World-wide data as of: 20200615_140637 UTC:
Self-Swabbing Tests for COVID-19 Accurate and Safe, Study Reports
The 30 study participants, who previously had tested positive for COVID-19, collected their own samples at a drive-through testing site after watching a short video animation and reading a one-page document instructing them how to perform the swab. The nasal swab for the study is more comfortable to use than the long nasopharyngeal swab currently used to collect samples from the back of the nasal cavity.
Allowing people who suspect they may have COVID-19 to collect their own sample has many advantages. Sample-collection kits could be widely distributed, allowing more people to be tested. Those using the kit wouldn't have to travel to a testing site, negating the risk of transmission to health care workers and others with whom they interact in transit. Self-collection would also conserve supplies of personal protective equipment used by health care workers.
[...] The study participants had tested positive in March at Stanford Health Care for the virus that causes COVID-19. Maldonado and her team contacted each of them by phone at home and provided them with written instructions and a short video about how to collect a nasal swab.
They were asked to return to Stanford Health Care for drive-through testing. At that visit, they collected their own specimen by applying a nasal swab to both nostrils. Then, a physician collected two additional samples using a nasal swab and a swab applied to the back of the throat and the tonsils. All three samples were tested for the presence of the virus at the Stanford Clinical Virology Laboratory.
Of the 30 participants, 29 received identical results -- either positive or negative for the presence of the virus -- for the three samples. Eleven of the participants were positive, and 18 were negative. One person's self-collected swab at the drive-through site revealed the presence of the virus, whereas the two swabs collected by the physician tested negative.
Jonathan Altamirano, Prasanthi Govindarajan, Andra L. Blomkalns, et al. Sensitivity and Specificity of Patient-Collected Lower Nasal Specimens for SARS-CoV-2 Testing [open], JAMA Network Open (DOI: 10.1001/jamanetworkopen.2020.12005)
Researchers Create New Type of COVID-19 Antibody Test
The researchers, who published their work in Science Immunology, created a blood test to pinpoint SARS-CoV-2 antibodies that target one unique piece of the SARS-CoV-2 spike protein. That piece is called a receptor binding domain, or RBD. Their RBD-based antibody test can measure the levels of that domain, which they found correlate to the levels of the all-important neutralizing antibodies that provide immunity.
The RBD of the spike protein in SARS-CoV-2 is not shared among other known human or animal coronaviruses. Therefore, antibodies against this domain are likely to be highly specific to SARS-CoV-2, and so these antibodies reveal if an individual has been exposed to the virus that can cause COVID-19. Indeed, when the researchers tested blood collected from people exposed to other coronaviruses, none had antibodies to the RBD of SARS-CoV-2.
"Our assay is extremely specific for antibodies to the virus that causes COVID-19, which is not the case for some currently available antibody tests," said co-senior author Aravinda de Silva, professor of microbiology and immunology and member of the UNC Institute for Global Health and Infectious Diseases. "Our results strongly support the use of RBD-based antibody assays for population-level surveillance and as a correlate of the neutralizing antibody levels in people who have recovered from SARS-CoV-2 infections."
First and co-senior author Prem Lakshmanane, PhD, assistant professor of microbiology and immunology at UNC, said, "We are now further streamlining our test into an inexpensive assay, so that instead of the test taking four to five hours to complete, our assay could be completed in about 70 minutes without compromising quality."
Lakshmanane Premkumar, Bruno Segovia-Chumbez, Ramesh Jadi, et al. The receptor binding domain of the viral spike protein is an immunodominant and highly specific target of antibodies in SARS-CoV-2 patients [open], Science Immunology (DOI: 10.1126/sciimmunol.abc8413)
Personality Traits Linked to Toilet Paper Stockpiling: High Levels of Emotionality and Conscientious
In the new study, researchers surveyed 1,029 adults from 35 countries who were recruited through social media. Between 23 and 29 March 2020, participants completed the Brief HEXACO Inventory -- which ranks six broad personality domains -- and shared information on their demographics, perceived threat level of COVID-19, quarantine behaviors, and toilet paper consumption in recent weeks.
The most robust predictor of toilet paper stockpiling was the perceived threat posed by the pandemic; people who felt more threatened tended to stockpile more toilet paper. Around 20 percent of this effect was also based on the personality factor of emotionality -- people who generally tend to worry a lot and feel anxious are most likely to feel threatened and stockpile toilet paper. The personality domain of conscientiousness -- which includes traits of organization, diligence, perfectionism and prudence -- was also a predictor of stockpiling.
Lisa Garbe, Richard Rau, Theo Toppe. Influence of perceived threat of Covid-19 and HEXACO personality traits on toilet paper stockpiling, PLOS ONE (DOI: 10.1371/journal.pone.0234232)
COVID-19: Tradeoffs Between Economics and Public Health
A new study by MIT researchers uses a variety of data on consumer and business activity to tackle that question, measuring 26 types of businesses by both their usefulness and risk. Vital forms of commerce that are relatively uncrowded fare the best in the study; less significant types of businesses that generate crowds perform worse. The results can help inform the policy decisions of government officials during the ongoing pandemic.
As it happens, banks perform the best in the study, being economically significant and relatively uncrowded.
[...] By contrast, other business types create much more crowding while having far less economic importance. These include liquor and tobacco stores; sporting goods stores; cafes, juice bars, and dessert parlors; and gyms. All of those are in the bottom half of the study's rankings of economic importance. At the same time, cafes, juice bars, and dessert parlors, taken together, rank third-highest out of the 26 business types in risk, while gyms are the fifth-riskiest according to the study's metrics -- which include cellphone location data revealing how crowded U.S. businesses get.
"Policymakers have not been making clear explanations about how they are coming to their decisions," says Avinash Collis PhD '20, an MIT-trained economist and co-author of the new paper. "That's why we wanted to provide a more data-driven policy guide."
And if the Covid-19 pandemic worsens again, the research can apply to shuttering businesses again.
"This is not only about which locations should reopen first," says Christos Nicolaides PhD '14, a digital fellow at IDE and study co-author. "You can also look at it from the perspective of which locations should close first, in another future wave of Covid-19."
[...] A key to the researchers' approach is recognizing that during the pandemic, many consumers are trying to limit trips that generate interaction with strangers, while still needing to get essential and useful transactions done.
[...] "The idea was, how can we think about rationing social contacts in a way that gives us the most bang for our buck, in terms of meetings, while keeping the risk of Covid transmission as low as possible?"
The study also rates risk on the basis of aggregate public exposure, per business type. On an individual basis, spending a couple of hours in a movie theater with strangers might seem quite risky. But in February 2020, movie theaters had about 17.6 million consumer visits in the U.S., whereas sit-down restaurants had almost 900 million visits in the same month. As a business category, sit-down restaurants would likely generate much more total transmission of Covid-19.
"It's not danger per visit, but it's a cumulative danger," Nicolaides explains. "If you look at movie theaters, they seem dangerous, but not that many people go to the movies every day ... and restaurants are a good counter-example."
Seth G. Benzell, Avinash Collis, Christos Nicolaides. Rationing social contact during the COVID-19 pandemic: Transmission risk and social benefits of US locations [open], Proceedings of the National Academy of Sciences (DOI: 10.1073/pnas.2008025117)
2 Million Cases and Counting: US COVID-19 Outbreak Charges on Amid Reopening
Both figures are expected to be underestimates, given difficulties and inconsistencies in identifying and logging all the infections and deaths. Still, with the official figures, the US now claims more than 25 percent of all COVID-19 cases globally despite having less than 5 percent of the global population.
Some states are seeing sustained declines of new cases, but others are seeing increases—leading to a high plateau for the US overall. "We're identifying between 20,000 and 25,000 new cases a day, and about 800 to 1,000 people a day are dying of this virus" nationwide, Ashish Jha, director of the Harvard Global Health Institute, told NPR.
Though increases in testing can explain some of the increases, experts say that there are real upticks in transmission in many places.
COVID-19 Threatens the Entire Nervous System: Neurological Symptoms May Appear Before Fever or Cough
About half of hospitalized patients have neurological manifestations of COVID-19, which include headache, dizziness, decreased alertness, difficulty concentrating, disorders of smell and taste, seizures, strokes, weakness and muscle pain.
"It's important for the general public and physicians to be aware of this, because a SARS-COV-2 infection may present with neurologic symptoms initially, before any fever, cough or respiratory problems occur," said lead author of the review, Dr. Igor Koralnik, Northwestern Medicine chief of neuro-infectious diseases and global neurology and a professor of neurology at Northwestern University Feinberg School of Medicine.
The review describes the different neurological conditions that may occur in COVID-19 patients and how to diagnose them, as well as likely pathogenic mechanisms.
[...] Since knowledge about the long term outcome of neurologic manifestations of COVID-19 is limited, Koralnik also will follow some of those patients prospectively in his new outpatient Neuro-COVID clinic to determine if neurological problems are temporary or permanent. These studies will provide the foundation on how to diagnose, manage and treat the many neurologic manifestations of COVID-19, he said.
Igor. J Koralnik, Kenneth L. Tyler. COVID‐19: a global threat to the nervous system, Annals of Neurology (DOI: 10.1002/ana.25807)
New Identification of Genetic Basis of COVID-19 Susceptibility Will Aid Treatment
Professor Alessandra Renieri, Director of the Medical Genetics Unit at the University Hospital of Siena, Italy, will describe her team's GEN-COVID project to collect genomic samples from Covid patients across the whole of Italy in order to try to identify the genetic bases of the high level of clinical variability they showed. Using whole exome sequencing (WES) to study the first data from 130 Covid patients from Siena and other Tuscan institutions, they were able to uncover a number of common susceptibility genes that were linked to a favourable or unfavourable outcome of infection. "We believe that variations in these genes may determine disease progression," says Prof Renieri. "To our knowledge, this is the first report on the results of WES in Covid-19."
Searching for common genes in affected patients against a control group did not give statistically significant results with the exception of a few genes. So the researchers decided to treat each patient as an independent case, following the example of autism spectrum disorder. "In this way we were able to identify for each patient an average of three pathogenic (disease-causing) mutations involved in susceptibility to Covid infection," says Prof Renieri. "This result was not unexpected, since we already knew from studies of twins that Covid-19 has a strong genetic basis."
Although presentation of Covid is different in each individual, this does not rule out the possibility of the same treatment being effective in many cases. "The model we are proposing includes common genes and our results point to some of them. For example, ACE2 remains one of the major targets. All our Covid patients have an intact ACE2 protein, and the biological pathway involving this gene remains a major focus for drug development," says Prof Renieri. ACE2 is an enzyme attached to the outer surface of several organs, including the lungs, that lowers blood pressure. It serves as an entry point for some coronaviruses, including Covid-19.
State Investigating Hospital With Coronavirus Policy That Profiled Pregnant Native American Mothers
New Mexico Gov. Michelle Lujan Grisham announced on Twitter Saturday that state officials would investigate allegations of racial profiling of pregnant Native American women at a top hospital in Albuquerque.
Lujan Grisham was reacting to a story published Saturday by New Mexico In Depth and ProPublica revealing that Lovelace Women's Hospital had a secret policy for screening Native American women for coronavirus based on their appearance and home ZIP code, according to several clinicians who work there.
Described as racial profiling by medical ethicists, the policy resulted in some Native American women being separated from their newborns at birth as hospital staff waited for test results, according to the clinicians.
"These are significant, awful allegations and, if true, a disgusting and unforgivable violation of patient rights," Lujan Grisham, a Democrat, wrote. "The state of New Mexico is investigating whether this constitutes a CMS violation and will unequivocally hold this hospital accountable."
CMS, or the U.S. Centers for Medicare and Medicaid Services, regulates hospitals to ensure that all patients have access to medical care.
[...] The CDC doesn't mention geography in its COVID-19 guidelines for pregnant women. It specifies that pregnant patients should be treated as people under investigation for COVID-19 only if they exhibit symptoms or have had recent high-risk contact with COVID-19 patients.
According to several Lovelace clinicians, when pregnant women showed up at the hospital who appeared to be Native American, staff members were instructed to compare the expectant mother's home ZIP code against a list of Indian reservation ZIP codes maintained by the hospital, known informally as the "Pueblos List," a reference to New Mexico's Pueblo Indian tribes. If the pregnant woman's ZIP code matched one on the list, she was designated as a "person under investigation" for COVID-19 and tested even if she did not have symptoms, the clinicians said.
Several Native American tribes in New Mexico have been hit hard by the coronavirus, recording some of the highest per capita rates of infection in the nation. But not all of the ZIP codes on the list are home to tribes with high prevalence of the disease.
Elastomeric Masks Provide a More Durable, Less Costly Option for Health Care Workers
The study is one of the first to evaluate the cost-effectiveness of using elastomeric masks in a health care setting during the COVID-19 pandemic, said Sricharan Chalikonda, MD, MHA, FACS, lead study author and chief medical operations officer for Pittsburgh-based Allegheny Health Network (AHN), where the study took place.
Disposable N95 masks are the standard face covering when health care providers require high-level respiratory protection, but during the pandemic, providers experienced widespread supply chain shortages and price increases, Dr. Chalikonda said. He said hospitals need a long-term solution.
"We don't know if there will be a shortage of N95s again. We don't know how long the pandemic will last and how often there will be virus surges," he said. "We believe now is the time to invest in an elastomeric mask program."
Dr. Chalikonda said an immediate supply of elastomeric masks in a health care system's stockpile of personal protective equipment is "game changing" given the advantages.
Benefits of elastomeric masks
Elastomeric masks are made of a tight-fitting, flexible, rubber-like material that can adjust to nearly all individuals' faces and can withstand multiple cleanings, Dr. Chalikonda said. These devices, which resemble gas masks, use a replaceable filter. According to the Centers for Disease Control and Prevention (CDC), elastomeric masks offer health care workers equal or better protection from airborne infectious substances compared with N95 masks.
[...] After a month of use, no one wearing an elastomeric mask chose to return to an N95 mask, according to the authors. Regarding the elastomeric masks, Dr. Chalikonda said, "Our clinicians were very comfortable with the fit, knowing it was an equivalent if not superior amount of protection, and that these masks were intended to be reused."
Furthermore, patients were receptive to their care providers wearing this type of respirator, he noted.
To determine if the elastomeric masks were cost-effective, the researchers performed a cost-benefit analysis over one month of mask disinfection and reuse comparing the new masks, with the filter replaced monthly, versus N95 masks at one hospital's 18-bed intensive care unit (ICU). Although the elastomeric mask costs about $20 and the filter costs $10 compared with only $3 at that time for an N95 mask, the research team found the elastomeric masks were "conservatively" 10 times less expensive.
Sricharan Chalikonda, Hope Waltenbaugh, Sara Angelilli, Tiffany Dumont, Curt Kvasager, Timothy Sauber, Nino Servello, Anil Singh, Rafael Diaz-Garcia. Implementation of an Elastomeric Mask Program as a Strategy to Eliminate Disposable N95 Mask Use and Resterilization: Results from a Large Academic Medical Center. Journal of the American College of Surgeons, 2020; DOI: 10.1016/j.jamcollsurg.2020.05.022
Doubt Looms Over Hydroxychloroquine Study That Halted Global Trials
The Lancet medical journal on Tuesday issued an "expression of concern" over the validity of a recent study suggesting that the anti-malarial drugs chloroquine and hydroxychloroquine raise the risk of death and heart complications in hospitalized COVID-19 patients.
More than a hundred outside experts have raised questions and skepticism about the data and analysis, even as researchers halted clinical trials in light of the study's findings.
The two drugs at the center of the controversy have had a high profile during the pandemic, with many prominent figures—most notably President Donald Trump—promoting them as effective against COVID-19. On May 18, Trump even told reporters that he was taking the drugs himself to prevent infection from the new coronavirus, SARS-CoV-2.
Despite the publicity, there's little evidence to support the efficacy of chloroquine or its analogue, hydroxychloroquine, to prevent or treat COVID-19. Small studies done so far have only provided mixed and inconclusive results in COVID-19 patients. The two drugs are only approved for use against malaria and autoimmune diseases, such as lupus and rheumatoid arthritis. They have also long been linked to risks of heart complications.
The limited evidence for use against COVID-19 and the known risks led the Food and Drug Administration to issue a safety warning that the drugs "should be limited to clinical trial settings or for treating certain hospitalized patients."
In the Lancet study—which was published May 22 and reported by Ars—researchers aimed to provide some clarity of the drugs' effects in COVID-19 patients. The researchers claimed to do so using the largest set of data to date, involving more than 96,000 hospitalized COVID-19 patients from six continents. According to the authors, a thorough hashing of the data indicated that those taking either hydroxychloroquine or chloroquine had significantly higher risks of death and heart complications compared with COVID-19 patients who did not take either of the drugs.
The safety issues were concerning enough that on May 26, the World Health Organization announced that it was suspending the use of hydroxychloroquine in its global Solidarity Trial, which is evaluating several potential COVID-19 therapies. Regulators in the UK and France also changed their recommendations surrounding the drugs.
Spain to Open Borders to Some Visitors: Coronavirus Live Updates
- US President Donald Trump is scheduled to hold a rally on June 20, which experts warn could prove to be "extraordinarily dangerous" amid the coronavirus pandemic.
- China reported 57 new confirmed - and nine asymptomatic - COVID-19 cases for June 13, the highest since April 13, according to data released by the national health authority on Sunday.
- African leaders say China will supply the continent with 30 million testing kits and 10,000 ventilators each month as the coronavirus pandemic accelerates there.
- More than 7.8 million people in total have been infected with the coronavirus, about 3.7 million have recovered, and at least 430,000 have died, according to Johns Hopkins University.
[...] After two weeks of political infighting, Chile Finance Minister Ignacio Briones announced a $12 billion citizen support and economic stimulus package to deal with the effects of the coronavirus.
The announcement came as the government was able to reach a cross-party agreement as working together was the only way to offer citizens "a sign of hope" in a "unique moment" of the country's history, said Briones.
[...] "Expert estimates the number of confirmed cases [in Pakistan] could go up to 300,000 by the end of June if we keep on flouting SOPs (standard operating procedures) and taking the problem lightly," said Umar, who is helping coordinate the government's coronavirus response.
"We fear the number of confirmed cases could go up further to 1.2 million by the end of next month," he added speaking to reporters in Islamabad.
[...] Saudi Arabia urged its citizens to comply with health measures as the country reported 4,233 new cases, its highest-ever daily increase since the start of the outbreak.
With more than 127,500 infections and about 970 deaths, the country records the highest number of cases among the six Gulf Arab states.
[...] The Kingdom started easing its restrictions last month by allowing its employees to return to offices, commercial centres to reopen and prayers at mosques to resume in a three phase plan.
A curfew is due to end by June 21.
Antibody Testing Suggests Immune Response post-COVID is Very Variable
How much of an immune response does a SARS-CoV-2 infection produce? It's a critical question for all sorts of reasons. To begin with, long-lasting immunity, either through an infection or a vaccine, is critical for any hope of returning the world to something that resembles its pre-pandemic state. It's also essential to understanding how safe people who have recovered from infections are and how they can behave in the face of continued outbreaks and spread.
But there are also more subtle public policy issues. Since testing wasn't generally available at the time of many outbreaks, we'll need antibody tests to figure out who was actually exposed. And the accuracy of those tests—which has been called into question—can have a big influence on studies of the pandemic's progression.
A bunch of recent draft papers have looked at the sort of immune response we're seeing in patients who have cleared the virus after testing positive for it. And the results suggest that it's very variable—as is the quality of the tests that detect it. (We'll remind you that pre-publication documents carry some quality risks.)
Face Masks Critical in Preventing Spread of COVID-19: Study Finds
Renyi Zhang, Texas A&M Distinguished Professor of Atmospheric Sciences and the Harold J. Haynes Chair in the College of Geosciences, and colleagues from the University of Texas, the University of California-San Diego and the California Institute of Technology have had their work published in the current issue of PNAS (Proceedings of the National Academy of Sciences).
The team examined the chances of COVID-19 infection and how the virus is easily passed from person to person. From trends and mitigation procedures in China, Italy and New York City, the researchers found that using a face mask reduced the number of infections by more than 78,000 in Italy from April 6-May 9 and by over 66,000 in New York City from April 17-May 9.
"Our results clearly show that airborne transmission via respiratory aerosols represents the dominant route for the spread of COVID-19," Zhang said. "By analyzing the pandemic trends without face-covering using the statistical method and by projecting the trend, we calculated that over 66,000 infections were prevented by using a face mask in little over a month in New York City. We conclude that wearing a face mask in public corresponds to the most effective means to prevent inter-human transmission.
"This inexpensive practice, in conjunction with social distancing and other procedures, is the most likely opportunity to stop the COVID-19 pandemic. Our work also highlights that sound science is essential in decision-making for the current and future public health pandemics."
[...] "Our work suggests that the failure in containing the propagation of COVID-19 pandemic worldwide is largely attributed to the unrecognized importance of airborne virus transmission," he said. "Social-distancing and washing our hands must continue, but that's not sufficient enough protection. Wearing a face mask as well as practicing good hand hygiene and social distancing will greatly reduce the chances of anyone contracting the COVID-19 virus."
Renyi Zhang, Yixin Li, Annie L. Zhang, et al. Identifying airborne transmission as the dominant route for the spread of COVID-19 [open], Proceedings of the National Academy of Sciences (DOI: 10.1073/pnas.2009637117)
Coronavirus Vaccine Update, June 11
Since I did a monoclonal antibody update in the last post, here's one on the vaccine front, where there is a lot of news – and where there are a lot of issues coming up similar to the ones with the antibodies as well. The last vaccine update post was here.
What we're seeing now is the plan for entering large-scale human trials. The Wall Street Journal's Peter Loftus broke the news of the overall plan in the US: Moderna's candidate was said to be going into Phase III in July, followed by the Oxford/AstraZeneca effort in September, with Johnson & Johnson's vaccine to follow. But J&J now says that they're moving up the timetable and negotiating with the NIAID for Phase III trials before then. Moderna has selected 100 micrograms as the Phase III dose, which is what was expected based on their earlier results. Meanwhile, AZ says that they will be scaling up the manufacturing of the Oxford vaccine during the trials themselves, on a risk basis, and it would not surprise me at all to see other companies doing something similar. They'll basically have to – if one or more of these vaccines reads out well in Phase III, you'd want to get to dosing people as quickly as possible.
Note that Pfizer (and their partner BioNTech) are not part of this government-funded initiative – they're going it alone, and (as mentioned before) seem to be taking the largest number of potential vaccine candidates into human trials. It's definitely an effort to be taken seriously. And then you have the Sanofi/GSK work, which has been less in the news, but involves two of the most experienced vaccine companies in the world. So don't ignore them, either. Merck is in the same category. Another company to keep in mind is Novavax, last mentioned here. They have now announced (no formal report yet) what appear to be very high antibody titers in primate dosing with their vaccine candidate, which they attribute to their proprietary adjuvant. As noted in that article, it's impossible to directly compare these numbers with those reported in the other primate studies, but these results are certainly of interest. They're expanding their manufacturing capacity as well.
[...] The next few months, then, are not going to be dull. Politics aside, the organization and execution of all these trials will be a huge and complex effort, as mentioned, and when the numbers start coming out of them we're going to surely be taken by surprise. That's what clinical trials do; this won't be different. I'm expecting sudden reversals, and sudden bursts of hope, despair, and confusion. None of us have ever seen anything like what's coming, and I hope we never have another opportunity to see anything like it again!
COVID-19 May Trigger New Diabetes, Experts Warn
A letter published today in the New England Journal of Medicine and signed by an international group of 17 leading diabetes experts involved in the CoviDiab Registry project, a collaborative international research initiative, announces the establishment of a Global Registry of new cases of diabetes in patients with COVID-19.
The Registry aims to understand the extent and the characteristics of the manifestations of diabetes in patients with COVID-19, and the best strategies for the treatment and monitoring of affected patients, during and after the pandemic.
Clinical observations so far show a bi-directional relationship between COVID-19 and diabetes. On the one hand, diabetes is associated with increased risk of COVID-19 severity and mortality. Between 20 and 30% of patients who died with COVID-19 have been reported to have diabetes. On the other hand, new-onset diabetes and atypical metabolic complications of pre-existing diabetes, including life-threatening ones, have been observed in people with COVID-19.
New-Onset Diabetes in Covid-19 [open], New England Journal of Medicine (DOI: 10.1056/NEJMc2018688)
Up to 45 Percent of SARS-CoV-2 Infections May be Asymptomatic
"The silent spread of the virus makes it all the more challenging to control," says Eric Topol, MD, founder and director of the Scripps Research Translational Institute and professor of Molecular Medicine at Scripps Research. "Our review really highlights the importance of testing. It's clear that with such a high asymptomatic rate, we need to cast a very wide net, otherwise the virus will continue to evade us."
Together with behavioral scientist Daniel Oran, Topol collected information from testing studies on 16 diverse cohorts from around the world. These datasets -- gathered via keyword searches of PubMed, bioRxiv and medRxiv, as well as Google searches of relevant news reports -- included data on nursing home residents, cruise ship passengers, prison inmates and various other groups.
"What virtually all of them had in common was that a very large proportion of infected individuals had no symptoms," says Oran. "Among more than 3,000 prison inmates in four states who tested positive for the coronavirus, the figure was astronomical: 96 percent asymptomatic."
The review further suggests that asymptomatic individuals are able to transmit the virus for an extended period of time, perhaps longer than 14 days. The viral loads are very similar in people with or without symptoms, but it remains unclear whether their infectiousness is of the same magnitude. To resolve that issue, we'll need large-scale studies that include sufficient numbers of asymptomatic people.
[...] "Our estimate of 40 to 45 percent asymptomatic means that, if you're unlucky enough to get infected, the probability is almost a flip of a coin on whether you're going to have symptoms. So to protect others, we think that wearing a mask makes a lot of sense," Oran concludes.
Prevalence of Asymptomatic SARS-CoV-2 Infection [open], Annals of Internal Medicine (DOI: 10.7326/M20-3012)
States are Reopening: See How Coronavirus Cases Rise or Fall
Notes Exact restrictions and rules for each state vary considerably, and counties or even cities may have their own rules in place. It has recently become clear that some states are combining different types of tests, which may make their positive test numbers appear better than they would otherwise. Here are more details on the five metrics we chose:
- Positive tests per 100K people: A seven-day moving average of the number of positive tests, adjusted for population. We show an arrow representing the trend over the last two weeks. This metric comes from White House guidelines, and the data is updated daily.
- Percentage of tests that are positive: A seven-day moving average of the percentage of total tests that are positive. We show an arrow representing the trend over the last two weeks. This metric comes from White House guidelines, and the data is updated daily.
- Tests per 100K people per day: A seven-day moving average of the number of total tests, adjusted for population. We show a goal of 100 tests per 100,000 people per day. That number is taken from statements by the White House suggesting 30 tests per 1,000 people per month as a target. While there have been several targets put forward by both the White House and public health experts for what would make a sufficient number of tests, our metric takes the White House's 30 tests per 1,000 people per month target and uses it to derive a minimum daily goal. This data is updated daily.
- ICU bed availability: The percentage of intensive care beds in the state's hospitals that are available. The White House's guidelines say that states should be able to "treat patients without crisis care." We've chosen to use ICU bed availability to track this criteria. We show a goal of 30% availability, which is taken from the target set by New York state. This data comes from a subset of facilities in each state that report this information to the CDC, and it is updated daily.
- Hospital visits for flu-like illness: The percentage of patient visits to health care providers for influenza-like illness. We show an arrow representing the trend over the last two weeks. This metric comes from White House guidelines. The data comes from a subset of facilities in each state that report this information to the CDC and is updated weekly.
The linked page provides a graphic of the United States along with a slider control where one can see the progress of the disease over time: independently for each state as well as the entire US.
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(2020-03-22) Coronavirus Roundup 03/22/2020
(2020-03-17) SoylentNews Community -- How has SAR-CoV-2 (Coronavirus) / COVID-19 Affected You?
(2020-03-12) CoronaVirus (SARS-CoV-2) Roundup 2020-03-12
(2020-02-29) COVID-19 (SARS-CoV-2 - CoronaVirus) Roundup
(2020-02-26) Roundup of Stories about the SARS-CoV-2 Coronavirus and COVID-19 Disease
(2020-02-17) Coronavirus Roundup (Feb. 17)
(2020-02-11) Coronavirus Roundup
(2020-02-07) Novel Coronavirus (2019-nCoV) Roundup
(2020-02-01) 2019-nCoV Coronavirus Story Roundup
Multiple Soylentils have submitted stories regarding the 2019-nCoV coronavirus which is believed to have originated in the city of Wuhan, China in December 2019. Rather than have a smattering of stories appear on the site, they have been gathered here in one story. Read on if you are interested; otherwise another story will be along presently.
Editor's Comment: The figures and statistics regarding the novel coronavirus outbreak are changing daily and there are differences between reports from different sources. The latest figures, which we believe to be from a reputable source and which are being regularly updated, can be found at the worldometers. If you have a favourite site for updated information please leave a link in the comments.
Chinese Whistleblower Doctor Dies Due to Coronavirus
A Chinese doctor who tried to issue the first warning about the deadly coronavirus outbreak has died, the hospital treating him has said. Li Wenliang contracted the virus while working at Wuhan Central Hospital. He had sent out a warning to fellow medics on 30 December but police told him to stop "making false comments".
There had been contradictory reports about his death, but the People's Daily now says he died at 02:58 on Friday (18:58 GMT Thursday).
The virus has killed 636 people and infected 31,161 in mainland China, the National Health Commission's latest figures show. The death toll includes 73 new deaths reported on Thursday.
An AC writes:
This story has been updated to reflect the latest statement from Wuhan Central Hospital, after confusion in state media reports.
Li died of the novel coronavirus in Wuhan in the early hours of Friday morning (local time).
"Our hospital's ophthalmologist Li Wenliang was unfortunately infected with coronavirus during his work in the fight against the coronavirus epidemic," the latest hospital statement read.
"He died at 2:58 am on Feb 7 after attempts to resuscitate were unsuccessful."
Earlier on Thursday night, several state media outlets had reported Li's death, following which Chinese social media erupted in profound grief and anger.
Both c0lo and takyon write in with today's coronavirus collection of stories:
So far, it seems that youth protects against the worst effects of 2019-nCoV.
The outbreak of a new coronavirus in China has killed more than 900 people, but one group has escaped with minimal damage: children.
Youth can certainly contract the virus. Among the infected are at least two newborns, according to Chinese health officials. But few children are among those sick enough to be diagnosed with the coronavirus, according to an article published Feb. 5 in the Journal of the American Medical Association. According to the data analyzed in that article — and numbers are changing quickly as the outbreak evolves — the median age of patients skews older, between 49 and 56 years old.
It's not entirely clear why children seem to be escaping the worst effects of the virus, dubbed 2019-nCoV. But a similar pattern holds for many infectious diseases, from the familiar, such as chickenpox and measles, to the newly emerged, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), doctors say.
This story is a roundup of several virus stories that were submitted over the past few days. This is a changing story, so some of what is posted below may have changed since the time of their originally being published.
What's in a name? One significant change is what the names are for everything. There is the question of what to call the actual virus and then what to call it when someone is infected.
Virus: The virus by itself is now officially referred to as SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2). It was formerly known as 2019-nCoV (2019 novel coronavirus).
Disease: Those who have been infected by this virus are said to have a disease. The name of the disease is coronavirus disease (COVID-19) which is also known as 2019-nCoV acute respiratory disease.
More details are available on Wikipedia.
The six submitted stories are presented below.
NIH Official Says Coronavirus 'on the Verge' of Becoming Global Pandemic Unless Containment Improves
Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told CBS's "Face The Nation" that multiple person-to-person transmissions need to occur in multiple countries in order to reach the pandemic threshold.
[...] "Technically speaking, the [World Health Organization] wouldn't be calling this a global pandemic. But it certainly is on the verge of that happening reasonably soon unless containment is more successful than it is right now," he said.
There have been several significant developments in the battle against the SARS-CoV-2 coronavirus, and the resulting illness COVID-19. This story gathers a selection of stories from across the web.
WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 - 24 February 2020
We're encouraged by the continued decline in cases in China.
Earlier today the WHO-China joint mission concluded its visit and delivered its report.
[...] The team has made a range of findings about the transmissibility of the virus, the severity of disease and the impact of the measures taken.
They found that the epidemic peaked and plateaued between the 23rd of January and the 2nd of February, and has been declining steadily since then.
They have found that there has been no significant change in the DNA of the virus.
They found that the fatality rate is between 2% and 4% in Wuhan, and 0.7% outside Wuhan.
They found that for people with mild disease, recovery time is about two weeks, while people with severe or critical disease recover within three to six weeks.
The team also estimate that the measures taken in China have averted a significant number of cases.
The report contains a wealth of other information, highlights questions for which we still don't have answers, and includes 22 recommendations.
[...] But the key message that should give all countries hope, courage and confidence is that this virus can be contained.
[...] The sudden increases of cases in Italy, the Islamic Republic of Iran and the Republic of Korea are deeply concerning.
There's a lot of speculation about whether these increases mean that this epidemic has now become a pandemic.
Many nations have begun to take special measures to address the problem of the spread of the COVID-19 virus over every continent. It would be pointless to report the details of all such measures; they are limited to each specific country and liable to frequent change as the situation develops. The USA FDA (Food and Drug Administration) have carried out what they describe as a "Supply Change Update", see the link below, but for others we suggest using a bit of web-search-fu to discover a site more appropriate to your own area of interest.
Worldwide, newspapers and other media need to maintain sales and subscriptions — many tend, therefore, to sensationalize their reporting. This has two undesirable effects: firstly it can result in data being quoted out of context to support the report they are making and, secondly, it tends to stress the possible effects of the COVID pandemic, should it be declared as such. In a comment elsewhere, I reported 2 tables which contain the most accurate figures we can find from a reputable source. They indicate the vulnerability of people to the virus by age, and any links to comorbidity (as far as they are known). There is no doubt that the virus poses a serious threat but it is not the same for all ages and many deaths are attributed to a combination of COVID-19 infection and other pre-existing conditions. For the latter it has not be proven that the virus was the sole cause of death; it is possible that the person would have died anyway. As postmortems have not been carried out in the vast majority of cases, the figures are open to misinterpretation. The WHO (World Health Organization) stresses that they will be unable to clarify these findings for a long time to come.
As it stands, for a person below the age of 70 with no other medical conditions, the chances of dying from a COVID-19 infection is less than 1%. That is still a large number of people at risk and the implications for every nation are significant. It is, however, much lower than some of the figures that have been quoted in the press. The figures for people over 70 and with other conditions cause the rate to rise quite sharply, and I would suggest that we all keep an watchful eye on the elderly or infirm members of our family and friends.
The majority of people will only suffer mild flu-like symptoms and will make a full recovery. - janrinok
Even though it has only been a short while since our last round-up there are 22 separate stories merged into this round-up. Many report duplicate news but, nevertheless, we have tried to distill the important elements of each submission.
Firstly, there is some confusion regarding the actual names that are reported for the virus, the disease that it causes, and names frequently seen in media reporting. From https://www.nature.com/articles/s41564-020-0695-z:
The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic. The Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the classification of viruses and taxon nomenclature of the family Coronaviridae, has assessed the placement of the human pathogen, tentatively named 2019-nCoV, within the Coronaviridae. Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2.
In order to facilitate communication, the CSG proposes to use the following naming convention for individual isolates: SARS-CoV-2/host/location/isolate/date. While the full spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined, the independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance. This will improve our understanding of virus–host interactions in an ever-changing environment and enhance our preparedness for future outbreaks.
There is much more information at the link provided.
Secondly, as this is a fusion of stories received over the last week or so take all quoted figures of casualties as possibly out-of-date. At the time of merging these stories (12 Mar 20) there have been 127,863 confirmed cases world-wide resulting in 4,717 deaths. 68,309 people have already recovered with the remainder either in self-imposed or advisory isolation, in basic hospital care and a relatively small number in critical care. The pandemic has affected 116 countries/regions. Source: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 - a graphical display produced by Johns Hopkins University (JHU).
Many countries have taken emergency measures to restrict travel or large gatherings of people. As this is a very fluid situation we suggest you refer to the media of any specific country in which you have an interest. President Trump has banned transatlantic air travel from countries in mainland Europe to the USA from Friday 2020-03-13 at 23:59 (no timezone stated) for a period initially of 30 days, and air travel within Europe is also significantly disrupted.
A lot has already happened this year. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) which can cause COVID-19 (COronaVIrus Disease 2019) has been making headlines shortly after it was first reported. The first cases were reported to WHO (World Health Organization) on 2019-12-31. The virus spread. It began as an epidemic in China . The world watched apprehensively. Reports surfaced of cases in other countries and the the apprehension grew. For many folk, it turned to fear when it was upgraded to a pandemic: WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020: "We have therefore made the assessment that COVID-19 can be characterized as a pandemic."
We have seen increasing efforts to stem the spread of the disease. Efforts have run the gamut. Closing of borders. Cancellation of sporting events. Conferences cancelled. Churches and other places of worship also closed. Schools closed. Panic buying of household goods and supplies. Supply chain disruptions affecting manufacturers. Restaurant, bars, and other such establishments closed. Work-from-home policies established and enacted.
The changes have been many, widespread, and continuing.
Reading about all the ways that "other people" have been affected is one thing. It seems different, somehow, when it hits closer to home and affects us directly. With many of our usual social activities curtailed or cancelled, it is easy to begin isolating and lose perspective. SoylentNews arose from a troubled period (the SlashCott) and a community has formed from that challenging period.
How have you been affected? Have you been infected? Had a family member or friend who was? Helped neighbors who are struggling? Hunkering down and isolating? (In a basement is optional.) Are you suddenly working from home and finding it challenging to manage your time? Still working on site, but now have a faster commute due to all the other people staying home? Catching up on watching TV shows? Reading more SoylentNews? How has your life changed?
From a somewhat different perspective, how have others helped you to cope... and how have you been able to help others? One of the potential impacts of social distancing is isolation and depression. I count myself fortunate, indeed, to have served this site for over 6 years and for all the people I have gotten to know, here. For those who may not be aware, SoylentNews has its own IRC (Internet Relay Chat) server. Feel free to drop in to #Soylent and just say "Hi!"
Social distancing is permanent when you're dead. So, practice good hygiene and stay safe.
Previously (oldest first):
China Battles Coronavirus Outbreak: All the Latest Updates
2019-nCoV Coronavirus Story Roundup
Novel Coronavirus (2019-nCoV) Roundup
Coronavirus Roundup (Feb. 17)
Roundup of Stories about the SARS-CoV-2 Coronavirus and COVID-19 Disease
COVID-19 (SARS-CoV-2 - CoronaVirus) Roundup
CoronaVirus (SARS-CoV-2) Roundup 2020-03-12
Working from Home: Lessons Learned Over 20 Years
Charter engineer quits over "reckless" rules against work-from-home
Arthur T Knackerbracket has found the following story:
A Charter Communications engineer called the company's rules against working from home during the coronavirus pandemic "pointlessly reckless" and "socially irresponsible" before subsequently resigning instead of continuing to work in the office, according to a TechCrunch article published yesterday.
Charter CEO Tom Rutledge last week told employees in a memo to keep coming to the office even if their jobs can be performed from home, because people "are more effective from the office." Employees should only stay home if they "are sick, or caring for someone who is sick," Rutledge wrote.
Nick Wheeler, a video operations engineer for Charter in Denver, sent an email expressing his displeasure with the policy to a senior vice president and "hundreds of engineers on Friday," TechCrunch wrote. The email said:
I do not understand why we are still coming into the office as the COVID-19 pandemic surges around us. The CDC guidelines are clear. The CDPHE [Colorado Department of Public Health & Environment] guidelines are clear. The WHO guidelines are clear. The science of social distancing is real. We have the complete ability to do our jobs entirely from home. Coming into the office now is pointlessly reckless. It's also socially irresponsible. Charter, like the rest of us, should do what is necessary to help reduce the spread of coronavirus. Social distancing has a real slowing effect on the virus—that means lives can be saved.
A hazard condition isn't acceptable for the infrastructure beyond the short-term. Why is it acceptable for our health?
The CDC's advice to businesses stresses that sick people should not come to the office but also urges businesses to "Ensure that you have the information technology and infrastructure needed to support multiple employees who may be able to work from home."
Within hours of sending the email, Wheeler was out of a job.
-- submitted from IRC
This story presents a roundup of a selection of our COVID-19, SARS-Cov-2, coronavirus story submissions. Some stories have been omitted because they were a duplicate, outdated, superseded, and sometimes just as a matter of keeping the size of these roundups managable. etc. (Before thinning, this story contained over 16,500 words (excluding HTML markup) and that excluded what is contained in this introduction.
If you are not interested in this coverage, then please ignore this story; another story will appear presently. Otherwise, please see the rest of the story below the fold:
This story is a merge of 30 story submissions. Given that it was well over 17,000 words of original source material (excluding HTML markup!), a great deal of pruning was performed to get it to a manageable size. I strongly encourage folks to read the linked articles for more information.
For latest statistics, and finer granularity, see https://www.worldometers.info/coronavirus/.
As of 20200330_151936 UTC, it reported these world-wide totals:
- Coronavirus Cases: 743,081
- Deaths: 35,347
- Recovered: 157,046
- Active Cases:
- 550,688 (Currently Infected Patients)
- 522,206 (95%) in Mild Condition
- 28,482 (5%) Serious or Critical
- Closed Cases:
- 192,393 Cases which had an outcome
- 157,046 (82%) Recovered / Discharged
- 35,347 (18%) Deaths
Stories appear below the fold.
This story is a merge of 26 story submissions.[* See Note] Given that it was well over 18,000 words of original source material (excluding HTML markup!), a great deal of pruning was performed to get it to a manageable size. We strongly encourage folks to read the linked articles for more information.
For latest statistics, and finer granularity, see https://www.worldometers.info/coronavirus/ or https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6.
Coronavirus Cases: 1,182,827
874,679 Currently Infected Patients
832,714 (95%) in Mild Condition
41,965 (5%) Serious or Critical
308,148 Cases which had an outcome:
244,224 (79%) Recovered / Discharged
63,924 (21%) Deaths
[*] NOTE: We had an issue with the site's story-merging interface. It apparently was not ever used all that much, and certainly not for merging more than a couple stories or so. Further, we have repurposed the submissions classification feature to gather all COVID-19 stories into the "Hold" classification. That gives us a clean view of all virus stories in one view. And, even more usefully, a clean view of all the non-virus submissions exactly where we would normally see them.
The story submissions list page we use tries to be helpful (or maybe just fails to notice and uses a hard-coded value?) Anyway, there are times when one's view of the "Hold" stories is automatically changed to the "Unclassified" (normal) view. During the processing of this story, we clicked the button to "Select all stories in the submission queue, and then clicked "Merge". There was some surprise, when it was realized we accidentally got a new story containing a merge of all of the non-virus stories.
The error was corrected by a manual re-submission of each of the 26 accidentally-merged, non-virus stories. If you had a story submission pending at the time, you may find that your story is marked as "Accepted" as a result of this mistake. We regret the confusion if your story submission was one of these. --martyb
Stories appear below the fold.
This story is a merge of 28 story submissions. Given that it was well over 18,000 words of original source material (excluding HTML markup!), a great deal of pruning was performed to get it to a manageable size. We strongly encourage folks to read the linked articles for more information.
For latest statistics, and finer granularity, see https://www.worldometers.info/coronavirus/ or https://www.arcgis.com/apps/opsdashboard/index.html.
Coronavirus Cases: 1,700,741
1,221,395 Currently Infected Patients
1,171,568 (96%) in Mild Condition
49,872 (4%) Serious or Critical
479,346 Cases which had an outcome:
376,572 (79%) Recovered / Discharged
102,774 (21%) Deaths
Data as at 11 Apr 2020, at 08:01 UTC.
2020-05-03 Roundup of COVID-19 (SARS-CoV2, Coronavirus) Stories
One in three COVID-19 survivors in a study of more than 230,000 mostly American patients were diagnosed with a brain or psychiatric disorder within six months, suggesting the pandemic could lead to a wave of mental and neurological problems, scientists said.
Researchers who conducted the analysis said it was not clear how the virus was linked to psychiatric conditions such as anxiety and depression, but that these were the most common diagnoses among the 14 disorders they looked at.
[...] The new findings, published in the Lancet Psychiatry journal, analysed health records of 236,379 COVID-19 patients, mostly from the United States, and found 34 per cent had been diagnosed with neurological or psychiatric illnesses within six months.
The Lancet article includes this disclaimer:
Big-data studies of this kind have intrinsic limitations, even when drawing on 81 million people, 236 379 of whom had COVID-19. In this pandemic context, not all individuals who are infected with SARS-CoV-2 (particularly those with mild or asymptomatic illness) will be diagnosed, which could result in some contamination of the comparison groups.
The question: will severe, enduring, and less common conditions such as psychoses behave more like neurological disorders or common mental disorders? Among the COVID-19 cohort in this study, a first diagnosis of a psychotic disorder was substantially more common in patients hospitalised with COVID-19.
Lungs, hearts and brains..
Jonathan P Rogers. A longer look at COVID-19 and neuropsychiatric outcomes, The Lancet Psychiatry (DOI: 10.1016/S2215-0366(21)00120-6)
One study promised that popular blood-pressure drugs were safe for people infected with the coronavirus. Another paper warned that anti-malaria drugs endorsed by President Trump actually were dangerous to these patients.
The studies, published in the New England Journal of Medicine and The Lancet, were retracted shortly after publication, following an outcry from researchers who saw obvious flaws.
The hasty retractions, on the same day this month, have alarmed scientists worldwide who fear that the rush for research on the coronavirus has overwhelmed the peer review process and opened the door to fraud, threatening the credibility of respected medical journals just when they are needed most.
[...] "The problem with trust is that it's too easy to lose and too hard to get back," said Dr. Jerome Kassirer, a former editor in chief of the New England Journal of Medicine, which published one of the retracted papers in early May. "These are big blunders."
If outside scientists detected problems that weren't identified by the peer reviewers, then the journals failed, he said. Like hundreds of other researchers, Dr. Kassirer called on the editors to publish full explanations of what happened.
[NB: This follows up on "Doubt Looms Over Hydroxychloroquine Study That Halted Global Trials" which was part of 2020-06-15 Roundup of COVID-19 (SARS-CoV2, Coronavirus) Stories --martyb]