Coronavirus Tidbits #58 6/16/20

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

News: 

Terrifying: Trump: If COVID-19 testing stops — the US won’t have coronavirus cases anymore

https://www.rawstory.com/2020/06/trump-if-covid-19-testing-stops-the-us-wont-have-coronavirus-cases-anymore/

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27 state and local health officials across 13 states have resigned, retired or been fired since April

—a result of increasing pressure to reopen states. This politicization of #publichealth is a danger to our nation's people.

The abuse ranges from antisemitic comments and harassing them at their homes to death threats.

Many of these officials are women.

https://www.startribune.com/public-health-workers-fighting-virus-face-growing-threats/571211822/

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Arizona is the new national hotspot for COVID-19 with more than 4,400 new cases in just the last 72 hours. Per capita, Arizona’s infection rate is now more than three times higher than New York state. It’s spreading like wildfire.

But Gov. Ducey does not require masks and has allowed bars and other places to reopen.

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22 states have had daily increases in COVID cases over the last 2 weeks (since Memorial Day)

with at least 12 reaching their highest numbers yet since pandemic started. Really concerning.

Arizona, Alabama, and Florida are esp worrisome

Diagnostics:

still an incredible, negligent lack of testing.

Drugs:

The FDA has revoked its emergency use authorization for chloroquine and hydroxychloroquine as a coronavirus treatment - saying "it is no longer reasonable" to believe they may be effective for this purpose and that known and potential risks outweigh known and potential benefits.

Here's the FDA's FAQ page on its revocation of the hydroxychloroquine emergency authorization (fda.gov/media/138946/d), and here's a longer letter about the decision (fda.gov/media/138945/d).

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RECOVERY Trial: Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19

A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).

Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.

Overall dexamethasone reduced the 28-day mortality rate by 17% (0.83 [0.74 to 0.92]; P=0.0007) with a highly significant trend showing greatest benefit among those patients requiring ventilation (test for trend p<0.001). But it is important to recognise that we found no evidence of benefit for patients who did not require oxygen and we did not study patients outside the hospital setting.

https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19

NOTE: this is a press release, not a journal paper. At least they gave more detailed results than most

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Ushering an antibody cocktail, designed to reduce antibody resistance, to trial as COVID-19 therapy

AAAS 15-JUN-2020

Following two studies that screened thousands of human antibodies to SARS-CoV-2 to identify highly potent pairs, in which both antibodies bind the viral target simultaneously, a resultant antibody cocktail is being tested in human trials. The double-antibody approach, versus use of a single antibody, is designed not only to be effective as a treatment, the authors say, but to protect against antibody resistance that might arise in response to selective pressure from single antibody therapies, which are also being explored to treat COVID-19.

The authors of both studies say their data strongly supports use of double ("cocktail") antibody therapy in which two antibodies were chosen so as to bind to distinct and non-overlapping regions of the viral target. Hansen et al. write: "Inclusion of such antibodies into an antibody cocktail may deliver optimal antiviral potency while minimizing odds of virus escape." Such an antibody cocktail is now being tested in human trials (clinicaltrials.gov NCT04426695 and NCT04425629).

https://www.eurekalert.org/pub_releases/2020-06/aaft-uaa061520.php

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Ohio State Football Players Asked to Sign Waivers Acknowledging COVID-19 Risk

Athletic Coach Smith told ESPN it is intended more for educational purposes than for liability reasons...but

The Dallas Morning News' Sam Blum reported Monday that SMU'sOffice of Legal Counsel required student-athletes to agree that they could not hold the school liable for anything related to COVID-19 upon returning to school. It waives the students’ right to litigation. It is unclear, however, if the document, titled, "ACKNOWLEDGEMENT OF RISK FOR COVID-19 SUMMER 2020," is legally binding.

https://www.si.com/college/2020/06/15/ohio-state-players-waiver-covid19

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FDA Warns of Newly Discovered Potential Drug Interaction That May Reduce Effectiveness of a COVID-19 Treatment

co-administration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended as it may result in reduced antiviral activity of remdesivir.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-warns-newly-discovered-potential-drug-interaction-may-reduce

Devices:

More evidence for  Masking:

Research shows the highest viral load in the upper respiratory tract prior to symptom onset, "suggesting the peak of infectiousness on or before symptom onset and substantial asymptomatic transmission for SARS-CoV-2." (not new info).

use of face masks in New York City reduced the number of infections by over 66,000 from April 17 to May 9, according to Renyi Zhang, PhD, of Texas A&M University in College Station, and colleagues.

Moreover, mandated face coverings is estimated to have reduced the number of infections in Italy by over 78,000 from April 6 to May 9, the authors wrote in Proceedings of the National Academy of Sciences.

They went a step further, arguing that airborne transmission of the virus actually represents "the dominant route for infection."

[Debate continues over relative role of airborne transmission vs tiny droplets--primarily because of the relatively low rate of infection within households (10-15%), which argues against airborne spread and for droplets]

https://www.medpagetoday.com/infectiousdisease/covid19/87047?

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Epidemiology/Infection control:

FAUCI: "Although we'd love to get back to businesses usual, just take a look at the numbers. You can see it's not over. There are 1,000 or so deaths every day (in US). There are, last time we looked, around 20,000 new infections each day. It's not over. It's just not."

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Globally: “It took more than 2 months for the first 100,000 cases to be reported. For the past two weeks, more than 100,000 new cases have been reported almost every single day“, says @drtedros at regular @WHO presser on #covid19. Globally, more than 7,8 million cases and 430,000 deaths.

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New @CDCMMWR: Among people with COVID-19,

hospitalizations were 6 times higher and deaths 12 times higher among those with reported underlying conditions

compared to those with no reported underlying conditions. Protect yourself and others. bit.ly/MMWR61520

-5% of people who tested positive died

-14% hospitalized

Median age 48 -Incidence HIGHER among 40-60 yr olds than 60-80 but highest >80 (1/2)

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Estimates suggest one in five people worldwide have an underlying health condition that could increase their risk of severe COVID-19 if infected

  • The share of the population at increased risk (with at least one underlying health condition relevant to COVID-19) is highest in countries with ageing populations, African countries with high HIV/AIDS prevalence, and small island nations with high diabetes prevalence.
  • The share of the population with an underlying health condition varies by age, from less than 5% of those under 20, to over 66% of those aged 70 and above.

https://www.eurekalert.org/pub_releases/2020-06/tl-pss061520.php

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8 days after quarantine and testing negative, 142 Fort Benning soldiers test positive for COVID-19

out of 640 recruits

COVID-19 prevention efforts at basic trainings are failing

Similarly to Fort Benning's outbreak, the Marine Corps experienced COVID-19 clusters among recruits who had previously all tested negative for the virus.

the Department of Defense reported a total of 9,885 positive cases of COVID-19. Across the force, the pandemic has resulted in 36 deaths.

https://connectingvets.radio.com/articles/fort-benning-confirms-142-covid-19-cases-in-2-battalions?

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Impressive Data Viz:

Florida’s new covid dashboard, created by Rebekah Jones and team after she was forced out of Florida DOH for refusing to fudge their numbers is wondrous, and so much more informative than most sites. Check it out.

https://wolf-badger.maps.arcgis.com/apps/opsdashboard/index.html#/2e337b492f82481d92417fe22391f0a4

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Maternal transmission of COVID-19 to baby during pregnancy is uncommon, study finds

UNIVERSITY OF NOTTINGHAM  15-JUN-2020

Transmission of COVID-19 from mother to baby during pregnancy is uncommon, and the rate of infection is no greater when the baby is born vaginally, breastfed or allowed contact with the mother, according to a new study.

The research also found that babies that did test positive for COVID-19, were mostly asymptomatic. The findings are published in BJOG: An International Journal of Obstetrics and Gynaecology.

https://www.eurekalert.org/pub_releases/2020-06/uon-mto061520.php

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COVID-19 may trigger new diabetes, experts warn

KING'S COLLEGE LONDON 12-JUN-2020

Emerging evidence suggests that COVID-19 may actually trigger the onset of diabetes in healthy people and also cause severe complications of pre-existing diabetes.

A letter published today in the New England Journal of Medicine and signed by an international group of 17 leading diabetes experts involved in the CoviDiab Registry project, a collaborative international research initiative, announces the establishment of a Global Registry of new cases of diabetes in patients with COVID-19.

The Registry aims to understand the extent and the characteristics of the manifestations of diabetes in patients with COVID-19, and the best strategies for the treatment and monitoring of affected patients, during and after the pandemic.

Clinical observations so far show a bi-directional relationship between COVID-19 and diabetes. On the one hand, diabetes is associated with increased risk of COVID-19 severity and mortality. Between 20 and 30% of patients who died with COVID-19 have been reported to have diabetes. On the other hand, new-onset diabetes and atypical metabolic complications of pre-existing diabetes, including life-threatening ones, have been observed in people with COVID-19.

It is still unclear how SARS-Cov-2, the virus that causes COVID-19, impacts diabetes.

https://sciencesources.eurekalert.org/pub_releases/2020-06/kcl-cmt061220.php

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COVID-19 demands slow flu tracking

Tedros said the pandemic burden is creating difficult challenges for global flu surveillance activities... with pandemic demands leading to suspensions or declines in flu surveillance as well as a sharp drop in sharing flu information and viruses.

"Compared with the last three years, we’ve seen a dramatic decrease in the number of specimens tested for influenza globally," he said, adding that WHO Collaborating Centers have seen a 62% drop in virus shipments, and GISAID has seen a 94% decline in the number of flu virus sequences uploaded to its sharing database. Repurposed staff and supplies, overburdened labs, and transport restrictions are among the reasons for the drop in flu surveillance activities.

Tedros warned that the disruptions may have short- and long-term effects, including the loss of capacity to detect and report new flu viruses that have pandemic potential. And the WHO also depends on the latest information about flu viruses to make annual vaccine strain recommendations.

https://www.cidrap.umn.edu/news-perspective/2020/06/beijing-battles-coronavirus-cluster-pandemic-hampers-flu-tracking

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Updated CDC guidance:

“In general,” the CDC writes, “the more closely you interact with others and the longer that interaction, the higher the risk of Covid-19 spread.”

This all aligns with what experts have told Vox: People should think about Covid-19 risk in four dimensions: distance to other people, environment, activity, and time spent together. More distance is better, outdoors is safer than indoors, activities that involve lots of exhaling (like singing or shouting) are more dangerous than quieter ones, and a longer time spent with others is more dangerous than a shorter time.

Perhaps a helpful way to think about the risk is this: Imagine everyone is smoking, as Ed Yong suggested in the Atlanticand you’d like to avoid inhaling as much smoke as possible. In a cramped indoor space, that smoke is going to get dense and heavy fast. If the windows are open, some of that smoke will blow away. If fewer people are in the space, less smoke will accumulate, and it might not waft over to you if you’re standing far enough away. But spend a lot of time in an enclosed space with those people, and the smoke grows denser.

The denser the smoke, the more likely it is to affect you. It’s the same with this virus: The more of it you inhale, the more likely you are to get sick.

https://huntsvilletribune.com/the-cdc-finally-has-new-guidelines-for-reducing-covid-19-risk-post-lockdowns/

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Politics:

Tulsa World editorial: This is the wrong time and Tulsa is the wrong place for the Trump rally

...We don’t know why he chose Tulsa, but we can’t see any way that his visit will be good for the city.

...The city and state have authorized reopening, but that doesn’t make a mass indoor gathering of people pressed closely together and cheering a good idea. There is no treatment for COVID-19 and no vaccine. It will be our health care system that will have to deal with whatever effects follow...

...This is the wrong time.

...His 2016 Tulsa rally provoked a heated response for some, and his ability to provoke opponents has only grown since then.

Again, Tulsa will be largely alone in dealing with what happens at a time when the city’s budget resources have already been stretched thin.

...There’s no reason to think a Trump appearance in Tulsa will have any effect on November’s election outcome in Tulsa or Oklahoma. It has already concentrated the world’s attention of the fact that Trump will be rallying in a city that 99 years ago was the site of a bloody race massacre.

This is the wrong place for the rally.

https://www.tulsaworld.com/opinion/editorials/tulsa-world-editorial-this-is-the-wrong-time-and-tulsa-is-the-wrong-place-for/article_26388374-1747-5120-bc01-24b81c1b0c78.html

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Trump lie #?: “They’ve come up with the AIDS vaccine”

Reality: There is no AIDS vaccine. PrEP, or pre-exposure prophylaxis, is a highly effective HIV prevention drug developed with taxpayer funds that costs $8/month in Australia and $2400/month in the USA. The CDC estimates over 1 million Americans need PrEP and can’t afford it.

https://twitter.com/sexposparenting/status/1272939819363119104?s=20

 

Trump on coronavirus: "If we stop testing right now, we'd have very few cases, if any" hill.cm/g4vKJ4u

Another day, another lie...or many more:

 

There isn't a 2nd wave in US because we are nowhere near out of the first wave and politicians opened up.

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A Hospital’s Secret Coronavirus Policy Separated Native American Mothers From Their Newborns

Pregnant Native American women were singled out for COVID-19 testing based on their race and ZIP code, clinicians say. While awaiting results, some mothers were separated from their newborns, depriving them of the immediate contact doctors recommend.

https://www.propublica.org/article/a-hospitals-secret-coronavirus-policy-separated-native-american-mothers-from-their-newborns?

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Montgomery, Alabama City Council votes down mask ordinance, sends doctors out in disgust

as hospitals are at capacity with surge in Covid, and people question public health messages...

https://www.montgomeryadvertiser.com/story/news/2020/06/16/montgomery-council-votes-down-mask-ordinance-doctors-disgust/3203300001/

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Get out the VOTE

Feel good du jour:

~ ~ ~

And I come back to Rahul Dabey again when I need some cheer.

Comic relief:

Perspective/Poem

“They lived and laughed and loved and left.”

James Joyce

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How Asia’s Densest Slum Chased the Virus Has Lessons for Others

In Dharavi slum: Authorities have knocked on 47,500 doors since April to measure temperatures and oxygen levels, screened almost 700,000 people in the slum cluster, and set up fever clinics, official data show. Recognizing the need to isolate residents in the tenement where as many as eighty share a toilet, those with symptoms were shifted to nearby schools and sports clubs converted into quarantine centers.

Fresh daily infections are now down to a third compared with early May, half the sick are recovering, and the number of deaths plummeted this month...the rest of India, whose daily tally of new infected cases has quadrupled since early May.

A strict lockdown and accessible testing was part of Dharavi’s strategy. If someone was not feeling well, the person could admit themselves into a quarantine center and on-site doctors would test, Dighavkar said. This compares with a jumble of rules for residents across Mumbai.

However, Dighavkar knew none of this would be possible without gaining the community’s trust. Home to nearly a million people where a family of seven may be living in a 100-square feet hutment, word travels fast in Dharavi and small gestures help.

For instance, Ramadan -- the Muslim holy month -- was crucial. Those in isolation centers were concerned about how they’d keep up with rituals, such as breaking their religious fasts at sunset. Authorities ensured they got fruits and dates and distributed proper meals at appropriate times, while all others received three meals a day.

Everyone in the isolation centers also received round-the-clock medical supervision free of cost, even as millions around the country lost their jobs due to the nationwide lockdown and reports trickled in of people dying before they were allotted hospital beds.

Once word got around, people would volunteer themselves to be quarantined as soon as symptoms appeared.

https://www.bloomberg.com/news/articles/2020-06-13/how-asia-s-densest-slum-chased-the-virus-has-lessons-for-others

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A Small Needful Fact

Ross Gay

Is that Eric Garner worked
for some time for the Parks and Rec.
Horticultural Department, which means,
perhaps, that with his very large hands,
perhaps, in all likelihood,
he put gently into the earth
some plants which, most likely,
some of them, in all likelihood,
continue to grow, continue
to do what such plants do, like house
and feed small and necessary creatures,
like being pleasant to touch and smell,
like converting sunlight
into food, like making it easier
for us to breathe.

Bits of beauty:

 

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