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Science |
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Covid-19 disease |
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COVID-19 as an Acute Inflammatory Disease Authors: Rose H Manjili, Melika Zarei, Mehran Habibi and Masoud H Manjili Publication date: 01 July 2020 Journal: The Journal of Immunology DOI: 10.4049/jimmunol.2000413 The 2019 coronavirus disease (COVID-19) pandemic caused by the virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created an unprecedented global crisis for the infrastructure sectors, including economic, political, healthcare, education, and research systems. Although over 90% of infected individuals are asymptomatic or manifest noncritical symptoms and will recover from the infection, those individuals presenting with critical symptoms are in urgent need of effective treatment options. Emerging data related to mechanism of severity and potential therapies for patients presenting with severe symptoms are scattered and therefore require a comprehensive analysis to focus research on developing effective therapeutics. A critical literature review suggests that the severity of SARS-CoV-2 infection is associated with dysregulation of inflammatory immune responses, which in turn inhibits the development of protective immunity to the infection. Therefore, the use of therapeutics that modulate inflammation without compromising the adaptive immune response could be the most effective therapeutic strategy. |
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Epidemiology |
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Authors: Hippisley-Cox J et al Publication date: 31 July 2020 Journal: Heart DOI: 10.1136/heartjnl-2020-317486 Background: There is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission. Methods: This was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20–99 years. We used Cox proportional hazards models to derive adjusted HRs for exposure to ACE inhibitor and ARB drugs adjusted for sociodemographic factors, concurrent medications and geographical region. The primary outcomes were: (a) COVID-19 RT-PCR diagnosed disease and (b) COVID-19 disease resulting in ICU care. Findings: Of 19 486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced risk of COVID-19 disease (adjusted HR 0.71, 95% CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95% CI 0.75 to 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1.25) for ICU care. There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1.59) groups than the white group (adjusted HR 0.66, 95% CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95% CI 0.99 to 1.58) than the white (adjusted HR 0.56, 95% CI 0.52 to 0.62) group. Interpretation: ACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study. |
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Transmission |
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SARS-CoV-2 and the Role of Orofecal Transmission: Systematic Review Authors: Heneghan C, Spencer E, Brassey J and Jefferson T Publication date: 10 August 2020 Journal: medRxiv preprint DOI: 10.1101/2020.08.04.20168054 Background How SARS-CoV-2 is transmitted is of key public health importance. SARS-CoV-2 has been detected in the feces of some Covid-19 patients which suggests the possibility that the virus could additionally be transmitted via the orofecal route. Methods This review is part of an Open Evidence Review on Transmission Dynamics of Covid-19. We conduct ongoing searches using LitCovid, medRxiv, Google Scholar and Google for Covid-19; assess study quality based on five criteria and report important findings on an ongoing basis. Where necessary authors are contacted for further details or clarification on the content of their articles. Results We found 59 studies: nine reviews and 51 primary studies or reports (one cohort study also included a review) examining the potential role of orofecal transmission of SARS-CoV-2. Half (n=29) were done in China. Thirty seven studies reported positive fecal samples for SARS-CoV-2 based on RT-PCR results (n=1,034 patients). Six studies reported isolating the virus from fecal samples of nine patients, one study isolated the virus from rectal tissue and one laboratory study found that SARS-CoV-2 productively infected human small intestinal organoids. Eleven studies report on fecal samples found in sewage, and two sampled bathrooms and toilets. Conclusions Various observational and mechanistic evidence support the hypothesis that SARS-CoV-2 can infect and be shed from the human gastrointestinal tract. Policy should emphasize the importance of strict personal hygiene measures, and chlorine-based disinfection of surfaces in locations where there is presumed or known SARS-CoV-2 activity. Authors: Nguyen LH MD et al Publication date: 31 July 2020 Journal: The Lancet Public Health DOI: 10.1016/S2468-2667(20)30164-X Background: Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods: We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509. Findings: Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation: In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. |
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Covid-19 patients |
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Authors: Lee S et al Publication date: 06 August 2020 Journal: JAMA Internal Medicine DOI: 10.1001/jamainternmed.2020.3862 Design, Setting, and Participants: A retrospective evaluation was conducted for a cohort of 303 symptomatic and asymptomatic patients with SARS-CoV-2 infection between March 6 and March 26, 2020. Participants were isolated in a community treatment center in Cheonan, Republic of Korea. Main Outcomes and Measures: Epidemiologic, demographic, and laboratory data were collected and analyzed. Attending health care personnel carefully identified patients’ symptoms during isolation. The decision to release an individual from isolation was based on the results of reverse transcription–polymerase chain reaction (RT-PCR) assay from upper respiratory tract specimens (nasopharynx and oropharynx swab) and lower respiratory tract specimens (sputum) for SARS-CoV-2. This testing was performed on days 8, 9, 15, and 16 of isolation. On days 10, 17, 18, and 19, RT-PCR assays from the upper or lower respiratory tract were performed at physician discretion. Cycle threshold (Ct) values in RT-PCR for SARS-CoV-2 detection were determined in both asymptomatic and symptomatic patients. Results: Of the 303 patients with SARS-CoV-2 infection, the median (interquartile range) age was 25 (22-36) years, and 201 (66.3%) were women. Only 12 (3.9%) patients had comorbidities (10 had hypertension, 1 had cancer, and 1 had asthma). Among the 303 patients with SARS-CoV-2 infection, 193 (63.7%) were symptomatic at the time of isolation. Of the 110 (36.3%) asymptomatic patients, 21 (19.1%) developed symptoms during isolation. The median (interquartile range) interval of time from detection of SARS-CoV-2 to symptom onset in presymptomatic patients was 15 (13-20) days. The proportions of participants with a negative conversion at day 14 and day 21 from diagnosis were 33.7% and 75.2%, respectively, in asymptomatic patients and 29.6% and 69.9%, respectively, in symptomatic patients (including presymptomatic patients). The median (SE) time from diagnosis to the first negative conversion was 17 (1.07) days for asymptomatic patients and 19.5 (0.63) days for symptomatic (including presymptomatic) patients (P = .07). The Ct values for the envelope (env) gene from lower respiratory tract specimens showed that viral loads in asymptomatic patients from diagnosis to discharge tended to decrease more slowly in the time interaction trend than those in symptomatic (including presymptomatic) patients (β = −0.065 [SE, 0.023]; P = .005). Conclusions and Relevance: In this cohort study of symptomatic and asymptomatic patients with SARS-CoV-2 infection who were isolated in a community treatment center in Cheonan, Republic of Korea, the Ct values in asymptomatic patients were similar to those in symptomatic patients. Isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2. |
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Therapeutics |
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The Functional Medicine Approach to COVID-19: Virus-Specific Nutraceutical and Botanical Agents Authors: Evans JM et al Publication date: 11 August 2020 Journal: ICMJ As the novel infection with SARS-CoV-2 emerges, objective assessment of the scientific plausibility of nutraceutical and botanical interventions for prevention and treatment is important. We evaluate twelve such interventions with mechanisms of action that modulate the immune system, impair viral replication, and/or have been demonstrated to reduce severity of illness. These are examples of interventions that, mechanistically, can help protect patients in the presence of the prevalent and infectious SARS-CoV-2 virus. While there are limited studies to validate these agents to specifically prevent COVID-19, they have been chosen based upon their level of evidence for effectiveness and safety profiles, in the context of other viral infections. These agents are to be used in a patient-specific manner in concert with lifestyle interventions known to strengthen immune response (see related article in this issue of IMCJ). Authors: Shakoor H et al Publication date: 09 August 2020 Journal: Maturitas DOI: 10.1016/j.maturitas.2020.08.003 The world is currently in the grips of the coronavirus disease (COVID-19) pandemic, caused by the SARS-CoV-2 virus, which has mutated to allow human-to-human spread. Infection can cause fever, dry cough, fatigue, severe pneumonia, respiratory distress syndrome and in some instances death. COVID-19 affects the immune system by producing a systemic inflammatory response, or cytokine release syndrome. Patients with COVID-19 have shown a high level of pro-inflammatory cytokines and chemokines. There are currently no effective anti-SARS-CoV-2 viral drugs or vaccines. COVID-19 disproportionately affects the elderly, both directly, and through a number of significant age-related comorbidities. Undoubtedly, nutrition is a key determinant of maintaining good health. Key dietary components such as vitamins C, D, E, zinc, selenium and the omega 3 fatty acids have well-established immunomodulatory effects, with benefits in infectious disease. Some of these nutrients have also been shown to have a potential role in the management of COVID-19. In this paper, evidence surrounding the role of these dietary components in immunity as well as their specific effect in COVID-19 patients are discussed. In addition, how supplementation of these nutrients may be used as therapeutic modalities potentially to decrease the morbidity and mortality rates of patients with COVID-19 is discussed. Potential role of hypovitaminosis D and Vitamin D supplementation during COVID-19 pandemic Authors: Monica Verdoia and Giuseppe De Luca Publication date: 31 July 2020 Journal: QJM DOI: 10.1093/qjmed/hcaa234 Vitamin D deficiency is a pandemic disorder affecting over 1 billion of subjects worldwide and displaying a broad spectrum of implications on cardiovascular and inflammatory disorders. Since the initial reports of the association between hypovitaminosis D and COVID-19, Vitamin D has been pointed as a potentially interesting treatment for SARS-Cov-2 infection We provide an overview on the current status of vitamin D deficiency, the mechanisms of action of vitamin D and the current literature on the topic, with a special focus on the potential implications for COVID-19 pandemic. |
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Covid-19 and children |
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Authors: Gibble K, Marinelli K and Tomori C Publication date: 06 August 2020 Journal: Journal of Human Lactation DOI: 10.1177/0890334420949514 Some COVID-19 policies separate infants and mothers, preventing or impeding breastfeeding, despite no evidence for vertical transmission of SARS-CoV-2 and generally mild symptoms in infants.
Children and COVID-19: State Data Report Publication date: 30 July 2020 Source: American Academy of Pediatrics Summary of State-Level Data Provided in this Report Detail and links to state/local data sources provided in Appendix Cumulative Number of Child COVID-19 Cases*
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Testing |
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Viral cultures for COVID-19 infectivity assessment. Systematic review Authors: Tom Jefferson, Elizabeth Spencer, Jon Brassey and Carl Heneghan Publication date: 04 August 2020 Journal: medRxiv preprint DOI: 10.1101/2020.08.04.20167932 We report the results of a review of the evidence from studies comparing SARS-CoV-2 culture with reverse transcriptase polymerase chain reaction (rt-PCR), as viral culture represents the best indicator of current infection and infectiousness of the isolate. We identified fourteen studies succeeding in culturing or observing tissue invasion by SARS-CoV in sputum, naso or oropharyngeal, urine, stool and environmental samples from patients diagnosed with Covid-19. The data are suggestive of a relation between the time from collection of a specimen to test, copy threshold, and symptom severity, but the quality of the studies was moderate with lack of standardised reporting and lack of testing of PCR against viral culture or infectivity in animals. This limits our current ability to quantify the relationship between viral load, cycle threshold and viable virus detection and ultimately the usefulness of PCR use for assessing infectiousness of patients. Prospective routine testing of reference and culture specimens are necessary for each country involved in the pandemic to establish the usefulness and reliability of PCR for Covid-19 and its relation to patients factors such as date of onset of symptoms and copy threshold, in order to help predict infectivity. |
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Immunity |
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Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area Authors: Moscola J et al Publication date: 06 August 2020 Journal: JAMA DOI: 10.1001/jama.2020.14765 The greater New York City (NYC) area, including the 5 boroughs and surrounding counties, has a high incidence of coronavirus disease 2019 (COVID-19),1 and health care personnel (HCP) working there have a high exposure risk. HCP have expressed concerns about access to testing so that infection spread to patients, other HCP, and their families can be minimized.2 The Northwell Health System, the largest in New York State, sought to address this concern by offering voluntary antibody testing to all HCP. We investigated the prevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among HCP and associations with demographics, primary work location and type, and suspicion of virus exposure. Discussion: A 13.7% prevalence of SARS-CoV-2 antibodies in this large cohort study of HCP in the greater NYC area was similar to that among adults randomly tested in New York State (14.0%)4 but higher than among adults in Los Angeles (4.1%).5 HCP in a single hospital in Belgium had lower seroprevalence (6.4%), which was significantly associated only with household contact.6 In this study, high levels of HCP-reported suspicion of virus exposure and prior positive PCR testing results were most strongly associated with seropositivity. |
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Social Impacts |
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Authors: Kaufman HW et al Publication date: 04 August 2020 Journal: JAMA Network Open DOI: 10.1001/jamanetworkopen.2020.17267 Introduction: In response to the coronavirus disease (COVID-19) pandemic, the American Society of Clinical Oncology recommends, “to conserve health system resources and reduce patient contact with health care facilities,… that cancer screening procedures that require clinic/center visits, such as screening mammograms and colonoscopy, be postponed for the time being.”1 A Washington Post headline reported, “Patients with heart attacks, strokes, and even appendicitis vanish from hospitals.”2 A study from 9 high-volume US cardiac catheterization laboratories3 found a 38% decrease in patients treated for ST-elevation myocardial infarction, considered a life-threatening condition. In this study, we analyzed weekly changes in the number of patients with newly identified cancer before and during the COVID-19 pandemic. Discussion: Our prepandemic data represented a good share of the National Cancer Institute weekly incidence estimates of the 6 cancers, ranging from 16% (lung cancer) to 42% (breast cancer).4 A potential limitation of this study is that the association of delayed diagnoses of cancer with outcomes likely depends on the final stage of disease at diagnosis, relative to baseline, and associated treatment implications (curative vs palliative). Our results indicate a significant decline in newly identified patients with 6 common types of cancer, mirroring findings from other countries.5 The Netherlands Cancer Registry has seen as much as a 40% decline in weekly cancer incidence, and the United Kingdom has experienced a 75% decline in referrals for suspected cancer since COVID-19 restrictions were implemented.5 While residents have taken to social distancing, cancer does not pause. The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes. One study suggests a potential increase of 33 890 excessive cancer deaths in the Untied States.6 Our findings are consistent with previous research,1-3,5 and they call for urgent planning to address the consequences of delayed diagnoses. Planning may entail more robust digital technology to strengthen clinical telehealth offerings and other patient-clinician interactions, including self-service scheduling across specialties and well-designed collection processes. |
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Government and Health Authorities |
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Lockdowns |
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Direct and Indirect Impacts of COVID-19 on Excess Deaths and Morbidity: Executive Summary Publication date: 07 August 2020 Source: UK Department of Health and Social Care Background The COVID-19 pandemic will impact the health of many people in England and unfortunately many people will lose their lives. This paper provides a summary of research and analysis, discussing and estimating the health impacts (both excess deaths1 and morbidity) from the pandemic. Impacts of the pandemic may be direct from COVID-19 or may be indirect from changes to the healthcare system or lockdown measures. We conceptualise harm to health using the following four categories: A. Health impacts from contracting COVID-19 (A) B. Health outcomes for COVID-19 worsened because of lack of NHS critical care capacity (B) C. Health impacts from changes to health and social care made in order to respond to COVID- 19, such as changes to emergency care (C1), changes to adult social care (C2), changes to elective care (C3) and changes to primary and community care (C4). D. Health impacts from factors affecting the wider population, both from social distancing measures (D1) and the economic impacts increasing deprivation (D2). The results are briefly discussed in the section below; summary tables of the mortality and morbidity impacts can also be found below. |
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Infection rates |
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Largest testing programme for coronavirus shows virus continued to decline in June Publication date: 06 August 2020 Source: UK Government
The second report from the country’s largest study on coronavirus rates of infection has been published, showing further decline in COVID-19 in late June and early July. The study involved 150,000 volunteers tested across England between 19 June and 8 July. The research, which examines levels of infection in the general population in England, has been published by Imperial College London and will undergo peer review before a final report is published. The findings show the virus continued to decline across the country even when some restrictions had been lifted. Despite people having more interaction with people outside their households and non-essential shops reopening, the virus continued to halve every 8 to 9 days during this period. REACT-1: real-time assessment of community transmission of coronavirus (COVID-19) in June 2020 Publication date: 06 August 2020 Source: UK Department of Health & Social Care Results Overall prevalence of infection in the community was 0.077% (0.065%, 0.092%). Out of 159,199 swab results, 123 were positive. This was lower than the prevalence of 0.13% (0.11%, 0.15%) measured during May 2020. During the period 19 June to 8 July 2020 prevalence decreased by half every 8.7 (5.3, 23) which is very similar to the 8.6 days (6.2, 13.6) measured during May 2020. The reproduction number R was estimated to be 0.58 (0.37, 0.82) which is very similar to that measured during May 2020 at 0.57 (0.45, 0.72). Prevalence of infection in London remains higher than in other regions, despite falling from 0.20% (0.13%, 0.31%) in May 2020 to 0.15% (0.10%, 0.22%) between 19 June and 8 July 2020. Also spatial clustering of cases was observed in and around London in that positive cases were found to be closer to each other than were negative cases. There were no significant differences between the prevalence of infection for key workers and non-key workers. This is different from May 2020 when care workers and healthcare workers had increased risk of infection compared with those who were not key workers. Recent contact with a known COVID-19 case was associated with a higher prevalence at 1.69% (0.89, 3.18) and for contact with a suspected case at 0.16% (0.03, 0.90). Black, Asian and other ethnicity was associated with higher prevalence of infection at 0.15%, 1.0% and 0.15% respectively compared with white ethnicity at 0.07%. Following adjustment, no significant difference was found in the rates in infection within households of different sizes. There were no significant differences in the rates of infection by age which is different to the May results where higher rates of infection were seen in the 8 to 24 years age group. 81% (73, 87) of participants who tested positive did not report any symptoms at the time of swabbing or in the previous 7 days. This is higher than the proportion testing positive without symptoms in May, at 69% (61, 76) and may reflect increased mainstream testing for those with symptoms. Conclusion During the period 19 June to 8 July 2020, SARS-CoV-2 virus was circulating with relatively low prevalence and was declining. Subsequent rounds of REACT-1 will allow accurate assessment of trends in prevalence and transmission. |
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Mortality |
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Analysis of excess all-cause mortality in Ireland during the COVID-19 epidemic Publication date: 03 July 2020 Source: Health Information and Quality Authority (Ireland) The Health Information and Quality Authority (HIQA) analysed excess mortality in Ireland from 11 March 2020 to 16 June 2020 to determine whether the reported COVID-19 mortality provides an accurate estimate of excess mortality during the epidemic. The analysis uses data from Ireland’s death notices website ‘RIP.ie’. Data were analysed using a time series approach whereby expected deaths were predicted using historical RIP.ie death notice data. Sensitivity analyses were conducted to determine the robustness of the findings. Based on the available data, the main findings of this analysis are:
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Vaccines |
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COVID-19 Vaccine Messaging, Part 1 Publication date: 07 July 2020 Source: ClinicalTrials.gov This study tests different messages about vaccinating against COVID-19 once the vaccine becomes available. Participants are randomized to 1 of 12 arms, with one control arm and one baseline arm. We will compare the reported willingness to get a COVID-19 vaccine at 3 and 6 months of it becoming available between the 10 intervention arms to the 2 control arms. |
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Social Impacts |
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Combatting COVID-19's effect on children Publication date: 11 August 2020 Source: OECD The COVID‑19 pandemic is harming health, social and material well-being of children worldwide, with the poorest children, including homeless children and children in detention, hit hardest. School closures, social distancing and confinement increase the risk of poor nutrition among children, their exposure to domestic violence, increase their anxiety and stress, and reduce access to vital family and care services. Widespread digitalisation mitigates the education loss caused by school-closures, but the poorest children are least likely to live in good home-learning environments with internet connection. Furthermore, increased unsupervised on-line internet use has magnified issues around sexual exploitation and cyber-bullying. Immediate government measures need to ensure that children have access to good food, receive protection against child abuse and neglect, have continued access to child physical and mental health services, and can navigate safely on the internet. Policies also need to support parental employment since it is key to fighting child poverty. Read more... |
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Media – Science related |
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Immunity |
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Does the Common Cold Protect You from COVID-19? Author: Chris Baraniuk Publication date: 04 August 2020 Source: The Scientist There are emerging signs that some people might have heightened protection against SARS-CoV-2, perhaps thanks to recent infection by other coronaviruses. In labs all over the world lately, scientists working on COVID-19 have stumbled on an intriguing sort of finding again and again. They’ve found that blood samples from healthy people who were never exposed to the SARS-CoV-2 coronavirus contain reactive immune cells and targeted antibodies that could, perhaps, help stave off COVID-19. These people may—it is still just a hypothesis—possess some degree of pre-existing immunity. If correct, it’s even possible that this immunity has saved thousands from the worst manifestations of this terrible disease. Some of the first hints of pre-existing immunity came via T cells, the white blood cells that destroy infected cells in the body or help other parts of the immune system target an invading pathogen. In one study originally published as a preprint on medRxiv April 22, a group of scientists in Germany reported an intriguing result. Out of 68 healthy donors who had been tested for prior exposure to SARS-CoV-2 and who were found to be negative, 24 of them had a small number of T cells in their blood that reacted when exposed to the SARS-CoV-2 spike (S) protein—a complex structure protruding from the virus’s exterior surface. The study, which was later published in Nature July 29, explains that the cells in question produced proteins on their surfaces, an indication of an immune response. |
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Covid-19 patients |
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America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine Author: Sarah Varney Publication date: 06 August 2020 Source: Kaiser Health News For a world crippled by the coronavirus, salvation hinges on a vaccine. But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity. Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different. “Will we have a COVID vaccine next year tailored to the obese? No way,” said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill. “Will it still work in the obese? Our prediction is no.” |
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Transmission |
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Europe's Top Health Officials Say Masks Aren't Helpful in Beating COVID-19 Author: Jon Miltimore Publication date: 06 August 2020 Source: Foundation for Economic Education Denmark boasts one of the lowest COVID-19 death rates in the world. As of August 4, the Danes have suffered 616 COVID-19 deaths, according to figures from Johns Hopkins University. That’s less than one-third of the number of Danes who die from pneumonia or influenza in a given year. Despite this success, Danish leaders recently found themselves on the defensive. The reason is that Danes aren’t wearing face masks, and local authorities for the most part aren’t even recommending them. This prompted Berlingske, the country’s oldest newspaper, to complain that Danes had positioned themselves “to the right of Trump.” “The whole world is wearing face masks, even Donald Trump,” Berlingske pointed out. This apparently did not sit well with Danish health officials. They responded by noting there is little conclusive evidence that face masks are an effective way to limit the spread of respiratory viruses. Face coverings in the community and COVID-19: a rapid review Publication date: 06 June 2020 Source: Public Health England Key messages
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Mortality |
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European Case-Fatality Rates beyond lockdown and the UK’s outlier status Authors: Jason Oke and Carl Heneghan Publication date: 10 August 2020 Source: The Centre for Evidence-Based Medicine Analysing deaths since mid-July the UK is a clear outlier with a Case Fatality Rate(CFR) of 6.57. Every other European country has a CFR for this period less than three, and Spain is as low as 0.15. Spain has reported over 60,000 cases, but only 94 deaths; Germany has 21,000 cases compared to the UK’s 26,500 cases but reports 93% fewer deaths (129 versus 1,744), and Russia has nearly ten times as many cases as the UK but only twice the deaths. The difference in the UK is so stark that the primary explanation has to be in the current recording and reporting of deaths. We are expecting the UK numbers to be revised this week to bring them, somewhat, in line with the rest of Europe. The Telegraph, however, is reporting that The official Covid-19 daily death toll may never be brought back. We’ll keep you posted. |
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Testing |
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Are you infectious if you have a positive PCR test result for COVID-19? Authors: Tom Jefferson and Carl Heneghan Publication date: 05 August 2020 Source: The Centre for Evidence-Based Medicine PCR detection of viruses is helpful so long as its accuracy can be understood: it offers the capacity to detect RNA in minute quantities, but whether that RNA represents infectious virus may not be clear. During our Open Evidence Review of oral-fecal transmission of Covid-19, we noticed how few studies had attempted or reported culturing live SARS-CoV-2 virus from human samples. This surprised us, as viral culture is regarded as a gold standard or reference test against which any diagnostic index test for viruses must be measured and calibrated, to understand the predictive properties of that test. In viral culture, viruses are injected in the laboratory cell lines to see if they cause cell damage and death, thus releasing a whole set of new viruses that can go on to infect other cells. We, therefore, reviewed the evidence from studies reporting data on viral culture or isolation as well as reverse transcriptase-polymerase chain reaction (RT-PCR), to understand more about how the PCR results reflect infectivity. |
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Therapeutics |
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‘Politicized’ Hydroxychloroquine Being ‘Discarded Prematurely’ Warns Oxford Professor Author: Nick Regan Publication date: 07 August 2020 Source: The National Pulse LEADING SCIENTIFIC RESEARCHERS FROM THE UNIVERSITY OF OXFORD HAVE WARNED THAT “THE ANTIVIRAL MEDICATION HYDROXYCHLOROQUINE IS BEING ‘DISCARDED PREMATURELY’ AND COULD STILL HAVE BENEFIT AGAINST COVID-19”, POTENTIALLY SAVING TENS OF THOUSANDS OF LIVES. Studies taken place to date have sought to treat patients who have already caught the virus, however, experts say it may still be able to stop people from getting infected in the first place. Both the BBC and the PharmaTimes report on the matter. The Oxford University-led trial is aiming to enrol 40,000 frontline workers around the world. Investigators hope the large-scale, double-blind randomised study will show if early use of the treatment prevents the virus from getting worse. “We know now that it doesn’t work in treatment of hospitalised patients,” says Prof Nick White, one of the study’s investigators. “But it’s still is a medicine that may prove beneficial in preventing Covid-19.” Prof. White is a well-respected scientists who was awarded the Order of the British Empire (OBE) in 1999 and has worked with Oxford University as well as other high profile medical departments over a four-decade long career. |
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Lockdowns |
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Leicester lockdown: could better data have prevented it? Author: Jacqui Wise Publication date: 05 August 2020 Journal: The BMJ DOI: 10.1136/bmj.m3028 Leicester was the first place in the UK to be singled out for a local lockdown in response to a spike in covid-19 cases—and some people have questioned whether it was necessary. Others certainly think it could have been handled better. Leicester’s mayor, Peter Soulsby, has accused the government of using a sledgehammer to crack a nut and says he is “incredibly frustrated” by Public Health England’s inability to provide timely and detailed testing data that critics say could have helped the city avoid the lockdown. As this article went to press, the government had just announced further local restrictions in Greater Manchester, Lancashire, and West Yorkshire in response to rising numbers of covid-19 infections. The move brought criticism for the timing and clarity of the communication, raising questions about future local lockdowns. Incomplete data England’s health and social care secretary, Matt Hancock, first mentioned a new covid-19 “outbreak” in Leicester on 18 June during the government’s daily briefing (box 1). Soulsby says this took him by surprise; he knew cases were increasing but said this was the first time anyone had used the word outbreak. |
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Vaccines |
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New data reveals who’s most likely to refuse a COVID-19 vaccine Publication date: 10 August 2020 Source: Ipsos Mori The research, by King’s College London and Ipsos MORI, finds that a greater likelihood of refusing a potential vaccine is linked to beliefs, attitudes and values that reflect greater scepticism about science and authority and less concern about the COVID-19 pandemic. Higher proportions of the following groups say it’s doubtful they would get a vaccine, or say they definitely won’t:
Publication date: 06 August 2020 Source: The Children’s Health Defense Summary:
Publication date: 05 August 2020 Source: Center for Science in the Public Interest COVID-19 vaccines should be made widely available only after the Food and Drug Administration has been able to evaluate safety and efficacy data from completed Phase 3 clinical trials, according to the nation’s leading vaccine authorities. Nearly 400 experts in virology, epidemiology, vaccinology, clinical care, and public health are calling on FDA Commissioner Stephen Hahn to ensure a thorough, transparent process that will give experts and the general public alike reassurance that the candidate vaccines are safe and effective. The federal effort to accelerate progress on COVID-19 vaccines, branded as “Operation Warp Speed,” has as its stated goal the delivery of 300 million doses of a safe and effective COVID-19 vaccine by January 21. The need for such a vaccine for COVID-19, which has killed more than 157,000 and infected more than 4.7 million Americans, is urgent, the experts say. But the process should be as thorough as the FDA’s review for previous vaccine candidates and involve open meetings of the FDA’s Vaccines and Related Biologics Product Approval Committee. |
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Social Impact |
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Authors: Reginald D. Williams II, Arnav Shah, Roosa Tikkanen, Eric C. Schneider, M.D., and Michelle M. Doty Publication date: 06 August 2020 Source: The Commonwealth Fund With more than 4 million confirmed cases and 150,000 deaths as of August, the United States is failing to control the COVID-19 pandemic. At a time when many nations are reopening their economies and societies, the U.S. is struggling in its attempts to do the same. To examine the early impact of the pandemic on the well-being of adults in the U.S. and abroad, the Commonwealth Fund joined the survey research firm SSRS to interview 8,259 adults age 18 and older between March and May 2020. It is the latest in the Commonwealth Fund’s series of cross-national comparisons featuring the United States and nine other high-income countries that participate in the Fund’s annual International Health Policy Survey. The following exhibits illustrate COVID-19’s effects on people’s mental health and economic security and compare levels of public trust in national leaders in responding to the pandemic. SURVEY HIGHLIGHTS
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Media – Reporting |
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Second wave |
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No, Europe isn't being engulfed by a deadly second wave Author: Ross Clark Publication date: 11 August 2020 Source: The Telegraph Hard luck to those who switched their holidays to Greece when Spain was put back on the quarantine list. The Greek government has just officially declared a "second wave". Once holidaymakers have explored the Aegean they face getting to know a lot more about the insides of their own homes upon their return, as Greece is now a favourite to be added to the ever-growing list of countries whose air bridges with Britain have collapsed. But how real is this "second wave" apparently sweeping Europe? Look at the chart of new recorded infections in Greece and, sure enough, you can call it a second wave. Recorded cases began to inch upwards from mid-June onwards. The figure for Sunday – 202 – was markedly higher than the peak in new recorded infections in Greece’s first wave, which reached 156 on April 21. But then look at the chart for Greece’s Covid deaths and there is not the slightest trace of a second wave. Deaths have been running at around one a day – fewer than the average of five a day recorded at the peak in April. Inevitably, there is going to be a lag between diagnoses, but if Greece was going to suffer a second peak in deaths you would have expected it by now. In April most countries saw only a week’s gap between their peaks in recorded infections and deaths. |
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Lockdowns |
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We Need a Principled Anti-Lockdown Movement Author: Jeffrey A Tucker Publication date: 09 August 2020 Source: American Institute for Economic Research Shell-shocked is a good way to describe the mood in the U.S. for a good part of the Spring of 2020. Most of us never thought it could happen here. I certainly did not, even though I’ve been writing about pandemic lockdown plans for 15 years. I knew the plans were on the shelf, which is egregious, but I always thought something would stop it from happening. The courts. Public opinion. Bill of Rights. Tradition. The core rowdiness of American culture. Political squeamishness. The availability of information. Something would prevent it. So I believed. So most of us believed. Still it happened, all in a matter of days, March 12-16, 2020, and boom; it was over! We were locked down. Schools shut. Bars and restaurants closed. No international visitors. Theaters shuttered. Conferences forcibly ended. Sports stopped. We were told to stay home and watch movies…for two weeks to flatten the curve. Then two weeks stretched to five months. How lucky for those who lived in the states that resisted the pressure and stayed open, but even for them, they couldn’t visit relatives in other states due to quarantine restrictions and so on. Lockdowns ended American life as we knew it just five months ago, for a virus that 99.4-6% of those who contract it shake off, for which the median age of death is 78-80 with comorbidities, for which there is not a single verified case of reinfection on the planet, for which international successes in managing this relied on herd immunity and openness. The Myth That Lockdowns Stop Pandemics Author: Stacey Rudin Publication date: 07 August 2020 Source: Real Clear Politics From the beginning of time, humans have used mythology to make sense of a chaotic natural world. Sir G.L. Gomme dubbed myths “the science of a pre-scientific age.” Folklore provided pre-scientific people a comforting sense of control over nature. To address dry spells, they deployed rain dances. Sunless stretches hindering crops prompted offerings to Helios. Then, our ancestors sat back and waited. The rains always came. The sun always reappeared, validating their “wisdom,” the illusion of control reinforced. Thanks to science, we know this was pure superstition. Though the same outcomes would have occurred had the tribe taken no action, the tribe leader would still have received credit or blame from his constituents. Similarly, today’s politicians race to take credit -- or place blame -- for COVID-19 “results.” Do politicians really control these outcomes, or are they simply exploiting our ingrained tendencies? When China first deployed lockdown in January to “defeat COVID-19,” The Washington Post approvingly quoted a Georgetown University professor as saying, “The truth is those kinds of lockdowns are very rare and never effective…” In March, Imperial College London's dire projections influenced the White House, but a careful reading of the advice contained in the Imperial College report reveals that its authors knew lockdown alone could not eliminate any infections, only delay them: “The more successful a strategy is at temporary suppression,” it stated, “the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity.” Lockdown easing did not lead to rise in coronavirus infections in England, survey shows Author: Sarah Knapton Publication date: 06 August 2020 Source: The Telegraph The easing of lockdown restrictions did not result in an increase in Covid-19 infection rates in England, the largest swab testing survey carried out to date has found. Although there are fears that releasing measures too soon has led to localised spikes in some areas, new data suggests that there was no overall rise after primary schools returned and non-essential shops reopened. According to Imperial College London and Ipsos Mori, community prevalence actually fell after lockdown measures were relaxed, decreasing from 12 infections per 10,000 people in May to eight in 10,000 by mid-June to early July. Matt Hancock, the Health Secretary, said: "This research highlights how, thanks to everyone's efforts and sacrifice, alongside targeted measures to counter the spread of this virus in health and care settings, we were able to keep rates of infection low as some restrictions were lifted. Physical distancing, mask-wearing could be in place for 2-3 years even with vaccine, Tam warns Author: Ryan Patrick Jones Publication date: 04 August 2020 Source: CBC Canadians shouldn't expect a COVID-19 vaccine to be a "silver bullet" that will bring a swift end to the coronavirus pandemic and a return to normal, according to the country's chief public health officer. Dr. Theresa Tam used her briefing on Tuesday in Ottawa to temper expectations about the speed and effectiveness of a vaccine. She reiterated the importance of physical distancing, proper hand hygiene and mask-wearing, and attempted to dispel any notion that a vaccine will make life go back to the way it was in a couple of months. "We can't at this stage just put all of our focus [on a vaccine] in the hopes that this is the silver bullet solution," said Tam. "We're going to have to manage this pandemic certainly over the next year, but certainly [we are] planning for the longer term of the next two to three years during which the vaccine may play a role but we don't know yet." Tam said it's unclear at this stage how effective a vaccine will be. She said key questions remain about the degree and duration of immunity a vaccine will provide, the dosage that will be needed and whether it will prevent people from getting infected altogether or simply prevent severe illness requiring hospitalization. |
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Mortality |
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Thousands of England's virus deaths 'to be wiped off records due to counting mishap' Author: Ryan Merrifield Publication date: 06 August 2020 Source: The Mirror Up to 10 percent of coronavirus deaths recorded in England will be chalked off due to an error in counting, it has been claimed. Public Health England currently includes all fatalities of anyone who has tested positive for Covid-19, regardless of whether their death is related to the disease. Scientists noticed the error as early as July, leading to an urgent review, with some deaths on the official count happening months after someone was infected. The mishap means all of England's 265,000 confirmed cases would in time be included on the toll, regardless of the circumstances around someone's death. The numbers will be reconfigured so deaths are only counted if a person dies within 28 days of testing positive - like in Scotland and Northern Ireland. |
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Vaccines |
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Dr. Anthony Fauci says chance of coronavirus vaccine being highly effective is ‘not great’ Authors: Berkeley Lovelace Jr and Noah Higgins-Dunn Publication date: 08 August 2020 Source: CNBC White House coronavirus advisor Dr. Anthony Fauci said Friday that the chances of scientists creating a highly effective vaccine — one that provides 98% or more guaranteed protection — for the virus are slim. Scientists are hoping for a coronavirus vaccine that is at least 75% effective, but 50% or 60% effective would be acceptable, too, Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a Q&A with the Brown University School of Public Health. “The chances of it being 98% effective is not great, which means you must never abandon the public health approach.” “You’ve got to think of the vaccine as a tool to be able to get the pandemic to no longer be a pandemic, but to be something that’s well controlled,” he said. The Food and Drug Administration has said it would authorize a coronavirus vaccine so long as it is safe and at least 50% effective. Dr. Stephen Hahn, the FDA’s commissioner, said last month that the vaccine or vaccines that end up getting authorized will prove to be more than 50% effective, but it’s possible the U.S. could end up with a vaccine that, on average, reduces a person’s risk of a Covid-19 infection by just 50%. |
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Return to school |
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Scientists urge routine Covid testing when English schools reopen Author: Nicola Davis Publication date: 10 August 2020 Source: The Guardian Scientists have called for routine Covid testing of teachers and pupils alongside a robust test-and-trace system, amid a debate over how to safely reopen schools in England. On Sunday, the children’s commissioner for England, Anne Longfield, said teachers and pupils should have weekly tests, but Nick Gibb, the schools minister, ruled out the idea, saying instead that those who are symptomatic should be tested. Now researchers behind a report from Delve, a multidisciplinary group convened by the Royal Society, have said routine testing will be necessary when the majority of children return to school. Dr Ines Hassan, a researcher in the global health governance programme at the University of Edinburgh and a lead author of the report, said the group were recommending the widespread and regular screening of all staff in schools, including those who are asymptomatic. Author: Laura Meckler and Emily Guskin Publication date: 06 August 2020 Source: The Washington Post Most American parents think it is unsafe to send their children back to school given the risks of the novel coronavirus, and more than 80 percent favor holding school at least partly online, according to a Washington Post-Schar School survey conducted by Ipsos. But parents also express serious concerns with online schooling and many are drawn to systems that mix the two. The mixed feelings reflect deep and widespread anxiety among parents as they approach the end of a summer break that has produced no national consensus on how to balance the risks of the virus against the academic, social and economic impacts of keeping schools closed. Given three options for the fall, a plurality of parents — 44 percent — want their schools to offer a mix of online and in-person classes, an idea that has been considered by many school districts and adopted by some. In a close second place is all-virtual education, favored by 39 percent of parents. |
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Social Impacts |
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Extreme poverty rises and a generation sees future slip away Authors: Elias Meseret and Cara Anna Publication date: 10 August 2020 Source: Associated Press As a domestic worker, Amsale Hailemariam knew from the inside out the luxury villas that had grown up around her simple shelter of raw metal and plastic sheeting. And in them, she saw how her country, Ethiopia, had transformed. The single mother told herself, “Oh God, a day will come when my life will be changed, too.” The key lay in her daughter, just months from a career in public health, who studied how to battle the illnesses of want and hunger. Then a virus mentioned in none of her textbooks arrived, and dreams faded for families, and entire countries, like theirs. Decades of progress in one of modern history’s greatest achievements, the fight against extreme poverty, are in danger of slipping away because of the COVID-19 pandemic. The world could see its first increase in extreme poverty in 22 years, further sharpening social inequities. “We are living in a state where we are above the dead and below the living,” Amsale said, near tears. “This is not life.” With the virus and its restrictions, up to 100 million more people globally could fall into the bitter existence of living on just $1.90 a day, according to the World Bank. That’s “well below any reasonable conception of a life with dignity,” the United Nations special rapporteur on extreme poverty wrote this year. And it comes on top of the 736 million people already there, half of them in just five countries: Ethiopia, India, Nigeria, Congo and Bangladesh. UK to plunge into deepest slump on record with worst GDP drop of G7 Author: Richard Partington Publication date: 09 August 2020 Source: The Guardian Britain’s economy will be officially declared in recession this week for the first time since the 2008 financial crisis, as the coronavirus outbreak plunges the country into the deepest slump on record. Figures from the Office for National Statistics on Wednesday are expected to show that gross domestic product (GDP), the broadest measure of economic prosperity, fell in the three months to June by 21%. After a decline of 2.2% in the first quarter, the latest snapshot will confirm the UK economy’s descent into recession after the outbreak spread in March and the government imposed a nationwide lockdown to contain it. Economists consider two consecutive quarters of shrinking GDP as the technical definition of a recession. Sluggish footfall in first full week of mandatory face coverings Author: Elias Jahshan Publication date: 03 August 2020 Source: Retail Gazette The first full week of mandatory coverings in retail shops around England has led to sluggish overall footfall figures across the UK, new data suggests. According to experts at Springboard, footfall across all retail destinations throughout the UK rose by 2.8 per cent last week from the previous week. Springboard said that this was a “modest uplift” from the week before when face coverings were only mandatory on the Friday and Saturday, during which footfall had risen by 4.4 per cent across the country. However in England, during the first full week of mandatory face coverings footfall rose by just 2.5 per cent across all destinations compared to more than four per cent in each of the other UK nations. |
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