Coronavirus Tidbits # 67 7/18/20
News Diagnostics Drugs Devices Epidemiology/Infection control Tips Politics Feel good du jour Comic relief Perspective/Poem Bits of beauty
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.
Federal Law Enforcement Use Unmarked Vehicles To Grab Protesters Off Portland Streets
Chilling story. People in camouflage were driving around the area in unmarked minivans grabbing people off the street.
The tactic appears to be another escalation in federal force deployed on Portland city streets, as federal officials and President Donald Trump have said they plan to “quell” nightly protests outside the federal courthouse and Multnomah County Justice Center that have lasted for more than six weeks.
Officers from the U.S. Marshals Special Operations Group and Customs and Border Protection’s BORTAC, have been sent to Portland. [Some question if the unidentifiable “officers” arresting people at Lafayette Square was a dress rehearsal for larger operations.]…
This week, Trump has repeatedly spoken out about what he calls lawlessness in the city. He praised the role of federal law enforcement officers in Portland and alluded to increasing their presence in cities nationwide. Speaking to Fox News on Thursday, Acting U.S. Customs and Border Protection Commissioner Mark Morgan called the protesters criminals.
“I don’t want to get ahead of the president and his announcement,” Morgan said, “but the Department of Justice is going to be involved in this, DHS is going to be involved in this; and we’re really going to take a stand across the board. And we’re going to do what needs to be done to protect the men and women of this country.”…
Mayor Ted Wheeler’s office declined to offer comment on the latest events involving federal officers, but reiterated a statement from earlier in the week, saying federal officers should be restricted to guarding federal property.
“We do not need or want their help,” Wheeler said. “The best thing they can do is stay inside their building, or leave Portland altogether.”
Oregon Democratic Sen. Jeff Merkely said if Wolf is coming to inflame the situation in Portland so the President can “look tough,” the acting DHS leader should leave.
“Federal forces shot an unarmed protester in the face,” Merkely said in a tweet. “These shadowy forces have been escalating, not preventing, violence.”
Oregon Gov. Kate Brown similarly called for federal law enforcement officers to leave Portland. She added, Wolf is on a “mission to provoke confrontation for political purposes.”
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More hidden data on risks to states and need to roll back reopenings
A document prepared for the White House Coronavirus Task Force but not publicized suggests more than a dozen states should revert to more stringent protective measures, limiting social gatherings to 10 people or fewer, closing bars and gyms and asking residents to wear masks at all times.
The document, dated July 14 and obtained by the Center for Public Integrity, says 18 states are in the “red zone” for COVID-19 cases, meaning they had more than 100 new cases per 100,000 population last week. Eleven states are in the “red zone” for test positivity, meaning more than 10 percent of diagnostic test results came back positive.
The 18 states that are included in the red zone for cases in the document are:
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Fertility rate: ‘Jaw-dropping’ global crash in children being born
Falling fertility rates mean nearly every country could have shrinking populations by the end of the century. And 23 nations – including Spain and Japan – are expected to see their populations halve by 2100. Countries will also age dramatically, with as many people turning 80 as there are being born.
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Nearly one-third of children tested for COVID in Florida are positive.
State statistics also show the percentage of children testing positive is much higher than the population as a whole. Statewide, about 31% of 54,022 children tested have been positive. The state’s positivity rate for the entire population is about 11%.
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Opioid overdoses have skyrocketed amid the coronavirus, but states are nevertheless slashing addiction treatment program budgets
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Virologist Vincent Racaniello (@profvrr) interviews Dr. Fauci:
on This Week in Virology #TWiV to discuss #SARSCoV2 transmission, testing, immunity, pathogenesis, vaccines, and preparedness https://bit.ly/2BbuNqk #science #podcast #COVIDー19
still an incredible, negligent lack of accurate testing.
The Lancet Public Health: Speed of testing is most critical factor in the success of contact tracing strategies to slow COVID-19 transmission
* Even if all contacts are successfully traced, a delay of three days or more between symptom onset and testing will not reduce onward transmission of the virus sufficiently to control further spread, according to modelling study
* In the best-case scenario, with zero delays and at least 80% of contacts traced, the R number is reduced from 1.2 to around 0.8, and 80% of onward transmission per person diagnosed could be prevented
* For conventional contact tracing to work, test results need to be delivered within a day of an individual developing symptoms
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CDC to recommend against retesting coronavirus patients before they end isolation
denying that it is because of shortages of testing supplies and backlogs, but…
“Experts have warned that patients recovering from COVID shouldn’t be transferred to a facility without being tested first.”…”Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment and staff to accept COVID-19 patients is a recipe for disaster.“
Coronavirus Drug and Treatment Tracker
Treatments rated for safety and efficacy:
Do NOT use Bleach, silver, or UV light, despite what Fearless Leader claims.
Lopinavir and ritonavir–but the trials were in critically ill patients. Perhaps it would help earlier? No data.
Hydroxychloroquine and chloroquine
Tentative or mixed evidence:
REGN-COV2 and other monoclonal antibodies
Cytosorb is a cartridge that filters immune-signalling molecules called cytokines from the blood.
Renal replacement therapy
Strong evidence for efficacy:
Remdesivir, made by Gilead Science, was the first drug to get emergency authorization from the F.D.A. for use on Covid-19. It stops viruses from replicating by inserting itself into new viral genes. Remdesivir was originally tested as an antiviral against Ebola and Hepatitis C, only to deliver lackluster results. But preliminary data from trials that began this spring suggested the drug can reduce the hospital stays of people with severe cases of Covid-19 from 15 to 11 days. These early results did not show any effect on mortality, though retrospective data released in July hints that the drug might reduce death rates among those who are very ill.
became the first drug shown to reduce Covid-19 deaths. That study of more than 6,000 people, which has not yet been published in a scientific journal, found that dexamethasone reduced deaths by one-third in patients on ventilators, and by one-fifth in patients on oxygen. It may be less likely to help — and may even harm — patients who are at an earlier stage of Covid-19 infections, however. In its Covid-19 treatment guidelines, the National Institutes of Health recommends only using dexamethasone in patients with COVID-19 who are on a ventilator or are receiving supplemental oxygen.
The simple act of flipping Covid-19 patients onto their bellies opens up the lungs. The maneuver has become commonplace in hospitals around the world since the start of the pandemic. It might help some individuals avoid the need for ventilators entirely. The treatment’s benefits continue to be tested in a range of clinical trials.
Enoxaparin and other anticoagulants
The coronavirus can invade cells in the lining of blood vessels, leading to tiny clots that can cause strokes and other serious harm. Breaking up these clots with anticoagulants, which have long been used on patients with various heart conditions, improves the prospects of seriously ill patients. Early data has linked the use of anticoagulants to survival among Covid-19 patients, and many clinical trials teasing out this relationship are now underway.
For more details on evaluating treatments, see the N.I.H. Covid-19 Treatment Guidelines.
More than 100 Covid-19 vaccines are currently in development, with 21 already being tested in human clinical trials.
According to a Reuters/Ipsos poll, one-quarter of Americans have little or no interest in getting a coronavirus vaccine because of concerns that the speed of development could compromise safety.
Safety data is likely to be collected by an opt-in registry of vaccine recipients, which would collect self-reported data from people who have been exposed to the Covid-19 virus.
FDA issues COVID-19 vaccine guidance, setting 50% effectiveness threshold
To be adopted for widespread use, the sponsor will have to demonstrate that the vaccine is at least 50% effective in a placebo-controlled trial.
[This part is refreshing, if actually true:] “FDA strongly encourages the inclusion of diverse populations in all phases of clinical development, including populations most affected by COVID-19, specifically racial and ethnic minorities, as well as adequate representation in late phase trials of elderly individuals and those with medical comorbidities,” FDA says.
FDA stresses that later phase trials should be randomized, double-blinded and placebo-controlled. While the agency says that “1:1 randomization between vaccine and placebo groups is usually the most efficient study design for demonstrating vaccine efficacy,” other types of randomization may be acceptable. If adequately designed, a study evaluating multiple vaccine candidates against a single placebo group could be used as well.
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The study, which was run by the National Institutes of Health, showed that volunteers who received the vaccine made more neutralizing antibodies than have been seen in most patients who have recovered from Covid-19. But a second injection, four weeks after the first, was required before the vaccine produced a dramatic immune response.
One big question is whether producing antibodies predicts protection against infection — and how much protection. Another is whether the antibodies will last.
The study enrolled [ONLY] 45 healthy volunteers ages 18 to 55, testing three dose levels of Moderna’s vaccine. The trial participants were split roughly 50-50 between men and women. The population was 89% white, 13% Hispanic, 4% Black, 2% Asian, and 2% Native American.
At the 100-microgram dose, the one Moderna is advancing into larger trials, all 15 patients experienced side effects, including fatigue, chills, headache, muscle pain, and pain at the site of injection. All side effects were considered mild or moderate.
A higher, 250-microgram dose led to more serious reactions and has been set aside. Although no side effects were severe, they were unpleasant….
“It’s like six years of work has been compressed into six months.”
That very speed is a reason for caution, said Paul Offit, chief of the division of infectious diseases at the Children’s Hospital of Philadelphia. He advised companies to be humble. He noted that he had worked on rotavirus vaccines for 25 years, and still the first attempt at one turned out to have a side effect that sent researchers back to the drawing board.
Some decontamination processes damage N95 face masks
Certain methods of decontaminating medical face masks for repeated use during the COVID-19 pandemic appear to damage the masks’ integrity and protective function, according to research by a University of Massachusetts Amherst environmental health scientist.
“Some treatments for decontamination had no impact on respirator performance, while other treatments resulted in substantial damage to masks,” writes Richard Peltier, associate professor in the School of Public Health and Health Sciences and lead author of the paper published July 16 in the journal Infection Control and Hospital Epidemiology.
Treatments that involve hydrogen peroxide and gas plasma at high concentrations (Sterrad 100NX Standard, concentration = ~90%), or long dwell times (Sterrad 100S) appear to induce damage to masks. Repeated UVGI processing appears to slowly diminish filtration efficiency, and this reaches a level that warrants caution after about 9 repeated treatments.
Respirators that were treated between one and 10 times with specific vaporized hydrogen peroxide (vHP) sterilizers or up to five times with shorter decontamination cycles of gas plasma hydrogen peroxide (gpHP) retain their original filtration capabilities. A decontamination process using ultraviolent germicidal irradiance (UVGI) slowly diminishes filtration efficiency, reaching a level “that warrants caution” after nine repeated treatments, the research found. “However, there are still a number of sterilizer systems that are being used on these masks which we don’t have information about and therefore can’t determine if they keep workers safe,” Peltier says.
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I have a slide in today’s webinar that just features an array of “mask fails”. Mask fails are the new social media “as seen in Walmart”. It keeps getting worse – much worse. pic.twitter.com/Vch4syDzfp— Larry Lynam (@scopedbylarry) July 17, 2020
A Detailed Map of Who Is Wearing Masks in the U.S.
Political party was biggest predictor.
We have published an extremely detailed map of where people are wearing masks in the United States. https://t.co/2ij9fXDTcs @jshkatz @KevinQ pic.twitter.com/vd7cH1uF40— Margot Sanger-Katz (@sangerkatz) July 17, 2020
You can see broad regional patterns–mask use is high throughout the Northeast, where Covid hit hard early.— Margot Sanger-Katz (@sangerkatz) July 17, 2020
But there are also interesting local patterns. Look at the D.C.-metro area. (Or, you can zoom in on any area you want.) https://t.co/2ij9fXDTcs pic.twitter.com/krua7atVYD
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Pregnancy and Covid:
Hispanic and non-Hispanic black pregnant women appear to be disproportionately affected by SARS-CoV-2 infection during pregnancy. Among reproductive-age women with SARS-CoV-2 infection, pregnancy was associated with hospitalization and increased risk for intensive care unit admission, and receipt of mechanical ventilation, but not with death.
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Case updates from Tom Frieden:
1/11 Weekly epi review. Just when you thought it couldn’t get worse….But stay tuned for news Tuesday about a better way to get a nation-wide approach despite lack of national leadership. The folks at exit strategy added “bruised red” to their map. The bruise is spreading. pic.twitter.com/j7mN0AEXUF— Dr. Tom Frieden (@DrTomFrieden) July 17, 2020
States with high rates, high and rising test positivity: FL, TX, GA, LA, SC, AL, NV, ID. AZ stabilized at high rate. CA, UT and many others intermediate; CA population means large numbers. Reassuring so far but at risk: Northeast, WY, SD. HI and AK low with small increases.
Where does the epidemic go from here? This modeling site has performed better than most, using solely deaths and machine learning. Nationally, @youyanggu estimates 4.8 million people with Covid today – 1 of every 70 people. https://covid19-projections.com
The same site projects 211,500 deaths in the US by the end of October. Leaving Belgium, which may count deaths differently, aside, that could possibly put the US death rate ahead of those of France, Sweden, Italy, and Spain and about tied with the UK for worst in the world.
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“Safe Coat”- New Coating Deactivates COVID-19 Virus on Surfaces
Virginia Tech researcher William Ducker found a mixture that worked– Cuprous Oxide, a form of Copper, mixed with everyday household polyurethane. It would kill 99.9% of the virus on surfaces, but takes an hour. (They are looking to speed that up) The protection lasts for at least a year and likely longer according to the team. Their findings have just been published in the American Chemical Society Journal of Applied Materials and Interfaces.
Also, whatever is painted becomes rust colored.
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Tips, general reading for public:
Wash your hands.
Rinse and repeat.
Interesting article by Roxanne Khamsi:
Why those most at risk of COVID-19 are least likely to respond to a vaccine
COVID-19 could be a double whammy for older people — they’re more likely to die from it and they might be less likely to respond to a vaccine. This might be due to “#immunosenescence” and “#inflammaging“, as I describe in my latest story:
The White House Press Secretary on Trump’s push to reopen schools: “The science should not stand in the way of this.”
There are things we all could do to reduce spread of #Covid19. But it “is impossible to win the fight if a large fraction of the population is not believing there is something to fight.” — @alexvespi
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Governor Brian Kemp bans Georgia cities and counties from mandating masks and face coverings
or making more restrictions than he has.
Is this a new attempt at voter suppression, since we know Blacks have a higher death rate? Kill off your opponents?
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Coronavirus is too dangerous for Republicans to have their convention inside, but they expect our kids to go back to school.
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Expect more actions throughout the country like that in Portland:
As unmarked feds snatch protesters off the streets in Portland, memo leaked to me shows they'll be deployed indefinitely and in undisclosed locations, with drones "on standby to assist as needed":https://t.co/dIrNSlbM6B pic.twitter.com/LR4COtuvGs— Ken Klippenstein (@kenklippenstein) July 17, 2020
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STAT News has more details on the abrupt decision by HHS to have Covid data sent to them and not to CDC:
Is it an attempt to sideline CDC? To cook the numbers? Or just clumsy rollout?
“The legwork necessary to rapidly transition hospitals from using one data system to another can’t be understated.” Having worked at hospitals implementing new computer systems–particularly EPIC (and NextGen), training took days and resulted in many errors. I would not recommend doing that when hospitals are already strapped.
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Throwback to 5 years ago when Tony Fauci, at 74 yo, was suiting up to treat an Ebola patient himself because he "wanted to show his staff that he wouldn't ask them to do anything he wouldn't do himself". This is what leadership looks like. https://t.co/QctW672ykC pic.twitter.com/71j5qNWOsP— Adam Phillippy (@aphillippy) July 15, 2020
Feel good du jour:
To Eliminate Plastic, College Grad Designs Ramen Packaging That Dissolves in Hot Water
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How many stories have you read about New Zealand and how many about Rwanda? Low income African countries don't make the news as often as "poster-child" nations.— AM (@bhalomanush) July 16, 2020
Rwanda has also done a great job managing COVID-19. https://t.co/9SWY4s5baW
Dan Piraro. As always, dead on. pic.twitter.com/BD5uG5hfk8— Peg (@ethnobot) July 14, 2020
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How to immigration policy pic.twitter.com/qxjmIXPZkL— Sarah Cooper (@sarahcpr) July 15, 2020
"You would have thought that we would be able to handle this pandemic much better. But we're among the worst in the world and it's because of a misinformation campaign & mismanagement from the federal government," says Dr. Ashish Jha.— Health Care Voter (@HealthCareVoter) July 14, 2020
The Trump administration has failed us. https://t.co/KoyyCuQ7QU
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Americans watching other countries that have gotten Covid under control. pic.twitter.com/6dGIqYlnIG— Duchess of Wakanda @HRComedy (@hadiyah) July 16, 2020
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Rep. John Lewis reflects on MLK's legacy:— NBC News (@NBCNews) April 4, 2018
"It is very simple: When you see something that is not right, something that is not fair, something that is not just, you have a moral obligation to say something, to do something. You cannot be quiet." pic.twitter.com/S6sTGeTdaD
Bits of beauty: