. Covid-19: four fifths of cases are asymptomatic, China figures indicate Author: Michael Day Publication date: 7 April 2020 Journal: The BMJ DOI: 10.1136/bmj.m1375 New evidence has emerged from China indicating that the large majority of coronavirus infections do not result in symptoms. Chinese authorities began publishing daily figures on 1 April on the number of new coronavirus cases that are asymptomatic, with the first day’s figures suggesting that around four in five coronavirus infections caused no illness. Many experts believe that unnoticed, asymptomatic cases of coronavirus infection could be an important source of contagion. A total of 130 of 166 new infections (78%) identified in the 24 hours to the afternoon of Wednesday 1 April were asymptomatic, said China’s National Health Commission. And most of the 36 cases in which patients showed symptoms involved arrivals from overseas, down from 48 the previous day, the commission said. Authors: Liu Y et al Publication date: 10 March 2020 Journal: bioRxiv DOI: 10.1101/2020.03.08.982637 Background The ongoing outbreak of COVID-19 has spread rapidly and sparked global concern. While the transmission of SARS-CoV-2 through human respiratory droplets and contact with infected persons is clear, the aerosol transmission of SARS-CoV-2 has been little studied. Conclusions Room ventilation, open space, proper use and disinfection of toilet can effectively limit aerosol transmission of SARS-CoV-2. Gathering of crowds with asymptomatic carriers is a potential source of airborne SARS-CoV-2. The virus aerosol deposition on protective apparel or floor surface and their subsequent resuspension is a potential transmission pathway and effective sanitization is critical in minimizing aerosol transmission of SARS-CoV-2. |
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Epidemiology |
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Characterizing key attributes of the epidemiology of COVID-19 in China: Model-based estimations Authors: Ayoub HH et al Publication date: 11 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.08.20058214 Background: A novel coronavirus strain, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China in late 2019. The resulting disease, Coronavirus Disease 2019 (COVID-2019), soon became a pandemic. This study aims to characterize key attributes of the epidemiology of this infection in China. Methods: An age-stratified mathematical model was constructed to describe the transmission dynamics and estimate the age-specific differences in the biological susceptibility to the infection, age-assortativeness in transmission mixing, case fatality rate (CFR), and transition in rate of infectious contacts (and reproduction number R0) following introduction of mass interventions. Results: The model estimated the infectious contact rate in early epidemic at 0.59 contacts per day (95% uncertainty interval (UI)=0.48-0.71). Relative to those 60-69 years of age, susceptibility to the infection was only 0.06 in those ≤19 years, 0.34 in 20-29 years, 0.57 in 30-39 years, 0.69 in 40-49 years, 0.79 in 50-59 years, 0.94 in 70-79 years, and 0.88 in ≥80 years. The assortativeness in transmission mixing by age was very limited at 0.004 (95% UI=0.002-0.008). Final CFR was 5.1% (95% UI=4.8-5.4%). R0 rapidly declined from 2.1 (95% UI=1.8-2.4) to 0.06 (95% UI=0.05-0.07) following onset of interventions. Conclusion: Age appears to be a principal factor in explaining the patterns of COVID-19 transmission dynamics in China. The biological susceptibility to the infection seems limited among children, intermediate among young to mid-age adults, but high among those >50 years of age. There was no evidence for differential contact mixing by age, consistent with most transmission occurring in households rather than in schools or workplaces. Authors: An Pan, PhD, Li Liu MD, PhD and Chaolong Want, PhD et al Publication date: 10 April 2020 Journal: JAMA DOI: 10.1001/jama.2020.6130 Importance: Coronavirus disease 2019 (COVID-19) has become a pandemic, and it is unknown whether a combination of public health interventions can improve control of the outbreak. Conclusions and Relevance: A series of multifaceted public health interventions was temporally associated with improved control of the COVID-19 outbreak in Wuhan, China. These findings may inform public health policy in other countries and regions. Author: Roberto Pancrazi Publication date: 9 April 2020 Institution: University of Warwick Main Results Let's summarise the main results. For the UK overall it is likely that we are approaching the peak of the epidemic, which the model pinpoints during the current week. This timeline holds even when accounting for the large variability of daily tests. It will take then around one to three weeks before the epidemic is half-way on the decaying path. The more positive scenario places the day with zero new cases around May 10th, while the more negative scenario places it at the end of May. Importantly, these predictions are conditional on strict social distancing. As these are likely to be imperfect, the day of the peak might be delayed by a few days. In the case of Italy, the final estimated peak was 5 days later than the one originally estimated. SARS-CoV-2 infects T lymphocytes through its spike protein-mediated membrane fusion Authors: Wang X etal Publication date: 7 April 2020 Journal: Cellular & Molecular Immunology DOI: 10.1038/s41423-020-0424-9 COVID-19, the novel coronavirus disease caused by SARS-CoV-2 and outbroken at the end of 2019 in Wuhan, China,1 becomes a worldwide pandemic. SARS-CoV-2 belongs to the betacoronavirus genus and has 79.5% identity to SARS-CoV. SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as its host entry receptor.2 The clinical manifestations of COVID-19 include pneumonia, diarrhea, dyspnea, and multiple organ failure. Interestingly, lymphocytopenia, as a diagnostic indicator, is common in COVID-19 patients. Xiong et al. found upregulation of apoptosis, autophagy, and p53 pathways in PBMC of COVID-19 patients.3 Some studies reported that lymphocytopenia might be related to mortality, especially in patients with low levels of CD3+, CD4+, and CD8+ T lymphocytes.4,5 Lymphocytopenia was also found in the Middle East respiratory syndrome (MERS) cases. MERS-CoV can directly infect human primary T lymphocytes and induce T-cell apoptosis through extrinsic and intrinsic apoptosis pathways, but it cannot replicate in T lymphocytes.6 However, it is unclear whether SARS-CoV-2 can also infect T cells, resulting in lymphocytopenia. |
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Mortality & morbidity |
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Understanding pathways to death in patients with COVID-19 Authors: Jean-Louis Vincent and Fabio S Taccone Publication date: 6 April 2020 Journal: The Lancet Respiratory Medicine DOI: 10.1016/S2213-2600(20)30165-X Since the first cases of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were identified in China in December, 2019, we have witnessed increasing numbers of infections and associated deaths worldwide. Although the case fatality rate for SARS-CoV-2 infection (ie, the total number of deaths in patients positive for SARS-CoV-2 divided by the total number of people with a positive test) is not high, given the huge scale of the pandemic, the actual numbers of deaths are considerable. In The Lancet Respiratory Medicine, Jason Phua and colleagues1 provide an excellent overview of the current issues raised by COVID-19—in particular, the impact of the disease on intensive care. The Review is clearly and comprehensively written, covering many aspects of the disease, from epidemiology and diagnosis through to intensive care treatment and resource management. One issue raised by this Review is how the reported case fatality rates for patients with COVID-19 can be accurately interpreted. Using a delay-adjusted case fatality ratio to estimate under-reporting Authors: Russell TW et al Publication date: 11 April 2020 Source: Centre for Mathematical Modelling of Infectious Diseases Aim To estimate the percentage of symptomatic COVID-19 cases reported in different countries using case fatality ratio estimates based on data from the ECDC, correcting for delays between confirmation-and-death. |
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Tracking |
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COVID-19 Data Visualization Center - John Hopkins University A daily visual update on the coronavirus pandemic Track how the novel coronavirus is spreading around the globe with up-to-date visuals that give context to the data collected on Johns Hopkins University's COVID-19 map. |
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Testing |
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Authors: Liu J et al Publication date: 14 April 2020 Journal: Journal of Medical Virology DOI: 10.1002/jmv.25875 An outbreak of coronavirus disease 2019 (COVID-19) pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), started in Wuhan City, Hubei Province, China. The real-time reverse- transcriptase polymerase - chain - reaction (RT - PCR) method can be used for the detection of SARS-CoV-2 in oral swabs1 . Now, results have confirmed the presence of the live virus in stool samples from patients with COVID- 19. Recurrent PCR positivity after hospital discharge of people with coronavirus disease 2019 (COVID-19) Author: Dr Minlin Jiang Publication date: 11 April 2020 Journal: Journal of Infection (pre-proof) DOI: 10.1016/j.jinf.2020.03.024 During January 28 to March 13, 6 COVID-19 recurrence cases were found in Shangqiu, Henan Province, China (Figure 1). Among the recurrence cases, one case (Case 1) had significant post-discharge clinical symptoms and discomfort for nine days, one case (Case 3) had a mild cough, and 4 cases (Case 2, 4, 5, and 6) were asymptomatic with positive RT-PCR nucleic acid test. False negative rate of COVID-19 is eliminated by using nasal swab test Authors: Xie C et al Publication date: 11 April 2020 Journal: Travel Medicine and Infectious Diseases DOI: 10.1016/j.tmaid.2020.101668 Several studies of the new outbreak of COVID-19 patients on clinical, epidemiological, and radiological features have now published [1,2]. A positive RT-PCR result of the discharged patients was reported by Lan et al. [3], we are now reporting the expanded population data of the re-positive patients in Guangzhou City, China. Collect the discharged COVID-19 patients' information from former epidemiological investigation of Guangzhou Center for Disease Control and Prevention. Data was included the date of onset, date of conformed diagnose, date of discharge, date of first sampling, and the date of the nucleic acid test returned positive. All the discharged patients were followed the criteria of: (a) temperature returned to normal more than 3 days later, (b) Disappearance of respiratory symptoms, (c) substantially improved acute exudative lesions on chest computed tomography (CT) images, and (d) two consecutive negative nucleic acid tests separated by at least 1 day [4]. False-negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: Rather than recurrence Authors: Xiao AT Dr, MD et al Publication date: 9 April 2020 Journal: Journal of Medical Virology DOI: 10.1002/jmv.25855 A novel coronavirus (COVID‐19) pandemic cause by Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) threatens the world. We read with interest the recent report by Li et al. that included 610 patients with Coronavirus Disease 2019 (COVID‐19). They reported a high false‐negative rate of real‐time reverse transcription polymerase chain reaction (RT‐PCR) results for SARS‐CoV‐2 detection. In addition, recent report regarding SARS‐CoV‐2 “turn positive” in recovered cases with COVID‐19 were published. Here, we studied the characteristics of nucleic acid conversion for SARS‐CoV‐2 from 70 COVID‐19 patients. We found that 15 (21.4%) patients experienced a “turn positive” of nucleic acid detection by RT‐PCR test for SARS‐CoV‐2 after two consecutive negative results, which may be related to the false negative of RT‐PCR test and prolonged nucleic acid conversion. Estimating false-negative detection rate of SARS-CoV-2 by RT-PCR Authors: Wikramaratna P et al Publication date: 7 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.05.20053355 Reverse transcription-polymerase chain reaction (RT-PCR) assays are used to test patients and key workers for infection with the causative SARS-CoV-2 virus. RT-PCR tests are highly specific and the probability of false positives is low, but false negatives can occur if the sample contains insufficient quantities of the virus to be successfully amplified and detected. The amount of virus in a swab is likely to vary between patients, sample location (nasal, throat or sputum) and through time as infection progresses. Here, we analyse publicly available data from patients who received multiple RT-PCR tests and were identified as SARS-CoV-2 positive at least once. We identify that the probability of a positive test decreases with time after symptom onset, with throat samples less likely to yield a positive result relative to nasal samples. Empirically derived distributions of the time between symptom onset and hospitalisation allowed us to comment on the likely false negative rates in cohorts of patients who present for testing at different clinical stages. We further estimate the expected numbers of false negative tests in a group of tested individuals and show how this is affected by the timing of the tests. Finally, we assessed the robustness of these estimates of false negative rates to the probability of false positive tests. This work has implications both for the identification of infected patients and for the discharge of convalescing patients who are potentially still infectious. Authors: Ai T et al Publication date: 26 Feb 2020 Journal: Radiology DOI: 10.1148/radiol.2020200642 Background: Chest CT is used for diagnosis of 2019 novel coronavirus disease (COVID-19), as an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. Conclusion: Chest CT has a high sensitivity for diagnosis of COVID-19. Chest CT may be considered as a primary tool for the current COVID-19 detection in epidemic areas. Read more... Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR Authors: Fang Y et al Publication date: 19 February 2020 Journal: Radiology DOI: 10.1148/radiol.2020200432 Summary: In a series of 51 patients with chest CT and RT-PCR assay performed within 3 days, the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71% (p<.001). Authors: Yang Y et al Publication date: 17 February 2020 Journal: medRxiv preprint DOI: 10.1101/2020.02.11.20021493. Background: The outbreak of novel coronavirus pneumonia (NCP) caused by 2019-nCoV spread rapidly, and elucidating the diagnostic accuracy of different respiratory specimens is crucial for the control and treatment of this disease. Interpretation: Sputum is most accurate for laboratory diagnosis of NCP, followed by nasal swabs. Detection of viral RNAs in BLAF is necessary for diagnosis and monitoring of viruses in severe cases. CT scan could serve as an important make up for the diagnosis of NCP. |
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Covid-19 patients |
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Authors: Petrilli CM et al Publication date: 11 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.08.20057794 Background: Little is known about factors associated with hospitalization and critical illness in Covid-19 positive patients. Methods: We conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at a single academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters. Results: Among 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged home, and 292/1,999 (14.6%) have died or were discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age ≥75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200. Conclusions: Age and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness. UK report on 3883 patients critically ill with COVID-19 Report on 3883 UK patients critically ill with COVID-19. Institution: Intensive Care National Audit & Research Centre (ICNARC) Publication date: 10 April 2020 Read more... Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China Authors: Ling Mao, Huijuan Jin, Mengdie Wang et al Publication date: 10 April 2020 Journal: JAMA Neurology DOI: 10.1001/jamaneurol.2020.1127 Importance: The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations. Objective: To study the neurologic manifestations of patients with COVID-19 Conclusions and Relevance: Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission. Authors: Gard S MD et al Publication date: 8 April 2020 Institution: Centers for Disease Control and Prevention Publication: Morbidity and mortality weekly report (MMWR) DOI: 10.15585/mmwr.mm6915e3external icon What is already known about this topic? Population-based rates of laboratory-confirmed coronavirus disease 2019 (COVID-19)–associated hospitalizations are lacking in the United States. What is added by this report? COVID-NET was implemented to produce robust, weekly, age-stratified COVID-19–associated hospitalization rates. Hospitalization rates increase with age and are highest among older adults; the majority of hospitalized patients have underlying conditions. Rapid response to: Covid-19: a remote assessment in primary care Cholesterol-lowering treatment may worsen the outcome of a Covid-19 infection Author: Uffe Ravnskov Publication date: 4 April 2020 Journal: The BMJ Dear Editor According to Hu et al. serum cholesterol is significantly lower among Chinese patients with Covid-19 (1). The reason may be that low cholesterol predisposes to infectious diseases, because LDL partake in the immune system by adhering to and inactivating almost all types of microorganisms and their toxic products. This is a little-known fact but it has been documented in many ways by more than a dozen research groups (2,3) For instance, human LDL inactivates up to 90% of staphylococcus aureus -toxin and rats injected with mortal bacterial toxins survive if they are injected with human LDL as well (3). The anti-infectious property of LDL has been documented in human studies as well. In a meta-analysis of 19 cohort studies including almost 70,000 deaths, Jacobs et al. found an inverse association between serum cholesterol and mortality from respiratory and gastrointestinal diseases, most of which are of an infectious origin (4). It is unlikely that the low cholesterol was caused by these diseases because the associations remained after exclusion of deaths occurring during the first 5 years. Furthermore, in a 15-year follow-up of more than 120,000 adult, multiethnic people, Iribarren et al. found a strong, inverse association between initially determined cholesterol and the risk of being admitted to hospital later in life due to an infectious disease (5). As LDL-cholesterol is able to inactivate virus as well (6,7) patients on cholesterol-lowering treatment and with a life-threatening Covid-19-infection should cease this treatment; at least until they have recovered from the infection. |
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Susceptibility |
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Authors: Abdullahi IN et al Publication date: 10 April 2020 Journal: Le Infezioni in Medicina The world has been thrown into pandemonium due to the recent Coronavirus Disease-19 (COVID-19) pandemic. Early available clinical data have indicated that geriatric persons cum those with co-morbidity such as cardiovascular, metabolic and immunological disorders suffered severe form of COVID-19. All countries and territories of the world are currently exploring available strategies to control the pandemic with the hope to significantly minimize its morbidity and mortality rate. This present study critically reviewed available and latest research progress of the genetics and ecology of SARS-CoV-2, as well as the influence of climatic factors on the spread of COVID-19, and thus, discussed how these concepts could be harnessed for COVID-19 control and further scientific advancements in resolving the pandemic. |
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Therapeutics |
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Authors: Zhou Z, Zhu CS, Zhang B Publication date: 13 April 2020 Journal: Zhongguo Zhong Yao Za Zi DOI: 10.19540/j.cnki.cjcmm.20200220.502 The coronavirus disease 2019(COVID-19) is developing rapidly and posing great threat to public health. There is no specific medicine available for treating the disease. Luckily, traditional Chinese medicine has played a positive role in the fighting against COVID-19. In this paper, We collected and sorted the prescriptions of modern Chinese medicine for COVID-19 released by national government, different provinces, autonomous regions and municipalities, as well as online databases, such as CNKI, WanFang medical network, and VIP database. These prescriptions were combined with the inheritance of traditional Chinese medicine auxiliary V2.5, and the complex system entropy clustering method was used to determine the association rules and frequency of single drug and drug combination in the prescription. In the end, 96 effective prescriptions were included. Among them, the four properties were mainly concentrated in temperature, cold and level, the five tastes were mainly concentrated in bitter, hot and sweet, and the meridians were mainly concentrated in lung, stomach and spleen. The high-frequency drugs were Glycyrrhizae Radix et Rhizoma, Armeniacae Semen Amarum, Gypsum Fibrosum, etc., and the high-frequency combinations are Gypsum Fibrosum-Armeniacae Semen Amarum, Gypsum Fibrosum-Glycyrrhizae Radix et Rhizoma, Armeniacae Semen Amarum-Glycyrrhizae Radix et Rhizoma, the core combinations are Lepidii Semen-Armeniacae Semen Amarum-Gypsum Fibrosum, Pogostemonis Herba-Zingiberis Rhizoma Recens-Magnoliae Officinalis Cortex, Ophiopogonis Radix-Armeniacae Semen Amarum-Scutellariae Radix and so on. Form new prescriptions Lepidii Semen, Armeniacae Semen Amarum, Gypsum Fibrosum, Pogostemonis Herba, Zingiberis Rhizoma Recens, Magnoliae Officinalis Cortex. Ophiopogonis Radix, Armeniacae Semen Amarum, Scutellariae Radix, Schisandrae Sphenantherae Fructus, Panacis Quinquefolii Radix. From the medicinal properties to high-frequency drugs and new prescriptions, it could be seen that the overall treatment of COVID-19 by traditional Chinese medicine was to strengthen body resistance, eliminate pathogenic factors, and give attention to Qi and Yin. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19) Authors: Sanders JM et al Publication date: 13 April 2020 Journal: JAMA DOI: 10.1001/jama.2020.6019 Observations: No proven effective therapies for this virus currently exist. The rapidly expanding knowledge regarding SARS-CoV-2 virology provides a significant number of potential drug targets. The most promising therapy is remdesivir. Remdesivir has potent in vitro activity against SARS-CoV-2, but it is not US Food and Drug Administration approved and currently is being tested in ongoing randomized trials. Oseltamivir has not been shown to have efficacy, and corticosteroids are currently not recommended. Current clinical evidence does not support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19. Conclusions and Relevance: The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918. The speed and volume of clinical trials launched to investigate potential therapies for COVID-19 highlight both the need and capability to produce high-quality evidence even in the middle of a pandemic. No therapies have been shown effective to date. Classical drug digitoxin inhibits influenza cytokine storm, with implications for COVID-19 therapy Authors: Harvey B Pollard, Bette S Pollard and John R Pollard Publication date: 11 April 2020 Journal: bioRxiv preprint DOI: 10.1101/2020.04.09.034983 Influenza viruses, corona viruses and related pneumotropic viruses cause sickness and death partly by inducing a hyper-proinflammatory response by immune cells and cytokines in the host airway. Here we show that the cardiac glycoside digitoxin suppresses this response induced by influenza virus strain A/Wuhan/H3N2/359/95 in the cotton rat lung. The cytokines TNFa, GRO/KC, MIP2, MCP1, TGFb, and IFNg. are significantly reduced. Since the hyper-proinflammatory overproduction of cytokines is a host response, we suggest that digitoxin may have therapeutic potential for not only influenza and but also for coronovirus infections. Authors: Bean D et al Publication date: 11 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.07.20056788 Background: The SARS-Cov2 virus binds to the ACE2 receptor for cell entry. It has been suggested that ACE-inhibitors, which are commonly used in patients with hypertension or diabetes and which raise ACE2 levels, may increase the risk of severe COVID-19 infection. Methods: We evaluated this hypothesis in an early cohort of 205 acute inpatients with COVID-19 at King's College Hospital and Princess Royal University Hospital, London, UK with the primary endpoint being death or transfer to a critical care unit for organ support within 7-days of symptom onset. Findings: 53 patients out of 205 patients reached the primary endpoint. Contrary to the hypothesis, treatment with ACE-inhibitors was associated with a reduced risk of rapidly deteriorating severe disease. There was a lower rate of death or transfer to a critical care unit within 7 days in patients on an ACE-inhibitor OR 0.29 (CI 0.10-0.75, p<0.01), adjusting for age, gender, comorbidities (hypertension, diabetes mellitus, ischaemic heart disease and heart failure). Interpretation: Although a small sample size, we do not see evidence for ACE-inhibitors increasing the short-term severity of COVID-19 disease and patients on treatment with ACE-inhibitors should continue these drugs during their COVID-19 illness. A potential beneficial effect needs to be explored as more data becomes available. Compassionate Use of Remdesivir for Patients with Severe Covid-19 Authors: Grein J, MD et al Publication date: 10 April 2020 Journal: The New England Journal of Medicine DOI: 10.1056/NEJMoa2007016 Background Remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS-CoV-2. Conclusions In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.) Authors: Martin Scholz and Roland Derwand Publication date: 6 April 2020 Journal: Preprints DOI: 10.20944/preprints202004.0124.v1 Currently, drug repurposing is an alternative to novel drug development for the treatment of COVID-19 patients. The antimalarial drug chloroquine (CQ) and its metabolite hydroxychloroquine (HCQ) are currently being tested in several clinical studies as potential candidates to limit SARS-CoV-2-mediated morbidity and mortality. CQ and HCQ (CQ/HCQ) inhibit pH-dependent steps of SARS-CoV-2 replication by increasing pH in intracellular vesicles and interfere with virus particle delivery into host cells. Besides direct antiviral effects, CQ/HCQ specifically target extracellular zinc to intracellular lysosomes where it interferes with RNA-dependent RNA polymerase activity and coronavirus replication. As zinc deficiency frequently occurs in elderly patients and in those with cardiovascular disease, chronic pulmonary disease, or diabetes, we hypothesize that CQ/HCQ plus zinc supplementation may be more effective in reducing COVID-19 morbidity and mortality than CQ or HCQ in monotherapy. Therefore, CQ/HCQ in combination with zinc should be considered as additional study arm for COVID-19 clinical trials. Author: David N Juurlink Publication date: 8 April 2020 Journal: CMAJ DOI: 10.1503/cmaj.200528 Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) has spread rapidly around the globe in recent months. With deaths from its associated disease, corona- virus disease 2019 (COVID-19), projected to reach into the millions and a vaccine unlikely in the near term, the search is on for existing drugs that might prevent COVID-19 or improve out- comes for patients who have COVID-19. Chloroquine and its derivative hydroxychloroquine, which have been used for decades in the treatment and prevention of malaria as well as chronic inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus, have received much attention as potential therapies. Chloroquine and hydroxychloroquine in covid-19 Authors: Robin E Ferner and Jeffrey K Aronson Publication date: 8 April 2020 Journal: The BMJ DOI: 10.1136/bmj.m1432 Use of these drugs is premature and potentially harmful TheBMJ in 1925 cautiously endorsed Moellgaard’s gold treatment for tuberculosis,1 although it found his pharmacological reasoning “both interesting and instructive.”2 We should be similarly cautious about proposed treatments for people infected with SARS-CoV-2, the virus that causes covid-19. Many proposals are based on in vitro investigations, studies in experimental animals, or experience with interventions in infections with other viruses, whether similar to SARS-CoV-2 (eg, SARS-CoV-1) or not (HIV). This is all true of chloroquine and hydroxychloroquine, both 4-aminoquinolines, which have been suggested as potential treatments for covid-19. Currently, at least 80 trials of chloroquine, hydroxychloroquine, or both, sometimes in combination with other drugs, are registered worldwide. Authors: Sheahan TP et al Publication date: 6 April 2020 Journal: Science Translational Medicine DOI: 10.1126/scitranslmed.abb5883 Coronaviruses (CoVs) traffic frequently between species resulting in novel disease outbreaks, most recently exemplified by the newly emerged SARS-CoV-2, the causative agent of COVID-19. Herein, we show that the ribonucleoside analog β-D-N4-hydroxycytidine (NHC, EIDD-1931) has broad spectrum antiviral activity against SARS-CoV-2, MERS-CoV, SARS-CoV, and related zoonotic group 2b or 2c Bat-CoVs, as well as increased potency against a coronavirus bearing resistance mutations to the nucleoside analog inhibitor remdesivir. In mice infected with SARS-CoV or MERS-CoV, both prophylactic and therapeutic administration of EIDD-2801, an orally bioavailable NHC-prodrug (β-D-N4-hydroxycytidine-5′-isopropyl ester), improved pulmonary function, and reduced virus titer and body weight loss. Decreased MERS-CoV yields in vitro and in vivo were associated with increased transition mutation frequency in viral but not host cell RNA, supporting a mechanism of lethal mutagenesis in CoV. The potency of NHC/EIDD-2801 against multiple coronaviruses and oral bioavailability highlight its potential utility as an effective antiviral against SARS-CoV-2 and other future zoonotic coronaviruses. COVID-19: A promising cure for the global panic Authors: Vellingiri B et al Publication date: 4 April 2020 Journal: Science of the Total Environment DOI: 10.1016/j.scitotenv.2020.138277 The novel Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, which is the causative agent of a potentially fatal disease that is of great global public health concern. The outbreak of COVID-19 is wreaking havoc worldwide due to inadequate risk assessment regarding the urgency of the situation. The COVID-19 pandemic has entered a dangerous new phase. When compared with SARS and MERS, COVID-19 has spread more rapidly, due to increased globalization and adaptation of the virus in every environment. Slowing the spread of the COVID-19 cases will significantly reduce the strain on the healthcare system of the country by limiting the number of people who are severely sick by COVID-19 and need hospital care. Hence, the recent outburst of COVID-19 highlights an urgent need for therapeutics targeting SARS-CoV-2. Here, we have discussed the structure of virus; varying symptoms among COVID-19, SARS, MERS and common flu; the probable mechanism behind the infection and its immune response. Further, the current treatment options, drugs available, ongoing trials and recent diagnostics for COVID-19 have been discussed. We suggest traditional Indian medicinal plants as possible novel therapeutic approaches, exclusively targeting SARS-CoV-2 and its pathways. Optimisation of Vitamin D Status for Enhanced Immuno-protection Against Covid-19 Authors: D M McCartney and D G Byrne Publication date: 3 April 2020 Journal: Irish Medical Journal Vitamin D deficiency is common and may contribute to increased risk of respiratory infection including Covid-19. We recommend that all older adults, hospital inpatients, nursing home residents and other vulnerable groups (e.g. thos with diabetes mellitus or compromised immune function, those with darker skin, vegetarians and vegans, those who are overweight or obese, smokers and healthcare workers) be urgently supplemented with 20-50μg/d of vitamin D to enhance their resistance to Covid-19 and that this advice be quickly extended to the general adult population. Authors: Eammon Laird and Rose Anne Kenny Publication date: April 2020 Source: Trinity College Dublin DOI: 10.38018/TildaRe.2020-05 In this report, we aim to describe the importance of vitamin D for immune function, the prevalence of vitamin D deficiency and vitamin D supplement use in Ireland by age group, gender, geographic location and by obesity and lung disease (particularly vulnerable to COVID-19), describe those most at risk of deficiency and the best sources of vitamin D and recommendations to improve status. By compiling this report, we hope the information given can help in the mitigation of the negative health consequences of COVID-19. Authors: Grant WB et al Publication date: 2 April 2020 Journal: Nutrients DOI: 10.3390/nu12040988 The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations. COVID-19: Melatonin as a potential adjuvant treatment Authors: Zhang R et al Publication date: 23 March 2020 Journal: Life Sciences DOI: 10.1016/j.lfs.2020.117583 This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation. Management of Corona Virus disease-19 (COVID-19): The Zhejiang Experience Author: Xu K et al Publication date: 21 February 2020 Journal: Journal of Zhejiang University. Medical sciences Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients' blood samples at acute period and 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces. Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm. Moreover, it also favoured the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and non-invasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned. Some patients with COVID-19 showed intestinal microbialdysbiosis with decreased probiotics such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should be assessed for all patients. Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed. The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19. |
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Vaccines |
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BCG protects against COVID-19? A word of caution Authors: Reka Szigeti, Domos Kellermayer and Richard Kellermayer Publication date: 11 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.09.20056903 The COVID-19 pandemic, caused by type 2 Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), puts all of us to the test. Epidemiologic observations could critically aid the development of protective measures to combat this devastating viral outbreak. A recent publication, linked nation based universal Bacillus Calmette-Guerin (BCG) vaccination to potential protection against morbidity and mortality from SARS-CoV-2, and received much attention in public media, even before its peer review. We wished to validate the findings by examining the association between daily rates of COVID-19 case fatality (i.e. Death Per Case /Days of the endemic [dpc/d]) and the presence of universal BCG vaccination before 1980, or the year of the establishment of universal vaccination. There was no significant association in either analysis. In this work we emphasize caution amidst the publication surge on COVID-19, and highlight the political/economical-, arbitrary selection-, and fear/anxiety related biases, which may obscure scientific rigor. It is underscored that physical (social) distancing (i.e. quarantine) and use of personal protective equipment (PPE) are the only epidemiologic measures (Iceland being a great example, where universal BCG vaccination policy was never in place), which consistently associate with successful counteraction of morbidity and mortality during the pandemic. The COVID-19 vaccine development landscape Authors: Thanh Le T et al Publication date: 9 April 2020 Journal: Nature Reviews Drug Discovery DOI: 10.1038/d41573-020-00073-5 The genetic sequence of SARS-CoV-2, the coronavirus that causes COVID-19, was published on 11 January 2020, triggering intense global R&D activity to develop a vaccine against the disease. The scale of the humanitarian and economic impact of the COVID-19 pandemic is driving evaluation of next-generation vaccine technology platforms through novel paradigms to accelerate development, and the first COVID-19 vaccine candidate entered human clinical testing with unprecedented rapidity on 16 March 2020. Authors: Berg MK et al Publication date: 7 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.05.20054163 Prior work suggests that BCG vaccination reduces the risk of different infectious diseases. BCG vaccination may thus serve as a protective factor against COVID-19. Here, we drew on day-by-day reports of both confirmed cases and deaths and analyzed growth curves in countries that mandate BCG policies versus countries that do not. Linear mixed models revealed that the presence of mandated BCG policies was associated with a significant flattening of the exponential increase in both confirmed cases and deaths during the first 30-day period of country-wise outbreaks. This effect held after controlling for median age, gross domestic product per capita, population density, population size, geographic region, net migration rate, and various cultural dimensions (e.g., individualism and the tightness vs. looseness of social norms). Our analysis suggests that mandated BCG vaccination can be effective in the fight against COVID-19. Authors: Kim E et al Publication date: 1 April 2020 Journal: EBioMedicine DOI: 10.1016/j.ebiom.2020.102743 Findings: Here we describe the development of MNA delivered MERS-CoV vaccines and their pre-clinical immuno- genicity. Specifically, MNA delivered MERS-S1 subunit vaccines elicited strong and long-lasting antigen-specific antibody responses. Building on our ongoing efforts to develop MERS-CoV vaccines, promising immunogenicity of MNA-delivered MERS-CoV vaccines, and our experience with MNA fabrication and delivery, including clinical trials, we rapidly designed and produced clinically-translatable MNA SARS-CoV-2 subunit vaccines within 4 weeks of the identification of the SARS-CoV-2 S1 sequence. Most importantly, these MNA delivered SARS-CoV-2 S1 subunit vaccines elicited potent antigen-specific antibody responses that were evident beginning 2 weeks after immunization. Interpretation: MNA delivery of coronaviruses-S1 subunit vaccines is a promising immunization strategy against coronavirus infection. Progressive scientific and technological efforts enable quicker responses to emerging pandemics. Our ongoing efforts to develop MNA-MERS-S1 subunit vaccines enabled us to rapidly design and produce MNA SARS-CoV-2 subunit vaccines capable of inducing potent virus-specific antibody responses. Collectively, our results support the clinical development of MNA delivered recombinant protein subunit vaccines against SARS, MERS, COVID-19, and other emerging infectious diseases. |
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Comorbidities |
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Authors: Simonnet A et al Publication date: 9 April 2020 Journal: Obesity DOI: 10.1002/oby.22831 Objective: : The Covid-19 pandemic is rapidly spreading worldwide, notably in Europe and North America, where obesity is highly prevalent. The relation between obesity and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has not been fully documented. Conclusion: The present study showed a high frequency of obesity among patients admitted in intensive care for SARS-CoV-2. Disease severity increased with BMI. Obesity is a risk factor for SARS-CoV-2 severity requiring increased attention to preventive measures in susceptible. Endocrine and metabolic link to coronavirus infection Authors: Bornstein SR et al Publication date: 2 April 2020 Journal: Nature Reviews Endocrinology DOI: 10.1038/s41574-020-0353-9 Type 2 diabetes mellitus (T2DM) seems to be a risk factor for acquiring the new coronavirus infection. Indeed, T2DM and hypertension have been identified as the most common comorbidities for other coronavirus infections, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS-CoV)1. According to several reports, including those from the Centers for Disease Control and Prevention (CDC), patients with T2DM and the metabolic syndrome might have up to ten-times greater risk of death when they contract COVID-19 (CDC coronavirus reports). Although T2DM and the metabolic syndrome increase the risk of more severe symptoms and mortality in many infectious diseases, there are some additional specific mechanistic aspects in coronavirus infections that require separate consideration, which will have clinical consequences for improved management of patients who are severely affected. |
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Co-infections |
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Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens (Research letter) Authors: David Kim PhD, James Quinn MD MS and Benhamin Pinsky MD PhD Publication date: 15 April 2020 Journal: JAMA DOI: 10.1001/jama.2020.6266 As of April 3, 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had caused 972 303 cases of coronavirus disease 2019 (COVID-19) and 50 322 deaths worldwide.1 Early reports from China suggested that co-infection with other respiratory pathogens was rare.2 If this were the case, patients positive for other pathogens might be assumed unlikely to have SARS-CoV-2. The Centers for Disease Control and Prevention endorsed testing for other respiratory pathogens, suggesting that evidence of another infection could aid the evaluation of patients with potential COVID-19 in the absence of widely available rapid testing for SARS-CoV-2.3 Here we report on co-infection rates between SARS-CoV-2 and other respiratory pathogens in Northern California. These results suggest higher rates of co-infection between SARS-CoV-2 and other respiratory pathogens than previously reported, with no significant difference in rates of SARS-CoV-2 infection in patients with and without other pathogens. The presence of a non–SARS-CoV-2 pathogen may not provide reassurance that a patient does not also have SARS-CoV-2. |
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Social distancing |
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Sustainable social distancing through facemask use and testing during the Covid-19 pandemic Authors: Chowell G et al Publication date: 6 April 2020 Journal: medRxiv preprint DOI: 10.1101/2020.04.01.20049981 We investigate how individual protective behaviors, different levels of testing, and isolation influence the transmission and control of the COVID-19 pandemic. Based on an SEIR-type model incorporating asymptomatic but infectious individuals (40%), we show that the pandemic may be readily controllable through a combination of testing, treatment if necessary, and self-isolation after testing positive (TTI) of symptomatic individuals together with social protection (e.g., facemask use, handwashing). When the basic reproduction number, R0, is 2.4, 65% effective social protection alone (35% of the unprotected transmission) brings the R below 1. Alternatively, 20% effective social protection brings the reproduction number below 1.0 so long as 75% of the symptomatic population is covered by TTI within 12 hours of symptom onset. Even with 20% effective social protection, TTI of 1 in 4 symptomatic individuals can substantially 'flatten the curve' cutting the peak daily incidence in half. |
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Clinical trials |
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National Institutes of Health (NIH) ClinicalTrials.gov website: Covid-19 related trials
Use of Ascorbic Acid in Patients With COVID 19 Sponsor: University of Palermo Different studies showed that ascorbic acid (vitaminC) positively affects the development and maturation of T-lymphocytes, in particular NK (natural Killer) cells involved in the immune response to viral agents. It also contributes to the inhibition of ROS production and to the remodulation of the cytokine network typical of systemic inflammatory syndrome. Recent studies have also demonstrated the effectiveness of vitamin C administration in terms of reducing mortality, in patients with sepsis hospitalized in intensive care wards. Given this background, in the light of the current COVID-19 emergency, since the investigators cannot carry out a randomized controlled trial, it is their intention to conduct a study in the cohort of hospitalized patients with covid-19 pneumonia, administering 10 gr of vitamin C intravenously in addition to conventional therapy. Hyperbaric Oxygen Therapy (HBOT) as a Treatment for COVID-19 (COVID-19) Infection Sponsor: Ochsner Health System After enrollment, patients will be randomized into treatment vs control group. Both populations will receive the same inpatient medical treatment. All patients in the treatment group will undergo hyperbaric oxygen therapy under the same treatment protocol. After completion of the treatment protocol, specific study endpoints will be compared between the treatment and control groups. Proflaxis Using Hydroxychloroquine Plus Vitamins-Zinc During COVID-19 Pandemia Sponsor: Istinye University Healthcare professionals mainly doctors, nurses and their first degree relatives (spouse, father, mother, sister, brother, child) who have been started hydroxychloroquine(plaquenil) 200mg single dose repeated every three weeks plus vitaminC including zinc once a day were included in the study. Study has conducted on 20th of march. Main purpose of the study was to cover participants those who are facing or treating COVID19 infected patients in Ankara. Traditional Chinese Medicine for Severe COVID-19 Sponsor: Xiyuan Hopsital of China Academy of Chinese Medical Sciences Patients with severe COVID-19 have rapid disease progression and high mortality rate. This may attribute to the excessive immune response caused by cytokine storm. Strategies based on anti-virus drugs and treatments against symptoms have now been employed. However, these managements can't effectively treat the lethal lung injury and uncontrolled immune responses, especially in the elderly with severe COVID-19. Traditional Chinese Medicine (TCM), which treats the disease from anther perspective, has achieved satisfactory results. National Health Commission of China released a series of policies to enhance the administration of TCM prescriptions. This study is aimed to evaluate the efficacy and safety of Traditional Chinese Medicine as an adjuvant treatment for severe COVID-19. Sponsor: ProgenaBiome This is a Phase II interventional study testing whether treatment with hydroxychloroquine, Vitamin C, Vitamin D, and Zinc can prevent infection with COVID-19 NIH begins study to quantify undetected cases of coronavirus infection Sponsor: National Institutes of Health A new study has begun recruiting at the National Institutes of Health in Bethesda, Maryland, to determine how many adults in the United States without a confirmed history of infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), have antibodies to the virus. The presence of antibodies in the blood indicates a prior infection. In this “serosurvey,” researchers will collect and analyze blood samples from as many as 10,000 volunteers to provide critical data for epidemiological models. The results will help illuminate the extent to which the novel coronavirus has spread undetected in the United States and provide insights into which communities and populations are most affected. |
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Nutrition during lockdown |
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Nutritional recommendations for CoVID-19 quarantine Authors: Muscogiuri G et al Publication date: 14 April 2020 Journal: European Journal of Clinical Nutrition DOI: 10.1038/s41430-020-0635-2 Since quarantine is associated to the interruption of the work routine, this could be result in boredom. Boredom has been associated with a greater energy intake, as well as the consumption of higher quantities of fats, carbohydrates, and proteins [1]. Further, during quarantine continuously hearing or reading about the pandemic without a break can be stressful. Consequently, the stress pushes people toward overeating, mostly looking for sugary “comfort foods” [2]. This desire to consume a specific kind of food is defined as “food craving”, which is a multidimensional concept including emotional (intense desire to eat), behavioral (seeking food), cognitive (thoughts about food), and physiological (salivation) processes [3]. Of interest, a gender difference has been reported in food craving, with a higher prevalence in women than in men. Carbohydrate craving encourages serotonin production that in turn has a positive effect on mood. In a sense, carbohydrate-rich foods can be a way of self-medicating anti stress. The effect of carbohydrate craving on low mood is proportional to the glycemic index of foods. This unhealthy nutritional habit could increase the risk of developing obesity that beyond being a chronic state of inflammation, it is often complicated by heart disease, diabetes, and lung disease that have been demonstrated to increase the risk for more serious complications of CoVID-19. |
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Personal protection |
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Covid-19: should the public wear face masks? Author: Babak Javid, Michael P Weekes and Nicholas J Matheson Publication date: 10 April 2020 Journal: The BMJ DOI: 10.1136/bmj.m1442 Yes—population benefits are plausible and harms unlikely When covid-19 became a global health emergency, there was a visible contrast between the responses of citizens in east Asia and the rest of the world. In east Asia, wearing of masks was ubiquitous, and sometimes mandated by governments. In Europe and North America, concerned citizens were repeatedly told that masks were not recommended for general use. Now, increasing numbers of agencies and governments, including the Czech Republic and the US Centers for Diseases Control and Prevention are advocating that the general population wears masks, but others, such as the World Health Organization and Public Health England are not. In a linked article Greenhalgh and colleagues argue in support of the public wearing masks on the basis of the “precautionary principle” (doi:10.1136/bmj.m1435). So, what is the evidence? And what might be the downsides? |
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Mental Health |
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Authors: Yeen Huang and Ning Zhao Publication date: 14 April 2020 Journal: Psychology, Health & Medicine DOI: 10.1080/13548506.2020.1754438 In December, 2019, an outbreak of respiratory illness caused by Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China and spread rapidly to other parts of China and around the world. We aimed to identify high-risk groups whose mental health conditions were vulnerable to the COVID-19 outbreak. Data were collected from 7,236 self-selected participants measured by anxiety symptoms, depressive symptoms, and sleep quality. The overall prevalence of anxiety symptoms, depressive symptoms, and poor sleep quality were 35.1%, 20.1%, and 18.2%, respectively. People aged < 35 years reported a higher prevalence of anxiety symptoms and depressive symptoms than people aged ≥ 35 years. Healthcare workers have the highest rate of poor sleep compared to other occupations. Healthcare workers/younger people who spent a high level of time (≥ 3 hours/day) had a particular higher prevalence of anxiety symptoms than in those who spent less time (< 1 hours/day and 1-2 hours/day) on the outbreak. During the COVID-19 outbreak, healthcare workers and younger people were at an especially high-risk of displaying psychological impact when they spent too much time thinking about the outbreak. Continuous monitoring of the psychological consequences for high-risk population should become routine as part of targeted interventions during times of crisis. |
Media – Science related |
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Origins |
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COVID-19: genetic network analysis provides ‘snapshot’ of pandemic origins Publication date: 10 April 2020 Source: University of Cambridge Study charts the “incipient supernova” of COVID-19 through genetic mutations as it spread from China and Asia to Australia, Europe and North America. Researchers say their methods could be used to help identify undocumented infection sources. Researchers from Cambridge, UK, and Germany have reconstructed the early “evolutionary paths” of COVID-19 in humans – as infection spread from Wuhan out to Europe and North America – using genetic network techniques. By analysing the first 160 complete virus genomes to be sequenced from human patients, the scientists have mapped some of the original spread of the new coronavirus through its mutations, which creates different viral lineages. |
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Genetics |
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NYU Langone Scientists Tracking Genetic Evolution of Coronavirus in New York City Publication date: 9 April 2020 Source: The Journal of Precision Medicine As of April 9, NYU Grossman School of Medicine researchers had determined the genetic code for COVID-19 virus taken from 91 New York City patients during the current pandemic, the researchers say. Upon determining the order of the genetic letters in the codes from the local viral samples, also called their “sequences,” the researchers submit them to GISAID EpiFlu – the Global Initiative on Sharing All Influenza. Founded in 2008 to promote the international sharing of data on influenza infections, the GISAID database is now tracking the evolution of the new coronavirus. The NYU Langone Health team determined the viral sequences from samples taken from the nasal swabs of patients at Tisch Hospital, NYU Winthrop Hospital and NYU Langone Hospital Brooklyn. |
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Clinical trials |
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KD Pharma and SLA Pharma to study EPAspire for Covid-19 Publication date: 15 April 2020 KD Pharma Group and SLA Pharma are set to conduct a clinical trial of drug candidate EPAspire to potentially treat Covid-19 symptoms. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) approved the trial, which will investigate the ability of the drug candidate to decrease the mortality risk in severely ill patients. The companies are currently in discussions with authorities in other European countries. An application has been filed with the US Food and Drug Administration (FDA). Enrolment for the trial is set to begin soon and more hospital sites are being added. KD Pharma CEO Oscar Groet said: “We hope EPAspire will be able to reduce the risk of coronavirus complications progressing to serious outcomes like ARDS, the need for artificial ventilation, and intensive care. ArtemiLife Inc. collaborates with Max Planck Institute against COVID-19 Publication date: 9 April 2020 ArtemiLife Inc. announced today a collaboration with the Potsdam, Germany based Max Planck Institute of Colloids and Interfaces. The collaboration is with a group of medical researchers in Denmark and Germany that will be testing Artemisia annua plant extract and artemisinin derivatives in laboratory cell studies against the novel coronavirus disease (COVID-19). Publication date: 9 April 2020 Source: The Journal of Precision Medicine Novartis has announced plans to initiate a Phase III clinical trial in collaboration with Incyte to evaluate the use of Jakavi® (ruxolitinib) for treatment of a type of severe immune overreaction called cytokine storm that can lead to life-threatening respiratory complications in patients with COVID-191-3. The decision is based on pre-clinical evidence and preliminary reports from independent studies, and is supported by extensive data on the safety and efficacy of Jakavi in conditions like acute graft versus host disease and myeloproliferative neoplasms. The proposed trial will assess Jakavi in combination with standard of care (SoC) therapy, compared to SoC therapy alone, in patients with severe COVID-19 pneumonia as a result of SARS-CoV-2 infection. |
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Therapeutics |
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Author: Adam Pope Publication date: 7 April 2020 Source: University of Alabama at Birmingham The University of Alabama at Birmingham has been selected to begin enrolling patients in an international study assessing the use of inhaled nitric oxide (iNO) to improve outcomes for COVID-19 patients with severely damaged lungs. |
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Testing |
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Guidance on the use of Covid-19 rapid diagnostic tests Author: Jan Jacobs Institution: Unit of Tropical Bacteriology, Department of Clinical Sciences of ITM Publication date: 9 April 2020 Source: Institute of Tropical Medicine Antwerp ITM researchers wrote a position paper to guide the use of rapid diagnostic tests to test for COVID-19 infection. These rapid tests are particularly interesting for low resource settings where lab tests are less obvious. The Institute has years of experience in developing and evaluating diagnostic tests for infectious diseases. Thousands of coronavirus tests are going unused in US labs Author: Amy Maxmen Publication date: 9 April 2020 Journal: Nature DOI: 10.1038/d41586-020-01068-3 US labs that underwent huge efforts to retool for COVID-19 testing still aren’t operating at full capacity. Experts say the lack of a national strategy is largely to blame. COVID-19 Testing: The Threat of False-Negative Results Authors: West CP MD et al Publication date: 9 April 2020 Journal: Mayo Clinic Proceedings DOI: 10.1016/j.mayocp.2020.04.004 As healthcare systems around the world attempt to cope with the coronavirus disease 2019 (COVID-19) ‘tsunami’, concerns about ongoing spread of disease from individuals who are infected without symptoms have been raised.1, 2 Efforts to develop and implement testing protocols are underway, and expanded testing for COVID-19 is a necessary immediate step toward understanding and resolving this crisis.3 As tests become more available, observing principles of evidence-based clinical reasoning concerning the meaning of diagnostic test results is essential. For negative test results in particular, failure to do so has direct implications for the safety of the public and healthcare workers and for the success of efforts to curb the pandemic. Specifically, anticipation of a less visible second wave of infection from individuals with false- negative test results is needed. Author: Prof Sir John Bell Publication date: 5 April 2020 Source: University of Oxford Professor Sir John Bell explores the challenges of antibody testing for Covid-19, noting that no tests to date have performed well. The UK government has been creating a testing strategy that is intended to manage all aspects of Covid-19, including PCR tests on swabs from the nose or throat to detect the virus (which is being done in UK super labs in three locations across the country), as well blood testing to detect people who might have had the virus and hence be protected with immunity. These people would be able to go back to work without the fear of being infected again because they are now immune to the disease. This combination will give UK citizens all the information they and the health system need to manage those with the disease by giving access to rapid disease diagnosis and manage the population as a whole to ensure we will not put ourselves or others at risk while the virus is circulating. If You Have Coronavirus Symptoms, Assume You Have the Illness, Even if You Test Negative Author: Harlan M Krumholz MD Publication date: 1 April 2020 Source: The New York Times You had some exposures that may put you at risk for coronavirus. A few days later you come down with a bad cough yourself and feel a little short of breath and really tired. You take your temperature: 101 degrees. A fever. You suspect you might have Covid-19, the disease caused by the novel coronavirus. The days roll into each other, and your doctor urges you to stay home unless your condition worsens. You feel pretty bad, though, and finally get an appointment. They test you for influenza by sticking a swab far up your nose, and you are told the test came back negative, you don’t have flu. They tell you they are saving the Covid-19 tests for those who are even worse off than you are. You go home with a prescription for antibiotics, possibly because they don’t know what else to do, and read about celebrities who are testing positive but don’t seem so sick. A couple of days later, still with fevers, you go back, and the doctors relent and test you for SARS-CoV-2, the virus that causes Covid-19. They again stick something up your nose to what feels like the bottom of your eyeball. They tell you that the results will be available in a couple of days and you go home and wait. Finally, the results come back and you are told you do not have Covid-19. Now what? Read more... |
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Research censorship |
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China is tightening its grip on coronavirus research Author: Andrew Silver & David Cyranoski Publication date: 15 April 2020 Source: Nature China’s government has started asserting tight control over COVID-19 research findings. Over the past two months, it appears to have quietly introduced policies that require scientists to get approval to publish — or publicize — their results, according to documents seen by Nature and some researchers. This fits with media reports that at least two Chinese universities have posted notices online stating that research on the virus’s origins needs to be approved by the university’s academic committee and the Ministry of Science and Technology (MOST) or Ministry of Education (MOE) before being submitted for publication. Read more... |
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Vaccines |
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GSK actions to support the global response to COVID-19 Publication date: 14 April 2020 Source: Glaxosmithkline GSK is closely monitoring the COVID-19 pandemic and is supporting global efforts to tackle the virus. Since the outbreak, we have been actively exploring ways to help, with our science and expertise, alongside protecting the health and wellbeing of our people and managing our global supply chains to support patients and consumers who depend on our products. We are collaborating with companies and research groups across the world working on promising COVID-19 vaccine candidates through the use of our innovative vaccine adjuvant technology. The use of an adjuvant is of particular importance in a pandemic situation since it may reduce the amount of vaccine protein required per dose, allowing more vaccine doses to be produced and therefore contributing to protecting more people. Studying animal coronavirus defences is opening route to human treatments Publication date: 7 April 2020 Source: Horizon – The EU Research & Innovation Magazine A team that has spent the last five years developing a pipeline of technologies that can churn out a remedy for almost any newly emerging virus may have treatments ready for safety trials on Covid-19 patients by the end of the year. The 20-strong private-public collaboration has been pooling and connecting a series of diverse technologies to build a fast pipeline where the genetic code of a new virus can be plugged in at one end – and thousands of vaccines or antibodies can emerge at the other just a few months later. The pipeline is not ready yet, but the scientists have realised it has already generated antibodies active against SARS-CoV-2, the virus that causes Covid-19. |
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Covid transmission |
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Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period Authors: Kissler SM et al Publication date: 14 April 2020 Journal: Science DOI: 10.1126/science.abb5793 It is urgent to understand the future of severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission. We used estimates of seasonality, immunity, and cross-immunity for betacoronaviruses OC43 and HKU1 from time series data from the USA to inform a model of SARS-CoV-2 transmission. We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave. Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022. Additional interventions, including expanded critical care capacity and an effective therapeutic, would improve the success of intermittent distancing and hasten the acquisition of herd immunity. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to SARS-CoV-2. Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024. Author: Jurgen Thoelen Publication date: 10 April 2020 Source: Medium The initial article: “Belgian-Dutch Study: Why in times of COVID-19 you should not walk/run/bike close behind each other.” created a big interest and reached more than 9.1 million people. As with any article that gathers such a massive audience, there were questions for more details. The investigators created now a “Questions and Answers” document that answers the majority of these questions. Below you can find an unedited, original transcript of this document. The reason I publish it here is, so it can potentially also reach a larger audience and clarify any open points. Publication date: 6 April 2020 Source: Aalto University A joint project carried out by four Finnish research organisations has studied the transport and spread of coronavirus through the air. Preliminary results indicate that aerosol particles carrying the virus can remain in the air longer than was originally thought, so it is important to avoid busy public indoor spaces. This also reduces the risk of droplet infection, which remains the main path of transmission for coronavirus. Watch video of a3D model of a person coughing in an indoor environment… |
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Mental Health |
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Mental Health and the Covid-19 Pandemic Authors: Betty Pfefferbaum MD and Carol S North MD Publication date: 13 April 2020 Journal: The New England Journal of Medicine DOI: 10.1056/NEJMp2008017 Uncertain prognoses, looming severe shortages of resources for testing and treatment and for protecting responders and health care providers from infection, imposition of unfamiliar public health measures that infringe on personal freedoms, large and growing financial losses, and conflicting messages from authorities are among the major stressors that undoubtedly will contribute to widespread emotional distress and increased risk for psychiatric illness associated with Covid-19. Health care providers have an important role in addressing these emotional outcomes as part of the pandemic response. |
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Food Insecurity |
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COVID-19 and the crisis in food systems: Symptoms, causes, and potential solutions Author: Communiqué by IPES-Food Publication date: 14 April 2020 Source: International Panel of Experts on Sustainable Food Systems The COVID-19 health crisis has brought on an economic crisis, and is rapidly exacerbating an ongoing food security and nutrition crisis. In a matter of weeks, COVID-19 has laid bare the underlying risks, fragilities, and inequities in global food systems, and pushed them close to breaking point. Our food systems have been sitting on a knife-edge for decades: children have been one school meal away from hunger; countries – one export ban away from food shortages; farms – one travel ban away from critical labour shortages; and families in the world’s poorest regions have been one missed day-wage away from food insecurity, untenable living costs, and forced migration. The lockdowns and disruptions triggered by COVID-19 have shown the fragility of people’s access to essential goods and services. In health systems and food systems, critical weaknesses, inequalities, and inequities have come to light. These systems, the public goods they deliver, and the people underpinning them, have been under-valued and under-protected. The systemic weaknesses exposed by the virus will be compounded by climate change in the years to come. In other words, COVID-19 is a wake- up call for food systems that must be heeded. |
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Media – Government & Health authorities |
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Categorisation of deatha |
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Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID–19) Publication date: 3 April 2020 Source: US Centers for Disease Control Monitoring the emergence of COVID–19 in the United States and guiding public health response will also require accurate and timely death reporting. The purpose of this report is to provide guidance to death certifiers on proper cause-of-death certification for cases where confirmed or suspected COVID–19 infection resulted in death. As clinical guidance on COVID–19 evolves, this guidance may be updated, if necessary. When COVID–19 is determined to be a cause of death, it is important that it be reported on the death certificate to assess accurately the effects of this pandemic and appropriately direct public health response. New process for reporting COVID-19 deaths Publication date: 2 April 2020 Source: Scottish Government The Scottish Government has outlined details of the improved process to report COVID-19 deaths that began today, Thursday April 2. Health Protection Scotland (HPS) has worked with National Records of Scotland (NRS) to put the new, more efficient procedure in place, which involves cross-checking records between HPS and NRS to identify individuals who have died and have a laboratory confirmed report of COVID-19. Coronavirus Act – excess death provisions: information and guidance for medical practitioners Publication date: 31 March 2020 Source: NHS In England and Wales - NHS Guidance has now been published for doctors that details the new procedures and all additional information for death certification, completing MCCDs (medical cause of death certificate), cremation forms and reporting to the coroner. Read more... |
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Therapeutics |
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Coronavirus (COVID-19) Update: FDA Authorizes Blood Purification Device to Treat COVID-19 Publication date: 10 April 2020 Source: US Food & Drug Administration The U.S. Food and Drug Administration issued an emergency use authorization for a blood purification system to treat patients 18 years of age or older with confirmed Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) with confirmed or imminent respiratory failure. The authorized product works by reducing the amount of cytokines and other inflammatory mediators, i.e., small active proteins in the bloodstream that control a cell’s immune response by filtering the blood and returning the filtered blood to the patient. The proteins that are removed are typically elevated during infections and can be associated with a “cytokine storm” that occurs in some COVID-19 patients, leading to severe inflammation, rapidly progressive shock, respiratory failure, organ failure and death. |
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Testing |
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NIH begins study to quantify undetected cases of coronavirus infection Publication date: 10 April 2020 Source: National Institutes of Health A new study has begun recruiting at the National Institutes of Health in Bethesda, Maryland, to determine how many adults in the United States without a confirmed history of infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), have antibodies to the virus. The presence of antibodies in the blood indicates a prior infection. In this “serosurvey,” researchers will collect and analyze blood samples from as many as 10,000 volunteers to provide critical data for epidemiological models. The results will help illuminate the extent to which the novel coronavirus has spread undetected in the United States and provide insights into which communities and populations are most affected. Help the government increase coronavirus (COVID-19) testing capacity Publication date: 8 April 2020 Last updated: 10 April 2020 Source: Gov.UK The government wants help from businesses to increase testing capacity in the UK as part of its strategy to protect the NHS and save lives. On 2 April 2020, the government announced its new national testing strategy, including a commitment to deliver 100,000 tests a day by the end of the month, and many more beyond that. We want industry to help us in meeting that challenge. Over time, we want to build a large diagnostic industry in this country able to tackle this challenge in the longer term. We’re encouraging the innovative minds of British academia and industry – large and small, across sectors – to dedicate their talents, ambitions and skills to that task. |
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Media – Reporting |
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Origins |
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China clamping down on coronavirus research, deleted pages suggest Authors: Stephanie Kirchgaessner, Emma Graham-Harrison and Lily Huo Publication date: 11 April 2020 Source: The Guardian China is cracking down on publication of academic research about the origins of the novel coronavirus, in what is likely to be part of a wider attempt to control the narrative surrounding the pandemic, documents published online by Chinese universities appear to show. Two websites for leading Chinese universities appear to have recently published and then removed pages that reference a new policy requiring academic papers dealing with Covid-19 to undergo extra vetting before they are submitted for publication. Research on the origins of the virus is particularly sensitive and subject to checks by government officials, the notices posted on the websites of Fudan University and the China University of Geosciences (Wuhan) said. Both the deleted pages were accessed from online caches. Virologist Who Made Simplified CCP Virus Test Backs Lab Origin Theory Author: Petr Svab Publication date: 10 April 2020 Source: The Epoch Times A Czech virologist who developed a simpler way to detect CCP virus infections has come out in support of the theory that the virus likely originated in a laboratory. Sona Pekova, a virologist at the Tilia Laboratories in the Czech Republic, has come into media spotlight after she uncovered several cases of the CCP (Chinese Communist Party) virus, commonly known as novel coronavirus, in the small central European country. |
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Susceptibility |
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Smokers and Vapers May Be at Greater Risk for Covid-19 Author: Jan Hoffman Publication date: 9 April 2020 Source: The New York Times Anxious times — like a pandemic — can lead to unhealthy but self-soothing habits, whether it’s reaching for a bag of potato chips, more chocolate or another glass of wine. But some stress-reducing behaviors are alarming to medical experts right now — namely vaping and smoking of tobacco or marijuana. Because the coronavirus attacks the lungs, this is exactly the moment, they say, when people should be tapering — or better yet, stopping — their use of such products, not escalating them. ”Quitting during this pandemic could not only save your life, but by preventing the need for your treatment in a hospital, you might also save someone else’s life,” said Dr. Jonathan Winickoff, director of pediatric research at the Tobacco Research and Treatment Center at Massachusetts General Hospital. |
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Therapeutics |
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Posted by: Ian Schwartz Publication date: 10 April 2020 Source: RealClear Politics ONE AMERICA NEWS: As experts from the medical field are rushing against the clock to find a cure for COVID-19, one New York doctor claims to have successfully healed around 500 patients using a cocktail of hydroxychloroquine, azithromycin (Z-Pak), and zinc sulfate. The treatment plan of Dr. Vladimir Zelenko, a board-certified family practitioner, has caught the attention of physicians around the world as well as President Trump. One America's Caitlin Sinclair caught up with the New York doctor to discuss his success. Author: Allison Bond Publication date: 10 April 2020 Source: Stat News SAN FRANCISCO — For President Trump, whether Covid-19 patients should take a once-obscure malaria drug is not even a close call: “What do you have to lose?” he said during a briefing this week. “And a lot of people are saying that, and are taking it.” For physicians on the frontlines, the question of whether to use that drug or other unproven medicines is among the most challenging they’ve faced: They’re trained to make decisions based on rigorous data but have little to go on in treating patients with an entirely new disease. Licorice Inhibits Replication of Coronavirus Publication date: 10 April 2020 Source: Mercola.com
85 COVID Patients at The Center for Holistic Medicine: Zero Hospitalizations and No Deaths Publication date: 9 April 2020 Source: Dr Brownstein’s Holistic Medicine 85 COVID Patients at The Center for Holistic Medicine: Zero Hospitalizations and No Deaths At my office, the Center for Holistic Medicine (CHM), we have had 85 COVID patients. At this time, no one has been hospitalized, no one has been diagnosed with pneumonia, and there have been no deaths. There are five practitioners at CHM: Drs. Brownstein, Ng, Nusbaum, Jenny Drummond, PA, and Taylor Easson, NP. Since the start of the COVID-19 crisis, I have been asking my partners how their COVID patients are doing. As of this week, we have had 85 patients either diagnosed with COVID or suspected COVID. I am pleased to report that our patients are doing well with this illness. (Note, since new guidelines have come out stating that any suspected COVID patient can be diagnosed with COVID, I am lumping COVID and suspected COIVD patients together for this post.) |
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Testing |
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US coronavirus cases top 500,000 as researchers say the worst is yet to come in Texas and Florida Authors: Nicole Chavez, Dakin Andone and Faith Karimi Publication date: 11 April 2020 Source: CNN Antibody tests that would verify whether a person recently had the novel coronavirus could be available within a week, according to the nation's top infectious disease expert. "Within a period of a week or so, we're going to have a rather large number of tests that are available," Fauci said on CNN's New Day Friday morning. Having antibodies to the coronavirus could mean someone is protected from getting re-infected, making such tests important for medical workers and others on the front lines fighting the pandemic. As officials begin discussing what it would take for the US to reopen, there could be "merit under certain circumstances" to the idea of Americans carrying certificates of immunity that prove they have tested positive for coronavirus antibodies, Fauci said. Coronavirus Tests Are Being Fast-Tracked by the FDA, but It’s Unclear How Accurate They Are Authors: Lydia DePillis and Caroline Chen Publication date: 10 April 2020 Source: ProPublica “What good is a test if you don’t know it’s giving you reliable results?” one expert said. Concerns are mounting that a lack of accurate testing will make it more difficult for America to relax social distancing. |
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Mortality & morbidity |
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How did New York become the coronavirus capital of the world? Author: Josie Ensor Publication date: 10 April 2020 Source: The Telegraph New York has now become the coronavirus capital of the world, recording more cases than any country across the globe. As of Thursday, the state, which is home to some 19.5 million people, had recorded 159,937 Covid-19 cases - the highest subnational total. It has now surpassed the number of infected people in every country worldwide other than America itself, overtaking second-worst hit Spain, which has 152,446 cases, and Italy with 139,422. The US, as a whole, has 462,000. China, where the virus is widely thought to have originated, has so far tallied 81,865. Authors: Sharon Begley and Hyacinth Empinado Publication date: 9 April 2020 Source: StatReports The numbers seem catastrophic, overwhelming, beyond a magnitude that the human mind or heart can grasp: What do 60,000 — or even 240,000 — deaths look like? Those are roughly the lower and upper limits of projected fatalities in the U.S. from Covid-19 in models that have been informing U.S. policy. Last month, when the lower estimate was 100,000, the White House recommended nationwide countermeasures. Those started with a ban on gatherings and quickly escalated to closing schools and businesses, advising people to wear face masks, and reminding them to stay physically apart. This week, when the lower estimate (from the Institute for Health Metrics and Evaluation) dropped to 60,000, reflecting how well those measures are working, it stoked optimism that the epidemic might soon end with less loss of life. |
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Categorisation of deaths |
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Government has misled public over UK deaths being lower than France Author: Matt Discombe Publication date: 14 April 2020 Source: Health Service Journal (HSJ) The government’s daily coronavirus briefings have repeatedly and incorrectly indicated that the UK has fewer coronavirus deaths than France, based on the numbers of deaths in hospitals, HSJ has learned. The global death comparison chart used in the televised briefing on Monday 13 April showed covid-19 fatalities in France were just above 14,000, as compared to the UK total of 11,329 confirmed hospitalised deaths. Chief scientific adviser Sir Patrick Vallance said the chart only “looks at deaths in hospital”. But, according to Public Health France, the figure for France included deaths from outside hospitals, such as in care and nursing homes. In fact, on 13 April, there had been a total of 9,588 reported deaths of covid-19 patients in French hospitals, from the total of 14,967 deaths in all settings. Author: Sam Blanchard Publication date: 14 April 2020 Source: Daily Mail More than one in five deaths recorded in England and Wales were linked to coronavirus, new figures show, making the start of April the deadliest week on record. Data from the Office for National Statistics shows Covid-19 was mentioned on 3,475 death certificates in the week ending April 3, including hospital, care home and community deaths. The total number of deaths recorded in Week 14 - as it is officially known - was 16,387, meaning coronavirus has pushed the death toll in England and Wales to its highest level since official weekly figures began in 2005. Feds classifying all coronavirus patient deaths as ‘COVID-19’ deaths, regardless of cause Publication date: 7 April 2020 Source: New York Post The federal government is classifying the deaths of patients infected with the coronavirus as COVID-19 deaths, regardless of any underlying health issues that could have contributed to the loss of someone’s life. Dr. Deborah Birx, the response coordinator for the White House coronavirus task force, said the federal government is continuing to count the suspected COVID-19 deaths, despite other nations doing the opposite. In a video she says “if someone dies with Covid-19 we’re counting that [as a Covid death]” Publication date: 10 April 2020 Source: Off Guardian Minnesota State Senator says Department of Health guidelines instruct doctors to list Covid19 as cause of death, without being tested. Minnesota State Senator Scott Jensen appeared on a local news show to report that doctors were receiving instructions from the Minnesota Department of Health to report Covid19 as a cause of death, even if the patient was never tested. Senator Jensen, who is also a practising physician, said he had never before in his thirty-five-year career received specific instructions on how to fill out a death certificate. The apparent policy of Minnesota – to report any and all pneumonia or “flu-like illness” decedents as Covid19 cases, with or without a test – ties in with the US policy as described by the CDC’s official memos. Fauci dismisses 'conspiracy theory' of overstated US Covid-19 death toll Author: Oliver Milman Publication date: 9 April 2020 Source: The Guardian Anthony Fauci, the top US infectious diseases expert, has warned that baseless “conspiracy theories” are swirling around the coronavirus crisis following claims that America’s official death toll from Covid-19 has been overstated. Fauci, who has been director of the National Institute of Allergy and Infectious Diseases since 1984, said he had seen unfounded conjecture attach itself to previous crises and dismissed the emerging idea, largely promoted by high-profile figures in rightwing media, that the US’s Covid-19 death toll is being inflated by unrelated medical conditions. Are deaths of people with Covid-19 being accurately recorded? Publication date: 23 March 2020 Source: Off Guardian According to Prof Walter Ricciardi – “the way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.” “On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity - many had two or three,” he says. Author: Gabriela Segura MD Publication date: 29 March 2020 Source: Health Matrix 'A doctor on the front-line' in the 'war against COVID-19' questioning the way deaths are being recorded |
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Second wave infections |
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Singapore sees jump in virus cases as second wave grows Publication date: 10 April 2020 Source: Medical Xpress Singapore reported almost 200 new coronavirus cases and one death Friday as a country previously seen as a model for tackling the disease battles a fast-moving second wave of infections. The city-state was among the first places to report COVID-19 cases after the virus emerged in China, but kept the outbreak under control with a strict regime of testing and contact-tracing. It has however seen a sharp surge in locally transmitted cases this month, prompting the government to impose tough curbs it had previously resisted, including the closure of most workplaces. |
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Tracking |
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Apple and Google partner on COVID-19 contact tracing technology Publication date: 10 April 2020 Source: Apple Newsroom Across the world, governments and health authorities are working together to find solutions to the COVID-19 pandemic, to protect people and get society back up and running. Software developers are contributing by crafting technical tools to help combat the virus and save lives. In this spirit of collaboration, Google and Apple are announcing a joint effort to enable the use of Bluetooth technology to help governments and health agencies reduce the spread of the virus, with user privacy and security central to the design. |
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Vaccines |
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Here’s why Bill Gates wants indemnity… Are you willing to take the risk? Publication date: 11 April 2020 Source: Children’s Health Defense Why are the world’s top vaccine promoters, like Paul Offit and Peter Hotez, frantically warning us about the unique and frightening dangers inherent in developing a coronavirus vaccine? In this video footage, Offit, Hotez and even Anthony Fauci (in an unguarded moment), warn that any new coronavirus vaccine could trigger lethal immune reactions “vaccine enhancement” when vaccinated people come in contact with the wild virus. Instead of proceeding with caution, Fauci has made the reckless choice to fast track vaccines, partially funded by Gates, without critical animal studies before moving into human clinical trials that could provide early warning of runaway immune response. Safety concerns over vaccine for coronavirus still remain, says expert Author: Audrey Cher Publication date: 9 April 2020 Source: CNBC Key points
Bill Gates on where the COVID-19 pandemic will hurt the most Authors: Judy Woodruff, Courtney Vinopal and Courtney Norris Publication date: 7 April 2020 Source: PBS News Hour Bill Gates, the billionaire and philanthropist who sounded a prescient warning five years ago about the threat of a global pandemic, spoke about the need for more testing and vaccine capabilities in the fight against the novel coronavirus. |
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Indirect effects on healthcare system |
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Warning as UK coronavirus outbreak leads to sharp rise in deaths at home Authors: Denis Campbell, Sarah Marsh and Sarah Johnson Publication date: 16 April 2020 Source: The Guardian The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned. Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them. And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. ‘Mountain’ waiting list will need five-year plan, says royal college Author: Sharon Brennan Publication date: 14 April 2020 Source: Health Services Journal (HSJ) The NHS will need a five-year strategy to deal with a “mountain” of an elective waiting list following the coronavirus outbreak, the Royal College of Surgeons has said. Elective procedures have been subject to suspension as hospitals have retrained and redeployed staff to treat covid-19 patients. The elective waiting list already stood at 4.4 million patients before the outbreak, the highest figure since the referral to treatment pathway began in 2007. Derek Alderson, RCS president, told an online webinar this morning: “Numbers [on the waiting list] are going to rise substantially when we come out of this crisis and the longer we are restricted in ability to deliver surgery, the greater that number is going to be and the bigger the size of the catch-up process. With Covid-19 delaying routine care, chronic disease startups brace for a slew of complications Author: Erin Brodwin Publication date: 14 April 2020 Source: Stat Clinicians at health tech startups who treat patients with chronic conditions are raising a looming concern: Will their patients — many of whom have had their routine care disrupted during the Covid-19 pandemic — see a relapse in their illnesses or new complications once the crisis subsides? Chronic conditions are as broad as they are diverse, ranging from diabetes and hypertension to Crohn’s disease and depression. As the pandemic has overwhelmed the health care system, people with chronic illnesses have been forced to postpone much of their care, which can be critical to keeping their most troublesome symptoms at bay. Now, digital health companies focused on the chronically ill are preparing for the ripple effects of those delays — and trying to get ahead of them by doubling down on patient outreach. Alarm sounded over rise in non-coronavirus deaths in Scotland Authors: Libby Brooks and Caelainn Barr Publication date: 8 April 2020 Source: The Guardian New figures reveal a significant rise in deaths unrelated to Covid-19 in Scotland, prompting warnings of the “huge risks” if people do not seek medical treatment because they believe that the health service is already overstretched. Data from the National Records of Scotland shows that in the last full week, from 30 March to 5 April, the number of registered deaths from all causes across Scotland was 60% higher than the five-year average – at 1,741 deaths compared with the average of 1,098. Combining that week with the previous one, from 23 March to 5 April, the overall number of deaths registered was 27% above the five-year average. |
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Nature, recovery and Covid-19 |
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COVID-19 and nature are linked. So should be the recovery Author: Marie Quinney Publication date: 14 April 2020 Source: World Economic Forum The COVID-19 pandemic is a stark reminder of our dysfunctional relationship with nature. Studies show deforestation and loss of wildlife cause increases in infectious diseases. Half of the world’s GDP is highly or moderately dependent on nature. For every dollar spent on nature restoration, at least $9 of economic benefits can be expected. |
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Food supply |
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Pandemic reveals weaknesses of EU's food system Author: Elena Sánchez Nicolás Publication date: 16 April 2020 Source: EU Observer The restrictive measures imposed to slow the spread of the coronavirus have disrupted the usual cross-border flow of seasonal workers for this time of the year, affecting the EU's food supply system. Farmers of asparagus, strawberries or apples across the bloc have already warned that they might have to ditch this year's crop season, which mainly relies on workers from eastern Europe and third countries. Coronavirus: Five ways the outbreak is hitting global food industry Publication date: 13 April 2020 Source: BBC As the world's population was plunged into lockdown, our social media feeds became filled with stories of shortages at local supermarkets. But with many restaurants and other areas of the hospitality industry effectively shut for business, food producers are warning they actually have too much stock which will now go to waste. These are some of the ways the coronavirus pandemic is impacting the supply chain of food around the world. Dumped milk, smashed eggs, plowed vegetables: Food waste of the pandemic Authors: David Yaffe-Bellamy and Michael Corkery Publication date: 11 April 2020 Source: The New York Times In Wisconsin and Ohio, farmers are dumping thousands of gallons of fresh milk into lagoons and manure pits. An Idaho farmer has dug huge ditches to bury 1 million pounds of onions. And in South Florida, a region that supplies much of the Eastern half of the United States with produce, tractors are crisscrossing bean and cabbage fields, plowing perfectly ripe vegetables back into the soil. After weeks of concern about shortages in grocery stores and mad scrambles to find the last box of pasta or toilet paper roll, many of the nation’s largest farms are struggling with another ghastly effect of the pandemic. They are being forced to destroy tens of millions of pounds of fresh food that they can no longer sell. The closing of restaurants, hotels and schools has left some farmers with no buyers for more than half their crops. And even as retailers see spikes in food sales to Americans who are now eating nearly every meal at home, the increases are not enough to absorb all of the perishable food that was planted weeks ago and intended for schools and businesses. |
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Financial impact |
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Sunak says Britain's GDP may fall by up to 30% amid virus crisis – paper Publication date: 13 April 2020 Source: Reuters Britain’s gross domestic product (GDP) could fall by up to 30% between April and June, Chancellor of the Exchequer Rishi Sunak told his colleagues as members of the cabinet call for easing lockdown restrictions amid the coronavirus outbreak, the Times reported. Sunak discussed the possibility of a 25% to 30% fall in GDP in the second quarter, the newspaper reported, adding that ten ministers were pressing for the lockdown to be eased next month. |
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Covid transmission |
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Nobody will die from coronavirus in Belarus, says president Author: Andrei Makhovsky Publication date: 13 April 2020 Source: Reuterselarus President Alexander Lukashenko said on Monday nobody would die from the coronavirus in his country and again rejected any need for the strict lockdown measures adopted by most countries to contain the spread of the pandemic. Sweden, has not adopted a strict lock-down policy and has near normal mortality levels Publication date: 10 April 2020 Source: InProportion2 Sweden currently has normal overall mortality levels and has not adopted the strict lock-down policies other countries have. |
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Public response |
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Coronavirus lockdown: German lawyer detained for opposition Author: Alex Thomson Publication date: 14 April 2020 Source: UKColumn A large number of well-established doctors and lawyers in the German-speaking countries have questioned the constitutionality of their governments' stringent confinement measures, which are commonly being referred to by the English loan-word der Shutdown (as there is no precedent for what to call the situation in German). These measures have begun to be challenged openly on the streets of Berlin. The medical and legal dissidents number in the dozens. None, however, has paid such a price for that freedom of speech as the German medical lawyer Beate Bahner, who has been committed to a psychiatric institution for publicly disagreeing with the measures and policies followed by the German government. German Lawyer Sent to Psych Ward for Organizing Protest Against COVID-19 Lockdown Author: Kurt Nimmon Publication date: 14 April 2020 Source: Another Day in the Empire In the Soviet Union, activists were sent to state psychiatric wards. According to the state, any and all opposition to government policy was considered a form of mental illness. Stephanie Buck writes about the treatment of the “social parasite” Joseph Brodsky. In 1963, Russian poet Joseph Brodsky was seized and sent to a mental institution… Hospital workers pumped him with tranquilizers and repeatedly woke him during the night. He was given cold baths and wrapped in wet canvas that shrank and cut his skin while drying. It is not likely German lawyer Beate Bahner will be tortured like Brodsky. However, that does not make her arrest and forced confinement in a mental institution any less egregious. |
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