Category Archives: Clinical Testing

The New Culture War

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American Identity Is The New Culture War - Auburn Seminary

You’re either a liberal snowflake controlled by big government or a greedy conservative willing to sacrifice Grandma for the economy. It took less than two months for Americans to get here.

Wear a mask? You’re a liberal snowflake controlled by big government. Want to reopen restaurants? You’re a greedy conservative willing to sacrifice Grandma for the economy.

It took less than two months for the coronavirus pandemic to become just the latest battle in the culture wars.

With the country still in the firm grip of the coronavirus pandemic, conservatives are on social media and Fox News stoking protests that argue masks, stay-at-home orders and social distancing violate constitutional rights and are causing unacceptable harm to the economy.

Liberals, at the same time, say personal liberties must be sacrificed for public health, even as millions file for unemployment and more than a quarter of the work force is jobless in some states.

Take a look at what two governors — one from a reliably Republican state and another from a reliably Democratic state — said this week.

“We have a public health crisis in this country, there’s no doubt about it,” Gov. Tate Reeves of Mississippi said in an appearance on “Fox News Sunday.” “But we also have an economic crisis.”

“We have turned the corner and we are on the decline,” Gov. Andrew M. Cuomo said, citing an article showing that the death rate has fallen by half in New York City, in his daily briefing on Wednesday. “To me, that vindicates what we are doing here in New York, which says: Follow the science, follow the data, put the politics aside and the emotion aside. What we’re doing here shows results.”

The problem with all these politics? Epidemiology.

So far, the virus has hit Democratic states the hardest, with the most cases per capita in five deeply Democratic states — New York, New Jersey, Massachusetts, California and Illinois. Cities have borne the brunt of the caseload. And African-Americans and Latinos — a key part of the Democratic coalition — are getting sick and dying of the virus at higher rates.

But anyone who believes this virus is fading away — or somehow contained to urban areas — is engaging in some serious magical thinking.

At least 25,000 new coronavirus cases are identified almost daily, meaning that the total in the United States — which has the highest number of known cases in the world — is expanding daily by 2 to 4 percent.

A New York Times analysis found that 18 of the states that are reopening had an increase of daily average cases over the last two weeks. Fifteen of those states are led by Republican governors.

Three of the top five states where the virus is spreading the fastest — Texas, Georgia and Ohio — have Republican governors and Republican-controlled legislatures. All three have moved toward reopening.

In the Midwest and South, smaller towns and more rural areas have suddenly been hit hard as the virus tears through nursing homes, meatpacking plants and prisons.

The nation’s highest per capita infection rate can be found in Trousdale County, Tenn., a rural county where a prison has become a hot spot. Businesses in the county are reopening this week.

In the Trump era, rural counties like Trousdale have represented the backbone of the Republican base. In Trousdale, nearly 67 percent of the county supported President Trump in 2016. Over all, the average margin of victory in rural counties won by Republicans was nearly 47 percent in 2016.

Rural areas tend to be older and have a larger share of the population with pre-existing medical conditions, making them far more vulnerable to the worst health effects of the virus.

Republican governors and conservative activists may think the coronavirus is an urban problem. Or a density problem. Or, quite frankly, a Democratic problem.

They may soon find out that it’s not.

 

 

 

 

Reopening the U.S. Economy

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https://www.goldmansachs.com/insights/pages/reopening-the-us-economy.html

Click to access report.pdf

Allison Nathan, senior strategist for Goldman Sachs Research, discusses her latest Top of Mind report where she speaks with leading experts across health and policy to understand how well-positioned the U.S. is to achieve a safe reopening of the economy and how quickly it would translate into economic recovery. 

With COVID-19 mitigation measures leading to an apparent leveling off of case
growth globally at the same time that the economic costs of such measures continue
to mount, several countries around the world have begun to plan for—or have
already started to implement—economic reopening. But absent herd immunity or
a vaccine for the virus, such reopenings increase the risk of disease resurgence.
With this in mind, what a safe reopening might look like, how well-positioned the
US is to achieve one and how quickly reopening would really translate into economic
recovery is Top of Mind. We consult three experts on these questions: University of
Pennsylvania’s Dr. Zeke Emanuel, Duke University’s Dr. Mark McClellan and Harvard
University’s Dr. Barry Bloom. And we share our own take on a potential US recovery path, informed by lessons from
China’s reopening experience so far. Finally, with more complete economic normalization only likely with an effective
testing regime, treatments, or a widely available vaccine for COVID-19-we discuss where we are on all of the above.

 

 

 

The U.S. coronavirus recovery is way behind Europe

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Nathan Newman 🧭 (@nathansnewman) | Twitter

Other countries — even some hit hard by the coronavirus — are beating back their outbreaks more successfully than the U.S., Axios’ Dave Lawler and I report.

Why it matters: The number of new cases every day is holding steady in the U.S., but it’s not going down — a key benchmark many other countries achieved before loosening their lockdowns and social distancing measures.

In some of Europe’s hardest-hit countries, case counts seemed to skyrocket uncontrollably even amid some of the world’s strictest lockdowns.

  • Italy and Spain followed a similar pattern. New cases climbed over about a month from under 100 per day to terrifying peaks of roughly 8,000 per day in Spain and 6,000 per day in Italy.
  • The fall was nearly as sharp. Within two weeks of the peak, the rates of daily recorded cases had been halved. They’ve continued to fall since.

America’s daily rate climbed faster and higher (due in part to its larger population), but appears to have peaked at around 30,000 new cases per day in the first week of April.

  • But rather than falling, the rate stagnated. Outside of New York (which has bent its curve) the rate is actually continuing to climb.

Between the lines: The U.S. didn’t lock down as tightly as some of those countries, and made a host of mistakes early in the response.

  • Italy and Spain issued strict nationwide lockdowns that forced most people to remain inside except to shop for necessities. Spain didn’t allow children outside at all.
  • “Our economic shutdown … wasn’t as broad as some of the other countries’, so there was more opportunity for the virus to spread,” said Amesh Adalja, a senior scholar at the John Hopkins Center for Health Security.

The big picture: “It seems that this is a controllable pandemic without it having to run its natural course,” says Columbia University economist Jeffrey Sachs.

 

 

 

Cartoon – Poor Safety and False Hopes

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The False Hope Comics And Cartoons | The Cartoonist Group

New Studies Add to Evidence that Children May Transmit the Coronavirus

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New Studies Add to Evidence that Children May Transmit the ...

Experts said the new data suggest that cases could soar in many U.S. communities if schools reopen soon.

Among the most important unanswered questions about Covid-19 is this: What role do children play in keeping the pandemic going?

Fewer children seem to get infected by the coronavirus than adults, and most of those who do have mild symptoms, if any. But do they pass the virus on to adults and continue the chain of transmission?

The answer is key to deciding whether and when to reopen schools, a step that President Trump urged states to consider before the summer.

Two new studies offer compelling evidence that children can transmit the virus. Neither proved it, but the evidence was strong enough to suggest that schools should be kept closed for now, many epidemiologists who were not involved in the research said.

Many other countries, including Israel, Finland, France, Germany, the Netherlands and the United Kingdom have all either reopened schools or are considering doing so in the next few weeks.

In some of those countries, the rate of community transmission is low enough to take the risk. But in others, including the United States, reopening schools may nudge the epidemic’s reproduction number — the number of new infections estimated to stem from a single case, commonly referred to as R0 — to dangerous levels, epidemiologists warned after reviewing the results from the new studies.

In one study, published last week in the journal Science, a team analyzed data from two cities in China — Wuhan, where the virus first emerged, and Shanghai — and found that children were about a third as susceptible to coronavirus infection as adults were. But when schools were open, they found, children had about three times as many contacts as adults, and three times as many opportunities to become infected, essentially evening out their risk.

Based on their data, the researchers estimated that closing schools is not enough on its own to stop an outbreak, but it can reduce the surge by about 40 to 60 percent and slow the epidemic’s course.

“My simulation shows that yes, if you reopen the schools, you’ll see a big increase in the reproduction number, which is exactly what you don’t want,” said Marco Ajelli, a mathematical epidemiologist who did the work while at the Bruno Kessler Foundation in Trento, Italy.

The second study, by a group of German researchers, was more straightforward. The team tested children and adults and found that children who test positive harbor just as much virus as adults do — sometimes more — and so, presumably, are just as infectious.

“Are any of these studies definitive? The answer is ‘No, of course not,’” said Jeffrey Shaman, an epidemiologist at Columbia University who was not involved in either study. But, he said, “to open schools because of some uninvestigated notion that children aren’t really involved in this, that would be a very foolish thing.”

The German study was led by Christian Drosten, a virologist who has ascended to something like celebrity status in recent months for his candid and clear commentary on the pandemic. Dr. Drosten leads a large virology lab in Berlin that has tested about 60,000 people for the coronavirus. Consistent with other studies, he and his colleagues found many more infected adults than children.

The team also analyzed a group of 47 infected children between ages 1 and 11. Fifteen of them had an underlying condition or were hospitalized, but the remaining were mostly free of symptoms. The children who were asymptomatic had viral loads that were just as high or higher than the symptomatic children or adults.

“In this cloud of children, there are these few children that have a virus concentration that is sky-high,” Dr. Drosten said.

He noted that there is a significant body of work suggesting that a person’s viral load tracks closely with their infectiousness. “So I’m a bit reluctant to happily recommend to politicians that we can now reopen day cares and schools.”

Dr. Drosten said he posted his study on his lab’s website ahead of its peer review because of the ongoing discussion about schools in Germany.

Many statisticians contacted him via Twitter suggesting one or another more sophisticated analysis. His team applied the suggestions, Dr. Drosten said, and even invited one of the statisticians to collaborate.

“But the message of the paper is really unchanged by any type of more sophisticated statistical analysis,” he said. For the United States to even consider reopening schools, he said, “I think it’s way too early.”

In the China study, the researchers created a contact matrix of 636 people in Wuhan and 557 people in Shanghai. They called each of these people and asked them to recall everyone they’d had contact with the day before the call.

They defined a contact as either an in-person conversation involving three or more words or physical touch such as a handshake, and asked for the age of each contact as well as the relationship to the survey participant.

Comparing the lockdown with a baseline survey from Shanghai in 2018, they found that the number of contacts during the lockdown decreased by about a factor of seven in Wuhan and eight in Shanghai.

“There was a huge decrease in the number of contacts,” Dr. Ajelli said. “In both of those places, that explains why the epidemic came under control.”

The researchers also had access to a rich data set from Hunan province’s Center for Disease Control and Prevention. Officials in the province traced 7,000 contacts of 137 confirmed cases, observed them over 14 days and tested them for coronavirus infection. They had information not just for people who became ill, but for those who became infected and remained asymptomatic, and for anyone who remained virus-free.

Data from hospitals or from households tend to focus only on people who are symptomatic or severely ill, Dr. Ajelli noted. “This kind of data is better.”

The researchers stratified the data from these contacts by age and found that children between the ages of 0 and 14 years are about a third less susceptible to coronavirus infection than those ages 15 to 64, and adults 65 or older are more susceptible by about 50 percent.

They also estimated that closing schools can lower the reproduction number — again, the estimate of the number of infections tied to a single case — by about 0.3; an epidemic starts to grow exponentially once this metric tops 1.

In many parts of the United States, the number is already hovering around 0.8, Dr. Ajelli said. “If you’re so close to the threshold, an addition of 0.3 can be devastating.”

However, some other experts noted that keeping schools closed indefinitely is not just impractical, but may do lasting harm to children.

Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health, said the decision to reopen schools cannot be made based solely on trying to prevent transmission.

“I think we have to take a holistic view of the impact of school closures on kids and our families,” Dr. Nuzzo said. “I do worry at some point, the accumulated harms from the measures may exceed the harm to the kids from the virus.”

E-learning approaches may temporarily provide children with a routine, “but any parent will tell you it’s not really learning,” she said. Children are known to backslide during the summer months, and adding several more months to that might permanently hurt them, and particularly those who are already struggling.

Children also need the social aspects of school, and for some children, home may not even be a safe place, she said.

“I’m not saying we need to absolutely rip off the Band-aid and reopen schools tomorrow,” she said, “but we have to consider these other endpoints.”

Dr. Nuzzo also pointed to a study in the Netherlands, conducted by the Dutch government, which concluded that “patients under 20 years play a much smaller role in the spread than adults and the elderly.”

But other experts said that study was not well designed because it looked at household transmission. Unless the scientists deliberately tested everyone, they would have noticed and tested only more severe infections — which tend to be among adults, said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

“Assumptions that children are not involved in the epidemiology, because they do not have severe illness, are exactly the kind of assumption that you really, really need to question in the face of a pandemic,” Dr. Hanage said. “Because if it’s wrong, it has really pretty disastrous consequences.”

A new study by the National Institutes of Health may help provide more information to guide decisions in the United States. The project, called Heros, will follow 6,000 people from 2,000 families and collect information on which children get infected with the virus and whether they pass it on to other family members.

The experts all agreed on one thing: that governments should hold active discussions on what reopening schools looks like. Students could be scheduled to come to school on different days to reduce the number of people in the building at one time, for example; desks could be placed six feet apart; and schools could avoid having students gather in large groups.

Teachers with underlying health conditions or of advanced age should be allowed to opt out and given alternative jobs outside the classroom, if possible, Dr. Nuzzo said, and children with underlying conditions should continue to learn from home.

The leaders of the two new studies, Dr. Drosten and Dr. Ajelli, were both more circumspect, saying their role is merely to provide the data that governments can use to make policies.

“I’m somehow the bringer of the bad news but I can’t change the news,” Dr. Drosten said. “It’s in the data.”

 

 

 

Where the virus is spreading

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Axios

The Trump administration’s reopening guidelines detail that in order to start lifting restrictions and reopening the economy, a state needs to report 14-day trends of fewer cases or fewer positive tests (though local officials do get some leeway in adjusting the metrics).

  • Not a lot of states meet that criteria, Axios editor-in-chief Nick Johnston writes.

Our chart compares each state’s seven-day average of new cases from Monday and the seven-day average from a week prior, April 27.

  • By this metric, Minnesota, Nebraska and Puerto Rico have the most worrisome trends, while Arkansas and Wyoming have the most positive trends. Twelve states are moving in the right direction.
  • But more than a third of the nation still has growing numbers of cases. And that includes states such as Texas and Virginia, where Republican and Democratic governors are beginning to unveil re-opening plans.

Yes, but: These trends only tell us so much.

  • Some states may see their case counts rise not necessarily because their outbreaks are getting dramatically worse, but because their testing is getting better, so they’re catching more cases.
  • That’s why health officials are also pulling in other metrics — including the number of deaths, the number of hospitalizations and the percentage of tested patients who test positive. A higher percentage means you’re probably missing people.
  • Still, public-health guidance calls for a steady decrease in cases before opening up, and few states have achieved that.

The bottom line: The virus isn’t just some other states’ problem. It’s everyone’s problem.

 

The next phase of America’s coronavirus failure

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The next phase of America's coronavirus failure has begun - Axios

The evidence is mounting that America is steamrolling toward a nightmarish failure to control the coronavirus.

Where it stands: We made a lot of mistakes at the beginning, and despite a month of extreme social distancing to try to hit “reset,” a hurried reopening now raises the risk that we’ll soon be right back where we started.

Driving the news: The Trump administration is in “preliminary discussions” to wind down its coronavirus task force, possibly in early June, Vice President Mike Pence told reporters yesterday.

  • The formal existence of a task force isn’t necessarily going to make or break the coronavirus response, but its dissolution is yet another sign that the administration is ready to move on — despite all of the indications that we’re not prepared.

What we’re watching: The U.S. is still seeing around 30,000 new coronavirus cases a day — and those are just the ones that we’re catching, because we are still not testing enough people.

  • Even with a robust contact tracing workforce, which we don’t have, tracking down the interactions of 30,000 people a day would be an impossible task.
  • And even if it weren’t, we have no system in place for isolating those people to prevent them from infecting their family members, coworkers or other contacts.
  • Once we lift social distancing measures and people start interacting with one another again, the number of cases will inevitably spike, making containment even more impossible.

We don’t have a treatment or a vaccine, and we’re about to loosen the reins on a virus whose reach, symptoms and long-term effects we are still learning.

Yes, but: Some cities and states have been more proactive in building up their public health infrastructure, and have said they’ll continue with social distancing until their caseloads indicate it’s safe to begin returning to normal.

 

 

 

 

Whistleblower alleges Trump administration ignored coronavirus warnings

Posted on by • Posted in 2020 Election Issues, Clinical Research, Clinical Research Funding, Clinical Testing, Clinical Trials, Conflicts of Interest, Coronavirus, Credibility, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Food and Drug Administration (FDA), Health Policy, Hydroxychloroquine, Misinformation, Mislead, Misleading, Mistake, Mistrust, Scientists, Transparency, Trust, Truth, U.S. Biomedical Advanced Research and Development Authority (BARDA) • Leave a comment

https://www.axios.com/coronavirus-rick-bright-whistleblower-f48cc9c6-8e6e-4662-a127-03e51f323288.html?stream=health-care&utm_source=alert&utm_medium=email&utm_campaign=alerts_healthcare

Whistleblower alleges Trump administration ignored coronavirus ...

Rick Bright, the former director of the U.S. Biomedical Advanced Research and Development Authority (BARDA), filed a whistleblower complaint Tuesday alleging that the Department of Health and Human Services failed to take early action to mitigate the threat of the novel coronavirus.

Flashback: Bright said last month he believes he was ousted after clashing with HHS leadership over his attempts to limit the use of hydroxychloroquine to treat the coronavirus.

What’s new: In his complaint, Bright claims he was excluded from an HHS meeting on the coronavirus in late January after he “pressed for urgent access to funding, personnel, and clinical specimens, including viruses” to develop treatments for the coronavirus should it spread outside of Asia.

  • Bright alleges it “became increasingly clear” in late January that “HHS leadership was doing nothing to prepare for the imminent mask shortage.”
  • Bright claims he “resisted efforts to fall into line with the Administration’s directive to promote the broad use of chloroquine and hydroxychloroquine and to award lucrative contracts for these and other drugs even though they lacked scientific merit and had not received prior scientific vetting.”
  • He adds that “even as HHS leadership began to acknowledge the imminent shortages in critical medical supplies, they failed to recognize the magnitude of the problem, and they failed to take the necessary urgent action.”

The White House declined to comment. HHS did not immediately respond to a request for comment.

https://www.documentcloud.org/documents/6882494-NEW-R-Bright-OSC-Complaint-Redacted.html

 

 

 

 

Coronavirus Dashboard

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https://www.axios.com/coronavirus-latest-news-quick-highlights-57a186a3-7547-45bf-852a-83019849d8d5.html

Photo collage of newspaper clippings with cutout of a red virus in the middle

  1. Global: Total confirmed cases as of 3:30 p.m. ET: 3,630,942 — Total deaths: 254,592 — Total recoveries — 1,184,625 — Map.
  2. U.S.: Total confirmed cases as of 3:30 p.m. ET: 1,193,027 — Total deaths: 70,110 — Total recoveries — 187,180 — Total tested: 7,285,178 — Map.
  3. Trump administration: Whistleblower alleges HHS failed to act quickly on coronavirus — Pence says the White House is considering disbanding the coronavirus task force.
  4. World: U.K. reports highest coronavirus death toll in Europe.
  5. States: New York reports 1,700 new coronavirus deaths in nursing homes.
  6. 🎓 Commencement: Barack and Michelle Obama to take part in virtual commencement ceremonies for class of 2020.
  7. What should I do? Hydroxychloroquine questions answered — Traveling, asthma, dishes, disinfectants and being contagious — Masks, lending books and self-isolating — Exercise, laundry, what counts as soap — Pets, moving and personal health — Answers about the virus from Axios experts — What to know about social distancing — How to minimize your risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

 

 

 

White House plans to scale back coronavirus task force

Posted on by • Posted in 2020 Election Issues, Clinical Research, Clinical Testing, Coronavirus, Credibility, Crisis, Crisis Management, Denial, Economic Crisis, Economy, False Hope, Health Policy, Infection Control, Infectious Virus, Misinformation, Mislead, Misleading, Mortality, Pandemic, Partisanship, Public Health, Public Safety, Quarantine, Social Distancing, Vaccination, Vaccine, Wishful Thinking • Leave a comment

https://thehill.com/homenews/administration/496211-white-house-signals-it-will-wind-down-coronavirus-task-force

Anthony Fauci - Axios

The White House is in the early stages of winding down its coronavirus task force, Vice President Pence’s office confirmed Tuesday.

The surprise decision comes as most states are preparing to loosen restrictions meant to slow the spread of the virus, while a number of areas continue to see increases in new COVID-19 cases and deaths.

Pence’s office confirmed to The Hill that the vice president told reporters at a limited briefing that his plan is to scale back the task force’s role by Memorial Day. Pence has been leading the task force since late February.

Members are likely to return to their respective departments and manage the coronavirus response from there.

Dr. Deborah Birx, who was brought in from the State Department to coordinate the White House virus response, will “continue to review and analyze data and work with the departments in agencies to help that data inform their decision making processes,” a spokesman for Pence’s office said.

The New York Times first reported on the expected demise of the task force.

The task force, which includes nearly two dozen officials from various government agencies, held near-daily press briefings for more than a month but has been less visible in recent weeks as President Trump and others transition their focus to the economic consequences of the pandemic.

There have been no coronavirus task force briefings in more than a week, and the daily meetings have become less frequent. The group was scheduled to meet Tuesday afternoon.

But the decision to formally disband the task force is sure to raise concern among public health experts who have warned the coronavirus will likely be part of life in the U.S. until there is a widely available vaccine, which could take a year or longer to develop.