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Science |
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SARS-CoV-2 pandemic |
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Authors: Riley S et al Publication date: 03 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.30.20223123 Background REACT-1 measures prevalence of SARS-CoV-2 infection in representative samples of the population in England using PCR testing from self-administered nose and throat swabs. Here we report interim results for round 6 of observations for swabs collected from the 16th to 25th October 2020 inclusive. Methods REACT-1 round 6 aims to collect data and swab results from 160,000 people aged 5 and above. Here we report results from the first 86,000 individuals. We estimate prevalence of PCR-confirmed SARS-CoV-2 infection, reproduction numbers (R) and temporal trends using exponential growth or decay models. Prevalence estimates are presented both unweighted and weighted to be representative of the population of England, accounting for response rate, region, deprivation and ethnicity. We compare these interim results with data from round 5, based on swabs collected from 18th September to 5th October 2020 inclusive. Results Overall prevalence of infection in the community in England was 1.28% or 128 people per 10,000, up from 60 per 10,000 in the previous round. Infections were doubling every 9.0 (6.1, 18) days with a national reproduction number (R) estimated at 1.56 (1.27, 1.88) compared to 1.16 (1.05, 1.27) in the previous round. Prevalence of infection was highest in Yorkshire and The Humber at 2.72% (2.12%, 3.50%), up from 0.84% (0.60%, 1.17%), and the North West at 2.27% (1.90%, 2.72%), up from 1.21% (1.01%, 1.46%), and lowest in South East at 0.55% (0.45%, 0.68%), up from 0.29% (0.23%, 0.37%). Clustering of cases was more prevalent in Lancashire, Manchester, Liverpool and West Yorkshire, West Midlands and East Midlands. Interim estimates of R were above 2 in the South East, East of England, London and South West, but with wide confidence intervals. Nationally, prevalence increased across all age groups with the greatest increase in those aged 55-64 at 1.20% (0.99%, 1.46%), up 3-fold from 0.37% (0.30%, 0.46%). In those aged over 65, prevalence was 0.81% (0.58%, 0.96%) up 2-fold from 0.35% (0.28%, 0.43%). Prevalence remained highest in 18 to 24-year olds at 2.25% (1.47%, 3.42%). Conclusion The co-occurrence of high prevalence and rapid growth means that the second wave of the epidemic in England has now reached a critical stage. Whether via regional or national measures, it is now time-critical to control the virus and turn R below one if further hospital admissions and deaths from COVID-19 are to be avoided. |
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Mutations |
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Emergence and spread of a SARS-CoV-2 variant through Europe in the summer of 2020 Authors: Hodcroft EB et al Publication date: 28 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.25.20219063 A variant of SARS-CoV-2 emerged in early summer 2020, presumably in Spain, and has since spread to multiple European countries. The variant was first observed in Spain in June and has been at frequencies above 40% since July. Outside of Spain, the frequency of this variant has increased from very low values prior to 15th July to 40-70% in Switzerland, Ireland, and the United Kingdom in September. It is also prevalent in Norway, Latvia, the Netherlands, and France. Little can be said about other European countries because few recent sequences are available. Sequences in this cluster (20A.EU1) differ from ancestral sequences at 6 or more positions, including the mutation A222V in the spike protein and A220V in the nucleoprotein. We show that this variant was exported from Spain to other European countries multiple times and that much of the diversity of this cluster in Spain is observed across Europe. It is currently unclear whether this variant is spreading because of a transmission advantage of the virus or whether high incidence in Spain followed by dissemination through tourists is sufficient to explain the rapid rise in multiple countries. |
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Covid-19 patients |
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Authors: Pawlowski C et al Publication date: 03 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.28.20221655 The current diagnostic gold-standard for SARS-CoV-2 clearance from infected patients is two consecutive negative PCR test results. However, there are anecdotal reports of hospitalization from protracted COVID complications despite such confirmed viral clearance, presenting a clinical conundrum. We conducted a retrospective analysis of 266 COVID patients to compare those that were admitted/re-admitted post-viral clearance (hospitalized post-clearance cohort, n=93) with those that were hospitalized pre-clearance but were not re-admitted post-viral clearance (non-hospitalized post-clearance cohort, n=173). In order to differentiate these two cohorts, we used neural network models for the augmented curation of comorbidities and complications with positive sentiment in the EHR physician notes. In the year preceding COVID onset, acute kidney injury (n=15 (16.1%), p-value: 0.03), anemia (n=20 (21.5%), p-value: 0.02), and cardiac arrhythmia (n=21 (22.6%), p-value: 0.05) were significantly enriched in the physician notes of the hospitalized post-clearance cohort. This study highlights that these specific pre-existing conditions are associated with amplified hospitalization risk in COVID patients, despite their successful SARS-CoV-2 viral clearance. Our finding that pre-COVID anemia amplifies risk of post-COVID hospitalization is particularly concerning given the high prevalence and endemic nature of anemia in many low- and middle-income countries (per the World Bank definition; e.g. India, Brazil), which are unfortunately also seeing high rates of SARS-CoV-2 infection and COVID-induced mortality. This study motivates follow-up prospective research into the specific risk factors we have identified that appear to predispose some patients towards the after effects of COVID-19. |
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Infectivity |
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Authors: Hu S et al Publication date: 29 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.07.23.20160317 Several mechanisms driving SARS-CoV-2 transmission remain unclear. Based on individual records of 1,178 SARS-CoV-2 infectors and their 15,648 contacts in Hunan, China, we estimated key transmission parameters. The mean generation time was estimated to be 5.7 (median: 5.5, IQR: 4.5, 6.8) days, with infectiousness peaking 1.8 days before symptom onset, with 95% of transmission events occurring between 8.8 days before and 9.5 days after symptom onset. Most of transmission events occurred during the pre-symptomatic phase (59.2%). SARS-CoV-2 susceptibility to infection increases with age, while transmissibility is not significantly different between age groups and between symptomatic and asymptomatic individuals. Contacts in households and exposure to first-generation cases are associated with higher odds of transmission. Our findings support the hypothesis that children can effectively transmit SARS-CoV-2 and highlight how pre-symptomatic and asymptomatic transmission can hinder control efforts. Wearable sensor data and self-reported symptoms for COVID-19 detection Authors: Quer G et al Publication date: 29 October 2020 Journal: Nature Medicine DOI: 10.1038/s41591-020-1123-x Traditional screening for COVID-19 typically includes survey questions about symptoms and travel history, as well as temperature measurements. Here, we explore whether personal sensor data collected over time may help identify subtle changes indicating an infection, such as in patients with COVID-19. We have developed a smartphone app that collects smartwatch and activity tracker data, as well as self-reported symptoms and diagnostic testing results, from individuals in the United States, and have assessed whether symptom and sensor data can differentiate COVID-19 positive versus negative cases in symptomatic individuals. We enrolled 30,529 participants between 25 March and 7 June 2020, of whom 3,811 reported symptoms. Of these symptomatic individuals, 54 reported testing positive and 279 negative for COVID-19. We found that a combination of symptom and sensor data resulted in an area under the curve (AUC) of 0.80 (interquartile range (IQR): 0.73–0.86) for discriminating between symptomatic individuals who were positive or negative for COVID-19, a performance that is significantly better (P < 0.01) than a model1 that considers symptoms alone (AUC = 0.71; IQR: 0.63–0.79). Such continuous, passively captured data may be complementary to virus testing, which is generally a one-off or infrequent sampling assay. Authors: Musuuza J et al Publication date: 28 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.27.20220566 Introduction: The recovery of other respiratory viruses in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology and outcomes of co-infection and super infection are limited. The purpose of this study was to examine occurrence of respiratory co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. Patients and Methods: We searched literature databases for studies published from October 1, 2019, through June 11, 2020. We included studies that reported clinical features and outcomes of co-infection or super-infection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines and we registered the protocol with PROSPERO as: CRD42020189763. Results: Of 1310 articles screened, 48 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 12% (95% confidence interval (CI): 6%-18%, n=29, I2=98%) and that of super-infection was 14% (95% CI: 9%-21%, n=18, I2=97%). Pooled prevalence of pathogen type stratified by co- or super-infection: viral co-infections, 4% (95% CI: 2%-7%); viral super-infections, 2% (95% CI: 0%-7%); bacterial co-infections, 4% (95% CI: 1%-8%); bacterial super-infections, 6% (95% CI: 2%-11%); fungal co-infections, 4% (95% CI: 1%-8%); and fungal super-infections, 4% (95% CI: 0%-11%). Compared to those with co-infections, patients with super-infections had a higher prevalence of mechanical ventilation [21% (95% CI: 13%-31%) vs. 7% (95% CI: 2%-15%)] and greater average length of hospital stay [mean=12.5 days, standard deviation (SD) =5.3 vs. mean=10.2 days, SD= 6.7]. Conclusions: Our study showed that as many as 14% of patients with COVID-19 have super-infections and 12% have co-infections. Poor outcomes were associated with super-infections. Our findings have implications for diagnostic testing and therapeutics, particularly in the upcoming respiratory virus season in the Northern Hemisphere. |
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Transmission |
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Authors: Riley S et al Publication date: 29 October 2020 Source: Imperial College London Background: REACT-1 measures prevalence of SARS-CoV-2 infection in representative samples of the population in England using PCR testing from self-administered nose and throat swabs. Here we report interim results for round 6 of observations for swabs collected from the 16th to 25th October 2020 inclusive. Methods: REACT-1 round 6 aims to collect data and swab results from 160,000 people aged 5 and above. Here we report results from the first 86,000 individuals. We estimate prevalence of PCR-confirmed SARS-CoV-2 infection, reproduction numbers (R) and temporal trends using exponential growth or decay models. Prevalence estimates are presented both unweighted and weighted to be representative of the population of England, accounting for response rate, region, deprivation and ethnicity. We compare these interim results with data from round 5, based on swabs collected from 18th September to 5th October 2020 inclusive. Results: Overall prevalence of infection in the community in England was 1.28% or 128 people per 10,000, up from 60 per 10,000 in the previous round. Infections were doubling every 9.0 (6.1, 18) days with a national reproduction number (R) estimated at 1.56 (1.27, 1.88) compared to 1.16 (1.05, 1.27) in the previous round. Prevalence of infection was highest in Yorkshire and The Humber at 2.72% (2.12%, 3.50%), up from 0.84% (0.60%, 1.17%), and the North West at 2.27% (1.90%, 2.72%), up from 1.21% (1.01%, 1.46%), and lowest in East of England at 0.55% (0.45%, 0.68%), up from 0.29% (0.23%, 0.37%). Clustering of cases was more prevalent in Lancashire, Manchester, Liverpool and West Yorkshire, West Midlands and East Midlands. Interim estimates of R were above 2 in the South East, East of England, London and South West, but with wide confidence intervals. Nationally, prevalence increased across all age groups with the greatest increase in those aged 55-64 at 1.20% (0.99%, 1.46%), up 3-fold from 0.37% (0.30%, 0.46%). In those aged over 65, prevalence was 0.81% (0.58%, 0.96%) up 2-fold from 0.35% (0.28%, 0.43%). Prevalence remained highest in 18 to 24-year olds at 2.25% (1.47%, 3.42%). Conclusion: The co-occurrence of high prevalence and rapid growth means that the second wave of the epidemic in England has now reached a critical stage. Whether via regional or national measures, it is now time-critical to control the virus and turn R below one if further hospital admissions and deaths from COVID-19 are to be avoided. Authors: Pouwels KB et al Publication date: 27 October 2020 Journal: medRxiv preprint DOI: 10.1101/2020.10.26.20219428 Background: Decisions regarding the continued need for control measures to contain the spread of SARS-CoV-2 rely on accurate and up-to-date information about the number of people and risk factors for testing positive. Existing surveillance systems are not based on population samples and are generally not longitudinal in design. Methods: From 26 April to 19 September2020, 514,794 samples from 123,497 individuals were collected from individuals aged 2 years and over from a representative sample of private households from England. Participants completed a questionnaire and nose and throat swab were taken. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time using dynamic multilevel regression and post-stratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also evaluated using multilevel regression models. Findings: Between 26 April and 19 September 2020, in total, results were available from 514,794 samples from 123,497 individuals, of which 489 were positive overall from 398 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between end of April and June, followed by low levels during the summer, before marked increases end of August and September 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive in the first period but not (yet) in the second period of increased positivity rates, and age (young adults) being an important driver of the second period of increased positivity rates. A substantial proportion of infections were in individuals not reporting symptoms (53%-70%, dependent on calendar time). Interpretation: Important risk factors for testing positive varied substantially between the initial and second periods of higher positivity rates, and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the epidemic moving forwards. Authors: Richard S whittle and Ana Diaz-Artiles Publication date: 04 September 2020 Journal: BMC Medicine DOI: 10.1186/s12916-020-01731-6 Background: New York City was the first major urban center of the COVID-19 pandemic in the USA. Cases are clustered in the city, with certain neighborhoods experiencing more cases than others. We investigate whether potential socioeconomic factors can explain between-neighborhood variation in the COVID-19 test positivity rate. Methods: Data were collected from 177 Zip Code Tabulation Areas (ZCTA) in New York City (99.9% of the population). We fit multiple Bayesian Besag-York-Mollié (BYM) mixed models using positive COVID-19 tests as the outcome, a set of 11 representative demographic, economic, and health-care associated ZCTA-level parameters as potential predictors, and the total number of COVID-19 tests as the exposure. The BYM model includes both spatial and nonspatial random effects to account for clustering and overdispersion. Results: Multiple regression approaches indicated a consistent, statistically significant association between detected COVID-19 cases and dependent children (under 18 years old), population density, median household income, and race. In the final model, we found that an increase of only 5% in young population is associated with a 2.3% increase in COVID-19 positivity rate (95% confidence interval (CI) 0.4 to 4.2%, p=0.021). An increase of 10,000 people per km2 is associated with a 2.4% (95% CI 0.6 to 4.2%, p=0.011) increase in positivity rate. A decrease of $10,000 median household income is associated with a 1.6% (95% CI 0.7 to 2.4%, p<0.001) increase in COVID-19 positivity rate. With respect to race, a decrease of 10% in White population is associated with a 1.8% (95% CI 0.8 to 2.8%, p<0.001) increase in positivity rate, while an increase of 10% in Black population is associated with a 1.1% (95% CI 0.3 to 1.8%, p<0.001) increase in positivity rate. The percentage of Hispanic (p=0.718), Asian (p=0.966), or Other (p=0.588) populations were not statistically significant factors. Conclusions: Our findings indicate associations between neighborhoods with a large dependent youth population, densely populated, low-income, and predominantly black neighborhoods and COVID-19 test positivity rate. The study highlights the importance of public health management during and after the current COVID-19 pandemic. Further work is warranted to fully understand the mechanisms by which these factors may have affected the positivity rate, either in terms of the true number of cases or access to testing. |
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Immunity |
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Role of IgM and IgA Antibodies in the Neutralization of SARS-CoV-2 Authors: Klingler J et al Publication date: 02 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.08.18.20177303 SARS-CoV-2 has infected millions of people globally. Virus infection requires the receptor-binding domain (RBD) of the spike protein. Although studies have demonstrated anti-spike and - RBD antibodies to be protective in animal models and convalescent plasma as a promising therapeutic option, little is known about immunoglobulin (Ig) isotypes capable of blocking infection. Here, we studied spike- and RBD-specific Ig isotypes in convalescent and acute plasma/sera. We also determined virus neutralization activities in plasma/sera, and purified Ig fractions. Spike- and RBD-specific IgM, IgG1, and IgA1 were produced by all or nearly all subjects at variable levels and detected early after infection. All samples also displayed neutralizing activity. Regression analyses revealed that IgM and IgG1 contributed most to neutralization, consistent with IgM and IgG fractions’ neutralization potency. However, IgA also exhibited neutralizing activity at a lower potency. Together, IgG, IgM and IgA are critical components of convalescent plasma used for COVID-19 treatment. Robust SARS-CoV-2-specific T-cell immunity is maintained at 6 months following primary infection Authors: Zuo J et al Publication date: 02 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.11.01.362319 The immune response to SARS-CoV-2 is critical in both controlling primary infection and preventing re-infection. However, there is concern that immune responses following natural infection may not be sustained and that this may predispose to recurrent infection. We analysed the magnitude and phenotype of the SARS-CoV-2 cellular immune response in 100 donors at six months following primary infection and related this to the profile of antibody level against spike, nucleoprotein and RBD over the previous six months. T-cell immune responses to SARS-CoV-2 were present by ELISPOT and/or ICS analysis in all donors and are characterised by predominant CD4+ T cell responses with strong IL-2 cytokine expression. Median T-cell responses were 50% higher in donors who had experienced an initial symptomatic infection indicating that the severity of primary infection establishes a ‘setpoint’ for cellular immunity that lasts for at least 6 months. The T-cell responses to both spike and nucleoprotein/membrane proteins were strongly correlated with the peak antibody level against each protein. The rate of decline in antibody level varied between individuals and higher levels of nucleoprotein-specific T cells were associated with preservation of NP-specific antibody level although no such correlation was observed in relation to spike-specific responses. In conclusion, our data are reassuring that functional SARS-CoV-2-specific T-cell responses are retained at six months following infection although the magnitude of this response is related to the clinical features of primary infection. Role of IgM and IgA Antibodies to the Neutralization of SARS-CoV-2 Authors: Klingler J et al Publication date: 02 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.08.18.20177303 SARS-CoV-2 has infected millions of people globally. Virus infection requires the receptor-binding domain (RBD) of the spike protein. Although studies have demonstrated anti-spike and -RBD antibodies to be protective in animal models and convalescent plasma as a promising therapeutic option, little is known about immunoglobulin (Ig) isotypes capable of blocking infection. Here, we studied spike- and RBD-specific Ig isotypes in convalescent and acute plasma/sera. We also determined virus neutralization activities in plasma/sera, and purified Ig fractions. Spike- and RBD-specific IgM, IgG1, and IgA1 were produced by all or nearly all subjects at variable levels and detected early after infection. All samples also displayed neutralizing activity. Regression analyses revealed that IgM and IgG1 contributed most to neutralization, consistent with IgM and IgG fraction neutralization potency. However, IgA also exhibited neutralizing activity at a lower potency. Together, IgG, IgM and IgA are critical components of convalescent plasma used for COVID-19 treatment. Herd Immunity and Implications for SARS-CoV-2 Control Authors: Omer SB etal Publication date: 19 October 2020 Journal: JAMA DOI: 10.1001/jama.2020.20892 Herd immunity, also known as indirect protection, community immunity, or community protection, refers to the protection of susceptible individuals against an infection when a sufficiently large proportion of immune individuals exist in a population. In other words, herd immunity is the inability of infected individuals to propagate an epidemic outbreak due to lack of contact with sufficient numbers of susceptible individuals. It stems from the individual immunity that may be gained through natural infection or through vaccination. The term herd immunity was initially introduced more than a century ago. In the latter half of the 20th century, the use of the term became more prevalent with the expansion of immunization programs and the need for describing targets for immunization coverage, discussions on disease eradication, and cost-effectiveness analyses of vaccination programs.1 Eradication of smallpox and sustained reductions in disease incidence in adults and those who are not vaccinated following routine childhood immunization with conjugated Haemophilus influenzae type B and pneumococcal vaccines are successful examples of the effects of vaccine-induced herd immunity. |
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Mortality |
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Report 34 - COVID-19 Infection Fatality Ratio Estimates from Seroprevalence Publication date: 29 October 2020 Source: MRC Centre for Global Infectious Disease analysis The infection fatality ratio (IFR) is a key statistic for estimating the burden of coronavirus disease 2019 (COVID-19) and has been continuously debated throughout the current pandemic. Previous estimates have relied on data early in the epidemic, or have not fully accounted for uncertainty in serological test characteristics and delays from onset of infection to seroconversion, death, and antibody waning. After screening 175 studies, we identified 10 representative antibody surveys to obtain updated estimates of the IFR using a modelling framework that addresses the limitations listed above. We inferred serological test specificity from regional variation within serosurveys, which is critical for correctly estimating the cumulative proportion infected when seroprevalence is still low. We find that age-specific IFRs follow an approximately log-linear pattern, with the risk of death doubling approximately every eight years of age. Using these age-specific estimates, we estimate the overall IFR in a typical low-income country, with a population structure skewed towards younger individuals, to be 0.23% (0.14-0.42 95% prediction interval range). In contrast, in a typical high income country, with a greater concentration of elderly individuals, we estimate the overall IFR to be 1.15% (0.78-1.79 95% prediction interval range). We show that accounting for seroreversion, the waning of antibodies leading to a negative serological result, can slightly reduce the IFR among serosurveys conducted several months after the first wave of the outbreak, such as Italy. In contrast, uncertainty in test false positive rates combined with low seroprevalence in some surveys can reconcile apparently low crude fatality ratios with the IFR in other countries. Unbiased estimates of the IFR continue to be critical to policymakers to inform key response decisions. It will be important to continue to monitor the IFR as new treatments are introduced. Authors: Levin AT et al Publication date: 31 October 2020 Journal: medRxiv DOI: 10.1101/2020.07.23.20160895 This paper assesses the age specificity of the infection fatality rate (IFR) for COVID-19 using results from 29 seroprevalence studies as well as five countries that have engaged in comprehensive tracing of COVID-19 cases. The estimated IFR is close to zero for children and younger adults but rises exponentially with age, reaching 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. We find that differences in the age structure of the population and the age-specific prevalence of COVID-19 explain nearly 90% of the geographical variation in population IFR. Consequently, protecting vulnerable age groups could substantially reduce the incidence of mortality. |
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Therapeutics |
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Authors: Hunter J et al Publication date: 04 November 2020 Journal: medRxiv preprint DOI: 10.1101/2020.11.02.20220038 OBJECTIVE: To evaluate the benefits and risks of any type of zinc intervention to prevent or treat SARS-CoV-2. DESIGN: A living, systematic review and meta-analysis, incorporating rapid review methods. DATA SOURCES: 17 English and Chinese databases and clinical trial registries were searched in April/May 2020, with additional covid-19 focused searches in June and August 2020. Eligibility criteria and analysis: Randomized control trials (RCTs) published in any language comparing zinc to a control to prevent or treat SARS-CoV-2. Other viral respiratory tract infections (RTIs) were included, but the certainty of evidence downgraded twice for indirectness. Screening, data extraction, risk of bias appraisal (RoB-2 tool) and verification was performed by calibrated, single reviewers. RCTs with adult populations were prioritised for analysis. RESULTS: 123 RCTs were identified. None were specific to SARS-CoV-2 nor other coronaviruses. 28 RCTs evaluated oral (15-45mg daily), sublingual (45-300mg daily), or topical nasal (0.09-2.6 mg daily) zinc to prevent or treat nonspecific viral RTIs in 3,597 adults without zinc deficiency. Compared to placebo, zinc prevented 5 mild to moderate RTIs per 100 person-months, including in older adults (95% confidence interval 1 to 9) (number needed to treat (NTT)=20). There was no significant difference in the rates of non-serious adverse events (AE). For RTI treatment, a clinically important reduction in peak symptom severity scores was found for zinc compared to placebo (mean difference 1.2 points, 0.7 to 1.7), but not average daily symptom severity (standardised mean difference 0.2, 0.1 to 0.4). 19 fewer per 100 adults were at risk of remaining symptomatic over the first 7 days (2 to 38, NNT=5) and the mean duration of symptoms was 2 days shorter (0.2 to 3.5), however, there was substantial heterogeneity (I2 = 82% and 97%). 14 more per 100 experienced a non-serious AE (4 to 16, NNT=7) such as nausea, or mouth or nasal irritation. No differences in illness duration nor AE were found when zinc was compared to active controls. No serious AE, including copper deficiency, were reported by any RCT. Quality of life outcomes were not assessed. Confidence in these findings for SARS-CoV-2 is very low due to serious indirectness and some concerns about bias for most outcomes. CONCLUSIONS: Zinc is a potential therapeutic candidate for preventing and treating SARS-CoV-2, including older adults and adults without zinc deficiency (very low certainty). Zinc may also help to prevent other viral RTIs during the pandemic (moderate certainty) and reduce the severity and duration of symptoms (very low certainty). The pending results from seven RCTs evaluating zinc for SARS-CoV-2 will be tracked. COVID-19 Pandemic: Epidemiology, Etiology, Conventional and Non-Conventional Therapies Authors: Rauf A et al Publication date: 04 November 2020 Journal: Nutrients DOI: 10.3390/ijerph17218155 Coronavirus disease 2019 (COVID-19), which reported in an outbreak in 2019 in Wuhan, Hubei province, China, is caused by the SARS-CoV-2 virus. The virus belongs to the beta-coronavirus class, along with the Middle East Respiratory Syndrome coronavirus and Severe Acute Respiratory Syndrome coronavirus. Interestingly, the virus binds with angiotensin-converting enzyme-2 found in host cells, through the spike (S) protein that exists on its surface. This binding causes the entry of the virus into cells of the host organism. The actual mechanism used by the COVID-19 virus to induce disease is still speculative. A total of 44,322,504 cases, a 1,173,189 death toll and 32,486,703 recovery cases have been reported in 217 countries globally as of 28 October 2020. Symptoms from the infection of the virus include chest pain, fever, fatigue, nausea, and others. Acute respiratory stress syndrome, arrhythmia, and shock are some of the chronic manifestations recorded in severe COVID-19. Transmission is majorly by individual-to-individual through coughing, sneezing, etc. The lack of knowledge regarding the mechanism of and immune response to the virus has posed a challenge in the development of a novel drug and vaccine. Currently, treatment of the disease involves the use of anti-viral medications such as lopinavir, remdesivir, and other drugs. These drugs show some efficacy in the management of COVID-19. Studies are still on-going for the development of an ideal and novel drug for treatment. In terms of natural product intervention, Traditional Chinese Medicines (TCM) have been employed to alleviate the clinical manifestation and severity of the disease and have shown some efficacy. This review presents an updated detailed overview of COVID-19 and the virus, concerning its structure, epidemiology, symptoms and transmission, immune responses, and current interventions, and highlights the potential of TCM. It is anticipated that this review will further add to the understanding of COVID-19 and the virus, hence opening new research perspectives Authors: Suzana Almoosawi and Luigi Palla Publication date: 27 October 2020 Journal: BMJ Nutrition, Prevention & Health DOI: 10.1136/bmjnph-2020-000150 Objective: To examine the cross-sectional association between vitamins A, E, C and D from diet and supplements and the prevalence of respiratory complaints in a nationally representative sample of UK adults. Methods Data from adult participants of the National Diet and Nutrition Survey Rolling Programme: years 2008–2016 were used for the analysis. Logistic regression adapted for complex survey design was used to investigate the relationship between each vitamin intake in turn (exposure) and self-reported respiratory complaints (outcome), adjusting for relevant confounders. Results: Overall, respiratory complaints were found in 33 of the 6115 adult patients aged 19 years and above. After adjustment for potential confounders, a negative association was observed between the intake of vitamin A and E intake from diet and supplements and respiratory complaints. For vitamin D, intake from supplements, but not diet, was inversely significantly associated with respiratory complaints. No association between vitamin C and respiratory complaints was observed. Conclusion: In conclusion, intake of vitamin A and E from diet and supplements, and vitamin D from supplements, show strong evidence of association with lower self-reported prevalence of respiratory complaints in a nationally representative sample of UK adults. Vitamin C—An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19 Authors: Holford P et al Publication date: 20 October 2020 Journal: Preprints DOI: 10.20944/preprints202010.0407.v1 There are limited proven therapies for the treatment of COVID-19. Vitamin C’s antioxidant, anti-inflammatory and immunomodulating effects, make it a potential therapeutic candidate, both for the prevention and amelioration of COVID-19 infection, and as an adjunctive therapy in the critical care of COVID-19, supporting anti-inflammatory treatment. This literature review focuses on vitamin C deficiency in respiratory infections including COVID-19; the mechanism of action in infectious disease and adrenal function supporting the anti-inflammatory actions of glucocorticosteroids: its role in preventing and treating colds and pneumonia and its role in treating sepsis and COVID-19. The evidence to date indicates that oral vitamin C (2-8g/d) may reduce incidence and duration of respiratory infections and intravenous vitamin C (2-24g/d) has been shown to reduce mortality, Intensive Care Unit and hospital stays, time on mechanical ventilation in severe respiratory infections. Further trials are urgently warranted. Given the favourable safety profile and low cost of vitamin C, and frequency of vitamin C deficiency in respiratory infections it may be worthwhile testing patients’ vitamin C status and treating accordingly with intravenous use within ICUs and orally with doses between 2 and 8g/day in hospitalised and infected persons. |
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Vaccines |
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Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination Authors: Roy M Anderson, Carolin Vegvari, James Truscott and Benjamin S Collyer Publication date: 04 November 2020 Journal: The Lancet DOI: 10.1016/S0140-6736(20)32318-7 Vaccines to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have risen up the agenda of most policy makers and individuals as the second wave of COVID-19 in northern hemisphere countries grows and there is increasing pressure on health-care systems. For any licensed vaccine, efficacy and duration of protection are key issues. Vaccine efficacies to protect against infection above 80% are desirable,1 but duration of protection will remain uncertain for a number of years post licensure of COVID-19 vaccines. Preliminary evidence suggests waning antibody titres in those who have recovered from SARS-CoV-2 infection,2 but antibodies are only one part of the human immune response and acquired immunity to reinfection or the prevention of disease when reinfected.3, 4, 5 Data on immunity to other coronaviruses suggest that immunity to SARS-CoV-2 might be short lived, perhaps 12–18 months in duration.6 Whether past infection will prevent severe COVID-19 on re-exposure to SARS-CoV-2 is not known at present. Presently 45 candidate COVID-19 vaccines are in clinical trials in humans and ten of these vaccines are in phase 3 trials,7, 8 with expectations that some results might be announced before the end of 2020. If the results of the phase 3 trials are satisfactory, wide-scale deployment of COVID-19 vaccines is not expected until mid to late 2021.7 Developing the structure of a within-country immunisation programme will be crucial, including defining priorities for receiving vaccination, solving distribution challenges, and encouraging public acceptance of vaccination. Addressing vaccine hesitancy will require good communication strategies on the value of being protected as an individual and the benefits for the community in reducing viral transmission. Authors: Almuqrin A et al Publication date: 20 October 2020 Journal: Research Square preprint DOI: 10.21203/rs.3.rs-94837/v1 Background: ChAdOx1 nCoV-19 is a recombinant adenovirus vaccine candidate against SARS-CoV-2. Although replication defective in normal cells, 28kbp of adenovirus genes are delivered to the cell nucleus alongside the SARS-CoV-2 S glycoprotein gene. Methods: We used direct RNA sequencing to analyse transcript expression from the ChAdOx1 nCoV-19 genome in human MRC-5 and A549 cell lines that are non-permissive for vector replication alongside the replication permissive cell line, HEK293. In addition, we used quantitative proteomics to study over time the proteome and phosphoproteome of A549 and MRC5 cells infected with the ChAdOx1 nCoV-19 vaccine candidate. Results: The expected SARS-CoV-2 S coding transcript dominated in all cell lines. We also detected rare S transcripts with aberrant splice patterns or polyadenylation site usage. Adenovirus vector transcripts were almost absent in MRC-5 cells but in A549 cells there was a broader repertoire of adenoviral gene expression at very low levels. Proteomically, in addition to S glycoprotein, we detected multiple adenovirus proteins in A549 cells compared to just one in MRC5 cells. Conclusions: Overall the ChAdOx1 nCoV-19 vaccine’s transcriptomic and proteomic repertoire is as expected. The combined transcriptomic and proteomics approaches provide an unparalleled insight into the behaviour of this important class of vaccine candidate and illustrate the potential of this technique to inform future viral vaccine vector design. |
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Low tech preventions |
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Preventing the Spread of SARS-CoV-2 With Masks and Other “Low-tech” Interventions Authors: Andrea M Lerner, Gregory K Folkers and Anthony S Fauci Publication date: 26 October 2020 Journal: JAMA DOI: 10.1001/jama.2020.21946 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has caused a global pandemic of historic proportions in the 10 months since cases were first reported in Wuhan, China, in December 2019, with worldwide morbidity, mortality, and disruptions to society. Ultimately, a safe and effective vaccine will be essential to control the pandemic and allow resumption of the many activities of normal life. While results of phase 3 trials for multiple candidate vaccines are on the near horizon, “low-tech” tools to prevent the spread of SARS-CoV-2 are essential, and it must be emphasized that these interventions will still be needed after a vaccine is initially available. Even if one or more vaccines have high efficacy and uptake in the population, it will take at least several months for enough people to be vaccinated to confer herd immunity on a population basis. |
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Environmental |
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Authors: Wu X et al Publication date: 04 November 2020 Journal: Science Advances DOI: 10.1126/sciadv.abd4049 Assessing whether long-term exposure to air pollution increases the severity of COVID-19 health outcomes, including death, is an important public health objective. Limitations in COVID-19 data availability and quality remain obstacles to conducting conclusive studies on this topic. At present, publicly available COVID-19 outcome data for representative populations are available only as area-level counts. Therefore, studies of long-term exposure to air pollution and COVID-19 outcomes using these data must use an ecological regression analysis, which precludes controlling for individual-level COVID-19 risk factors. We describe these challenges in the context of one of the first preliminary investigations of this question in the United States, where we found that higher historical PM2.5 exposures are positively associated with higher county-level COVID-19 mortality rates after accounting for many area-level confounders. Motivated by this study, we lay the groundwork for future research on this important topic, describe the challenges, and outline promising directions and opportunities. |
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Government and Health Authorities |
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Transmission |
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Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020 Authors: Grijalva CG et al Publication date: 30 October 2020 Source: Centers for Disease Control What is already known about this topic? Transmission of SARS-CoV-2 occurs within households; however, transmission estimates vary widely and the data on transmission from children are limited. What is added by this report? Findings from a prospective household study with intensive daily observation for ≥7 consecutive days indicate that transmission of SARS-CoV-2 among household members was frequent from either children or adults. What are the implications for public health practice? Household transmission of SARS-CoV-2 is common and occurs early after illness onset. Persons should self-isolate immediately at the onset of COVID-like symptoms, at the time of testing as a result of a high risk exposure, or at time of a positive test result, whichever comes first. All household members, including the index case, should wear masks within shared spaces in the household. |
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Media – Science related |
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Origins |
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COVID was just one—there could be 850,000 other animal viruses in the zoonotic pipeline Publication date: 30 October 2020 Source: Phys.org Future pandemics will emerge more often, spread more rapidly, do more damage to the world economy and kill more people than COVID-19 unless there is a transformative change in the global approach to dealing with infectious diseases, warns a major new report on biodiversity and pandemics by 22 leading experts from around the world. Convened by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services ( IPBES ) for an urgent virtual workshop about the links between degradation of nature and increasing pandemic risks, the experts agree that escaping the era of pandemics is possible, but that this will require a seismic shift in approach from reaction to prevention. |
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Covid-19 patients |
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590 people's stories of leaving hospital during COVID-19 Publication date: 27 October 2020 Source: Healthwatch Our new report with the British Red Cross looks at how well the new hospital discharge policy is working for patients, carers and healthcare professionals. In March 2020, the Government introduced a new hospital discharge policy to help the NHS free up beds by getting people out of hospital quickly. This meant anyone who may need out-of-hospital support to help them recover would now have their needs assessed after being discharged, rather than in hospital. We wanted to find out how the new policy was affecting people's experience of leaving hospital. Together with the British Red Cross, we spoke to over 500 patients and carers and conducted 47 in-depth interviews with health and care professionals involved in the hospital discharge process. Covid-19: Hospital discharges during pandemic were often chaotic, says watchdog Author: David Oliver Publication date: 27 October 2020 Journal: The BMJ DOI: 10.1136/bmj.m4155 Many patients discharged from hospitals in England in the past six months under new arrangements to free up beds did not get the follow-up support they needed, concludes a report from HealthWatch, which represents patients’ interests in England.1 Sometimes basic checks such as whether people needed transport to get home were missed, says the report. In many cases people reported feeling unprepared to leave hospital and confused about whom to contact for further information. Many reported never receiving a follow-up assessment after they left hospital. The report also highlighted concern that some patients were not tested for covid-19 while in hospital or did not receive their test results before discharge. The report was based on interviews with 590 patients or their carers on their experiences with discharge from hospital between March and August 2020. |
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Immunity |
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Cellular immunity to SARS-CoV-2 found at six months in non-hospitalised individuals Publication date: 02 November 2020 Source: UK Coronavirus Immunology Consortium Cellular (T cell) immunity against SARS-CoV-2 is likely to be present within most adults six months after primary infection, a new pre-print on bioRxiv suggests. The research from the UK Coronavirus Immunology Consortium (UK-CIC), Public Health England and Manchester University NHS Foundation Trust demonstrates robust T cell responses to SARS-CoV-2 virus peptides at this timepoint in all participants following asymptomatic or mild/moderate COVID-19 infection. A key question is whether previous infection with SARS-CoV-2 results in immunity to reinfection, and if so for how long. The immune system is extremely complex and there are many different potential routes whereby it can generate immunity to a disease post-infection. This study examines the role of T cells in contributing to immunity against SARS-CoV-2 at six months post infection. |
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Vaccines |
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Highly potent nanoparticle COVID-19 vaccine designed using computer Author: Hannah Balfour Publication date: 03 November 2020 Source: European Pharmaceutical Review Researchers have developed a self-assembling nanoparticle vaccine candidate for COVID-19. According to the team, the vaccine produced 10 times the amount of SARS-CoV-2-specific neutralising antibodies in mice than a soluble SARS-CoV-2 Spike (S) protein vaccine did. SARS-CoV-2 is the virus that causes the novel coronavirus disease 2019 (COVID-19). The vaccine candidate was developed using structure-based vaccine design techniques invented at University of Washington School of Medicine (UW Medicine) in Seattle, US. The self-assembling protein nanoparticle displays 60 copies of the SARS-CoV-2 S protein’s receptor-binding domain in a highly immunogenic array. The molecular structure of the vaccine roughly mimics that of a virus, which may account for its enhanced ability to provoke an immune response. According to researchers, compared to vaccination with soluble SARS-CoV-2 S protein (the approach which many of the COVID-19 vaccines currently in development are based on), their novel nanoparticle candidate produced ten times more neutralising antibodies in mice at a five-fold lower dose Trials Unlikely to Show if COVID-19 Vaccine Prevents Severe Cases Author: Max Kozlov Publication date: 30 October 2020 Source: The Scientist Nearly 50 vaccines to protect against COVID-19 are speeding through clinical trials at an unprecedented pace. These studies are designed to test the vaccines’ safety and efficacy, but a review published in The Lancet earlier this week (October 27) outlines the challenges in determining whether a vaccine candidate really is efficacious. The authors of the review note that there are many definitions of efficacious—reducing the likelihood of developing severe symptoms is one, for instance, reducing the number of deaths is another. Presently, the ongoing clinical trials are mainly designed to determine if recipients have a reduced risk of a coronavirus infection, but knowing whether a vaccine can prevent people from developing severe COVID-19 or dying is a long way off. Vaccine developers have not produced evidence of such a benefit yet, rather, a number of them have reported evidence of an immune response in recipients, data that do not necessarily mean the vaccine will prevent infection, the authors write. The Scientist spoke with University of Oxford infectious disease specialist and coauthor Susanne Hodgson, who’s working on the UK clinical trials of an AstraZeneca COVID-19 vaccine, about the timeline for generating evidence of vaccines’ effect on morbidity and mortality rates. Britain starts accelerated review for AstraZeneca's potential COVID-19 vaccine Author: Kanishka Singh Publication date: 01 November 2020 Source: Reuters AstraZeneca Plc said on Sunday Britain’s health regulator had started an accelerated review of its potential coronavirus vaccine. “We confirm the MHRA’s (Medicines and Healthcare Products Regulatory Agency) rolling review of our potential COVID-19 vaccine,” an AstraZeneca spokesman said. In rolling reviews, regulators are able to see clinical data in real time and have dialogue with drug makers on manufacturing processes and trials to accelerate the approval process. The approach is designed to speed up evaluations of promising drugs or vaccines during a public health emergency. AstraZeneca’s COVID-19 vaccine is being developed along with the University of Oxford. Bloomberg reported on Friday that MHRA had also begun an accelerated review for the COVID-19 vaccine candidate from Pfizer Inc. FDA shows signs of cold feet over emergency authorization of Covid-19 vaccines Author: Helen Branswell Publication date: 23 October 2020 Source: STAT There are serious signs the Food and Drug Administration is getting cold feet over the notion of issuing emergency use authorizations to allow for the widespread early deployment of Covid-19 vaccines. Instead, it appears the agency may be exploring the idea of using expanded access — a more limited program that is typically used for investigational drugs — in the early days of Covid vaccine rollouts. Whereas a few weeks ago the agency’s concern was to protect against the possibility that unproven vaccines would be pushed out prematurely due to pressure from President Trump, now the fear is that early authorization of vaccines could squander a one-time chance to determine how well the various vaccines work and which work best in whom. Marion Gruber, director of the FDA’s office of vaccines research and review, put the issue on the table when members of the Vaccines and Related Biological Products Advisory Committee began to discuss a series of questions FDA staff posed at the end of a grueling day-long virtual meeting Thursday. |
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Schools |
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Why schools probably aren’t COVID hotspots Author: Dyani Lewis Publication date: 29 October 2020 Source: Nature Data gathered worldwide are increasingly suggesting that schools are not hot spots for coronavirus infections. Despite fears, COVID-19 infections did not surge when schools and day-care centres reopened after pandemic lockdowns eased. And when outbreaks do occur, they mostly result in only a small number of people becoming ill. However, research also shows that children can catch the virus and shed viral particles, and older children are more likely than very young kids to pass it on to others. Scientists say that the reasons for these trends are unclear, but they have policy implications for older children and teachers. Schools and childcare centres seem to provide an ideal setting for coronavirus transmission because large groups gather indoors for extended periods of time, says Walter Haas, an infectious-diseases epidemiologist at the Robert Koch Institute in Berlin. Yet, globally, COVID-19 infections are still much lower among children than among adults, he says. “They seem rather to follow the situation than to drive it.” |
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Social impacts |
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Author: Tom Avril Publication date: 15 October 2020 Source: The Philadelphia Inquirer Anthony S. Fauci, the man millions turn to for pandemic wisdom, displayed his trademark bluntness Thursday in an address to the medical community at Thomas Jefferson University, warning against premature hopes of “herd immunity" to COVID-19. Speaking via Zoom to the Philadelphia institution’s faculty, staff, and students, he gave a crash course on the biology of the coronavirus and the latest medical advice on how to tackle it. Fauci said that if the vaccine is 70% effective, and if some people resist taking it, many months will elapse before society reaches herd immunity. “You’re not going to have a profound degree of herd immunity for a considerable period of time, maybe toward the end of 2021, into 2022,” he said. “I feel very strongly that we’re going to need to have some degree of public-health measures to continue. Maybe not as stringent as they are right now.” |
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Media – Reporting |
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Origins |
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In hunt for virus source, W.H.O. let China take charge Authors: Selam Gebrekidan, Matt Apuzzo, Amy Qin and Javier C. Hernández Publication date: 03 November 2020 Source: New York Times As it praised Beijing, the World Health Organization concealed concessions to China and may have sacrificed the best chance to unravel the virus’s origins. Now it’s a favorite Trump attack line. On a cold weekend in mid-February, when the world still harbored false hope that the new coronavirus could be contained, a World Health Organization team arrived in Beijing to study the outbreak and investigate a critical question: How did the virus jump from animals to humans? At that point, there were only three confirmed deaths from Covid-19 outside China and scientists hoped that finding an animal source for the coronavirus would unlock clues about how to stop it, treat it and prevent similar outbreaks. “If we don’t know the source then we’re equally vulnerable in the future to a similar outbreak,” Michael Ryan, the World Health Organization’s emergency director, had said that week in Geneva. “Understanding that source is a very important next step.” What the team members did not know was that they would not be allowed to investigate the source at all. Despite Dr. Ryan’s pronouncements, and over the advice of its emergency committee, the organization’s leadership had quietly negotiated terms that sidelined its own experts. They would not question China’s initial response or even visit the live-animal market in the city of Wuhan where the outbreak seemed to have originated. |
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Mutations |
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Author: Connor Boyd Publication date: 29 October 2020 Source: Mail Online A mutated strain of coronavirus that originated in Spain may be the culprit behind Europe's catastrophic second wave, a study has claimed. An international team of scientists tracking the virus as it spreads and evolves, said the variant, called 20A.EU1, is behind 90 per cent of cases in the UK since summer. Every virus mutation has its own genetic signature, which means they can be traced back to the place they originated. The experts tracked 20A.EU1 back to a farm in northern Spain in June and believe it raced through the continent as holidaymakers returned over summer, when there was a lull in transmission and lockdowns were eased. It raises questions about whether the spiralling second wave - which is forcing European nations to retreat back into national shutdowns - could have been averted by improved screening at airports and borders. The scientists believe the strain is also behind 80 per cent of infections in Spain, 60 per cent in Ireland and up to 40 per cent in Switzerland and France. |
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Transmission |
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Author: Dr Mike Yeadon Publication date: 30 October 2020 Source: Mail Online arlier this week, my wife and I were congratulating ourselves on being in France, far from the draconian Covid restrictions now spreading throughout Britain. Then, on Thursday, with less than 24 hours’ notice, President Emmanuel Macron announced his plan to plunge the French into a second national lockdown for at least a month. And if everything I hear and read about the UK is to be believed, this country is heading in the same direction. On Monday more than 30million Britons will be under Tier Two and Three restrictions. We will then have days – a few weeks at best – until the inevitable total lockdown. While Boris Johnson will be the person announcing that catastrophic decision, the measures are being dictated by a small group of scientists who, in my view, have repeatedly got things terribly wrong. The Scientific Advisory Group for Emergencies (Sage) has made three incorrect assumptions which have had, and continue to have, disastrous consequences for people’s lives and the economy. |
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Second wave |
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Hospital intensive care no busier than normal for most trusts, leaked documents show Author: Sarah Knapton Publication date: 03 November 2020 Source: The Telegraph Hospital intensive care is no busier than normal for the majority of trusts, leaked documents have shown, raising more questions about whether a second national lockdown is justifiable. An update from the NHS Secondary Uses Services (SUS), seen by The Telegraph, shows that capacity is tracking as normal in October with the usual numbers of beds available that would be expected at this time of year, even without extra surge capacity. An NHS source said: "As you can see, our current position in October is exactly where we have been over the last five years." The new data shows that, even in the peak of the Covid outbreak in April, critical care beds were never more than 80 per cent full. Although there has been a reduction in surge capacity since the first wave, with the closure of the emergency Nightingale Hospitals, there is still 15 per cent spare capacity across the country – fairly normal for this time of year. |
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Lockdowns |
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UK can expect at least three Covid waves with lockdowns, Mordaunt says Authors: Jessica Elgot and Heather Stewart Publication date: 03 November 2020 Source: The Guardian The UK should be braced for at least a third wave of the coronavirus pandemic and further lockdowns, a minister has said as Tory sceptics warned they would not vote to extend England’s four-week shutdown. Penny Mordaunt, the paymaster general, told MPs on Tuesday that there could yet be a rolling series of lockdowns – but argued this was not evidence that the measure was ineffective. It came as the former chief whip, Mark Harper, criticised a lack of engagement with Conservative backbenchers before a Commons vote on England’s lockdown on Wednesday, and said the government would be forced to rely on Labour votes to pass any extension beyond 2 December. Ministers expect a moderate number of Conservative MPs to rebel but Labour support means the measures are guaranteed to pass. |
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Social Impacts |
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Authors: Liz Hull, James Tozer and Chris Brooke Publication date: 04 November 2020 Source: Mail Online A retired nurse has been arrested for trying to take her 97-year-old mother out of a care home before lockdown. Ylenia Angeli, 73, was detained by police after forcing her way into the home and removing her mother, Tina Thornborough, who she had not hugged for nine months because of the pandemic. In distressing footage posted online, Mrs Angeli can be seen being handcuffed and detained in the back of a police car in Market Weighton, East Yorkshire, while her frail mother looks on. Stillbirths Nearly Double During UK’s First Lockdown Author: Victoria Friedman Publication date: 03 November 2020 Source: Breitbart There were nearly double the number of stillbirths during the height of the coronavirus lockdown, with concerns the “protect the NHS” message may have discouraged women from seeking urgent medical help. According to recent figures reported in the Health Services Journal, there were 40 stillbirths after labour in England between April and June, nearly double the 24 from the same time last year. As a result, the UK’s Healthcare Safety Investigation Branch (HSIB) said it will launch a review of the increase. The HSIB’s clinical director, Louise Page, said, according to the Daily Mail: “One of the big concerns across the healthcare system is about whether there had been unintended consequences of some of the changes that took place in March and April. |
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