|Title||2020-06-15 Roundup of COVID-19 (SARS-CoV2, Coronavirus) Stories|
|Date||Monday June 15 2020, @12:30PM|
|from the round-em-up dept.|
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 conscientiousness are indicators for stockpiling behavior:
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 and Separated Them From Newborns:
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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