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Science |
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Origins |
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Authors: Li-Meng Y, Shu K, Jie G and Shanchang H Publication date: 08 October 2020 Journal: Zenodo DOI: 10.5281/zenodo.4073131 Two possibilities should be considered for the origin of SARS-CoV-2: natural evolution or laboratory creation. In our earlier report titled “Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route”, we disproved the possibility of SARS-CoV-2 arising naturally through evolution and instead proved that SARS-CoV-2 must have been a product of laboratory modification. Despite this and similar efforts, the laboratory creation theory continues to be downplayed or even diminished. This is fundamentally because the natural origin theory remains supported by several novel coronaviruses published after the start of the outbreak. These viruses (the RaTG13 bat coronavirus, a series of pangolin coronaviruses, and the RmYN02 bat coronavirus) reportedly share high sequence homology with SARS-CoV-2 and have altogether constructed a seemingly plausible pathway for the natural evolution of SARS-CoV-2. Here, however, we use in-depth analyses of the available data and literature to prove that these novel animal coronaviruses do not exist in nature and their sequences have been fabricated. In addition, we also offer our insights on the hypothesis that SARS-CoV-2 may have originated naturally from a coronavirus that infected the Mojiang miners. Revelation of these virus fabrications renders the natural origin theory unfounded. It also strengthens our earlier assertion that SARS-CoV-2 is a product of laboratory modification, which can be created in approximately six months using a template virus owned by a laboratory of the People’s Liberation Army (PLA). The fact that data fabrications were used to cover up the true origin of SARS-CoV-2 further implicates that the laboratory modification here is beyond simple gain-of-function research. The scale and the coordinated nature of this scientific fraud signifies the degree of corruption in the fields of academic research and public health. As a result of such corruption, damages have been made both to the reputation of the scientific community and to the well-being of the global community. Importantly, while SARS-CoV-2 meets the criteria of a bioweapon specified by the PLA, its impact is well beyond what is conceived for a typical bioweapon. In addition, records indicate that the unleashing of this weaponized pathogen should have been intentional rather than accidental. We therefore define SARS-CoV-2 as an Unrestricted Bioweapon and the current pandemic a result of Unrestricted Biowarfare. We further suggest that investigations should be carried out on the suspected government and individuals and the responsible ones be held accountable for this brutal attack on the global community. |
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Pathogenesis |
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Authors: Lan SD et al Publication date: 05 October 2020 Journal: Scientific Reports DOI: 10.1038/s41598-020-71936-5 SARS-CoV-2 has a zoonotic origin and was transmitted to humans via an undetermined intermediate host, leading to infections in humans and other mammals. To enter host cells, the viral spike protein (S-protein) binds to its receptor, ACE2, and is then processed by TMPRSS2. Whilst receptor binding contributes to the viral host range, S-protein:ACE2 complexes from other animals have not been investigated widely. To predict infection risks, we modelled S-protein:ACE2 complexes from 215 vertebrate species, calculated changes in the energy of the complex caused by mutations in each species, relative to human ACE2, and correlated these changes with COVID-19 infection data. We also analysed structural interactions to better understand the key residues contributing to affinity. We predict that mutations are more detrimental in ACE2 than TMPRSS2. Finally, we demonstrate phylogenetically that human SARS-CoV-2 strains have been isolated in animals. Our results suggest that SARS-CoV-2 can infect a broad range of mammals, but few fish, birds or reptiles. Susceptible animals could serve as reservoirs of the virus, necessitating careful ongoing animal management and surveillance. |
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Epidemiology |
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Authors: Burn E et al Publication date: 06 October 2020 Journal: Nature Communications DOI: 10.1038/s41467-020-18849-z Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19. |
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SARS-CoV-2 pandemic |
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Scientific consensus on the COVID-19 pandemic: we need to act now Authors: Alwan NA et al Publication date: 15 October 2020 Journal: The Lancet DOI: 10.1016/S0140-6736(20)32153-X Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by WHO as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19. SARS-CoV-2 spreads through contact (via larger droplets and aerosols), and longer-range transmission via aerosols, especially in conditions where ventilation is poor. Its high infectivity,1 combined with the susceptibility of unexposed populations to a new virus, creates conditions for rapid community spread. The infection fatality rate of COVID-19 is several-fold higher than that of seasonal influenza,2 and infection can lead to persisting illness, including in young, previously healthy people (ie, long COVID).3 It is unclear how long protective immunity lasts,4 and, like other seasonal coronaviruses, SARS-CoV-2 is capable of re-infecting people who have already had the disease, but the frequency of re-infection is unknown.5 Transmission of the virus can be mitigated through physical distancing, use of face coverings, hand and respiratory hygiene, and by avoiding crowds and poorly ventilated spaces. Rapid testing, contact tracing, and isolation are also critical to controlling transmission. WHO has been advocating for these measures since early in the pandemic. Authors: The Editors Publication date: 08 October 2020 Journal: New England Journal of Medicine DOI: 10.1056/NEJMe2029812 Covd-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy. The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly. SARS-CoV-2 Spike protein co-opts VEGF-A/Neuropilin-1 receptor signaling to induce analgesia Authors: Aubin M et al Publication date: 01 October 2020 Source: PAIN DOI: 10.1097/j.pain.0000000000002097 Global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues unabated. Binding of SARS-CoV-2’s Spike protein to host angiotensin converting enzyme 2 triggers viral entry, but other proteins may participate, including neuropilin-1 receptor (NRP-1). As both Spike protein and vascular endothelial growth factor-A (VEGF-A) – a pro-nociceptive and angiogenic factor, bind NRP-1, we tested if Spike could block VEGF-A/NRP-1 signaling. VEGF-A–triggered sensory neuronal firing was blocked by Spike protein and NRP-1 inhibitor EG00229. Pro-nociceptive behaviors of VEGF-A were similarly blocked via suppression of spontaneous spinal synaptic activity and reduction of electrogenic currents in sensory neurons. Remarkably, preventing VEGF-A/NRP-1 signaling was antiallodynic in a neuropathic pain model. A ‘silencing’ of pain via subversion of VEGF-A/NRP-1 signaling may underlie increased disease transmission in asymptomatic individuals. |
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Covid-19 patients |
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Low zinc levels at clinical admission associates with poor outcomes in COVID-19 Authors: Vogel M et al Publication date: 11 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.07.20208645 Background: Biomarkers to predict Coronavirus disease-19 (COVID-19) outcome early at infection are urgently needed to improve prognosis and treatment. Zinc balances immune responses and also has a proven direct antiviral action against some viruses. Importantly, zinc deficiency (ZD) is a common condition in elderly and individuals with chronic diseases, two groups with more severe COVID-19 outcomes. We hypothesize that serum zinc content (SZC) influences COVID-19 disease progression and thus might represent a useful biomarker. Methods: We run a retrospective observational study with 249 COVID-19 patients admitted in Hospital del Mar. We have studied COVID-19 severity and progression attending to SZC at admission. In parallel we have studied SARS-CoV2 replication in the Vero E6 cell line modifying zinc concentrations. Findings: Our study demonstrates a correlation between serum zinc levels and COVID-19 outcome. Serum zinc levels lower than 50 mcgg/dl at admission correlated with worse clinical presentation, longer time to reach stability and higher mortality. Our in vitro results indicate that low zinc levels favor viral expansion in SARS-CoV2 infected cells. Interpretation: SZC is a novel biomarker to predict COVID-19 outcome. We encourage performing randomized clinical trials to study zinc supplementation as potential prophylaxis and treatment with people at risk of zinc deficiency. UK report on 11,750 patients critically ill with COVID-19 Institution: Intensive Care National Audit & Research Centre (ICNARC) Publication date: 09 October 2010 Clinical Outcomes in Young US Adults Hospitalized With COVID-19 Authors: Jonathan W Cunningham, Muthiah Vaduganathan and Brian L Claggett et al Publication date: 09 October 2020 Journal: JAMA DOI: 10.1001/jamainternmed.2020.5313 Coronavirus disease 2019 (COVID-19) is increasing rapidly among young adults in the US.1 Often described as a disease affecting older adults, to our knowledge, few studies have included younger patients to better understand their anticipated clinical trajectory. We investigated the clinical profile and outcomes of 3222 young adults (defined by the US Census as age 18-34 years) who required hospitalization for COVID-19 in the US. T-Cell Hyperactivation and Paralysis in Severe COVID-19 Infection Revealed by Single-Cell Analysis Authors: Kalfaoglu B et al Publication date: 08 October 2020 Journal: Frontiers in Immunology DOI: 10.3389/fimmu.2020.589380 Severe COVID-19 patients show various immunological abnormalities including T-cell reduction and cytokine release syndrome, which can be fatal and is a major concern of the pandemic. However, it is poorly understood how T-cell dysregulation can contribute to the pathogenesis of severe COVID-19. Here we show single cell-level mechanisms for T-cell dysregulation in severe COVID-19, demonstrating new pathogenetic mechanisms of T-cell activation and differentiation underlying severe COVID-19. By in silico sorting CD4+ T-cells from a single cell RNA-seq dataset, we found that CD4+ T-cells were highly activated and showed unique differentiation pathways in the lung of severe COVID-19 patients. Notably, those T-cells in severe COVID-19 patients highly expressed immunoregulatory receptors and CD25, whilst repressing the expression of FOXP3. Furthermore, we show that CD25+ hyperactivated T-cells differentiate into multiple helper T-cell lineages, showing multifaceted effector T-cells with Th1 and Th2 characteristics. Lastly, we show that CD25-expressing hyperactivated T-cells produce the protease Furin, which facilitates the viral entry of SARS-CoV-2. Collectively, CD4+ T-cells from severe COVID-19 patients are hyperactivated and FOXP3-mediated negative feedback mechanisms are impaired in the lung, which may promote immunopathology. Therefore, our study proposes a new model of T-cell hyperactivation and paralysis that drives immunopathology in severe COVID-19. Extrafollicular B cell responses correlate with neutralizing antibodies and morbidity in COVID-19 Authors: Woodruff MC et al Publication date: 07 October 2020 Journal: Nature Immunology DOI: 10.1038/s41590-020-00814-z A wide spectrum of clinical manifestations has become a hallmark of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic, although the immunological underpinnings of diverse disease outcomes remain to be defined. We performed detailed characterization of B cell responses through high-dimensional flow cytometry to reveal substantial heterogeneity in both effector and immature populations. More notably, critically ill patients displayed hallmarks of extrafollicular B cell activation and shared B cell repertoire features previously described in autoimmune settings. Extrafollicular activation correlated strongly with large antibody-secreting cell expansion and early production of high concentrations of SARS-CoV-2-specific neutralizing antibodies. Yet, these patients had severe disease with elevated inflammatory biomarkers, multiorgan failure and death. Overall, these findings strongly suggest a pathogenic role for immune activation in subsets of patients with COVID-19. Our study provides further evidence that targeted immunomodulatory therapy may be beneficial in specific patient subpopulations and can be informed by careful immune profiling. Presence of hyaluronan in lung alveoli in severe Covid-19 - an opening for new treatment options? Authors: Hellman U et al Publication date: 25 September 2020 Journal: Journal of Biological Chemistry DOI: 10.1074/jbc.AC120.015967 Severe corona virus disease 2019 (Covid-19) is characterized by inflammation of the lungs with increasing respiratory impairment. In fatal Covid-19, lungs at autopsy have been filled with a clear liquid jelly. However, the nature of this finding has not yet been determined.The aim of the study was to demonstrate if the lungs of fatal Covid-19 contain hyaluronan as it is associated with inflammation and acute respiratory distress syndrome (ARDS) and may have the appearance of liquid jelly.Lung tissue obtained at autopsy from three deceased Covid-19 patients was processed for hyaluronan histochemistry using a direct staining method and compared with staining in normal lung tissue.Stainings confirmed that hyaluronan is obstructing alveoli with presence in exudate and plugs, as well as in thickened perialveolar interstitium. In contrast, normal lungs only showed hyaluronan in intact alveolar walls and perivascular tissue. This is the first study to confirm prominent hyaluronan exudates in the alveolar spaces of Covid-19 lungs, supporting the notion that the macromolecule is involved in ARDS caused by SARS-CoV-2. The present finding may open up for new treatment options in severe Covid-19, aiming at reducing the presence and production of hyaluronan in the lungs. |
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Immunity |
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Author: Gennadi Glinsky Publication date: 12 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.03.20206151 Several recent studies identified SARS-CoV-2 reactive T cells in people without exposure to the virus. However, pathophysiological implications of these findings remain unknown. Here, the potential impact of pre-existing T cell reactivity against SARS-CoV-2 in uninfected individuals on markedly different COVID-19 mortality levels in different countries has been investigated. The inverse correlation is documented between the prevalence of pre-existing SARS-CoV-2 reactive T cells in people without exposure to the virus and COVID-19 mortality rates in different countries. In countries with similar levels of pre-existing SARS-CoV-2 cross-reactive T cells in uninfected individuals, differences in COVID-19 mortality appear linked with the extend and consistency of implementations of social measures designed to limit the transmission of SARS-CoV-2 (lockdown; physical distancing; mask wearing). Collectively, these observations support the model that the level of pre-existing SARS-CoV-2 reactive T cells is one of the important determinants of the innate herd immunity against COVID-19. Together with the consistent social measures directed to limit the virus spread, high levels of pre-existing SARS-CoV-2 reactive T cells appear significant determinants diminishing the COVID-19 mortality. Observations reported in this contribution should have significant impact on definitions of the herd immunity threshold required to effectively stop the pandemic in different countries across the globe. SARS-CoV-2 Elicits Robust Adaptive Immune Responses Regardless of Disease Severity Authors: Nielsen SSF et al Publication date: 09 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.08.331645 The SARS-CoV-2 pandemic currently prevails worldwide. To understand the immunological signature of SARS-CoV-2 infections and aid the search for treatments and vaccines, comprehensive characterization of adaptive immune responses towards SARS-CoV-2 is needed. We investigated the breadth and potency of antibody-, and T-cell immune responses, in 203 recovered SARS-CoV-2 infected patients who presented with asymptomatic to severe infections. We report very broad serological profiles with cross-reactivity to other human coronaviruses. Further, >99% had SARS-CoV-2 epitope specific antibodies, with SARS-CoV-2 neutralization and spike-ACE2 receptor interaction blocking observed in 95% of individuals. A significant positive correlation between spike-ACE2 blocking antibody titers and neutralization potency was observed. SARS-CoV-2 specific CD8+ T-cell responses were clear and quantifiable in 90% of HLA-A2+ individuals. The viral surface spike protein was identified as the dominant target for both neutralizing antibodies and CD8+ T cell responses. Overall, the majority of patients had robust adaptive immune responses, regardless of disease severity. These data support the possibility of achieving protective immunity through natural infection and bode well for the prospects of inducing immunological memory through vaccination. Antibody reactivity to SARS-CoV-2 in adults from the Vancouver metropolitan area, Canada Authors: Majdoubi A et al Publication date: 09 October 2020 Source: medRxiv preprint DOI: 10.1101/2020.10.05.20206664 Background: Quantifying antibody reactivity against multiple SARS-CoV-2 antigens at the population level may help understand individual differences in COVID-19 severity. Pre-existing low antibody cross-reactivity may be particularly prevalent among childcare providers, including pediatric health care workers (HCW) who may be more exposed to circulating coronaviruses. Methods: Cross-sectional study that included adults in the Vancouver area in British Columbia (BC), Canada, between May 17 and June 19, 2020. SARS-CoV-2 seroprevalence was ascertained by measuring total SARS-CoV-2 IgG/M/A antibodies against a recombinant spike (S1) protein, and adjusted for bias due to false-positive and false-negative test results. A novel, high sensitivity multiplex assay was also used to profile IgGs against four SARS-CoV-2 antigens, SARS-CoV and four circulating coronaviruses. Findings: Among 276 participants (71% HCW), three showed evidence of direct viral exposure, yielding an adjusted seroprevalence of 0.60% [95%CI 0% - 2.71%], with no difference between HCW and non-HCW, or between paediatric and adult HCW. Among the remaining 273 unexposed individuals, 7.3% [95%CI 4.5% - 11.1%], 48.7 [95%CI 42.7% - 54.8%] and 82.4% [95%CI 77.4% - 86.7%] showed antibody reactivity against SARS-CoV-2 RBD, N or Spike proteins, respectively. SARS-CoV-2 reactivity did not correlate with age, sex, did not differ between HCW and non-HCW (prevalence: 1.0% vs 1.0%; P=1.00) and between pediatric and adult HCW (prevalence: 0.7% vs 1.6%; P=0.54), and weakly correlated with reactivity to circulating coronaviruses (Spearman rho range: 0.130 to 0.224 for 7 significant out of 16 correlations; false-discovery rate-adjusted for a total of 36 correlations). Interpretation: A substantial proportion of individuals showed low, but detectable antibody reactivity against SARS-CoV-2 antigens in this population despite a low evidence of direct SARS-CoV-2 exposure. Authors: Ripperger TJ et al Publication date: 05 October 2020 Journal: Cell DOI: 10.1016/j.immuni.2020.10.004 We conducted a serological study to define correlates of immunity against SARS-CoV-2. Relative to mild COVID-19 cases, individuals with severe disease exhibited elevated virus-neutralizing titers and antibodies against nucleocapsid (N) and the receptor binding domain (RBD) of spike protein. Age and sex played lesser roles. All cases, including asymptomatic individuals, seroconverted by 2 weeks post-PCR confirmation. Spike RBD and S2 and neutralizing antibodies remained detectable through 5-7 months post-onset, whereas α-N titers diminished. Testing of 5882 members of the local community revealed only 1 sample with seroreactivity to both RBD and S2 that lacked neutralizing antibodies. This fidelity could not be achieved with either RBD or S2 alone. Thus, inclusion of multiple independent assays improved the accuracy of antibody tests in low seroprevalence communities and revealed differences in antibody kinetics depending on the antigen. We conclude that neutralizing antibodies are stably produced for at least 5-7 months after SARS-CoV-2 infection. |
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Therapeutics |
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Remdesivir for the Treatment of Covid-19 — Final Report Authors: Beigel JH et al Publication date: 08 October 2020 Journal: The New England Journal of Medicine DOI: 10.1056/NEJMoa2007764 Background: Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), no antiviral agents have yet been shown to be efficacious. Methods: We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults who were hospitalized with Covid-19 and had evidence of lower respiratory tract infection. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. Results: A total of 1062 patients underwent randomization (with 541 assigned to remdesivir and 521 to placebo). Those who received remdesivir had a median recovery time of 10 days (95% confidence interval [CI], 9 to 11), as compared with 15 days (95% CI, 13 to 18) among those who received placebo (rate ratio for recovery, 1.29; 95% CI, 1.12 to 1.49; P<0.001, by a log-rank test). In an analysis that used a proportional-odds model with an eight-category ordinal scale, the patients who received remdesivir were found to be more likely than those who received placebo to have clinical improvement at day 15 (odds ratio, 1.5; 95% CI, 1.2 to 1.9, after adjustment for actual disease severity). The Kaplan–Meier estimates of mortality were 6.7% with remdesivir and 11.9% with placebo by day 15 and 11.4% with remdesivir and 15.2% with placebo by day 29 (hazard ratio, 0.73; 95% CI, 0.52 to 1.03). Serious adverse events were reported in 131 of the 532 patients who received remdesivir (24.6%) and in 163 of the 516 patients who received placebo (31.6%). Conclusions: Our data show that remdesivir was superior to placebo in shortening the time to recovery in adults who were hospitalized with Covid-19 and had evidence of lower respiratory tract infection. Authors: Janssen R et al Publication date: 07 October 2020 Journal: British Journal of Nutrition DOI: 10.1017/S0007114520003979P Coronavirus disease 2019 (Covid-19), caused by SARS-CoV-2, exerts far-reaching effects on public health and socioeconomic welfare. The majority of infected individuals have mild to moderate symptoms but a significant proportion develops respiratory failure due to pneumonia. Thrombosis is another frequent manifestation of Covid-19 that contributes to poor outcomes. Vitamin K plays a crucial role in activation of both pro- and anticlotting factors in the liver, and the activation of extrahepatically synthesised protein S which seems to be important in local thrombosis prevention. However, the role of vitamin K extends beyond coagulation. Matrix Gla protein (MGP) is a vitamin K-dependent inhibitor of soft tissue calcification and elastic fibre degradation. Severe extrahepatic vitamin K insufficiency was recently demonstrated in Covid-19 patients, with high inactive MGP levels correlating with elastic fibre degradation rates. This suggests that insufficient vitamin K-dependent MGP activation leaves elastic fibres unprotected against SARS-CoV-2 induced proteolysis. In contrast to MGP, Covid-19 patients have normal levels of activated factor II, in line with previous observations that vitamin K is preferentially transported to the liver for activation of procoagulant factors. We therefore expect that vitamin K-dependent endothelial protein S activation is also compromised, which would be compatible with enhanced thrombogenicity. Taking these data together, we propose a mechanism of pneumonia-induced vitamin K depletion, leading to a decrease in activated MGP and protein S, aggravating pulmonary damage and coagulopathy, respectively. Intervention trials should be conducted to assess whether vitamin K administration plays a role in prevention and treatment of severe Covid-19. Pilot Trial of High-dose vitamin C in critically ill COVID-19 patients Authors: Zhang J et al Publication date: 23 September 2020 Journal: Research Square DOI: 10.21203/rs.3.rs-52778/v2 Background: No specific medication has been proven effective for the treatment of patients with severe coronavirus disease 2019 (COVID-19). Here, we tested whether high-dose vitamin C infusion was effective for severe COVID-19. Methods: This randomized, controlled, clinical trial was performed at 3 hospitals in Hubei, China. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ICU were randomly assigned in as 1:1 ratio to either the high-dose intravenous vitamin C (HDIVC) or the placebo. HDIVC group received 12 g of vitamin C/50 ml every 12 hours for 7 days at a rate of 12 ml/hour, and the placebo group received bacteriostatic water for injection in the same way. The primary outcome was invasive mechanical ventilation-free days in 28 days(IMVFD28). Secondary outcomes were 28-day mortality, organ failure, and inflammation progression. Results: Only fifty-six critical COVID-19 patients were ultimately recruited due to the early control of the outbreak. There was no difference in IMVFD28 between two groups. During the 7-day treatment period, patients in the HDIVC group had a steady rise in the PaO2/FiO2 (day 7: 229 vs. 151 mmHg, 95% CI 33 to 122, P=0.01). Patients with SOFA scores ≥3 in the HDIVC group exhibited a trend of reduction in 28-day mortality (P=0.06) in univariate survival analysis. IL-6 in the HDIVC) group was lower than that in the placebo group (19.42 vs. 158.00; 95% CI -301.72 to -29.79; P=0.04) on day 7. Conclusion: This pilot trial showed that HDIVC might show a potential signal of benefit for critically ill patients with COVID-19, improving oxygenation even though it failed to improve IMVFD28. |
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Mortality |
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Authors: Kontis V et al Publication date: 14 October 2020 Journal: Nature Medicine DOI: 10.1038/s41591-020-1112-0 The Coronavirus Disease 2019 (COVID-19) pandemic has changed many social, economic, environmental and healthcare determinants of health. We applied an ensemble of 16 Bayesian models to vital statistics data to estimate the all-cause mortality effect of the pandemic for 21 industrialized countries. From mid-February through May 2020, 206,000 (95% credible interval, 178,100–231,000) more people died in these countries than would have had the pandemic not occurred. The number of excess deaths, excess deaths per 100,000 people and relative increase in deaths were similar between men and women in most countries. England and Wales and Spain experienced the largest effect: ~100 excess deaths per 100,000 people, equivalent to a 37% (30–44%) relative increase in England and Wales and 38% (31–45%) in Spain. Bulgaria, New Zealand, Slovakia, Australia, Czechia, Hungary, Poland, Norway, Denmark and Finland experienced mortality changes that ranged from possible small declines to increases of 5% or less in either sex. The heterogeneous mortality effects of the COVID-19 pandemic reflect differences in how well countries have managed the pandemic and the resilience and preparedness of the health and social care system. Excess Deaths From COVID-19 and Other Causes, March-July 2020 Authors: Steven H Woolf, Derek A Chapman, Roy T Sabo et al Publication date: 12 October 2020 Journal: JAMA DOI: 10.1001/jama.2020.19545 Previous studies of excess deaths (the gap between observed and expected deaths) during the coronavirus disease 2019 (COVID-19) pandemic found that publicly reported COVID-19 deaths underestimated the full death toll, which includes documented and undocumented deaths from the virus and non–COVID-19 deaths caused by disruptions from the pandemic.1,2 A previous analysis found that COVID-19 was cited in only 65% of excess deaths in the first weeks of the pandemic (March-April 2020); deaths from non–COVID-19 causes (eg, Alzheimer disease, diabetes, heart disease) increased sharply in 5 states with the most COVID-19 deaths.1 This study updates through August 1, 2020, the estimate of excess deaths and explores temporal relationships with state reopenings (lifting of coronavirus restrictions). COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries Authors: Alyssa Bilinski and Ezekiel J Emanuel Publication date: 12 October 2020 Journal: JAMA DOI: 10.1001/jama.2020.20717 The US has experienced more deaths from coronavirus disease 2019 (COVID-19) than any other country and has one of the highest cumulative per capita death rates.1,2 An unanswered question is to what extent high US mortality was driven by the early surge of cases prior to improvements in prevention and patient management vs a poor longer-term response.3 We compared US COVID-19 deaths and excess all-cause mortality in 2020 (vs 2015-2019) to that of 18 countries with diverse COVID-19 responses. Authors: Pormohammad A et al Publication date: 09 October 2020 Journal: Medical Virology DOI: 1002/rmv.2179 We compared clinical symptoms, laboratory findings, radiographic signs and outcomes of COVID‐19 and influenza to identify unique features. Depending on the heterogeneity test, we used either random or fixed‐effect models to analyse the appropriateness of the pooled results. Overall, 540 articles included in this study; 75,164 cases of COVID‐19 (157 studies), 113,818 influenza type A (251 studies) and 9266 influenza type B patients (47 studies) were included. Runny nose, dyspnoea, sore throat and rhinorrhoea were less frequent symptoms in COVID‐19 cases (14%, 15%, 11.5% and 9.5%, respectively) in comparison to influenza type A (70%, 45.5%, 49% and 44.5%, respectively) and type B (74%, 33%, 38% and 49%, respectively). Most of the patients with COVID‐19 had abnormal chest radiology (84%, p < 0.001) in comparison to influenza type A (57%, p < 0.001) and B (33%, p < 0.001). The incubation period in COVID‐19 (6.4 days estimated) was longer than influenza type A (3.4 days). Likewise, the duration of hospitalization in COVID‐19 patients (14 days) was longer than influenza type A (6.5 days) and influenza type B (6.7 days). Case fatality rate of hospitalized patients in COVID‐19 (6.5%, p < 0.001), influenza type A (6%, p < 0.001) and influenza type B was 3%(p < 0.001). The results showed that COVID‐19 and influenza had many differences in clinical manifestations and radiographic findings. Due to the lack of effective medication or vaccine for COVID‐19, timely detection of this viral infection and distinguishing from influenza are very important. |
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Testing |
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Authors: Riley S et al Publication date: 09 October 2020 Source: Imperial College Background: REACT-1 is quantifying prevalence of SARS-CoV-2 infection among random samples of the population in England based on PCR testing of self-administered nose and throat swabs. Here we report results from the fifth round of observations for swabs collected from the 18th September to 5th October 2020. This report updates and should be read alongside our round 5 interim report. Methods: Representative samples of the population aged 5 years and over in England with sample size ranging from 120,000 to 175,000 people at each round. Prevalence of PCR-confirmed SARS-CoV-2 infection, estimation of reproduction number (R) and time trends between and within rounds using exponential growth or decay models. Results: 175,000 volunteers tested across England between 18th September and 5th October. Findings show a national prevalence of 0.60% (95% confidence interval 0.55%, 0.71%) and doubling of the virus every 29 (17, 84) days in England corresponding to an estimated national R of 1.16 (1.05, 1.27). These results correspond to 1 in 170 people currently swab-positive for the virus and approximately 45,000 new infections each day. At regional level, the highest prevalence is in the North West, Yorkshire and The Humber and the North East with strongest regional growth in North West, Yorkshire and The Humber and West Midlands. Conclusion: Rapid growth has led to high prevalence of SARS-CoV-2 virus in England, with highest rates in the North of England. Prevalence has increased in all age groups, including those at highest risk. Improved compliance with existing policy and, as necessary, additional interventions are required to control the spread of SARS-CoV-2 in the community and limit the numbers of hospital admissions and deaths from COVID-19. Authors: Petersen I, Phillips A Publication date: 08 October 2020 Journal: DovePress DOI: 10.2147/CLEP.S276825 Background: To reduce transmission of SARS-CoV-2, it is important to identify those who are infectious. However, little is known about what proportion of infectious people are asymptomatic and potential “silent” transmitters. We evaluated the value of COVID-19 symptoms as a marker for SARS-CoV-2 infection from a representative English survey. Methods: We used data from the Office for National Statistics Coronavirus (COVID-19) Infection Survey pilot study. We estimated sensitivity, specificity, the proportion of asymptomatic cases (1 – sensitivity), positive predictive value (PPV) and negative predictive value (NPV) of COVID-19 symptoms as a marker of infection using results of the SARS-CoV-2 test as the “gold standard”. Results: In total, there were 36,061 individuals with a SARS-CoV-2 test between 26 April and 27 June 2020. Of these, 625 (1.7%) reported symptoms on the day of the test. There were 115 (0.32%) with a positive SARS-CoV-2 test result. Of the 115, there were 27 (23.5%) who were symptomatic and 88 (76.5%) who were asymptomatic on the day of the test. Focusing on those with specific symptoms (cough, and/or fever, and/or loss of taste/smell), there were 158 (0.43%) with such symptoms on the day of the test. Of the 115 with a positive SARS-CoV-2, there were 16 (13.9%) reporting symptoms. In contrast, 99 (86.1%) did not report specific symptoms on the day of the test. The PPV for all symptoms was 4.3% and for the specific symptoms 10.1%. The specificity and NPV of symptoms were above 98%. Conclusion: COVID-19 symptoms are poor markers of SARS-CoV-2. Thus, 76.5% of this random sample who tested positive reported no symptoms, and 86.1% reported none of those specific to COVID-19. A more widespread testing programme is necessary to capture “silent” transmission and potentially prevent and reduce future outbreaks. |
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Vaccines |
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Authors: King RG et al Publication date: 11 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.10.331348 The coronavirus disease 2019 (COVID-19) pandemic has highlighted the urgent need for effective preventive vaccination to reduce burden and spread of severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) in humans. Intranasal vaccination is an attractive strategy to prevent COVID-19 as the nasal mucosa represents the first-line barrier to SARS-CoV-2 entry before viral spread to the lung. Although SARS-CoV-2 vaccine development is rapidly progressing, the current intramuscular vaccines are designed to elicit systemic immunity without conferring mucosal immunity. Here, we show that AdCOVID, an intranasal adenovirus type 5 (Ad5)-vectored vaccine encoding the receptor binding domain (RBD) of the SARS-CoV-2 spike protein, elicits a strong and focused immune response against RBD through the induction of mucosal IgA, serum neutralizing antibodies and CD4+ and CD8+ T cells with a Th1-like cytokine expression profile. Therefore, AdCOVID, which promotes concomitant systemic and local mucosal immunity, represents a promising COVID-19 vaccine candidate. Authors: Clement de Chaisemartin and Luc de Chaisemartin Publication date: 23 August 2020 Journal: Clinical Infectious Diseases DOI: 10.1093/cid/ciaa1223 Background: The bacille Calmette-Guérin (BCG) tuberculosis vaccine has immunity benefits against respiratory infections. Accordingly, it has been hypothesized to have a protective effect against coronavirus disease 2019 (COVID-19). Recent research found that countries with universal BCG childhood vaccination policies tend to be less affected by the COVID-19 pandemic. However, such ecological studies are biased by numerous confounders. Instead, this paper reports on a rare nationwide natural experiment that occurred in Sweden in 1975, where discontinuation of newborns’ BCG vaccination led to a dramatic decrease in BCG coverage rate, thus allowing us to estimate BCG’s effect without the biases associated with cross-country comparisons. Methods: Numbers of COVID-19 cases and hospitalizations were recorded for birth cohorts born just before and just after 1975, representing 1 026 304 and 1 018 544 individuals, respectively. We used regression discontinuity to assess the effect of BCG vaccination on COVID-19–related outcomes. On such a large population, this method allows for a precision that would be hard to achieve using a randomized controlled trial. Results: The odds ratios (95% CI) for COVID-19 cases and COVID-19–related hospitalizations were 1.0005 (.8130–1.1881) and 1.2046 (.7532–1.6560), allowing us to reject fairly modest effects of universal BCG vaccination. We can reject with 95% confidence that universal BCG vaccination reduces the number of cases by 19% and the number of hospitalizations by 25%. Conclusions: While the effect of a recent vaccination must be evaluated, we provide strong evidence that receiving the BCG vaccine at birth does not have a protective effect against COVID-19 among middle-aged individuals. Author: Christian Wehenkel Publication date: 01 October 2020 Journal: PeerJ Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing global health crisis, directly and indirectly impacting all spheres of human life. Some pharmacological measures have been proposed to prevent COVID-19 or reduce its severity, such as vaccinations. Previous reports indicate that influenza vaccination appears to be negatively correlated with COVID-19-associated mortality, perhaps as a result of heterologous immunity or changes in innate immunity. The understanding of such trends in correlations could prevent deaths from COVID-19 in the future. The aim of this study was therefore to analyze the association between COVID-19 related deaths and influenza vaccination rate (IVR) in elderly people worldwide. Methods: To determine the association between COVID-19 deaths and influenza vaccination, available data sets from countries with more than 0.5 million inhabitants were analyzed (in total 39 countries). To accurately estimate the influence of IVR on COVID-19 deaths and mitigate effects of confounding variables, a sophisticated ranking of the importance of different variables was performed, including as predictor variables IVR and some potentially important geographical and socioeconomic variables as well as variables related to non-pharmaceutical intervention. The associations were measured by non-parametric Spearman rank correlation coefficients and random forest functions. Results: The results showed a positive association between COVID-19 deaths and IVR of people ≥65 years-old. There is a significant increase in COVID-19 deaths from eastern to western regions in the world. Further exploration is needed to explain these findings, and additional work on this line of research may lead to prevention of deaths associated with COVID-19. |
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Lockdowns |
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The impact of COVID‐19 stay‐at‐home orders on health behaviors in adults Authors: Flanagan EW et al Publication date: 11 October 2020 Journal: Obesity DOI: 10.1002/oby.23066 Objective: Stay‐at‐home orders in response to the COVID‐19 pandemic have forced abrupt changes to daily routines. This study assessed lifestyle changes across different BMI classifications in response to the global pandemic. Methods: The online survey targeting adults was distributed in April 2020 and collected information on dietary behaviors, physical activity, and mental health. All questions were presented as “before” and “since” the COVID‐19 pandemic. Results: In total, 7,753 participants were included. The sample included 32.2% of individuals with normal weight, 32.1% overweight, and 34.0% had obesity. During the pandemic, overall scores for healthy eating increased (p<0.001), due to less eating out and increased cooking (p<0.001). Sedentary leisure behaviors increased while time spent in physical activity (absolute time and intensity‐adjusted) declined (p<0.001). Anxiety scores increased 8.78±0.21 during the pandemic and the magnitude of increase was significantly greater in people with obesity (p≤0.01). Weight gain was reported in 27.5% of the total sample compared to 33.4% in participants with obesity. Conclusions: The COVID‐19 pandemic produced significant health effects, well beyond the virus itself. Government mandates together with fear of contracting the virus have significantly impacted lifestyle behaviors alongside declines in mental health. These deleterious impacts have disproportionally affected individuals with obesity. |
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Social Impacts |
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Place and causes of acute cardiovascular mortality during the COVID-19 pandemic Authors: Wu J et al Publication date: 28 September 2020 Journal: Heart DOI: 10.1136/heartjnl-2020-317912 Objective: To describe the place and causes of acute cardiovascular death during the COVID-19 pandemic. Methods: Retrospective cohort of adult (age ≥18 years) acute cardiovascular deaths (n=5 87 225) in England and Wales, from 1 January 2014 to 30 June 2020. The exposure was the COVID-19 pandemic (from onset of the first COVID-19 death in England, 2 March 2020). The main outcome was acute cardiovascular events directly contributing to death. Results: After 2 March 2020, there were 28 969 acute cardiovascular deaths of which 5.1% related to COVID-19, and an excess acute cardiovascular mortality of 2085 (+8%). Deaths in the community accounted for nearly half of all deaths during this period. Death at home had the greatest excess acute cardiovascular deaths (2279, +35%), followed by deaths at care homes and hospices (1095, +32%) and in hospital (50, +0%). The most frequent cause of acute cardiovascular death during this period was stroke (10 318, 35.6%), followed by acute coronary syndrome (ACS) (7 098, 24.5%), heart failure (6 770, 23.4%), pulmonary embolism (2 689, 9.3%) and cardiac arrest (1 328, 4.6%). The greatest cause of excess cardiovascular death in care homes and hospices was stroke (715, +39%), compared with ACS (768, +41%) at home and cardiogenic shock (55, +15%) in hospital. Conclusions and relevance: The COVID-19 pandemic has resulted in an inflation in acute cardiovascular deaths, nearly half of which occurred in the community and most did not relate to COVID-19 infection suggesting there were delays to seeking help or likely the result of undiagnosed COVID-19. |
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Misinformation |
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Susceptibility to misinformation about COVID-19 around the world Authors: Roozenbeek J et al Publication date: 14 October 2020 Journal: Royal Society Open Science DOI: 10.1098/rsos.201199 Misinformation about COVID-19 is a major threat to public health. Using five national samples from the UK (n= 1050 and n= 1150), Ireland (n = 700), the USA (n = 700), Spain (n= 700) and Mexico (n= 700), we examine predictors of belief in the most common statements about the virus that contain misinformation. We also investigate the prevalence of belief in COVID-19 misinformation across different countries and the role of belief in such misinformation in predicting relevant health behaviours. We find that while public belief in misinformation about COVID-19 is not particularly common, a substantial proportion views this type of misinformation as highly reliable in each country surveyed. In addition, a small group of participants find common factual information about the virus highly unreliable. We also find that increased susceptibility to misinformation negatively affects people's self-reported compliance with public health guidance about COVID-19, as well as people's willingness to get vaccinated against the virus and to recommend the vaccine to vulnerable friends and family. Across all countries surveyed, we find that higher trust in scientists and having higher numeracy skills were associated with lower susceptibility to coronavirus-related misinformation. Taken together, these results demonstrate a clear link between susceptibility to misinformation and both vaccine hesitancy and a reduced likelihood to comply with health guidance measures, and suggest that interventions which aim to improve critical thinking and trust in science may be a promising avenue for future research. |
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Government and Health Authorities |
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Infections |
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Authors: Fisher KA PhD et al Publication date: 11 September 2020 Source: Centers for Disease Control In the 14 days before illness onset, 71% of case-patients and 74% of control- participants reported always using cloth face coverings or other mask types when in public. Close contact with one or more persons with known COVID-19 was reported by 42% of case- patients compared with 14% of control-participants (p<0.01), and most (51%) close contacts were family members. |
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Herd immunity |
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WHO Director-General's opening remarks at the media briefing on COVID-19 - 12 October 2020 Publication date: 12 October 2020 Source: World Health Organization There has been some discussion recently about the concept of reaching so-called “herd immunity” by letting the virus spread. Herd immunity is a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached. For example, herd immunity against measles requires about 95% of a population to be vaccinated. The remaining 5% will be protected by the fact that measles will not spread among those who are vaccinated. For polio, the threshold is about 80%. In other words, herd immunity is achieved by protecting people from a virus, not by exposing them to it. Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. It is scientifically and ethically problematic. |
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Social impacts |
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Diary of a nation: Life in lockdown Publication date: October 2020 Source: Office for National Statistics Six months ago, lockdown measures were introduced in Great Britain to slow the spread of the coronavirus (COVID-19). Throughout the pandemic, we have been asking people about their opinions and behaviours, and for the first time we present people’s experiences in their own words. |
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Legal Actions |
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‘Covering up’: Vic Government slammed in court for redacting key legal advice Author: Frances Vinall Publication date: 02 October 2020 Source: News.co.au The Victorian Government tried “covering up” key legal advice by releasing a version that redacted embarrassing paragraphs, a court has heard. The Supreme Court of Victoria this week ordered the Government to release legal advice it received on the state’s former 9pm-5am curfew. The order came as part of an ongoing trial challenging whether or not the curfew breached human rights. On Friday, barrister Marcus Clarke QC, who is acting for the woman who brought the lawsuit, said the unredacted version of the legal advice revealed the Government had “cherry-picked” what it wanted to public to know. The lawsuit names then-deputy public health commander Michelle Giles, who was filling in for a man on leave when she signed the order authorising an extension to the state’s curfew from September 14. |
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Media – Science related |
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Covid-19 Cases |
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COVID-19 will probably become endemic – here’s what that means Author: Hans Heesterbeek Publication date: 12 October 2020 Source: The Conversation We can’t say with any certainty what the future of COVID-19 is. But based on our experience with other infections, there is little reason to believe that the coronavirus SARS-CoV-2 will go away any time soon, even when vaccines become available. A more realistic scenario is that it will be added to the (large and growing) family of infectious diseases that are what is known as “endemic” in the human population. With the worldwide spread of the disease increasing again, it seems unlikely that the currently available measures can do more than bring that spread under control – except in countries that can effectively isolate themselves from the outside world. The fact that the vast majority of people are still susceptible to some degree means that there is sufficient fuel for the fire to keep burning for quite some time. What does the Covid data really tell us? Authors: Tom Jefferson and Carl Heneghan Publication date: 11 October 2020 Source: The Spectator Another week has passed with more restrictions piled on – but as lockdown measures become ever more restrictive, the demand for evidence grows. Sir Keir Starmer, for instance, has asked to see evidence for new lockdown measures. In mid-August, Andy Burnham called on the government not to put Oldham into lockdown as Sir Richard Leese, the lead for health in Greater Manchester, pointed out that there is ‘no evidence’ that additional lockdown measures would improve the chances of halting the virus. Tomorrow, we’re told, there will be more restrictions still. But on what grounds? The main evidence presented to us by the government is the new daily total for new Covid infections. But how severe are the cases? Severity can be assessed quantitatively starting from the clearest and unquestionable outcome – death. But even there, the evidence is not clear. Is a ‘Covid death’ someone killed by the virus, or someone who died from other reasons who also had the virus? Probable healthcare associated infections in England Authors: Daniel Howdon, Jason Oke, Tom Jefferson and Carl Heneghan Publication date: 09 October 2020 Source: Centre for Evidence-Based Medicine Recent days have seen an apparent rise in the proportion of patients newly admitted in hospital with COVID-19 that represent probable healthcare-associated infections (HCAIs), with these comprising 18% of all new hospital cases on 6 October. This is most apparent in the North West of England, where HCAIs made up 24% of all patients on this date. NHS England produces a daily update on new hospitalisations by region. As of 22 September, the daily information from situation reports on the number of hospital admissions and diagnoses for COVID-19 were made available. This contains several data series which categorise patients based on whether they tested positive for COVID-19 before admission, whether they were admitted from a care home and, if applicable, the point in their hospital stay at which they were diagnosed with COVID-19. We used these data to construct a measure of the number of patients in hospital who are test-positive for COVID-19. We consider patients to be newly in hospital with COVID-19 at the point of admission (if they tested positive prior to admission) or at the point at which they test positive (if they test positive in hospital). In line with NHS England guidance, we consider patients who test positive after over 7 days in hospital to be probable healthcare-associated infections (HCAIs). |
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Covid-19 pandemic |
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WHO (Accidentally) Confirms Covid is No More Dangerous Than Flu Author: Kit Knightly Publication date: 08 October 2020 Source: Off Guardian The World Health Organization has finally confirmed what we (and many experts and studies) have been saying for months – the coronavirus is no more deadly or dangerous than seasonal flu. The WHO’s top brass made this announcement during a special session of the WHO’s 34-member executive board on Monday October 5th, it’s just nobody seemed to really understand it. In fact, they didn’t seem to completely understand it themselves. At the session, Dr Michael Ryan, the WHO’s Head of Emergencies revealed that they believe roughly 10% of the world has been infected with Sars-Cov-2. This is their “best estimate”, and a huge increase over the number of officially recognised cases (around 35 million). Dr. Margaret Harris, a WHO spokeswoman, later confirmed the figure, stating it was based on the average results of all the broad seroprevalence studies done around the world. How we can fix this pandemic in a month Author: Damien Downing, MBBS, MRSB Publication date: 06 October 2020 Source: Orthomolecular Medicine News Services The Orthomolecular Medicine News Service has been publicizing the importance of vitamins D and C, and the minerals zinc and magnesium, in this pandemic since January [1]. I have been writing about vitamin D and sunlight for over 30 years [2], and it has never been more relevant. If you caught the COVID19 virus right now, having a good vitamin D status (from already having taken a supplement) would greatly reduce your risk of contracting the infection, of the disease becoming severe, and of dying. Vitamin D enhances innate immunity while reducing the severity of inflammatory responses and supporting antioxidant activity [3]. Vitamin D deficiency correlates with risk of ARDS, sepsis and death from these [4]. You can even get some protection from living somewhere sunny [5] - or better still somewhere where people generally have good vitamin D status, probably from dietary sources [6]. For countries in Europe, the probability of developing COVID-19, and of dying from it, is negatively correlated with mean population vitamin D status, with both probabilities reaching zero above about 75nmol/L, as clearly shown here [7]. The chart is redrawn from the original data, and also shows, at the top, the significantly lower vitamin D levels for the elderly in Spain and Italy. |
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Testing |
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COVID-19 Diagnostics: How Do Saliva Tests Compare to Swabs? Author: Amanda Heidt Publication date: 09 October 2020 Source: The Scientist Since the early days of the pandemic, clinicians and researchers have been looking for alternatives to nasopharyngeal swabs. While samples collected from swabs are considered the gold standard in terms of generating accurate results, these tests require more supplies, place health care workers in closer contact with potentially infected individuals, and are difficult to scale up for mass testing. Saliva has been put forth as a low-cost, easy alternative, but it’s efficacy and accuracy remain points of contention. Even as large universities have begun rolling out ambitious, saliva-based initiatives on campuses across the United States, private companies looking to develop rapid, in-home diagnostic tests have moved away from such tools. Trials of saliva-based testing being deployed in the field have yielded mixed results, and it remains unknown under what conditions saliva is most useful or how best it can be rolled into the existing testing framework. Anne Wyllie, an epidemiologist at the Yale School of Public Health, has studied the use of saliva as a source of genetic material for the last decade, and more recently has investigated saliva’s role in testing for COVID-19. Wyllie has been tracking the emergent literature during the pandemic to see how often saliva outperforms nasopharyngeal swabs. Across the almost 30 studies she has analyzed, “it’s almost half and half,” she says. |
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Lockdowns |
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Coronavirus: WHO backflips on virus stance by condemning lockdowns Author: Alex Turner-Cohen Publication date: 11 October 2020 Source: News.com.au The World Health Organisation has backflipped on its original COVID-19 stance after calling for world leaders to stop locking down their countries and economies. Dr. David Nabarro from the WHO appealed to world leaders yesterday, telling them to stop “using lockdowns as your primary control method” of the coronavirus. He also claimed that the only thing lockdowns achieved was poverty – with no mention of the potential lives saved. “Lockdowns just have one consequence that you must never ever belittle, and that is making poor people an awful lot poorer,” he said. |
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Vaccines |
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Publication date: 12 October 2020 Source: Johnson & Johnson At Johnson & Johnson, there is no greater priority than the safety and well being of the people we serve every day around the world. We are committed to providing transparent updates throughout the clinical development process of our vaccine candidate, in compliance with regulatory standards and our own high ethical and scientific principles. We have temporarily paused further dosing in all our COVID-19 vaccine candidate clinical trials, including the Phase 3 ENSEMBLE trial, due to an unexplained illness in a study participant. Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians. Adverse events – illnesses, accidents, etc. - even those that are serious, are an expected part of any clinical study, especially large studies. Based on our strong commitment to safety, all clinical studies conducted by the Janssen Pharmaceutical Companies of Johnson & Johnson have prespecified guidelines. These ensure our studies may be paused if an unexpected serious adverse event (SAE) that might be related to a vaccine or study drug is reported, so there can be a careful review of all of the medical information before deciding whether to restart the study. Authors: Elaine Ruth Fletcher and Raisa Santos Publication date: 12 October 2020 Source: Healthy Policy Watch WHO issued a stiff warning to Covid-skeptics who have been saying that in the absence of a vaccine, policies that let the SARS-CoV-2 virus spread freely would lead to eventual “herd immunity” , and that might be preferable to continued containment and social-distancing measures. “Herd immunity is a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached, for example, that immunity against measles requires about 95% of the population to be vaccinated,” said WHO Director General Dr Tedros Adhanom Ghebreyesus at a press briefing on Monday. |
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Education |
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The ‘New Normal’ – The future of education after Covid-19 Publication date: October 2020 Source: Institute for Public Policy Research The Covid-19 pandemic has resulted in an unprecedented disruption to schools and learners in England. Schools were closed from March 2020, with only the children of key workers and those identified as vulnerable being invited to attend. Most children in England were instead expected to learn remotely, with most schools providing learning materials for home use and/or digital lessons. External exams did not take place in the 2019/20 academic year and performance league tables for the year will not be published. Meanwhile, Ofsted inspections and reports were suspended throughout the pandemic. There has been significant focus on ‘recovering’ the existing system but there is also an opportunity to ‘build back better’. There is a growing sense of urgency about the need to recover the education system and ‘lost learning’ among students after the pandemic. But less has been said about the pandemic as an opportunity for us to reimagine our education system going forward. England’s education system undoubtedly has strengths that we must seek to retain in the future. But it also suffers from a number of longstanding weaknesses that pre-date the pandemic. The pandemic provides us with an opportunity to stand back and reflect on these weaknesses. How can we ‘build back better’? What do we want the ‘new normal’ in schools to look like? And what do we need to do now to achieve that? |
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Loss of freedoms |
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Government in a pandemic: how coronavirus caused a dramatic shift in our relationship with the state Author: Thomas Hancocks Publication date: 08 October 2020 Source: The Conversation As we head into the colder months, the increased threat of a second spike in the pandemic has forced the UK government to reintroduce new restrictive measures, including targeted local lockdowns, new rules (“of six”) and early pub closures. At the same time, compliance is fraying. One of the deeper issues with the government restrictions, which has less often been discussed, is a moral one. It concerns the level of control we grant to the government over our individual healthcare decisions. Understanding this dimension helps to explain why many people around the world are disobeying restrictions. Recent UK data indicates that of those who reported having COVID-19 symptoms in the last seven days, only 18.2% said they were following the self-isolation requirements. While there are a number of reasons for this growing reluctance to obey, the one I want to highlight here is the moral dimension. |
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Media – Reporting |
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Cases |
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Students who catch Covid may be saving lives Author: Matt Ridley Publication date: 17 October 2020 Source: The Spectator It is counterintuitive but the current spread of Covid may on balance be the least worst thing that could happen now. In the absence of a vaccine, and with no real prospect of eradicating the disease, the virus spreading among younger people, mostly without hitting the vulnerable, is creating immunity that will eventually slow the epidemic. The second wave is real, but it is not like the first. It would be a mistake to tackle it with compulsory lockdowns (even if called ‘circuit breakers’), whether national or local. The cure would be worse than the disease. If you cannot extinguish an epidemic at the start, the best strategy is for the healthy to get infected first. Lockdowns ensure that the vulnerable and the healthy both get infected with similar probability. School closures, concluded a recent paper in the British Medical Journal, can paradoxically lead to more deaths by prioritising the protection of the least vulnerable. Author: Connor Boyd Publication date: 12 October 2020 Source: Mail Online England's growing second wave of Covid-19 was today laid bare by an array of graphs that revealed under-30s in the North are driving the spiralling outbreak — but that the disease is slowly creeping South. Professor Jonathan Van-Tam, England's deputy chief medical officer, presented a series of striking charts showing how the coronavirus situation is unfolding. In a televised briefing from Downing Street this morning, he warned about a 'marked pick-up' in cases which will inevitably lead to more deaths. And he said it was of 'concern' that Covid-19 was 'heating up' in more of England than a week ago, saying the crisis has changed in 'a matter of just a few days'. 'It's possible Germany will see more than 10,000 coronavirus cases a day,' warns health chief Publication date: 08 October 2020 Source: The Local de Germany is experiencing a "worrying jump" in coronavirus cases, Health Minister Jens Spahn said Thursday, as the number of new infections over the past 24 hours soared past 4,000 for the first time since early April. Lothar Wieler, the head of Germany's Robert Koch Institute (RKI) for disease control, also warned the country could see an uncontrollable spread of the virus. Germany recorded 4,058 new Covid-19 infections over the last 24 hours, a stark increase on Wednesday's figure of 2,828, according to the RKI. "The numbers are showing a worrying jump," Spahn told a press conference in Berlin, urging Germans not to drop their guard against the deadly virus. "Barely any other country in Europe has managed the crisis as well so far," he said. "But we must not gamble away what we've achieved." He reminded Germans to stick to the well-known rules of mask-wearing, hand washing and social distancing. |
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Testing |
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Covid-19: China's Qingdao to test nine million in five days Publication date: 12 October 2020 Source: BBC News The Chinese city of Qingdao is testing its entire population of nine million people for Covid-19 over a period of five days. The mass testing comes after the discovery of a dozen cases linked to a hospital treating coronavirus patients arriving from abroad. In May, China tested the entire city of Wuhan - home to 11 million people and the epicentre of the global pandemic. The country has largely brought the virus under control. That is in stark contrast to other parts of the world, where there are still high case numbers and lockdown restrictions of varying severity. Turkey will declare asymptomatic COVID-19 cases as of next week Publication date: 11 October 2020 Source: Middle East Monitor Turkey will start declaring the number of asymptomatic COVID-19 cases from Oct. 15, its health minister said in remarks published on Sunday, following criticism that its disclosure of only symptomatic cases hid the extent of infections, Reuters reports. At the end of July, Turkey changed the wording of its daily coronavirus report to show the number of “patients” instead of “cases” . At a news conference on Sept 30, Koca said that the government was only sharing the number of COVID-19 positive cases with symptoms. Medics and opposition parties criticised the practice, saying it was aimed at hiding the real scale of the pandemic and was meant to keep the economy moving. “We will start (releasing all the numbers) on 15th,” Health Minister Fahrettin Koca was quoted as saying in an interview with daily newspaper Hurriyet. |
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Mortality |
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Covid deaths three times higher than flu and pneumonia Publication date: 09 October 2020 Source BBC News Three times as many people have died from Covid-19 than from flu and pneumonia in England and Wales this year, according to official figures. Between January and August 2020, there were 48,168 deaths due to Covid-19 compared to 13,600 from pneumonia. Only 394 were due to flu. The Office for National Statistics analysis looked at the underlying cause of death. Deaths from flu have been particularly low this year. The highest number of deaths from flu and pneumonia occurred in January, during winter, when there is usually lots of flu around. But deaths due to Covid-19 were higher between March and June - after the epidemic started and lockdown began. |
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Vaccines |
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Coronavirus: UK launches clinical trial of BCG vaccine Author: Ian Sample Publication date: 10 October 2020 Source: The Guardian Doctors in the UK have launched a clinical trial to see whether the cheap and widely available BCG vaccine can boost the immune system enough to prevent healthcare workers from catching coronavirus. The Bacillus Calmette–Guérin (BCG) vaccine is given to protect people from tuberculosis, but studies suggest that it stimulates broader immune responses that help the body keep other infections at bay. Researchers at Exeter University are enrolling up to 2,000 community healthcare workers, particularly from care homes and GP surgeries, including nurses, caterers and administration staff, for the UK arm of the international Brace trial, which is recruiting 10,000 volunteers worldwide. Prof John Campbell at the University of Exeter Medical School said the vaccine would be a “global gamechanger” if it helped prevent people from falling ill with the virus and passing it on to others. China joins WHO-backed vaccine programme COVAX rejected by Trump Authors: Colin Qian and Stephanie Nebehay Publication date: 09 October 2020 Source: Reuters China has joined a global scheme for the distribution of COVID-19 vaccine backed by the World Health Organization (WHO), it said on Friday, giving a major boost to an initiative shunned by U.S. President Donald Trump. Beijing’s latest bid to join the global fight against the coronavirus follows criticism over its handling of the pandemic, which has contributed to a growing unfavourable view of China in advanced nations, a recent survey showed. “We are taking this concrete step to ensure equitable distribution of vaccines, especially to developing countries, and hope more capable countries will also join and support COVAX,” foreign ministry spokeswoman Hua Chunying said in a statement. |
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Lockdowns |
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Trump Covid adviser Scott Atlas pushes herd immunity Author: Kiran Stacey Publication date: 14 October 2020 Source: Financial Times While Donald Trump is on the campaign trail, his administration’s coronavirus policy is increasingly being shaped by Scott Atlas, a neuroradiologist who has been championing a new version of the controversial “herd immunity” strategy. The US president appointed Dr Atlas to his coronavirus task force earlier this year, and his voice has become increasingly prominent in recent weeks as other members have been sidelined. Scientists are concerned that Dr Atlas’ renewed backing of a herd immunity strategy that protects the most vulnerable while allowing the virus to run its course among the rest of the population could undermine efforts to control an incipient “winter wave”. Despite this, the White House is urging states not to impose lockdowns again. A senior administration official said earlier this week: “Lockdowns do not eliminate the virus; lockdowns are extremely harmful; and the best policy to save lives is to aggressively protect the vulnerable and open schools and society.” RICHARD LITTLEJOHN: Driven by fear and dodgy science, this was bound to end in tiers Author: Richard Littlejohn Publication date: 13 October 2020 Source: Mail Online That pungent smell coming from the direction of Downing Street is naked fear. The so-called evidence wheeled out to justify the Government's latest 'Three Tier' lockdown policy was intended solely to silence sceptics and scare the public into submission. Yet again there were more questions than answers. All we got was an avalanche of colourful graphs and statistics designed to bamboozle, not enlighten. As usual, there was no context, only an insistence that unless we do exactly as we're told YOU'RE ALL GOING TO DIE! Boris solemnly informed the Commons that he must with great reluctance curtail still further our civil liberties. The new measures were presented as a fait accompli. We are asked to believe, in the memorable words of one of his distinguished predecessors as PM, that There Is No Alternative. 'If we stand aside, let nature take its course, let the virus rip, there will be an intolerable death toll.' Forgive me, but I have yet to hear any lockdown sceptic suggest we should 'let the virus rip'. Covid: Second national lockdown possible, says top UK scientist Publication date: 11 October 2020 Source: BBC News Another national coronavirus lockdown is a possibility and we have to do what we can to avoid that at all costs, a leading UK scientist has said. Prof Peter Horby said the UK was at a "precarious point" as Covid cases and hospital admissions continue to rise. His comments echo those of England's deputy chief medical officer, who said more deaths would follow and urged people to limit social contact. Ministers say their local approach to restrictions is the right way forward. The prime minister is expected to announce tougher local restrictions on Monday. In a statement to MPs, Boris Johnson will outline plans for a three-tier system, where each region in England is placed into a tier based on the severity of cases in the area. Author: Patrick Knox Publication date: 08 October 2020 Source: The Sun SPAIN appears to be bringing to heel its Covid-19 second wave without closing bars or imposing harsh local lockdowns like those being planned in the UK. The country saw a steep rise in coronavirus cases after it began reopening non-essential businesses in mid-May and had the highest infection rate in Europe throughout August and September. Although still one of the worst hit country, the average trend has now started to drop. Infections are falling to an average of 9,500 this week from 11,200 two weeks ago. This is despite Spanish authorities keeping bars and restaurants open and largely avoiding local lockdowns. The exact reason for the fall is unclear, but the figures perhaps give hope to Britain, where some parts face shuttering bars and restaurants. Italy to fine people up to €1,000 for not wearing a face mask in public Publication date: 07th October 2020 Source: The Local it Face masks are now compulsory in Italy everywhere in public, even outdoors, and the maximum penalty for failing to wear one has been hiked to 1,000 euros. In an update to existing emergency measures wearing a mask in Italy will become obligatory whenever you leave your home, at all times of the day and in all parts of the country, after the government on Wednesday tightened its rules in response to recent rises in new cases of Covid-19. The government has also raised the fines for refusing to wear a mask to between €400 and €1,000, with police patrols deployed to check that people are complying. Until now the maximum penalty was €400, though some regions had introduced higher fines locally. Businesses that fail to enforce the rules on their premises can be fined up to €1,000 and risk being shut down for up to 30 days. |
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Dissention |
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GP to close practice after threat of suspension over anti-mask views Author: Paul Cullen Publication date: 08 October 2020 Source: The Irish Times A Dublin GP says he has decided to close his practice after being threatened with suspension by the Medical Council over his anti-lockdown and anti-mask views on Covid-19. Dr Marcus de Brun said he decided to end his HSE contract and to step back from public speaking “under duress”, in order to avoid being struck off. Dr de Brun was a member of the Medical Council until last April, when he resigned over what he felt were failures to protect nursing home residents earlier in the pandemic. He is the third doctor to come under pressure after expressing anti-lockdown views. Dr Martin Feeley resigned as clinical director of Dublin Midlands Hospital Group last month after advocating the shielding of vulnerable groups and the lifting of general restrictions. Limerick GP Pat Morrissey was this week removed as chairman of ShannonDoc after criticising the National Public Health Emergency Team (Nphet) and saying he treats patients with hydroxychloroquine against official guidelines. |
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Covid-19 patients |
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Long Covid patients to be offered care in special NHS clinics Author: Kat Lay Publication date: 08 October 2020 Source: The Telegraph The NHS is to set up a network of specialist centres to help people with “long Covid”, the lingering symptoms of the virus months after initial infection. Sir Simon Stevens, chief executive of NHS England, announced a £10 million funding package to establish the clinics that he said expected to see “probably hundreds of thousands” of people. He told the NHS Providers conference that the health service needed to mobilise to help them in the same way it rapidly reorganised to deal with acute Covid-19 infections this year. |
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Social Impacts |
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Unemployment rate hits highest level in three years Author: Daniel Thomas Publication date: 13 October 2020 Source: BBC News The UK unemployment rate has surged to its highest level in over three years as the pandemic continues to hit jobs. The unemployment rate grew to 4.5% in the three months to August, compared with 4.1% in the previous quarter. Meanwhile redundancies rose to their highest level since 2009, the Office for National Statistics (ONS) said. It comes as the government prepares to impose tough local lockdown rules that will force some businesses to close, potentially leading to more job losses. Who has been affected? According to the ONS, an estimated 1.5 million people were unemployed between June and August, while redundancies stood at 227,000. Jonathan Athow, the ONS's deputy national statistician for economic statistics, said there had been a "sharp increase" in those out of work and job hunting since March. "Overall employment is down about half a million since the pandemic began and there are particular groups who seem to be most affected, young people in particular," he told the BBC's Today programme. The Devastating Economic Impact of Covid-19 Shutdowns Authors: Amelia Janaskie and Peter C Earle Publication date: 10 October 2020 Source: American Institute for Economic Research To this point, the destruction caused by state and Federal Covid-19 lockdowns has largely been expressed in aggregates. Yet along the same line as a popular critique of Keynesianism, economic aggregates present a greatly truncated story by smoothing over minute but revealing evidence at lower levels. Looking at the policy impact on a smaller scale – regionally, and in terms of industries/sectors – exposes the impact of mandated shutdowns in greater detail. In response to the Covid-19 pandemic, widespread lockdown restrictions were imposed, ostensibly to keep hospitals from being overwhelmed and medical resources from being consumed to exhaustion. Whether policymakers purposely or out of ignorance disregarded them, the tradeoffs of stay-at-home orders were immediate and severe: a massive spike in unemployment, rivaling the Great Depression; similarly historic drops in GDP, and others. By looking at disaggregated data, though, the devastation of lockdowns becomes all the more apparent. Authors: Daniel Martin and Jason Groves Publication date: 08 October 2020 Source: Mail Online Ministers were accused of using flimsy data after they relied on figures based on fewer than 100 pubs to justify the potential closure of tens of thousands of venues across the North of England. It came as No10 faced a concerted backlash from local leaders and MPs over plans to subject millions of people living in the North to even tougher restrictions from next week. One Tory MP said the data had been 'cobbled together' to justify the pub closures, using a three-month-old survey carried out in the US as well as cherry-picked figures. Italy imposes mask mandate outside and in as virus rebounds Author: Nicole Winfield Publication date: 07 October 2020 Source: ABC News Italy imposed a nationwide outdoor mask mandate Wednesday with fines of up to 1,000 euros ($1,163) for violators, as the European country where COVID-19 first hit hard scrambles to keep rebounding infections from spiraling out of control. The government passed the decree even though Italy’s overall per capita infection rate is among the lowest in Europe. But Premier Giuseppe Conte warned that a steady, nine-week rise in infections nationwide demanded new preventive measures to stave off economically-devastating closures and shutdowns. “We have to be more rigorous because we want to avoid at all cost more restrictive measures for production and social activities," Conte said. The decree was passed on the same day that Italy added 3,678 new infections and 31 deaths to its official coronavirus toll, the highest increase in new cases since the peak of the outbreak in April. Both hard-hit Lombardy and southern Campania added more than 500 cases each. |
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Profiteering |
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While the Poor Get Sick, Bill Gates Just Gets Richer Author: Tim Schwab Publication date: 05 October 20200 Source: The Nation In the early days of the pandemic, President Trump made headlines when he reportedly tried to secure rights to a vaccine from German developer CureVac on behalf of the US government—a move that stirred questions about equity and justice. Should the United States get priority access to the Covid vaccine just because we are the world’s wealthiest nation? Shouldn’t the most vulnerable—no matter their nationality or salary—get vaccinated first? “Capitalism has its limits,” one German lawmaker noted in a widely reported tweet. Had Trump succeeded, the deal might also have sent another stark message about economic inequality—delivering a financial windfall to one of the most moneyed players in the pandemic response: the Gates Foundation. |
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