The next phase of America’s coronavirus failure

https://www.axios.com/newsletters/axios-vitals-7038a5b1-74fa-44e3-ba7e-43c87052e1c5.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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.

 

 

 

 

The good and bad news about asymptomatic coronavirus cases

https://www.axios.com/asymptomatic-carrier-coronavirus-fauci-b7ccb7e4-b972-412e-b461-0e07f0689cb7.html

The good news and bad news about asymptomatic coronavirus cases ...

We don’t yet know what proportion of people infected with the coronavirus are asymptomatic, but it’s becoming clear that there’s a large number of them.

Why it matters: The more people that have been asymptomatic carriers of the coronavirus, the lower its fatality rate. But asymptomatic carriers also present unique problems for stopping the virus’s spread, as they likely don’t know they have it.

The big picture: Until we can do widespread, reliable antibody testing to determine how many people have had the virus, the best data we have to go off of are one-off studies — which have suggested widely varying rates of asymptomatic carriers.

  • A study earlier this month found that 13.9% of 3,000 New Yorkers tested had signs of the coronavirus, suggesting that about 10 times the number of people who have officially tested positive have had it, per Bloomberg. That means a lot of people either couldn’t get tested, or never knew anything was wrong.
  • Around half of the soldiers on the Theodore Roosevelt aircraft carrier who tested positive for the coronavirus were asymptomatic, per the LA Times. Another study found that about 18% of positive cases on the Diamond Princess cruise ship were asymptomatic.
  • “We don’t know the definitive answer, but it probably is a substantial proportion,” infectious disease expert Anthony Fauci told me. “That is a non-scientifically based estimate, based on these dribs and drabs of information that we get.”

Between the lines: If asymptomatic cases are common, that mathematically increases the likelihood (age and pre-existing conditions aside) that you or I could catch the virus and be completely fine.

  • It also means that a lower percentage of people who get the coronavirus will need hospitalization, which is good news for the health care system.
  • In the darkest of plausible scenarios, where we fail to contain the virus and it spreads relatively unencumbered throughout the U.S., a high asymptomatic rate would translate into a lower death rate — a small comfort.

Yes, but: It also is hugely problematic for efforts to keep the coronavirus from spreading.

  • It could then spread undetected, and if there’s already a high number of asymptomatic cases, that means the virus may be more widespread than we thought.
  • It also makes the virus hard to track. “If you have so many asymptomatic people around, it’s going to be much more difficult to get your arms around contact tracing, because you’re going to have so many people who get exposed to someone who is asymptomatic,” Fauci said. That puts extra emphasis on the need to do surveillance testing even among healthy-seeming populations, particularly in places like prisons and nursing homes.

The bottom line: A low number of asymptomatic cases would mean the virus is deadlier than we’d like it to be, while a high number of such cases means it most likely has been more widely transmitted. The uncertainty around that complicates how to manage its spread.

 

 

 

 

U.S. Coronavirus Updates

https://www.axios.com/coronavirus-west-virginia-first-case-ac32ce6d-5523-4310-a219-7d1d1dcb6b44.html

COVID-19 in the U.S.

As of May 3, 11pm EDT

Deaths     Confirmed cases

67,682         1,158,040

Kudlow defends claiming U.S. had coronavirus "contained" in ...

 

Former FDA commissioner Scott Gottlieb said on Sunday that despite widespread mitigation efforts, the coronavirus has exhibited “persistent spread” that could mean a “new normal” of 30,000 new cases and over 1,000 deaths a day through the summer.

The big picture: COVID-19 has killed over 66,000 Americans and infected over 1.1 million others in less than three months since the first known death in the U.S., Johns Hopkins data shows.

By the numbers: As states try to mitigate the spread of the coronavirus while easing restrictions, unemployment filings in the U.S. topped 30 million in six weeks, and the number of unemployed could be higher than the weekly figures suggest.

  • Over 175,000 Americans have recovered from the virus and over 6.8 million tests have been conducted in the U.S. as of Sunday.

Catch up quick: The number of deaths in states hit hardest by the coronavirus is well above the normal range, according the CDC.

Lockdown measures: Dozens of states have outlined plans to ease coronavirus restrictions, but the pandemic’s impact on our daily lives, politics, cities and health care will outlast stay-at-home orders.

 

Reopening is a risk for Republican governors

https://www.axios.com/coronavirus-reopening-republican-governors-cases-deaths-c0233fd4-8f92-448e-a11c-ec5bded1def1.html

Coronavirus reopening is a risk for Republican governors - Axios

Republican governors run a big risk — both to public health and their own political fortunes — if they open up their economies too soon, without adequate safeguards.

The big picture: The hardest-hit areas so far have mostly been in states with Democratic governors. But the number of coronavirus cases is now increasing more quickly in states with Republican governors.

By the numbers: Coronavirus cases and deaths are both higher in Democratic states than in Republican ones, even after adjusting for population.

  • However, over the last two weeks, reported infections have increased 91% in red states versus 63% in blue states.
  • We see the same pattern for COVID-19 deaths: 170% growth in red states vs. 104% in blue states.

Driving the news: Texas has begun easing its lockdown measures, and other red states are also moving quickly. Florida has reopened some beaches, and some southern states in particular never locked down as tightly as the Northeast and West coast.

  • Yes. but: Every governor wants to open up when they can to get the economy going, and there are some Democratic governors who are also taking steps to ease distancing measures.

Between the lines: The core of the Republican base in white, rural areas is at risk.

  • 20% of people living in non-metro areas are older than 65, compared with 15% in metro areas.
  • And rural residents under 65 are more likely to have pre-existing health conditions (26%), compared to their urban counterparts (20%).

The bottom line: Polls show that Republicans are far more likely than Democrats to think that the worst is behind us when it comes to COVID-19.

  • That may be partly because they, and the Republican governors, think this is largely someone else’s problem. It isn’t.

 

 

 

 

U.S. coronavirus caseload has held steady

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The number of new coronavirus cases in the U.S. has held steady ...

The number of new coronavirus cases nationally hovered around 30,000 a day during the entire month of April, meaning that the virus has managed to spread in spite of stringent social distancing measures.

Why it matters: Many states have already started to lift these measures, which will enable the virus to spread even faster.

Between the lines: Many Americans — like health care workers, grocery workers and emergency personnel — haven’t been able to stay home, as their jobs are considered essential. That’s enabled the virus to spread among these populations.

  • It has also been able to spread among people who live close together, like nursing home residents.

The big picture: The fewer people who have the virus once society reopens, the easier it will be to control. That’s part of why we shut down — the caseload had already outgrown our public health infrastructure’s ability to respond to it.

  • We’ve built up our testing capacity over the last several weeks and are starting to do the same with contact tracing, but these tools can only do so much against exponential spread — even when fully developed, which they’re not yet.
  • Even if we’re able to keep the caseload at current levels, that’s still an enormously challenging reality to live with.

What they’re saying: “Continuing spread at something near current levels may become the cruel ‘new normal.’ Hospitals and public-health systems will have to contend with persistent disease and death,” former FDA commissioner Scott Gottlieb wrote in a Wall Street Journal op-ed yesterday.

The bottom line: April was tough, but as states begin to reopen, we don’t yet know what lies ahead of us.

  • Things could get worse, or today’s status quo could be in place for a long time.
  • What happens will look different from one community to another.

 

 

 

How Long Will a Vaccine Really Take?

Health - Digg

A vaccine would be the ultimate weapon against the coronavirus and the best route back to normal life. Officials like Dr. Anthony S. Fauci, the top infectious disease expert on the Trump administration’s coronavirus task force, estimate a vaccine could arrive in at least 12 to 18 months.

The grim truth behind this rosy forecast is that a vaccine probably won’t arrive any time soon. Clinical trials almost never succeed. We’ve never released a coronavirus vaccine for humans before. Our record for developing an entirely new vaccine is at least four years — more time than the public or the economy can tolerate social-distancing orders.

But if there was any time to fast-track a vaccine, it is now. So Times Opinion asked vaccine experts how we could condense the timeline and get a vaccine in the next few months instead of years.

Here’s how we might achieve the impossible.

Normally, researchers need years to secure funding, get approvals and study results piece by piece. But these are not normal times.

There are already at least 254 therapies and 95 vaccines related to Covid-19 being explored.

“If you want to make that 18-month timeframe, one way to do that is put as many horses in the race as you can,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

Despite the unprecedented push for a vaccine, researchers caution that less than 10 percent of drugs that enter clinical trials are ever approved by the Food and Drug Administration.

The rest fail in one way or another: They are not effective, don’t perform better than existing drugs or have too many side effects.

Fortunately, we already have a head start on the first phase of vaccine development: research. The outbreaks of SARS and MERS, which are also caused by coronaviruses, spurred lots of research. SARS and SARS-CoV-2, the virus that causes Covid-19, are roughly 80 percent identical, and both use so-called spike proteins to grab onto a specific receptor found on cells in human lungs. This helps explain how scientists developed a test for Covid-19 so quickly.

There’s a cost to moving so quickly, however. The potential Covid-19 vaccines now in the pipeline might be more likely to fail because of the swift march through the research phase, said Robert van Exan, a cell biologist who has worked in the vaccine industry for decades. He predicts we won’t see a vaccine approved until at least 2021 or 2022, and even then, “this is very optimistic and of relatively low probability.”

And yet, he said, this kind of fast-tracking is “worth the try — maybe we will get lucky.”

The next step in the process is pre-clinical and preparation work, where a pilot factory is readied to produce enough vaccine for trials. Researchers relying on groundwork from the SARS and MERS outbreaks could theoretically move through planning steps swiftly.

Sanofi, a French biopharmaceutical company, expects to begin clinical trials late this year for a Covid-19 vaccine that it repurposed from work on a SARS vaccine. If successful, the vaccine could be ready by late 2021.

As a rule, researchers don’t begin jabbing people with experimental vaccines until after rigorous safety checks.

They test the vaccine first on small batches of people — a few dozen during Phase 1, then a few hundred in Phase 2, then thousands in Phase 3. Months normally pass between phases so that researchers can review the findings and get approvals for subsequent phases.

But “if we do it the conventional way, there’s no way we’re going to be reaching that timeline of 18 months,” said Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine and an investigator at the Howard Hughes Medical Institute.

There are ways to slash time off this process by combining several phases and testing vaccines on more people without as much waiting.

Last week the National Academy of Sciences showed an overlapping timeline, describing it as moving at “pandemic speed.”

It’s here that talk of fast-tracking the timeline meets the messiness of real life: What if a promising vaccine actually makes it easier to catch the virus, or makes the disease worse after someone’s infected?

That’s been the case for a few H.I.V. drugs and vaccines for dengue fever, because of a process called vaccine-induced enhancement, in which the body reacts unexpectedly and makes the disease more dangerous.

Researchers can’t easily infect vaccinated participants with the coronavirus to see how the body behaves. They normally wait until some volunteers contract the virus naturally. That means dosing people in regions hit hardest by the virus, like New York, or vaccinating family members of an infected person to see if they get the virus next. If the pandemic subsides, this step could be slowed.

“That’s why vaccines take such a long time,” said Dr. Iwasaki. “But we’re making everything very short. Hopefully we can evaluate these risks as they occur, as soon as possible.”

This is where the vaccine timelines start to diverge depending on who you are, and where some people might get left behind.

If a vaccine proves successful in early trials, regulators could issue an emergency-use provision so that doctors, nurses and other essential workers could get vaccinated right away — even before the end of the year. Researchers at Oxford announced this week that their coronavirus vaccine could be ready for emergency use by September if trials prove successful.

So researchers might produce a viable vaccine in just 12 to 18 months, but that doesn’t mean you’re going to get it. Millions of people could be in line before you. And that’s only if the United States finds a vaccine first. If another country, like China, beats us to it, we could wait even longer while it doses its citizens first.

You might be glad of that, though, if it turned out that the fast-tracked vaccine caused unexpected problems. Only after hundreds or thousands are vaccinated would researchers be able to see if a fast-tracked vaccine led to problems like vaccine-induced enhancement.

“It’s true that any new technology comes with a learning curve,” said Dr. Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “And sometimes that learning curve has a human price.”

Once we have a working vaccine in hand, companies will need to start producing millions — perhaps billions — of doses, in addition to the millions of vaccine doses that are already made each year for mumps, measles and other illnesses. It’s an undertaking almost unimaginable in scope.

Companies normally build new facilities perfectly tailored to any given vaccine because each vaccine requires different equipment. Some flu vaccines are produced using chicken eggs, using large facilities where a version of the virus is incubated and harvested. Other vaccines require vats in which a virus is cultured in a broth of animal cells and later inactivated and purified.

Those factories follow strict guidelines governing biological facilities and usually take around five years to build, costing at least three times more than conventional pharmaceutical factories. Manufacturers may be able to speed this up by creating or repurposing existing facilities in the middle of clinical trials, long before the vaccine in question receives F.D.A. approval.

“They just can’t wait,” said Dr. Iwasaki. “If it turns out to be a terrible vaccine, they won’t distribute it. But at least they’ll have the capability” to do so if the vaccine is successful.

The Bill and Melinda Gates Foundation says it will build factories for seven different vaccines. “Even though we’ll end up picking at most two of them, we’re going to fund factories for all seven, just so that we don’t waste time,” Bill Gates said during an appearance on “The Daily Show.”

In the end, the United States will have the capacity to mass-produce only two or three vaccines, said Vijay Samant, the former head of vaccine manufacturing at Merck.

“The manufacturing task is insurmountable,” Mr. Samant said. “I get sleepless nights thinking about it.”

Consider just one seemingly simple step: putting the vaccine into vials. Manufacturers need to procure billions of vials, and billions of stoppers to seal them. Sophisticated machines are needed to fill them precisely, and each vial is inspected on a high-speed line. Then vials are stored, shipped and released to the public using a chain of temperature-controlled facilities and trucks. At each of these stages, producers are already stretched to meet existing demands, Mr. Samant said.

It’s a bottleneck similar to the one that caused a dearth of ventilators, masks and other personal protective equipment just as Covid-19 surged across America.

If you talk about vaccines long enough, a new type of vaccine, called Messenger RNA (or mRNA for short), inevitably comes up. There are hopes it could be manufactured at a record clip. Mr. Gates even included it on his Time magazine list of six innovations that could change the world. Is it the miracle we’re waiting for?

Rather than injecting subjects with disease-specific antigens to stimulate antibody production, mRNA vaccines give the body instructions to create those antigens itself. Because mRNA vaccines don’t need to be cultured in large quantities and then purified, they are much faster to produce. They could change the course of the fight against Covid-19.

“On the other hand,” said Dr. van Exan, “no one has ever made an RNA vaccine for humans.”

Researchers conducting dozens of trials hope to change that, including one by the pharmaceutical company Moderna. Backed by investor capital and spurred by federal funding of up to $483 million to tackle Covid-19, Moderna has already fast-tracked an mRNA vaccine. It’s entering Phase 1 trials this year and the company says it could have a vaccine ready for front-line workers later this year.

“Could it work? Yeah, it could work,” said Dr. Fred Ledley, a professor of natural biology and applied sciences at Bentley University. “But in terms of the probability of success, what our data says is that there’s a lower chance of approval and the trials take longer.”

The technology is decades old, yet mRNA is not very stable and can break down inside the body.

“At this point, I’m hoping for anything to work,” said Dr. Iwasaki. “If it does work, wonderful, that’s great. We just don’t know.”

The fixation on mRNA shows the allure of new and untested treatments during a medical crisis. Faced with the unsatisfying reality that our standard arsenal takes years to progress, the mRNA vaccine offers an enticing story mixed with hope and a hint of mystery. But it’s riskier than other established approaches.

Imagine that the fateful day arrives. Scientists have created a successful vaccine. They’ve manufactured huge quantities of it. People are dying. The economy is crumbling. It’s time to start injecting people.

But first, the federal government wants to take a peek.

That might seem like a bureaucratic nightmare, a rubber stamp that could cost lives. There’s even a common gripe among researchers: For every scientist employed by the F.D.A., there are three lawyers. And all they care about is liability.

Yet F.D.A. approvals are no mere formality. Approvals typically take a full year, during which time scientists and advisory committees review the studies to make sure that the vaccine is as safe and effective as drug makers say it is.

While some steps in the vaccine timeline can be fast-tracked or skipped entirely, approvals aren’t one of them. There are horror stories from the past where vaccines were not properly tested. In the 1950s, for example, a poorly produced batch of a polio vaccine was approved in a few hours. It contained a version of the virus that wasn’t quite dead, so patients who got it actually contracted polio. Several children died.

The same scenario playing out today could be devastating for Covid-19, with the anti-vaccination movement and online conspiracy theorists eager to disrupt the public health response. So while the F.D.A. might do this as fast as possible, expect months to pass before any vaccine gets a green light for mass public use.

At this point you might be asking: Why are all these research teams announcing such optimistic forecasts when so many experts are skeptical about even an 18-month timeline? Perhaps because it’s not just the public listening — it’s investors, too.

“These biotechs are putting out all these press announcements,” said Dr. Hotez. “You just need to recognize they’re writing this for their shareholders, not for the purposes of public health.”

What if It Takes Even Longer Than the Pessimists Predict?

Covid-19 lives in the shadow of the most vexing virus we’ve ever faced: H.I.V. After nearly 40 years of work, here is what we have to show for our vaccine efforts: a few Phase 3 clinical trials, one of which actually made the disease worse, and another with a success rate of just 30 percent.

Researchers say they don’t expect a successful H.I.V. vaccine until 2030 or later, putting the timeline at around 50 years.

That’s unlikely to be the case for Covid-19, because, as opposed to H.I.V., it doesn’t appear to mutate significantly and exists within a family of familiar respiratory viruses. Even still, any delay will be difficult to bear.

But the history of H.I.V. offers a glimmer of hope for how life could continue even without a vaccine. Researchers developed a litany of antiviral drugs that lowered the death rate and improved health outcomes for people living with AIDS. Today’s drugs can lower the viral load in an H.I.V.-positive person so the virus can’t be transmitted through sex.

Therapeutic drugs, rather than vaccines, might likewise change the fight against Covid-19. The World Health Organization began a global search for drugs to treat Covid-19 patients in March. If successful, those drugs could lower the number of hospital admissions and help people recover faster from home while narrowing the infection window so fewer people catch the virus.

Combine that with rigorous testing and contact tracing — where infected patients are identified and their recent contacts notified and quarantined — and the future starts looking a little brighter. So far, the United States is conducting fewer than half the number of tests required and we need to recruit more than 300,000 contact-tracers. But other countries have started reopening following exactly these steps.

If all those things come together, life might return to normal long before a vaccine is ready to shoot into your arm.

 

 

 

 

 

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

Slavery 21st Century

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.

 

 

 

 

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.

 

 

 

US surpasses 1 million COVID-19 cases

https://thehill.com/policy/healthcare/494792-us-surpasses-1-million-covid-19-cases

Did the Trump Administration Overpromise 1 Million COVID-19 ...

More than a million people in the United States have tested positive for the coronavirus, a sobering milestone that experts say represents only the beginning of a months-long battle to end the pandemic.

The United States has now registered about a third of all confirmed cases of COVID-19 around the globe, according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University. More than 57,000 people have died in the United States, about a quarter of the known COVID-19 deaths around the globe.

The United States has now registered more confirmed cases than the next five countries suffering the largest outbreaks — Spain, Italy, France, Germany and the United Kingdom — combined.

Those numbers are partly a reflection of population, but there are troubling signs for the United States.

While those countries have reduced the pace of transmission and the growth in the number of new cases they are seeing on a daily basis, the United States has not similarly bent the curve.

Instead, it is stuck at a deadly plateau: In the last week, the U.S. has reported between 24,000 and 41,000 new cases a day, and between 1,200 and 2,600 deaths per day, according to The Covid Tracking Project, a group of researchers who keep tallies of case counts around the country.

Even as some states begin to relax orders that closed retail and service stores, experts warned the country is still at risk of a new rush of cases, and that the downslope of declining case counts will be much longer than the sudden surge the United States saw in April.

“We’re in the opening stages of this,” said Michael Osterholm, director of the Center for Infectious Disease Research and Prevention at the University of Minnesota. States “are not in the mountains, they’re in the foothills. The mountains are still to come.”

More than a quarter million residents of New York have tested positive for the virus, and commuter suburbs in New Jersey and Connecticut have reported tens of thousands of cases. More than 50,000 residents of Massachusetts have tested positive, and California, Illinois and Pennsylvania have all confirmed more than 40,000 cases.

There are growing signs that the virus is shifting into new, more rural territory. States like Arkansas, Kansas, Minnesota, Nebraska, New Mexico, Rhode Island, Tennessee and Virginia all recorded substantial growth in the number of new cases they had confirmed in the last few days.

That pattern of viral spread beginning in large urban cores and eventually making its way to rural areas is typical, experts said, given societal connections between urban areas, suburbs and more rural areas.

“Epidemiologists know that this pattern is a very expectable one, that rural areas are going to have lagged waves of cases. So we’ve been bracing for that,” said Nita Bharti, a biologist at the Center for Infectious Disease Dynamics at Penn State University. “What they’re experiencing now is what cities have been seeing. It’s the same, it’s just delayed, and we knew it would happen.”

About six months after the coronavirus outbreak was detected in Wuhan, China, and four months after the first case arrived on American shores, the United States still lags the world in testing capacity. States have bolstered their capacity in recent days, conducting more than 225,000 tests per day over four of the last five days, the capacity needed to ensure the virus can be brought under control lags substantially.

An analysis by Harvard researchers for the scientific publication STAT found more than half of states would have to significantly bolster their testing capacity in order to safely begin easing stay-at-home orders in May. The hardest-hit state, New York, will have to be able to test at least 100,000 more people every day than it is currently able to; New Jersey’s capacity would need to increase by 68,000 a day.

Smaller states and those that have yet to experience thousands of new cases — places like Mississippi, Idaho, Montana, Wyoming, Arizona and New Mexico — already have the testing capacity they need to identify and squelch any new viral hotspots. Even Washington state, the first state to confirm a positive case, has built its capacity to meet demand.

Public health experts say a robust testing program must be supplemented by armies of contact tracers who can track down those who are at risk of contracting the virus.

Already, Massachusetts has partnered with the nonprofit Partners In Health to deploy about 1,000 contact tracers across the state. Alaska has managed to trace the contacts of each of its 341 positive cases. New York City Mayor Bill de Blasio said Monday that the city would hire 1,000 contact tracers of its own, and former Mayor Mike Bloomberg has pledged $10 million to kick start a contact tracing program in the tri-state area.

On Monday, a bipartisan group of top public health experts led by President Trump‘s former FDA commissioner Scott Gottlieb and President Obama’s former Centers for Medicare and Medicaid Services administrator Andy Slavitt called on Congress to spend $46 billion to expand contact tracing capacity, including $12 billion to hire 180,000 new workers.

It is unclear how the outbreak in the United States compares with outbreaks in authoritarian countries like China, Russia and Iran, which do not report reliable numbers.

But even in the United States, where state and local governments are transparent about the data they collect, the actual number of cases and deaths are higher — likely significantly so. Early antibody tests in places like New York City and Miami show a significant number of people contract the virus without showing symptoms, and as studies show people who died inexplicably over the last several months tested positive for the virus.