In educated and affluent Massachusetts, coronavirus cases surged. The decline has yet to come.

https://www.washingtonpost.com/national/coronavirus-massachusetts-cases-high/2020/05/01/8b7b748c-8b2b-11ea-8ac1-bfb250876b7a_story.html?fbclid=IwAR1Hon5rQwU9Tf5b2HQZktH2i8VbLURJomAkHzGmwde1J6N1rkqlaUaVup4&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Coronavirus cases surged in educated and affluent Massachusetts ...

Massachusetts has one of the most educated and affluent populations in the country. It’s home to some of the nation’s most preeminent medical centers. And it has political leaders who have worked cooperatively, across party lines, in the face of a crisis.

Massachusetts also has the third-highest number of confirmed state coronavirus cases, along with the fourth-highest death toll. And despite predictions that numbers would be falling by now after a month and a half of people staying at home, new case counts have instead remained stubbornly high.

The state’s struggle to combat the coronavirus reflects just what a tenacious adversary it really is. Even for a place that has a lot going for it, the toll has been severe — and it is growing by the day.

As of Friday, Massachusetts had more than 64,000 cases — behind only New York and New Jersey, its larger northeastern neighbors. New cases totaled 2,106, continuing a dismal streak lasting more than two weeks of at least 1,500 additional cases per day. Deaths hit 3,716, behind only New York, New Jersey and Michigan.

Even as many states began opening up their economies Friday — allowing restaurants, shopping malls and hair salons to do business — that remained a distant prospect in Massachusetts. Instead, Gov. Charlie Baker (R) on Friday was announcing new restrictions, including a requirement that people wear masks while in public.

“This is going to be a way of life,” Baker said. “No ifs, no ands, no buts, no doubts.”

The persistence with which people keep getting sick in Massachusetts has been matched in other hard-hit states. Rather than a precipitous decline, the number of new cases in places such as Illinois, California and the D.C. metro area has instead been leveling off slowly.

Experts say that is to be expected, even if it means a long road ahead.

“If social distancing is done well — and Massachusetts has done it pretty well — the effect is going to be to flatten the curve and spread it out over more time,” said David Hamer, professor of global health at Boston University and an infectious-disease physician at Boston Medical Center. “Instead of a peak, it’s a prolonged plateau. It’s going to be a gradual decline.”

Like other states, Massachusetts has avoided some of the most dire projections about how many people would fall ill. Its social distancing measures also have prevented hospitals from becoming overwhelmed.

But actually pushing down the rate — rather than treading water — will be tricky to pull off, because of the nature of who is getting sick.

More than half the state’s deaths have been people in long-term-care facilities, such as nursing homes. The elderly make up a slightly higher share of the Massachusetts population than the national average.

Essential workers — who have to commute to their jobs each day and often are in close quarters with others — also have been hit hard.

“Some people have been able to completely shelter at home. Their risk of getting anything is very low indeed,” said Jeffrey K. Griffiths, who teaches public health at Tufts University. “But there are other groups of people that man the gas stations, the grocery stores, the hospitals. They’re police and firefighters. They still have to go to work.”

And then there are the poor, for whom social distancing at home is particularly challenging.

Geralde Gabeau, an advocate for the state’s Haitian community, said she knows of immigrant families that are living 10 to a two-bedroom apartment and sharing a single bathroom.

“If one person gets infected, the likelihood of everyone being infected is very high,” she said. “There is no room for people to isolate.”

Gabeau said the immigrant assistance group she runs, Immigrants Family Services Institute-USA, has gone from helping 60 families to more than 300. “Our phone never stops,” she said.

And she hesitates before opening Facebook: “All you see is RIP,” she said. “Every single day, people are losing their grandparents. Yesterday we lost a young man, 34 years old. A family in Boston lost four people. The Haitian community is mourning like crazy.”

Immigrant groups say Massachusetts needs to do a better job circulating information about the coronavirus in multiple languages. Though much of the literature is translated into Spanish, that accounts for only about 40 percent of the state’s population that is not proficient in English. Gabeau said she has taken it upon herself to produce videos in Creole to help spread the truth about the virus for the Haitian community, which makes up a significant share of the state’s 1 million-plus foreign-born residents.

Massachusetts was among the earliest states to reckon with a coronavirus outbreak, recording its first case on Feb. 1. But Hamer said the virus was probably present far earlier, and it was far more widespread than anyone knew when Baker declared a state of emergency on March 10. With everyone cooped up indoors for the New England winter but without official mandates to socially distance, the virus had ample opportunity to spread.

Many of the cases from early March were traced back to a late-February conference hosted by a biotech company, Biogen.

Experts say that on the whole, the state has done well with its response. Baker is a Republican, while Democrats dominate the legislature. The two sides have worked cooperatively, with little partisan rancor.

“I would say that as a state we are doing this right,” said Maryanne Bombaugh, president of the Massachusetts Medical Society. “It’s a very positive example of how you can work together and make a difference for your people.”

Bombaugh cited in particular the prevalence of testing in Massachusetts, including of the asymptomatic, which she said accounts at least in part for the state’s relatively high infection levels. The state also is tracing those who come into close contact with people who have tested positive, a vital step in containing future outbreaks.

Unlike states that have been besieged by protests, there has been comparatively little pressure in Massachusetts to reopen before public health experts give the all clear. The state is among a coalition, led by New York, that is trying to coordinate reopenings across the Northeast rather than acting individually, as many states have done.

The state’s nonessential-business closure extends until at least May 18, with an advisory group due to report back to Baker by then on the best way to gradually reopen.

The governor on Friday said he was encouraged by a slight decrease in the percentage of coronavirus-positive patients requiring hospitalization. “Overall, this is a very good sign,” he said.

Yet testing is still below what epidemiologists would like to see before stay-at-home restrictions can be lifted. A sustained drop in positive results is another prerequisite. And although experts say it is probably coming, it will take some time to get there.

“The plateau is telling us that we’re getting there,” Griffiths said. “But if we were to open up again while we’re at that plateau, we would just see another sharp spike up.”

 

 

 

 

Cartoon – Just Two on the Front Lines Who Checkout Hundreds of People a Day

Slavery 21st Century

Fauci warns states rushing to reopen: ‘You’re making a really significant risk’

https://www.washingtonpost.com/nation/2020/05/01/fauci-open-states-coronavirus/?fbclid=IwAR2zliMTNSIDC3ldCr7P3x4owkyZfqVKSJGj0M2pzYOH7XakQw6ztNAXcsI&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Fauci warns states rushing to reopen amid coronavirus pandemic ...

With the White House’s social distancing guidelines expiring Thursday, leaving states largely in charge of deciding how to move forward, Anthony S. Fauci warned local leaders to avoid “leapfrogging” critical milestones in an effort to reopen their economies amid the ongoing coronavirus pandemic.

“Obviously you could get away with that, but you’re making a really significant risk,” Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday evening on CNN.

Fauci, who has repeatedly cautioned against prematurely easing restrictions, said he already noticed that some states and cities are not adhering to the steps laid out in the White House’s recently issued guidance on reopening — a plan that administration officials say will now replace the expired federal social distancing measures.

“If you follow the guidelines, there’s a continuity that’s safe, that’s prudent and that’s careful,” he said.

But if governors rush to reopen when they aren’t ready, Fauci cautioned that the move would likely only set back the progress their states have made.

“There’s no doubt in my mind that when you pull back mitigation, you’re going to start seeing cases crop up here and there,” he said. “If you’re not able to handle them, you’re going to see another peak, a spike, and then you almost have to turn the clock back to go back to mitigation.”

Fauci’s comments come as dozens of states have unveiled plans to begin easing stay-at-home orders, with some changes already taking effect despite the number of coronavirus cases and related deaths continuing to rise nationwide. Georgia Gov. Brian Kemp (R), for example, weathered intense criticism, including from President Trump, after announcing that he would lift restrictions on a wide array of businesses, allowing them to open a week ago.

The patchwork effort to return to some semblance of normalcy coupled with the absence of stringent social distancing recommendations has left health experts worried, The Washington Post’s Yasmeen Abutaleb and Rachel Weiner reported. Attempts to reopen states too soon at a time when social distancing remains the most effective way to stem the spread of the virus could increase the risk of new outbreaks, experts say. According to most recent figures, the United States has more than 1 million cases of the coronavirus and nearly 63,000 deaths.

On Thursday, Fauci appeared to echo those concerns, but stressed that major problems could be avoided so long as states adhere to the federal government’s reopening guidelines, which he described as “very well thought out and very well delineated.”

“I keep trying to articulate to the public and to the leaders, ‘Take a look at the guidelines,’ ” Fauci said on CNN. “They don’t tell you because you’ve reached the end of the 30-day mitigation period that, all of a sudden, you switch a light on and you just go for it. That’s not the way to do it. Each state, each city, each region is going to be a little different.”

Citing the guidelines, Fauci reiterated that states need to report a steady decrease in coronavirus cases within a 14-day period in addition to meeting other requirements before even thinking about moving on to the first phase of reopening.

“The discretion is given to the governors, they know their states. The mayors know their cities, so you want to give them a little wiggle room,” he said. “But my recommendation is don’t wiggle too much.”

While Fauci acknowledged that some local leaders are following the guidance, he said “others are taking a bit of a chance.”

“I hope they can actually handle any rebound that they see,” he added.

Later in the segment, Fauci was asked by CNN’s chief medical correspondent Sanjay Gupta about whether the rise in cases in states that are reopening would be incremental or exponential. In response, Fauci said that though he doesn’t know for sure, he doubted that any area would see “something as explosive as we saw in New York.” New York, which has yet to lift restrictions, is the epicenter of the U.S. outbreak with more than 300,000 confirmed cases and roughly 23,600 deaths.

But he warned that states could really find themselves in trouble if infections managed to “spill over into the general community,” similar to the way the virus spread in New York.

“If you can’t stop that from happening, then I think you’re really going to see the sharp peak,” Fauci said. “That is going to be very disturbing when that happens because it’s really going to take a while to get it back down.”

 

 

 

 

Why summer likely won’t save us from the coronavirus

https://www.vox.com/2020/4/29/21231906/coronavirus-pandemic-summer-weather-heat-humidity-uv-light

Summer weather could help slow the coronavirus. But it’s likely not enough.

Some Americans are hoping for a natural reprieve to social distancing as the coronavirus pandemic drags on: that sunnier, warmer, and more humid weather in the summer will destroy the Covid-19 virus — as it does with other viruses, like the flu — and let everyone go back to normal.

There is some evidence that heat, humidity, and ultraviolet light could hurt the coronavirus — an idea that President Donald Trump bizarrely leaned into when he suggested the use of “ultraviolet or just very powerful light … inside the body” to treat people sickened by Covid-19 (an idea with no scientific merit, as experts have repeatedly stated).

But even if heat, humidity, and light help slow the virus’s spread, sunny, hot, and humid weather alone won’t be enough to end the epidemic. Experts point to the examples of SingaporeEcuador, and Louisiana, all of which have recently had growing numbers of Covid-19 cases despite temperatures hitting 80-plus degrees Fahrenheit and humidity levels reaching more than 60, 70, or even 80 percent.

High levels of heat, UV light, and humidity can help prevent more widespread infections of the flu or colds in the summer, along with medical treatments and vaccines (when available). But the Covid-19 coronavirus is still new to humans, so we don’t have as much immune protection built up against it — so the virus seems able to overcome summer-like weather and still cause big outbreaks.

“For the novel coronavirus SARS-CoV-2, we have reason to expect that like other betacoronaviruses, it may transmit somewhat more efficiently in winter than summer, though we don’t know the mechanism(s) responsible,” Marc Lipsitch, an epidemiologist at Harvard, wrote. “The size of the change is expected to be modest, and not enough to stop transmission on its own.”

Still, the studies on heat, light, and humidity, plus the fact coronavirus has a harder time spreading in open-air areas, suggest that the outdoors may be a safe target for a slow reopening as transmission of the virus slows, as long as precautions like physical distancing and mask-wearing are followed. So outdoor activities could offer a respite to lockdowns and quarantines — one that’s also, potentially, good for physical and mental health.

It also means that if Covid-19 becomes endemic (a disease that regularly comes back, like the flu or common cold), then heat, sunlight, and humidity could restrict bigger outbreaks to fall and winter. But that possibility is likely still years away, experts say.

So summer weather may make the outdoors a little safer, but it won’t be enough to quash coronavirus on its own. That means we’ll likely need to continue social distancing to some degree in the coming months, and continue working on getting more testing, aggressive contact tracing, and medical treatments up to scale before places can safely reopen their economies.

Hotter, more humid weather does seem to hurt the coronavirus

There are a few ways that summer weather could have an effect on SARS-CoV-2. Higher temperatures can help weaken the novel coronavirus’s outer lipid layer, similar to how fat melts in greater heat. Humidity in the air can effectively catch virus-containing droplets that people breathe out, causing these droplets to fall to the ground instead of reaching another human host — making humidity a shield against infection. UV light, which there’s a lot more of during sunny summer days, is a well-known disinfectant that effectively fries cells and viruses.

“There are multiple coronaviruses out there that affect our population, and many of them, if not most of them, exhibit a seasonal influence,” Mauricio Santillana, the director of the Machine Intelligence Lab at Boston Children’s Hospital and a researcher on the effects of the weather on coronavirus, told me. “The hypothesis postulated for Covid-19 is that it will have a similar behavior.”

But that’s hypothetical. How does it play out in reality?

So far, the coronavirus has largely spread in the Northern Hemisphere, where it’s been winter and early spring. It’s not clear if the weather is a reason for that, because data on its spread in the Southern Hemisphere — particularly poorer countries in Africa and South America — is largely lacking due to weak public health infrastructure.

Still, we have some evidence. The National Academies of Sciences, Engineering, and Medicine — one of America’s top scientific evidence reviewers — summarized the research earlier in April. It looked at two kinds of studies: those that tested the effects of summer-like temperatures in a laboratory, and those that attempted to tease out the effects of heat, UV light, and humidity in the real world.

In the lab, researchers use sophisticated tools to see how the virus fares in different conditions. Generally, they’ve found more heat, UV light, and humidity seem to weaken the coronavirus — although one preliminary study suggested that coronavirus may fare better in the more summer-like conditions than the flu, SARS, and monkeypox viruses.

This is the kind of study Bill Bryan, the undersecretary for science and technology at the Department of Homeland Security, presented at the April 23 White House press briefing. That study found that coronavirus seemed to die off much more quickly in hotter, more humid environments with a lot of UV light.

As the National Academies noted, however, this evidence comes with big caveats. Perhaps most importantly, these studies haven’t yet been peer reviewed. So they could have big methodological errors that we just don’t know about yet. (This Wired article does a good job breaking down the concerns with such early research.)

But even if these studies are well-conducted, the real world is simply a lot messier than a laboratory setting. For example, the lab-grown virus used in these studies may act at least somewhat differently than the natural virus in the real world.

People can also act differently in summer than they do in winter, and the lab studies don’t account for how those behaviors affect coronavirus’s spread. People are more likely to stay indoors during the winter to avoid the cold — but indoor spaces are generally more poorly ventilated and cramped, both of which make it easier for the coronavirus to spread. Warmth and sunshine also could impact the immune system, though that relationship is still unclear.

We’ll get more evidence on real-life seasonal effects as the months go by — especially if more places take potentially dangerous risks. “In Georgia, where they are opening back up without really any concrete measures to encourage distancing, we might be able to better evaluate how [the coronavirus] spreads in the summer months,” Angela Rasmussen, a virologist at Columbia, told me.

But there is some early real-world research already, which the National Academies also reviewed. These studies looked at whether the SARS-CoV-2 virus was affected by different climates in real-world settings, and if it spread more easily in places where it was colder and less humid and there was less UV light. Some researchers also developed models based on data from different outbreaks in different parts of the world.

One upcoming study from a group of researchers at the University of Nebraska Medical Center tried to model the effects of heat, humidity, and UV light, finding that they mitigated the spread of the virus. UV light seemed to play a bigger role, although the researchers cautioned that their findings will need to be replicated and verified with, ideally, years of data. “This is a very new virus, and there are lots of things we don’t know about it,” Azar Abadi, one of the researchers, told me.

But this aligns with the evidence that the National Academies reviewed.

“There is some evidence to suggest that SARS-CoV-2 may transmit less efficiently in environments with higher ambient temperature and humidity,” Harvey Fineberg, author of the National Academies report, wrote. “[H]owever, given the lack of host immunity globally, this reduction in transmission efficiency may not lead to a significant reduction in disease spread without the concomitant adoption of major public health interventions.”

Heat and humidity won’t be enough to beat the pandemic — far from it

This is the point experts emphasized again and again: It’s one thing for the weather to have some sort of effect on coronavirus; it’s another thing for that effect to be enough to actually halt the virus’s widespread transmission. We have early evidence the weather has an effect, but we also have early evidence that it won’t be enough.

The problem: Other factors, besides the weather, play a role in the spread of diseases. In the case of coronavirus, these other factors seem to play a much bigger role than weather.

The mayor of Guayaquil, Ecuador, where it’s regularly 80-plus degrees Fahrenheit, described her city’s experience with Covid-19 “like the horror of war” and “an unexpected bomb falling on a peaceful town.” Ecuador now has one of the worst coronavirus death tolls in the world — a sign that warm, sunny, and humid weather can’t make up for struggling public health infrastructure in a still-developing country.

Singapore, which is nearly on the equator, managed to contain coronavirus at first, but it has seen a growing outbreak recently. The problem, it seems, is the government neglected migrant workers in its initial response — letting Covid-19 spread in the cramped and sometimes unsanitary conditions many migrants live in. Warm, humid weather alone wasn’t enough to overcome preexisting issues and an overly narrow public policy response.

Meanwhile, Louisiana is suffering a significant coronavirus outbreak, with the fifth-most deaths per 100,000 people out of all the states. According to experts, Mardi Gras — held on February 25 — may have accelerated that. The massive celebration seemed to cause a lot of transmission, even as New Orleans saw temperatures up to the 70s, and cases continued to climb even as temperatures reached the 80s. Maybe the weather made things better than they would be otherwise, but it was, again, no match for human behavior’s effects on the spread of Covid-19.

The bigger problem is too many people in the US are still vulnerable to the virus. “While we see some influence [of the weather], the effect that we’re seeing — if there’s any effect — is eclipsed by the high levels of susceptibility in the population,” Santillana said. “Most people are still highly susceptible. So even if temperature or humidity could play a role, there’s not enough immunity.”

That made it extremely easy for the virus to spread, regardless of the weather, especially since SARS-CoV-2 appears to be so contagious relative to other pathogens. In contrast, if you think about the viruses that are more affected by the seasons — the flu and colds — humans have been dealing with them for hundreds if not thousands of years. That’s let us build some population-level protection that we just don’t have for Covid-19, making other factors besides our actions, like the weather, a bit more important for the seasonal viruses.

So down the line, if Covid-19 becomes endemic — a possibility if, for example, immunity to it isn’t as permanent as we’d like — it’s possible that seasons will have a much stronger sway over when it pops up again.

Even then, it’s worth acknowledging that seasons don’t fully determine when the flu and colds hit. As the National Academies pointed out, some flu pandemics have started in the summer: “There have been 10 influenza pandemics in the past 250-plus years — two started in the northern hemisphere winter, three in the spring, two in the summer and three in the fall.”

In fact, some of this research could be taken to mean that coronavirus will be even more dangerous eventually: If the colder, dryer weather this fall and winter empowers the virus, that could lead to a bigger outbreak. The National Academies noted, as an example, that a second spike is typical for flu pandemics: “All had a peak second wave approximately six months after emergence of the virus in the human population, regardless of when the initial introduction occurred.”

But, as is true in the reverse, other factors besides the weather likely play a bigger role in the spread. So if governments and the public do the right thing through the fall and winter, there’s still a good chance that there won’t be a big spike.

Americans will likely be social distancing through the summer

The upshot of all of this: The changing weather likely won’t be enough on its own to relax social distancing. Given that there’s still a lot about Covid-19 we still need to learn, experts don’t know this for certain. But it’s what they suspect, based on the data that we’ve seen in the research and real world so far.

“If the only concern is the health of people, it’s irresponsible to go back to relaxing social distancing anytime soon,” Santillana said. “We’re not done, even if summer starts.”

So as the plans to end social distancing indicate, the world will likely need at least some level of social distancing until a vaccine or a similarly effective medical treatment is developed, which is possibly a year or more away. That may not require the full lockdown that several states are seeing today, but it will mean restrictions on larger gatherings and some travel, while perhaps continuing remote learning and work.

Weather could help determine how safe it is to go outside, even as social distancing continues. Some states, for example, are considering opening parks and beaches during the earlier phases of reopening their economies. Experts warn that summer weather won’t allow large gatherings — 50 people or more is often cited as way too many — but it could give people some assurance that they can go outdoors as long as they keep 6 feet or more of distance from others they don’t live with, avoid touching surfaces and their faces, and wear masks.

Otherwise, however, how much social distancing will be relaxed in the coming months won’t come down to the weather but likely how much the US improves its testing and surveillance capacity. Testing gives officials the means to isolate sick people, track and quarantine the people whom those verified to be sick came into close contact with (a.k.a. contact tracing), and deploy community-wide efforts if a new cluster of cases is too large and uncontrolled otherwise.

While the US has seen some gains in testing, the number of new tests a day still fall below estimates of what’s needed (500,000 on the low end and tens of millions on the high end) to safely ease social distancing.

Along with testing, America will need aggressive contact tracing, as countries like South Korea and Germany have done, to control its outbreak.report from the Johns Hopkins Center for Health Security and Association of State and Territorial Health estimated the US will need to hire 100,000 contact tracers — far above what states and federal officials have so far said they’re hiring. A phone app could help mitigate the need for quite as many tracers, but it’s unclear if Americans have the appetite for an app that will effectively track their every move.

These are, really, the things everyone has been hearing about the entire time during this pandemic. It’s just worth emphasizing that the summer weather likely won’t be enough on its own to mitigate the need for these other public health strategies.

“The best-case scenario is if we’re doing that [social distancing] and there’s a dampening [in the summer], maybe there is a possibility of limiting this virus here in the United States and other places,” Jesse Bell, one of the University of Nebraska Medical Center researchers, told me. “But then again we just don’t know.”

So we’re very likely going to need social distancing, testing, and contact tracing for the foreseeable future, regardless of how warm, sunny, and humid it is outside.

 

 

 

 

What you need to know about the COVID-19 vaccine

https://www.gatesnotes.com/Health/What-you-need-to-know-about-the-COVID-19-vaccine?WT.mc_id=20200430164943_COVID-19-vaccine_BG-FB&WT.tsrc=BGFB&linkId=87665504&fbclid=IwAR0SsBGe1GTcy-fOIXz86kImkScsdCGlRVgmDcPOgXMcaU7kdO39SyNpRSs

What you need to know about the COVID-19 vaccine | Bill Gates

Humankind has never had a more urgent task than creating broad immunity for coronavirus.

One of the questions I get asked the most these days is when the world will be able to go back to the way things were in December before the coronavirus pandemic. My answer is always the same: when we have an almost perfect drug to treat COVID-19, or when almost every person on the planet has been vaccinated against coronavirus.

The former is unlikely to happen anytime soon. We’d need a miracle treatment that was at least 95 percent effective to stop the outbreak. Most of the drug candidates right now are nowhere near that powerful. They could save a lot of lives, but they aren’t enough to get us back to normal.

Which leaves us with a vaccine.

Humankind has never had a more urgent task than creating broad immunity for coronavirus. Realistically, if we’re going to return to normal, we need to develop a safe, effective vaccine. We need to make billions of doses, we need to get them out to every part of the world, and we need all of this happen as quickly as possible.

That sounds daunting, because it is. Our foundation is the biggest funder of vaccines in the world, and this effort dwarfs anything we’ve ever worked on before. It’s going to require a global cooperative effort like the world has never seen. But I know it’ll get done. There’s simply no alternative.

Here’s what you need to know about the race to create a COVID-19 vaccine.

The world is creating this vaccine on a historically fast timeline.

Dr. Anthony Fauci has said he thinks it’ll take around eighteen months to develop a coronavirus vaccine. I agree with him, though it could be as little as 9 months or as long as two years.

Although eighteen months might sound like a long time, this would be the fastest scientists have created a new vaccine. Development usually takes around five years. Once you pick a disease to target, you have to create the vaccine and test it on animals. Then you begin testing for safety and efficacy in humans.

Safety and efficacy are the two most important goals for every vaccineSafety is exactly what it sounds like: is the vaccine safe to give to people? Some minor side effects (like a mild fever or injection site pain) can be acceptable, but you don’t want to inoculate people with something that makes them sick.

Efficacy measures how well the vaccine protects you from getting sick. Although you’d ideally want a vaccine to have 100 percent efficacy, many don’t. For example, this year’s flu vaccine is around 45 percent effective.

To test for safety and efficacy, every vaccine goes through three phases of trials:

  • Phase one is the safety trial. A small group of healthy volunteers gets the vaccine candidate. You try out different dosages to create the strongest immune response at the lowest effective dose without serious side effects.
  • Once you’ve settled on a formula, you move onto phase two, which tells you how well the vaccine works in the people who are intended to get it. This time, hundreds of people get the vaccine. This cohort should include people of different ages and health statuses.
  • Then, in phase three, you give it to thousands of people. This is usually the longest phase, because it occurs in what’s called “natural disease conditions.” You introduce it to a large group of people who are likely already at the risk of infection by the target pathogen, and then wait and see if the vaccine reduces how many people get sick.

After the vaccine passes all three trial phases, you start building the factories to manufacture it, and it gets submitted to the WHO and various government agencies for approval.

This process works well for most vaccines, but the normal development timeline isn’t good enough right now. Every day we can cut from this process will make a huge difference to the world in terms of saving lives and reducing trillions of dollars in economic damage.

So, to speed up the process, vaccine developers are compressing the timeline. This graphic shows how:

In the traditional process, the steps are sequential to address key questions and unknowns. This can help mitigate financial risk, since creating a new vaccine is expensive. Many candidates fail, which is why companies wait to invest in the next step until they know the previous step was successful.

For COVID-19, financing development is not an issue. Governments and other organizations (including our foundation and an amazing alliance called the Coalition for Epidemic Preparedness Innovations) have made it clear they will support whatever it takes to find a vaccine. So, scientists are able to save time by doing several of the development steps at once. For example, the private sector, governments, and our foundation are going to start identifying facilities to manufacture different potential vaccines. If some of those facilities end up going unused, that’s okay. It’s a small price to pay for getting ahead on production.

Fortunately, compressing the trial timeline isn’t the only way to take a process that usually takes five years and get it done in 18 months. Another way we’re going to do that is by testing lots of different approaches at the same time.

There are dozens of candidates in the pipeline.

As of April 9, there are 115 different COVID-19 vaccine candidates in the development pipeline. I think that eight to ten of those look particularly promising. (Our foundation is going to keep an eye on all the others to see if we missed any that have some positive characteristics, though.)

The most promising candidates take a variety of approaches to protecting the body against COVID-19. To understand what exactly that means, it’s helpful to remember how the human immune system works.

When a disease pathogen gets into your system, your immune system responds by producing antibodies. These antibodies attach themselves to substances called antigens on the surface of the microbe, which sends a signal to your body to attack. Your immune system keeps a record of every microbe it has ever defeated, so that it can quickly recognize and destroy invaders before they make you ill.

Vaccines circumvent this whole process by teaching your body how to defeat a pathogen without ever getting sick. The two most common types—and the ones you’re probably most familiar with—are inactivated and live vaccines. Inactivated vaccines contain pathogens that have been killed. Live vaccines, on the other hand, are made of living pathogens that have been weakened (or “attenuated”). They’re highly effective but more prone to side effects than their inactivated counterparts.

Inactivated and live vaccines are what we consider “traditional” approaches. There are a number of COVID-19 vaccine candidates of both types, and for good reason: they’re well-established. We know how to test and manufacture them.

The downside is that they’re time-consuming to make. There’s a ton of material in each dose of a vaccine. Most of that material is biological, which means you have to grow it. That takes time, unfortunately.

That’s why I’m particularly excited by two new approaches that some of the candidates are taking: RNA and DNA vaccines. If one of these new approaches pans out, we’ll likely be able to get vaccines out to the whole world much faster. (For the sake of simplicity, I’m only going to explain RNA vaccines. DNA vaccines are similar, just with a different type of genetic material and method of administration.)

Our foundation—both through our own funding and through CEPI—has been supporting the development of an RNA vaccine platform for nearly a decade. We were planning to use it to make vaccines for diseases that affect the poor like malaria, but now it’s looking like one of the most promising options for COVID. The first candidate to start human trials was an RNA vaccine created by a company called Moderna.

Here’s how an RNA vaccine works: rather than injecting a pathogen’s antigen into your body, you instead give the body the genetic code needed to produce that antigen itself. When the antigens appear on the outside of your cells, your immune system attacks them—and learns how to defeat future intruders in the process. You essentially turn your body into its own vaccine manufacturing unit.

Because RNA vaccines let your body do most of the work, they don’t require much material. That makes them much faster to manufacture. There’s a catch, though: we don’t know for sure yet if RNA is a viable platform for vaccines. Since COVID would be the first RNA vaccine out of the gate, we have to prove both that the platform itself works and that it creates immunity. It’s a bit like building your computer system and your first piece of software at the same time.

Even if an RNA vaccine continues to show promise, we still must continue pursuing the other options. We don’t know yet what the COVID-19 vaccine will look like. Until we do, we have to go full steam ahead on as many approaches as possible.

It might not be a perfect vaccine yet—and that’s okay.

The smallpox vaccine is the only vaccine that’s wiped an entire disease off the face of the earth, but it’s also pretty brutal to receive. It left a scar on the arm of anyone who got it. One out of every three people had side effects bad enough to keep them home from school or work. A small—but not insignificant—number developed more serious reactions.

The smallpox vaccine was far from perfect, but it got the job done. The COVID-19 vaccine might be similar.

If we were designing the perfect vaccine, we’d want it to be completely safe and 100 percent effective. It should be a single dose that gives you lifelong protection, and it should be easy to store and transport. I hope the COVID-19 vaccine has all of those qualities, but given the timeline we’re on, it may not.

The two priorities, as I mentioned earlier, are safety and efficacy. Since we might not have time to do multi-year studies, we will have to conduct robust phase 1 safety trials and make sure we have good real-world evidence that the vaccine is completely safe to use.

We have a bit more wiggle room with efficacy. I suspect a vaccine that is at least 70 percent effective will be enough to stop the outbreak. A 60 percent effective vaccine is useable, but we might still see some localized outbreaks. Anything under 60 percent is unlikely to create enough herd immunity to stop the virus.

The big challenge will be making sure the vaccine works well in older people. The older you are, the less effective vaccines are. Your immune system—like the rest of your body—ages and is slower to recognize and attack invaders. That’s a big issue for a COVID-19 vaccine, since older people are the most vulnerable. We need to make sure they’re protected.

The shingles vaccine—which is also targeted to older people—combats this by amping up the strength of the vaccine. It’s possible we do something similar for COVID, although it might come with more side effects. Health authorities could also ask people over a certain age to get an additional dose.

Beyond safety and efficacy, there are a couple other factors to consider:

  • How many doses will it be? A vaccine you only get once is easier and quicker to deliver. But we may need a multi-dose vaccine to get enough efficacy.
  • How long does it last? Ideally, the vaccine will give you long-lasting protection. But we might end up with one that only stops you from getting sick for a couple months (like the seasonal flu vaccine, which protects you for about six months). If that happens, the short-term vaccine might be used while we work on a more durable one.
  • How do you store it? Many common vaccines are kept at 4 degrees C. That’s around the temperature of your average refrigerator, so storage and transportation is easy. But RNA vaccines need to be stored at much colder temperature—as low as -80 degrees C—which will make reaching certain parts of the world more difficult.

My hope is that the vaccine we have 18 months from now is as close to “perfect” as possible. Even if it isn’t, we will continue working to improve it. After that happens, I suspect the COVID-19 vaccine will become part of the routine newborn immunization schedule.

Once we have a vaccine, though, we still have huge problems to solve. That’s because…

We need to manufacture and distribute at least 7 billion doses of the vaccine.

In order to stop the pandemic, we need to make the vaccine available to almost every person on the planet. We’ve never delivered something to every corner of the world before. And, as I mentioned earlier, vaccines are particularly difficult to make and store.

There’s a lot we can’t figure out about manufacturing and distributing the vaccine until we know what exactly we’re working with. For example, will we be able to use existing vaccine factories to make the COVID-19 vaccine?

What we can do now is build different kinds of vaccine factories to prepare. Each vaccine type requires a different kind of factory. We need to be ready with facilities that can make each type, so that we can start manufacturing the final vaccine (or vaccines) as soon as we can. This will cost billions of dollars. Governments need to quickly find a mechanism for making the funding for this available. Our foundation is currently working with CEPI, the WHO, and governments to figure out the financing.

Part of those discussions center on who will get the vaccine when. The reality is that not everyone will be able to get the vaccine at the same time. It’ll take months—or even years—to create 7 billion doses (or possibly 14 billion, if it’s a multi-dose vaccine), and we should start distributing them as soon as the first batch is ready to go.

Most people agree that health workers should get the vaccine first. But who gets it next? Older people? Teachers? Workers in essential jobs?

I think that low-income countries should be some of the first to receive it, because people will be at a much higher risk of dying in those places. COVID-19 will spread much quicker in poor countries because measures like physical distancing are harder to enact. More people have poor underlying health that makes them more vulnerable to complications, and weak health systems will make it harder for them to receive the care they need. Getting the vaccine out in low-income countries could save millions of lives. The good news is we already have an organization with expertise about how to do this in Gavi, the Vaccine Alliance.

With most vaccines, manufacturers sign a deal with the country where their factories are located, so that country gets first crack at the vaccines. It’s unclear if that’s what will happen here. I hope we find a way to get it out on an equitable basis to the whole world. The WHO and national health authorities will need to develop a distribution plan once we have a better understanding of what we’re working with.

Eventually, though, we’re going to scale this thing up so that the vaccine is available to everyone. And then, we’ll be able to get back to normal—and to hopefully make decisions that prevent us from being in this situation ever again.

It might be a bit hard to see right now, but there is a light at the end of the tunnel. We’re doing the right things to get a vaccine as quickly as possible. In the meantime, I urge you to continue following the guidelines set by your local authorities. Our ability to get through this outbreak will depend on everyone doing their part to keep each other safe.

 

 

 

Contact tracing is the next big hurdle in the push to re-open cities

https://www.axios.com/contact-tracing-is-the-next-big-hurdle-in-the-push-to-re-open-cities-358eff5e-aaa6-448f-9273-c29e281de410.html

Contact tracing is the next big hurdle in the push to re-open ...

As some states take steps to partially re-open their economies, public health officials and local governments are trying to aggressively ramp up contact tracing to track the spread of COVID-19 in their communities.

Why it matters: If we are indeed in the midst of a war against an invisible enemy, a contact-tracing offensive — launched by both an army of human tracers and an arsenal of technological tools — will be a big part of the key to winning.

  • Identifying who has come in contact with people infected with the disease is critical to isolating the coronavirus while also allowing some semblance of daily life to resume.

Between the lines: State and city budgets are being hammered by the economic fallout of COVID-19, making it harder to find the resources to hire and train people to contact trace or acquire needed technologies.

  • Some governments are recruiting volunteers, retirees and students to do the work. But the sheer number of people needed — at least 100,000 across the U.S., per Johns Hopkins — and the open-ended duration of the work makes that a very daunting task.
  • “We haven’t seen a big push coming from the federal government in either traditional contact tracing or these technology-based approaches,” said Josh Michaud, associate director for Global Health Policy at the Kaiser Family Foundation. “That leaves most of the legwork and decision-making to the states and local authorities.”

State and county public health officials are ramping up tracing efforts now that testing availability is improving — since tracing only works with widespread testing.

  • Massachusetts Gov. Charlie Baker allotted $44 million to an ambitious contact tracing program, which is training 1,000 tracers to staff a virtual call center to track people who came in close contact with those who’ve tested positive for the virus, starting from 48 hours before the symptoms emerged, per the Boston Globe.
  • Texas’ Harris County — the nation’s third-most populous county with 4.7 million people, including the city of Houston — this week approved the hire of 300 contact tracers.

For every case, we have an average of about 20 people to contact. … So if you have 100 cases, you’ve got 2,000 contacts you’ve got to handle for that day because you know the next day you’ll have maybe another 100–150 cases.”

— Umair Shah, executive director of Harris County Public Health

What’s happening: Other countries are relying on tech to varying degrees to augment contact tracing.

  • In March, Singapore launched TraceTogether, an app that uses Bluetooth signals to help users learn whether they’ve been in contact with someone who tests positive. More than 1 million people have downloaded it, and Singapore has made it available to other countries.
  • Australia said more than a million people downloaded its Bluetooth contact tracing app, based on Singapore’s version, within hours of the government making it available.
  • South Korea used phone GPS records, credit card transactions and closed-circuit television to augment patient interviews for its contact tracing effort.
  • Iceland claims a 93% success rate of voluntary contact tracing through a smartphone app.

In the U.S., the most likely scenario for widespread, tech-enabled contact tracing lies with work done by Google and Apple.

  • The two companies are sharing an early version of what they’re calling COVID-19 exposure notification technology with certain developers working with public health authorities. Apple and Google want to release the first phase of the project, which will enable users to opt-in to Bluetooth-based contact tracing, by mid-May.
  • MIT researchers, who launched a project to perform private automated contact tracing, are using their expertise with radar to help figure out how Bluetooth can show the distance between users.
  • Marc Zissman, associate head of the Cyber Security and Information Sciences Division at MIT’s Lincoln Laboratory, said Google and Apple’s effort appears to be incorporating the privacy principles researchers have called for, including sending randomized data that is not personally identifiable.
  • “Our best guess is that when Google and Apple release this, this is going to be what it is,” Zissman said. “There was Betamax and VHS. Everybody was using Betamax. And then every company but Sony went with VHS, and that was it. And then Betamax just stopped being used. That’s kind of like what’s going to happen here I think in the United States.”

The success of the effort will depend on widespread adoption of the technology so people will be notified when they come in contact with someone who tests positive.

What to watch: Zissman said MIT researchers will reverse engineer the Google/Apple programs to ensure they are following the privacy protocols, and also expect pilot testing in limited settings like hospitals or universities before states begin implementing.

  • It may also take a public service campaign featuring trusted voices to encourage Americans to opt in.
  • “There’s a lot of doubts, one, that people’s privacy concerns can be addressed sufficiently and, two, that enough people would download the app to make it helpful and actually provide the service it’s supposed to provide,” Michaud said.

 

 

 

Iowa tells workers to return to their jobs or lose unemployment benefits, despite warnings that reopening could lead to a 2nd wave of infections

https://www.businessinsider.com/iowa-tells-workers-return-to-work-or-lose-unemployment-benefits-2020-4?fbclid=IwAR3OghoKRKsPt9JVz4TIsn_Qv5im_ZPaCmzPenmsEFgJR80YXbFJ2QWrxpE

Iowa tells workers to return to work or lose unemployment benefits ...

  • Iowa is preparing to partially reopen 77 counties on Friday.
  • The state said furloughed employees who refuse to return to work that they would lose their unemployment benefits — and Gov. Kim Reynolds said it could disqualify them from future unemployment benefits.
  • However, a group of experts advised the governor last week not to loosen restrictions and said the state has not reached its peak of infections and deaths.

As Iowa prepares to partially reopen on Friday, the state has told furloughed workers that they will lose their unemployment benefits if they refuse to return to work.

The Des Moines Register reported that businesses like restaurants, bars, retail stores, and fitness centers would be allowed to reopen at half capacity starting on May 1. Gov. Kim Reynolds said the 77 reopening counties either have no cases or are on a downward trend.

Iowa Workforce Development, a state agency that provides employment services for individual workers, said an employee’s refusal return to work out of fear would be considered a “voluntary quit” — which would mean they could no longer receive unemployment benefits. The announcement applies to workers across the state.

Ryan West, the deputy director of Iowa Workforce Development, told Radio Iowa that there were some exceptions, such as workers diagnosed with COVID-19.

The Iowa Workforce Development website prompts employers to fill out what it calls a Job Offer Decline Form for employees who refuse to return to work. The governor has said that opting not to go back to work could disqualify employees from future unemployment benefits.

Business Insider’s Andy Kiersz reported that 232,913 Iowans filed for unemployment between March 15 and April 18, which is 13.5% of the state’s labor force.

Last week, seven epidemiology and biostatistics professors from the University of Iowa advised the governor not to loosen social-distancing restrictions, KWWL reported. They wrote a research paper for the governor after they were commissioned by the Iowa Department of Public Health.

“We observe a huge range of possible outcomes, from relatively low fatalities to catastrophic loss of life,” the paper said.

The scientists said there was still “considerable uncertainty” over how many deaths the state may eventually have; the projections range from 150 to over 10,000 deaths.

“We have found evidence of a slowdown in infection and mortality rates due to social distancing policies, but not that a peak has been reached,” the paper said. The professors said that did not mean measures should be eased: “Therefore, prevention measures should remain in place. Without such measures being continued, a second wave of infections is likely.”

 

 

 

We Work on the Front Lines of COVID-19. Here’s What Hospitals Should Do

https://www.medpagetoday.com/infectiousdisease/covid19/86185?xid=fb_o&trw=no&fbclid=IwAR3iM5LMZj3BxWisk3puZ2T3bOCeBaDS_xCRoTrnVaZYfj4-DZPmUfr01cw

We Work on the Front Lines of COVID-19. Here's What Hospitals ...

A game plan from ground zero.

It’s only a matter of time before all of us are directly affected by COVID-19. Proper preparation is the only way to ensure high-quality patient care and staff well-being in this challenging time. Having collectively spent time caring for patients at two different tertiary care facilities in New York on the medical floors and intensive care units, common themes are emerging that represent opportunities for hospitals in other parts of the country to start taking action before COVID-19 patients start filling up beds en masse.

Staffing

It takes a LOT of people to care for a COVID-19 onslaught; mapping out different staffing scenarios in the event you have 40 or 400 COVID patients is imperative. Staffing needs for COVID patients are higher than normal because of the patients’ complex medical needs — many require ICU level nursing and respiratory therapists — and because both clinical and non-clinical staff will inevitably become sick and need to be taken out of work. Staff should be screened for symptoms and high-risk contacts; those who are symptomatic should be proactively encouraged to stay home instead of showing up to work not feeling well and putting other care team members and patients at risk. This requires back-up staffing plans to fill in when your people become sick. Shutting down non-urgent and elective departments provides staffing redundancy to pull from when needed. All employees should be given advance notice about staffing plans so that potential role changes are clear.

Testing

Robust testing processes for both patients and your healthcare workforce are critical for success. Hospitals should be taking this time to obtain in-house rapid testing kits to avoid unnecessary patient isolation and conserve personal protective equipment (PPE) while waiting for test results.

Healthcare workers are understandably scared about contracting COVID-19 themselves and giving it to their family members. We recommend all staff members be tested for active infection so that those who are infected can be proactively quarantined.

Forward-thinking institutions should be prioritizing antibody testing for healthcare workers. While this testing is still in its infancy, it is quite likely that those with strong antibodies to COVID-19 possess some degree of immunity. Therefore, if you can identify which doctors, nurses, respiratory therapists, physical therapists, and janitorial staff have already developed an immune response to COVID-19, these staff members can take priority staffing infected units with the goal of reducing the number of new infections in healthcare workers and limiting exposure to those who have yet to contract the virus.

Communication

Each institution’s COVID-19 protocols and policies change rapidly as we learn more about the virus. How you communicate these ever-changing procedures with staff is critical. Most hospitals rely on daily email updates that are text-heavy; however, overwhelmed inboxes and less time with devices while wearing PPE limits the success of email as a sole communication channel.

Communication through graphics takes on new importance — signage noting changes in hospital geography, large pictures of donning and doffing instructions, phone numbers to call with equipment shortages, and clear instructions to staff about testing protocols, isolation, and removing patients from isolation need to be conveniently placed where staff can access information in real time without consulting their electronic devices. High-yield locations for just-in-time visual communication include outside patient rooms, nursing stations, break rooms, and elevators, so that the target information reaches its busy, hard-working audience successfully and repeatedly, minimizing confusion and augmenting clarity.

Limiting the Need to Enter the Room

Given ongoing PPE shortages, particularly around single-use gowns and N95 masks, minimizing the number of instances that staff, particularly nurses, need to enter the room is critical. This requires an adjustment from normal patient care. We recommend extension tubing to bring IV poles and medications outside the room. Tablets such as iPads can permit video calls with patients to check on non-urgent items. Centralized monitoring of oxygen saturations for all admitted patients can minimize the frequency of supplemental oxygen adjustment.

Similarly, given the increased risk of COVID-19 in diabetic patients, continuous blood glucose monitoring can minimize the need for frequent manual fingerstick measurements for patients receiving supplemental insulin.

Discharge Planning

Discharging patients to home or rehabilitation facilities presents novel challenges. A home discharge requires education, equipment, and follow-up. Education on home monitoring of vitals signs like oxygen saturation and blood pressure with instructions on critical values that should prompt patients to return to the hospital can expedite discharge and open hospital beds for other sick patients. Both patients and family members must also be educated on quarantine procedures to limit household transmission.

Many patients will have temporary oxygen requirements and we have seen home oxygen shortages in our areas. Coordinating a strategy with your outpatient clinicians, home oxygen suppliers, and insurance companies can facilitate getting patients home sooner on home oxygen and freeing up beds for sicker patients. Further, many patients are eager to go home earlier since hospital visitation limitations mean they’re sitting in bed alone away from family and the more a hospital can do to safely discharge patients home with appropriate supplies and follow-up will be beneficial to both patients and the hospital.

Hospitals must also be prepared to integrate these patients into their existing telehealth infrastructure, which has become the mainstay of ambulatory medicine in lieu of traditional office visits. For many patients, this will be a new way of accessing care. Prior to discharge, hospital staff should ensure patients have downloaded the necessary apps with login information and feel comfortable they will be able to follow up with their physician using technology following discharge.

There is a huge opportunity for hospitals that have not been caring for large numbers of COVID-19 patients to prepare ahead of time in a manner that optimizes patient care and minimizes risks to staff. Those of us on the early front lines have learned many of these lessons the hard way. An ounce of prevention is worth a pound of cure — we encourage all healthcare systems to take action before the storm comes.

 

 

 

 

U.S. Coronavirus Cases Passes 1 Million–A Third Of All Cases Globally

https://www.forbes.com/sites/mattperez/2020/04/28/us-coronavirus-cases-passes-1-million–a-third-of-all-cases-globally/?utm_source=newsletter&utm_medium=email&utm_campaign=dailydozen&cdlcid=5d2c97df953109375e4d8b68#5526ebe370a5

U.S. Coronavirus Cases Passes 1 Million--A Third Of All Cases Globally

TOPLINE

Confirmed cases of the COVID-19 coronavirus passed 1 million in the United States Tuesday, making up a third of all global cases, according to data compiled by Johns Hopkins University.

KEY FACTS

Of the 1,002,498 Americans who have been confirmed to have contracted the disease, 57,266 have died while 112,315 have recovered.

The new milestone comes as some states announce plans for reopening, something President Trump has been adamantly pushing for as 26 million Americans lose their jobs during the pandemic.

New York, the epicenter of the outbreak with 295,106 cases, saw its hospital admittance number drop below 1,000 for the first time in a month on Monday, with Governor Andrew Cuomo detailing a plan to start easing stay-at-home restrictions in parts of the state starting as early as May 15.

Georgia Governor Brian Kemp, however, with the state’s 24,604 cases, has drawn criticism from health officials and even Trump for allowing businesses like restaurants, hair salons and gyms to reopen before seeing a sustained reduction in cases.

Around 5.6 million people, or about 1.7% of the population, have been tested for the coronavirus, but researchers at Harvard Global Health Institute report that the country will need to perform 3.5 million tests per week at minimum before reopening.

Dr. Anthony Fauci, the country’s top infectious disease doctor, warned Tuesday during an interview that “it’s inevitable that we will have a return of the virus,” and that states reopening prematurely could cause “a rebound to get us right back in the same boat that we were in a few weeks ago.”

BIG NUMBER

87%. That’s how many Americans support current social distancing restrictions, or even want stronger measures in place, according to an Associated Press-NORC Center for Public Affairs Research survey conducted from April 16-20.

KEY BACKGROUND

The U.S. reached 500,000 cases on April 10 and 100,000 on March 27. The model prefered by the federal government increased the projected death count from the coronavirus for the second time in a week on Tuesday, now projecting 74,000 total deaths from the virus.

TANGENT

Germany has been a leader in mitigating the spread of the coronavirus, but after easing some lockdown restrictions this past week, the country saw an uptick in infection rate.